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415 Cards in this Set
- Front
- Back
- 3rd side (hint)
What are the 5 portions of the APGAR score?
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Appearance
Pulse (HR) Grimace Activity Respirations |
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Dx:
A lump on the face after a foreceps delivery |
Subcutaneous Fat Necrosis
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Dx:
rash that starts after the first day of life as a flat reddish area with a central papule that becomes a pustule and persists for a couple of weeks Test? |
Erythema Toxicum
test: Wright stain of vesicular fluid will show Eosinophils |
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Dx;
Strawberry rash of newborn with difficulty breathing |
Epiglottic Hemangioma
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Dx:
sharply demarcated bruise-like appearance on sacral area of newborn |
Mongolian spots
(do not confuse w/ Abuse, which is not sharply demarcated) |
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Dx:
orange/yellow warty lesion on the scalp in newborn that displaces hair growth Tx? what can it lead to? |
Nevus sebaceous
Tx: leave alone until Adolescence (should go away) leads to: 15% chance to become malignant |
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Dx:
scalp swelling that crosses suture lines and goes away in a few days |
Caput
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Dx:
scalp swelling that does not cross suture lines and goes away in a couple of months cause? |
Cephalohematoma
cause: Subperiosteal bleed |
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When do anterior fontanels normally open and close?
Posterior? |
Anterior:
opens: birth closes: 9 - 18 months Posterior: opens: sometimes at birth closes: 4 - 5 months |
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what is possible diagnosis if:
1. both fontanels are enlarged? 2. One fontanel only is enlarged? |
1. Hydrocephalus
2. Hypothyroidism |
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Newborn eye:
White reflex |
Retinoblastoma
(another source: MCC is Congenital Cataracts) |
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Newborn eye:
lens opacity |
Cataracts
(possible Galactosemia) |
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Newborn eye:
Aniridia and hemihypertrophy (one side of body larger then other) |
Wilms Tumor
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Dx:
blue baby pinks up on crying confirmatory test? |
Choanal Atresia
test: Catheter doesn’t pass thru nose |
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MC abdominal mass in newborn
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Polycyctic Kidney disease
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when should an umbilical hernia close?
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by 5 months
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which has a sac--Omphalocele or Gastroschisis?
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Omphalocele
(“O” is like a closed sac) |
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what should be avoided in a patient with Epispadias or Hypospadias?
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do NOT circumsize
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how long can undescended testis remain undescended before you need to bring them down?
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one year
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MC type of Ambiguous genitalia
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Congenital Adrenal Hyperplasia
(21-hydroxylase deficiency is the MC of the CAH) |
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Dx:
newborn has a mass on the right anterior, superior chest and crepitus on exam Tx? |
Clavicle fracture
(MC newborn fracture) Tx: None (will heal on its own) |
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MC birthing brachial plexus injury?
what nerve roots? another name for this injury? |
Erb-Duchenne
roots: C5-C6 (C4: if ipsilateral diaphragmatic paralysis also) another name: “waiter’s tip” – wrist flexed |
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birthing injury where baby has hand extended and fingers flexed
what nerve roots? another name for this injury? |
Klumpke
roots: C8-T1 another name: “claw hand” |
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What are the (3) 'diseases' tested for during a newborn screening?
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1. PKU
2. Galactosemia 3. Hypothyroidism |
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Dx:
baby born with Mental retardation, Eczema, musty odor, fair hair, fair skin and blue eyes |
PKU
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Dx:
baby born with Jaundice, Hypoglycemia, and Cataracts genetic inheritance? what is contraindicated in this baby? |
Galactosemia
(Autosomal Recessive) Contraindication: Breastfeeding |
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Dx:
Newborn with Jaundice, mottled, constipation, Large tongue, Umbilical hernia what is seen on blood test? |
Hypothyroidism
blood test: high TSH, low T4 |
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Dx:
pre-term baby with ground glass appearance on CXR Tx? (2 in order) |
Respiratory Distress Syndrome
Tx: 1. Surfactant 2. Ventilation |
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Dx:
baby delivered by C-section has a Rapid respiratory descent but after 72 hours of Tachypnea, then gets better; CXR shows possible fluid in the fissure |
Transient Tachypnea of newborn
(when delivered by C-section that do not get a vaginal squeeze and then don’t expel amniotic fluid) patient does not need respiratory support (a main way to differentiate) |
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What are the 3 differences b/t physiologic and pathologic jaundice?
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Physiologic:
1. Appears >24 hours of age 2. peaks at or below 12.9 by 3 days 3. resolves by 1 week Pathologic: 1. Within first day of life 2. Level >13 3. Lasts > 1 week |
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MC type of pathologic Jaundice?
Tx? |
Hemolysis
(Rh or ABO incompatibility) Tx: Phototherapy |
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Dx:
newborn with Jaundice within 8 hours of birth, a Direct bilirubin increase; Acholic (or clay-colored) stools |
Biliary Atresia
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Aside from certain meds, what are the (6)* main contraindications of offering newborn breast milk?
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“A Healthy Toddler Gladly Sucks Vitamins”:
AIDS; Herpes if breast lesions; TB (active, untreated); Galactosemia; Syphilis; Varicella |
“A Healthy Toddler Gladly Sucks Vitamins”
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How many calories are in baby formula?
When can Whole milk be started? When should Iron supplementation begin? |
Formula: 20 cal/oz
whole milk: > 1 year-old Iron: > 6 months old |
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What test can be done in newborn to test for Turner's syndrome?
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Buccal smear
(to test for Barr Bodies) |
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definition:
child is short but expect a growth spurt at a later age |
Constitutional Delay
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MCC for childhood obesity?
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take in too many calories and don't burn enough off
(don't be tricked and look for a pathologic cause) |
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when do most reflexes disappear?
which (2) don't at this time? what time do they disappear? |
reflexes disappear: 4 - 6 months
except: Babinski: until 18 months; Parachute: never |
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Rule for Cube stacking in child
(give 3 milestones) |
“3 + 4 = 7” are the milestone cubes
…start with 3 and (and multiply by 5 to get first date), then from first date in months is +3 (for 4), then +3, +3 (for 7): 3 cubes at 15 months 4 cubes at 18 months 7 cubes at 24 months |
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MCC for Enuresis
First Tx? |
Primary Nocturnal
(usually a male child that is just a deep sleeper) Tx: 1. Give it Time 2. Alarms 3. Meds (Imipramine; DDAVP) |
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In the severely immunocompromised, what vaccination do you not give?
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MMR
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what 3 vaccinations are contraindicated with an allergy to neomycin?
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1. IPV
2. MMR 3. Varicella |
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which vaccination do you give:
child > 2 yo who has not been vaccinated if they have immunodeficiency of any kind, are asplenic or lack splenic function (sickle cell) |
Pneumococcus spp.
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which vaccination is contraindicated in patient who has streptomycin allergy?
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IPV
(also CI if they have neomycin allergy) |
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what 2 additional vaccinations are required specifically if patient is asplenic?
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1. Meningococcal
2. Pneumococcus spp. |
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MCC of Meningitis in:
Neonate |
Group B Strep
(from mother) |
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MCC of Meningitis in:
Patient > 2 months old |
Pneumococcus
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MCC of Meningitis in:
College or Military (sexually active) |
N. Meningococcus
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What is the first step in a suspected meningitis of any age?
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IV Ceftriaxone
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MCC of Meningitis in:
Elderly, HIV+, steroid user (immunocompromised) |
Listeria
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When should Ampicillin be added to the treatment of meningitis?
(2) When should Vancomycin be added? |
Ampicillin:
1. Listeria (as bug) 2. Neonates Vancomycin: Pneumococcus |
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Dx:
Lymphocytic meningitis, rash on wrists and ankles moving centrally Tx? |
Rocky Mountain Spotted Fever
Tx: Doxycycline (and Ceftriaxone for meningitis prophylaxis) |
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Differential for Lymphocytic meningitis and next test for each
(3) |
Test: IgG and IgM Serology
1. Rocky Mt. Spotted Fever 2. Lyme disease Test: India Ink (or cryptococcal antigen) 3. Cryptococcus |
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Treatment for meningitis caused by Cryptococcus
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Amphotericin
(then Fluconazole to take home) |
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What are the causes of CSF with very high protein and very low glucose?
(2) |
1. TB
2. fungal |
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What should be given prophylactically for a sneaker puncture of a pin that enters the foot?
For what bug? |
TMP-SMX
for: Pseudomonas |
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Bug causing septic arthritis from a dog or cat bite?
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Pasturella
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Pediatric patient without immunization history has coughing spasms, inspiratory whoop, facial petechiae and leucocytosis with lymphocytosis.
(2) possible confirmatory tests Tx? |
Pertussis
tests: 1. Positive cultured Nasopharyngeal washings 2. Rapid Fluorescent antibody stain Tx: Erythromycin |
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What can Fifth's disease lead to?
what can it cause in unborn child if mother has it? |
leads to:
Aplastic Anemia in unborn child: Hydrops |
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Dx:
three-day rash and lymphadenopathy |
Rubella
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what 2 test should be run if suspecting acetaminophen toxicity?
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1. Acetaminophen level in blood
2. LFTs |
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A child swallowed a bottle with no lable and has Sx of:
Hypernea/Tachypnea, Fever, N/V, Dehydration, Seizures, agitation, tinnitus Fastest diagnostic test? |
Aspirin toxicity
fastest test: Urine Ferric Chloride Test |
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what acid/base problems does Aspirin toxicity cause in a child?
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Respiratory Alkalosis w/ Metabolic Acidosis
(high pH, low pCO2 and bicarb) Tx: Charcoal |
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A child swallowed a bottle with no lable and has Sx of:
Tachycardia, HTN to Hypotension, confusion, drowsiness, dilated pupils, Seizures, Widened QRS; Ventricular arrhythmia Tx? (2) |
Tricyclic Antidepressant toxicity
Antidote/Tx: (1) Gastric Lavage/Charcoal (2) Sodium Bicarbonate (to alkalinize blood for arrhythmias) |
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What is the first test if you suspect a TCA toxicity?
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ECG
(will show Widened QRS, Ventricular arrhythmia) |
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A child presents with swallowing kerosene.
What is the primary objective? What are the first (2) tests? What are (2) Tx? |
objective:
Prevent Aspiration resulting in Chemical Pneumonitis tests: 1. CXR 2. Blood Gas Tx: 1. Prevent aspiration 2. avoid gastric lavage |
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a child swallows something from an unlabled bottle:
diarrhea, excessive urination, miosis, bradycardia Test? Tx? |
Organophosphate (insecticide) toxicity
test: Plasma Cholinesterase activity Tx: Atropine w/ Pralidoxime chloride |
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a child swallows an unlabled bottle of pills:
drowsey, delirius, hallucinate, N/V, DRY state, dilated pupils Test? Tx? |
Antihistamines
Test: Drug screen Tx: Physostigmine (if severe) |
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a child swallows an unlabled bottle of pills:
signs of hemorrhagic gastroenteritis (bloody diarrhea), N/V, diarrhea, acute liver failure, shock, coma Test? Tx? |
Iron pill overdose
test: Serum Iron level Tx: Deferoxamine |
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MCC of conjunctivitis in newborn (less then 24 hours-old)
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Chemical
(from Silver Nitrate drops) |
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MCC of infectious conjunctivitis in newborn
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Chlamydia
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Medical term:
Conjunctivitis within the first month of life |
Ophthalmia Neonatorum
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Difference in presentation b/t viral vs. bacterial conjunctivitis
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Viral:
Crusting of eyelid; Clear discharge Bacterial: Mucopurulent discharge |
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At what age is strabismus still normal?
What can it lead to if it is prolonged? |
Normal: up to 4 months old
leads to: Amblydopia |
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Dx:
2 yo child has a "lazy eye" Dx tests? (2) Tx? |
Amblydopia
tests: 1. Hirschberg test (shine light directly into eye and look to see if it falls at an angle) 2. Cover test (cover good eye and lazy eye will move straight ahead) Tx: Patch good eye (causes pt to use lazy eye; must be done early in life) |
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Child presents with a painful buldging eye; eyeball does not move when testing muscles
Dx test? Tx? (2 possible) |
Orbital Cellulitis
Dx test: CT Scan Tx: 1. Cefuroxime with Clindamycin, or 2. Ampicillin/Sulbactam |
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Child presents with swelling of eyelids and surrounding tissue; eye moves when checking ROM
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Preorbital cellulitis
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Tx for a large Retinoblastic tumor of the eye
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Enucleation
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Definition:
Otitis Media w/ Osteomyelitis of the bony canal or mastoid Bug? what Dz is it associated with? |
Malignant Otitis Media
bug: Pseudomonas Assoc Dz: Diabetes |
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What is the specific bug that produces a positive on throat swab culture?
Tx? (3 possible) (2) possible complications? |
Group A Strep
(A not B) Tx: 1. Penicillin 2. Erythromycin 3. Clindamycin complications: 1. Rheumatic Fever 2. Glomerulnephritis |
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Dx:
High fever, tonsil bulges, uvula deviates to non-involved side, "hot potato voice" Bug? Tx? (2 together) |
Peritonsillar Abscess
bug: Group A Strep Tx: 1. Drain abscess 2. Penicillin (Erythromycin if allergy) |
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Dx:
High fever, sore throat and ulcers scattered on the soft palate, tonsils and pharynx cause? Tx? |
Herpangina
cause: Coxsackievirus Tx: None...will go away |
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Dx:
High fever, sore throat and ulcers scattered on the soft palate, tonsils and pharynx, plus similar lesions on palms and soles |
Hand-Foot-and-Mouth disease
(Coxsackievirus) |
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Dx:
child with sudden onset respiratory distress, wheezing; hyperinflated lung on one side and tracheal deviation to the opposite side |
Foreign body aspiration
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Dx:
4 year-old that presents with a Barking cough with Inspiratory stridor Dx Test? Tx? (2 together) Tx if advanced or an emergency? |
Croup (Parainfluenza virus)
Test: P/A neck film: STEEPLE SIGN Tx: (1) Humidified air (2) Steroids beneficial Emergency: Racemic Epinepherine |
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Dx:
Dysphagia, Drooling, muffled voice, leaning forward to maximize air entry Bug? Dx test? Tx? (2) |
Epiglottitis
(EMERGENCY) Cause: H. flu type b (HIB) Dx Test: Lateral Neck: THUMBPRINT SIGN Tx: (1) Secure Airway CHERRY RED EPIGLOTTIS (seen w/ intubation) (2) antibiotics |
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Dx:
patient less then 2yo had a cold, then Wheezing, rales, tachypnea, Accessory muscles are used during respiration MCC? Dx test? (2) Prevention (for those predisposed)? |
Bronchiolitis
MCC: RSV Dx test: (1) Rapid assay from Nasal secretions (2) CXR (Hyperinflation) Prevention: Palivizumab – Monoclonal antibodies |
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MCC of death in 1 - 12 month-old children
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SIDS
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What are the (3) main Right-to-Left shunt developmental Heart disorders?
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1. Tetralogy of Fallot;
2. Transposition of the great vessels; 3. Tricuspid Atresia |
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What are the (3) main Left-to-Right shunt developmental Heart disorders?
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1. VSD
2. ASD 3. PDA |
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What are the (3) main "Mixed" developmental Heart disorders?
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1. Truncus Arteriosus
2. TAPVR 3. Hypoplastic LH |
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Dx:
Continuous murmur w/ wide pulse pressure heard in the upper left sternal border Tx? |
PDA
Tx: Indomethicin |
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Dx:
Apical Click followed by a late-systolic murmur |
Mitral Prolapse
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Dx:
Holosystolic murmur best heard at the Apex |
Mitral Regurgitation
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Dx:
Mid-diastolic murmur followed by opening Snap |
Mitral Stenosis
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Dx:
Systolic ejection murmur best heard at the left upper sternal border and a mid-diastolic murmur at the lower left sternal border; Fixed S2 |
ASD
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Dx:
Loud harsh pansystolic murmur heard in the Lower left sternal border What can it lead to? |
VSD
(MC heart defect) Leads to: Eisenmenger’s syndrome (VSD shunt reverses right to left when the PVR exceeds the SVR) |
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Dx:
VSD shunt reverses right to left when the PVR exceeds the SVR |
Eisenmenger’s syndrome
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Dx:
CHF early in life including a feeding difficulty, sweat while feeding and tachypnea; loud harsh pansystolic murmur heard in the Lower left sternal boarder What is it Associated with? |
Endocardial cushion defect
(Subclass of VSD and ASD; also known as “Common AV canal”) Assoc w: Down's Syndrome |
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Dx:
Weak/delayed/absent lower extremity pulses, HTN What is seen on CXR? What Dz is it assoc with? |
Coarctation of the Aorta
CXR: Rib notching Dz: Turner's Syndrome |
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(4) heart defects of the Tetralogy of Fallot
MC presenting Sx? |
"PROVe"
1. Pulmonary stenosis 2. RV hypertrophy 3. Overriding Aorta 4. VSD MC presenting Sx: Cyanosis |
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Dx:
Cyanosis; Single second heart sound; Murmur Heard in Upper left sternal border What is seen on CXR? |
Tetralogy of Fallot
CXR: Boot-shaped heart |
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Dx:
MCC of cyanosis in the first 24 hours of life; loud single S2 What is seen on CXR? Tx (aside from airway) until surgery? |
Transposition of Great Vessels
CXR: "Egg on a string" (ECG will show right axis deviation and RVH) Tx: Prostaglandin (to keep PDA open until surgery) |
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Dx:
CHF w/i weeks of birth; Systolic Ejection murmur in the Left sternal border; Single S2; Wide Pulse Pressure; bounding arterial pulses What Dz is it assoc with? |
Truncus Arteriosus
(Single arterial vessel arising from the base of the heart that goes to the coronary, systemic AND pulmonary circulation) Assoc with: DiGeorge Syndrome (22q11 microdeletion) |
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Dx:
single S2 pansystolic murmur with a CXR showing a Heart that looks like Snowman or Figure 8 |
Total Anomalous Pulmonary Venous Return
(TAPVR) |
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Dx:
Loud, palpable S2 without murmur; Common cause of heart failure in first week of life. What can Patient develop? |
Hypoplastic Left Heart
(Underdevelopment of left cardiac chambers, atresia or stenosis of aortic and/or mitral orifices, and hypoplasia of the aorta) Patient develops Metabolic Acidosis |
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What are the (5) parts of the Major criteria for Rheumatic Fever?
What is Ailment is it assoc with? |
Major (JONES) Criteria:
(2 of these = Rheumatic fever) J = Joints ♥ = carditis (O looks like a heart) N = Nodules (subcutaneous) E = Erythema marginatum S = Sydenham’s chorea Assoc with: Strep throat (GAS) |
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MCC of HTN in infants or children?
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Renal disease
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MCC of Diarrhea in children
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Rotavirus
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Dx:
watery to bloody Diarrhea, N/V, fever, possible neurologic Sx, caused by ingesting poultry or raw eggs Tx? |
Salmonella
Tx: Hydration only (no Abx - they prolong Dz) |
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Tx for diarrhea from Shigella
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TMP-SMX
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Tx of diarrhea from Campylobacter
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Erythromycin
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Tx for diarrhea from C. Difficile
(2 together) |
1. Metronidazole
2. Vancomycin |
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First test if suspecting Hirshprung's Dz
Diagnostic test? |
First: Barium Enema
Dx test: Colon Biposy |
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Dx:
chronic problem in infant consisting of cough, vomiting and apnea Dx test? |
GERD
Dx test in infant: pH probe |
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Dx:
Bilious vomiting and Double-bubble sign on abdominal X-ray What is it assoc with? |
Duodenal Atresia
assoc with: Down's Syndrome |
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Dx:
Nonbilious, Projectile vomiting; RUQ pain in infant First Dx test? |
Pyloric Stenosis
first test: Ultrasound |
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what acid/base problem is seen with pyloric stenosis?
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Hypochloremic, Hypokalemic Metabolic Alkalosis
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MCC of GI blood from neonate?
Dx Test? |
Anal Fissure
Dx test: Apt test (to confirm Dx: tells if fetal Hb versus mother Hb) |
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If a neonate has a positive Apt test, what is the cause of the GI blood?
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Swallowing maternal blood
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Dx:
Premature infant with Low Apgar and when fed the baby has bloody stools and abdominal distention What is seen on Abdominal x-ray? |
Necrotizing Enterocolitis
Abd x-ray: Pneumatosis intestinalis (Air in bowel wall) |
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Dx:
a child between the ages of 6 – 18 months presents with crampy abdominal pain, Currant jelly-like stool, Sausage-shaped abdominal mass Dx test? |
Intussusception
Dx test: Barium Enema (will see "Coil spring sign"; also treats problem) |
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Dx:
Painless rectal bleed in 2 yo that can cause intussusception Dx test? |
Meckel’s diverticulum
(disease of 2’s: 2% of population, 2:1 males, 2 years of age, 2 types of tissue, 2 feet from ileocecal valve, 2 cm in size) Dx Test: Technetium scan (Lights-up gastric tissue) |
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Dx:
Hematuria, Edema, Hypertension, Azotemia and Oligouria What infection does it follow? Dx Test? (2 plus results) |
Acute Glomerulonephritis
follows: Group A Strep infection Dx Test: 1. Urine: Red cell Casts 2. Blood: C3 decreased |
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Dx:
Renal failure in child with hearing loss and possible cataracts Genetics? |
Alport's Syndrome
(Mutation coding type IV collagen; Problem in basement membrane) genetics: X-linked Dominant |
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Dx:
Periorbital Edema / Ascites, High Proteinuria, Hypoalbuminemia, Hyperlipidemia |
Nephrotic Syndrome
(MCC in children: Minimal Change Dz) |
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What is the MCC of Nephrotic syndrome in Pediatrics?
Tx? Main possible Complication? |
Minimal Change Disease (MCD)
Tx: Steroids Complication: Spontaneous Peritonitis |
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Dx:
infant with Toes AND heel deviated inward; Cannot place in neutral, dorsiflex or plantarflex Tx? |
Talipes equinovarus
("Club Foot") Tx: Serial Casting (only intoeing needing treatment) |
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MCC of Limping and hip problem in age 0 - 3 yo
Dx test? (2 together) Tx? |
Congenital Hip Dysplasia
Dx test: 1. Ordalani or Barlows procedure (Hear a click on PE) 2. Ultrasound Tx: Harness or Casting |
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MCC of limping in Age: 4 – 8 years (Begins as Painless limping leading to limping and pain)
Dx test? |
Legg-Perthes
(Avascular necrosis of femoral head) Dx test: Hip x-ray |
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MCC of hip problems in a > 11 year-old obese adolescent, that may complain of Knee pain
Dx Test? (2 together) |
Slipped Capital Femoral Epiphysis
(Will externally rotate leg in an antalgic position) Dx Test: (1) Hip x-ray (2) Thyroid, LH and FSH (for obesity; think deficient gonads) |
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Dx:
Toddler with sudden traction to arm causing it to hang limp Tx? |
Radial head subluxation
("nursemaid injury") Tx: gentle Supination pops it back into place |
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MC adolescent bone tumor. It occurs in a Metaphyseal area on the Distal Femur, Proximal Tibia or Proximal Humerus
what is seen on x-ray? Who has an increased risk? |
Osteosarcoma
x-ray: Codman triangle (bony sclerosis) Inc risk: patients with Bilateral Retinoblastoma |
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Dx:
child who has painful bones that wake him from sleep but are relieved by aspirin |
Osteoid Osteoma
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Dx:
Bone tumor causing "onion-skinning" of mid-shaft of femur what chromosomal problem? |
Ewing's Sarcoma
chromosome: t(11;22) |
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Dx:
A child presents with recurrent episodes of non-pitting edema on the skin (including swelling of eyelids and lips), GI tract and respiratory system and a family history of the same problem; C4 complement is low What is the deficiency? Genetics? Tx? |
Hereditary Angioedema
Deficiency: C1 Esterase Inhibitor Genetics: Autosomal Dominant Tx: Epinepherine and airway (like for anaphylaxis) |
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Dx:
a male infant between the ages of 6 – 12 months presents with recurrent lung and sinus infections, esp. pneumococcus and H.influenzae; All Immunoglobulins are Low and B-cells are low or absent Tx? |
Bruton's Agammaglobinemia
(X-linked recessive) Tx: replace IgG |
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Dx:
A newborn child presents with hypocalcemia, truncus arteriosus, Fishmouth, tetany and Micrognathia What is deficient? |
DiGeorge syndrome
Deficiency: T-cells (from hypoplasia of 3rd and 4th pharyngeal pouches; thymus) |
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Dx:
Chorioretinitis, gingivitis, Granulomas in GI tract, Lupus syndromes; Recurrent Infections of Pneumonia, Abscesses, Lymphadenitis, Osteomyelitis, Bacterimia / Fungemia, and superficial skin infections (cellulitis and impetigo) Dx Test? Tx? Cure? |
Chronic Granulomatous Disease
(Deficiency in a step of NADPH oxidase w/i cells; X-linked recessive) Dx Test: Nitroblue Tetrazolium dye reduction (NBT) Tx: Long-term TMP-SMX (or Dicloxacillin) Cure: Bone Marrow Transplant |
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What are the symptoms of Wiskott-Aldrich syndrome?
(5)* |
MR. TExT:
Ig(M) deficient; Recurrent respiratory infections; Thrombocytopenia; Eczema; (x-linked recessive); T and B-cell deficiency |
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Patient develops anaphylaxis after IgG exposure. What is the first possibility?
|
IgA Deficiency
(MC primary immunodeficiency) |
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Dx:
recurrent respiratory, GU and GI infections; IgG subclass 2 and IgA are low; eveything else is normal |
IgA Deficiency
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What is the deficiency in most cases of Severe Combined Immunodeficiency (SCID)?
The incidence of what cancer is greater in this patient? |
Adenosine Deaminase deficiency
cancer: Lymphoma |
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Dx:
a patient has a specific component of the complement system that is low and continues to get Neisseria infections. |
Complement deficiency in any complement from C5 - C9
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What type of juvenile RA occurs in a few large joints (like knee, hip shoulder)?
|
Pauciarticular JRA
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What is positive and what sex is predominant in JRA pauciarticular arthritis type 1 versus type 2?
|
Type 1:
ANA+ Females Type 2: HLA B27+ Males |
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What does a baby have a risk of contracting when born to a mother with SLE?
|
Congenital Heart block
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Immunizations:
1. less then 1 month 2. at 2 months 3. at 4 months 4. at 6 months |
1. less then 1 month: (B)
Hep-B 2. at 2 months: (DHIP) DTP, HiB, IPV, Pneumo 3. at 4 months: (BDHIP) Hep-B, DTP, HiB, IPV, Pneumo 4. at 6 months: (DHP) DTP, HiB, Pneumo |
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Immunizations:
1. at 15 months 2. at 18 months 3. at 4 - 6 years |
1. at 15 months: (HeMP)
HiB, MMR, Pneumo 2. at 18 months: (BDIAV) Hep-B, DTP, IPV, Hep-A, Varicella 3. at 4 - 6 years: (DIM) DTP, IPV, MMR |
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Another name for Kawasaki disease?
|
Mucocutaneous LN syndrome
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Dx:
Child presents with Fever (for at least 5 days) + 4 of 5 of following: Bilateral, non-purulent Conjunctivitis, Mucous membrane changes, hot red Tongue or red, cracked lips, Peripheral extremity changes, Edema or peeling of the skin on fingers, Rash (leather-like) and cervical lymph nodes Dx test? Tx? (2 together) |
Kawasaki Disease
(Mucocutaneous LN syndrome) Dx test: Echocardiogram (rule-out possible Coronary Vasculitis or Anneurysm) Tx: 1. Aspirin (not high dose) 2. IV-IgG therapy |
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Dx:
Child had a viral or Group A Strep infection, then later gets a rash from the Waist downward, Elbows downward and Face, in addition to Sx of Vomiting, Abdominal pain, Ileus, and possible Upper and Lower GI bleeding Immuno problem? Tx? (2 together) |
Henoch-Schoenlein purpura
Immuno problem: IgA-mediated Vasculitis Tx: (1) Supportive (recovery in 4 – 6 weeks) (2) Corticosteroids for GI Sx |
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MCC of iron deficiency in newborn?
in child 9 - 24 months? |
newborn: Low Birth Weight
9 - 24 months: Diet |
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What can drinking cows milk before 1 year-old cause in an baby?
|
Iron Deficiency Anemia from gastric bleeding
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Dx;
Young child with pallor, scleral icterus and mild splenomegaly. CBC shows reticulocytosis, anemia with an Increased Mean Corpuscular Hemoglobin (MCH) concentration and indirect hyperbilirubinemia Genetics? What can Dx lead to? Next Dx Test? Tx? (2) |
Hereditary Spherocytosis
genetics: Autosomal Dominant leads to: Aplastic Anemia (especially after parvovirus B-19) next Dx Test: OSMOTIC FRAGILITY TEST Tx: 1. Folic acid supplementation 2. Splenectomy (in patient > 6yo) |
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What is the first test if you suspect you have a Sickle cell patient?
How is Sickle cell Diagnosis confirmed? Ongoing Tx? (3) |
First test: CBC w/ peripheral smear
Dx test: Hemoglobin Electrophoresis Tx: 1. Prophylactic Penicillin 2. Folate supplementation 3. Hydration |
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Dx:
a patient w/ sickle cell begins to have pain in various areas of the body. Tx? (3 together) |
Sickle cell crisis
Tx: 1. Oxygen 2. IV fluids 3. Analgesics (Narcotics) |
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Dx:
A 2 month-old develops Dactylitis (hand and foot swelling), vaso-occlusion causing Splenic and bone infarcts, multiple Infections |
Sickle cell anemia
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Dx:
A child has Sx of Petechiae (that do not blanch), but patient appears well and possible bleeding of mucous membranes; very low platelet count; Bone marrow is normal (or an increase in Megakaryocytes) Tx? (3 together) |
Idiopathic Thrombocytopenia
(ITP) Tx: (1) IV-IG (2) Steroids (must do bone marrow first) (3) Anti-D globulin |
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What (2) coagulopathies present with:
Normal PT, Normal PTT, High Bleeding time What else in blood work differentiates the two? |
ITP and TTP
Both have low platelets, but TTP also has LOW RBC |
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What (2) coagulopathies present with:
Normal PT, High PTT, Normal Bleeding time What medication also presents this way? What else in blood work differentiates it? |
Coags:
Hemophilia A and Hemophilia B (X-linked recessive) Med: Heparin Difference: Thrombocytopenia |
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What coagulopathy presents with:
High PT, High PTT, High Bleeding Time |
DIC
(will also see low platelet count) |
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What coagulopathy presents with:
Normal PT, High PTT, High Bleeding time |
vonWillebrand's Disease
(Autosomal dominant) |
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What coagulopathy presents with:
High PT, Normal PTT, Normal Bleeding Time |
Warfarin toxicity
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Dx:
a boy presents with a high PTT and Hemarthrosis Tx? |
Hemophilia A
Tx: replace Factor VIII |
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Dx:
A 3 – 5 yo child w/ an acute onset of Anorexia, pallor, fever, bone pain in 1/4 of patients, Pancytopenia. Dx Test? Tx? (3) MC places for Relapse? (2) |
Acute Lymphocytic Leukemia
(MC childhood cancer) Dx test: Bone Marrow bx Tx: 1. Chemotherapy, 2. Radiation, 3. Transplant Relapse: 1. TESTES 2. CNS |
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What Non-Hodgekin's Lymphoma presents as an abdominal mass and is associated with EBV?
what is seen on LN bx? Chromosomal anomaly and gene? |
Burkitt Lymphoma
LN Bx: "Starry sky" pattern Chromosomes: t(8;14) Gene: c-myc |
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Dx:
Persistant cervical lymphadenopathy, night sweats, otherwise normal adolescent Dx test? |
Hodgkin Lymphoma
Dx test: LN biopsy (Reed-Sternberg cells) |
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How is a Neuroblastoma and Wilms Tumor distinguished by CT scan?
|
Neuroblastoma:
1. on Adrenal gland 2. Calcifications seen Wilm's Tumor: 1. in Kidney 2. no calcifications |
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Dx:
child with morning Headache, vomiting (causing HA to go away); Ataxia, nystagmus, head-tilt, intention tremor Specific site? |
Cerebellar Astrocytoma
(MC childhood brain tumor) site: Infratentorial (posterior fossa) |
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Dx:
Child with short stature, Bitemporal hemianopsia and endocrine abnormalities Dx test? What can occur post-op? |
Craniopharyngioma(Supratentorial)
Dx test: X-ray of skull: Large Cella Tursica Post-op: Diabetes Insipidus |
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Dx:
A 3 - 5yo child presents with obstructive hydrocephalus, ataxia and CSF metastasis Specific site? |
Medulloblastoma
site: Infratentorial |
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Dx:
Child stares into space in middle of sentence, then 20 seconds later he resumes his sentence Dx test results? Tx? |
Absence seizure
Dx test: EEG showing 3-Hz Spike and Wave pattern Tx: Ethosuximide |
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MC type of seizure in pediatrics
Tx? |
Febrile Seizure
Tx: Acetaminophen (for fever) (check for underlying cause of seizure) |
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Dx test for Neonatal seizures
Tx? |
test: Continuous Bedside EEG
Tx: Phenobarbital |
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Dx:
A child of 2 – 7 months presents with Recurrent mixed Flexor-Extensor spasms lasting only a few seconds, but repeat more then 100 times in a row; Looks like multiple Startle or Moro response Dx Test & Result? Tx? (2 together) |
Infantile spasms
("West syndrome") Dx Test: EEG: HYPSARRTHYMIA Tx: 1. ACTH 2. prednisone |
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Difference in presentation with Niemann-Pick Dz and Tay-Sachs Dz?
|
Both have Cherry-red spot on Macula
NP: Hepatosplenomegaly TS: No hepatosplenomegaly |
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Dx:
child who constantly clears his throat |
Tourette's syndrome
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Dx:
MR, spasticity, aggressive behavior, self-mutilation, Gout arthritis |
Lesch-Nyhan
|
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What are the (2) disorders where infants have Hypotonia or Flaccidity?
|
1. Werding-Hoffmann Dz
2. Infant Botulism |
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Dx:
Infant with spinal muscular atrophy, Fasciculations, frog-leg posture Dx Test/results? (3) Tx? |
Werdnig-Hoffman Dz
("Floppy-Baby" syndrome) Dx Test: 1. EMG: Fibrillations 2. Muscle bx: denervation 3. Nerve bx: slowed conduction Tx: Supportive |
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Dx:
A child presents following a viral illness with Ascending weakness, Paralysis, Loss DTR, may progress to affect Diaphragm (breathing) Tx? (3 possible) |
Guillain-Barré
Tx: (1) Supportive (intubation may be needed) (2) Plasmapheresis (3) IVIG |
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Dx:
A boy 3 - 7 yo with Muscle and Hip girdle weakness and pseudohypertrophy of the calves Genetics? Dx Test? Confirmatory test? |
Duchenne muscular dystrophy
(MC inherited neuromuscular disease) genetics: X-linked recessive (only boys get it) Dx test: Blood shows greatly elevated Creatine Kinase Confirmatory test: Muscle Bx |
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Name the sign:
a patient w/ DMD is walking their hands up their legs to sit/stand properly |
Gower’s sign
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Dx:
Café-au-lait spots, axillary/inguinal freckling, Learning disorders, Renovascular HTN, Scoliosis, Lisch nodules (seen on slit lamp) Genetics? what chromosome has the problem? |
Neurofibromatosis
(von Recklinghausen) genetics: Autosomal Dominant chromosome: 17 (Type 2 - Bilateral Acoustic neuromas is chrom: 22) |
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Dx:
A child presents with pale hypopigmented areas, facial sebaceous adenomas, areas of abnormal skin thickening, MR and Seizures are common Genetics? Dx Test/results? |
Tuberous Sclerosis
genetics: Autosomal Dominant (Ash leaf spot – pale hypopigmented area) (Shagreen patch – areas of abnormal skin thickening) Dx Test: CT scan of Head: periventricular calcified tubers |
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Dx:
Facial nevus (port wine stain) with trigeminal distribution, MR, seizures difficult to control, visual impairment Dx Test/results? |
Sturge-Weber Dz
Dx Test: CT Scan of Head: intracranial calcifications |
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First sign of Puberty in:
1. Females 2. Males |
Females: Breast buds
Males: Testicular enlargement |
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What is the cause of Hypoglycemia in a newborn from a mother with DM?
|
Fetal Hyperinsulinemia
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What is the highest risk for a child to be born with developmental displasia of the hip?
What is the confirmatory test for DDH? |
Female Breech birth
test: Ultrasound of hip |
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Why does a mother with type O blood cause hemolysis in newborn if the child has type A or B?
|
Type O people have Antibodies to blood types A and B
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When should a child have their electrolytes checked if you suspect dehydration?
|
Moderate or Severe dehydration
(not Mild dehydration) |
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Tx for Mild, Moderate and Severe Dehydration in children?
|
Mild: Oral rehydration
Moderate/Severe: IV rehydration |
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What is considered Moderate dehydration percentage-wise?
Severe? |
moderate: 5-10% dehydrated
severe: > 10% dehydrated |
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Dx:
Baby is tired when feeding, diaphoretic and breathing strangely |
CHF in newborn
(tired when feeding is #1 sign) |
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|
what are the (2) criteria for a Dx of failure to Thrive in a newborn?
|
1. failure to regain birth weight by 3 weeks of age
2. continuous weight loss after 10 days of life |
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when a child has a decrease in respirations, what does it suggest?
increase in respirations? |
Dec: CNS depression
Inc: Infection |
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|
What are the (5) Tanner stages for Pubic hair?
|
1. None
2. Scant, Fine hair 3. Curly, extending laterally 4. Adult-like hair, NOT on medial thigh 5. Adult hair on medial thigh |
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At what age are solids introduced in an infant?
what is the average weight gain for a term infant per day? when should they be 2x the original weight? 3x? |
Solid foods: 4 - 6 months
Ave weight gain: 20-30g/day 2x: 4 - 5 months 3x: 12 months |
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What is the only vaccination that can cause a fever 7 days after it is given?
|
MMR
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when should a child's car seat start facing front?
|
> 1 yo + > 10 kg
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What are (4) developmental milestones at 6 months old?
|
"Six Babbling Strangers Switch Sitting at 6 months":
1. Babbles 2. Stranger recognition 3. Switches hands (transfers objects) 4. Sitting unsupported |
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What are (4) developmental milestones at 9 months old?
|
"Pinches Ma-ma's furniture Bye-Bye to cruise"
1. Pincher grasp 2. says: Mama or Dada 3. waves Bye-Bye 4. Cruises around furniture |
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What is the MC malignant tumor in infancy?
|
Neuroblastoma
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A child with sickle cell presents to your office with a fever.
Next step? |
Immediately admit to hospital
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A child with sickle cell presents with a stroke.
Tx? |
Exchange Transfusion
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What is the first sign of Nephrotic syndrome in a child?
|
Pitting Edema of the extremities
|
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Dx:
A child is involved in a MVA and presents with a HR that goes from 110 to 56 and BP that is 156/96, with irregular respirations. |
Increased ICP
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Dx:
A child presents with a rash that began on his neck and then spread to his trunk. On exam, you notice both new and old vesicles in the same area |
Varicella (Chicken pox)
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What is the difference b/t HUS and TTP?
(2) |
No Fever and Neurological signs in HUS
HUS = "RAT" (Renal failure, Anemia, Thrombocytopenia) TTP = "FAT RN" (Fever, Anemia, Thrombocytopenia, Renal problems, Neuro problems) |
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|
What GI complaint can HSP lead to causing sevre morbidity?
|
Intussusception
|
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What is the Tx for a sickle cell patient who presents with anemia and an enlarged spleen?
|
Blood Transfusion
|
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What (5)* medications can cause Thrombocytopenia?
|
PT CCS:
1. Phenytoin 2. TMP-SMX 3. Chloramphenicol 4. Carbamazepine 5. Sulfonamides |
PT CCS
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In assessing dehydration, what are the (7)* main findings to evaluate?
How many findings equal <5% dehydration? More then 10% dehydration? |
having Dehydration is "BUM NEWS":
1. BP and HR 2. Urine output 3. Mucous membranes and Tears 4. Neurological status 5. Eye and Fontanels 6. Weight 7. Skin turgor/color and Capillary refill <5% = <3 findings >10% = >6 findings |
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How many mL/kg water loss is considered Mild, Moderate and Severe?
|
Mild = < 50mL/kg
Moderate = 50 - 99mL/kg Severe = > 100mL/kg |
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|
in the steps of fluid management in children, when is the only time normal (0.9%) saline is given?
why is it given? what is given the other times? |
0.9% = Initial 20cc/kg Bolus
(continue boluses until patient urinates, except for DKA...for them monitor vitals and neuro status) Given to Restore Intravascular Volume 0.45% (1/2 normal) saline is used to correct dehydration and for maintenance fluids in a child |
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When is the earliest time to initiate testing for Type 2 DM in children?
How frequent do you test? What is the best test? |
Age of Initiation: 10-yo or at onset of Puberty
(whichever is first) Frequency: every 2 years Test: Fasting Plasma Glucose |
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|
Pediatrics are usually started on 3 insulin injections per day. What is the dosing pattern?
|
1. 2/3 of total dose in morning
(1/3 rapid or short-acting, 2/3 intermediate-acting) 2. 1/6 of total at dinner (as rapid or short-acting) 3. 1/6 of total before bed (as intermediate-acting) |
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|
A child has a seizure following the immunization.
What is the cause? What is done on the next immunization? |
Pertussis
-Do NOT ever give that immunization again! |
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When a child is bit by a snake, how do you determine the venom dose?
|
Based on the childs symptoms
(amount of envenomization) |
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|
Dx:
A 6-month-old infant presents to the emergency department with the new onset of weak cry, decreased activity, and poor feeding. The mother also states that the infant has been constipated for the past 2 days. On physical examination, the infant has a very weak cry, poor muscle tone, and absent deep tendon reflexes. Tx? |
Botulism
Tx: Supportive care (Airway PRN) |
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|
Dx:
A 16-year-old boy presents with a temperature of 38.4 C (101 F) and low back, wrist, and knee pain. He had a sore throat 1 month earlier. His arthritis is diffuse. Pea-sized swellings are noted over the skin on his knees. He has a serpiginous erythematous area on his anterior trunk. His blood and throat cultures are negative, and his CBC is unremarkable. His antistreptolysin-O (ASO) titer is high. Tx? (2 together) |
Rheumatic Fever
Tx: 1. Penicillin 2. Aspirin |
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|
On physical examination, the infant is afebrile with stable vital signs. She can lift her head to 90 degrees, her eyes follow past the midline, she laughs, regards her own hand and has slight awareness of her mother.
How old is she? |
4 months
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|
Dx:
A 5-year-old girl presents with a 3-day history of fever, dyspnea, and intermittent joint pain. She has a history of sore throat about 1 month ago. On physical examination, her temperature is 39.6 C (103.2 F), blood pressure is 94/60 mm Hg, pulse is 114/min, and respirations are 22/min. Her knees and elbow joints are swollen and tender to palpation. There is a grade III/VI diastolic murmur best heard at the apex. Multiple fine, pink macules are noted on her trunk. These macules are blanching in the middle. Tx? |
Rheumatic Fever
Tx: Penicillin |
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|
A 4-week-old infant presents with tachycardia, tachypnea, and poor weight gain. His arterial blood gas shows a pH of 7.34, a PaCO2 of 41 mm Hg, and a PaO2 of 74 mm Hg. A chest radiograph shows cardiomegaly. Echocardiography reveals a structurally normal heart, left ventricular dilatation, a left ventricular ejection fraction of 20%, and mild mitral and tricuspid regurgitation.
What IV med is the best first step in management? |
Furosemide
(patient has CHF) |
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|
Dx:
A term male infant is found to be cyanotic shortly after birth and requires endotracheal intubation. On physical examination, his blood pressure is 68/34 mm Hg (equal in all four extremities), pulse is 180/min, and respirations are 32/min. His precordium is dynamic, has a grade III systolic murmur, and a single S2. Chest radiography shows a normal heart size and increased pulmonary vascular markings. An arterial blood gas on an FiO2 of 100% shows pH 7.34; PaCO2, 47 mm Hg; PaO2, 46 mm Hg |
Total Anomalous Pulmonary Venous Return
(characterized by the pulmonary veins forming a confluence behind the left atrium, and draining into the right atrium. Complete mixing takes place in the right atrium, with a right-to-left shunt through the foramen ovale to the left side of the heart) |
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|
Dx:
A 1-month-old baby boy has bloody diarrhea. No infectious agent is identified, but the baby is found to be profoundly thrombocytopenic. The baby is also noted to have a skin rash, and a dermatologist diagnoses eczema. By three months of age, the baby begins to develop recurrent respiratory infections. If this child survives until adolescence, he is at particularly high risk of developing what? |
Wiskott-Aldrich syndrome
can lead to: Lymphoma |
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|
Dx:
A 9-month-old girl has had one serious infection after another since about 3 months of age, including thrush, pneumonias, and diarrhea. The baby is small for age. An older brother died at age 2 of pneumonia. Immunologic evaluation demonstrates lymphopenia and very low gamma globulin levels. Both T and B cell numbers are very low. Radiologic studies demonstrate "frayed" long bones, abnormally thick growth arrest lines, and dysplasia of the costochondral junctions |
Severe Combined Immunodeficiency (SCID)
(an Adenosine deaminase deficiency) |
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|
Dx:
A 17-year-old girl presents to the office with a 5-day history of a malodorous vaginal discharge. She is sexually active and uses condoms for sexual intercourse. On examination, a thin, white discharge is seen. A "fishy" odor is produced when KOH is added to the discharge. The vaginal fluid has a pH of 5. What is the most likely finding on a microscopic examination of the vaginal fluid? |
Bacterial Vaginosis
micro: Clue Cells |
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|
A 7-yo patient presents with Lyme disease.
Tx? |
oral Amoxicillin
(doxycycline is not given to kids under age 8) |
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|
In a patient diagnosed with vesicoureteral reflux, what is the first Dx step?
What is the Dx/confirmatory Test (2nd step)? |
first: Renal Ultrasound
Dx/confirm Test: Voiding Cystourethrogram |
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|
Dx:
a 12-yo girl presents with a fever and skin rash of 2 days duration. She complained of a sore throat and mild neck pain several days ago. The PE shows lymphadenopathy of the posterior occipital, retroauricular and cervical LN, plus an erythematous macules on the soft palate and a rash on the face, chest and proximal extremities. |
Rubella
|
|
|
Tx for Candida-induced oral thrush?
|
Nystatin therapy
|
|
|
A child presents with "cat-scratch Dz."
what is the bug? what is the Dx/confirmatory test? |
Bartonella henselae
test: Serum antibody titers |
|
|
what is the bone complication of NF-1?
|
Thinning of the Long Bone Cortex
|
|
|
what is the difference in RDW levels b/t thalassemia and Iron-deficiency anemia?
|
RDW:
normal in Thalassemia High in Iron-deficiency anemia |
|
|
A patient presents with painful ulcers on his penis. You think it is HSV. What is the Dx test?
|
Tzanck preparation
|
|
|
what is the Dx test for RSV?
|
Nasopharyngeal aspirate
|
|
|
Dx:
a 9-yo boy presents with increasing clumsiness, change in speech, wide-based unsteady gait, nystagmus and no DTRs. what heart problem can it lead to in the future? |
Friedrich Ataxia
leads to: Hypertrophic Cardiomyopathy |
|
|
Dx:
a 20-mo girl presents with loss of developmental milestones, repetative movements and acquired microcephalopathy |
Rett syndrome
|
|
|
What is the confirmatory test for DMD?
|
Muscle biopsy
|
|
|
What type of exercise induces "exercise-induced" asthma?
|
High intensity, continuous, prolonged exercise
(ex: a 5-K run) |
|
|
what deformities of the head are associated with congenital toxoplasmosis?
(2) |
1. Microcephaly
2. Hydrocephalus |
|
|
What vitamin is most likely to cause a pseudotumor cerebri?
|
Vitamin A
|
|
|
Dx:
a child with strep pharyngitis is given penicillin. The next day he develops a fine, papular rash over his body, which is accentuated in his axilla and groin. |
Scarlet Fever
(a rash from the penicillin would be urticarial in nature) |
|
|
What are the (11)* criteria (of which 4 or more need to be present) to diagnose SLE?
|
SOAP BRAIN MD:
1. Serositis (pleuritis/pericarditis) 2. Oral ulcers 3. Arthritis 4. Photosensitivity 5. Blood (any can be low) 6. Renal problems 7. ANA+ 8. Immunological (ds-DNA+) 9. Nero Sx (psych, seizures) 10. Malar Rash 11. Discoid Rash |
SOAP BRAIN MD
|
|
what is seen in the serum of someone with a pneumonia caused by Mycoplasma?
|
Cold Agglutinins
|
|
|
A 13-yo girl presents with lethargy, fever, severe HA and a stiff neck. On exam she has a unilateral fixed, dilated pupil and papilledema.
What is the initial step in management? |
Intubation and Hyperventilation
|
|
|
what is antibiotic used for the initial therapy of acute sinusitis?
|
Amoxicillin-clavulanic acid
|
|
|
In a child, if the monospot test comes back negative and you think the Dx is Mono, what is the next step?
|
EBV titer
(heterophil test has a poor response in children) |
|
|
How does a child with Breast milk Jaundice present?
|
Prolonged unconjugated hyperbilirubinemia in first weeks/months of life
|
|
|
A 4-yo child presents with a platelet count of 30K and you diagnose her with ITP.
what is the most appropriate Tx at this time? |
No specific therapy
(when platelets go below 20K start on oral prednisone; a splenectomy is done for those with no response to prenisone or those with recurrent ITP) |
|
|
Dx:
A 12-yo athelete presents with chest pain and dyspnea on exertion that resolves with rest. First step in Tx? |
Asthma (exercise-induced)
(<5% of kids have heart problems, aside from congenital anomalies) Tx: Trial of Albuterol inhaler |
|
|
A 2-mo is admitted with constipation and an abdominal mass, fever, feeding poorly and vomiting for the past 2 days. A barium enema is ordered and shows Hirschprung's Dz.
what is the most important next step? |
IV fluid hydration and IV antibiotics
(reestablish IV volume and prevent sepsis) |
|
|
What (2) electrolyte disorders accompany Rhabdomyolysis?
|
1. Hyperphosphatemia
(leading to...) 2. Hypocalcemia |
|
|
What are the minor criteria of Rheumatic fever?
(5) |
FAILS:
1. Fever 2. Arthralgia 3. Increased CRP or ESR 4. Long PR interval 5. Strep culture + or ASO+ |
|
|
what type of acid/base disorder do you see with a 2 day history of diarrhea?
|
Hyperchloremic Normal Anion gap Acidosis
(loss of bicarb in the stool stimulates renal tubular reabsorption of chloride ions) |
|
|
What (3) malignancies are associated with EBV?
|
1. Burkitt Lymphoma
2. Hodgkin Dz 3. Nasopharyngeal CA |
|
|
What is the difference in AST/ALT initially between Hepatitis B and Hepatitis C?
|
Hep B: AST/ALT in Thousands
Hep C: minimal or no elevation of AST/ALT |
|
|
What electrolyte abnormality is commonly seen in a newborn macrosomic infant from a mother with diabetes?
|
Hypocalcemia
(and hypomagnesemia) |
|
|
A 3000g female is born at 38 weeks to a mother that is positive for GBS.
What is the next step in managing the baby? |
CBC and blood culture
(in addition to 48 hours of observation in the hospital) |
|
|
An infant is crawling around on the floor at home and suddenly become cyanotic.
what is the first step? |
Back blows followed by chest thrusts
(never perform a blind finger sweep in a child, b/c it can push the aspirated object further) |
|
|
why does a CF patient present with Metabolic Alkalosis?
|
Potassium is lost in urine
|
|
|
MC presentation of Strep throat?
(4)* |
FEAT:
1. Fever 2. Exudate on Tonsils 3. Anterior Cervical lymphadenopathy 4. Throat pain |
|
|
A full-term newborn is born vaginally after a pregnancy complicated by gestational diabetes that was poorly controlled. He is born with scleral icterus. Three hours after birth the baby is plethoric, irritable and cyanotic. Six hours after birth he has a seizure.
What hematological abnormality is most likely seen on his CBC? |
Polycythemia
(a known complication in the infant of a diabetic mother) |
|
|
Dx:
A previously healthy 3-mo term boy presents to ED with tachypnea, poor feeding and pallor for 24 hours. He is tachycardic with a HR of 240 with narrow QRS complexes. Vagal maneuvers are attempted and unsuccessful. What drug should be given? |
Supraventricular Tachycardia (SVT)
drug: Adenosine (blocks AV conduction and SA-node pacemaker activity; DOC for SVT; if unavailable, can Cardiovert) |
|
|
What is the most important risk factor for a PE in children?
|
Central Venous catheter
(followed by immobility) |
|
|
What hormone is responsible for growth plate fusion?
|
Estradiol
|
|
|
Dx:
A patient presents with mild MR, prominent lips and a long philtrum, a systolic ejection murmur and hypercalcemia. |
Williams syndrome
|
|
|
What are the erruption times of permanent teeth?
(8)* |
"Mama Is In Pain, Papa Can Make Medicine":
1st Molar: 6 years 1st Incisor: 7 years 2nd Incisor: 8 years 1st Premolar: 9 years 2nd Premolar: 10 years Canine: 11 years 2nd Molar: 12 years 3rd Molar: 18-25 years |
"Mama Is In Pain, Papa Can Make Medicine"
|
|
What is the MCC of retinopathy in a premie?
|
Too much Oxygen saturation
(should be <95%) |
|
|
What occurs if you correct the following problems too fast?
1. DI 2. DKA 3. SIADH |
1. DI -> Seizures
2. DKA -> Cerebral edema -> Herniation 3. SIADH -> CPM |
|
|
What additional (3) things are needed in formula for premature infants?
|
1. Extra Calories (22kcal/oz)
2. Extra Calcium 3. Extra Phosphorus |
|
|
What is a normal systolic BP in the following ages of children?
1. Premie 2. up to 1mo 3. 1mo - 1yo 4. > 1yo |
1. Premie = meanBP > gestational age at birth
2. up to 1mo = >60 3. 1mo - 1yo = >70 4. > 1yo = 70 + (2 x age) |
|
|
Diarrhea that is caused by "chitlins" at a picnic
|
Vibrio
|
|
|
Dx:
Patient presents with absent LN, tonsils, lymphopenia, no thymus, recurrent infections of oral candida, diarrhea, pulmonary infections and viral infections |
SCID
(Severe Combined Immunodeficiency Dz) |
|
|
MC heart defect in congenital Rubella
|
PDA
|
|
|
Dx:
An infant presents with noisy breathing and on laryngoscopy the epiglottis is seen "rolling from side-to-side" Tx? |
Laryngomalacia
Tx: hold infant upright for 30 minutes after feeding (most disappear by 2 yo) |
|
|
What type of Pneumonia is seen in Hyper-IgM syndrome?
|
PCP
|
|
|
what are the (4)* MC congenital problems in infant of a diabetic mother?
|
"A Diabetic Causes Trouble":
1. Ancephaly / NT defects 2. Duodenal Atresia / small left colon 3. Caudal Regression syndrome 4. Transposition of the Great Vessels |
"A Diabetic Causes Trouble"
|
|
Dx:
a child presents with a slowly developing back pain and neuro degeneration with a "step-off" palpated at lumbosacral area |
Spondylolisthesis
|
|
|
Dx:
an infant presents with Cyanosis, Left Axis Deviation and VSD what does EKG show? |
Tricuspid Atresia
EKG: LVH (and hypoplastic RV) |
|
|
Dx:
a cyanotic newborn with a CXR showing cardiomegaly, increased vascular markings and right aortic arch. what does the EKG show? |
Truncus Arteriosus
EKG: Biventricular Hypertrophy |
|
|
what are the (4)* main features of Beckwith-Wiedmann syndrome?
|
HOMO:
1. Hypoglycemia & Hyperinsulinemia 2. Omphalocele 3. Macroglossia & Macrosomia 4. Organomegaly |
HOMO
|
|
If a child presents with asthma and other allergic disorders (allergic rhinitis or eczema), what is the best long term medication?
|
Mast Cell Stabilizers
(inhaled Cromolyn) |
|
|
Dx;
A 12-mo with foul-smelling, non-bloody stool 7-8 times/day, irritable, pre-tibial edema, erythematous vesicles on extensor surfaces of elbows and knees and microcytic anemia |
Celiac Disease
(begins at age 12 - 15 mo) |
|
|
MCC of Meningitis in following ages:
1. Newborn 2. 1-mo to 2-yo 3. 2-yo to 18-yo 4. > 18-yo |
1. Newborn = GBS
2. 1-mo to 2-yo = S. Pneumonia 3. 2-yo to 18-yo = N. Meningitis 4. > 18-yo = S. Pneumonia |
|
|
Dx:
a few days after birth a mother realizes that her child cannot move his hand on the right side and also has right lid ptosis |
Klumpke Paralysis
(birth injury to CN-7,8 and T1) |
|
|
What reflex is affected by a child born with E-D palsy?
|
Moro relex is absent
|
|
|
What is the test of choice in evaluating a child for Hyperlipidemia?
|
Screening Total Cholesterol level
(not Fasting Lipid Profile) |
|
|
What are the nodular swellings of the irises in NF-1 patients?
|
Hammartomas
|
|
|
When does Physiologic Jaundice begin?
Breast milk Jaundice? |
Physiologic Jaundice: starts 2nd or 3rd day of life
(resolves in several weeks) Breast milk Jaundice: starts after 1 week-old |
|
|
If an infant presents with a fever and no other Sx, what is the best first test?
|
Catheterized UA with culture
|
|
|
what is the first step in Tx for a patient with Allergic Rhinitis?
|
Antihistamines
(do be fooled with "environmental change") |
|
|
what one sign is most suggestive of Primary TB?
|
Hilar lymphadenopathy
|
|
|
Dx:
a 15-yo boy presents with pain in the right knee, Hx of easy bruising and chronic fatigue. PE shows mild HSM. X-ray of femur shows "Erlenmeyer Flask deformity." Labs show anemia and thrombocytopenia. Bone marrow shows "wrinkled paper" appearance. Deficient enzyme? |
Gaucher's Dz Type 1
(seen in adolescent ashkenazi jewish population) enzyme: Acid Beta-Glucosidase |
|
|
A 2-yo boy undergoes end-to-end repair of an aortic coarctation. Seven years later he has HTN symptoms again.
Tx? |
Angioplasty via balloon
(TOC for re-coarctation) |
|
|
Dx:
Marfan features + Thromboembolic events enzyme deficiency? |
Homocystinuria
enzyme: Cystathionine Synthase |
|
|
Dx:
Onset of HA with focal neurological sx soon after acute otitis media? |
Brain Abscess
|
|
|
Dx:
A <1-mo child with bilious vomiting, abdominal distention and passage of bloody stools |
Midgut Volvuvus
|
|
|
MCC of Jaundice in premature infant?
|
TPN-induced jaundice
|
|
|
Dx:
a child presents with a wide-based gait, decreased vibratory and position sense in lower extremities, absent ankle jerk bilaterally, atrophy of cervical spinal cord and T-wave inversions |
Friedreich Ataxia
(Trinucleotide repeats; Autosomal Recessive) |
|
|
Dx:
severe dehydration in neonate with HypoN, HyperK and HypoG plus Metabolic Acidosis |
Congenital Adrenal Hyperplasia
(21-hydroxylase deficiency) |
|
|
A premature infant on a vent has signs of pneumonia.
MC bug? |
Oxacillin-Resistant Staph Aureus
(MRSA would also cause skin pustules of periumbilical and diaper areas) |
|
|
What is the difference in presentation of ABO incompatability and Rh incompatability?
|
ABO:
Fetal anemia and Jaundice Rh: Hydrops (anemia, edema, ascites, cariomegaly and hepatomegaly) |
|
|
What is the difference in Tx wth Ewings Sarcoma and Osteosarcoma?
|
Ewings:
Surgery, Chemo, Radiation Osteosarcoma: Surgery & Chemo only! |
|
|
Aside from blood lead level, what else is increased in the blood with lead poisoning?
|
Erythrocyte Protoporphyrin
(usually seen w/ > 55mg/dL of lead) |
|
|
What is the best way to test for acid-fast bacilli of TB?
|
Early-morning Gastric Aspiration
|
|
|
Dx:
A 6-yo female child with constant leaking of urine |
Low implantation of Ureter
(into vagina) |
|
|
What is the age of precocious puberty in boy and girl?
What is the best Initial test for Evaluation of Precocious puberty? |
Boy: < 9-yo
Girl: < 8-yo test: Radiograph of Hand and Wrist to determine Bone Age |
|
|
Tx:
Hereditary Angioedema |
Danazol (and Epi if needed)
|
|
|
Dx:
Superoxide deficiency in Macrophages |
Chronic Granulomatous Dz
|
|
|
Dx test:
Chronic Granulomatous Dz |
Nitroblue Tetrazolium
|
|
|
Dx:
Defect in neutrophil chemotaxis |
Chediak-Higashi syndrome
|
|
|
Dx:
MR with rocker-bottom feet and clenched fist |
Edward's syndrome
(Trisomy 18) |
|
|
Dx:
MR with midline defects, cleft lip/palate |
Patau syndrome
(Trisomy 13) |
|
|
Dx:
Tall, infertile, gynecomastia, microtestes |
Klinefelter's syndrome
(XXY) |
|
|
Age:
Social smile |
1 - 2 months
|
|
|
Age:
Rolls onto Back |
4 months
|
|
|
Age:
Rolls onto Stomach |
5 months
|
|
|
Age:
Walks alone |
15 months
|
|
|
Age:
Copies Circle |
3 years
|
|
|
Age:
Copies Cross or Square |
4 years
|
|
|
Tanner stage:
Penile "growth spurt" |
Tanner stage 3
|
|
|
Dx:
Vaccination that cannot be taken if allergic to eggs |
Influenza A
|
|
|
Dx:
Place of foreign body aspiration in a child that was standing |
Right Bronchi in Superior Segment of Lower Lobe
|
|
|
Dx:
Place of foreign body aspiration in a child that was supine or is an epileptic |
Right Bronchi in Posterior Segment of Lower Lobe
|
|
|
Dx:
possible Kidney problem in Turner's Dz |
Horseshoe kidney
|
|
|
Dx test:
Duodenal Atresia |
AXR
(Double bubble) |
|
|
Dx test:
Rotavirus |
Immunoassay
|
|
|
Dx test:
steathorrhea plus protozoal cysts in stool |
Duodenal Aspirate
|
|
|
Bacterial Diarrhea:
Ulcerative colitis-like Sx plus Arthritis |
Campylobacter
(MCC of infectious diarrhea) |
|
|
Bacterial Diarrhea:
Child with acute onset of RLQ pain (like appendicitis) plus diarrhea |
Yersinia
|
|
|
Bacterial Diarrhea:
Daycare outbreak plus child with diarrhea and new onset seizure |
Shigella
|
|
|
Dx test:
Tuberous Sclerosis |
CT scan of head
(Calcified periventricular tubers) |
|
|
Tx:
West syndrome (Infantile spasms) (2) |
ACTH and Prednisone
|
|
|
Dx:
Anaphylaxis after blood trasnfusion |
IgA deficiency
|
|
|
Dx:
very low T- and B-cells (lymphopenia) with bacterial and fungal infections |
SCID
|
|
|
Prophylaxis needed for SCID
|
PCP
|
|
|
Tx:
SCID |
Bone Marrow Transplant
(or stem cell transplant with IgG) |
|
|
Dx:
baby less then 2-yo presents with tachypnea and wheezing |
Bronchiolitis (RSV)
|
|
|
Dx test:
Bronchiolitis (RSV) |
ELISA nasal washings
|
|
|
Bug:
Assoc with Guillain-Barre |
Campylobacter Jejuni
|
|
|
Dx:
Corneal clouding, cataracts, early renal failure |
Fabry's Dz
|
|
|
Dx:
Optic atrophy, spasticity, Globoid bodies in brain |
Krabbe's Dz
|
|
|
Dx:
Inspiratory stridor, barking cough |
Croup (Parainfluenza)
|
|
|
Tx:
Croup |
Steroids and humidified air
|
|
|
Dx:
Hearing loss, cataracts, microscopic hematuria |
Alport's syndrome
|
|
|
Dx:
salmon-colored rash with daily fever spikes, knee pain, leukocytosis, thrombocytosis, Inc ESR |
Still's Dz
(Systemic juvenile RA) |
|
|
Dx:
Surfactant deficiency in preterm infant |
Respiratory Distress Syndrome
(RDS) |
|
|
Dx:
Heart d/o assoc with DiGeorge syndrome |
Transposition of the Great Vessels
|
|
|
Dx:
short, Inc calcium, developmental delay, overy friendly, supravalvular aortic stenosis |
Williams syndrome
|
|
|
Dx:
Heart problem with Kartagener's syndrome |
Dextrocardia
|
|
|
Next step:
positive PPD |
Chest X-Ray
(before medicine) |
|
|
First test:
Nasal polyps found in child |
Pilocarpine Sweat Test
(polyps in child = CF) |
|
|
Dx:
Infant gets repeated pneumonias at beginning of life due to exhaustion of maternal IgG in system |
Transient Hypogammaglobinemia
|
|
|
Dx:
child with increased AA in urine, photosensitivity, ataxia and neuro problems |
Hartnup Dz
|
|
|
Dx:
6-yo boy presents with dark pubic hair, enlarged penis/testis, growth spurt and acne |
Hypothalamic tumor
(without growth spurt may be 21-hydroxylase deficiency) |
|
|
Dx:
Hereditary eye problem with progressive night blindness, field constriction and loss of acuity |
Retinitis Pigmentosa
|
|
|
First step:
Emergency airway in ER on patient < 12-yo |
Needle Cricothyroidotomy
|
|
|
Dx:
"sea-blue" histiocytes |
Niemann-Pick
|
|
|
Dx:
Acanthocytes (spiny RBC) |
Abetalipoproteinemia
|
|
|
Child Brain Tumor:
Originates from cerebellar vermis and grows to the fourth ventricle |
Medulloblastoma
|
|
|
Child Brain Tumor:
Cyst and mural nodule assoc with vonHipple-Lindau |
Hemangioblastoma
|
|
|
Child Brain Tumor:
Cyst with a mural nodule in the cerebellum |
PiloCYSTIC Astrocytoma
(similar to Hemangioblastoma) |
|
|
Dx:
Delayed passage of meconium, chronic constipation, FTT, air in bowel |
Hirschprung's Dz
|
|
|
Dx:
High fever for 3 days, then macular rash |
Roseola
|
|
|
Virus assoc with Roseola
|
HSV-6
|
|
|
another name for Measles
|
Rubeola
(not Roseola) |
|
|
First test:
Infant with seizures |
Serum chemistries
|
|
|
Dx:
BRBPR in infant 1 week to 3 months old |
Food Allergy-induced Colitis
|
|
|
Dx:
slight fever, sore throat, suboccipital and posterior auricular LN enlargement, rash starts on face and moves down body |
Rubella
|
|
|
MC genetic defect in CF
|
CFTR-508 Deletion on chromosome 7
|
|
|
Dx:
Sickle cell patient with acute severe anemia without reticulocytes, but with normal platelets and WBC |
Aplastic Anemia
|
|
|
First step:
child is cyanotic from congenital diaphragmatic hernia |
Orogastric Tube placement
(with continuous suction to prevent bowel from decompressing lung) |
|
|
Dx:
2-week-old infant presents with jaundice. He is exclusively breastfed, his stool has a lighter color, has hepatomegaly and direct bilirubin of 4 |
Biliary Atresia
(light stool, hepatomegaly and inc direct bilirubin) |
|
|
An increase in what lab in a 2-week-old infant would lead to breastfed jaundice conclusion?
|
Increased Indirect Bilirubin
(as high as 10 - 30mg/dL) |
|
|
Next step:
after confirming Dx of Septic Arthritis |
Emergent Surgical Drainage
|
|
|
Dx:
Jaundice within 24 hours of life and an increased direct and indirect bilirubin, anemia, pallor, HSM and reticulocytosis |
Erythroblastosis Fetalis
|
|
|
Dx:
Jaundice appearing after the 5 days of life, but within the first week |
Neonatal Sepsis
(causing Jaundice) |
|
|
Dx:
Child of 13-yo with femoral head off the metaphysis, with new bone formation |
Slipped Capital Femoral Epiphysis
|
|
|
First step:
Slipped Capital Femoral Epiphysis |
Emergency Surgery
|
|
|
Tx:
Kawasaki Dz |
IV immunoglobulins and Aspirin
|
|
|
Dx:
IgG, IgM and IgA are all very low, very low B-cells, bacterial infections in the first 5 years of life |
X-linked Agammaglobinemia
|
|
|
Dx:
low IgG, IgM and IgA levels, normal B-cells and T-cells; Sx begin at 15 - 35 years old. |
Common Variable Immunodeficiency
(CVID) |
|
|
Dx:
infant with Meningitis from Gonorrhea (meningococcemia) begins to get large purpuric lesions on flank |
Waterhouse-Friderichsen syndrome
(acute adrenal failure/hemorrhage from meningococcemia) |
|
|
COD:
Meningococcemia |
Adrenal Failure/Hemorrhage
(from advancing to Waterhouse-Friderichsen syndrome) |
|
|
Tx:
Homocystinuria |
Vitamin B6
|
|
|
Dx:
Beta-Galactosidase deficiency |
KraBBe's Dz
|
|
|
Dx:
Alpha-Galactosidase deficiency |
fAbry's Dz
(fAAAAAbry's) |
|
|
Dx:
Hyperinsulinemia, omphalocele, macroglossia, organomegaly |
Beckwith-Wiedemann syndrome
(HOMO) |
|
|
Dx:
short child with hypoglycemia, lactic acidosis, hyperuricemia and hyperlipidemia. Enlarged liver and kidneys and possible seizures |
Von-Gierke's syndrome
(G6P deficiency) |
|
|
Dx:
G-6-P deficiency |
Von-Gierke's syndrome
|
|
|
Dx:
Floppy baby with macroglossia and heart failure |
Pompe's syndrome
(Maltase deficiency) |
|
|
Dx:
Maltase deficiency |
Pompe's syndrome
|
|
|
Age:
walks alone, speaks 2 words, throws objects |
12 months old
|
|
|
Age:
walks up and down stairs without help and has 2 - 3 word phrases |
24 months old
|
|
|
First step:
Pyloric Stenosis |
Rehydrate and correct Electrolytes
|
|
|
When does stranger anxiety start and peak?
|
starts: 6 - 8 months
peaks: 12 - 15 months |
|
|
Dx:
IVP shows focal renal parenchymal scarring and blunting of calices |
Chronic Pyelonephritis
|
|
|
Dx:
Bilateral ptosis, difficulty getting up from chair and muscle weakness |
Myasthenia Gravis
|
|
|
Dx:
palpable purpura, glomerulonephritis, decreased complement, arthralgias, HSM, peripheral neuropathy and positive HCV |
Mixed Essential Cryoglobinemia
(hCv = Cryoglobinemia) |
|
|
MC Sx of mixed Sickle cell trait
|
painless Hematuria
|
|
|
When is the best time to give VZ-Ig to child who was playing with others that had chickenpox
|
within 3 - 5 days of exposure
(otherwise tell parents he will get Sx) |
|
|
Dx:
Non-immunized mother brings 2-week-old in b/c of spasms involving whole body and erythematous, tender umbilical cord and poor suckling |
Tetanus
|
|
|
Dx:
newborn lung problem due to right-to-left shunt from PDA or foramen ovale |
Persistent Pulmonary HTN of Newborn
|
|
|
Deficient enzyme:
FTT, bilateral cataracts, jaundice and hypoglycemia at birth |
Galactose-1-phosphate
|
|
|
Tx:
prevents painful episodes of Sickle cell crisis |
Hydroxyurea
|
|
|
MC child brain tumor in cerebrum
|
Benign Astrocytoma
|
|
|
Next step:
Foreign Body aspiration removal |
RIGID bronchoscopy
|
|
|
Define:
Meconium Ileus |
Failure to pass meconium within the first 24 hours of birth
|
|
|
MCC of high fever and chills or sepsis in Sickle cell patient
|
Strep Pneumococcus
(encapsulated organism that cannot be handled well due to asplenia) |
|
|
Dx:
Sickle cell patient with pain in the hip including restriction of abduction and internal rotation |
Avascular necrosis
(common in sickle cell adolescent) |
|
|
Dx:
premature neonate with "increased gastric residues" |
Necrotizing Entercolitis
|
|
|
Dx:
child born normal and asymptomatic until teens, when he began to have delayed muscle relaxation, progressive muscle weakness, thinning cheeks and atrophy of thenar and hypothenar eminences |
Myotonic Muscular Dystrophy
|
|