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500 Cards in this Set
- Front
- Back
Eye findings pathognomonic for child abuse.
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Retinal Hemorrhages
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Kid with fractures in various stages of healing. Diagnosis?
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Child Abuse
|
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Likely cause of stocking/glove burns.
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Child Abuse
|
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Child's story of injury does not match caretakers story.
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Suspect Child Abuse
|
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Child abuse can create what kind of fracture of the humerus or femur in a child less than 3?
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spiral fracture
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Shaking or jerking a child's limbs (abuse) can cause what kind of fracture?
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Bucket Fracture
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Rib fracture in what location is a clue to child abuse?
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Posterior
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When do you need further evaluation for child abuse in a child with genital trama.
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Always
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Under what age can you rule-in child abuse when you find an STD in a child?
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Pre-pubertal
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Classic inherited bone disorder often confused as child abuse.
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Osteogenesis Imperfecta
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Cigarette-like burns on a child. Rule this diagnosis out before calling it child abuse.
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bullous impetigo
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What is "coining"?
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alternative medicine in some cultures where skin is rubbed raw in certain areas by a coin
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Congenital skin condition common in Asian, East African, and Native American races which is commonly confused with child-abuse.
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Mongolian "Blue" Spot aka Congenital Dermal Melanocytosis
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4 STDs to test for when suspecting sexual abuse.
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Gonorrhea, Chlamydia, Syphilis, HIV
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CT head to look for what when you suspect child-abuse?
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subdural hematoma
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Can you be sued for reporting suspicious activity to child-protective-services?
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no
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Child with poor hygiene, poor social skills, behavioral abnormalities, or malnutrition. What social factor needs to be in the differential?
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Neglect (Child Abuse)
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Lithium is associated with what particular heart defect?
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Ebstein's Anomaly (tricuspid too inferior)
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What drug's teratogenicity profile resembles Fetal Alcohol Syndrome?
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Phenytoin
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Thalidomide, a classic teratogen, was found to cause defects where?
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limbs
|
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What infection causes congenital cardiac, cerebral, ophthalmic and auditory defects?
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Rubella
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What common disease of the American lifestyle is associated with an increase risk of congenital heart defects?
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DM
|
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What maternal metabolic disorder has a teratogenicity profile similar to Fetal Alcohol Syndrome?
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Maternal PKU
|
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Which shunt direction presents with cyanosis?
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right-to-left
|
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Noncyanotic heart diseases (3 D's)
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VSD, ASD, PDA
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Cyanotic heart diseases (5 T's)
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Truncus arteriosis, Transposition of the great Vessls, Tricuspid Atresia, Tetralogy of Fallot, Total Anomalous pulmonary venous return
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Most common congenital heart defect.
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VSD
|
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Why wait at least until after 12 months of age to fix a VSD in an asymptomatic child?
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most close spontaneously
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Murmur of a VSD.
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harsh holosystolic best at LLSB
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Cat like Cry in newborn. Diagnosis?
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Cri Du Chat
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Down Syndrome babies have a higher occurance of these 2 heart defects.
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VSD and ASD
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Common ECG changes even with small VSDs.
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LVH
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Diagnostic test for work-up of a congenital murmur.
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Echocardiogram
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Infant with VSD now has signs of Pulmonary Hypertension. Treatment?
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surgery
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Infant with VSD now has signs of CHF. Treatment?
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Medical: diruetics, inotropes, and ACEI
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Infant with VSD and his CHF is now not responding to medical treatment. Next step in management?
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Surgery to close defect
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Infant with recurrent respiratory infections found to have harsh holosystolic murmur. Cause of infections?
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VSD
|
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What is eisenmenger's syndrome?
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Left to Right shunt leads to Pulmonary Hypertension leads to Right to Left shunt.
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Blue when feeding, red when crying. Likely Diagnosis?
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Choanal Atresia
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How to confirm the diagnosis of choanal atresia?
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fails to pass NG tube
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Murmur of ASD.
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systolic ejection murmur best at ULSB w/ fixed split S2
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Fetal Alcohol Syndrome babies have a higher occurance of these 2 heart defects.
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VSD and ASD
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Holt-Oram syndrome means absent radii, first degree heart block, and this heart defect.
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ASD
|
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Common ECG changes with ASD (2).
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RVH and PR prolongation
|
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At what level of Pulmonary Hypertension is surgery indicated to close ASD in an infant?
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More than 2:1 Pulm to Systemic blood flow
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ASD with CHF in an infant. Treatment.
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Surgery to close defect
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Murmur of a PDA.
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Machine-like, continuous best at ULSB
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Pulse Pressure in PDA pt.
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wide
|
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This congenital/in-utero infection is associated with PDA.
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Rubella
|
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Males or Females more likely to have a PDA?
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Females
|
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Common ECG change with PDA.
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LVH
|
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Medication that closes PDA.
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Indomethacin
|
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Kid with PDA after 6 months despite Indomethacin. Treatment?
|
Surgical closing
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Cyanotic neonate with PDA. Treatment for PDA?
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Prostoglandin E1 analog to keep it open
|
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Top 4 differential diagnoses if neonate goes into shok.
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sepsis, IEM, PDA closes on ductal dependent heart defect, CAH
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Blue Neonate, Blue Infant, Blue Kid. What 3 respective heart defects?
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TGV (neonate), Tet of Fallot (infant), Eisenmengers e.g. VSD (kid)
|
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Genetic defect associated with Coarctation of the Aorta
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Turner's syndrome
|
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Valve malformation associated with Coarctation of the Aorta.
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Bicuspid Aortic Valve
|
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Asymptomatic hypertension in childhood. Echo may show what?
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Coarctation of the Aorta
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Coarctation of the Aorta shows what 2 signs on CXR?
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3 sign (pre&postdilation) and rib notching (collateral circulation)
|
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Immediate treatment for Coarcation of Aorta that presents with severe cyanosis in infancy.
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PGE1
|
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BP is decreased in leg compared to right arm in an infant. Diagnosis?
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Coarctation of the Aorta
|
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Differential Cyanosis (relatively higher O2 saturation in R arm) is pathognomonic for what?
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Coarctation of the Aorta
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Murmur with Coarcation of the Aorta
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short systolic murmur best in L Axilla
|
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Radiofemoral delay in an infant. Diagnosis?
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Coarctation of the Aorta
|
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Most common CYANOTIC congenital defect in newborns?
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Transposition of the Great Vessels (TGV)
|
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Rare genetic syndrome associated with TGV.
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DiGeorge Syndrome
|
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Most common CYANOTIC congenital defect in infants (4 to 18 months)?
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Tetralogy of Fallot; (Eisenmengers from VSD is in differential)
|
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Immediate treatment for Transposition of the Great Vessels (TGV)? (before surgery)
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PGE1
|
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Reverse Differential Cyanosis (deeper cyanosis Upper extremities compared to LEs) is pathognomonic for what?
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Transposition of the Great Vessels (TGV)
|
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DiGeorge CATCH22 mnemonic.
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Cardiac abnormalities, Abnormal facies, Thymic aplasia, Cleft palate, Hypocalcemia (tetany), 22q11 deletion
|
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"Egg Sillhouette" on CXR of cyanotic neonate. Diagnosis?
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Transposition of the Great Vessels (TGV)
|
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PROVo menomonic in Tetralogy of Fallot.
|
Pulmonary stenosis, RVH, Overriding aorta, VSD
|
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Maternal PKU is a risk factor for this congenital heart defect.
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Tetralogy of Fallot
|
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Toddler squatting for hypoxemia relief. Diagnosis?
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Tetralogy of Fallot (Tet spell)
|
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Murmur in Tetralogy of Fallot.
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systolic ejection murmur best at ULSB w/ single S2
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Common ECG changes with Tetralogy of Fallot.
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R axis dev. And RVH
|
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CXR shows boot shaped heart. What congenital heart defect?
|
Tetralogy of Fallot
|
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CXR shows increased vascular markings in these 2 congenital heart defects.
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ASD and VSD
|
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Severe pulmonary stenosis and early presentation of Tetralogy of Fallot. What immediate treatment (before surgery)?
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PGE1
|
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Treatment for Tet Spells.
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O2, morphine, propranolol
|
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1 month developmental milestone: social.
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makes eye contact
|
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2 month developmental milestone: gross motor
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lifts head/chest when prone
|
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2 month developmental milestone: social
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social smile (more than reflex smile)
|
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Four month developmental milestones: F sound mnemonic (2).
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Four: rolls Front to back (gross motor); lauGHs (social)
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Six month developmental milestones: "S" mnemonic.
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Sits, Switches objects hand-to-hand, Stranger anxiety
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When does a baby roll from back to front?
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5-6 months (just remember 6 months)
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How long to keep baby on back to sleep.
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Until can roll from back to front (usually 6 months)
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Non-specific "mama" or "dada" sounds. How old?
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9 months (remember it takes 9 mos to be a "mama")
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Immature pincer grasp (three fingers). How old?
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9 months
|
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Mature pincer grasp (tips of thumb and pointer finger). How old?
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12 months
|
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Gross motor developmental milestone at 12 months.
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Walks alone
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Language developement at age two years old.
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2 words together at 2 (2 word phrases); 1/2 understood by strangers
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Language developement at 2, 3, and 4 years old.
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2/4ths (1/2), 3/4ths, then 4/4ths (all) of language understood by strangers
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Language development at 3 years old.
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3 words together at 3 (3 word sentances); 3/4ths understood by strangers.
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Parallel play: how old?
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2 years old
|
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Group play: how old?
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3 years old
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4 years old fine motor skills: draws what?
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square or cross (4 sides at 4 years old)
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Copies a circle at how old?
|
3 years old
|
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Stacks 2-4 blocks at how old?
|
2 years old
|
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3 year old developmental milestones: "3" mnemonic for motor, language, and social.
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rides a TRIcycle, uses 3 words together, group play (3 or more people)
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Child took off his clothes and is found naked. How old is he at this milestone?
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2 years old
|
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Skipping is developmental milestone for what age?
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5 years old
|
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Head circumference rule of 3s, 9s, and 5s.
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birth=35cm, 3mo=40cm, 9mo=45cm, 3yr=50cm, 9yr=55cm
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Weight change as a function of Birth Weight (BW).
|
0-2wks=0.9xBW
2wks=BW 5mo=2xBW 12mo=3xBW 24mo=4xBW |
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Cooing milestone at what age?
|
2 months
|
|
Babblying milestone at what age?
|
6 months
|
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How many words at one year old?
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one: usually mama or dada (specific)
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|
Writes name and counts to 10. how old?
|
5 years
|
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How to calculate development in premature kids.
|
adjust for gestational age: use due-date as adjusted birth date
|
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Define Failure to Thrive (2).
|
on growth chart: persistently less than 5th percentile or crossing 2 major percentile lines
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in Failure to Thrive (FTT), list the usual order of falling off the curve: head, weight, height.
|
1st weight, 2nd height, 3rd head circumference
|
|
Average age of onset of puberty in girls.
|
10.5 years
|
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Average age of onset of puberty in boys.
|
11.5 years
|
|
Female usual order of progression of puberty.
|
thelarche
pubarche growth spurt menarche |
|
Male usual order of progression of puberty.
|
gonadarche
pubarche adrenarche growth spurt |
|
What is thelarche?
|
breast development
|
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What is gonadarche (male)?
|
testicular enlargement
|
|
age definition of delayed puberty (female) vs. primary amenorrhea
|
13 years w/ no developement=delayed puberty
14 years w/ no devo.=1*amenorrhea |
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16 year old has not had menarche, but has begun to develope pubic hair and breasts. Dx Amenorrhea?
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Yes, she has 1*amenorrhea
|
|
definition of delayed puberty in males.
|
no testicular enlargement by age 14.
|
|
Most common cause of delayed puberty.
|
consitutional growth delay (considered a normal variant despite the diagnosis of delayed puberty)
|
|
Definition of consitutional growth delay.
|
low on growth curve, but consistent growth (will eventually acheive target height potential)
|
|
precocious puberty age: girls vs. boys
|
under 8 in girls
under 9 in boys |
|
Memorize these 4 signs of autism (age 2 mo, 12 mo, 16 mo, and 24 mo).
|
no eye contact by 2 mo
no babbling by 12 mo no single words by 16 mo no 2-word phrases by 24 mo |
|
Simian crease; think what?
|
down syndrome
|
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Why do down-syndrome kids often have ASD or VSD?
|
endocardial cushion defects
|
|
What cancer is down syndrome associated with?
|
ALL
|
|
What neurologic disease is down syndrome associated with?
|
early alzheimer's
|
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More down syndrome babies have mothers with advanced maternal age. True or False.
|
False (women under 30 have way more babies, therefore, this group has more down syndrome babies total)
|
|
Mother with Down Syndrome baby due to Robertsonian translocation. What advice to give?
|
higher risk of recurrence
|
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2 most common pathologies (non-asian race) associated with "epicanthal folds."
|
Fetal Alcohol Syndrome and Down Syndrome
|
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Hirschsprung's disease found; consider what genetic disorder?
|
Down Syndrome
|
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2 GI pathologies associated with Down Syndrome
|
Hirschsprung's disease and duodenal atresia
|
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3 As and 3 Hs associated with Down Syndrome.
|
ALL
Alzheimer's ASD (and VSD) Hearing (and vision problems) Hirschsprung's Hypothyroidism |
|
Long philtrum and thin upper lip. Suspected Diagnosis?
|
Fetal Alcohol Syndrome
|
|
Percentage of people with Fetal Alcohol Syndrome with mental retardation? percent with learning disabilities?
|
25% MR; nearly 100% have learning disabilities
|
|
What percent of people with down syndrome are only "Mildly" retarded?
|
15%
|
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Usually death occurs in Edwards' syndrome (tri 18) and Patau's syndrome (tri 13) in what time period?
|
within 1 year of birth.
|
|
Edward's syndrome is trisomy of what chromosome?
|
18 (remember Edward is 6 letters and it is trisomy, so 6x3=18)
|
|
Patau's syndrome is trisomy of what chromosome?
|
13 (Patau has 5 letters and remember Edward's is chr. 18, so 18-5=13)
|
|
Patau's Syndrome (tri 13); remember P is for what?
|
Palate is cleft
|
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Edwards' Syndrome; remember E is for what? R is for what?
|
Eighteenth Chromosome; Rocker Bottom Feet
|
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Trisomy 13 often has what abnormality of the extremity?
|
polydactyly: remember 13 fingers
|
|
Remember these 3 things for Trisomy 18.
|
low-set ears, microagnathia, rocker-bottom feet
|
|
Remember these 3 things for Trisomy 13.
|
microphthalmia, microcephaly, polydactyly
|
|
Genetics of Klinefelter's
|
XXY
|
|
Tall stature, long extremities, and gynecomastia. What chromosomal abnormality is on the differential?
|
Klinefelter's
|
|
Test which confirms klinefelter's.
|
karyotype
|
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XXY versus fragile X: size of testicles.
|
XXY: small
Fragile X: large |
|
Asymptomatic Klinefelter's usually presents in what way?
|
infertility
|
|
Treatment for Klinefelter's.
|
testosterone
|
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Female with no barr body on karyotype. Diagnosis.
|
Turner's
|
|
why do turner's syndrome patients often present with swelling?
|
dysgenesis of the lymphatics causes lymphedema in hands and feet
|
|
Short stature, widely spaced nipples. Suspected diagnosis?
|
Turner's
|
|
Turner's associated with what heart abnormalities (2).
|
Coarctation of Aorta and bicuspid aortic valve
|
|
This chromosomal abnormality is observed with increased frequency in prisons.
|
XYY
|
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What chromosomal abnormality: tall, acne, antisocial behavior.
|
XYY
|
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What important preparation for PKU testing?
|
baby must eat a protein meal first
|
|
Long face, large jaw, large ears, and autism. Diagnosis?
|
Fragile X
|
|
Undiagnosed PKU presents what way? (2 besides mental retardation)
|
mousy urine odor
eczema/fair skin retardation |
|
Increase what in diet of PKU baby?
|
Tyrosine
|
|
CFTR is on what chromosome?
|
7
|
|
What race gets CF more often?
|
Caucasians
|
|
Why does Fragile X syndrome get worse in each successive generation?
|
Genetic anticipation from triplet repeat expansion
|
|
FTT and recurring sinopulmonary diseases. 1st on the differential?
|
CF
|
|
infants presenting with CF usually present this way.
|
Meconium ileus
|
|
Man presenting for infertility found to have congenital absence of the vas deferens. Diagnosis?
|
Likely Mild CF
|
|
Fat soluble vitamins.
|
ADEK
|
|
positive (suspected false) CF test on newborn screening. What follow-up test?
|
sweat chloride test
|
|
Treatment for CF related FTT: diet and supplements.
|
high calorie/high protein diet; supplement with pancreatic enzymes and vitamins ADEK
|
|
medical treatment for CF related pulmonary dxs (ABCD).
|
antibiotics, bronchodilators, corticosteroids, DNase
|
|
2 transplants to consider in CF patient
|
lung and pancreas
|
|
Niemann Pick disease: deficiency of what? Build up of what?
|
sphingomyelinase deficiency means build up of sphignomyelin cholesterol
|
|
Tay-Sachs disease: absence of what?
|
Hexosaminidase: remember tay-saX with heXose.
|
|
Cherry-red spot on macula. Diagnosis?
|
Tay-Sachs Disease
|
|
Tay Sachs is more common in what group?
|
Jewish decent
|
|
Prognosis for Tay-Sachs
|
death occurs by age 3
|
|
Tay Sachs presents with weakness and mental regression at what age?
|
3-6 months
|
|
Fabry's disease (X-linked lysosomal storage disease) causes ceramide trihexoside accumulation in these three organs increasing risk for:
|
kidney: renal failure
brain: stroke heart: MI |
|
Optic atrophy, spasticity, and early death because of galactocerebroside accumulation in the brain. What disease? (auto recessive lysosomal storage disease)
|
Krabbe's
|
|
Pt. with hepatosplenomegaly, anemia, and thrombocytopenia found "crinkled paper" cytoplasm in bone marrow cells. Caused by glucocerebroside accumulation in brain, liver, spleen, and bone marrow. What lysosomal storage disease?
|
Gaucher's disease
|
|
Accumulation of sulfatide in brain, kidney, liver, and peripheral nerves: what lysosomal storage disease?
|
metachromatic leukodystrophy
|
|
Deficiency in iduronidase that leads to corneal clouding and mental retardation. What lysosomal storage disease?
|
Hurler's syndrome
|
|
For difference between Hurler's Syndrome and Hunter's Syndrome (lysosomal storage diseases), remember this mnemonic
|
Hunters need to see to aim for the X. (Hunters=no corneal clouding, X-linked instead of Auto recessive)
|
|
Most common cause of bowel obstruction in first 2 years of life.
|
intussusception
|
|
Intermittent abdominal pain/cramp with vomiting in otherwise healthy kid; pain-free between episodes. Diagnosis?
|
intussusception
|
|
current jelly stool. Diagnosis?
|
intussusception (late)
|
|
Sausage shaped RUQ abdominal mass and abd. pain. Diagnosis?
|
intussusception
|
|
Untreated intussusception may progress to shock because?
|
blood flow is compromised which leads to necrosis
|
|
Meckel's diverticulum is a risk factor for this common cause of bowel obstruction.
|
Intussusception
|
|
Intussusception: Diagnosis? Treatment?
|
Air-Contrast Enema
|
|
When to consider surgery for intussusception? (3 reasons)
|
unstable
peritoneal signs (perforation) barium enema unsuccessful |
|
Classic metabolic derangement in pyloric stenosis.
|
Hypochloremic, Hypokalemic, Metabolic Alkalosis
|
|
Baby INITIALLY FEEDS WELL, then begins to vomit more and more often. Suspected diagnosis?
|
Pyloric Stenosis
|
|
Baby regurgitates and chokes on FIRST feed and not able to feed despite nursing coaching. Suspected diagnosis?
|
Esophageal atresia
|
|
Baby feeds fairly well, but often vomits after feeds. Suspected diagnosis?
|
Normal infantile GERD: "spitting-up"
|
|
Typical onset of symptoms in pyloric stenosis (age of infant).
|
3 weeks
|
|
Diagnostic of choice for pyloric stenosis.
|
Abd. U/S
|
|
"String sign" with barium X-ray is in Step 2 question: your differential based on age.
|
infant: pyloric stenosis (upper GI)
adult: Chron's (lower GI) elderly: Cancer (lower GI) |
|
Olive-shaped epigastric mass with no abdominal pain. Classic diagnosis?
|
Pyloric Stenosis
|
|
Infant with "projectile emesis." Diagnosis?
|
Pyloric Stenosis
|
|
Treatment for pyloric stenosis.
|
surgery (pyloromyotomy)
|
|
Immediate management of pyloric stenosis.
|
correct dehydration, hypokalemia, and alkalosis
|
|
Treatment for normal infantile GERD ("spitting-up").
|
thicken formula and sit baby upright while feeding
|
|
Meckel's rule of 2's (6 rules).
|
Most common in children under 2
2 times as common in males 2 types of tissue (pancreatic and gastric) 2 inches long found within 2 feet of ileocecal valve Occurs in 2 percent of the population |
|
What duct can create a Meckel's Diverticulum?
|
Omphalomesenteric (vitelline) duct
|
|
Sudden, painless rectal bleeding in 1 year old. Diagnosis?
|
Meckel's Diverticulum
|
|
Usual presentation of Meckel's Diverticulum.
|
usually incidental finding (asymptomatic)
|
|
Diagnostic test of choice for Meckel's Diverticulum.
|
scintigraphy scan (technetium-99m pertechnetate)
|
|
Treatment for Meckel's Diverticulum.
|
excision
|
|
Hirschsprung's Disease pathophysiology.
|
lack of ganglion cells in distal colon (uncoordinated peristalsis and decreased motility)
|
|
Presentation of severe Hirschsprung's (symptoms and age).
|
complete constipation, bilious vomiting, and FTT presenting at birth
|
|
Presentation of mild Hirschsprung's (symptoms and age).
|
chronic constipation presenting in childhood
|
|
Imaging study of choice for Hirschsprung's (not difinitive diagnosis).
|
Barium enema XR
|
|
Difinitive diagnositic test for Hirschsprung's.
|
full thickness rectal biopsy
|
|
What surgery for Hirschsprung's?
|
Coloectomy and Colostomy, followed by pull-through later
|
|
Bilious emesis at birth in Step 2 question. Your differential (based on stool habits).
|
Hirschsprung's: complete constipation
Volvulus: blood or mucus in stool (do AXR for possible NEC) |
|
Malrotation (e.g. Cecum in RUQ) and Ladd's bands (congenital) or Adhesions (postsurgery). Complications? (2)
|
prone to bowel obstruction and ischemia
|
|
Unstable newborn with bilious emesis. Work up?
|
emergent laparotomy
|
|
Stable newborn with bilious emesis. Work up?
|
AXR (r/o NEC) and EGD (r/o Malrotation); consider barium XR if constipated (Hirschprung's).
|
|
Management of bowel obstruction due to congenital malrotation.
|
NG decompression and IVF
|
|
Management of bowel ischemia due to volvulus.
|
emergent surgery
|
|
Biggest risk factor for NEC.
|
prematurity (but can occur in full-term as well)
|
|
Bloody stools in newborn. Diagnostic test?
|
serial AXRs (for NEC)
|
|
Pneumatosis intestinalis. Diagnosis?
|
NEC
|
|
When to consider surgery for NEC.
|
if worsening or unstable
|
|
Management of NEC (if stable).
|
nutrition: NPO, so TPN
sx: orogastric tube decompression ppx: antibiotics |
|
What does pneumatosis intestinalis look like.
|
air in bowel wall (double white line)
|
|
The feared complication of GI surgery in a child.
|
short bowel syndrome
|
|
What to remember about Lab findings in NEC.
|
they are non-specific, so you must maintain index of suspicion based on clinical picture
|
|
Chronic thrush in child. Suspect what?
|
immunodeficiency
|
|
50% of immunodeficiencies are this type of cell deficiency.
|
B-Cell
|
|
age of presentation of B-Cell immunodeficiencies
|
after six months (breast milk immunity wains)
|
|
age of presentation of T-Cell immunodeficiencies
|
1-3 months
|
|
Asplenia or splenic dysfunction (e.g. sickle cell) patients have what type of immunodeficiency.
|
complement deficiency
|
|
Recurrent mucous membrane infection and poor wound healing. What type of immunodeficiency?
|
phagocyte deficiencies (CGD, LAD, CHS, Job sx, MPD)
|
|
X-linked agammaglobulinemia (XLA) (Bruton's Agammaglobulinemia) is what type of cell deficiency and what gender?
|
Bruton's is B-Cell deficiency in Boys
|
|
Usual age of onset of Common Variable Immunodeficiency (CVID).
|
20s
|
|
Child presents at 1 year with 6 month history of recurrent pseudomonas, strep pneumo, and H. Flu infections. What specific immunodeficiency?
|
X-linked agammaglobulinemia (Bruton's) (or XLA)
|
|
Screening test for male with recurrent encapsulated infections which began at 6 months of age.
|
Quantitative immunoglobulin levels
|
|
Confirmation test for child with low Ig quantity (no 5th peak) and suspected X-linked agammaglobulinemia.
|
B-Cell and T-Cell subsets by flow cytometry (low B-Cells, usually high T-Cells)
|
|
Treatment for X-linked Agammaglobulinemia.
|
IVIG and prophylactic antibiotics
|
|
Treatment for CVID.
|
IVIG
|
|
Most common immunodeficiency (1/600).
|
IgA deficiency
|
|
Patient has anaphylactic transfusion reaction. What immunodeficiency is on the differential? Why?
|
IgA deficiency; reaction is due to formation of anti-IgA antibodies
|
|
Recurrent H. Flu and Giardia infections. What immunodeficiency? What diagnostic test?
|
IgA deficiency; do quantitative IgA levels
|
|
Why not IVIG for IgA deficiency (a B-Cell type deficiency).
|
anti-IgA antibodies will develop
|
|
Treatment for IgA deficiency.
|
treat infections as they arise
|
|
15-25% of patients with CVID get this cancer.
|
lymphoma
|
|
Screening test for CVID when patient in 20s gets recurrent pyogenic upper and lower respiratory infections.
|
Quantitative immunoglobulin levels
|
|
Confirmation test for child with low Ig quantity (no 5th peak) and suspected CVID.
|
B-Cell and T-Cell subsets by flow cytometry (low B-Cells)
|
|
Step 2 question shows Hypogammaglobulinemia. Your deferential based on age.
|
child over 6 months: XLA
adult in 20s: CVID |
|
what percentage of patients with CVID get an auto-immune disease (e.g. ITP or hemolytic anemia)?
|
25%
|
|
What infection to r/o when considering diagnosis of immunodeficiency.
|
always r/o HIV
|
|
Congenitally absent tonsils. What immunodeficiency?
|
XLA
|
|
What type of immunodeficiency is DiGeorge syndrome?
|
T-Cell deficiency
|
|
Test to screen for DiGeorge syndrome
|
absolute lymphocyte count (CBC w/ diff)
|
|
Treatment for DiGeorge syndrome.
|
BM transplant and IVIG
|
|
Baby with cleft palate, low set ears, and wide epicanthal fold. What feature in the question would clue you in to DiGeorge rather than a trisomy? (2)
|
More mild (older presentation); or can present with Tetany (hypocalcemia) in first days of life
|
|
what percent of SCIDs is x-linked?
|
50%
|
|
Frequent bacterial infections, thrush, and opportunistic infections in baby under 6 months. What immunodeficiency?
|
Severe Combined Immunodeficiency (SCID)
|
|
Oculocutaneous telangiectasias and progressive cerebellar ataxia; developmental delay. Found to have a DNA repair defect. What immunodeficiency?
|
ataxia-telangiectasia
|
|
Why try to avoid imaging with patients with Ataxia-Telangiectasia?
|
radiation induced cancers
|
|
Treatment for Ataxia-Telangiectasia?
|
no specific treatment; may need IVIG. Maintain high index of suspicion for associated cancer
|
|
Immediate management for baby with suspected SCID.
|
isolation
|
|
Treatment for SCID.
|
BM transplant and IVIG
|
|
Prophylaxis needed for SCID.
|
Jiroveci (e.g. TMP-SMX) and Fungal ppx
|
|
What percent of SCID is due to adenosine deaminase deficiency?
|
20%
|
|
No HLA expression and inherited auto-recessive. What type of (combined) immunodeficiency?
|
Bare-Lymphocyte syndrome.
|
|
Male infant or toddler with thrombocytopenia (bleeding) and h/o recurrent otitis media, Eczema, and Asthma. What immunodeficiency?
|
Wiskott-Aldrich Syndrome
|
|
Prognosis for Wiskott-Aldrich Syndrome.
|
Rarely survive to adulthood
|
|
Treatment for Wiskott-Aldrich Syndrome.
|
BMT; IVIG and antibiotics as needed
|
|
Why wear a helmet in Wiskott-Aldrich Syndrome?
|
prone to hemorrhage (thrombocytopenia etc.)
|
|
Chronic skin and bone infections. What immunodeficiency?
|
Chronic Granulomatous Disease (CGD)
|
|
This neutrophil oxygenation assay is used for diagnosing CGD.
|
TMP-SMX
Itraconazole IFN-gamma |
|
Three step prophylaxis for CGD.
|
TMP-SMX
|
|
Early omphalitits or delayed separation of the umbilical cord. What immunodeficiency?
|
Leukocyte Adhesion Deficiency (LAD)
|
|
Catalase positive skin infections (especially Staph and Aspergillis). What immunodeficiency?
|
Chronic Granulomatous Disease (CGD)
|
|
Common problem in GI and GU tracts in patients with CGD.
|
obstruction from granulomas
|
|
Treatment of colitis or granuloma obstruction in patients with CGD.
|
prednisone
|
|
Rare immunodeficiency syndrome that includes oculocutaneous albinism, neuropathy, and neutropenia.
|
Chediak-Higashi Syndrome
|
|
Treatment for Chediak-Higashi Syndrome
|
BMT
|
|
Wide nose, prominent forehead, doughy skin. What immunodeficiency?
|
Job syndrome (Hyper IgE)
|
|
Staph abscesses and Candida infections. Eczema is common. No thrombocytopenia. What immunodeficiency?
|
Job syndrome (Hyper IgE)
|
|
Appropriate vaccinations for terminal complement deficiencies.
|
Meningogoccal Vaccine
|
|
Hereditary Angioedema (episodes lasting hours provoked by stress; can be life-threatening) is what type of immunodeficieny?
|
Complement deficiency (C1 esterase deficiency)
|
|
Test for Complement Deficiency.
|
CH50
|
|
Use this before surgery in patients with complement deficiency C1 esterase.
|
purified C1 esterase and FFP
|
|
CRASH and Burn mnemonic for Kawasaki Disease criteria.
|
High fever for AT LEAST 5 days and:
Conjunctivits Rash (truncal) Adenopathy Strawberry tongue/mouth Hands and Feet red/swollen |
|
Age for Kawasaki Disease.
|
under 5 years old
|
|
Classic race for Kawasaki Disease.
|
Asian
|
|
Why Aspirin for acute Kawasaki Disease?
|
sx treatment (inflammation and fever)
|
|
Two part treatment for Kawasaki Disease.
|
IVIG and ASA
|
|
Why IVIG for Kawasaki Disease?
|
prevent coronary aneurisms
|
|
Why Aspirin for 6 weeks after Kawasaki Disease?
|
reduces risks (possible coronary aneurism and MI)
|
|
What regular follow-up is necessary after Kawasaki Disease?
|
Echocardiograms
|
|
Treatment for Juvenile Idiopathic Arthritis (JIA) (3).
|
1. NSAIDS
2. Corticosteroids 3. Immunosuppression (Methotrexate or Etanercept) |
|
Usual RF and ANA results in Juvenile Arthritis.
|
RF negative, ANA positive
|
|
Morning Stiffness for over six weeks in patient under 16 years old. Meets criteria for this diagnosis?
|
Juvenile Idiopathic Arthritis (JIA) - formerly JRA
|
|
Child with recurrent high fever, hepatosplenomegaly, rash, and Morning Stiffness in joints. Diagnosis?
|
Still's Disease (Systemic Onset Arthritis)
|
|
3 most common Acute Otitis Media (AOM) pathogens.
|
Strep pneumo, H. Flu, Moraxella cat.
|
|
When to give antibiotics in AOM? (3 age ranges)
|
under 6 months: always
6-24 months: if certain of diagnosis or if severe (high fever) 2-12 years old: if severe (high fever) |
|
Usual AOM antibiotic regimine.
|
Amoxicillin 80-90 mg/kg/day for 10 days
|
|
Add Clavulonate to Amoxicillin for AOM if (2 criteria)?
|
if failed Amoxicillin (H. Flu or Moraxella suspected) or if severe sx (high fever)
|
|
Treatment option to consider with chronic/recurrent AOM.
|
tympanostomy tubes
|
|
Most common cause of bronchiolitis.
|
RSV (often used interchangeably)
|
|
Age of RSV.
|
under 2
|
|
Season of RSV.
|
fall and winter months; longer in Florida
|
|
What 3 indications for RSV prophylaxis with RespiGam or Synagis (during RSV season).
|
premature, chronic lung disease, or congenital heart disease
|
|
How to diagnose RSV bronchiolitis.
|
clinically: fever and wheezing; NG aspirate not needed
|
|
When to hospitalize kid with RSV.
|
if under 3 months
if Desaturation or unstable if RFs: premature, cardio, or pulmonary disease |
|
Outpatient treatment for RSV bronchiolitis.
|
hydration and nebulizers
|
|
Inpatient treatment for RSV bronchiolitis (other than hydration and nebulizers)
|
O2 if needed, albuterol if it works
|
|
2 year old with stridor: most probable diagnosis (90%)?
|
croup (laryngotracheobronchitis)
|
|
What is the "steeple sign" in Croup?
|
XR shows subglottic narrowing of the trachea
|
|
Triple therapy if Croup requires hospital admission.
|
O2, IM corticosteroids, nebulized epinephrine
|
|
Age of Croup patient.
|
under 3 years
|
|
Age of Epiglottitis patient.
|
3-7 years
|
|
Age of Tracheitis patient.
|
under 2 years
|
|
Peritonsilar vs. Retropharyngeal abscess: classic associated symptoms.
|
Peritonsilar: can't open mouth (trismus)
Retropharyngeal: supine with neck extended |
|
Most common cause of Croup.
|
parainfluenza
|
|
Most common cause of pertionsilar and retropharyngeal abscesses.
|
Group A Strep (pyogenes)
|
|
Child with muffled voice and drooling. Retropharyngeal abscess vs. Epiglottitis: what is their posture?
|
Abscess: supine with neck extended
Epiglottitis: seated (tripod) with neck extended |
|
What does the "thumb print" on XR classically indicate?
|
Epiglottitis
|
|
Why has the etiology of Epiglottitis changed over the last 30 years?
|
H. Flu decreasing incidence since vaccination
|
|
Most common cause of Tracheitis.
|
Staph Aureus
|
|
Age of Peritonsillar Abscess patient.
|
usually over 10 years old
|
|
Age of Retropharyngeal Abscess patient.
|
6 months to 6 years
|
|
What is different on exam with peritonsillar abscess?
|
affected tonsil is deviated medially (no imaging necessary for diagnosis)
|
|
Diagnosis of Retropharyngeal Abscess (since there is no change visible on exam like Peritonsillar).
|
CT
|
|
Treatment of Retropharyngeal Abscess.
|
incision and drainage; antibiotics
|
|
Treatment of Peritonsillar Abscess
|
incision and drainage (+/- tonsillectomy); antibiotics
|
|
Immediate management if epiglottitis suspected.
|
intubate in OR
|
|
IV antibiotic for epiglottitis.
|
Ceftriaxone or Cefuroxime
|
|
Why should you not use a tongue depressor aggressively if evaluating for epiglottitis?
|
it may provoke airway spasm and collapse
|
|
Headach, high fever, nuchal rigidity. Diagnosis?
|
meningitis
|
|
Top 3 causes of meningitis in kids under 6 years old.
|
e. coli, s. pneumo, n. meningitis
|
|
How to remember Kernig and Burdzinski's signs for meningeal irritation.
|
K=Knee extension pain, B=bowed neck pain
|
|
Neonate with lethargy, poor tone, bulging fontanelle, low temperature, and vomitting. Diagnosis?
|
meningitis or encephalitis
|
|
What bacteria causes meningitis associated with petechial rash?
|
Neisseria Meningitidis
|
|
Most common causes of aseptic (viral) meningitis.
|
enterovirus (e.g. echovirus or coxsackie virus)
|
|
If testing LP for bacterial meningitis, what 2 things do you do first?
|
CT to check for ICP elevation, and order empiric antibiotics
|
|
Neonate with suspected meningitis: what empiric antibiotics?
|
Ampicillin and Gentamicin (or Amp and Cefotaxime)
|
|
Child with suspected meningitis: what empiric antibiotics?
|
Ceftriaxone and Vancomycin
|
|
HSV encephalitis panel ran as an add-on to LP for suspected meningitis. What must you do as well?
|
Start empiric Acyclovir
|
|
What bacteria causes Whooping Cough?
|
Bordetella Pertussis
|
|
What is the vaccine to prevent Whooping Cough?
|
DTaP
|
|
Why do we vaccinate to prevent whooping cough if immunity usually wains by adolescence?
|
Pertussis is lifethreatening in infants; milder infection in older children.
|
|
Three stages of whooping cough.
|
1) catarrhal (URI sx): 1-2 weeks
2) paroxysmal (cough): 2-3 months 3) convalescent (getting better) |
|
Whooping Cough patients report emesis even without nausea. Mechanism?
|
post-tussive gag reflex
|
|
Which of the 3 stages of whooping cough is the most contagious stage?
|
catarrhal
|
|
When to hospitalize kid with Pertussis.
|
if less than 6 months
|
|
Treatment for Pertussis.
|
Erythromycin x 14 days to patient and close contacts.
|
|
When can a kid go back to school after Pertussis (2 options).
|
After 3 weeks of sx or after 5 days of antibiotics
|
|
What is another name for Rubeola?
|
Measles
|
|
What causes Erythema Infectiosum (Fifth Disease)?
|
Parvovirus B19
|
|
Aplastic crisis in sickle cell or severe iron deficiency patients. Cause?
|
Parvovirus B19
|
|
Erythema Infectiosum (Fifth Disease) rash and progression.
|
maculopapular, pruritic; Starts on arms then spreads to trunk and trunk and legs
|
|
slapped cheek rash. Diagnosis?
|
Erythema Infectiosum (Fifth Disease)
|
|
Mom's rash not so bad, but congenital infection is associated with fetal hydrops and death. Viral Exanthum?
|
Erythema Infectiosum (Fifth Disease): Parvovirus B19
|
|
Erythema Infectiosum (Fifth Disease) prodrome characteristics.
|
usually none; sometimes low grade fever
|
|
What virus causes measles (Rubeola)?
|
Paramyxovirus
|
|
Measles (Rubeola) prodrome charcteristics.
|
The 3 c's: Cough, Coryza, and Conjunctivitis
|
|
What are Koplik's spots?
|
small irregular red spots with central blue/gray specks (associated with measles)
|
|
Measles (Rubeola) rash and progression.
|
maculopapular; head to feet
|
|
Rare complication of Measles used on House Season 1 Episode 2.
|
Subacute Sclerosing Panencephalitis
|
|
What virus causes Mumps?
|
Mumps virus
|
|
Bilateral Parotitis in non-vaccinated patient. Diagnosis?
|
Mumps
|
|
Males past puberty who develop Mumps have 30% risk of this complication.
|
Orchitis
|
|
The 3 day measles or German Measles.
|
Rubella
|
|
What virus causes Rubella?
|
Rubella virus
|
|
Clinical presentation of Rubella
|
low-grade fever; the "not-so-ill" measles
|
|
Rubella rash and progression.
|
macupapular, tender; face to trunk to extremities
|
|
What virus causes Roseola Infantum (Sixth Disease)?
|
HHV-6
|
|
Prodrome of Roseola Infantum (Sixth Disease)
|
3 days of high fever (usually over 40); no other sx
|
|
Rash of Roseola Infantum (Sixth Disease) and progression.
|
maculopapular rash appears as fever breaks; trunk to face and extremities
|
|
Most common cause of febrile seizures.
|
Roseola Infantum (Sixth Disease): due to rapid fever onset
|
|
What virus causes Chicken Pox?
|
Varicella Zoster Virus (VZV)
|
|
Prodrome of Varicella.
|
MILD fever, no appetite, malaise (for 24 hours before rash)
|
|
Teardrop on rose petal. Diagnosis?
|
Varicella
|
|
Congenital Rubella Syndrome (triad)
|
neuronal deafness, PDA or ASD, cataracts
|
|
Varicella rash description and progression.
|
vesicular lesions at different stages of healing; generalized at onset
|
|
Why vaccinate women who have never had chicken pox?
|
Prevent Congenital Varicella Syndrome
|
|
VZV vaccine effects on Zoster.
|
halves the incidence of zoster rash and lowers incidence of post-herpetic neuralgia by 2/3s!
|
|
What is the first symptom of Zoster?
|
dermatomal neuralgia
|
|
What test to order in young patient with Herpes Zoster?
|
HIV (Zoster is more likely when patient is immunocompromised)
|
|
Remember this complication can occur with any of the viral exanthums.
|
Encephalitis
|
|
What causes Hand-Foot-Mouth disease?
|
Coxsackie A virus
|
|
Rash description and location in Hand-Foot-Mouth disease.
|
maculopapular vesicular; located on hands, feet, and mouth AND BUTTOCKS
|
|
APGAR mnemonic.
|
Appearance
Pulse Grimace Activity Respiratory |
|
What is the intermediate range of APGAR scores that requires at least stimulation and observation.
|
4 to 7
|
|
Which type of hyperbilirubinemia in neonate is always pathologic (2)?
|
conjugated (direct) or any jaundice in first 24 hours
|
|
How to remember if Conjugated and Unconjugated is direct or indirect?
|
consanants (c=d) and vowels (u=i)
|
|
Pathophysiology of Kernicteris.
|
bilirubin deposition in the basal ganglia, pons, and cerebellum.
|
|
Neonatal jaundice now with high pitched cry, lethargy, poor feeding, and seizures. Likely Diagnosis?
|
Kernicteris
|
|
First 2 tests in work-up for neonatal jaundice with direct hyperbilirubinemia.
|
Observe stool (pale?) and test Urine: UA and Cx
|
|
Work-up for neonatal jaundice with direct hyperbilirubinemia that is normally done on all newborns anyway.
|
newborn metabolic screening
|
|
2 most common causes of direct hyperbilirubinemia on newborn screen.
|
galactosemia and hypothyroidism
|
|
imaging study to order if source for direct hyperbilirubinemia in neonate.
|
U/S or HIDA scan
|
|
7 tests to evaluate liver function (for neonatal hepatitis) in neonate with direct hyperbilirubinemia (LFT panel plus 3 more)
|
Alk Phos, AST, ALT, albumin, INR, blood glucose, and ammonia levels
|
|
in neonate with direct hyperbilirubinemia, what test will confirm elevated Alk Phos indicates obstruction as responsible for cholestasis?
|
gamma glutamyltransferase (GGT)
|
|
Fairly common inherited cause of direct hyperbilirubinemia in a neonate that is also associated with lung disease and diarrhea.
|
Alpha 1 antitrypsin deficiency
|
|
Rotor syndrome, Dubin-Johnson, Gilberts, and Crigler-Najjar syndrome: which hereditary cause of hyperbilirubinemia is NOT benign?
|
Crigler-Najjar (direct hyperbilirubinemia which predisposes to kernicteris)
|
|
Jaundice neonate who is febrile. Immediate work-up?
|
full sepsis work-up: blood cxs and LP
|
|
What mnemonic to remember for infections that may cause neonatal jaundice.
|
TORCH
|
|
Normally, when does jaundice present (physiologic)?
|
after 72 hours
|
|
Unconjugated bilirubin over what level is considered pathologic in a neonate?
|
15 mg/dL
|
|
If jaundice lasts longer than this, needs monitoring or further work-up.
|
1 week (2 weeks if preterm)
|
|
Treatment if suspecting breast-milk juandice.
|
increase frequency of feeds (hydration)
|
|
What non-rare mutation more common in caucasions can also cause neonatal hyperbilirubinemia?
|
CF (do a sweat test)
|
|
What to test in mom (as well as in baby) when neonate has pathologic jaundice.
|
blood type and coombs test
|
|
Tracheoesophageal fistula presentation.
|
aspiration on first feed as well as copious salivation
|
|
Treatment for Tracheoesophageal fistula.
|
Surgery
|
|
Air in GI tract on AXR; how to confirm tracheoesophageal fistula?
|
bronchoscopy
|
|
Congenital diaphragmatic hernias usually (90%) on this side.
|
Left
|
|
Presentation of congenital diaphragmatic hernia.
|
respiratory distress
|
|
U/S in utero suggests congenital diaphragmatic hernia. What confirmatory test?
|
post-natal CXR
|
|
Gastroschisis vs. Omphalocele: anatomic location of hernia
|
Gastroschisis: NEXT TO umbilicus (no sac)
Omphalocele: AT the umbilicus (into amniotic sac) |
|
Gastroschisis vs. Omphalocele: which one requires emergent surgery?
|
Gastroschisis (no sac, so peritoneum exposed)
|
|
C-Section can prevent Omphalocele sac rupture. What to do if it does rupture?
|
emergent surgery
|
|
Double Bubble on AXR. Diagnosis?
|
Dudodenal Atresia
|
|
Triple Bubble on AXR. Diagnosis?
|
Jejunal Atresia
|
|
Hyperbilirubinemia in Neonate above 20. Treatment?
|
exchange transfusion
|
|
Hyperbilirubinemia in Preterm Neonate (above 10). Treatment?
|
phototherapy
|
|
Ground Glass appearnace of CXR. Diagnosis?
|
Respiratory Distress Syndrome
|
|
What causes Respiratory Distress Syndrome
|
surfactant deficiency
|
|
Respiratory Rate over 60/min with hypoxemia and increased respiratory effort. Diagnosis?
|
Respiratory Distress Syndrome
|
|
CXR findings in Transient Tachypnea of the Newborn?
|
prominent perihilar streaking
|
|
Sign of probable Meconium Aspiration
|
green amniotic fluid
|
|
Newborn with patchy infiltrates on CXR, neutropenia. Suspected diagnosis?
|
pneumonia
|
|
Mom's at risk for baby with RDS: what prophylaxis to mom if under thirty weeks?
|
corticosteroids
|
|
If over 30 weeks gestation, how to tell if baby needs mom to get corticosteroid prophylaxis for RDS?
|
L/S ratio less than 2:1 indicates need
|
|
Most common presenting sign of Cerebral Palsy.
|
Delayed motor development
|
|
Most common movement disorder in children.
|
Cerebral Palsy (CP)
|
|
Intrauterine infection, perinatal asphyxia, and prenatal trauma all are risk factors for nperinatal neurologic insult which can result in this.
|
Cerebral Palsy (CP)
|
|
Common neuro co-morbidity with CP.
|
Seizure Disorder
|
|
What percent of CP patients have normal cognition?
|
10%
|
|
Toe walking and scissor stepping is called what?
|
spastic gait
|
|
Imaging of choice in older children to diagnose CP.
|
MRI
|
|
Treatment for spasticity of CP.
|
baclofen etc.
|
|
Typical age in Febrile seizures.
|
6 months to 5 years
|
|
Work-up for Febrile seizures under 12 months.
|
sepsis work up (find infection)
|
|
Work-up for Febrile seizures over 18 months
|
none needed if not concerned about CNS infection
|
|
Why avoid Aspirin in children?
|
Reye's syndrome
|
|
Work-up for Febrile seizures if longer than 15 minuts.
|
EEG and MRI
|
|
When to treat a Febrile seizure (diazepam or phenobarb).
|
if complex (more than 15 minutes, focal, or more than 1 in 24 hours)
|
|
What is the increase risk of Epilepsy disorder after a Febrile seizure?
|
no increased risk
|
|
Most common childhood malignancy.
|
ALL
|
|
Top 3 childhood malignancies
|
1) ALL
2) CNS 3) Lymphomas |
|
AML is more common than ALL in this cohort of children.
|
Black
|
|
Most patients with neuroblastoma are under this age.
|
under 2 years old
|
|
Nontender abdominal mass in child under 2. Diagnosis.
|
Nueroblastoma
|
|
Nontender abdominal mass in 2-5 year old.
|
Wilm's Tumor
|
|
WAGR Syndrome. W is for Wilm's Tumor. What is A for?
|
Aniridia (no iris)
|
|
Beckwith-Wiedemann syndrome has hemihypertrophy (one side of body is bigger than the other). What is the associated cancer?
|
Wilm's Tumor
|
|
Why get a CXR when suspecting Leukemia?
|
rule out mediastinal mass
|
|
Peripheral smear characteristic in Leukemia.
|
more than 90% lymphoblasts
|
|
What does immunophenotyping of a BM aspirate do in work-up for leukemia?
|
finds the exact type of cell that has undergone monoclonal expansion
|
|
Chemo for Leukemia often has this initial complication.
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tumor lysis syndrome
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what is tumor lysis syndrome (3 things) (caused by chemo)
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hyperkalemia, hyperphosphatemia, hyperuricemia
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How to treat tumor lysis syndrome
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allopurinal, urine alkalinization, diruetics and fluids, reduced phosphate intake
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What is chloroma (greenish soft-tissue tumor on skin or spinal cord) associated with?
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AML
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Treatment for neuroblastoma.
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resection then chemo or radiation
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Why chemo/radiation after resection of neuroblastoma.
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most patients have metastases at presentation
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How to assess kidney damage in Wilm's tumor.
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regular way: BUN, Crt, UA
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Why do a CT chest and abdomen in patient with Wilm's tumor?
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check for metastases
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Treatment of Wilm's tumor
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resection (plus nephrectomy) then chemo and radiation
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Ewing sarcoma and Osteosarcoma: systemic symptoms?
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Ewins: yes (fever, fatigue)
Osteosarcoma: rare |
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Ewing sarcoma and Osteosarcoma: which one more commonly has metastases?
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Osteosarcoma: metastes to lung in 20% (profoundly worse prognosis)
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2 childhood bone tumors which are important to differentiate.
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Ewing's and Osteosarcoma
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Child bone tumor presentation.
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local pain and swelling
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Ewing sarcoma and Osteosarcoma: location?
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Ewing's: midshaft of longbones
Osteosarcoma: metaphysis (near knee or shoulder) |
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Onion skin periosteal reaction on plain xray. What bone tumor?
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Ewing's Sarcoma
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Sunburst lytic bone lesion. What bone tumor?
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Osteosarcoma
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Treatment differences between Ewing Sarcoma and Osteosarcoma
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Ewing's responds to radiation; both need resection and chemo
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Most common cohort to get bone cancer in childhood.
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Male adolescents
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Most common primary childhood bone tumor.
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Osteosarcoma
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Water heater anticipatory guidance.
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keep temperature of water under 48.8 C or 120 F
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When can a child face forward in car seat?
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current guidelines say at 1 year and over 20 lb (some say 2 years)
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When to introduce solid foods (age)?
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6 months or more (introduce no more than one per week)
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When to introduce cow milk (age)?
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12 months or more
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Syrup of Ipecac recommendations.
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not recommended anymore for poisoning; just call poison control
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Leukoria (lack of red reflex). Top 3 ddx.
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retinoblastoma, congenital cataracts, retinopathy of prematurity
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Strabismus can be considered normal until what age?
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3 months
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Treatment of Strabismus.
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cover the normal eye
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Why treat Strabismus?
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to avoid Amblyopia (permanently suppressed vision in a mis-aligned eye)
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Tested false contraindications to vaccinations (3)
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mild illness, current antiobiotics, premature
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Vaccine schedule in a premature infant.
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give as normal and NOT according to adjusted age for gestation
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Egg allergy is a contraindication to these two vaccinations.
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MMR and Influenza
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3 live vaccines
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MMR, Polio, Varicella
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Avoid live vaccines in what 2 patient types?
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Immunocompromised or pregnant
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Seizure after DTaP. Which one is the culprit, and should be avoided in follow up vaccinations?
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Pertussis; give Dyptheria and Tetanus by themselves later
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Routine screening ages (2) for Lead poisoning (for high risk areas.)
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12 and 24 months
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Homes built before this year considered at high risk for lead-exposure
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1950
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Neuropathy of lead poisoning.
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Wrist or foot drop
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Lead level 45-70: treatment?
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chelation with inpatient EDTA or outpatient oral succimer (DMSA)
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Lead level over 70: treatement?
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chelation with inpatient EDTA and intramuscular dimercaprol (BAL)
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Lead level under 45: treatment?
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enviornmental changes; retest in 3 months
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CBC and peripheral smear results for Lead Poisoning.
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microcytic anemia with basophilic stippling
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