Peds/OB Flashcards by Ronak Chhaya

Abdominal mass benign in kid

most commonly Neuroblastoma

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Sxs of neuroblastoma

abdominal mass in kid, mainly benign. periorbital echhymosis, flushing (catecholamine release), hypertension (presses on renal a), opsoclonus-myoclonus, spinal cord compression

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most common renal tumor kids

Wilms tumor; age <5; usually painful, along with hypertension and hematuria; no flushing or sweating

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When can you have Rh incompatibility

Rh(D) negative mother + positive father. Prior pregnancy with RhD + fetus = antibodies that can cross placenta and destroy RhD postive fetal rbcs = Hemolytic disease of the newborn

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aplastic crisis

from Parvo b19; sudden drop in Hgb and v low reticulocyte count; transient arrest of hematopoeisis

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when do you get DTaP vaccine?

5 doses at 2, 4, 6 months; 15-18 months; 4-6 years

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contraindications to DTaP vaccine

Encephalopathy after previous dose or anaphylaxis to vaccine component. If they are on steroids, have some minor illness/infection, give it anyways

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first line treatment for allergic rhinitis

allergen avoidance 
intranasal corticosteroids (not decongestant)

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contraindications to MMR vaccine

anaphylaxis to MMR, neomycin or gelatin
immunodeficiency
pregnancy

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diagnostic criteria for kawasaki dz

fever >5 days with 4 of the following:

conjunctivitis
mucous membrane changes
rash
lymphadenopathy
extremity edema/erythema

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complications of kawasaki dz

coronary artery aneurysms (by day 10), MI and ischemia

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tx of kawasaki dz

Aspirin + IVIg; all kids get an Echo;

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Developmental dysplasia of the hip is characterized by abnormal _____ _____. Prognosis is

Acetabular development (=shallow hip socket, poor support femoral head). Prognosis is excellent, 95% pts have reduction of a dislocated hip.

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adolescents with leg-length discrepancy, gait abnormalities (toe walking, Trendelenburg gait), activity related pain

DDH. Can result in chronic, activity related hip pain and osteoarthritis in adolescents and young adults

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avascular necrosis of femoral head in children 5-7

Legg-Calve-Perthes dz. Caused by idiopathic interruption of blood supply.

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sxs of JIA

fever, joint pain and rash

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precocious puberty

onset of secondary sex characteristics:

<9 boys, <8 girls

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Sxs of Congential Adrenal Hyperplasia (decreased 21-hydroxylase on ACTH stim test)

early pubic/axillary hair growth
severe acne
hisutism and oligmenorrhea in girls
increased growth velocity and bone age
increased 17-hydroxyprogesterone

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Tx of Congenital Adrenal Hyperplasia

Hydrocortisone

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Target glucose levels gestational diabetes

Fasting <95
1 hour postprandial <140
2 hour postprandial < 120
–>can use most anti-hypoglycemic i.e. insulin, metformin or glyburide

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when do you screen for gestational diabetes?

usually 24-28 weeks; earlier if there are risk factors (obesity, prior macrosomic infant) at initial prenatal even

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Hyperthyroidism tx in pregnancy

1st trimester: PTU preferred (teratogenic effects methimazole)
2nd/3rd trimester: Methimazole preferred (hepatotoxiciy of PTU)

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when is post partum thyroditis?

<1 year following pregnancy. associaed with thyroid peroxidase antibody

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test to differentiate Graves from postpartum and silent thyroiditis

Radioactive iodine uptake. graves (high) from increased thyroid hormone synthesis; PT and silent (low RAIU) from thyroid peroxidase antibody.

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Absent testicular enlargement at age ____ = delayed puberty

test if you're worried about primary hypogonadism

Karyotype: Klinefelter = 47XXY

insulin is recommended in t2dm with ______

a1c>9, esp if + sxs

screening for gestational diabetes

1. administer 50g oral glucose test and check glucose after 1 hour: >140 then next step (challenge) 2. Admnister 100g oral glucose, check fasting each hour for 3 hr (glucose tolerance test)

when do you screen for gestational diabetes?

usually 24-28 weeks; earlier if there are risk factors (obesity, prior macrosomic infant) at initial prenatal even

how do you prevent neonatal rubella?

admin of MMR vaccine pre-conception (live vaccine so not during pregnancy)

baby born with hearing loss, no red reflex, heart murmur

congenital rubella | sxs include sensorineural hearing loss, cataracts, PDA

vertebral osteomyelities in traveler with cavitary pulm lesion

Pott's disease: TB betch

How long is patient with active pulm TB infectious with aerosolized droplets prior to onset of sxs?

3 months

Peds oropharyngeal lesions on anterior oral mucosa

apthous stomatitis (canker sores, recurrent) and Herpes gingivostomatitis (vesicles, ulcers, fevers)

peds tonsillar exudates

GAS (anterior cervical ln) | Mono (diffuse cervical ln, +/- hepatosplenomegaly)

peds oropharyngeal lesions on posterior oral mucosa

Herpangina (Coxsackie; vesicles, ulcers, painful pharyngitis, prevent by hand washing)

most common causes viral CNS infections

Enteroviruses (Coxsackie, Echovirus), then herpesvirus and arbovirus

tx for gastroparesis

dietary modification: smaller more frequent meals

common offenders for erosive esophagitis

Tetracyclines (Doxy), Bisphosphonates

best initial test for esophageal perforation

esophagram with water-soluble contrast

how do you dx painless bleeding in 2 year old?

Meckels diverticulum: need a Tech-99m pertechenate scan

failure of vitelline duct to obliterate during 1st 8 weeks of gestation

Meckel's diverticulum (common cause painless bleeding 2yo)

tx for diffuse esophageal

CCB

solid and liquid dysphagia, can be triggered by hot/cold liquids or gerd

diffuse esophageal spasm

first line tx for toxic megacolon (IBD)

steroids to treat underlying inflammatory bowel disease; if perforation then surgery

management of pt with gallstones and biliary colic

elective lap chole

weight loss + fat, bulky stools

fat malabsorption

labs for pyloric stenosis pt

hypokalemic, hypochloremic metablic alkalosis

who gets pyloric stenosis?

boys 3-6 weeks old, especially if first-born, bottle fed or preterm. azithromycin/erythromycin (macrolides) increase risk also

who gets hepatic adenoma?

young females on OCP, can improve with cessation of OCP if <5cm

breast milk jaundice

beta-glucuronidase in breast milk deconjugates = unconjugated bili,

tx for breast milk jaundice

continue breast feeding exclusively, will self resolve by month 3

isolated gastric varices

hallmark of splenic vein thrombosis (usually hx of pancreatitis)

screening test for Marfans kid

echo: high risk of SCD from aortic root dz

most common congenital heart defect Down's syndrome

endocardial cushion defect (get an echo)

for acute MR, is it the papillary muscle or chorda tendinae?

chorda tendinae, i.e. connective tissue disorder. CT-CT. papillary muscle rupture can happen 2-5 days post MI

echo is needed at time of dx and annually afterwards for this connective tissue disease

Marfan's Syndrome: majority of pts develop aortic root disease (dilation, dissection)

Berry aneurysms occur in this connective tissue dz

Ehlers-Danlos

prevention of preeclampsia in higher risk patients

aspirin at 12 weeks gestation

preventing preterm delivery if hx of preterm delivery

intramuscular hydroxyprogesterone

Rh(D) women with negative anti-D antibody

Anti-D immune globulin at 28 weeks and <72 hours after delivery

neonatal erbs palsy

brachius plexus injury from fetal macrosomia causing shoulder dystocia

breech positioning causes increased risk of

DDh

protracted labor

<1cm/2 hours after 6cm dilation

variable decelerations

abrupt drops in fetal HR <2 minutes; from umbilical cord compression; tx with amnioinfusion

what is misoprostol used for in pregnancy?

PGE1 analog, used for cervical ripening and induction of labor

when does unknown GBS status require tx?

delivery <37 weeks; intrapartum fever; rupture of membranes >18 hours

when do you screen for GBS

36-38 weeks via rectovaginal culture

what do you test at 24-28 week preconception visit?

Hgb/Hct; antibody screen if Rh(D) negative; 50g 1 hour gct

what do you test at 35-37 weeks?

GBS

why do you need intramuscular betamethasone if delivery <37 weeks?

decrease risk of necrotizing enterocolitis, neonatal respiratory distress, and intraventricular hemorrhage of prematurity

what bHCG is pregnancy visible on US

1500

how do you treat ectopic pregnancy

methotrexate or surgery

postexposure prophy after sexual assault

GC (Cef), Chlamydia (Azithro), HIV (HAART), Trichomonas (Metronidazole), Hep B (vaccine +/i immunoglobulin if not immunized)

most common cause of pathologic nipple discharge

papilloma

unilateral breast discharge eval

<30: US +/- mammogram | >30: US + mammogram

Peds/OB Flashcards

(76 cards)