UWorld Flashcards
(93 cards)
What are light microscopy and immunofluorsence staining of glomeruli of someone with minimal change diease show?
light microscopy: normal renal architecture
Immunofluorescence staining: diffuse effacement of foot processes of podocytes on EM
Renal biospy shows normal kidney architecture; usu not obtained in pts
Turner syndrome (short stature, amenorrheic, coarctation if aorta) -what are lab values for FSH, LH, estrogen
Due to ovarian dysgenesis, estrogen is low which will feedback positively to FSH. FSH is high so is LH
Inhibin is a marker of ovarian function. High or low in Turner?
Low b/c of ovarian dysgenesis
Describe symptoms of neonatal tetanus
- seen in infants born to unimmunized mothers
- frequently follows UMBILICAL STUMP infection (PE: swollen and erythematous umbilical cord)
- first two weeks of life with poor suckling, fatigue, followed by rigidity, spasms, and opisthotonus
How does vomiting assoc with pyloric stenosis results in a hypochloremic, hypokalemic metabolic alkalosis
- vomiting –> loss of gastric HCl –> initiation of metabolic alkalosis, hypochloremia
- vomiting –> volume depletion of loss of NaCl and H2O –> Renin-angiotensin system is activated –> angiotensin II (increases HCO3 reabsorption) –> aldosterone –> 1) Na+ reabsorption, 2) K+ secretion and 3) H+ secretion
What to watch out for in an infant with meningococcemia?
Waterhouse-Friderichsen syndrome: sudden vasomotor collapse and skin rash due to adrenal hemorrhage. Mortality is high
Suspect henoch schonlein purpura when child has palpable purpura on the lower extremities, arthralgias, abdominal pain, and renal disease. What will immunofluorescence show?
IgA deposition in mesangium
Treat supportively with hydration and NSAIDs for most; If severe, hospitalize and do systemic steroids
Most common causes of viral meningitis in peds
non-polioenteroviruses like echoviruses and coxsackievirus
Treatment of acute otitis media
1) amox for 10 days
If not improved, then do augmentin
When to suspect acute bacterial rhinosinusitis that requires abx vs viral rhinosinusitis which happens to be the most common predisposing factor?
often viral symptoms occur first and when they become persistent or worsen, then suspect progression to bacterial. Treat with augmentin
Unilateral cervical adenitis with rapidly enlarging, fluctuant cervical LNs in children are most commonly due to staph or strep infections. How to treat?
incision and drainage plus abx (clindamycin is a great choice)
How to treat non-bullous impetigo (painful non-itchy pusutles and honey-rusted lesions)?
Usu due to staph or strep
Can use topical abx like mupirocin
Prematurity and maternal diabetes are the two most impt risk factors for causing respiratory distress syndrome. How does maternal diabetes do that?
Maternal hyperglycemia –> fetal hyperglycemia –> triggers hyperinsulinemia –> high levels of insulin antagonizes cortisol that is impt in maturation of sphingomyelin
so low cortisol bc blocked by high insulin leads to low sphingomyelin –> RDS due to surfactant deficiency
What are steps involved in you suspect Wilms tumor?
1) US of abdomen
2) CT of abdomen w/ contrast to evaluate nature and extent of the mass and of chest to identify any pulmonary metastases as this is the most common site
3) treatment includes surgery, chemo, with radiation if high-stage
A child with macrocytic anemia, low retic count and congenital anomalies (short stature, webbed neck, cleft lip, shielded chest, triphalganeal thumbs)-suspect? Over 90% diagnosed within first year of life.
Diamond-Blackfan Syndrome aka congenital hypoplastic anemia
Fanconi’s anemia is AR d/o characterized by progressive pancytopenia and macrocytic aenmia. Avg age of diagnsois is 8 yr old. What are some assoc deformities?
- cafe au lait spots
- microcephaly
- short stature
- horseshoe kidneys
- absent thumbs
Iron poisoning when ingested in large amts can be corrosive to the GI mucosa. Symptoms can occur within 30 minutes to 4 days including abdominal pain, vomiting (hematemesis), diarrhea (melena), hypotensive shock. It can present as HAGMA. What will you see on x-ray?
X-ray will show radioopaque pills in GI tract
Can treat with whole bowel irrigation, deferoxime and supportive care
May get upper endoscopy to assess complications like gastric scarring and pyloric stenosis from the toxicity
ALL is the most common leukemia in children. Can present with petechiae, weight loss, fever, bone pain, anemia, thrombocytopenia, either leukopenia or leukocytosis. How to diagnose?
BM biopsy with at least 20% lymphoblasts (PAS+, terminal deoxynucleotidyltransferase (TdT) +
TdT is only expressed in pre B and T lymphoblasts
A child with recurrent sinopulmonary infections develops Giardia. What underlying immunodeficiency explains all this
lack of B cells b/c no IgA which is what is needed to fight the Giardia infection. The recurrent sinopulmonary infections are from H. influenzae and S. pneumoniae
Patients who are more prone to abscesses 2/2 to catalase producing organisms like staph, serratia, burkholderia. and aspergillus. Treatment?
Chronic granulomatous disease due to defect in NADPH oxidase system
Treatment includes prevention of infection with daily TMP-SMX and gamma-interferon 3x/week
T/F: All children age
True
Infant with microcolon and does not pass meconium within first 48 hrs of life… suspect
meconium ileus assoc with CF
microcolon b/c obstruction is at the ileum so the large bowel has not been used –> small in size
no squirt sign (rectal exam doesn’t cause passage of stool unlike in hirschsprung when it does)
Refeeding syndrome is a potentially fatal complication of nutritional rehabilitation in anorexia nervosa. Why?
Carb intake stimulates INSULIN activity, which promotes cellular intake of phosphorous, potassium and magnesium and thiamine.
Clinical manifestations: arrhythmia, CHF, seizures, wernicke
Triple bubble sign on X-ray with bilious vomiting
jejunal atresia (likely due to a vasoconstrictive process, mom could have taken cocaine during pregnancy)