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Pediatrics - CM
| Question | Answer |
|---|---|
| What does the APGAR Score stand for? | Appearance Pulse Grimace Activity Respiration |
| What does the following letter stand for in APGAR and what are the scores for it? First A | Appearaance Pale, Blue is 0 Pink body blue extremities 1 All pink 2 |
| What does the following letter stand for in APGAR and what are the scores for it? P | Pulse 0 is 0 Less than 100 is 1 Over 100 is 2 |
| What does the following letter stand for in APGAR and what are the scores for it? G | Grimace when stimulated No response is 0 Grimace is 1 Cough is 2 |
| What does the following letter stand for in APGAR and what are the scores for it? Second A | Activity (tone) Limp is 0 Some flexion is 1 Active is 2 |
| What does the following letter stand for in APGAR and what are the scores for it? R | Respiration Absent is 0 Slow, irregular is 1 Good is 2 |
| Is the APGAR predictive of outcome? | No |
| What is caput succedaneum? | Swelling of the scalp from the baby stuck in the birth canal Resolves over a few day but can be a source of jaundice *crosses suture lines* |
| What is Cephalhematoma? | *Does NOT cross suture lines* in the scalp.. Can get worse over the first few days *Sub periosteal bleed* takes a few days to go away |
| Firm rubbery nodules seen on a babies back/face shortly after delivery? | Subcutaneous fat necrosis Occur during difficult delivery, esp w forceps. Can cause hypocalcemia later in the baby if they calcify |
| What nerves are involved in Erb Duchenne Palsy? | C3 and C4...If C5 is involved you can get resp depression so get an ultrasound or CXR to look for elevated or paralyzed diaphragm on one side |
| What nerves are involved in Klumpke's paralysis and what syndrome might be associated? | C8 and T1 Might involve the sympathetic chain so you can get Horner's Syndrome Can see an associated Claw Hand too |
| Signs of a clavicular fracture in a baby? | LGA baby with crepitus over the bone, or a lump from callous formation if brought in after about a week.. No therapy is really done |
| What is the location of a port wine stain seen in Sturge Weber Syndrome? | Along the distribution of the facial nerve on one side of the face... Do not fade with time |
| What findings are associated with Sturge Weber Syndrome? | Calcifications Seizures Mental retardation |
| A baby has a strawberry hemangioma and is having difficulty breathing or increasing stridor...What should be the concern? | Another hemangioma in the airway! Investigate |
| Mongolian Spots v Child abuse? | Spots are well circuscribed and do not fade into the surrounding tissues as do the bruises of child abuse |
| What is erythema toxicum? | A skin rash seen in newborns that develops after 24 hours! It is the immune system over-reacting. The rash will migrate but eventually goes away and is not a problem. Skin scraping shows eosinophils |
| What is aniridia associated with (no iris)? | Wilms Tumor Esp if associated with hemi-hypertrophy |
| Two things to think of when you seen cataracts on a newborn? | TORCHeS infections and Galactosemia |
| Pre-auricular skin tags in babies are associated with... | Cleft palate |
| Pre-auricular pit is associated with... | Hearing Problems |
| What is microtia? | A gross malformation of the external ear... Associated with renal problems as seen in Potter's syndrome |
| Contraindication to circumcision? | Hypospadias...need the foreskin for the repair |
| By what age must you fix an undescended testicle? | One year of age |
| What is diastasis recti? | Where the abdominal muscles do not completely meet in the middle |
| Next test in syndactyly? | X-ray |
| What are the signs of Galactosemia? | Jaundice Hypoglycemia Cataract formation MR HIGH RISK for E-coli sepsis (Contraindication to breastfeeding) |
| What are the causes of symmetric intrauterine growth retardation? (Worse because head is involved too) | Syndrome problems Chromosomal problem TORCH infections.... |
| What are the causes of asymmetrical IUGR? (better than symmetric because head is spared) | Utero-placental insufficiency Smoking Malnutrition Hypertension |
| What is the definition of LGA? | Weight over 4500 grams |
| What is a post-term infant? What are possible complications? | Gestational age greater than 42 weeks They have increased risk of mortality and meconium aspiration |
| What is the definition of a SGA baby? | Less than 2500 grams |
| What is the definition of preterm baby? | GA less than 37 weeks at delivery |
| What is the definition of a 'neonate?' | Up to 28 days of life |
| What are common findings in infants of diabetic mothers? | Macrosomia Ruddy, plethoric appearance Can have RDS or the 'lazy left colon syndrome' which leads to them having meconium ileus... They get high RBCs and high bilirubin |
| If in the stem of a q with a baby in respiratory distress...If they give the baby O2 and he doesn't improve think of... | A cardiac defect or fixed shunt |
| Most common cause of respiratory distress in a preterm infant? | RDS |
| If a baby is in resp distress and has a short second stage of labor of a C-section think the cause is likely... | Transient tachypnea of the newborn.. Increased rate to blow off more of the amniotic fluid |
| What is choanal atresia? | Where the back of the nasal passage is not formed properly... This is a congenital problem. Baby will have difficulty breathing and will then cry and resp will improve as they are breathing thru their mouth |
| Best initial test for RDS? | CXR (ground glass appearance) |
| Most accurate test for RDS? | LS ratio...Lecithin to Sphingomyelin? |
| Best initial treatment for RDS | Give surfactant ..Maybe give antibiotics |
| Most effective treatment for RDS? | Prevention...get the baby to term, maybe give the mom steroids before the baby is delivered in an attempt to mature the lungs of baby |
| Treatment of TTN? | O2 therapy |
| What can meconium aspiration lead to? | Persistent fetal circulation, AKA pulmonary HTN of the newborn |
| First test for meconium ileus? | X-ray |
| First test for Hirschsprung disease? | X-ray |
| Baby has meconium ileus....Now they have what until proven otherwise? | CF |
| Signs of nectorizing entercolitis? | Preterm baby with low APGAR scores Bloody diarrhea with feeding Abd distention |
| Test of choice for Necrotizing entercolitis? | Abdominal X-ray |
| What is the best test for the diagnosis of Hirschsprungs? | Colonic biopsy of non-distended region |
| What is pneumatosis intestinale? | Air inside the bowel wall... Associated with Nectrotizing entercolitis |
| Findings in physiologic jaundice? | NOT present in first 24 hours of life Does NOT go above bili of about 13 Peaks by 3-5th day.. Indirect hyperbilirubinemia (Caused by increased RBC turnover and immature liver) |
| What are causes of Coombs (+) jaundice in the newborn? | Rh incompatibility (More severe, preventable with Immune Globulin RhoGam. Mom is Rh(-) Baby is (+) ABO incompatibility...Treat with phototherapy |
| Causes of Coombs negative High Hb jaundice in the newborn? | Polycythemia Twin-Twin transfer Infant of diabetic mother IUGR from hypoxia |
| What are the causes of a Coombs negative Low Hb jaundiced baby? | Enyzme or cell wall problems... Sphero/elliptocytosis G6PD Pyruvate kinase deficiency |
| Causes of Direct hyperbilirubinemia in a baby? | Many...Esp TORCH infections Galacto/Tyrosinemia TPN and BILIARY ATRESIA**** clay colored stools |
| What is Breast FEEDING jaundice? | Occurs within 1 week of birth! Caused by dehydration and not getting enough calories. Give the baby more frequent feeds |
| What is breast MILK jaundice? | Later onset, after at least one week, usually peaks in 2-3 weeks and is caused by milk proteins competing with biliruben for albumen...kicks bili off and it increases. |
| Top 4 causes of sepsis/meningitis in the newborn? | Group B strep agalactia Listeria E. Coli Herpes simplex virus..First few months of life |
| Which cephalosporin should be avoided in the first few months of life? | Ceftriaxone |
| Empiric treatment of sepsis in newborns? | Amp and aminoglycoside or Amp and cefotaxime |
| What is the TORCHES? | Toxoplasmosis Other- Rubella CMV Herpes Syphilis... |
| How is toxoplasmosis acquired? | Through eating undercooked meat, esp pork or Coming in contact with Cat feces |
| Best initial test for Any TORCHes infection? | Titers of the specific organism thought to be the culprit |
| What is classically seen on toxoplasmosis infection in babies on CT? | Intracranial calcifications-scattered Also see retinitis and microecphaly with IUGR |
| What is the treatment for toxoplasmosis in mother? Baby? | Spiramycin for momma Pyrimethamine with sulfasalazine and leucovorin for BM suppression caused by the sulfa drug |
| What infection causes the blueberry muffin baby? | Congenital Rubella |
| What are the findings in a baby affected with congenital rubella? | IUGR, symmetric Cataracts Heart defects (ASD, VSD) Blueberry muffin baby rash... Are of erythropoeisis |
| Best treatment for congenital rubella? | None, you cannot treat. Best way is to prevent with immunization of the population |
| What are findings of CMV infection in the newborn? | Retinitis PERIVENTRICULAR calcifications |
| Treatment for congenital CMV? | None..baby is already affected and is not contagious. |
| Best way to prevent HS virus in newborn? | Treat mom and deliver with C-section if she has active lesions Rx with acyclovir |
| Findings in babies within first 2 years if affected with newborn syphilis? | Fever, Anemia and Failure to thrive Rash, SNUFFLES Hepatosplenomegaly Periostitis** |
| Signs of late congenital syphilis, after 2 years? | Saber Shin Hutchinson teeth Saddle nose Rhagades (little clefts in the corners of the mouth) |
| Treatment for congenital syphilis? | PCN... Run VDRL and RPR for confirmation |
| Findings of Congenital varicella? | Limb hypoplasia Cutaneous scars microcephaly Chorioretinitis Cataracts |
| When do you treat a baby with VZIG for varicella? | For neonatal VZ when mother develops varicella 5 days before to 2 days after delivery |
| Best test to determine intraventricular hemorrhage in a neonate? | Ultrasound in preterm baby CT scan in term baby |
| Treatment for babies undergoing withdrawal? | Swaddling and possible long term sedation |
| Long term diseases that Down syndrome children are at higher risk for? | Leukemias Hypothyroidism Atlano-Axial instability....check for when getting a special olympics sports physical |
| Physical findings of Trisomy 18? | MR with prominent occiput Rockerbottom feet and Hammer Toes Clenched hands Cardiac problems (ASD/VSD)... only 10% survive to a year |
| Signs of Turners? | Lymphedema of hands and feet esp at birth Wide spaced nipples Multiple Nevi Webbed Neck Hypothyroidism |
| Cardiac abnormalities in Turners syndrome? | Bicuspid aortic valve or Coartation of the aorta |
| Common renal problem in Turners? | Horseshoe kidney |
| Findings of Fragile X Syndrome? | Midface hypoplasia Enlarged testes/Ears and Head MR..most common inherited cause |
| What are the major findings of achondroplasia? | Short stature Frontal bossing Lumbar lordosis |
| Mode of inheritance of achondroplasia? | AD but 90 % are new mutations Associated with older paternal age |
| Problems associated with achondroplastic dwarves? | Spinal cord compression Small eustachian Tubes |
| Are either Ehlers Danlos or Marfans mentally retarded? | No, normal mentation |
| What are the major findings of someone with Ehler's Danlos? | Joint laxity Hyperextensible skin Fragile skin with easy bruising Autosomal dominant |
| Cardiac problems associated with Marfans? | Aortic dissection and MVP |
| Which type of Osteogenesis imperfecta is lethal? | Type 2 usually in utero |
| What are the major findings of Osteogenesis imperfecta? | Blue sclera and translucent teeth Growth deficiency with frequent bone breaks and deformations |
| Associated findings of Fetal Alcohol Syndrome babies? | Thin Upper Lip Absent philtrum Cardiac ASD and VSD problems |
| How must wt should a baby lose in the first week after birth? | Usually lose 10% and regain it by 2 weeks of age |
| At what age should a babies birth weight double? Triple? | 6 months and 12 months |
| What is the best indicator of acute malnutrition? | Weight/height ratio of less than 5th percentile |
| Major contraindications to breastfeeding? | HIV CMV HSV if lesions are on the breast HBV unless baby has been vaccinated Breast Ca Substance abuse |
| When do babies typically need iron fortification? | After 4-6 months... |
| Why is breast milk better than cows milk for infants? | Has a lower renal solute load so it is better on the kidneys and Even though breast has less iron it is better absorbed so the baby gets more if it |
| What vitamin is breast milk low in? | Vit K |
| Foods to avoid in the first year of life? | HONEY avoid honey Egg whites Citrus and Nuts, all because they are highly allergenic |
| Boy is 13 years and his bone age is 11 years...what does that mean? | He is behind in his growth, but still has room to grow and thus likely just has a constitutional growth delay |
| What is the one reflex that is not present at birth in a baby? | The parachute reflex, putting their arms out in front of them if you place them in the prone position... Usually appears around 6-8 months and never goes away |
| When do babies begin to have a social smile and start making cooing noises? | 4-8 weeks of age |
| When does a baby usually start reaching for objects? | Around 3 months... |
| At what age can babies usually bring their hands to the midline and hold their head to vertical when prone? | 4 months of age...good time to start supplemental feeds |
| At what age are babies usually pissed if you stop playing with them? | 4 months...will begin to cry |
| When do babies roll from stomachs on to their backs? | Usually at 4 months |
| When do babies roll from their backs onto their stomachs? | 6 months of age... May creep, crawl |
| At what age can babies sit with pelvic support? | 6 months |
| At what age do babies sit alone or walk with hands held? | 9 months |
| When does a pincer grasp develop? | 9 months |
| At what age can a child build a 3 block tower? | 15 months |
| At what age can a child build a 4 block tower? | 18 months |
| At what age can a child build a 7 block tower? | 2 years |
| What is primary nocturnal enuresis? | When child, usually a boy, is dry during the day but keeps wetting the bed at night. UA is normal.. Problem is boy does not wake up with the urge to pee in the middle of the night... |
| How is Rett Syndrome acquired? | X-linked dominant |
| Which are the common live attenuated vaccines? | MMR Varicella Nasal influenza |
| If you give two live vaccines on different days how long should you wait before giving the second one? | 1 month to provide better efficay |
| What do you do when you have a lapse in immunizations? | Begin where you left off, do not start over. |
| You give someone gamma globulin, how long you do have to wait before you can give them a live virus? | 3 months! otherwise you get diminished immune response |
| Should you delay giving a child vaccinations if they have mild illness? | No...fever over 102? yea probably delay |
| What vaccines are contraindicated in patients with egg allergy? | INFLUENZA and Yellow fever (MMR is ok) |
| Patient has a history of anaphylaxis to neo or streptomycin, what immunizations shouldn't be given? | Inactivated polio virus IPV MMR Varicella... They contain these abx |
| What vaccines are recommended in pregnancy? | Tdap Influenza DO NOT GIVE RUBELLA |
| Mom is immune competent and pregnant can you give her daughter the MMR vaccine? | Hellz yea Don't give to a daughter whose father is severely immunocompromised tho |
| What are the causes of Croup? | Parainfluenza virus in number one RSV Adenovirus |
| What age of patient gets croup? | 3 months to 5 years... Seen in winter |
| Signs of croup? | Respiratory illness followed by seal-barking cough, inspiratory stridor and hoarseness |
| Treatment of Croup? | Usually supportive... Can give nebulized epinephrine or corticosteroids |
| What X-ray finding is associated with Croup? | The Steeple sign, AKA pencil sign showing narrowing of the subglottal airway |
| Common causes of Epiglottitis? | S. pyogenes S pneumonia Staph aureus H-flu B |
| How is epiglottitis diagnosed? | Laryngoscopy...will see a cherry red epiglottis |
| What are the signs of epiglottitis? | Acute, toxic looking patient with dysphagia, drooling and is sitting in the 'tripodding position' to allow easier air entry |
| Treatment of epiglottitis? | Give an airway and antibiotics |
| What sign is seen on lateral X-ray of epiglottitis? | Thumbprint sign.. Looks like a thumb print next to the hyoid bone |
| Most common cause of bacterial tracheitis? | S. aureus |
| Which age group gets bacterial tracheitis? | Less than three usually in the Winter following URIs |
| Signs of bacterial tracheitis? | Brassy cough with high fever but no drooling or dysphagia... |
| Diagnosis of bacterial tracheitis? | Laryngoscopy... Give abx, may need airway. |
| Findings of acute infectious laryngitis? | Cough, sore throat with hoarseness and loss of voice out of proportion to systemic findings. |
| First test when suspecting foreign body aspiration? | CXR...see air trapping in the bronchus with hyperinflation, possible mediastinal shift |
| How is a foreign body removed from the airway? | Rigid bronch |
| A coin is seen on X-ray oriented front to back.....where in the throat would it be? | In the esophagus... If it were in the trachea is has to orient itself sideways to avoid the cartilaginous rings |
| What is the most common cause of Bronchiolitis? | RSV... Then parainfluenza, adenovirus, mycoplasma... |
| When is bronchiolitis seen? | In ages up to a year, usually winter, early spring |
| What is seen in bronchiolitis? | It is inflammation of the small airways leading to air trapping and overinflation. Wheezing is seen. Usually follows a cold |
| What does bronchiolitis show on CXR? | Hyperinflation with patchy atelectasis |
| What is the treatment for bronchiolitis? | Supportive, but hospitalize if resp distress... Can try beta agonist but doesnt always work. Ribavirin is controversial |
| What is palivizumab and who would get it? | It is a monoclonal ab against RSV F protein... Babies who are at increased risk for bronchiolitis |
| MCC of pneumonia in children under 5? | Viruses, esp RSV Usually have previous URI |
| MCC of pneumonias in children over 5? | Bacterial like S. pneumoniae and mycoplasma pneumoniae |
| What are signs of pneumonia caused by chlamydia trachomatis? | No fever/wheezing Conjuctivitis at birth! Staccato cough and Peripheral eosinophilia |
| Best way to diagnose Mycoplasma pneumonia? | IgM titers |
| If a child is described as having a 'pneumoatocele' on X-ray think... | Staph aureus |
| Do you get sputum cultures in children? | No, they don't ever really cough up sputum |
| General treatment of outpatient pneumonia? | Amoxicillin |
| General treatment for a hospitalized child with pneumonia? | Cefuroxime |
| What is the best test for CF? | Sweat chloride test |
| What gene on what chromosome is CF associated with and how is it inherited? | CFTR on Ch 7.. AR |
| Common findings in pts with CF? | Large nasal polyps Pancreatic dysfunction etc... Clubbing-bronciectasis Sterile males Meconium ileus Fatty, foul smelling stool and rectal prolapse |
| Common bacterial infections in the lungs in CF patients? | S. aureus and Pseudomonas |
| Treatment of CF pneumonia? | Have to cover pseudomonas! Tobramycin and piperacillin or Ceftazidime |
| Who is at risk for SIDS? | Low SES African America, NAmerican 2-4 month olds highest risk Winter time Males |
| What are common lab findings in patient with Allergic Rhinitis? | Eosinophils in the peripheral blood OR EOSINOPHILS in the nasal secretions, which is more sensitive |
| What are the causes of Eosinophila? | NAACP Neoplasms Allergies/Asthma Addison's disease Connective tissue diseases Parasites |
| Which food allergies do kids commonly grow out of? | Milk and Egg allergies |
| Characterize hive rash... | Wheal and Flare Raised and palpable Blanching |
| How is hereditary angioedema inherited? | AD... C1-esterase inhibitor deficiency |
| Characterize atopic dermatitis rash... | Very pruritic, can lead to scratching and excoriation Weeping, serous discharge with crusting Common on the face and the extensor surfaces like knees/elbows of children |
| Treatment of atopic dermatitis? | Avoid precipitating cause Don't wear rough clothes Dont bath excessively... Can use topical steroids if needed |
| Common findings in DiGeorges syndrome? | Cardiac abnormalities (Tetrology or Truncus) Atypical Facies Thymic hypoplasia Cleft palate Hypocalcemia/parathyroidism |
| What pouches are involved in DiGeorges syndrome what chromosome is involved? | 22q11 deletion Causes dysgenesis of the 3rd/4th pharyneal pouches |
| Most common presenting feature of DiGeorges? | Hypocalcemic seizure |
| What lab findings are seen in DiGeorges? | Low absolute neutrophil count Decreased CD3 Absent respiratory burst |
| What is the ultimate treatment for Digeorges? | Thymic tissue transplant or BM transplant |
| MCC of otitis externa? | P. aeruginosa S aureus |
| MCCs of Otitis media? | S pneumoniae H Flu, nontypable** M. catarrhalis |
| Increased incidence of otitis media? | Infants, Males in daycare Secondhand smoke |
| First line treatment of otitis media? | Amoxicillin... If the pt isnt any better after 2-3 days consider B-lactamase producer like M catarrhalis |
| Indications for tympanotomy tubes? | Hearing loss or Recurrent infections |
| What is a cholesteatoma? | Squamous epithelium that can grow into the ear canal described as granulation tissue... essentially a tumor, can destroy the area |
| What is Kiesselbach plexus? | Most common site of bleeding from the nose, in the anterior septum |
| Most common causes of nose bleeds in children? | Digital trauma Dry air Inflammation from URI, allergy |
| Which sinuses are we born with? | Ethmoid and maxillary... Sphenoid at 5 Frontal begins at 7-8 |
| MCC of chronic sinusitis? | S. aureus |
| When does strep throat usually occur in children? | Between 5-10... Think of virus if less than 5 or with URI |
| Signs of Herpangina? | Vesicles or ulcers on the posterior pharynx along with a sore red throat...Think Coxsackie |
| Signs of Hand-Foot and Mouth disease? | Inflamed oropharynx Vesicles on the mouth, hands feet and buttocks that can ulcerate and become painful. |
| What is the gold standard for the diagnosis of strep throat? | Throat culture! Do one if the rapid strep test, best initial test, is negative. Takes 1-2 days |
| Treatment of strep throat prevents... | Rheumatic fever |
| Best treatment of Strep Throat? | Penicillin |
| What is the best test to look for retropharyngeal abscess? | Lateral neck X-ray Ct is the next test.. Finally drain it |
| Signs of a peritonsillar abscess? | Drooling Hot potato voice Uvula deviation away from it |
| What pediatric murmurs are considered pathologic? | If there are symptoms Cyanosis Grade 3/6 or higher Diastolic Abnormal heart sounds Abnormally strong/weak pulses |
| What are 3 left to right congenital shunts? | ASD VSD PDA |
| What are 3 congenital right to left shunts? | Tetralogy Transposition of the great vessels Tricuspid atresia |
| Most common congenital heart defect? | VSD |
| When does an Eisenmenger complex occur? | When the pulmonary vascular resistance is greater than systemic |
| Complications of VSDs? | Heart failure Endocarditis...same for any high flow valvular lesion |
| Most common type of ASD? | Ostium Secundum |
| Wide fixed split of S2? | ASD ...has a systolic murmur |
| Findings in patient with a PDA? | Bounding pulses esp in palms and feet Widened pulse pressure |
| What is a good initial treatment for coarctation of the aorta? | Give PGE1 infusion to keep the PDA open |
| What is tetrology? | Pulmonary stenosis VSD Overriding aorta Right ventricular hypertrophy |
| What heart sounds are associated with the Tetralogy of Fallot? | SINGLE s2 heart sound or a soft pulmonic component |
| What are characteristic findings of tetralogy of Fallot on CXR? | Boot shaped heart and dark lung fields |
| Best diagnostic test for Endocarditis? | Positive blood culture |
| Most common bug causing dental caries in children? | S. mutans... Common from bottle propping |
| Best test for diagnosing Diarrhea in children? | A stool exam...can look for mucus, blood, leukocytes etc. |
| Most useful first test to do for screening of malabsorption? | Spot stool for fat test.... |
| How do you confirm the best initial test for evaluation of malabsorption? | 72 hour stool for fecal fat... Gold standard |
| What is the definitive test for carbohydrate malabsorption? | Breath hydrogen test |
| What is the best screening test for suspected protein loss in the stool? | Spot stool for alpha one antitrypsin level |
| What foods exacerbate celiac disease? | Rye, wheat and barley |
| What two serological markers for celiac disease? | Antiendomysial and antigliadin antibodies... antibodies against tissue transglutaminase |
| How is celiac disease confirmed, ie what is gold standard? | Biopsy with histology |
| What is the best test for pyloric stenosis? | Ultrasound |
| When does pyloric stenosis manifest? | NOT AT BIRTH...usually around 2 weeks + after birth. Projectile non-bilious vomiting |
| Suspecting duodenal atresia in a newborn? The next step in management is... | X-ray...look for the double bubble sign |
| Where does a Ladds bands obstruction occur? | In the duodenum...usually as a consequnce of malrotation of the gut |
| Suspect malrotation with volvulus in a child...what is the next step? | Abd X-ray and look at the bowel gas pattern...will see shifting of bowel gas to one side as result of malrotation |
| Findings of Meckel Diverticulum? | 2 types of epithelium (like the stomach) 2 inch in diameter 2 feet from the ileocecal valve 2 % of the population Usually in first 2 years of life it presents |
| What is the most frequent GI anomaly in children? | Meckel's diverticulum.. Comes across as hematochezia... painless |
| Complication of Meckels diverticulum? | Intussusception |
| How is Meckel's diverticulum diagnosed? | With a technetium** scan, and meckel radionucleotide scan Technetium is taken up by GI mucosa |
| What disease is described as a sausage shaped mass usually in the RUQ? | Intussusception |
| What is the first test to do when suspecting intussusception? | Plain abd X-ray to rule out free air |
| What is the best diagnostic and therapeutic intervention for intussusception? | Air enema*** or contrast enema if not given |
| Common causes of intussusception? | Enlarged lymph nodes in the abd or Meckels diverticulum etc... |
| What is the APT test? | A test that can be done on blood from feces passed by a neonate that tells you if it is the Fetal Hb blood or if it is from mom, something that the baby swallowed in utero or while breast feeding |
| Most common bowel obstruction in neonates? | Hirschprung Disease |
| When should patients get a voiding cystourethrogram? | Any male with a UTI or any female under the age of 5 to look for reflux |
| When should posterior urethral valves be considered? | In a newborn male with a palpable bladder and a weak urinary stream |
| How do you diagnose posterior urethral valves? | Voiding cystourethrogram |
| How are posterior urethral valves treated? | Cathterization after broad spectrum abx followed by surgery.. Otherwise can cause anything from VUR to ESRD |
| When does PSGN present? | In ages 5-12 years 1-2 weeks after a throat or 3-6 weeks after a skin infection like impetigo.. Look for HTN, hematuria and edema |
| What complement abnormality is seen in PSGN? | low c3!!!!! |
| What is the single best test for diagnosis of acute PSGN? | Anti DNAse test... antistreptolysin o are likely positive |
| Treatment of PSGN? | Antibiotics to eliminate the strain of GN Control HTN with ACE |
| How is Alports syndrome inherited and what are common findings or buzzwords? | X-linked dominant Hearing loss Cataracts or lens problems *foam cells* |
| Treatment of HUS? | Supportive! Dont give abx, platelets or antithrombotic drugs |
| Most common palpable mass in a newborn abdomen? | Polycystic kidneys...Bilateral... Autosomal recessive Diagnose with ultrasound |
| Most common cause of proteinuria in children? | Orthostatic....increased protein on their urinalysis from standing too long... Can check by doing a UA first thing in the morning |
| What are the C3 and C4 levels in Minimal Change Disease? | Normal.. |
| What are patients with nephrotic syndrome at increased risk of acquiring? | Spontaneous bacterial peritonitis |
| How do you diagnose testicular torsion? | Color doppler |
| What is seen on UA in a patient with Epididymitis? | Sterile pyuria... WBCs... |
| Treatment of epididymitis? | Bedrest and antibiotics |
| Where do tumors in ALL that has been treated tend to crop up again later? | In the testicles |
| What is the definition of precocious puberty in boys/girls and what is the most common cause? | Sexual development in girls before 8 Boys before 9 MCC is familial Might have early epiphyseal closure |
| How do you screen for precocious puberty? | Check LH levels, which will be high... Definitive test is with the GnRH stimulation test and you will see a BRISK LH response |
| What test needs to be done if Barlow or Ortolani tests are positive? | Dynamic ultraound up to 4 months of age... Rx is pavlik harness |
| Treatment for torticollis in the newborn? | Passive stretching exercises |
| Triad of osteogenesis imperfecta? | Fractures Blue sclera Early deafness |
| Osteosarcoma X-ray findings? | Sunburst pattern and Codmans triangle... seen in teenage years usually |
| What are common findings or associations with developing HSP? | Usually following URI, More common in males in the winter MOST COMMON CAUSE of nonthrombocytopenic purpura |
| Common findings in patients with HSP? | Maculopapular rash that develops to petechiae and purpura over a week...almost always below the waist Arthritis! GI probs, esp intussusception Renal problems like glomerulonephritis Seizures! |
| Lab findings on HSP? | Normal platelets Anemia Increased IgA and IgM Heme positive stool |
| HSP treatment? | Mostly supportive, it is self limited.... Corticosteroids if you insist |
| Common findings in patients with lead poisoning? | Behavioral changes... Developmental delays Abd pain/vomiting, constipation |
| Gold standard for lead poisoning? | Blood lead level... done if screening level if high |
| What gives basophilic stippling on RBCs? | Lead poisoning |
| Treatment for Lead poisoning? | Oral succimer or BAL or EDTA |
| Glossitis with anemia? | Vitamin B12 deficiency is likely |
| How are elliptocytosis or sphereocytosis inherited? | AD |
| How is G6PD inherited? | X-linked |
| What is the defect in sickle cell anemia? | Single base pair change at the 6th codon of the Beta gene...Valine in placed instead of glutamate |
| What is usually the first sign of Sickle cell? | Dactylitis at around 2 months |
| Causes of sickling? | Hypoxia Acidosis Fever |
| Cause of aplastic crisis in Sickle Cell? | Parvovirus |
| Diagnosis of Sickle Cell? | Hb electrophoresis |
| What type of bleeding is associated with hemophilias? | Hemearthrosis, with easy bleeding with crawling and walking |
| What type of bleeding is associated with vWF disease? | Platelet type bleeding, small petichiae or bleeding on the gums, nose bleeds |
| What factor is deficient in Hemophilia A? | Factor VIII PTT is elevated Normal platelets, normal PT, normal bleed time and normal vWF |
| What factor is deficient in Hemophilia B? | Factor IX PTT is elevated Normal platelets, normal PT, normal bleed time and normal vWF |
| How is vWF inherited? | AD |
| What lab values are changed on vWF deficiency? | Increased PTT, bleeding time |
| When do you usually see ITP? | 1-4 weeks after a viral illness. Pts will present with a 'rash' which is petichiae... OTHERWISE pt is well... IF HSM or lymphadenopathy think something else |
| Lab findings of ITP? | Platelets less than 20,000 Normal other cell lines. BM can show normal to increased megakaryocytes |
| What is the treatment for ITP? | IVIG for 1-2 days can be given.. If response is inadequate give prenisone but must do biopsy of BM first to rule out malignancy |
| Common findings in children with ALL? | Pallor/Bruising Petichiae with lymphadenopathy 1/4 present with bone and joint pain |
| What are two places ALL malignancy can remain dormant and crop up years laster? | Testes in boys and in the CNS... Intrathecal chemo is often given for this reason |
| Prevention of tumor lysis syndrome? | Hydration Alkalinize the urine Prevent uric acid formation with allopurinol |
| Reed Sternberg Cell? | Hodgkin Disease |
| Presentation of Hodgkin disease? | Painless firm cervical or supraclavicular LN*** Night sweats, fever, wt loss PRURITIS* |
| What virus is thought to have a major causative role in Burkitt Lymphoma? | EBV |
| Best initial test for Brain tumors? | Head CT |
| What is the most common brain tumor in children? | Astrocytoma, juvenile pilocytic...Usually seen in cerebellum |
| What is the second most common type of tumor in children? | Medulloblastoma! Seen midline in the cerebellum, can cause gait disturbances and if it compresses the 4th ventricle it will cause obstruction and hydrocephalus |
| Signs of the craniopharyngeoma? | Panhypopituitarism Growth failure Visual Loss Calcifications on X-ray in the sella turcica |
| What tumor is commonly seen in pts with neurofibromatosis? Signs? | Rhabdomyosarcomas or Optic nerve glioma... Unilateral visual loss, proptosis, eye deviation with nystagmus and strabismus |
| What is a Wilms tumor and what is it associated with? | Nephroblastoma Hemihypertrophy Aniridia other GU anomalies... Maybe htn, hematuria |
| Best way to diagnose Wilms tumor? | Abd CT scan |
| What is the most common cancer of neonates and what are the findings on CT, which is the best test? | Neuroblastoma! Can be anywhere because it arises from NCCs... Commonly in abd in the adrenals.. Can calicify or cause hemorrhage |
| What are the tumor markers for Neuroblastoma? | Increase HVA** or VMA in urine |
| Contraindications to LP in a child with meningitis? | Evidence of ICP Severe cardiopulmonary problems Infection over the site of the puncture. DO NOT DELAY ABX after LP |
| Treatment specifically for HiB meningitis? | Ampicillin |
| When do you give steroids for children with meningitis? | IV dexamethasone if child is over 6 weeks and ONLY with H flu B |
| Pt with meningitis has a focal seizure or temporal lobe involvement think... | Herpes simplex... give acyclovir |
| What is the most common presentation of varicella zoster meningitis? | Acute cerebellar ataxia with Encephalitis |
| Best test for diagnosing viral meningitis? | PCR... If Herpes Simplex give acyclovir otherwise self limited |
| Gold standard for diagnosis of Pertussis? | Culture |
| What is seen on CBC of patients with Pertussis? | Leukocytosis, often VERY high with like 90% lymphocytes |
| Treatment of Pertussis? | Erythromycin to prevent spread. Treat all household contacts as well |
| Signs of Measles? | Cough Coryza Conjuncitivitis Koplik spots later... Fever AND RASH at same time... Very sick children... rash starts head to toe |
| Most common complication of Measles? | Otitis Media |
| Signs of Rubella? | Retroauricular or POSTERIOR OCCIPITAL lymphadenitis... along with rash etc... |
| What causes Roseola? | HHV-6... |
| What are the signs of Roseola!??? | HIGH HIGH fever, with the fever going away and then a rash appearing a few days later... No treatment |
| What are the signs of Mumps? | Fever/malaise/abd pain Parotid swelling Orchitis* |
| What is Fifth's disease AKA and what causes it? | Erythema infectiosum Parvovirus B19 |
| What are the signs of Fifths disease? | Slapped cheek with lacy rash |
| What complications can occur with Fifth's disease? | Aplastic crisis esp in Sicklers, Erythroblastosis Fetalis |
| Cause of Mono? | EBV.. Which is associated with Burkitts, Hodgkin disease, nasopharyngeal cancer |
| How is Mono diagnosed? | Heterophile antibodies |
| Best test to diagnose HIV in a newborn? | PCR |
| Treatment for head lice? | Malathion or Permethrin cream |
| What is the ferric chloride test? | A urine test...if it comes back positive the patient ingested aspirin |
| Treatment of aspirin OD? | Alkalinize urine, dialysis |
| Tanner Staging for Hair? | Stage 1 none 2: sparse patches 3: Darkened, curling and increased amt 4: Coarse, curling not on thighs 5: Adult type, coarse, on thighs |
| First sign of puberty in girls/boys? | Breast development Scrotal enlargement |
| Common puberty normal variants? | Gynecomastia in boys Spotty irregular periods for 1 year in girls Asymmetric breast development |
| Vaginal exam shows frothy vaginal discharge and Strawberry cervix...Dx? | Trichomoniasis. Rx with metronidazole |
| Impetigo treatment? | Mupirocin topically |
| Describe the lesion of Erythema Multiforme? | Target like papules with erythematous outer border, inner pale ring... Raised Itchy Blanching Can be triggered by viruses |
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