TrueLearn Flashcards by Sarah Gillen

Oral hypoglycemic overdose that is refractory to glucagon and dextrose infusion should be managed next with ______

octreotide

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Differentiating cerebral salt wasting and SIADH

SIADH has low UOP (and can look euvolemic), while cerebral salt wasting tends to have higher UOP (and look hypovolemic)

[bonus: differentiating hyponatremic dehydration from SIADH: hyponatremic dehydration has low urine sodium]

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Pediatric HTN requires _____ readings to diagnose, and it’s important to check a manual BP.

Pre-HTN is defined as > ____ percentile
Stage I is defined as ______ percentile + 5 mm Hg
Stage II is defined as ______ percentile + 5 mm Hg

3 readings

Pre-HTN is defined as > 90th percentile
Stage I is defined as 95th-99th percentile + 5 mm Hg
Stage II is defined as >99th percentile + 5 mm Hg

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Which IBD are these associated with?

arthritis
erythema nodosum
episcleritis
gallstones

Crohns

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7 y/o previously healthy comes in with with jaundice, declining school performance, decline in handwriting performance, more impulsive behavior, scleral icterus, drooling, dysarthric speech, LFT elevation, normal CBC (aka HEPATIC + NEURO SXS)

Disease, confirmatory test, and treatment

Wilson disease

Confirm with liver biopsy (may see low serum ceruloplasmin and elevated urinary copper excretion, but liver bx is the confirmatory test if dx uncertain)

Tx is penicillamine

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lesions with erythematous border surrounding a clear ring with purplish center

erythema multiforme

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True/False: Randomized control trials are limited in that results are difficult to generalize beyond population studied

True

[aka external validity is poor – but internal validity (accuracy) is great in a well-designed study]

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best way to avoid cholestasis in neonates on TPN

increase rate of infusion, so as to cycle TPN over 12-14 hrs – this reduces insulin exposure and allows for mobilization of fats

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4 year old comes in with signs of meningitis + petechial rash – what bacteria?

Neisseria meningitidis

[Strep pneumo is most common cause in that age, but does NOT cause petechial rash]

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how do you test for CMV in immunocompromised/transplant patient?

CMV blood PCR

[IgG, IgM, and urine CMV unreliable in this population]

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What syndrome?

dysmorphic facies- anteverted nares, broad alveolar ridges, cleft palate

polydactyly or syndactyly
intellectual disability
growth retardation
ambiguous genitalia

Smith-Lemli-Opitz

[AR, abnl cholesterol biosynthesis]

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False positive test = Type ___ error

Type I error

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Live virus vaccines should be given simultaneously if appropriate, or greater than or equal to ____ days apart for optimal immune response

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Acute anaphylaxis to blood transfusion is usually secondary to _______ deficiency

IgA

[check IgA levels]

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Most common Salter Harris fracture – extends through the physis to the metaphysis

Type II

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Marfanoid appearance, cognitive deficits, downward displacement of the lens

Homocystinuria

[contrast with Marfan syndrome which does not have cognitive deficit, and displacement of the lens is upward]

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Abnormal facies
Cardiac abnormalities
Butterfly vertebrae
Direct hyperbili

Alagille syndrome (JAG1 mutation)

[Qstem had ToF, prominent forehead, hypertelorism, saddle nose, small chin; liver biopsy with paucity of bile ducts with giant cell transformation)

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Toddler presents with seizures, low grade temp, and cardiac arrhythmia (tachycardia, irregular PVCs, prolonged QRS), found to have metabolic acidosis, stem mentions maternal hx depression. What is this and what do you do?

TCA overdose – give sodium bicarb

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triple bubble sign

jejunoileal atresia

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What should you think about with trio of fair skin, eczema, and intellectual disability?

PKU

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Patients with hx of uncontrolled seizures should not receive what vaccine?

any vaccine containing pertussis component (DTaP, TDaP, etc)

other c/I include progressive neurologic disorders, hx of brief seizure within 3 days of vaccine in the past, history of shock like picture within 48 hrs of DTaP administration, or hx of encephalopathy or prolonged seizure within 1 week of DTaP

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Patient with Addison’s disease in adrenal crisis – what happens to their sodium and potassium levels?

Hyponatremia
Hyperkalemia

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Acute _______ intoxication may present with euphoria, agitation, hyperthermia, hypertension, tachycardia, diaphoresis, mydriasis, and “bugs on the skin” hallucinations. First line management is with a benzodiazepine; for severe hyperthermia, rapid cooling should be initiated, and for severe refractory HTN, _______ should be used.

cocaine; phentolamine

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Differentiate laryngomalacia vs tracheomalacia

laryngomalacia peaks at 6 months; inspiratory stridor

tracheomalacia has expiratory stridor, monophonic wheeze, most resolve by 6-12 mo

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infant of diabetic mother at risk of ____ blood glucose, ____ calcium, and ____ magnesium

low; low; low

General mixing instructions for infant formula (powdered)

1 scoop per 2 oz water

When is the routine 2-dose series of serogroup A, C, W, Y meningococcal vaccine given?

11-12 years 16 years [at-risk kids will get earlier]

To meet criteria of Tourette syndrome, the tics (which are suppressible for a period of time) must have occurred for more than ____ months with the presence of BOTH vocal and motor tics at some point during the course

12 months

study type good for assessing prevalence

cross sectional

Phenotypic male incidentally found to have uterus and Fallopian tubes during an abdominal surgery. There is normal male external genitalia.

Persistent mullerian duct syndrome

What to do in immunosuppressed person who presents 4 days after exposure to varicella

Varicella-zoster immune globulin (can be given up to 10 days after exposure, start ASAP though) If unable to give VIG, start acyclovir PEP starting 7 days after exposure

False negative test = Type ___ error

Type II error

Transfusion associated lung injury (TRALI) occurs when _______ from the donor are activated in the pulmonary system causing acute hypoxia or respiratory distress during or within 1-2 hrs of transfusion. Tx is supportive and may require intubation

neutrophils

determining ETT size (cuffed and uncuffed)

Cuffed ETT size = (age in years/4) + 3.5 Uncuffed ETT size = (age in years/4) + 4

inheritance of fragile X

X-linked dominant

most common ingredient to be allergic to in MMR, varicella vaccines

gelatin

T/F: a patient who presents with nits following treatment with permethrin for lice represents a re-infestation

False -- this is treatment failure! Try a different topical like malathion. If that fails, can move to oral ivermectin

In children with medical conditions like diabetes mellitus, Hodgkin disease, lymphoma, and chronic renal failure, OR if child is younger than 4 years, born in or traveled to high TB prevalent area, or children frequently exposed to adult with HIV or is homeless, incarcerated, drug user, or living in nursing home, a TST is considered positive if induration is greater than _____

10 mm

_________ _________ = deficits in both intellectual and adaptive functioning starting in the developmental period

intellectual disability

male gynecomastia is a red flag at what stage(s) of puberty?

late stage like 4-5

Which of the following do you do for concerns of uteroplacental insufficiency and/or inability to tolerate labor? A. Nonstress test B. Stress test C. Biophysical profile

B. Stress test stress test evaluates fetal response to contractions over 15-20 mins

most common ingredient to be allergic to if child given MMR, varicella, and polio vaccines

neomycin, streptomycin (gelatin used in MMR and varicella but not polio)

When would you perform a biophysical profile?

after 2 nonreactive non-stress tests. BPP includes assessment of fetal movement, fetal tone, fetal breathing, and amniotic fluid volume. If BPP <4, you would induce labor or take for C-section [Note: non stress test measures fetal HR in response to fetal movements]

16 y/o female found to have vagina ending in blind pouch, absence of uterus, presence of testes in abdomen, karyotype is 46 XY, testosterone levels are elevated

Androgen insensitivity syndrome

when is hepatitis A vaccine routinely given

2 doses, separated by at least 6 months starting at age 12 months

pathophys of meckel diverticulum

failure of closure of omphalomesenteric duct during gestation

2 components of risk stratification in near-drowning

O2 saturation (>95 is good px) GCS (>13 is good px)

_________ _________ consists of micrognathia, glossoptosis, and high-arched, or cleft palate. Recognition early in life will help prevent future complications like cor pulmonale which can be seen on _____

Pierre Robin sequence; echocardiogram

Infants born to parents with hepatitis C virus should receive screening for perinatally acquired HCV when?

between 2-6 months of age with HCV RNA

HSV 1 vs HSV 2 -- either one can be associated with HSV infections anywhere on the body. But which one is more likely associated with GU infections?

HSV-2

Immunosuppression levels of steroids include dosing of prednisone at 2 mg/kg/day for 4-6 weeks. For children receiving immunosuppression therapy or who have immunosuppressive condition like HIV, TST is positive at greater than _____

5 mm [note that having lymphoma or Hodgkin disease requires 10 mm induration to be considered positive]

4p vs 5p deletion

4p deletion is Wolff Hirschorn -- hypertelorism, micrognathia, short philtrum, microcephaly, abnormal ears, CHD 5p deletion is Cri du chat -- LBW, microcephaly, down slanting palpebral fissures, hypotonia, cat-like cry

A clavicle fracture located where is considered higher risk for neuromuscular injury?

medial

study type good for incidence

cohort

Per NRP, if at 30 seconds of life or after, the newborn is not breathing spontaneously, is only gasping, or has a HR below _____, PPV should be the next intervention

100 bpm

If a patient has a benign murmur, what do you expect to happen when they move from supine to sitting?

Softens or disappears

Treatment for acute cluster headache

O2 + Triptans [CCBs for prevention]

Chronic suppurative otitis media (CSOM) is defined as persistent discharge/otorrhea through a perforated tympanic membrane for greater than 6 weeks. What are the 2 most common pathogens?

Pseudomonas Staph aureus

Can mom still breastfeed if she is HBsAg positive?

yes

Hypotension, hypoglycemia (with possible seizure), and wheezing (2/2 bronchoconstriction) = signs of what toxicity?

Beta blocker

Car seat stuff is most likely to be tested based on age, since different car seats have different height and weight requirements. Generally kids should be in their car seat until they exceed the height and weight limitations of that car seat. What are general age ranges for the rear facing, forward facing, booster seat, and seat belt?

rear facing = birth to 2-4 forward facing = 2-4 to at least 5 years booster seat = 5 years to 57 inches tall A seat belt generally fits properly around 9 to 12 years of age, when the child is around 57 inches (~4' 9")

bottle propping increases the risk of what?

AOM

most common ingredient to be allergic to in yellow fever vaccine

embryonated egg or gelatin

Cold poorly perfused extremities, hepatomegaly, lethargy, diaphoresis, and pallor are signs of what type of shock?

cardiogenic [also see hypotension, tachycardia, tachypnea]

Reducing nursemaids elbow

supination of forearm with full flexion of elbow [alternatively hyperpronation with moderate pressure on radial head]

Patient has what looks like nummular eczema (even has hx of atopy), but then reports story of Koebner phenomena (lesions appearing at sources of trauma -- i.e., on elbow after hitting it on car door)

Psoriasis

17 y/o F with no menses, no breasts, sensorineural deafness, seizure disorder, no pubic hair, normal cervix and uterus

Kallman syndrome [low/no GnRH, low FSH/LH, low estradiol/testosterone]

Differentiate balanitis from balanoposthitis

balanitis = inflammation of glans (erythema, edema, discharge) balanoposthitis = inflammation of glans + foreskin

CHARGE syndrome

Coloboma (notched iris) Heart defects Atresia of choanae Retardation of growth Genital abnormalities Ear anomalies/deafness

What drug: Hypertension, tachycardia, miosis, horizontal and vertical nystagmus

PCP

Inverted nipples, strabismus, GERD, hypoproteinemia secondary to protein-losing enteropathy

congenital disorders of glycosylation

which is better for premies with moderate to severe BPD -- inhaled corticosteroids or diuretic therapy?

Diuretics! data for ICS use is mixed. Typically long term therapy with thiazide diuretic and spironolactone

rare genetic disorder characterized by adenomatous GI polyps, osteomas, supernumerary teeth, and multiple family members with the diagnosis. Management consists of screening colonoscopies and EGDs until eventual colectomy to prevent colon cancer

Gardner syndrome [pt in question stem presented at age 12 with bloody diarrhea, non-tender hard nodule on mandible, and FHx colon cancer]

ADHD diagnosis requires input from at least 2 sources. Patients must have at least _____ symptoms consistent with inattention, hyperactivity, or impulsivity present for at least ______ months to qualify. Furthermore, these symptoms must have started prior to age _____.

6 symptoms; 6 months; age 12

when does the stepping reflex disappear?

2 months

1 day old with diffuse rash with pinpoint pustules, ruptured pustules with small ring of surrounding scale, and tiny hyper pigmented macules. What is it?

transient neonatal pustular melanosis (neutrophils) Contrast with erythema toxicum which is small yellow-white papules with surrounding erythema (eosinophils)

Phenotypic female with normal vagina, uterus, and Fallopian tubes, found to be 46 XY, low testosterone levels

Swyer syndrome [low testosterone levels distinguish from androgen insensitivity which has high testosterone]

Normal Hep B vaccine schedule

Birth, 2 months, 6 months

recall bias is particularly problematic in what type of study?

case-control [ppl w/disease are more likely to remember/report certain exposures]

How many Hib vaccines are in the PRIMARY series?

depends on the vaccine used! there are 2 options in the US DTaP-IPV/Hib (PRP-T) - 3 dose primary series at 2, 4, and 6 months (4 dose total with 12-15 month booster) Hib-HepB (PRP-OMP) - 2 dose primary series at 2 and 4 months (3 dose total with 12-15 month booster)

Kingella kingae arthritis tends to have a more indolent course, note that it can be preceded by MOUTH ULCERS. It must be treated with ______ if suspected

cephalosporins (i.e., cefazolin)

A triglyceride level >100 is considered high for pts younger than 10, while >130 is high for age 10-19. When fasting TG is > 500, ____ can be used as an adjunctive treatment mostly to prevent pancreatitis

fibrates (i.e., fenofibrate)

Patient with hand-foot-mouth disease and cardiac murmur, what infectious etiology?

Coxsackie A [Note that Coxsackie B can also cause myocarditis, but causes a flu-like illness with GI symptoms, headache, fever, and Myalgias -- no oral lesions or rash]

measurement of lysosomal alpha-galactosidase in leukocytes would help confirm ______ disease, which is the most prevalent lysosomal storage disorder characterized by neuropathic limb pain, telangiectasias and angiokeratomas, corneal opacities, hypohydrosis, and abnormal kidney function

Fabry

What type of hypersensitivity reaction is ITP?

Type II (antibody-mediated) Other examples of type II are bullies pemphigoid, Goodpasture, and myasthenia gravis

A patient with hypertrophic cardiomyopathy will have a systolic murmur that _______ in intensity with standing and Valsalva, and ________ with squatting.

increases; decreases

The ___________ vaccine is recommended in a 2- or 3-dose series starting at age 10 for children with sickle cell disease, asplenia, or persistent complement deficiency

serogroup B meningococcal (MenB) Note that these kids will typically have already gotten their usual ACWY meningococcal

When does the rooting reflex disappear?

4 months

what is abnormal LDL

>130 -- lifestyle changes if >250, start statin right away

Kid looks like Hurler syndrome (macrocephaly, coarse features, HSM) but presents later (age 4-5) after losing milestones

Sanfilippo syndrome

What syndrome? Very small posterior set jaw Hypertelorism, droopy eyes Bilateral colobomas Eyelash aplasia Hypoplastic zygomatic arches Congenital hearing loss

Treacher Collins [AD, malformation of 1st pharyngeal arch]

T/F - breastfeeding can be recommended to compliant mothers who are stable in methadone treatment programs

true

Common sites for relapse of ALL

bone marrow CNS testes

ROP affects up to 50% of all infants born at less than 1500 g, or is born at less than ______ weeks. Screening is done either at 31 weeks PMA, or at _____ weeks of life, whichever is LATER

30 weeks; 4 weeks

Hypokalemia Metabolic alkalosis Answer choices include Liddle, Bartter, Gitelman - how to differentiate?

Liddle = hypertension (others have low-normal BP) Bartter = looks like Gitelman but presents in infancy Gitelman = looks like Bartter but tends to present late childhood or adulthood

9 mo male with FTT, seizures, hypoglycemia, ketosis, lactic acidosis, hyperuricemia, abnormal lipid panel

glycogen storage disease (long term management is oral cornstarch)

Type ___ errors are more likely in tests with poor sensitivity

Type II errors

Birth trauma injury that does NOT cross suture lines

Cephalohematoma

T/F - an anaphylactic reaction to contrast media is IgE-mediated

False -- treated the same as a type 1 hypersensitivity, but it is caused by histamine release from basophils and mast cells independent of IgE

fracture extends across metaphysis, physis, and epiphysis into the joint space -- what salter Harris?

type IV [type III similar but no metaphyseal involvement -- look at photos]

Which IBD are these associated with? Pyoderma gangrenosum Sclerosing cholangitis Chronic hepatitis Ankylosing spondylitis

Ulcerative colitis

2 Ottawa ankle criteria

Cannot bear weight Point tenderness involving the tip or POSTERIOR aspect of EITHER ankle malleolus [also note Low Risk Ankle Rule states that if a child has tenderness and swelling isolated to either the distal fibula and/or any adjacent lateral ligaments distal to the tibial anterior joint line, radiography not necessary]

______________ can result in bacterial neonatal meningitis. CSF gram stain will typically be negative for bacteria, but CSF pleocytosis will be present.

Listeria

what 3 fracture types have the highest risk of neuromuscular injury?

Supracondylar (distal humerus) Distal femur Scaphoid

Drug options for anaerobic coverage

Penicillin + beta lactamase inhibitor (pip/tazo, augmentin) Metronidazole Carbapenems

Mom is diagnosed with chorioamnionitis after baby is delivered. Baby is well-appearing. What are 3 risk factors to evaluate for in your decision to observe vs. culture/abx?

GBS colonization/appropriate tx Prolonged ROM >18 hrs Preterm labor

Testing for hereditary angioedema

C4 and C1 inhibitor

T/F: HSV-2 genital infections are more likely to cause recurrence than HSV-1

true

HSM Pancytopenia Erlenmeyer flask deformities of long bones

Gaucher disease (dx by measurement of glucoserebrosidase activity in leukocytes)

Murmurs associated with HoCM _______ with valsava maneuver

increase [dynamic obstruction of the left ventricular outflow tract is exaggerated by underfilling of the left ventricle. Valsalva decreases systemic venous return to the heart, therefore decreasing left ventricular preload, which accentuates the murmur]

risk of recurrence for trisomy 21 for maternal balanced translocation

10-15% unbalanced translocation = 1% paternal balanced translocation = 2-5% nondisjunction = 1% + age related risk in mom<35

What is the general rule for resumption of contact sports after EBV infection

4 weeks after illness onset

Classic triad of toxoplasmosis

Chorioretinitis Hydrocephalus Intracranial calcifications

Differentiate phimosis from paraphimosis

phimosis = can't retract foreskin paraphimosis = retracted foreskin cannot be replaced

The AAP does not recommend using insect repellent in children younger than _________

2 months

T/F: There is no evidence that sensitivity to seafood or iodine predisposes to radiocontrast media reactions

True

Measles exposure. If unvaccinated, get vaccine within _________, and ideally get immunoglobulin within _______. If no prophylaxis given, you skip work for 21 days

3 days 6 days

Baby weighing 1850 g at birth and Hep B positive mom. How many total doses of Hep B vaccine will baby get in lifetime?

4 (HBV and HBIG now, repeat at 1-2 months, 3-4 months, and 6 months) This is the case because baby is <2000 g at birth -- if baby was >2000 g at birth, would only get 3 doses (get HBV and HBIG now, then 2 additional doses per usual schedule)