UT High Yiedl Flashcards
(209 cards)
1
Q
What does APGAR tell you?
A
General info about how newborn tolerated labor and how responding to resuscitation
2
Q
What does APGAR not tell you?
A
Not predictive of outcome, does not guide therapy
3
Q
What does it mean if arm extended and medially rotated after birth?
A
Erb Duchenne = waiters tip
C5-C6
Tx: refer at 3-6 mo for surgery
4
Q
What does it mean if you feel crepitus at clavicle in newborn? What should you do?
A
clavicle fracture
tx: reassurance and watch
5
Q
What is edema on baby’s head that crosses suture lines?
A
caput
6
Q
What is fluctuant mass on baby’s head that does not cross suture lines?
A
cephalohematoma
7
Q
What are mongolian spots made of?
A
arrested melanocytes
8
Q
What is pale pink vascular macules on nuchal area and face?
A
salmon patch = nevus simplex
less sharply demarcated than hemangiomas
facial regress, nuchal stick around
9
Q
What is firm white papule on day of life 1 w/ keratin?
A
milia
10
Q
When do you see neonatal acne?
A
week of like 1-2
11
Q
Firm yellow white pustules/papules on erythematous base?
A
filled with eos
erythema toxicum
12
Q
What is area of alopecia w/ orange colored nodular skin?
management?
A
nevus sebaceous
remove before adolesence b/c risk of malignant degeneration
13
Q
What is treatment for cradle cap?
A
mild shampoo or antifungal
14
Q
What are two disorders screened for in every state?
A
galactossemia
PKU
15
Q
What is PKU? How does it present?
A
deficient Phe hydroxylase
see sx a few months later, MR, delay, athetosis, seizure, vomit
fiar hair, eyes, skin, musty
16
Q
What is galactosemia? How does it present?
A
Deficient G1P uridyl-trasnferase
G1P accumulates to damage kidney/liver/brain
sx right away b/c galactose crosses the placenta
MR, direct hyperbili, jaundice, low glucose, cataracts, seizure
predisposed to E coli sepsis
17
Q
What is physiologic jaundice?
A
b/c liver conjugation not mature, gone by day 5, bili
18
Q
What is breastfeeding jaundice mech?
A
increased enterohepatic circulation –> reabsorb deconjugated bili
19
Q
What is breast milk jaundice?
A
breast milk has glucoronidase that deconjugated bili in infant GI tract
20
Q
Causes of direct hyperbili?
A
galactosemia hypothyroid choledochal cyst CF biliary atresia SEPSIS!
21
Q
Inherited indirect hyperbili?
A
gilbert + crigler-najjar
22
Q
Inherited direct hyperbili?
A
rotor (no black liver) + dubin johnson (black liver)
23
Q
What is mech of phototherapy?
A
isomerizes unconjugated bilirubin so can be excreted
24
Q
Treatment for diaphragmatic hernia?
A
give lungs 3-4 days to mature then do surgery
*deliver at a facility with ECMO
25
Resp distress w/ excess drooling: dx? what else should you look for?
place feeding tube, take xray
look for VACTERL: vertebral, anal atresia, cardiac, radial, renal
26
What should you think if 1 wk old cyanotic when feeding but pink when crying? What else should you look for?
choanal atresia
CHARGE: coloboma, heart defects, retarded growth, GU anomalies, deafness
27
How do you diagnose RDS prenatal?
L/S ratio
28
Treat RDS?
O2 therapy w/ nasal CPAP to keep alveoli open
29
When do you use theophylline in NICU?
for central apnea
30
What is pathophys in TTN? signs in CXR?
path: retained fluid
CXR: perihilar streaking, retained fluid in fissures, air trapping
risks: C section
31
Meconium aspiration syndrome next best step? complications?
intubate + suction before stimulation
complications: pneumonia, pneumonitis, pulm artery HTN
32
What is defect lateral to midline w/o sac?
gastroschisis
not associated w/ other anomalies
problem --> bowel exposed gets scarred --> bowel resection --> etc
33
What is defect in midline covered by sac?
Associated w/ what disease
omphalocele
associated w/ beckwith wiedemann = big baby w/ big tongue, ear pits, low glucose
34
When do we treat umbilical hernia?
if persists past age 2-3
35
Metabolic complication w/ pyloric stenosis?
hypochloremic metabolic alkalosis
36
2 wk old w/ biliious vomiting + polyhydramnios?
duodenal atresia
37
1 wk old baby w/ billious vomiting, draws up legs, ab distension?
malrotation and volvulus
| --> ladds bands can kink the duodenum
38
3 day old has not passed meconium?
CF --> gastrograffin enema = Dx/Tx
HIrshprungs --> squirt sign = explosion of poo w/ enema, tx ganglia
39
What do you see on CXR w/ ENC?
pneumocystitis intestinalis (air in the wall)
40
What is treatment for NEC?
NPO, TPN (if necessary), abx, resent necrotic bowel
risk: prematurity
most important = stop feeding
41
Newborn male w/ no palpable testes -- where are they? next best test?
usually in inguinal canal
| if not there --> do US
42
What is prune belly syndrome?
problem w/ ventral musculature of abdomen, have cryptorchidism
43
When do you surgery for cryptorchidism?
at 1 yr, decreases sterility makes it easier to detect cancer
44
What is it called if newborn has urethral opening on ventral surface?
hypospadia
45
What do you not do in hypospadias?
circumcise --> foreskin used for repair
46
What is treatment for 21 hydroxylase?
give hydrocortisone and fludrocortisone
47
Baby w/ anterior midline mass that doesnt pee?
posterior urethral valves = common cause of anuria
Tx: catheterize then surgical correction
48
Associations w/ pre-existing maternal DM?
IUGR, congenital, caudal regression, small left colon
49
Associations w/ gestational DM?
LGA, hypoglycemia, hypocalcemia, polycythemia, jaundice
50
Risks of LGA?
increased risk of birth trauma --> clavicle, erbs, TTN
51
What are complications of neonatal hypoglycemia?
seizure
52
Why polycythemia in LGA?
big baby needs more O2 = hypoxia --> more EPO
53
What should you order in baby
CBC w/ diff, CXR, blood culture, urine culture (w/ catheter), LP
54
What are risk factors for neonatal sepsis?
premature, chorioamnionitis, intrapartum fever, maternal leukocytosis, prolonged rupture of membranes (>18 hrs), GBS+ mom
55
What are most common bugs for neonatal sepsis? empiric treatment?
GBS, E Coli, Listeria
ampicillin + gentamicin
56
Neonate w/ maculopapular rash on palm/soles, snuffles, periostitis?
treat?
syphilis
Tx: penicillin
57
Neonate w/ hydrocephalus, intracranial calcifications, chorioretinitis? Treat?
toxo
Tx: sulfadiazine + leucovorin
58
Neonate w/ cataracts, deafness, heart defects (esp PDA/VSD), extramedullary hematopoiesis? Treat?
Rubella
Tx: none
59
Neonate w/ microcephaly, periventricular calcifications, deafness, thrombocytopenia, petechiae? Treat?
CMV
Tx: ganciclovir
60
Neonate w/ limb hypoplasia, cutaneous scars, cataracts, chorioretinitis, cortical atrophy? Treat?
Congenital varicella
if mom infected 5 days before or 2 days after delivery --> baby gets VZIG
61
Treat gonococcal conjuncitivits?
topical erythromycin and IV 3rd gen Ceph
62
Treat chlamydia conjunctivitis (mucopurulent/mucoid)?
oral erythromycin
complication = chlamydia pna
63
IQ in Down syndrome?
moderate MR and dev delay
64
Associations w/ Down syndrome: Heart? GI? Endocrine? MSK? Neuro? Cancer?
```
Heart: endocardial cushion, VSD
GI: hirshprung, duodenal atresia
Endocrine: hypothyroid
MSK: atlantoaxial instability
Neuro: alzheimers (APP on 21)
Cancer: ALL
```
65
Associated anomalies w/ turner? treatment?
coarctation of aorta, bicuspid aortic valve, horseshoe kidney
treat: give estrogen to undergo puberty and avoid osteoporosis
66
What are associations w/ klinefelters?
increased risk of gonadal malignancy
67
What syndrome: manidublar hypoplasia, glossoptosis, cleft soft palate, w/ FAS or edwards?
Pierre robyn seuqence
68
What syndrome: broad square face, short stature, self injurious, del 17?
smith mcguinnes
69
What chr is prader willi?
chr 15
70
What chr is williams?
chr 7
71
What syndrome: IUGR, hypertonia, distinct facies, limb malformations, self injurious behavior, hyperactive?
cornelia de lange
72
What is genetics of fragile X?
CGG repeats on X chr
73
What syndrome: AD, w/ advanced paternal age, short palpebral fissures, white forelock, deafness
Waardenburg
74
Multiple infecitons and no tonsils?
Bruton agammaglobulinemia
75
B cells normal but low Igs in later kid? complication?
CVID --> increased lymphoid tissue so increased risk lymphoma
76
Most common B cel defect w/ recurrent URIs and diarrhea?
IgA deficiency
77
3 wk old w/ seizure, truncus arteriosus, micrognathia?
DiGeorge, chr 22
78
Inheritance of SCID? treat?
MC XR, also AR ADA deficiency
tx --> BM transplant by age 1 or death
79
Dx chronic granulomatous disease?
nitrotetrazolium blue, flow cytometry
80
What disease w/ severe eczema, petechiae, recurrent ear infections? What IG make up?
wiskott aldrich
high IgE/IgA, low/normal IgG/IgM
prolonged bleeding after circumcision
81
When do you double length by?
4-5 years
82
Breast milk vs formula?
breast milk = whey, more lactose, more long chain fatty acids, less Fe but better absorbed
83
What should you think if kid always 5% in height, parents late bloomers? Bone age?
constitutional growth delay
| bone age
84
What is bone age in obesity?
bone age > real age b/c of estrogen
85
When do you have moro? grasp? rooting? placing?
birth to 4/6 mo for all
86
When is parachute?
from 6-8 mo for rest of life
87
When can baby roll over?
6 mo
88
When can baby skip + copy triangle?
5 yr
89
When can baby walk alone?
12-15 mo
90
When can baby walk upstairs w/ alternating feet?
30 mo
91
When can baby copy cross and square
4 yrs
92
When can baby sit unsupported + pincer grasp?
9 mo
93
When can baby walk downstairs, copy circle, jump w/ both feet?
3 yr
94
When is 1/2 of speech comprehensible and 2-3 word sentences
2 yr
95
When can baby social smile, start to coo?
2 mo
96
When should achieve urinary continence? What are medical causes to rule out?
by 5 years, after that = pathologic
medical causes: UTI (do UA), constipation (disimpact), or DM (check sugar)
97
When shoul achieve fecal continence?
4 yrs
treat: disimpact, stool softeners
98
What vaccines at 2, 4 6mo?
hep B, rota, DTap, HIB, IPV, pneumococcal
99
What vaccines due at 12 mo?
MMR, varicella, Hep A
100
What are contraindication to MMR?
neomycin/streptomycin allergy
101
Stills murmur?
systolic ejection murmur 2/5
102
Venous hum?
best heard in anterior neck, disappears when jugular vein compressed
disappears when supine
103
Newborn cyanotic at brith and o2 does not improve? associated with what? murmur? Tx?
transposition
more common in infants of DM mothers
no murmurs
Tx: PGE1
104
Associated murmur w/ tet? treat?
systolic ejection murmur of VSD
| treat: O2 and knee checst
105
What is presentation of ebstein anomaly? associated arrhythmia?
holosystolic murmur worse on inspiration
associated w/ WPW
106
What does it mean if murmur worse on inspiration?
R sided murmur
107
Heart defect w/ DiGeorge?
truncus arteriosis
108
CXR finding in truncus arteriosus?
increased pulm blood flow and biventricular hypertrophy
109
What are two conditions associated w/ PDA?
prematurity, congenital rubella
110
Murmur of HOCM
systolic ejection murmur
louder standing, exercise, valsalva
quieter squat, handgrip
111
Tx HOCM?
no sports give B Blockers or CCB
alcohol ablation or surgical myotomy for definitive
112
What are signs at birth of CF?
meconium ileus --> dilated loops, ground glass
can also have rectal prolapse w/ chronic diarrhea, FTT, floating stools, recurrent resp infections, nasal polyps
113
What is treatment for thick resp secretions in CF?
DNAse(mucolytic), albuterol/saline nebs
114
What is treatment for pna in CF?
usually pseudomonas or Burkholderia
treat --> piperacillin + tobramycin or ceftazidime
115
What is treatment for pancreatic insufficiency in CF?
replace enzymes w/ meals
116
What is treatment for electrolyte loss through skin in CF?
adequate fluid replacement when exercise or hot
117
What does it mean if normal PCO2 in asthma exacerbation?
means impending resp failure --> need to intubate
PCO2 should be low
118
Next step if DKA?
start insulin drip + IVF, monitor blood gluc and anion gap
start K, bridge w/ glargine once tolerating PO
119
What are diagnostic criteria for DM?
fasting gluc > 125 (twice)
2hr OGTT > 200
any gluc > 200 + sx
120
super high fever then rash later?
HHV6 = roseola
121
slapped cheek rash?
parvovirus B19 = erythema infectiosum
122
maculo-papular desquamating rash on chest and spreads to neck, trunk, extremities + strawberry tongue?
scarlet fever
treat: penicillin
123
cough, runny nose, fever, rash spreads down + gray spots on buccal mucosa?
measles
treat: vit A
124
sore throat, joint pain, fever, pinpoint rash on face spreads down, rose spots on palate?
rubella (b/c joint pain + sore throat w/ rash)
125
complications of mumps?
orchitis leading to sterility
126
complications of lyme?
heart block, meningitis, arthritis, bells
treat: amoxicillin 8
IV ceftriaxone if menignitis
127
rickettsia complications? treatment?
complications = vasculitis and gangrene
tx: doxy no matter what age
128
scabies treatment?
permethrin for everyone in the house
129
DX: honey crusted plaque? treatment?
impetigo, MC bug is staph if bullous
tx: topical muciprocin
130
Inflamed conjunctiva + multiple blisters, Nikolsky +? Treat?
staph scalded skin syndrome
from exfoliative toxin
treat: IV ABx
131
Meningitis post brain surgery?
staph aureus
132
Treatment for lyme meningitis?
IV ceftriaxone
133
First step if suspect meningitis?
start empiric treatment
then check CT if signs of increased LP
then do LP
134
Fever to 102, tympanic membrane red and bulging: what test to dx? treatment?
Dx: limited mobility on insufflation or air fluid level
risks: daycare
treatment: amoxicillin 10 days
complication: deafness from effusions
135
Pain behind ear and thick exudate from ear? treatment?
otitis externa
treat: topical cipro (think pseudomonas)
136
Complication of otitis externa?
malignant otitis externa --> can invade temporal bone --> facial paralysis, vertigo
need CT and IV abx, may need surgery
137
Sore throat w/ exudative pharyngitis w/ tender cervical lymph node -- next step?
rapid strep antigen --> if negative do culture
138
treatment for strep throat?
penicillin or erythromycin
139
muffled voice, stridor, refuse to turn head to left? Dx? Treat? Complications?
Retropharyngeal abscess (prevents turning head)
treat: aspirate, treat with 3rd gen ceph + amp or clinda
complications: mediastinitis b/c communicates w/ mediastinum
140
Hot potato voice and uvula deviated to R 2/2 bulge? Dx? Treat?
Peritonsilar abscess
I&D + abx
tonsillectomy if recurrent
141
Dx mono?
monospot, blood smear w/ atypical lymphocytes
142
What disease do you see steeple sign? clinical sx? treatment?
Croup --> parainfluenza
barking cough, loud noises on inspiration
tx: mist, epinephrine neb, steroids
143
What disease should you think if fever, drooling, intercostal retractions, tripod position? xray buzzword? next step? treat?
epiglottitis --> strep pyogenes/strep pneumo/staph or h flu
xray: thumb sign
next step: intubate in OR
treat: anti staph abx + 3rd gen ceph
144
PNA vs bronchitis?
bronchitis = cough, funky yellow/green sputum, runny nose, but normal lung exam
145
MC PNA in neonate
GBS, e coli, lysteria
146
MC PNA 1-3 mo?
Chlamydia, RSV, paraflu, strep pneumo
147
MC PNA 4-5 mo?
VIRAL then s pneumo
148
9 mo w/ runny nose, wheezy cough, RR 60, retractions, pulse ox 91%? DX? CXR findings? treatment?
RSV bronchiolitis
CXR: atlectasis, hyperinflation
treat: hospitalize if resp distress, treat w/ nebs
149
Who gets RSV vaccine?
preemie, CHD, lung disease, immune disease
150
lab findings in bordetella pertussis?
high lymphocytes
151
treatment for bordetella pertussis?
erythromcyin for 14 days
152
Dx UTI?
urinalysis, catheterize to get clean catch for culture
153
Treat UTI?
trim-sulfa or nitrofurantoin
154
Treat pyelo?
14 days IV ceftriaxone or amp + gent
155
MCC limping kid?
trauma
156
risk factor DHD?
1st born, F, + FH, breech position
157
5 yo w/ painless limp no pain in thigh?
legg-calve-perthes = avascular necoris
158
next best step if transient synovitis?
bed rest for 1 wk + NSAIDs
159
Treatment SCFE?
need surgery to prevent osteonecrosis
160
Good and bad prognostic factors w/ JIA?
good: ANA+
bad: RF+, polyarticular, older age at onset
161
Treatment JIA?
1st line = NSAIDs
2nd = methotrexate
last = steroids
162
lab findings in kawasaki?
lymphocytosis, thrombocytosis (esp wk 2-3), sterile pyuria, high LFTs, high CSF protein
163
best 1st test in kawasaki?
echo and EKG
164
Diffuse bone pain w/ petechiae/pallor/infections?
leukemia
165
Sudden drop in HCT with decreased retic in sickle?
aplastic crisis
166
recurrent RUQ pain after meals in sickel?
pigment gallstones --> cholecystectomy
167
resp distress + emergent tonsillectomy in sikcle?
hyperplasia of lymphoid --> need to do tonsillectomy
168
MC cause sepsis in sickel?
strep pneumoe
169
MCC death in sickle? treat?
acute chest
treat = abx and exchagne transfusion
170
assess risk for stroke in sickle?
transcranial doppler
171
Physiologic anemia?
drop in 1st 2-3 mo
172
Folate deficiency risk?
sickle, goats milk diet
173
baby w/ normal plts, WBCs but hb 4, low retics, triphalangeal thumsb?
blackfan diamond anemia
174
baby w/ low plts, low WBC, profound anemia, cafe au lait, microcephaly, absent thumbs/radii?
fanconi anemia
175
Tx for lead?
succimer if 70
176
15 yo w/ recurrent epistaxis, heavy menses & petechiae, only platelets low? treat?
ITP
treat: IVIG then prednisone then splenectomy
177
15 yo w/ recurrent epistaxis, heavy menses, petechiae, normal plts increased BT and PTT? treat?
vWF
treat: DDAVP
178
7 yo M recurrent bruising, hemarthrotsis, increased PTT wthat corrects w/ mixing? dx?
hemophilia
179
1 wk old, bleeding from umbilical stump, bleeding diasthesis? dx?
vit K deficiency = hemorrhagic disease of newborn
180
9 yo w/ wilsons disease and fulminant liver disease -- first factor depleted? two factors not depleted?
1st depleted: VII
not depleted: VIII, vWF
181
Treat HUS?
dialysis, NO PLATELTS OR ABX
182
HSP MCC? treat?
upper resp infection
treat = symptomatic
183
New onset seizure ataxia HA 2 most common causes?
astrocytoma = most common, in cerebellum
2nd: medulloblastoma --> can cause hydrocephalus, bad prognosis
184
Associations w/ wilms tumor?
WAGR
| Beckwith Wiedemann
185
Best test for wilms tumor?
ab CT, do CXR to check for lung met
186
Dx for neuroblastoma?
high urine HVA/VMA
187
3 yo, HSM, petechiae, pallor, cells CALLA and TdT+? Dx? Poor prognostic factors?
ALL
dx: bone marrow biopsy --> > 30% lymphoblasts
treat: chemo, including intrathecal methotrexate
prognostic: 10yo, > 100K WBC
188
best test for hodgkins lymphoma?
excisional biopsy --> then stage (CT)
treat: chemo and radiaotion
189
7 yo girl w/ nonproductive cough and large anterior mediastinal mass on CXR? test? treat?
nonhodgkin lymphoma
best test: biopsy
treat: surgery then radiation
190
What is treatment for secretory diarrhea?
oral rehydration therapy
191
What should you think if nephrotic syndrome + fever?
empirically treat b/c increased risk encapsulated peritonitis, pneumonia, sepsis
192
What is pathogenesis of VUR?
shortened submucosal tunnel in which ureter inserts through bladder wall
193
What happens in renal vein thrombosis?
sudden onset gross hematuria, U/L or B/L flank mass
194
What type of RTA has hyperkalemia?
Type IV, also have urine pH
195
What do you see in urine in type 2 RTA?
type 2 RTA = fanconi
see glucose, AA, phos in urine
normal/low K, urine pH
196
What is inheritance pattern of Alport?
XD
197
What is the workup for an ALTE?
EEG, EKG
198
What lab findings in chlamydia PNA?
eosinophilia
199
What is most common cause of abdominal mass in newborn?
hydronephrosis
200
What are common etiologies of PPHN? treatment?
perinatal asphyxia
treat = O2 --> causes vasodilation in pulm
201
What should you expect to occur in 100% O2 test in heart disease w/ increased pulm flow, decreased pulm flow, and in primary lung pathology?
increased pulm flow (ex. truncus) --> small increase in PaO2
decreased pulm flow (Tet, transposition) --> minimal/no increase in PaO2
lung disease --> very increased PaO2
202
What is the management of fever of unknown origin in kid?
need to rule out bacteremia + UTI
--> give empiric ceftriaxone
203
What is empiric treatmnet for meningitis?
vanc + 3rrd gen cef (cefotaxime/ceftriaxone)
204
What should you think if sandparper rash + fever?
scarlet fever
205
What bacterial GI infection can mimic appendicitis?
mesenteric adenitis
206
What infection causes blue color on cheeks? organism?
buccal cellulits = H flu type B
207
What type of bacterial infection causes well demarcated erythema?
erysepalas
208
What are the two inherited long QT syndromes?
jervell lang neilson --> AR, deafness
| Romano ward --> AD, no deafness
209
When is pain with pericarditis worst?
when supine --> improved by leaning forward
