UW Peds Flashcards
(151 cards)
1
Q
Management of septic arthritis in kid
A
- arthrocentesis
- blood & synovial fluid cx
- empiric abx
2
Q
top three bugs in septic arthritis in kids > 3mos
A
- Staph aureus
- Group A strep
- S pneumo
3
Q
Abx for septic arthritis in kids > 3mos
A
Nafcillin OR clindamycin OR cefazolin OR vanc
4
Q
Top 3 bugs in septic arthritis in babies < 3 mos
A
- Staph aureus
- Group B strep
- Gram neg bacilli
5
Q
Abx for septic arthritis in babies < 3 mos
A
Nafcillin OR vanc
PLUS
gent OR cefotaxime
6
Q
Abx of choice for pertussis tx and post-exposure ppx
A
macrolides (azithro)
7
Q
all close contacts of a kid with pertussis should get [WHAT?]
A
azithromycin
8
Q
what pertussis tx/ppx should you give to babies < 1 mo?
A
azithro bc erythro is associated with pyloric stenosis and no avail safety date of clarithro
9
Q
w/u of cyanotic breath holding spell
A
CBC looking for iron deficiency anemia
10
Q
Tx uncomplicated acute bacterial rhinosinusitis?
A
oral amox-clavulanic acid (augmentin)
11
Q
give augmentin for sinusitis if persistent sx > or = [how many days?] without improvement
A
10 days
12
Q
give augmentin for sinusitis if severe sx, fever > 102, purulent nasal d/c, or face pain > or = [how many days?]
A
3 days
13
Q
give augmentin for sinusitis if worsening sx > or = [how many days?] after initially improving viral URI
A
5 days
14
Q
give augmentin for sinusitis in the following three situations
A
- 10 days pers. sx
- 3 days severe sx
- sx 5 days s/p viral URI
15
Q
confirm Lyme arthritis dx w/
A
serum ELISA or Western blot testing
16
Q
Tx Lyme arthritis
A
oral doxy or amox
17
Q
what dz causing limp and insidious hip pain classically occurs in obese adolescents? (avg age is 12 in girls and 13.5 in boys)
A
SCFE (slipped capital femoral epiphysis)
18
Q
First step in management of newborn with respiratory compromise and susp congenital diaphragmatic hernia?
A
Endotracheal intubation!
Then gastric tube.
Bag-and-mask ventilation can exacerbate resp decline!
19
Q
fancy name for chorlide sweat test
A
quantitative pilocarpine iontophoresis
20
Q
Triad of HUS
A
anemia, thrombocytopenia, renal failure
21
Q
Kid with LE purpura, arthritis, and hematuria
A
HSP
22
Q
renal biopsy of HSP shows
A
IgA deposition in the mesangium
23
Q
AD expansion of a CTG repeat in DMPK on 19q13.3 causing muscle wasting/weakness, cataracts, testicular atrophy, baldness
A
Myotonic muscular dystrophy
24
Q
X-linked disorder characterized by eczema, thrombocytopenia, and hypogammaglobulinemia
A
Wiskcott-Aldrich
25
Pure red cell aplasia without macrocytosis in a 1 yo w/o congenital abnormalities
transient erythroblastopenia of childhood
26
AR dz w/ progressive pancytopenia and macrocytosis in ~8 yo a/w cafe-au-lait spots, microcephaly, micropthalmia, horseshoe kidneys, and absent thumbs
Fanconi's
27
macrocytic pure red aplasia a/w short stature, webbed neck, cleft lip, shielded chest, and triphalangeal thumbs
Diamond-Blackfan syndrome
28
tx clubfoot
stretching and manipulation of the foot, followed by serial plaster casts, malleable splints, or taping. if no improvement, surgery between 3-6 mos.
29
3-4 mo w/ doll-like face (fat cheeks), thin extremities, short stature, & protuberant abd. w/ hypoglycemia (seizure), lactic acidosis, hyperuricemia, and hyperlipidemia = Type I GSD = Von Gierkes' dz = deficiency of ?
glucose-6-phosphatase
30
3-4 mo w/ hypoglycemia, lactic acidosis, hyperuricemia, hyperlipidemia = glucose-6-phosphatase deficiency = Type 1 GSD = ?
Von Gierkes' dz
31
2-3 wk old baby w/ feeding difficulties, macroglossia, & HF due to progressive HOCM = Type II GSD = Pompes' dz = deficiency of ?
Acid maltase = alpha-1,4- glucosidase
32
hepatomegaly, hypoglycemia, hyperlipidemia PLUS elevated transaminases, fasting ketosis, and NL blood lactate & uric acid concentrations = Type III GSD = Cori's dz = deficiency of?
Glycogen debranching enzyme
33
18 mo with HSM (progressive cirrhosis) and FTT = Type IV glycogen storage dz = deficiency of
Branching enzyme
34
benign course of hepatomegaly, growth retardation, mild hypoglycemia, hyperlipidemia, and hyper ketosis with nl lactic acid and uric acid levels
liver phosphorylase deficiency
35
AR disorder caused by cystathione synthase deficiency --> Marfanoid habitus, ID, DW lens dislocation, & hypercoag
homocystinuria
36
GSD V = McArdle's dz = deposition of glycogen in muscles --> myoglobinuria and elevated CK = deficiency of
Muscle glycogen phosphorylase = myophosphorylase
37
tx homocystinuria
vitamin supplementation and anti platelet or anticoagulation to prevent thromboembolic events
38
beta hexoaminidase A deficiency
Tay Sachs
39
galactocerebrosidase deficciency
Krabbe dz
40
alpha-galactosidase deficiency
Fabry disease
41
baby with cyanosis, loud S2, and no murmur
transposition (give prostaglandin E1 to maintain PDA)
42
3 types of cyanotic heart disease that cause increased pulmonary flow
transposition, truncus, TAPVR
43
2 causes of neonatal cyanotic heart disease with severe HF
hypoplastic left heart syndrome, critical aortic valve stenosis
44
tet, tricuspid atresia/stenosis, ebstein's anomaly, PV atresia/stenosis all cause cyanotic heart disease with [inc or dec?] pulmonary flow
decreased
45
children < 2 yo with first febrile UTI should be treated with 1-2 wks abx and what imaging?
renal and bladder u/s
46
deficiency that causes dry beriberi (peripheral neuropathy) or wet beriberi (dilated cardiomyopathy) or Wernicke-Korsakoff syndrome
Thiamine
47
Deficiency that causes pellagra (symmetric reddish rash, dementia, diarrhea)
niacin
48
deficiency that causes ecchymoses, petechiache, bleeding gums, hyperkeratosis, and coded hair
vitamin C deficiency
49
deficiency that causes angular chalets, stomatitis, glossitis, normocytic-normochromic anemia, and seborrheic dermatitis
riboflavin deficiency
50
deficiency that causes angular chalets, stomatitis, glossitis, normocytic-normochromic anemia, and seborrheic dermatitis
riboflavin deficiency
51
neonate with HSM, cutaneous lesions, jaundice, anemia, rhinorrhea, and on X-ray, metaphysical dystrophy and periostitis
congenital syphils
52
neonate with IUGR, HSM, petechiae or purport, chorioretinisis, hearing loss, and periventricular calcificiations
congenital CMV
53
neonate with IUGR, HSM, petechiae or purport, chorioretinitis, hearing loss, and periventricular calcifications
congenital CMV
54
how does refeeding syndrome cause arrhythmias and cardiopulmonary failure
carbs stimulate insulin activity, wh/ promotes cellular uptake of P, K+, and Mg++
55
how does refeeding syndrome cause arrhythmias and cardiopulmonary failure
carbs stimulate insulin activity, wh/ promotes cellular uptake of phosphorus, K+, mag
56
girl with precocious puberty, pigmentation (cafe au lait spots), and polyostotic fibrous dysplasia
McCune-ALbright syndrome
57
Herpangina is caused by coxsackie virus and p/w vesicles on the?
POSTERIOR oropharyng
58
Herpetic gingivostomatitis is caused by HSV1 and p/w vesicles on the?
ANTERIOR oropharynx
59
Herpangina is caused by coxsackie virus and p/w vesicles on the?
POSTERIOR oropharynx
60
Herpetic gingivostomatitis is caused by HSV1 and p/w vesicles on the?
ANTERIOR oropharynx
61
delayed separation of the umbilical cord
Leukocyte adhesion defect 1
62
tx non-bullous impetigo
topical mupriocin
63
new onset hearing loss or chronic ear drainage despite abx + granulation tissue and skin debris =
cholesteatoma
64
elevated 17-hydroxyprogesterone
21 hydroxylase deficiency (CAH)
65
abnormal serum lead w/u
measure venous lead level
66
abnormal serum lead w/u
measure venous lead level
67
bug for non-bulbous impetigo
staph aureus or group A strep
68
bug for bullous impetigo
staph aureus
69
tx bullous impetigo
oral abx such as cephalexin, dicloxacillin, or clinda
70
repeat cystitis in pt w/ constipation
urinary stasis
71
all vaccines should be adm by chronological not gestational age in premees, e/c
must be over 2 kg for first hep B
72
gold standard for diagnosing malrotation
upper GI series (after abd xr)
73
prenatal exposure to valproic acid
neural tub defects
74
prenatal exposure to phenytoin
fetal hydantoin syndrome
75
prenatal exposure to cocaine
jitteriness, hyperactive moro
76
prenatal exposure to heroin
neonatal abstinence syndrome - irritability and high-pitched cry
77
fetal alcohol syndrome
IUGR, long smooth philtrum, thin upper lip
78
fetal alcohol syndrome
IUGR, long smooth philtrum, thin upper lip
79
bug in cervical adenitis
strep or staph (in older kids w/ cavities can be oral anaerobes)
80
tx cervical adenitis
clinda plus I&D
81
amox covers what gram positives?
strep, not staph
82
bactrim covers what gram positives?
staph (inc MRSA) but not group A strep
83
well-appearing neonate has painless bloody stools
milk or soy protein prctocolitis
84
triad of fever, severe morning or nocturnal headache, and focal neurologic defect or seizure
brain abscess
85
risk factors for brain abscess
otitis media, mastoiditis, frontal or ethmoid sinusitis, dental infection; cyanotic heart disease, other bacteremia
86
PEPpx for chickenpox in immunocompentent
vaccine w/i 3-5 days
87
PEPpx for chickenpox in immunocompromised
immunoglobulin
88
the following are complications of what?
1. fractured clavicle
2. fractured humerus
3. Erb-Duchenne palsy
4. Klupke palsy
5. Perinatal asphyxi
shoulder dystocia
89
extended elbow + pronated forearm + flexed wrist and fingers
"waiter's tip" = erb-duchenne (5th and 6th cervical nerves)
90
extended wrist + hyperextended MCPs + flexed IPs + absent grasp + horner
klumpke palsy (8th cervical and 1st thoracic)
91
adolescent w/ epistaxis, localized mass, and bony erosion on back of nose
angiofibroma
92
neonatal conjunctivitis w/i 24 hours of lief
chemical (silver nitrate pox), tx supportive
93
neonatal conjunctivitis at 2-5 days (profuse, purulent)
gonococcal, tx: IM ceftriaxone or cefotaxime
94
neonatal conjunctivitis at 5-14 days (watery or mucopurulent, w/ blood)
chlamydial, tx: oral erythromycin
95
most common cause of bacterial PNA in CF (esp w/ coexisting flu)
Staph aureus, tx: IV vanc
96
iron antidote
deferoxamine
97
lead antidote
calcium EDTA
98
prev healthy infant p/w bulbar palsies, constipation, & hypotonia
ask about honey! but still might have ingested botulism spores from environment.
tx: Botulism immunoglobulin
99
most common causes of acute bacterial rhinosinusitis
strep pnemo and non-typeable H flu
100
electrolyte abnormalities in pyloric stenosis
loss of HCl by vomiting --> met all + hypocholoremia; down H+ means down K+ (into cells, also aldo release in response to hypovolemia)
101
mid systolic click with late systolic murmur
MVP
102
BLANK can be a/w several cardiac abnormalities including supravalvular AS, PS, or septal defects
Williams syndrome
103
continuous flow murmur at the LSB; mildly accentuated peripheral pulses
PDA
104
characteristics of benign cardiac murmurs
1. grade 2 or less
2. early or mid-sstolic
3. dec w/ standing and valsalva
4. nl associated S2
5. child o/w healthy
105
kid w/ croup is deteriorating. what do you try before intubating?
racemic epinephrine
106
most common cause of urinary tract obstruction in newborn boys
posterior urethral valves
107
"rash that resembles a sunburn"
pellagra (niacin deficiency)
108
management of caustic ingestion (oven cleaner)
1. ABCs
2. remove clothes, wash
3. CXR if rest
4. upper GI endoscopy
109
brief episodes of impaired consciousness, staring spells, automatisms, POST ICTAL CONFUSION
partial complex; EEG normal or w/ brief d/cs
110
brief episodes of impaired consciousness, staring spells, automatisms, NO POST ICTAL CONFUSION
absence; EEG shows 3Hz spike and wave
111
adolescent with unilateral or bilateral myoclonic jerks in the morning
Juvenile myoclonic epilepsy
112
child w/ seizures of mult types, impaired cog fxn, and slow spike & wave activity on EEG
Lennox-Gastaut
113
w/u precocious puberty with high LH
MRI w/ contrast
114
w/u precocious puberty w/ low LH
GnRH stimulation test
115
w/u isolated proteinuria on dipstick?
repeat dipstick on 2 separate occasions
116
4 anomalies of tetrology
PROVe
- pulmonary stenosis
- RVH
- overriding aorta
- VSD
117
what causes a tet spell?
sudden spasm of RVOT during exertion
118
murmur in tet?
harsh crescendo decrescendo systolic murmur over LUSB (PS)
119
what do you call it when the aorta comes out of the RV and the pulmonary artery comes out of the LV?
transposition
120
follicular conjunctivitis and pannus (neovascularization) formation in the cornea
trachoma
121
congenital marrow failure, poor growth, morphologic abnormalities, and macrocytic anemia in a kid
Fanconi anemia (caused by chromosomal breaks)
122
tx neonatal clavicular fracture
nothing! (acetaminophen and reassurance)
123
neonate with jaundice, large tongue, hoarse cry, and decreased activity
congenital hypothyroidism
124
most common cause of congenital hypothyroidism in the US
thyroid dysgenesis
125
hemolytic anemia, thrombocytopenia, ARF
HUS
126
purpura, joint pain, NORMAL platelet count
HSP
127
newborn with FTT, bilateral cataracts, jaundice, hypoglycemia
galactosemia (galactose-1-phosphate uridyl transferase deficiency)
128
newborn with bilateral cataracts and NO OTHER SX
galactokinase deficiency
129
how to distinguish iron deficiency and thalassemia trait
in iron deficiency, decreased ferritin, increased TIBC and RDW; these values are NORMAL in thalassemia trait
130
most common cancer in children
ALL
131
dx ALL
> 25% lymphoblasts on BMB
132
osteosarcoma on xray
sunburst and codman
133
ewing on xray
onion skinning
134
impaired oxidative metabolism and susceptibility to catalase + orgs (aspergillus and staph)
CGD
135
kid w. complement deficiency is susceptible to:
neisseria
136
genetic defect in SCID
adenosine deaminase
137
pt > 6 mos who presents w. inc susc to giardia, h flu, and s pneumo
b cell deficiency
138
bugs causing pediatric viral myocarditis
coxsackie B, adenomvrius
139
viral prodrome + dyspnea, syncope, tachycardia, n/v, hepatomegaly + holosystolic murmur should make you think...
viral myocarditis
140
diagnostic studies for viral myocarditis
CXR (cardiomegaly and pulmonary edema), EKG (sinus tach), echo (dec EF, diffuse hypkinesis), endomycoardial biopsy (gold standrd)
141
what does endomyocardial biopsy show in viral myocarditis?
inflammatory infiltrate o fteh mycoardium with myocyte necerosis
142
what is the gold standard for dx of ped viral myocarditis?
endomyocardial biopsy
143
mortality of viral myocarditis
newborns (75%); older infants/kids (25%); of survivors, 1/3 have dilated cardiomyopathy or chronic HF
144
all patients with history of rheumatic fever should received continuous antibiotic prophylaxis with
IM benzathine pencilllin G every 4 weeks
145
EKG with shortened PR interval, slurred initial portion of the QRS (delta wave), widened QRS complex
WPW
146
electrolyte derangements that can prolong QT interval
Hypo -calcemia, -kalemia, -magnesemia
147
two inherited long QT syndromes
Jervell and Lange-Nielsen (AR)
AND
Romano-Ward (AD)
148
AR long QT (~600 ms) syndrome caused by defects in potassium channels that is a/w congenital sensorineural deafness
Jervell & Lange-Nielsen
149
Tx Jervell & Lange-Nielson
Beta blocker (ANY BUT SOTALOL, wh/ is class III)
150
harsh crescendo-decrescendo systolic murmur over the LUSB
Tetrology (pulmonic stenosis murmur)
151
distant heart sounds, distended jugular veins (or scalp veins in infants), and hypotension
Beck's triad of cardiac tamponade; pulses paradoxus may also be present
