Peds EOR Exam Flashcards
1
Q
Presentation of neonatal acne
A
4 week old, comedomes, papules and pustules on the lateral aspect of the face
2
Q
Presentation of acne vulgaris
A
14 year old boy with erythematous papules, pustules, and cysts
Atrophic scarring also seen
3
Q
Comedomes of acne
A
Open - Blackheads
Closed - Whiteheads
4
Q
Grade 1 acne
A
Mild with open comedomes or blackheads
5
Q
Grade 2 acne
A
Moderate with more blemishes, papules and pustules also present
6
Q
Grade 3 acne
A
Severe many blemishes with high risk of scarring, inflammation is more pronounced
7
Q
Grade 4 acne
A
Cystic with severe scarring
Angry blemishes of the face and jaw line
8
Q
Difference between acne and rosacea
A
Rosacea doe not have comedomes
9
Q
Treatment for acne vulagaris
A
Most acne - topical retinoids
10
Q
Treatment for cystic acne
A
Tetracyclines, then oral retinoids
11
Q
Pregnancy testing on isotretinoin
A
Twice before starting and monthly while taking
12
Q
Presentation of androgenetic alopecia
A
Terminal hair becomes vellus
20-40 men and 50+ women
13
Q
Diagnosis of androgenetic alopecia
A
Biopsy showing telogen and atrophic follicles
14
Q
Treatment for androgenetic alopecia
A
Minoxidil topical
Finasteride
Spironolactone
15
Q
Presentation of atopic dermatitis
A
Thick, dry skin found in antecubital fossa, wrist, ankles. Family hx of asthma
Face and scalp in infants
16
Q
Diagnosis of atopic dermatitis
A
Patch testing and allergy referral
17
Q
Treatment for atopic dermatitis
A
Review meds
Humidifier
Benadryl
Oral steroids
Phototherapy (PUVA)
18
Q
Acid burns
A
Coagulation, necrosis, eschar - irrigation needed
19
Q
Alkaline burns
A
Liquifaction necrosis
Deep damage
20
Q
4 degrees of burns
A
1 - Sunburn, erythema and blanching
2 - Red, blistered skin, tender
3 - Tough and leathery, non-tender
4 - Into bone and muscle
21
Q
Pediatric rule of nines
A
Head - 18%
1 Arm - 9%
Chest - 18%
Back - 18%
1 Leg - 14%
22
Q
Palmar burn method
A
Patient palm = 1% of surface area - for small burns
23
Q
Tx for mild burns
A
Fluids!!
Clean with soap and water
Drain and debride bullae and cover with 1% silver sulfadiazine
24
Q
Tx for moderate and severe burns
A
Cover with dry dressing, hospital admission
25
Children in need of formal fluid resuscitation for burns
Greater the 10% of total body surface area burned
26
Fluids for pediatric burn victims who warrant it
LR - 3ml x weight in kg x body surface area affected
Half over 8 hours, rest over 16 hours
27
Presentation of contact dermatitis
Erythematous rash with itching and potentially vescicles.
Chronic - scaling, lichenification
Well demarcated borders
28
Allergic etiology of contact dermatitis
Type 4 hypersensitivity
Nickle, poisin ivey, etc.
29
Diagnosis of contact dermatitis
Allergy referral - NO skin prick tests
30
Treatment for contact dermatitis
Review meds, humidifier
Antihistamine
Triamcinolone
Oral steroids
31
Presentation of diaper dermatitis
Rash on buttocks common from 3wks to 2yrs
Fussiness, crying w/ diaper change
Shiny erythema with dull margins
Elevated with satellite pustules
32
Dx for diaper dermatitis
KOH for candida
Viral for scabies
Culture for strep
33
Tx for diaper dermatitis
Keep dry!
Zinc oxide and petroleum jelly
Nystatin or clotrimazole for candida
34
Presentation of perioral dermatitis
MC in young women
Papulopustular plaques and scales
Vermillion border SPARED
35
Dx for perioral dermatitis
Clinical, a biopsy may help
36
Tx for perioral dermatitis
Mild - topical ALONE:
Pimecrolimus, Erythromycin, Metronidazole
Moderate add oral doxy
37
5 agents of drug eruptions
PCNs
Bactrim
Anticonvulsants
NSAIDs
Sulfonamides
38
Treatment for drug eruptions
Stop agent, give epinephrine for anaphylaxis
39
Epinephrine peds dosing
Weight based under 16 lbs
0.15 for 16-55 lbs
0.3 for 55-110 lbs
0.5 for 110+ lbs
40
Tx for SJS in children
Burn unit with fluids
41
Etiology of erythema multiform
Type IV hypersensitivity
Self limited and recurring
Herpes, mycoplasma and upper respiratory may also be drugs
42
Presentation of erythema multiforme
Non itchy, target/iris like and SPLOTCHY rash, blanches
43
Major erythema multiforme
Widesperead lesions with 2+ mucosal site affected
44
Minor erythema multiforme
Limited with only 1 type of mucosa affected
45
Dx of erythema multiforme
Target lesions with rings and dusky center
Negative nikolsky sign (skin does not slide off)
46
Tx for erythema multiforme
Remove offending agent
IV fluids
Systemic steroids for severe
47
Erythema infectiousum
Parvovirus B-19 or Fifths Disease
Slapped cheeks with lacy extremity rash SPARING palms and soles
Resolves in 2-3 weeks
48
Hand Foot and Mouth disease
Cocksackie
Under 10 years old
Rashes on hands, feet and mouth
Supportive tx
49
Rubeola (4Cs)
Measles
4 C's - Cough, coryza, conjunctivitis, cephalocaudal spread
Brick red rash with koplik spots
50
Rubella
German Measles
3-day rash
Rapid cephalocaudal spread
Pink to light red
Teratogenic
51
Roseola
Sixth disease
Herpevirus
TRUNK first!!
High fever followed by rosy rash
Supportive
52
Presentation of impetigo
MCC - S aureus
Face and extremities
Red sores and honey colored crust, vescicles
Weeping
53
Presentation of bullous impetigo
Bullous vescicles with varnish like crust
Fever and diarrea
Also S aureus
54
Dx for impetigo
Gram stain and cx with negative nikolsky
55
Tx for impetigo
Warm soaks
Topical mupirocin 1st line (bactoban)
Keflex or erythromycin for severe
Oral abx for bullous
56
Tx for MRSA impetigo
Vanc
57
Presentation of lice
Pruritic scalp, groin, body with white specs on hair shaft
Bites and hair loss
58
Tx for lice
Launder in 131 F water
Permethrin shampoo or lotion
59
Presentation of lichen planus
Autoimmune
5 Ps - Purple, Papule, Polygonal, Pruritis, Planar
IE. Itchy flat topped bumps
60
Tx for lichen planus
Topical steroids
61
Presentation of pityriasis rosacea
Children and young adults
Herald oval patch followed by papulosquamous rash - christmas tree pattern - itchy
62
Tx for pityriasis rosacea
Self limiting - use topical or oral steroids
Antihistamines also useful
63
Presentation of scabies
Pruritic papules with S-shaped or linear burrows on the skin
INtense itching - see excoriations
64
Dx for scabies
Micrscopic observation of scraping - mites, eggs, feces
65
Tx for scabies
Topical permethrin over entire body washing after 8-14 hours
Repeat in one week
Oral ivermectin for severe
66
Presentation of SJS
Rash on 3-10% of the body
Started new drug (ie. phenytoin)
Positive nikolsky sign
Fever
67
Dx for SJS
Skin biopsy showing necrotic epithelium
68
Tx for SJS
Stop offending medications
IVIG
Steroids out of favor
69
Tinea
Superficial non-candidal fungal infections
Dx with KOH prep
Fungal hyphae with septation
70
KOH prep for candida
Budding yeast and pseudohyphae
71
KOH prep for tinea versicolor
Sphaggheti and meatballs - short hyphae with cluster of spores
72
Tinea barbae
Papules and pustules around hair follicles
Oral griseofulvin or terbinafine
73
Tinea pedis
Athletes foot
Scaly eruptions between toes
Topical azoles
74
Tinea unguium
Oral terbinafine for mild to moderate
75
Tinea cruris
Topical azoles or nystatin
Diffusely red rash of groin or scrotum
76
Tinea capitis
MC fungal infection in peds 3-7 years
Oral griseofulvin
Ropical selenium sulfide as adjunct may be used
77
TInea corporis
Topical azole for 2-4 weeks or terbinafine
78
Tinea versicolor
Melssezia furfur hypo or hyperpigmented macules and papules
Use selenium sulfide for 7-10 days
79
Nystatin and dermatophytes
NOT effective
80
Toxic epidermal necrolysis presentation
Like SJS - but older patients and with 30+ percent of skin involved
Admit to burn unit
81
Presentation of urticaria
Blanchable, pruritic, raised, erythematous papules, plaques or wheels
Darrier's sign (urticaria with skin rubbing)
Disappears in 24 hours
82
Dx for urticaria
May do IgE testing for specific trigger
83
Tx for urticaria
Antihistamine (first gen causes sleep ie. hydroxyzine)
Steroids
Epi for anaphylaxis
84
Tx for verrucae
Cryotherapy,
At home salicylic acid
85
Presentation of otitis media
Bulging TM with 2 other signs of inflammation:
TM erythema
Fever
Ear pain
86
Tx for otitis media
Amoxicillin
Cephalosporin for allergies
Clinda or Z max third line
Tympanostomy for recurrent
87
Presentation of mononucleosis
Lymphadenopathy, splenomegaly, and positive heterophile agglutination test (monospot)
Supportive tx
PCN causes a rash
88
Presentation of strep pharyngitis w/ centor criteria (4)
GABS - S. pyogenes
Centor criteria:
No cough
Exudates
Fever over 100.4
Cervicle Lymphadenopathy
89
When to get a strep test or cultrue
Rapid strep is 3/4 centor criteria
THroat cx if negative centor
90
Tx for strep pharyngitis
PCN or Z-max (secondary)
91
Sport resumption in mono
3-4 weeks from symptom onset
92
Presentation of allergic rhinitis
Clear nasal drainage with plae, bluish boggy mucosa, allergic shiners, nasal crease, histamine release
93
Tx for allergic rhinitis
Avoid allergens
Cromolyn sodium
Nasal/systemic corticosteroids
94
Rhinitis medicamentosa
From using intranasal decongestants for more than 3-5 days
95
Strep/Staph conjunctivitis or M cat/ gonococcal
Acute and mucopurulent - gentamycin or tobramycin
96
Chlamydial conjunctivitis
Giemsa stain and inclusion body
scant discharge
Erythromycin to treat
97
Allergic conjunctivitis
Tx with azelastin, antihistamines
98
Presentation of viral conjunctivitis
URI and eye watering
Self limited
99
Presentation of epiglottitis
Dysphagia, Drooling, Respiratory Distress
EMERGENCY
Caused by HIB
Stridor
100
Dx for epiglottitis
THumbprint sign on lateral neck x-ray
Culture for H. flu
101
Tx for epiglottitis
Intubate if needed
Supportive care
Ceftriaxone
102
MC site for anterior nosebleeds
Kiessalbach's plexus
103
MC site for posterior nosebleeds
Woodruff's plexus
Use posterior balloon packing
104
Dx for epistaxis
Most do not need direct visualization
CBC, PT, PTT for frequent bleeds
105
Tx for anterior nosebleeds
Direct pressure and leaning forward
Abx if packing is used
Petroleum jelly
106
Presentation of mastoiditis
Fever, otalgia, pain and erythema posterior. Forward displacement of the ear
107
Dx for mastoiditis
CT scan of the temporal bone with contrast for complicated and toxic appearing
108
Tx for mastoiditis
IV ceftriaxone
ENT referral
Middle ear drainage
109
Presentation of oral candidiasis
Mouth pain and white plaques that bleed when scraped
110
Dx for oral candidiasis
KOH prep with budding yeast and pseudohyphae
111
Tx for oral candidiasis
Nystatin or oral fluconazole
112
Presentation of orbital cellulitis
Decreased extra-ocular movement
Pain and proptosis
Often with sinusitis
7-12 y/o
113
Dx for orbital cellulitis
CT scan of orbits
FOcused assessment of extra-ocular muscles
114
Tx for orbital cellulitis
IV-broad spectrum abx
Vancomycin!!
115
Presentation of otitis externa
Edema with cheesy white discharge and painful palpation of tragus
Bone conduction > ear conduction
116
Treatment for otitis externa
Cipro or ofloxacin for 7 days if perforation
Hospitalize for malignant (seen in diabetics)
117
Fungal otitis externa
Pruritis and weeping with black, yellow or gray
Acetic acid or clotrimazole to treat
118
Presentation of peritonsillar abcess
Hot potato voice
Uvula deviation
Severe sore throat
Strep pyogenes
119
Diagnosis for peritonsillar abcess
X-ray of neck when in doubt
120
Tx for pertonsillar abcess
Aspiration/I&D
Oral amoxicillin/augmentin/clinda
May consider tonsillectomy
121
Presentation of strabismus
Lazy eye
Exo - out
Eso - in
HYper - up
Hypo - down
+tropia
122
Cover test
For strabismus:
Cover one eye observe the other
+ test uncovered eye shifts to refixate
123
Cover-uncover test
For strabismus
See deviation in the affected eye
124
Tx for strabismus
Glasses, occlusion therapy, orthoptic exercises
Amblyopia if untreated before 2
125
TM perforation
Only floxin drops can be used
SHould heal on own by 2 months (needs surgery if not healed by then)
126
Treatment for mycobacterium avium
Fever diarrhea and weight loss
AFB and culture for dx
Clarithromycin, ethambutol +/- rifampin
127
Tx for mycobacterium kansasii
Rifampin and ethambutol
128
Tx and presentation for mycobacterium marinum
Exposure to marine mammals
Dx by culture
Tetracyclines, FQs, Macrolides, Sulfonamides for 4-6 weeks
129
Presentation of epstein barr virus (mono)
Fever, lymphadenopathy and pharyngitis
Saliva transmission
Splenomegaly
Malaise
130
Dx for EBV
Heterophile agglutination test (monospot) - may not work in first 4 weeks
Maculopapular rash with ampicillin tx
Atypical lymphocytes with enlarge nuclei
131
Tx for EBV
Supportive with ibuprofen
Steroids if severe
132
Presentation of erythema infectiosum
Fifths disease/Parvo B-19
Slapped cheeks with lacy reticular rash sparing palms and soles
Sickle cell patients may develop eplastic crisis
133
Dx for erythema infectiosum
Parvo B-19 antibodies on PCR
Enlarge nuclei
134
Tx for erythema infectiosum and length of course
Symptomatic
Resolves in 2-3 weeks
135
Presentation of hand foot and mouth disease
Sores on hands, feet, mouth and buttocks
Children under 10 years
Sore throat, feeling unwell, anorexia
136
Tx and length for hand foot and mouth disease
Supportive and anti-inflammatories
Clears in 10 days
137
HHV 3
Herpes of chicken pox
138
HHV 4
Herpes of mono
139
HHV 5
Herpes of CMV
140
HHV 6
Herpes of roseola
141
Presentation of herpes simplex ophthalmicus in newborns
3-15 days postpartum
Lid vescicles
142
Tx for herpes simplex ophthalmicus in newborns
Acyclovir 60mg/kg/day for 14 days
143
Presentation of influenza
Fever, coryza, cough, headache, malaise
Dx via rapid antigen test
144
Age at which influenza vaccination is given
6 months and up
145
Treatment for influenza
Mostly symptomatic
Antivirals is under 48 hours for high risk patients
Amantadine and rimantadine only treat influenza a
146
Presentation of measles
Cough, Coryza, and Conjunctivitis
Koplik spots
Brick red exanthem spreading cephalocaudally
147
Dx of measles
Koplik spots are diagnostic
IgM titer
RNA test
148
Tx for measles
IG administration
1 week isolation
Vitamin A
149
MMR vaccine administration
1st at 12-15 months
2nd at 4-6 years
150
Presentation of mumps
Paramyxovirus
Orchitis, Meningitis, and parotitis
May cause pancreatitis
151
Diagnosis of mumps
PCR, elevated amylase, CSF lymphocytes
152
Tx for mumps and duration
Supportive
Lasts 7-10 days
May need scrotal support
153
Presentation of pertussis
Cough over 2 weeks in patients under 2 years old
Cold-like symptoms followed by coughing with inspiratory whoop
154
Dx for pertussis
Nasopharyngeal swab for culture
155
Tx for pertussis
Macrolide - erythromycin or Z-max
156
Tdap vaccination schedule (5 doses)
2,4,6,15-18 months and 4-6 years
157
Presentation of pin worms
Enterobiasis
Nocturnal perianal itching
Eggs on scotch tape test
158
Tx for pinworms
Albendazole or mebendazole
159
Presentation of roseola
High fever of 102-104 followed by as red rash - maculopapular
Starts on trunk, goes to extremities
Resolves without tx
160
Presentation of rubella
3-day rash
Cephalocaudal spread
More rapid than rubeola
Does not darken or coalesce
No coryza (stuffy nose)!!
161
Presentation of varicella (chickenpox)
Cephalocaudal rash with dewdrop on rose petal lesions in differing stages
May use acyclovir in special cases
162
Schedule for varicella vaccine
12-15 months
4-6 years
163
Etiology of acute bronchiolitis
Caused by RSV - infants and young children
164
Presentation of acute bronchiolitis
Tachypnea, respiratory distress and wheezing with a fever in an infant/young child
Fall and winter months
165
Dx for acute bronchiolitis
RSV culture positive with normal CXR
166
Treatment for bronchiolitis
Oxygen
Ribivirin for severe dise
Supportive tx
167
Indication for hospitalization for bronchilitis
O2 sat under 95-96%
Age under 3 months
RR over 70
Nasal flaring
Atelectasis on CXR
ANY ONE!
168
Presentation of asthma
Attacks of breathlessness and wheezing
Hx of allergies or eczema
169
Dx for asthma
Decreased FEV1/FVC (under 75-80%) with over 10% increase with bronchodilator therapy
170
Intermittent asthma
Less than 2 times per week with less than 2 night symptoms per month
SABA PRN - Albuterol
171
Mild persistent asthma
More than 2 times per week or 3-4 nigt symptoms per month
Low dose ICS
172
Moderate persistent asthma
Daily symptoms or more than 1 nightly episode per week
Low/medium dose ICS and LABA - ie. budesonide
173
Severe persistent asthma
SYmptoms several times a day and nightly
High dose ICS and LABA and steroids maybe
174
Acute asthma tx
Oxygen, Nebulizer, Ipratropium bromide, Oral steroids
175
Presentation of croup
Parainfluenza virus
6mo. to 3 years
Barking cough, stridor and steeple sign
176
Tx for croup
Supportive
For severe - racemic epinephrine, steroids
177
Cystic fibrosis inheritance
CFTR mutation
Autosomal recessive
178
Presentation of cystic fibrosis
THick mucous and pseudomonas infections
Steatorrhea
Growth retardation and foul smelling stools
Atelectasis
179
Dx for cystic fibrosis
Sweat chloride test
180
Tx for CF
Physiotherapy, SUpplement fat soluble vitamins with High fat diet
181
MC site for aspirated foreign body
RIght bronchus
182
Presentation of bronchial FB
Inspiratory stridor or wheezing
with decreased breath sounds below
Hyperinflation of affected side on CXR
183
Tx for bronchial FB
Remove with bronchoscope
RIGID bronchoscope is preferred in children
184
Presentation of nasal FB
Persistent unilateral foul smelling nasal discharge
185
Tx for nasal FB
Oxymetazoline drops to shrink mucous membrane prior to removal
186
Tx of otic FB
Topical pain agents and flushing
Insects MUST be immobilized with mineral oil or lidocaine
187
Management for ocular FB
Metallic objects may leave a rust ring
CT for globe penetration
May irrigate to remove corneal FB
188
Hyaline membrane disease
Seen in premature infants
Atelectasis due to lack of surfactant production
189
Presentation of hyaline membrane disease
Infant born before 30 weeks
Develops shallow respirations at 60/min
Grunting, retractions, cyanosis
190
Dx of hyaline membrane disease
Ground glass lungs and air bronchogram
191
Tx for hyaline membrane disease
Antenatal steroid 24-48 hours before birth
ET tube surfactant
PP mechanical ventilation
192
MCC of viral pneumonia in kids
RSV
193
Dx for viral pneumonia
CXR with bilateral interstitial infiltrates
POsitive RSV rapid antigen testing
194
Tx for viral pneumonia
B2 agonists, fluids, rest
195
Presentation of bacterial pneumonia
Fever, dyspnea, tachycardia, cough with or without sputum
196
Dx and labs for bacterial pneumonia
CXR with patchy, segmental or lobar consolidation
Get gram stain and blood cultures x2
197
Outpatient tx for pneumonia
Doxy or macrolides
198
Inpatient tx for pneumonia
Ceftriaxone and Azithromycin/Levaquin
199
Presentation of rheumatic fever
Fever with skin lesions, joint nodules, hx of sore throat some weeks ago with positive antistreptolysin titer
200
Valves MC to be infected in rheumatic fever
MC - mitral
2nd - aortic
3rd -tricuspid
201
M-protein
Present in rheumatic fever - antibodies against M protein may cross react with heart tissue
202
5 major JONES criteria for rheumatic fever
Carditis
Chorea
Erythema marginatum
Polyarthritis
SQ nodules
203
Erythema marginatum
Pink patches outlined with red
204
5 minor jones criteria for rheumatic fever
Arthralgia
Elevated ESR/CRP
Fever
Increased PR interval
Leukocytosis
205
Tx for Rheumatic fever
PCN and ASA
206
Presentation of an ASD
Wide fixed, split second heart sound
Systolic ejection murmur
Failure to thrive
207
Dx for ASD
Diagnosed by passing a catheter through the defect
208
Tx for ASD
Diuretics, ACEI, Digoxin
Surgical closure - under 5 mm may close on own
209
Presentation of aortic coarctation
Elevated BP in arms with low BP in legs
Pulses in legs also diminished
Aortic ejection murmur radiating to the back
210
Dx of aortic coarctation
EKG - LVH
CXR - Notching of the ribs causing a figure of 3 sign
211
Tx for aortic coarctation
Balloon angioplasty, stent placement or surgical correction usually performed between 2 and 4
212
Pharm for neonatal aortic coarctation
Prostaglandin E1
213
Presentation of hypertrophic CM
SOB, chest, pain and near syncope in young athletes
Systolic murmur louder with vlasalva quiet with squatting
214
Dx and Tx for hypertrophic CM
Echo to diagnose
BB and CCB
NO diuretics!!
215
Presentation of Kawasaki disease
CRASH and burn
Conjunctival injection
Rash - all over
Adenopathy - cervical
Strawberry tonggue
Hand and foot swelling
FEVER! 5 days without response to antipyretics
216
Demographics of kawasaki disease
Kids under 5
MC in boys
217
Dx for kawasaki disease
4 CRASH symptoms with 5+ day fever
Echo for cardiac issues
218
Tx for kawasaki disease
Autoimmune
IVIG and ASA
Resolves in 6-8 weeks
25% risk of heart complications if untreated
219
Presentation of PDA
3-6 week infants with tachypnea, diaphoresis, and FTT
Machinery murmur in late systole at pulmonic post
220
Dx for PDA
Echo
221
Tx for PDA
Indomethacin to help close (NSAIDs CI in pregnancy because they close it in utero)
222
Dx criteria for orthostatic hypotension
20mmHg drop systolic of 10mmHg drop in diastolic after standing
223
Tx for POTS
Patient education to avoid triggers
Exercise conditioning
No approved drugs
224
4 features of tetralogy of fallot
VSD
Pulm stenosis
RV hypertophy
Overriding aorta
225
Presentation of terology of fallot
Difficulty feeding and FTT
CYanosis and loss of conscienceness when crying (TET spells)
Crecendo decrescendo holosystolic murmur at LSB radiating to back
226
Imaging for tetrology of fallot
Boot shaped heart
227
Presentation of VSD
Noncyanotic
Tires easily
Loud, harsh holosystolic murmur on LLSB without radiation
MC pathologic childhood murmur
228
Tx for VSD
Small or medium close by 6 years
Surgery for large defects
229
Presentation of appendicitis
Colicky pain around the unbilicus that moves to the RLQ
Rebound tenderness
Rovsing, Obturator, and Psoas signs
230
Dx for appendcitis
US or CT
Neutrophillia on CBC
Tx - appendectomy
231
Presentation of colic
Severe paroxysmal crying peaking at 2-3 months, ending around 4 months
Exterme fussiness and drawing knees to abdomen
232
Dx for colic
Rule of 3's
3hrs per day
3 days/wk
for 3 weeks
232
Management of colic
Don't shake baby
Will likely stop around 4 months
Possible formula switch
233
Presentation of childhood constipation
Under two BMs per week, 1 or more encopresis episodes per week
Hard painful BMs
Fecal mass in rectum
Toilet obstruction
234
MC triggers for childhood constipation
Transition to solid foods
Potty training
Reduced fiber d/t solid foods
235
Treatment for childhood constipation
Increase fiber 11-24 g/day
Decreased milk
Mineral oil or Miralax (polyethylene glycol)
236
Presentation of pediatric dehydration
Prolonged cap refill
Poor skin turgor
Abnormal breathing
Dry mucous membranes
237
Signs that dehydration is severe
Lethargy and unconsciousness
Absent tears
Thready pulse
238
Tx for pediatric dehydration
Oral rehydration in small amounts - 5 mL every 1-2 mins
Use IV if that fails
239
Presentation of duodenal atresia
Closure or absence of the duodenal lumen
Causes increased amniotic fluid as a baby
Early billious emesis
Associated with Down syndrome
240
Dx for duodenal atresia
Double bubble on XR
Commonly caught prenatally
Corkscrew formation
241
Tx for duodenal atresia
Suction and drain secretions
IV glucose and abx
SURGERY!
242
Presentation of encopresis
Repetetive involuntary stooling in children 4+
Associated with constipation
Loose stools
242
Dx for encopresis
Rectal exam and KUB US
243
Tx for encopresis
Miralax
Suppository of glycerin
ELiminate cows milk
Laxatives for 6-12 months
5-10 minutes toilet sitting after meals
243
Tx for FB swallowing in peds - button batteries
Remove all button batteries past the esophagus
243
Tx for FB swallow - sharp object
Monitor with serial imaging if beyond pylorus
244
Tx for swallowed small blunt object
Remove if stuck at pylorus for 3-4 weeks
244
Management for over 3cm object ingestion
Remove if before pylorus, monitor with serial imaging after pylorus
245
Tx for acid or alkaline ingestion
Do not induse vomiting
ABCs
Endoscopy after 2-3 weeks
246
Presentation of gastroenteritis
Diarrhea, anorexia, vomiting and abdominal pain
MCC - virus (rotavirus) can be bacterial (campylobacter/e coli), fungal, etc.
246
Dx for gastroenteritis
Clinical
Stool cultures if under 5
246
Management for gastroenteritis
HYdration status (are they crying/peeing)
Abx for children with bloody diarrhea - Cipro, Doxy, Zmax, Bactrim
247
Rotavirus vaccination schedule
2,4,6 months (rotarix only 2 and 4; rotateq at 2,4,6)
248
Presentation of GERD
A small amount is normal in infants
FTT, Pneumonia, choking, apneic episodes
Emesis with meals
249
MCC of gerd
Overfeeding
249
CMP for GERD
hypochloremic, hypokalemic, metabolic alkalosis
250
Tx for GERD
Smaller frequent feedings
Tickened feeds
PPI for esophagitis
251
Presentation of neonatal hepatitis
Jaundice, acholic stools, hepatomegaly and FTT
Slef limited disease
Exclusion of other dx
252
Tx for neonatal hepatitis
Triglyceride containing formulas
Fat soluble vitamins
Orsodeoxycholic acid
Liver transplant if severe
253
Presentation of viral hepatitis
Malaise, jaundice, vomiting
Scleral icterus
254
Dx for viral hepatitis
Uniformly elevated liver enzymes
anti-HAV antibodies
254
Hepatitis titers of acute HBV infection
Positive HBsAg and Anti HBc positive early on HBeAg
255
Hepatitis titers of resolve hepatitis
Positive Anti HBs, HBc, and HBe
256
Hepatitis titers for chronic HBV infection
Positive HBs and anti-HBc
HBe and anti-HBe may or maynot be positive
257
Tx for viral hepatitis
IVIG for HAV within 14 days of exposure
Refer for chronic elevation of ALT
257
Immunization schedule for HBV
Birth, 1-2 months, 6-18 months
258
Immunization schedule for HAV
12 and 18 months (second dose before 2 years)
259
Presentation of hirschprungs disease
Contraction of distal segment of the colon due to lack of ganglion migration
Inability to pass meconium in first 48 hours of life
Constipation, vomiting, abdominal distension
260
Dx of hischprungs disease
Rectal suction biopsy revealing paucity of ganglion cells
Barium radiography
DRE
260
Tx for hirschprung's disease
Resection of bowel or colostomy
260
Dx for inguinal hernia
Ultrasound if no bulge seen of PE
260
Tx for inguinal hernia
Surgical repari within 14 days recommended
Emergent referral for incarceration
261
Presentation of intussisception
MC at 5-9 months
After viral infections
Crampy, colicky abdominal pain with legs drawn to chest
Sausage shaped mass and currant jelly stools
261
Diagnosis/Treatment for intussusception
Barium enema - treats
Crescent sign or Bull's eye on XR
Operation if enema fails
262
Presentationof neonatal jaundice
Total billirubin over 2 mg/dL
262
Physiologic jaundice parameters
Isolated and Unconjugated
Rises slower than 0.2 mg/dL per hour or 5 mg/dL per day
Remains lower than 18 mg/dL
262
Diagnostics for jaundice
Coombs test for ABO/Rh incompatibility
Hemoglobin for hematomas
Reticulocytes for hemolysis
If all three are normal likely breast milk jaundice
263
Presentation of lactose intolerance
Abdominal pain, bloating, borborygmy, nausea
TYpical within 30 minutes of dairy consumptoms
May have low calcium
264
Dx of lactose intolerance
Lactose hydrogen breath test - definitive
Stool acidity
Usually clinical
264
Presentation of niacin deficiency
4 Ds - Diarrhea, dementia, dermatitis, death
Corn staple diets are a risk factor
265
NIacin RDAs
9-13 - 6-12mg
Preg - 18 mg
Lact - 14 mg
265
Dx for niacin deficiency
N-methylnicotinamide levels
or erythrocyte NAD:NADP ratio
266
Presentation of pyloric stenosis
Under 3 months
Nonbilious projectile vomiting with every feed
Olive shaped mass in abdomen
267
Dx of pyloric stenosis
Pyloric US with double track
Barium string or shoulder sign
HYpochloremic, Hypokalemic metabolic alkalosis
268
Tx for pyloric stenosis
Pylormyotomy
269
When to refer umbilical hernia to surgery
If it persists beyond 2 years of life
270
Presentation of vitamin A deficiency
Dry eyes, Night blindness, impaired immunity
Egg yolk, butter, leafy vegetables
271
Dx for vitamin A deficiency
Serum retinol levels under 20 mcg/dL
272
Presentation of vitamin C deficiency
Swollen gums, bruising, petechiae, poor wound healing
Infants fed evaporated/boiled cows milk
273
Dx for vitamin C deficiency
Plasma leukocyte vitamin C levels
274
Vitamin A dietary recommendation
100K IU 6-12 months
200k after
275
Peds vitamin C recommendation
100 mg 3 times daily for deficiency
276
Presentation of vitamin D deficiency
Rickets - bowed legs with increased fractures
Dark pigmentated individuals who are exclusively breast fed
277
Dx of vitamin D deficiency
Serum 25OHD levels
Insufficient - 12-20 ng/mL
Deficient - Under 12 ng/mL
277
Vitamin D supplementation for breastfed infants
400 IU daily
278
2 month milestones
Alert to sounds
Recognizes parent
Eyes track past midline
279
4 month milestones
Rolls front to back
Laughs
Grasps rattle
280
6 month milestones
Sits
Babbles
Feeds self
281
9 month milestones
Pincer grasp
Mama/Dada
Bye bye
Bangs objects
282
12 month milestones
Stands/Walks on own
Fine pincer
Follows 1 step commands
282
15 month milestones
Stoops and recovers
Scribbles
3-5 words
Turns pages
283
18 month milstones
Runs
3 cube tower
Points to body parts
284
24 month milestones
Kicks ball
50+ words
Undresses
285
36 month milestones
Pedals tricycle
Copy circle
Brushes teeth
286
48 month milestones
Copies square
100% intelligible
Knows 4 colors
287
60 month milestones
Skips
Copies triangle
Defines words and uses 5 word sentences
288
Neonatal guidance
Breast feed every 2-3 hours
Crib safety
288
2-4 week guidance
Tummy time when awake for 5-10 mins 2-3 time per day
2 weeks should be back to birth weight
289
Guidance for 2 months
After 3 months no more nocturnal eating
Parent return to work
290
4 month guidance
Introduce solid food
Back to sleep and choking
291
6 month guidance
Start water and baby food
292
9 month guidance
NO honey before 1
Avoid juice
293
12 month guidance
Introduce cows milk
Timeout vs. corporeal punishment
293
15 month guidance
Less eating with slower growth
294
18 month guidance
Prep for toilet training
295
2 year guidance
Forward facing car seat
TOilet training
296
4 year guidance
Bike helmet
297
5 year guidance
DIscuss rules and consequences
298
7-10 year guidance
Lap and shoulder belt no back seat until 13
299
5 features of down syndrome
Single palmar crease
ASD
Umbilical hernia
Hypotonia
Abundant neck skin
300
Sterility in down syndrome
Males are sterile
301
Testing for downs
Amniocentesis at 15th week
CVS at 10th-12th week
Quad screen
302
Quad screen positive for downs
Increase bHCG and Inhibin A
Decreased Unconjugated estriol and alpha fetoprotein
303
Presentation of febrile seizure
Convulsions associated with temperature above 100.4 F
Between 6 months and 5 years
Viral in fections MC
303
Dx for febrile seizure
Lumbar puncture is meningitis suspected
Clinical
303
Tx for febrile seizure
Reassure
Benzo if over 5 minutes
May get an EEG do not have to
304
Tdap vaccination schedule
2 months
4 months
6 months
15-18 months
4-6 years
Boosters start at 11
305
HIB vaccination schedule
2 months, 4 months, 12-15 months
305
Prevnar vaccine schedule
2 months, 4 months, 6 months, 12-15 months
306
Polio vaccine schedule
2 months, 4 months, 6-18 months, 4-6 years
307
HPV vaccine schedule
Two doses between 9-14, three if above 15
Given at 0 months, 1-2, and then 6 month intervals
307
Meningococcal vaccine shcedule
11-12 years
16 years
307
Presentation of meningitis
Headache, Fever, Nuchal rigidity
No mental status change (unlike enchephalitis
308
MCC of neonatal meningitis
E. coli and Group B strep
309
Most people MCC of meningitis
S. Pneumo, N. meningiditis
309
Tx for menigitis
Dexamethasone with empiric abx:
Cephalosporin, Vanc, PCN)
Acyclovir for HSV
310
Treatment for focal seizures
Phenytoin or Carbamazepine
311
Tonic seizure
Seizure presenting with rigidity
312
TX for status epilepticus
Benzodiazepines (lorazepam) followed by phenytoin
312
Benign myoclonus of infancy
Seizure disorder in a neonate with a NORMAL EEG
Valproate is the drog of choice
313
Characteristics of a pseudoseizure
TOngue biting
No incontinence
Will stop hands from hitting face
314
When to treat epilepsy
After two unprovoked seizures
314
General maintainance for focal seizures
Lamictal
315
General tx for generalized seizures
Valproate or Levetiracetam
316
Presentation of teething
6-24 months of age
Drooling, CHewing, Irritability, Elevated temp but not fever
316
Tx for teething
Chilled teething ring
AVOID Lidocaine
Tylenol or Ibuprofen
316
Presentation of turner syndrome
45, XO
Short stature, webbed neck, heart/kidney defects, shield chest, amennorhea
316
Diagnostics for turner syndrome
Low AMH
Karyotype
GI telangiectasias
316
Tx for turner syndrome
GH therapy and Sex hormone therapy
317
Presentation for GAD
Excessive worry pertaining to multiple domains for 6+ months
318
Tx for GAD
SSRIs first line or venlafaxine
Buspirone
Benzos short term
THerapy
319
Presentation of panic disorder
Unexpected, recurrent panic attacks for 1+ months
Peak in 10 minutes
320
Tx for panic disorder
SSRI
Benzos for acute
CBT
320
First line tx for specific phobia
Exposure therapy
SSRI for agoraphobia
321
Presentation of ADHD
Hyperactivity, impulsivity, or inattentiveness manifesting before 12 years
6 symptoms for 6 months
More than 1 setting
321
1st line Treatment for ADHD - 4 meds
Methylphenidate (Ritalin, Concerta, Daytrana)
Dexmethylphenidate (Focalin)
Amphetamine (Adderall, Dexedrine)
Atomoxetine (Strattera)
322
2nd line tx for ADHD - 4 meds
Guanfacine, Clonidine, Bupropion, Venlafaxine
322
Presentation of autism spectrum disorder
Social communication defecit
Restricted or repetetive behavior
Symptoms present in early development
323
Management for autism spectrum disorder
SLP referral
THerapy
Abilify/Risperidone for mood
SSRI for stereotyped behavior
323
5 Red flag injuries for child abuse
Spiral fracture
Stocking glove or doughnut burns
Conflicting history
Various stages of healing
Face back and buttock regular injuries
324
What can be considered neglect
Minor allowed to engage in harmful behavior
Child under 13 unattended
324
Management for child abuse
Care for immediate injuries
Report to CPS
INvolve social work
325
Presentation of MDD
5+ symptoms for 2+ weeks with either depressed mood and or anhedonia
326
SIG E CAPS of depression
Sleep disturbances
Interest loss
Guilt
Energy loss
Concentration difficulty
Appetite changes
Psychomotor
Suicidal thoughts
326
Persistent depressive disorder
Symtpms for 2+ years
SSRI tx and exercise
326
Premenstrual dysphoric disorder
Depression the week before menstruation, absent during menstruation
Must include one of - Affective lability, conflict, depressed mood, anxiety
SSRI and birth control
327
Conduct disorder criteria
Three criteria in past 12 months and one in the past 6
327
Criteria of ODD
Irritable and angry mood with 4 symptoms for 6 months
Not aggressive and destructive like conduct disorder
328
Tx for ODD and CD
CBT and family therapy
May use antipsychotics for symptoms
329
Presentation of anorexia
BMI under 17 with preoccupation about weight (ie. weighting self multiple times, etc.)
Binge purge OR restrictive
329
Management of anorexia
Therapy is mainstay
Hospitalization if weight is under 75% expected
330
Bullimia
Mass eating followed by purging, feel out of control
Compensatory behaviors at least once a month for 3 months
FLuoxetine to treat
331
Presentation of avascular necrosis of the femur
Insidious onset pain in the groin, lateral hip, buttocks
332
Causes of avascular hip necrosis
Trauma, Steroid, SIckle cell disease
Legg-Calve Perthes disease for peds
333
Age of presentation for Legg Calve Perthe disease
2-11 with peak incidence at 4-8 years
334
Dx for avascular hip necrosis
MRI of the hip demonstrating necrosis effusion
334
Treatment for avascular hip necrosis
Conservative to hip replacement
334
Presentation of congenital hip dysplasia
Assymetric thigh creases
Positive barlow test with a clunk on ortelani
Limping, waddling, or unequal length
335
TX for congenital hip dysplasia
Pavlikc harness under 6 months
Hip spica cast 6-15 months
Open reduction and hip spica cast 15-24 months
335
Presentation of juvenile idiopathic arthritis
Begins before 16
Morning stiffness and stiffness after inactivity
336
3 types of JIA
Oligoarticular - 1-4 joints during first 6 months of disease
Polyarticular 5+ joints (RF negative have better prognosis
SYstemic - With fever, etc.
337
Management of JIA
Test for RF, ANA, HLA-B27
NSAIDs, Intra-articular steroids, methotrexate
337
Presentation of osteosarcoma
10-14 years - MC
Night pain, bone pain, and joint swelling
May look like growing pains
338
Dx and metastasis sites of osteosarcoma
XR with sunburst or hair on end appearance
Lung = MC site of mets
339
Tx for osteosarcoma
Limb sparing resection or amputation
340
Presentation of ewing sarcoma
5-25 years
Fever - like infection
Palpable mass
Swelling
Local tenderness
340
Diagnosis and tx for ewing's sarcoma
Lytic lesion with onion skinning appearance on XR
Chemo, surgery, and radiation
341
Presentation of osteochondroma
Benign lesion mostly in 10-20 y/o males
Pedunculated stalk on XR
Resect if becomes painful
341
Presentation of nursemaid's elbow
Ages 1-3
Child lifted by arm
Holds it slightly bent and close to the body
342
Treatment for nursemaid's elbow
Supination-flexion technique for subluxed radial head
343
Presentation of Osgood-Schlatter disease
9-14 year old male MC
Tenderness over tibial tubercle assoc with sports that involve running
US may show swelling around tuberosity
344
Tx for osgood schlatter disease
Ice, NSAIDs, rest
Ossicle resection in severe cases
345
Presentation of scoliosis
Cobb angle of over 10 degrees
MC to begin at 8-10 years of age
Assymetry noted
345
Dx for scoliosis
Adams test - forward bending to reveal assymmetry
PA and lateral radiographs
May use PFT or MRI
346
4 treatments of scoliosis depending on degree of curvature
10-15 degrees - 6-12 month follow up for XR
15-20 degrees 3-4 month follow ups (6-8 in patients almost grown)
20-40 degrees - PT and bracing (refer to ortho
40+ - Surgery - refer to ortho
347
Slipped capital femoral epiphysis
TYpical patient - obese boy, 10-16 years old
Head of the femur slps of neck of the femur inferiorly and posteriorly
348
Presentation of SCFE
Dull groin pain
Worse with physical activity
Recent growth spurt
Limp
Obese
349
Dx for SCFE
AP, Frog Leg, and Lateral XR
MRI if radiographs are negative
350
Tx for SCFE and one potential complication of the condition
Surgical fixation with screw
May consider prophylaxis in other hip
Avascular necrosis is a potential complication
351
Presentation of type 1 diabetes in children
Weight loss, polydipsia, polyphagia, and polyuria
Diffuse abdominal pain
Rapid breathing
Fruity breath
351
Dx for type 1 diabetes
Random blood glucose over 200 mg/dL
2 fasting glucoses over 126mg/dL
2 hour OGTT over 200
A1C over 6.5
LOW C-Peptide differentiating from T2DM
351
3 Antibodies potentially present in T1DM
Insulin, GAD65, and IA-2 antibodies -if present, presume T1DM
352
Tx for T1DM
Insulin therapy with fingerstick monitoring 4 times per day
353
Short acting insulins
Lispart, Aspart, Glulisine
30 minonset with 1-3 hour peak
354
Long acting insulin
Glargine, Degludec, Detemir
355
Presentation of hypercalcemia
FTT - often found on chemistry panel
May have hyperparathyoidism
Bisphosphonates for bone resorption
Surgery for hyperparathyroidism
356
Presentation of hyperthyroidism
Heat intolerance, restlessness, emotional lability, sweating, looses stools, etc.
OFten neonatal graves
356
Dx and Tx for hyperthyroidism
Elevated T4/T3 with suppressed TSH
Methimazole
LIfelong monitoring
357
Presentation and MCC of hypothyroidism
Hashimotos - MCC
Choking, lethargy, hoarseness, Floppiness, Low weight
Tx with synthroid
358
Normal weight BMI percentile
5-85th percentile for age and sex
Obese is over 95th percentile
358
XR for bone age
AP of left wrist taken to assess
359
Tanner stage 1 for males females and both
Hair - No hair
Fem - No galndular breast tissue palpable
Male -Testicular vol under 4mL axis under 2.5 cm
359
Tanner stage 2 for males females and both
Hair -DOwny hair
Fem - Breast bud palpable
Male - 4-mL or 2.5-3.3 cm
360
Tanner stage 3 for males females and both
Hair - Scant terminal hair
Fem - Breast bud outside of areola
Male - 9-12 mL 3.4-4.0 cm
361
Tanner stage 4 for males females and both
Hair - Triangle of terminal hair
Fem - Elevated areola formin "double scoop"
Male - 15-20 mL 4.1-4.5 cm long
362
Tanner stage 5 for males females and both
Hair beyond inguinal crease
Single breast contour with nipple protrusion
Over 20 mL or over 4.5 cm
362
Astrocytoma
MC primary CNS tumor in children
Often benign - morning headaches, vomiting, lethargy
Resection with radiation and chemo
363
Medulloblastoma
Malignant posterior fossa tumor
Mets through CSF
3-4 years pr 8-10 years
Vomiting, HA, visual changes
Surgery, radiation, chemo
364
Ependymoma
3rd MC tumor in children
Mean age is 6 years
Intercranial pressure
Resect, chemo, radiation
365
Retinoblastoma
Leukoria, surgical enuecleation and chemo
366
Two forms of hemophilia
Hemophilia A - Factor VIII
Hemophilia B - Factor IX
X linked recessive
367
Presentation of lead posoning
FTT
Abdominal pain
Lives in an older home
Lethargy
368
Diagnosis of lead poisoning
Serum lead level of 10mcg/dL
Basophilic stippling
Low MCV and MCH
Hemolysis
368
Management for lead poisoning
CHelation therapy - indicated for levels 45+
Dimercaprol
Hospitalize if levels over 70
369
Presentation of ALL
Lymphadenopathy, bone pain, bleeding, fever
Over 20% blasts in marrow
Peak age 3-7 years
ANC over 1000
Chemo
370
Presentation of AML
MC in males
Soft tissue tumor - chloroma in skin or spinal cord with green hue
Smear Auer rods
Bone pain, palor, ecchymosis
371
Tx for ALL and AML
Chemo for both, bone marrow transplant for AML
371
Presentation of hodgkin lymphoma
15-35 years
Painless cervical lymphadenopathy
Mediastinal nodes
B symptoms (fever, night sweats, weight loss)
372
Dx for hodgkin lymphoma
CXR mediastinal mass
Reed sternberg cells - pathognomic
372
Tx for hodgkin lymphoma
CHemo, radiation. Better prognosis than non-hodgkin
373
Presentation of non-hodgkin lymphoma
Painless lymphadenopathy with GI, bone marrow, and spinal cord lesions
Non contiguous spread
NO reed sternberg cells
374
Neutropenia
ANC under 1,000
Fever with hx of chemo
375
Therapies for outpatient, psuedomonas, and unstable neutropenia
Outpatient - Cipro and AUgmentin
Mono (psuedomonas) - Cefepime, Imipenem, or Augmentin
Unstable - Add vanc or metronidazole
375
Cryptorchidism treatment
Testes should be descended in full term infant
Correct as soon as possible after 4 months of age
375
Tx for cystitis in peds
Keflex (1st gen) if no kidney involvement
Cefuroxime (2nd gen) if kidney involvement
375
Normal age of bladder control
2-3 years
376
Age at which bed wetting becomes concerning
5 years
376
Medication for bed wetting
Desmopressin to produce less urine
377
Postinfectious group a strep glomerulonephritis
10-14 days after infection with elevated ASO titers and low complement
Abx and supportive tx, steroids
377
IgA nephropathy
24-48 hours after a URI of GI infection
Berger disease
377
Alport's syndrome
Isolated, painless hematuria
Renal failure and hearing loss
Conical lens of eye exam
378
Management of a hydrocele
Most resolve by 1 year on own
Needle aspiration of surgeyr can be done
379
Management for hypospadias
Don not circumcise, surgery
380
Window for testicular torsion surgery
4-6 hours
380
Prehns sign
Negative in testicular torsion -elevation does not help
381
Vesicoureteral reflux
Recurrent UTIs with pyelonephritis
Dx via VCUG
Mild may resolve, surgery and prophylactic abx for less mild
