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Peds > peds3 > Flashcards

peds3 Flashcards

1
Q

prophylactis for RSV bronchiolitis?

A

RSV monoclonal antibody called palivizumab

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2
Q

difference in sx of viral and bacterial pneumonia

A

viral sx begin with URI, whereas bacterial pneumonia has a more rapid onset with greater severity and not preceded by URI symptoms

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3
Q

difference in lab values between viral and bacterial pneumonia

A

for viral, WBC count is less than 20,000 cells/mm3 and for bacterial is more than that

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4
Q

common cause of afebrile pneumonia in 1-3 months of age

A

chlamydia

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5
Q

clinical clues that an infant with pneumonia has a chlamydia infection

A

a staccato-type cough, absence of fever, eosinophilia on WBC

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6
Q

management of chlamydia pneumonia

A

erythromycin or azithromycin

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7
Q

most common cause of bacterial pneumonia in older kids/adolescents

A

mycoplasma pneumonia and chlamydia

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8
Q

definitive dx of mycoplasma pneumonia

A

serum igM titers for mycoplasma

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9
Q

managmeent of mycoplasma pneumonia

A

oral erythromycin or azithromycin

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10
Q

pertussis aka

A

whooping cough

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11
Q

immunization for pertussis

A

beginning at 2 months

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12
Q

who is at greatest risk for pertussis?

A

infants less than 6 months

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13
Q

major source of pertussis

A

adolescents and adults whose immunity has waned

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14
Q

pertussis is characterized by what three stages

A

catarrhal stage, paroxysmal stage, convalescent stage

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15
Q

describe the cararrhal stage of pertussis

A

lasts 1-2 weeks; characterized by URI sx and low grade fever

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16
Q

describe the paroxysmal stage of pertussis

A

lasts 2-4 weeks; characterized by fits of forceful coughing; whoop= inspir gasp head at the very end of a coughing fit; post-tussive vomitting is common; between the fits, kids appear well and are afebrile

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17
Q

describe the convalescent stage of whooping cough

A

lasts weeks to months; recovery stage in which paroxysmal cough becomes less freq and less severe over time

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18
Q

definitive diagnosis of pertussis

A

direct fluorescent antibody tests of nasopharyngeal secretions

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19
Q

antibiotics and pertussis?

A

they don’t alter the course of the disease but they are given to help prevent the spread; azithromycin and erythromycin are options; respiratory isolation is required until antibiotics have been given for 5 days!

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20
Q

how common is asthma?

A

50% of kids by 1 year and 90% by 5 years of age; 30-50% have remission by puberty

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21
Q

what may be the only sx of asthma?

A

chronic or recurrent cough

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22
Q

what does cxr show in an asthma patient?

A

hyperinflation, peribronchial thickening, and patchy atelectasis

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23
Q

what do PFTs show in a patient with asthma

A

obstructive disease, increased lung volumes, decreaed expiratory flow rate

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24
Q

differential for acute wheezing

A

asthma, hypersensitivity reaction, bronchiolitis, pneumonia, foreign body aspiration, acute aspiration of stomach contents, environmental irritants

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25
Q

6 types of drugs for asthma

A

sympathomimetics, cromolyn sodium and nedocromil sodium; corticosteroids; anticholinergic agents; leukotriene modifiers; methylxanthines (theophylline)

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26
Q

examples of sympathomimetics

A

b2 adrenergic agonists, short acting bronchodilators (albuterol), long acting bronchodilators

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27
Q

what are cromolyn sodium and nedocromil sodium?

A

anti-inflamm prophylaxis by inhibiting release of inflamm mediators

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28
Q

corticosteroids in asthma patient

A

can be systemic (for 5-10 days after acute exacerbation) or inhaled

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29
Q

good and bad of theophylline

A

has both anti-inflamm and bronchodilator properties but narrow therapeutic window

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30
Q

diff between intermittent, mild, moderate, and severe asthma

A

intermittent is daytime less than twice a week and nighttime less than twice a month; mild is less than once a day and nighttime greater than 2x per month; moderate is daily symptoms and nighttime greater than once per week; severe is continuous symptoms and frequent nighttime sx

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31
Q

how common is CF?

A

one in 2500 caucasians

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32
Q

what percent of caucasians are carriers?

A

five percent

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33
Q

what chrom is CF mutation on?

A

chrom 7

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34
Q

common infectious agents in CF

A

staph aureus and then pseudomonas

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35
Q

what nose thing is common in CF?

A

nasal polyps

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36
Q

what does dx of CF require?

A

one or more phenotypic features OR pos fam hx OR increased immunoreactive trypsinogen on newborn screen; AS WELL AS lab evidence of abnormal CFTR (two CF mutations or sweat chloride over 60 or characteristic ion transport abnormality across the nasal epithelium

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37
Q

chronic lung disease

A

aka bronchopulmonary dysplasia; it is defined as oxygen dependency past 28 days of life; causes both obstructive and restrictive lung disease

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38
Q

what causes CLD?

A

acute lung injury followed by not good healing; often in children born prematurely with RDS

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39
Q

what does cxr show for CLD?

A

atelectasis, hyperinflation, linear or cystic radiodensities

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40
Q

foreign body aspiration- what kids are at greatest risk?

A

3 months to 5 years

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41
Q

aspirated object usually ends up in which bronchus?

A

right

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42
Q

definition of apnea of infancy

A

unexplained cessation of breathing for at least 20 seconds or a shorter pause that leads to bad things like cyanosis

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43
Q

what is short central apnea?

A

less than 15 sec; interestingly, this is normal at all ages

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44
Q

definition of periodic breathing

A

three or more episodes of apnea lasting 3 sec each with no more than 20 sec in between

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45
Q

what is ALTE?

A

loss of breathing and tone and choking or gagging and baby needs to be resussitated

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46
Q

SIDS

A

death of an infant less than 1 year that cannot be explained

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47
Q

when is peak SIDS age

A

2-4 months, with like 95% happening before 6 months of age

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48
Q

drooling and neck hyperextension

A

think retropharyngeal abscess or croup (caused by staph or strep in a vaccinated infant)

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49
Q

how do you treat moderate exacerbation (10 days) of asthma?

A

systemic corticosteroids for 5 days

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50
Q

management of intermittent asthma

A

no daily medication; SA beta ag for sx

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51
Q

management of mild persistent asthma

A

SABA, low dose inhaled corticosteroid

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52
Q

management of moderate persistent asthma

A

SABA, medium dose inhaled corticosteroid

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53
Q

management of severe persistent asthma

A

SABA, high dose inhaled steroid and LABA, long term systemic if needed

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54
Q

difference between essential and non-essential nutrients

A

essential cannot be synthesized by the body so must be taken in

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55
Q

of the 20 Aas, how many are essential?

A

9

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56
Q

vit E def can cause

A

anemia/hemolysis, neuro deficits, altered prostaglandin synthesis

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57
Q

vit K def can cause

A

coagulopathy/prolonged prothrombin time, abnormal bone matrix synthesis

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58
Q

vit B1 (thiamine) def can cause

A

beriberi (cardiac failure, peripheral neuropathy, hoarseness, or aphonia, wenicke’s encephalopathy)

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59
Q

vit B6 (pyroxidine) def can cause

A

dermatitis, cheilosis, glossitis, microcytic anemia, peripheral neuritis

60
Q

vit B12 (cobalamin) def can cause

A

megaloblastic anemia, demyelination, methylmalonic acidemia

61
Q

Vit c def can cause

A

scurvy

62
Q

sx of scurvy

A

hematologic abnormalities, edema, spongy swelling of the gums, poor wound healing, impaired collagen synthesis

63
Q

niacin def

A

pellagra (diarrhea, dermatitis, dementia), glossitis, stomatitis

64
Q

zince def

A

skin lesions, poor wound healing, immune dysfunction, diarrhea, growth failure

65
Q

marasmus

A

the most common energy depletion state; characterized by near starvation; patient is typically very thin from loss of bone and muscle

66
Q

kwashiorkor

A

less common than marasmus; seen in parts of the world where starches are the main dietary staple; protein-deficient state; characterized by edema, abdominal distension, changes in skin pigmentation and thin sparse hair

67
Q

how is malabsorption characterized

A

diarrhea, abdominal distension, and impaired growth

68
Q

carbohydrate malabsorption

A

unabsorbed sugars draw water into the lumen; result is watery stool that is acidic (pH below 5.6); the unabsorbed sugars are detected as reducing agents by a positive Clinitin test

69
Q

pos Clinitin test

A

unabsorbed sugars

70
Q

congenital enterokinase def

A

rare cause of protein malabsorption; hypoproteinemia causes edema and growth impairment

71
Q

inflamm disorders of the GI tract (crohn’s disease) cause what kind of malabsorption

A

protein

72
Q

how do you measure protein loss in the stool

A

fecal alpha 1 antitrypsin levels

73
Q

steatorrhea

A

fat in stool

74
Q

causes of exocrine pancreatic insuff (leads to decr lipid absorpt)

A

CF, Schwachman-Diamond syndrome, chronic pancreatitis

75
Q

acanthocytosis of erythrocytes

A

seen in abetalipoproteinemia

76
Q

Schwachman-Diamond syndrome

A

AR disorder characterized by pancreatic exocrine insufficiency, FTT, short stuature, neutropenia and sometimes pancytopenia

77
Q

infection with what can caue malabsorption

A

Giardia; can be x with stool studies

78
Q

most protein intolerance is caused by what protein?

A

cow’s milk protein

79
Q

what to expect in a kid with protein intolerance?

A

usually resolve by 1-2 years of age

80
Q

celiac disease pathology?

A

intolerance to gluten, which causes mucosal damage

81
Q

gold standard for dx of celiac

A

small bowel biopsy showing short, flat villi, deep crypts, and vacuolated epithelium with lymphocytes

82
Q

serum screens for celiac disease

A

serum igA endomysial and serum tissue transglutaminase antibody testing (in patients with igA deficiency, check serum antigliadin igG)

83
Q

what can non-compliance to a gluten free diet in adolescence in patients with celiac lead to?

A

growth failure and delayed sexual maturity

84
Q

distal small bowel resecstion (ileum resection) leads to what?

A

vitamin b12 and bile acid absorption deficiency

85
Q

predominant cause of GERD during childhood

A

transient lower esophageal sphincter relaxation

86
Q

another cause of GERD in kids

A

gastric emptying delay

87
Q

what to tell parents about their kid with emesis?

A

it is benign and usually resolves by a year old

88
Q

most common sx of GERD in infants

A

emesis

89
Q

Sandifer syndrome

A

torticollis with arching of the back caused by painful esophagitis

90
Q

how does GERD present in older kids?

A

midepigastric pain (“heart burn”)

91
Q

how does GERD lead to airway disease?

A

acid refluxate causes bronchopulm constriction and can also lead to aspriation

92
Q

who requires long term medical manaement of GERD

A

when infants have GERD past one year of age

93
Q

scintigraphy

A

uses radioactive marker (technetium 99m) mixed into food to measure the rate of gastric emptyng. Radioactive tracer detected in the lung confirms aspiration

94
Q

gold standard for diagnosis of GERD

A

pH probe in esophagus for 18 hours

95
Q

metoclopramide

A

motility agents increase LES tone or increase gastric emptying;though metoclopramide has side effects

96
Q

Nissen fundoplication

A

wraps the fundus of the stomach around the distal esophagus to reduce transient LES relaxation; works in 90% of kids; need gastrostomy tube for a short amt of time after this procedure

97
Q

pyloric stenosis results in what sx?

A

vomitting of non-billious milky fluid during the 2nd or 3rd week of life; jaundice can occur in 5% of patients

98
Q

who is affected most commonly by pyloric stenosi

A

caucasians and first born males

99
Q

“olive” on physical exam

A

hypertrophied pyloric muscle palpable up and to right of umbilicus

100
Q

what is acid/base and salt status of kid who has been vomitting due to pyloric stenosis

A

hypocalcemic, hypokalemic, metabolic alkalosis

101
Q

diagnosis of pyloric stenosis

A

u/s that measures the pyloris muscle length and thickness

102
Q

string sign on UGI

A

elongated, narrow pyloric channel due to stenosis

103
Q

tx for pyloric steonosis

A

partial pyloromyotomy

104
Q

malrotation

A

midgut twists around the mesenteric vessels (volvulus). Causes obstruction and infarction of the bowel

105
Q

maltrotation more common in what gender

A

2:1 male predominance

106
Q

Ladd’s bands

A

peritoneal bands that result from the small bowel compressing the duodenum; happens in malrotation

107
Q

presentation of malrotation/volvulis

A

billous vomitting and sudden onset of abdominal pain in an otherwise healthy infant; older kids might have crampy abdominal pain and vomitting

108
Q

diagnosis of volvulus

A

upper intestinal contrast imaging; shows abnormal position of the ligament of treitz to the right of midline, partial or complete duodenal obstruction, jejunum to the right of the midline

109
Q

management of volvulus

A

surgical emergency for the untwisting and removing any bowel that is dead; you also want to give fluid resuscitation (due to all the vomitting), and broad spectrum parenteral antibiotics

110
Q

how does duodenal atresia happen?

A

failure of the duodenum to recanalize at 8-10 weeks gestation

111
Q

most common cause of obstruction in the neonatal period

A

intestinal atresia

112
Q

duod atresia more common in who?

A

males and babies with down syndrome

113
Q

scaphoid abdomen with epigastric distension

A

duodenal atresia

114
Q

double bubble on abdominal radiography

A

duodenal atresia

115
Q

cause of jejunoileal atresia

A

caused by mesenteric vascular accident during fetal life

116
Q

intussusception

A

proximal portion into distal

117
Q

peak age of intussusception

A

5-9 months

118
Q

most common cause of bowel obstruction after the neonatal period in infants less than 2

A

intussusception

119
Q

most common location for intussuception

A

ileocolic

120
Q

Meckel’s diverticulum

A

diverticulum in the distal ileum

121
Q

how does intussception present?

A

sudden onset of crampy pain that comes in intervals followed by periods of calm

122
Q

currant jelly stools

A

intestinal ischemia and mucosal sloughing

123
Q

sausage shaped mass in the RUQ

A

intussusception

124
Q

gold standard dx for intussusception

A

air or contrast enema; both to reduce and diagnose the enema

125
Q

“coil spring” sign on contrast enema

A

intussusception

126
Q

management of intususception

A

contrast enema with air or hydrostatic pressure

127
Q

risk of recurrence after contrast reduction and surgical repair of intussception

A

5% after contrast and 1% after surgical

128
Q

acute abdomen

A

sudden onset of abdominal pain that requires urgent eval

129
Q

most common pediatric surgery

A

appendectomy, peak age 10-12 years

130
Q

appendix usually perforates by when

A

36 to 48 hours after onset of sx

131
Q

tenderness at mcburney’s point

A

appendicitis

132
Q

most common cause of acute pancreatitis

A

blunt trauma, then idiopathic, then infection

133
Q

presentation of acute pancreatitis

A

pain is periumbilical or epigastic and radiates to the back

134
Q

gray-turner sigh

A

bluish discoloration of the flanks, sign of severe pancreatitis

135
Q

cullen sign

A

bluish discoloration of of the periumbilica area, sign of pancreatitis

136
Q

most specific blood sign of acute pancreatiits

A

serum lipase, but serum amylase is also elevated

137
Q

other lab abnormalities in acute pancreatitis

A

interestingly, you see liver things go up; leukocytosis, hyperglycemia, hypocalcemia, elevated transaminases, and coagulopathy

138
Q

most common method for diagnosis pancreatitis

A

u/s

139
Q

management of pancreatitis

A

supportive care, TPN, antibiotics, and possibly surgery if there is lots of necrotic tissue around the pancreas

140
Q

complications of acute pancreatitis

A

ARDS, renal failure, shock, GI bleeding; also a pseudocyst (collection of fluid rich in pancreatic enzymes that arises from pancreatic tissue) may develop

141
Q

management of pseudocyst

A

small resolves on its own and large needs to be surgically removed

142
Q

acute acalculous cholecystitis

A

cholecystitis that is not associated with gall stones (note that cholecystitis is usually associated with gall stones)

143
Q

acute cholecystitis is uncommon in kids (as is pancreatitis), so if you see cholecystits, what should you think of?

A

sickle cell disease, or possibly CF or prolonged TPN

144
Q

murphy’s sign

A

palpation of RUQ during inspiraton elicits pain; sign of cholecystitis

145
Q

gold standard dx for cholecystitis

A

u/s, can detect stones and thickened gall bladder wall

146
Q

cholescintography

A

radioactive tracer goes through the biliary system; basically if it takes longer for the gall bladder to be visualized then there is inflamm

Peds (99 decks)

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