Flashcards in Uworld + NBME Deck (313):
Type 1,2,4 RTA:
Describe urine pH
1: distal, above 5.5
2: proximal, below 5.5
4: below 5.5
Which of the RTA's is associated with high potassium?
Causes of Type 1,2,4 RTA
1: poor H+ secretion
2: poor bicarb resorption
3: aldo resistance
(1= H+1, 2= BI)
What syndrome is most commonly associated with Type 2/ proximal RTA
What disorders may be associated with RTA 1?
Autoimmune: Sjogrens, Rheumatoid
Most common presentation RTA
-low bicarb/ normal anion gap acidosis
Sun screen guidelines:
SPF 15-30 or higher
apply 30 mins before exposure
reapply every 2 hours
Diagnosis associated with:
-recurrent sinopulmonary infection
-absent lymph tissue
Pnuemocystis pneumonia in a baby is suggestive of
Diagnosis associated with:
-failure to thrive
ADA deficiency (SCID)
Recurrent severe infection with staph, serratia, aspergillus is assc with with condition?
Chronic granulomatous disease
Niemann Pick vs Tay Sachs enzyme deficiencies :
+ inheritance pattern, age of onset
-Niemann Pick: sphingomyelinase
-Tay Sachs: hexosaminadase
both are AR, onset at 2-6 months
Symptoms assc with both tay sachs and neimann pick
-failure to thrive
-cherry red macula
How are neimann pick and tay sachs distginuished?
-tay sachs: no HSM, hyperreflexia
-neimann pick: HSM, areflexia
On imaging, where are trachea and esophagus located?
(on lateral view)
C1 inhibitor deficiency is assc with what condition?
Gold standard for diagnosis of muscular dystrophy
genetic testing, not muscular biopsy.
Do health departments track vaccine refusal?
Cause of strokes in kiddos
Sickle Cell Anemia
Condition most commonly predisposing to orbital cellulitis
DOC for px in cat bites?
Most common bacteria assc?
-pasteurella multocida (anaerobe)
Diagnosis assc with:
anion gab acidosis
radiopaque substances in abdomen
Treatment for iron to
Whole body convulsions + umbilical stump infection:
Dihydrorhadamine + nitroblue tetrazolium tests are used to diagnose what condition?
Treatment for cat scratch disease
Contrast TB and CSD adenitis
TB adenitis is nontender
Bacteria in dog/ cat mouths causing cellulitis
What animals carry salmonella?
What is the presentation of salmonella?
Common causes of acute lymphadenitis
Treatment of radial head subluxation
hyperpronation of forearm
Describe tennis elbow
-caused by excessive extensor use
Describe golfers elbow
What is Panner disease?
osteochondritis of the capitellum
loss of pronation/supination
Treatment for tinea corporis
Congenital rubella findings
-sensorineural hearing loss
Congenital toxo findings
Congeital varicella findings
Signs of deliberate scald injury
-sparing of the flexor surfaces
-lack of splash marks
-sharp line of demarcation
When is significant microcytosis seen in iron deficiency anemia?
When Hct drops well below 30
Treatment with what vitamin improves measles
Most common cause of vaginal bleeding in the neonate
Maternal withdrawl of estrogen
Neonatal chlamydia effects
Ddx excess testosterone + low LH in boys
-exogeneous use (not in younger kiddos!)
Signs of viral vs strep pharyngitis
-viral: cough, rhinorrhea, ulcers, conjunctivitis
-bacterial: exudates, edema, no viral symptoms
Treatment of strep pharyngitis
Symptoms of galactokinase deficiency
Symptoms of galactosemia (G1PUTD def)
Most common cardiac defect in trisomy 18
Karyotype assc with Kallmans
Treatment of neonates with Hep B exposure
HepB IVIG + Vaccination
Common manifestation of chronic constipation
How does constipation cause bladder infections?
Frequent UTIs + parenchymal scarring suggests ____.
Definition of precocious puberty in girls
puberty before age 8
Mass causing precocious puberty in girls
granulosa cell tumor
ADA def --> T cell failure --> B cell dysfxn
Treatment of SCID
stem cell transplant
Cause of noninfectious hydrocephalus in low birth weight baby
Treatment of chlamydial conjunctivitis
Most common symptom assc with sickle cell trait
CD19 cells are what type? CD3 cells are what type?
CD19- B cells
CD3- T cells
Leukocyte Adhesion Deficiency symptoms
-skin infections without pus, poor wound healing
-delayed cord separation
Treatment of tourettes
-A receptor agonists
-catalase + organisms: staph, serratia, burkholderia, aspergillus
Most common heart defect seen in Downs
-Complete atrioventricular septal defect
Life threatening GI condition in neonates with VLBW
Abdominal xray finding in NEC
-visible air in bowel wall
-portal venous air (pneumatosis intestinalis)
Afebrile bone pain in SCA cause:
-osteonecrosis (avascular necrosis)
Reyes Syndrome histo findings
-microvesicular fatty infiltration of the liver
3 bugs patients with SCA are susceptible to
Jaundice type assc with breast milk jaundice
within 2 weeks of birth
Biliary jaundice type
within 8 weeks of birth
Von Gierkes assc enzyme + metabolic findings
Glucose 6 Phosphatase
Ocular trachoma findings
Cause of anemia with ^ LDH in SCA
Primary ciliary dyskinesia:
-mutation in ?
-low nasal ?
Contraindications to breast feeding (maternal)
-active TB (until 2 weeks antiTB therapy)
-varicella infection 5 days before- 2 days after delivery
Breast feeding reduces maternal risks of which cancers?
Contraindications to breast feeding (neonatal)
In addition to improved immunity, how does breast feeding benefit baby?
-improved GI function
-decreased risk cancer, DM1, NEC
Most common cause of osteomyelitis
Cause of osteomyelitis in:
Prosthetics: staph epi
Diarrhea, Dermatitis, Dementia
Beefy red tongue
=deficiency of ?
B1, thiamine deficiency
high homocysteine levels
B6 deficiency, pyridoxine
Absence seizures are assc with what psych condition?
Cardiac rhabdomyoma + renal angiomyolipomas are assc with?
Cataplexy is assc with _____
Tourettes syndrome is assc with what other psych condition?
Optic Gliomas are assc with what syndrome?
(+café au lait; neurofibromas)
Most common GI anomaly
Drug assc with rash in mononucleiosis
Thymus location in neonate on CXR
Rt sided, triangular
Cause of edema in Turners syndrome
dysgenesis of the lymphatic network
Contrast syncope and seizure
Syncope= immediate return to consciousness
Seizure= delayed return to baseline consciousness
Contrast measles and rubella
measles= high fever, usually over 104, takes several days to spread
rubella= rash spreads 1 day, lower fever
*both spare hands, feet*
Location of adenopathy in measles vs rubella
measles- cervical adenopathy
rubella- posterior auricular, suboccipital adenopathy
Describe disseminated gonococcal presentation
-rash (vesiculopustular race sparing face)
Describe RMSF rash
-wrists ankles ----> centripetal spread
Secondary syphilis rash
-full body including palms and soles
Rash assc with varicella
-vesicular, appears in successive crops
Symptoms assc with Celiacs
Describe appearance of dermatitis herpetiformis in celiacs
vesicular rash on extensor surfaces
Risk factors for celiacs
-autoimmune disease (DM1, thyroiditis)
Abrupt onset changes in mood, bedwetting, academic difficulties = must rule out
Chronic stridor in an infant is termed
How is laryngomalacia diagnosed? treated?
laryngoscopy, will spontaneously resolve within 18 months
Most common primary immune deficiency?
Causes anaphylactic reaction to ....?
Selective IgA deficiency
Most common cause of hip pain in children?
abduction, external rotation
CRP greater than 20
White count greater than 12k
ESR greater than 40
Most common cause of proteinuria in children
transient proteinuria --> caused by fever, stress, exercise etc
Followup for isolated event of proteinuria
two subsequent tests
(if continue to be negative, benign condition, no further workup)
Treatment of impetigo
Pertussis exposure prophylaxis
azithromycin for all contacts
Time of pertussis vaccination
serum sickness --> MC cause = B lactams, sulfa drugs
Growing pain features
-bilateral lower extremities
-primarily at night
Constitutional growth delay is assc with _____
delayed bone age
Hypothyroid assc growth pattern
-abrupt falling off of curve
-delayed bone age
When is VZV vaccination given?
1 & 4 years
+post exposure prophylactic vaccination with exposure between 1-4 years. (use VZIG only if immunodeficient)
How often should vision screen be done in kiddos?
every well child visit
When is meningococcal vaccination given?
11-12 --> booster at 16
When is rotavirus vaccination given?
In addition to binge eating and temper tantrums, what are some features of prader willis? (4)
-small hands and feet
Pure red cell aplasia + triphalangeal thumbs
Wiskott Aldrich triad
Causes of idiopathic aplastic anemia
-chemicals (benzene, phenylbutazone)
-drugs (chloramphenicol, sulfa)
When is transient erythtroblastopenia of childhood typically diagnosed? MCV value?
After 1 year of age
Most common congenital cause of aplastic anemia
X linked --> chromosomal breaks
-features that are "small"
-eye and ear anomalies
-hypopigmentation + café au lait
-small stature, head, gonads, thumbs
-strabismus + low set ears
Leading cause of B12/cobalamin deficiency
pernicious anemia/ IF deficiency
Diagnosis of turner
Pelvic U/S --> streak ovaries
Karyotype analysis= 45 XO
-microangiopathic hemolytic anemia
-acute kidney injury
Ferritin increases with ______
inflammation, it is an acute phase reactant
Lab finding assc with pyloric stenosis
hypochloremic metabolic alkalosis
Idiopathic avascular necrosis of the hip in young boys
Legg Calve Perthes disease
Most common population with SCFE
obese adolescent boys
PE finding in SCFE
pts hold hip externally rotated/ fail to internally rotate
Pineal gland mass signs
-limited upward gaze
-upper eyelid retraction
-pupils respond to accommodation but not light
(dorsal MIDBRAIN SYNDROME!!)
What is Colliers sign?
upper eyelid retraction caused by pinealoma
Ab mediated dancing eyes and feet:
opsoclonus myoclonus syndrome
Hep B infection is a risk factor for what type of nephropathy?
How is membranous nephropathy diagnosed?
more than 3g/day protein excretion
Most common infection assc with focal segmental sclerosing glomerulonephritis
Most common cause of nephrotic syndrome in preadolescent children
minimal change disease
Most common cause of nephritic syndrome
post streptococcal glomerulonephritis
How does medulloblastoma lead to hydrocephalus
4th ventricle obstruction
In addition to rockerbottom feet, overlapping digits....
What are other physical characteristics of trisomy 18?
-low set ears
-limited hip motion
What two organ systems are affected by trisomy 18?
Trisomy 13 effects
-midline defects (holo, omphalocele, microphtalmia)
Typical location Mongolian spots + management
buttocks, totally benign
Bedwetting is normal up to what age?
5; may intervene after age 5 with alarm or DDAVP
How is pulmonary function tested in GBS?
Maneuvers that increase the murmur of HCOM
(all decrease preload)
Maneuvers that decrease the murmur of HCOM
hand grip (^afterload)
squatting (^pre+after load)
passive leg raise (^preload)
CT finding in retropharyngeal abscess
widened prevertebral space
Retropharyngeal abscess assc bugs
usually polymicrobial including staph aureus, strep pyo, and anaerobes
Cyclical vomiting is common in kiddos diagnosed with _______
Most common cause of congenital hypothyroid
Lymph nodes in what region are always abnormal?
Enzyme assc with Lesch Nyhan
Marfans genetic cause
AD mutation of fibrillin 1
Chemicals for lyme prevention
Endoscopy is recommended how long after caustic ingestion
within 24 hours
Contrast Ca/ Po content in breast milk v formula
more in formula but better gastric absorption in breast milk
Medial deviation of forefoot only=
metatarsus adductus --> recovers spontaneously
Medial deviaton of forefoot + hindfoot=
clubfoot= serial manipulation and casting
Ddx of rash in neonate
first two weeks, spares palms and soles
Appearance of coxsackie herpangina vs herpetic gingivostomatitis
coxsackie: gray, posterior oropharynx
HSV: clusters, posterior oropharynx, erythematous gingiva
Treatment of herpangina vs herpetic gingivostomatitis
Triple bubble sign cause
jejunal atresia -- vascular accident
Defintive diagnosis of lead poisoning
venous lead levels
(capillary= false +)
At what level of lead is chelation therapy begun?
45+ DMSA, succimer
-improved with NSAIDs
Symptom associated with vaso-occlusive hand foot swelling in SCA
#1 risk assc with RSV
Who gets palivizumab for RSV px?
preterm less than 29 weeks
congenital heart disease (hemodynamically significant)
Hammer toes + ataxia in males=
Freidrichs, AR, GAAepeat
MC COD in Freidrichs
When does milk protein enterocolitis onset?
spontaneous resolves by 1 year
Amenorrhea with evidence of uterus--> next diagnostic step =
Treatment for Jervell Lange Neilsen/ Romano Ward
propranolol + pacer
Contrast JLN and RW
JLN: AR, hearing loss
RW: AD no loss hearing
Both= K+ channels
BB that is avoided in long QT syndrome
Sotalolol, also class III anti-arrhythmic, blocks K+ channels = long QT
2 MC common causes viral myocarditis
When is renal/ bladder US indicated in children?
less than 24 months first febrile UTI
Treatment for vaginal foreign body in kiddos
irrigation with warm fluid
How long should a breath holding spell last
less than 1 minute
Cause of newborn jaundice in Asian baby
decrease hepatic uridine diphosphogluconuate glucuronosyltransferase activity (UGT)
Trendelenburg sign cause
SGN/gluteus minimus weakness
Risks assc with IUGR:
hypo- calcemia, glycemia, thermia
asphyxia, meconium aspiration, hypoxia
Management of central precocious puberty
-GnRH analog therapy
Contraindications to rotavirus vaccination
-anaphylaxis to ingredient
-history of inussusception, uncorrected malformation of GI tract
Timing of rotavirus vaccination
Treatment of acute abnormal uterine bleeding
-high dose estrogen, progestin, OCPs
Most common cause of abnormal uterine bleeding in adolescents
immature HPA axis --> anovulatory cycles
How to dx meckels diverticulum
technetium 99m pertechnetate scan
Rule of 2s for meckels diverticulum?
2:1 male: female ratio
2% symptomatic at age 2
within 2 feet of the ileocecal valve
Key symptom of meckels
How is intussusception diagnosed? treated?
U/S --> air enema
Workup of newborn bilious emesis
Abdominal xray to rule out perforation -->
contrast enema to distinguish between hirschsprungs and meconium ileus
(M.I.= obstruction at terminal ileus, hirschsprungs= colon)
Erythema chronicum migrans = what?
localized lyme disease
Treatment of lyme disease meningitis and heart block?
Treatment of localized lyme disease in kiddos under 8 + preggos
Which NF type is assc with megalocephaly?
How are pituitary adenomas and craniopharyngiomas distinguished on CT/MRI?
craniopharyngioma has calcifications
Treatment of hydrocele
reassurance... most resolve by 12 months
Most common bug in KIDS with CF?
Treatment of pneumonia in kids with CF?
cefepime (MSSA) + vanc (MRSA)
MC cause otitis externa
Treatment of croup
steroids + epi(if mod ---> severe)
Cause of bilateral chemosis in 5-14 day old?
MC cause of eye discharge in babies?
dacryostenosis (no conjunctival/eyelid inflammation)
Treatment of ocular misalignment
patch or cycloplegic drops for NORMAL eye
Testing needing for patients with emphysema
CXR to rule out PTX
Two GI complications assc with HSP
ECG and CXR findings assc with tricuspid atresia
-decreased pulmonary markings
-left axis deviation
-tall P waves
Peripheral smear finding in SCA
Howell Jolly Bodies
Cause of recurrent sinopulmonary & GI infections AFTER 6 months?
X linked agammaglobulinemia
Treatment of minimal change disease
Angular cheilosis + normocytic anemia cause
B2 (riboflavin) def
Cheilosis, irritability, glossitis, stomatitis cause
B6, pyridoxine def
Punctate hemorrhages, corkscrew hair, gingivitis cause
scurvy, vit C def
MCC causes of bilateral lymphadenopathy
2 most common causes of acute unilateral lymphadenitis
Radiographic sign of compartment syndrome
triangular large fat pad surrounding bone
Acute otitis media:
-most common bugs
-strep pneumo, h flu, m cat
-10 days amoxicillin
Three foodborne diseases that present with mainly VOMITING
Foodborne illnesses with WATERY, noninflammatory diarrhea (5)
Most common bacterial cause of rhinosinusitis
strep pneumo, h flu
followed by mcat
(same as AOM)
21 hydroxylase def causes elevation of what hormone?
Several weeks ear drainage + failed abx = suspicion for
First line treatment for epiglottitis
(not steroids + racemic epi!)
Virus assc with atopic dermatitis
(painful vesicles, crusting, fever, lymphadenopathy)
impaired cytoskeleton regulation
Café au lait spots + precocious puberty
McCune Albright, cAMP kinase defect
GI polyposis + mucocutaneous pigmentation, estrogen producing tumor =
Syndrome assc with McCune Albright
3 P's of McCune Albright
-polyostotic fibrous dysplasia
How is measles transmitted
Myotonic Dystrophy genetic cause
AD CTG repeat DMPK gene
COD in MD
respiratory/ cardiac failure
Duchenne/Becker genetic causes
XR absence vs decrease in dystrophin
Neuroblastoma origin cells
neural crest cells
+ metabolic acidosis
cause and treatment
Humoral deficiency assc with:
-lw B cells + Igs
-low IgA, IgG
-low B Cells + Ig's: X linked agammaglobulinemia
-low Igs: CVID
-low IgA: IgA Def (MC)
-low IgA, IgG: Hyper IgM
-Low IgG: IgG subclass def
Treatment of stroke in SCA
Prolonged arthropathy in hemophilia cause
UMN findings in down syndrome should raise suspicion for
Lymphocytes (as opposed to myelocytes) are + for what markers?
Lumbar Puncture + abx--> which comes first in meningitis management?
lumbar puncture unless acutely unstable
First step in management of CDH
CABs! endotracheal intubation
Treatment in ITP
if asymptomatic --> observe
if symptomatic --> steroids/ IVIG
Most common predisposing factor for bacterial sinusitis
Back pain + neuro dysfunction + palpable step off =
Most common location for spondylolisthesis
L5 over S1
Fluid type used for stabilization
normal saline, no dextrose until maintenance fluids are began
Evanescent pink rash is assc with _____
JIA lasts how long?
more than 6 weeks joint pain
Pain at patellar tendon insertion site
Osgood Sclatter/ traction apophysitis
Site of patellar tenson insertion
Treatment for Osgood Schlatter
Cyanosis that improves with crying
Treatment of pyloric stenosis
stabilize with fluids/ correct electrolytes --> surgery
In addition to prematurity, what four factors increase the risk of respiratory distress syndrome?
Palpable mass assc with torticollis
What should be avoided for stabilization in case of cardiac lesions?
Intubation --> not effective for cardiogenic shock
Motion assc with absence seziures
HSP glomerular abnormality assc
mesangial deposition of IgA
How does knee-chest position alleviate cyanotic spells in TOF?
increases systemic vascular resistance --> increased pulmonary blood flow
Refeeding syndrome is caused by a surge in _____
SCFE symptoms in boys younger than ten may be caused by
Legg Calve Perthes Disease
(limited internal rotation/ abduction)
Harsh systolic ejection murmur at LUSB + Single S2 =
What are the four types of hypersensitivity reactions?
Type I: immediate, IgE
Type II: cytotoxic, IgG/IgM autoantibodies
Type III: antibody, antigen complex
Type IV: delayed, Tcell/ macs
Three examples of Type III hypersensitivity:
Autoimmune hemolytic anemia + goodpastures syndrome are what types of hypersensitivity reactions?
Type II, cytotoxic, IgG/IgM autoantibodies
Falling with object in mouth may cause what vascular injury?
carotid artery dissection = hemiplegia
MC cause urinary tract obstruction leading to Potters?
posterior urethral valves
1st line therapy for bedwetting
alarm --> desmopressin --> tricyclics
Ddx of acute stridor
foreign body aspiration
Ddx of chronic stridor
Cause of anemia of prematurity
Risk assc with orchiopexy
Two causes of neonatal botulism
ingestion of spores from environmental dust
ingestion of preformed toxins from food
Treatment of paraphimosis
urgent reduction of prepuce
In addition to macrosomia, macroglossia, hemihyperplasia, what defects are seen in BWS?
abdominal wall defects, monitor abdominal US + AFP
Tumors assc with BWS
Chromosome assc with BWS
Three complications of Mumps
Treatment for scabies
mesdiastinal mass + anemia + high ferritin =
midline mass in abdomen w/ calcifications=
linear consolidation in lung lobe at birth
cough + post-tussive emesis - fever=
infantile UTI appropriate abx therapy
-ulcers on lips + tongue
-agitated + drooling
Treatment for HTN emergency
air fluid level at tympanic membrane-
otitis media with effusion
Causes of calcium deficiency with ^^PTH
1) lack of intake/sun
3) liver disease
5) renal osteodystrophy
6) Vd dep Type 1
Causes of PO4 def without ^^ PTH (5)
1) Genetic Primary Hypophosphatemia
3) RTA II
5) Phosphate malabsorption
Vitamin D Dep II is caused by
End organ resistance to 1,25 D3
Most common non-nutritional tickets cause
Genetic primary hypophosphatemia (XD)
(Poor 1,25 D formation and PO4 absorption)
Rachitic rosary and tetany are seen in what rickets type?
Nutritional, not familial
Vitamin D Dep II cause + inheritance pattern
AR, poor 1,25 D formation
Cause of ricketts as scheduled with malignancy
PEX protein ----> excess PO4 loss in urine and poor 1,25 D formation
Two substances found in urine with fanconis
What RTA is assc with urinary loss of PO4?
RTA II (proximal)