Random problems Flashcards
(106 cards)
1
Q
Crying that occurs in otherwise healthy infant for >3 hrs daily (usually evening), >3 times a wk and for a duration of >3 wks
A
Colic
2
Q
Colic rx
A
calming techniques
feeding patterns checked
3
Q
Gynecomastia in pubertal boys causes
A
transient increased testicular production of estrogen over testosterone and peripheral conversion of prohormones to estrogen
4
Q
kid with Fever> 5 days, conjunctivitis oral muosal changes rash cervical LAD
A
Kawasaki Disease
acute vasculitis of small/medium arteries
Peak age: 18-24 months
5
Q
Do Dx kawasaki what do you need?
A
Should have fever >5 days and 4/5 findings:
Conjunctivits: bilat, nonexudative, spares limbus
Oral mucosal changes: erythema, fissured lips, “Strawberry tongue”
Rash
Extremity: erythema, edema
desquamtion of hand/ft, (usually last manifestation)
Cervical LAD: >1.5cm
6
Q
Supporting lab values for Kawasaki Disease
A
Increased CRP/ ESR
leukocytosis w/ neutrophilia
Reactive thombocytosis
Sterile pyuria on urinalysis
7
Q
Complications of Kawasaki disease
A
Coronary artery Aneurysms
MI or ischemia
8
Q
Rx of Kawasaki disease
A
Aspirin plus IVIG
9
Q
What to be aware with Rx of kawasaki and when to stop?
A
Aspirin can cause Reye syndrome: hepatic encephalopathy
but it prevents coronary thrombosis
Clopidogrel can be substitued during acute influenca or VZV
10
Q
Intussusception can be assoc with
A
Henoch-Schonlein purpura
Meckels diverticulum
11
Q
Mongolian spots are
A
congenital dermal melanocytosis
benign usually on lower back and buttock
Fade by 1st decade of life
12
Q
Adrenal enzyme: 21-hydroxylase deficiency symptoms
A
Ambigous genitalia in girls Salt wasting(vominting, hypotension, Decrease Na, increased K)
13
Q
Dx 21 hydroxylase def
A
Inc 17-hydroxyprogesterone
inc testosterone
decr: cortisol/aldosterone
14
Q
Adrenal enzyme 11B-hydroxylase deficiency symptoms
A
Ambigous genitalia in girls
Fluid and salt retention
HTN
15
Q
DX 11B hydroxylase def?
A
Incresed testosterone and 11-deoxycorticosteone & 11 deoxycortisol
Decreased Cortisol and aldosterone
16
Q
Adrenal enzyme 17a hydroxylase deficiency C/F
A
All patients: phenotypicaly female
Fluid&salt retention
HTN
17
Q
Dx 17a hydroxylase
A
Decreased cortisol & testosterone
Increased Mineralocorticoids
Increased corticosterone
18
Q
Normal anion gap acidosis
failure to thrive
urine alkolotic
Dx?
A
Renal tubular acidosis
19
Q
RTA type 1
A
Distal: poor H ion secretion into Urine
Urine pH> 5.5
Serume K: low to normal
20
Q
Causes of RTA1
A
Genetic disorders
medication toxicity
AI disorders (SS, RA)
21
Q
RTA type 2
A
Proximal: poor hCO3 resorption
urine pH: below 5.5
Serum K-low to normal
22
Q
Causes of RTA2
A
Fanconi syndrome (glucosuria, phosphaturia, AAuria)
23
Q
RTA type 4
A
Aldosterone resistance
Urine pH: Below 5.5
Serum potassium: High
24
Q
Causes of RTA4
A
Obstructive uropathy
Congenital adrenal hyperplasia
25
Kid with sickle cell comes in with ABD pain and jaundice. type of blood issue
Chronic hemolysis: extravascular
Increased LDH, unconjugated bilirubin, reticulocytes
Low haptoglobin
26
Seperation anxiety is normal when
9-18 months
27
Child (9 months)with history of otitis media and used to babble but stopped. raises concern for?
Hearing problem
| Do a audiology evaluation
28
Girl seen due to hair loss for a week. Mom has vitiligo
| P/E: scaling slightly erythematous patch on scalp; no LAD
Tinea capitis infection
29
Tinea capitis C/F
```
Scaly, erythematous patch on scalp
Hair loss w/ residual black dot
Possible painful LAD
Blacks
Human->huma or fomite transmission
```
30
Dx/Rx tinea
KOH exam of hair shaft to document spores
| Rx: Griseofulvin or oral terbinafine
31
Smooth and discrete circular areas of hair loss w/out scaling... DX?
Alopecia areata
32
well demarcated plagues, inflammation and scarring of hair follicles, cutaneous lesions, and maybe photosensitivity.... Dx?
Discoid lupus erythematosus
33
Itchy scalp, neck and ears or asymptomatic. Whole family some how got it... Dx?
Lice: Pediculosis humanus capitis
34
MCC of 2ndry HTN in kids
```
Fibromuscular dysplasia (FMD)
20% of all cases of renal htn
```
35
Physical exam for FMD in kid with HTN?
hum or bruit in the costovertebral angle due to well -developed collaterals
R renal artery more affected than L
36
Angiography pattern in FMD
"string of beads" pattern to the renal artery
37
Kid OD's on grandmas TCA meds cause he is a moron. What to give him to help?
```
SUpplemental O2, intubation
IV fluids
Charcoal within 2 hrs
Seizures= BZs
IV Sodium Bicarb for QRS widening or ventricular arryhthmias
```
38
Kid comes in with bleeding from bottom, bruises, multiple pneumonias, and thrombocytopenia.. Dx?
Wiskot aldrich syndrome
X-linked WAS gene
T cells cunable to reorganize atin cytoskeleton
39
Wiskot aldrich syndrome mnemonic?
```
WAS gene
A: IgA/IgA Increased
Infections
Thrombocytopenia= purpura
Eczema= truncal
Response to bacterial polysacharides decreased
```
40
typical infections in WAS?
S. pneumonia
N. meningitis
H.influenzae
41
Febrile seizure R/Fs?
Fever from mild viral or bacterial infection (influenza, adenovirus, HHV-6)
Immunizations (DTaP, MMR)
Family Hx
42
Dx febrile seizure
```
Age 6m- 6 yrs
Temp>38 (100.4)
No hx of seizure
No CNS infection
No acute systemic metabnolic cause of seizures
```
43
Rx Febrile seizure
Reassurance/education
44
Kid with a infection, conjunctival redness, rhinorhea and high fever spike next day. Has seizure. upon arrival to ER feels better. Dx?
Febrile seizure
45
Bacterial vs viral conjunctivitis?
B- thick mucopurulent discharge
| V- watery
46
Kid comes in with a scotal swelling after a fever and cough which progress for 2 weeks. Also has rash on buttock, bloody urine. Dx?
Henoch-schonlein purpura
47
HSP C/F
```
Palpable purpura
Arthritis/arthralgia
Abd pain, intussusceptions
Renal disease similar to IgA nephropathy
Severe cases: scrotal pain
```
48
Cause of HSP?
IgA mediated leukocytoclastic vasculitis
49
Rx of HSP
Supportive: hydrate and NSAIDS
| Hospitilization and systemic steroids if severe
50
R/F for cholecystitis
Sickle cell anemia
Hereditary spherocytosis
obesity
51
Increased incidence of colonic diverticula and abd wall/inguinal hernia are seen in?
ADPKD
52
Recurrent Sinopulmonary infections, chronic cough, Nasal polyps, and digital clubbng.... Dx?
Cystic fibrosis
53
episodes of impaired consciousness, failure to respond to various stimuli during the episode, staring spells, automatism and post ictal confusion. Dx?
Complex partial seizure
| EEG-normal
54
Brief (few s) periods of impaired consciousnes, have automatisms, NO post ictal state
typical abscence seizure
| EEG generalized 3hz spike waves
55
EEG slow spike and wave activity with frquency less than 2.5 hz, 20 second impaired consciousness, Dx?
Atypical absence seizure
56
Adolescent w/ unilateral or bilateral myoclonic jerks
| usually in Am and precipated by sleep deprivation, Dx?
juvenile myoclonic epilepsy
57
Childhood seizures of multiple types, impaired cognitive function, Spike and wave activity on EEG; Dx?
Lennox-Gastaut syndrome
58
Cyclic vomiting syndrome
```
>3 epidose in 6 month period
last 1-10 days
vomits >4 times/hr at peak
no symptoms btw vomiting episodes
no underlying condition
```
59
Rx CVS
Hydration
antiemetics
reassurance to parents
60
CVS is associated w/
FH of migraine headaches in parents
| more like a abd migraine
61
Vomiting electrolyte imbalance
```
Hypochloremic, hypokalemic M. alkalosis
ph: high- alkalosis
PaCO2: increased
HCO3: increased
K: decreased
Cl: decreased
```
62
Fever, uriticaria and polyarthralgia 1-2 wks after first exposure;
H, Edema, LAD & splenomegaly less common
Serum sickness- like reaction
| usualy from antibiotics (B-lactams, sulfa)
63
Breath holding spells
Cyanotic: crying followed by breath holding in forced expiration, apnea, cyanosis, limpness & LOC
Pallid: Minor trauma followed by LOC, breath holding, pallor & diaphoresis
64
Rx: breath holding spells
Check CBC
| Serume ferritin
65
Refeeding syndrome in purger
Increased insulin:
Incred glycogen synthesis
increased protein synthesis
inc intracellular uptake of phosphorus, K, Mg, thiamin
66
In refeeding syndrome electrolyte issues
Drop in Phosphorus, K, Mg
decreased thiamine
Increased Na and H2O
67
Clinical manifestations of refeeding syndrome
Arrhythmia
CHF (pulmonary edema, peripheral edema)
Seizures
Wernicke encephalopathy
68
when to check lipid levels in kids?
screen for dyslipidemia 9-11 and 17-21
| relatively stable just prior and after puberty
69
normal weight loss in newborn in first 5 days of life?
7% birth weight
| regained by 10-14 days
70
Heroin abuse in mom, kid has... c/f
Neonatal abstinence syndrome (NAS):
irritability, high-itched cry, poor sleeping, tremors, seizures, sweating, sneezing, tachypnea, poor feeding, V/D
W/drawal around 48hrs
71
Methadone withdrawal in newborn occurs when
48 to 72 hrs after birth
72
prenatal exposure to cocaine, c/f of kid
jitteriness,
excessive suckling
hyperactive MORO relfex
long term, behavior, attention and intelligence problems
73
infants shouldnt drink cow milk until what age? and why?
until age 1 and
74
Continued ear drainage for several weeks despite appropriate antibiotic therapy think of
Cholesteatoma
75
Cholesteatoma is what
Chronic middle ear disease leads to formation of a retraction pocket in tympanic membrane which can fill with granulation tissue and skin debris
76
Rx a cholesteatoma
referr to otolaryngologist
| possibly Ct or surgical visualization to confirm Dx
77
erythematous vesicle symmetrically distributed on extensor surfaces
Dermatitis herpetiformis
78
Newborn with cyanosis that is aggravated by feeding and relieved by crying; dx?
Choanal atresia
79
watery Diarrhea, dermatitis, dementia(poor concentration, mental status change, aggressive), beefy red tongue
Pellagra, Def of Vit B3= Niacin
80
Cheilosis, glossitis, seborrheic dermatitis (often affecting genital areas), pharyngitis, edema or erythema of mouth; Dx?
Def of Vit B2: Riboflavin
81
Breastfeeding benefit for kid
Improved immunity
Improved GI function
Prevents infections: Otitis media, gastroenteritis, Resp Illness, UTI
Decreased risk of childhood cancer DMI, NEC
82
Maternal benefit to breastfeeding
Reduced risk of ovarian and breast cancer
rapid uterine involution and decreased postpartum bleed
faster return to prepartum weight
improved child spacing
Bonding
83
Lethargic newborn, hoarse cry,, poor feeding, constipation, jaundice, scleral icterus, dry skin,
TSH high, low free T4; Dx?
Congenital hypothyroidism
| mcc: Thyroid dysgenesis
84
C/I to rotavirus vaccine
Anaphylaxis to vaccine ingredients
History of intussusception
Hx of uncorrect congential malformation of GI tract (e.g meckels)
SCID
85
Late onset (nonclassical) congenital adrenal hyperplasia C/F
severe facial acne, advanced pubic/axillary hair, normal testicular volume, advanced bone age;
86
Late onset CAH labs
LH low at baseline and doesn't increase with GNRH stimulation
87
Vit B2: riboflavin def c/f
```
Angular cheilitis: fissures
Glossitis: hyperemic tongue
Stomatitis: hyperemic/edematous oropharyngeal mucous membranes, sore throat
Normocytic-normochromic anemia
Seborrheic dermatitis
```
88
Drugs for Enuresis management
1st line: Desmopressin
| 2nd: Imipramine, amitriptyline, desipramine
89
Lead poisoning screened by capillary blood; next step?
Venous lead measurements
90
Rx to lead poisoning 3 types:
Mild: 5-44 mcg/dl- no meds, repeat in 1 month
Moderat: 45-60- DMSA
Severe: >70- Dimercaprol + EDTA (calcium disodium edetate)
91
Congenital hypothyroidism C/f
```
Apathy
weakness
hypotonia
large tongue
sluggish mvts
abd bloating
umbilical hernia
prolonged jaundice
```
92
Maternal factors that lead to abnormal fetal growth(5)
```
Preeclampia
malnutrition
placental insufficiency
multiparity
drug use
```
93
Infants who are small for gestational age are at risk for (7)
```
hypoxia
perinatal asphyxia
meconium aspirationi
hypothermia
hypoglycemia
hypocalcemia
polycythemia
```
94
Large for gestational age infants are at risk of
hip subluxation
| talipes calcaneovalgus
95
SSSS is what
exfoliative toxin producing strains of S.aures;
| toxins against desmoglein: keratinocyte adhesion in superficial epidermis
96
In SSSS what starts in 24-28 after fever, irritability, skin tenderness
erythema starts on faces and generalizes in that ime
97
Nikolsky sign
gentle lateral pressure on skin surface adjacent to a blister causes slipping and detachment of a superficial layer of skin
98
Cystic fibrosis most patients will have
Pulmonary and pancreatic insufficiency
| 95% f men: infertile: congenital bilateral absence of vas deferens
99
hyperaldosteronism causes
Hypokalemia
hypernatremia
hypercholeremia
alkalosis
100
SIADH causes
Hyperkalemia
hypernatremia
inability to take in water,(Concentrate urine)
101
Addisons crisis labs
hyponatremia
hypokalemia
shock
102
Glucose 6 phosphatase def na/k labs
as a rule are hyperlipidemic: increased TG concentration decreases the volume of aqueous compartment
hypokalemia, hyponatremia can be factiticously seen
103
Neonatal presentation with neonatal thyrotoxicosis
```
mom with Hx of Graves
low birth weight
tachycardia
warm skin
irritability
```
104
Rx neonatal thyrotoxicosis
dx: anti-TSH R ab transplacental
Rx: methimazole and B-Blocker if severe
105
What are infants of diabetic mothers at increased risk for?
Hypoglycemia/Hypocalcemia
Caudal regression syndrome
Congenital heart disease/septal hypertrophy
polycythemia
RDS (insulin delays surfactant production)
106
What is acrodermatitis enteropathica?
Zinc deficiency with chronic diarrhea, alopecia, and rash around the mouth/anus/hands/feet
