PREP 1 Flashcards
1
Q
Early childhood dental carries present as
A
white discoloration along the gum line of the upper incisors (like the front teeth for ex) in children under 6
can then progress
2
Q
Super low calcium think
A
hypoparathyroidism
3
Q
In hypoparathyroidism, calcium levels are blank and phos levels are blank
A
calcium levels are LOW
and phos levels are high
4
Q
The job of PTH is to
A
keep calcium levels normal
without it, calcium gets super low
5
Q
What does PTH do to phosphorous levels:
A
PTH has a phosphorus-lowering effect by causing phos excretion through the kidneys.
(so in hypoparathyroidism, where PTH is low, phos will be HIGH)
6
Q
Low calcium, high phos =
A
hypoparathyroidism
7
Q
high calcium, low phos =
A
hypERparathyroidism
8
Q
This hormone releases calcium from bone
A
PTH
9
Q
What does vitamin D do for calcium levels
A
Increases calcium, because vitamin D increases absorption of calcium from the gut
10
Q
What does PTH do to vitamin D levels
A
PTH stimulates the kidney to make active vitamin D, so PTH increases vitamin D levels
this is how PTH increases Ca absorption from the gut (through vit D, which does this)
11
Q
Genetic disorder associated with hypoparathyroidism
A
22q11.2 deletion syndrome
12
Q
Long term tx for hypoparathyroidism
A
Give calcium and vitamin D (must give calcitriol, the active analogue, since without PTH the kidney cannot convert other forms of vit D into the active form)
13
Q
The activated form of vitamin D is…
A
calcitriol
(1,25-dihydroxyvitamin D)
14
Q
Vitamin D deficiency leads to blank calcium levels
A
Low
15
Q
What does vitamin D deficiency do to calcium and phos levels
A
both low
(low calcium means PTH is being very active trying to raise the calcium, and while being active one of the things PTH does is promote renal excretion of phos, so phos gets low)
16
Q
What is a kerion
A
= an acute, local inflammatory reaction to a tinea capitus infection
itchy, bad inflammaed looking boil on head for ex
tx is griseofulvin (systemic)
17
Q
Alopecia, scaling, pruritus and posterior cervical lymphadenopathy is highly suggestive of
A
Tinea capitus
18
Q
Tinea capitus is an infection of what exactly
A
the root of the hair follicle
19
Q
Are topical antifungals effective when treating tinea capitus
A
Nope. Because tinea capitus is an infection of the root of the hair follicle, so topical tx does not work. Need systmic oral antifungal tx.
20
Q
Blank is an inflammatory reaction to a scalp tinea infection that presents as a large, hairless, red and boggy area over the scalp
A
kerion
21
Q
Blank is the most common cause of tinea capitus, and blank is the second most common
A
Trichophyton, microsporum
22
Q
Tx for tinea capitus
A
oral antifugnal, like griseofulvin, terbinafine or fluconazole
23
Q
Define Tourette syndrome
A
= presence of vocal AND motor tics over a year
24
Q
Type 1 error
A
= when an investigator rejects the null hypothesis when it is in fact true
25
Type 2 error
= when an investigator fails to reject the null hypothesis when it is in fact false
26
Type 2 error is also known as
beta
(beta = the ´probability of a type 2 error occuring)
27
As the probability of committing a type 2 error decreases, blank increases
power
28
Power =
1 - beta
29
The probability of accepting an alternative hypothesis when it is in fact true =
power
30
The probability of rejecting the null hypothesis when the null hypothesis is in fact false =
power
31
Atypical mycobacterium infection typically presents how?
with subacute, unilateral cervical lymphadenopathy
swollen lymph node in well appearing child that just doesn't go away after typical abx treatment
the treatment is to surgically remove the whole node
32
Swollen, non tender, indurated cervical lymph node that has been there for weeks in well appearing 4 yo with normal CBC is most likely due to...
nonTB mycobacteria infection of a lymph node
33
Top 3 bacteria that cause AOM
H flu
Strep pneumo
Moraxella catarrhalis
34
When treating CHRONIC supporative otitis media, you should always cover for
pseudomonas
35
Define chronic suppurative otitis media
= more than 6 weeks of ear drainage from a perfed tympanic membrane
so like just ongoing pus drainage basically
36
The most common bugs to cause CHRONIC suppurative otits media are
staph aureus (MRSA and MSSA)
pseudomonas**
proteus mirabilis
anaerobes
37
How to initially treat a child presenting with chronic suppurative otitis media:
topical abx with pseudomonal coverage
so for ex ototopical ofloxicin
and also need to clear ear debris daily in the office, ugh
38
Criteria that need to be met to clear a kid/teen to go back to playing a sport after a concussion:
1. Full resolution of symptoms
2. And still full resolution of symptoms even when doing high intensity physical activity
3. return to baseline neurocognitive function/academic performance
NEUROPSYCH testing NOT NEEDED and should NOT guide return to play
39
Low TREC on newborn screen indicates
concern for a primary immunodeficiency
(or may just be a false positive in a premature infant)
40
TREC stands for
low T-cell receptor excision circle
41
If a baby has a truly low, confirmed TREC (repeat test still low and infant is at least 37 weeks corrected), what should your next move be?
to start prophylactic abx to prevent infection ASAP
(start prophylactic bactrim and fluconazole)
42
How to further work up a confirmed low TREC
flow cytometry for lymphocyte subsets
43
Should a baby with a confirmed low TREC continue to breastfeed?
No--not until it is determined WHICH immunodeficiency the baby has
This is because in some immunodeficiencies, like SCID, CMV can be transmitted through breastmilk and lead to viremia
44
Symptoms of epididymitis
dysuria
scrotal pain that improves with elevation
pyuria
NORMAL cremesteric reflex
45
Absent cremasteric reflex think
testicular torsion
46
Which pre-pubertal boys get epididymitis?
structural abnormalities of the urinary tract
47
What is the epididymis
= a curved structure at the back of the testicle, in which sperm is stored and matures
48
Sperm passes from the testicles to the vas deferens via the
epididymis
49
How acute epididymitis presents
Testicular pain, scrotal redness and warmth
50
In the pediatric population, who is most likely to get epididymitis?
adolescent boys
especially with a hx of being sexually active, any local trauma, or intense exercise
it's an ascending infection from the urethra through the vas deferens all the way to the epididymis
51
Most common bugs that cause epididymitis in sexually active adolescent boys:
chlamydia
neisseria
e coli
52
Symptoms of adolescent boy presenting with acute epididymitis
dysuria
urinary frequency
discharge
scrotal pain
fever
53
In epididymitis, is a normal cremesteric reflex present?
yes
54
What will the UA show in epididymitis?
pyuria
55
What is a varicocele?
dilation of the veins in the pampiniform plexus of the spermatic cord
56
In the pediatric population, who is most likely to present with varicocele? How do they present?
adolescent boys
painLESS soft scrotal mass, decreases in size when lying down
57
Treatement for ADEM
steroids
58
The FDA doesn't approve of cochlear implants until a baby is at least this age
must be at least 12 mo old
59
Name 2 groups of drugs that can cause sensorineural hearing loss
aminoglycosides
loop diuretics!
60
Name an aminoglycoside
gentamicin
61
Name a loop diuretic
Furosemide
aka lasix
62
MOA of loop diuretics:
they block the reabsorption of sodium, potassium and chloride in the ascending loops of henle
63
Electrolyte side effects of loop diuretics (aka lasix aka furosemide)
loss of sodium and water
hypokalemic metabolic alkalosis
increased calcium lossis in the urine (so you get hypocalcemic)
64
1st line TREATMENT for babies with sensorineural hearing loss is what?
behind the ear hearing aids, can start as early as 2 months
it's NOT cochlear implants apparently, not until age 1
65
Definition of delayed puberty in girls:
no breast development by age 13
66
LH and FSH are this type of hormone
gonadotropins
67
How to treat short stature associated with Turner Syndrome
with recombinant human growth hormone
68
Prenatal sign of Turner syndrome
cystic hygroma
69
Neonatal signs of Turner Syndrome
small size
lymphedema of the hands and feet
70
broad chest with wide spaced nipples think
Turner Syndrome
71
Is intelligence in Turner syndrome usually normal?
yes
72
Another name for primary ovarian failure is
hypergonadotrophic hypogonadism
73
How to confirm a diagnosis of primary ovarian failure in a girl with Turner syndrome who has not yet showed signs of puberty
Get GONADOTROPIN LEVELS (FSH and LH)
If they are high, then you know the pt has hypergonadotropic hypogonadism, and you should start estrogen treatment to induce puberty
74
How to induce puberty in a girl with Turner Syndrome who has hypergonadotropic hypogonadism:
Give estrogen
but start in low doses, and then gradually work up to what would be an adult dose (aka like a birth control pill) to try to mimic normal puberty
75
Conjugated hyperbili + microcephaly thinki
congenital CMV
76
Define conjugated hyperbili
= when conjugated bili is 20% or more of the total bili
77
Tx drug and duration for SYMPTOMATIC congenital CMV
oral valgancyclovir x 6 months
tx can decrease risk of sensorineural hearing loss later on
78
Risk of treatming CMV with valgancyclovir
gancyclovir can cause neutropenia
79
Should patients admitted to the hospital for a lyme disease complication (for ex lyme carditis with complete heart block) be treated with PO doxy or with IV ceftriaxone?
IV ceftriaxone
bcuz apparently the book says if you are admitted to the hospital for lyme then you must use IV meds
80
Monophonic wheezing + LACK of stridor localizes tracheomalacia to what physical location?
INTRAthoracic
81
What does intrathoracic airway obstruction, whether its in the small airways or the trachea, sound like on auscultation?
expiratory wheezing
82
What does extrathoracic airway obstruction sound like on auscultation?
stridor
83
The AAP recommends that men who have sex with men should be screened for these STDs annually:
HIV
syphilis
chlamydia
gonorrhea
84
Adolescent women having sex with men should be screened at least annually for
gonorrhea and chlamydia
85
Double standard of STD screening in adolescnents:
AAP says women having sex with men should be screened annually for gonorrhea and chlamydia
but men having sex with women shouldn't
wtf?
86
The most common type of heart block seen in neonatal Lupus is
complete heart block
87
Transplacental transfer of these antibodies leads to neonatal Lupus
anti-Ro/SSA or anti-La/SSB
88
Pathophys of why neonates with neonatal lupus can get complete heart block and other cardiac problems:
due to anti-ro/SSA and anti-la/SS mediated injury
these antibodies injure the fetal cardiac and conductive tissue
89
Screening for Hep B refers to doing what lab test exactly?
Hep B surface antigen (HBsAg)
90
When should you test new immigrant children for Schistosoma and Strongyloides species?
when their stool ova and parasites are negative but they have eosinophilia
91
ALL new immigrant / international adoptee children should receive these screenings when they arrive in the US:
Hep B surface antigen (regardless of Hep B vaccination status)
Syphilis
HIV
CBC
Stool ova and parasites (check for Giardia and cryptosporidium)
Tb skin test or interferon-gamma release assay
92
The first sign that a young child may go on to be diagnosed with intellectual disability is a delay in this area
receptive language
93
Adaptive skills refers to
skills involve in self-management and independent living
so things like self care, navigating relationships, work, money management etc.
94
A diagnosis of ID (intellectual disability) can be made in a child of what age, in what situation?
Age 5 or older
when the child is significantly below age expectations for both cognitive and adaptive development
95
Planning, reasoning, problem-solving and learning all fall under this umbrella term
Cognition
96
Blank is an important early indicator of cognition, and a lack of it can indicate increased likelihood of future intellectual disability
Receptive language
97
The first rotavirus vaccine needs to be give by this age, or else an infant should not get the vaccine series
needs to be given BEFORE 15 weeks, zero days of life
98
When should the first rotavirus vaccine be administered?
Between 6 weeks and 14 weeks, 6 days of life
99
The last rotavirus vaccine dose cannot be given after his age
8 months, zero days
100
MCV over what is macrocytic
Unclear
Varies by age
101
most common source of vitamin B12 is
animal fats
102
Neuro findings associated with folate deficiency
loss of developmental milestones
103
Causes of macrocytic anemia
B12 or folate deficiency
104
Loss of deep tendon reflexes + macrocytic anemia =
B12 deficiency
105
Common ish cause of both B12 and folate deficiency
Celiac disease
106
Neuro findings of B12 deficiency can include
hypotonia
ataxia
seizure
activity
loss of deep tendon reflexes
107
Symptoms of vitamin B12 deficiency
fatigue
generalized weakness
irritability, poor appetite
FTT
neuro symptoms (ataxia, low tone, loss of deep tendon reflexes... even seizures in extreme cases)
108
Vitamin B12 is also called
Cobalamin
109
Define enteropathy
= ongoing damage, irritation and;or swelling of the small intestine
110
Tx for nasal polyps
Due to allergies. Treat with intranasal steroids, nasal saline rinses, or systemic steroids.
If refractory, can be surgically removed.
111
Children with these conditions have a higher risk of developing nasal polyps
CF
PCD (primary ciliary dyskinesia)
112
Polyps are rare in children under this age
rare under age 10
113
What causes acute tubular necrosis
ischemia or exogenous or endogenous toxins
114
BLANK results from damage to renal tubular cells, either from ischemia (like from hypotension) or from toxins (endogenous or exogenous)
Acute tubular necrosis
115
What will urinalysis show in ATN
muddy brown granular casts
mild pyuria
low-grade proteinuria
urine can be dilute in ATN
116
Urine spec grav in PRE renal AKI
so this is when the kidneys just are not being perfused
so, urine should be very concentrated
spec grave will be > 1.02
117
Normal urine spec grav
1.005 - 1.030
118
What is considered a low spec grav, and what is considered a high spec grav
Low is < 1.005
High is >1.03
