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Flashcards in Random problems Deck (106):
1

Crying that occurs in otherwise healthy infant for >3 hrs daily (usually evening), >3 times a wk and for a duration of >3 wks

Colic

2

Colic rx

calming techniques
feeding patterns checked

3

Gynecomastia in pubertal boys causes

transient increased testicular production of estrogen over testosterone and peripheral conversion of prohormones to estrogen

4

kid with Fever> 5 days,
conjunctivitis
oral muosal changes
rash
cervical LAD

Kawasaki Disease
acute vasculitis of small/medium arteries
Peak age: 18-24 months

5

Do Dx kawasaki what do you need?

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

Supporting lab values for Kawasaki Disease

Increased CRP/ ESR
leukocytosis w/ neutrophilia
Reactive thombocytosis
Sterile pyuria on urinalysis

7

Complications of Kawasaki disease

Coronary artery Aneurysms
MI or ischemia

8

Rx of Kawasaki disease

Aspirin plus IVIG

9

What to be aware with Rx of kawasaki and when to stop?

Aspirin can cause Reye syndrome: hepatic encephalopathy
but it prevents coronary thrombosis
Clopidogrel can be substitued during acute influenca or VZV

10

Intussusception can be assoc with

Henoch-Schonlein purpura
Meckels diverticulum

11

Mongolian spots are

congenital dermal melanocytosis
benign usually on lower back and buttock
Fade by 1st decade of life

12

Adrenal enzyme: 21-hydroxylase deficiency symptoms

Ambigous genitalia in girls
Salt wasting(vominting, hypotension, Decrease Na, increased K)

13

Dx 21 hydroxylase def

Inc 17-hydroxyprogesterone
inc testosterone
decr: cortisol/aldosterone

14

Adrenal enzyme 11B-hydroxylase deficiency symptoms

Ambigous genitalia in girls
Fluid and salt retention
HTN

15

DX 11B hydroxylase def?

Incresed testosterone and 11-deoxycorticosteone & 11 deoxycortisol
Decreased Cortisol and aldosterone

16

Adrenal enzyme 17a hydroxylase deficiency C/F

All patients: phenotypicaly female
Fluid&salt retention
HTN

17

Dx 17a hydroxylase

Decreased cortisol & testosterone
Increased Mineralocorticoids
Increased corticosterone

18

Normal anion gap acidosis
failure to thrive
urine alkolotic
Dx?

Renal tubular acidosis

19

RTA type 1

Distal: poor H ion secretion into Urine
Urine pH> 5.5
Serume K: low to normal

20

Causes of RTA1

Genetic disorders
medication toxicity
AI disorders (SS, RA)

21

RTA type 2

Proximal: poor hCO3 resorption
urine pH: below 5.5
Serum K-low to normal

22

Causes of RTA2

Fanconi syndrome (glucosuria, phosphaturia, AAuria)

23

RTA type 4

Aldosterone resistance
Urine pH: Below 5.5
Serum potassium: High

24

Causes of RTA4

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