2014-03-07 USMLE peds - USMLE peds Flashcards Preview

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Flashcards in 2014-03-07 USMLE peds - USMLE peds Deck (500)
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1
Q

What should you do if birth screening test is positive

A

order a confirmatory test

2
Q

Most states screen for what at birth?

A
  • hypothyroidism
  • phenylketonuria
  • galactosemia
  • sickle cell disease
3
Q

Cow’s milk should not be given before age

A

1 year

4
Q

Hot water should be less than

A

110-120F

5
Q

Start introducing solid foods at age

A

6 months

6
Q

Head circumference should be measured routinely until what age

A

2 years

7
Q

2 major causes of increased head circumference

A
  • hydrocephalus

- brain tumor

8
Q

TORCH infections =

A
Toxoplasmosis
"other": syphilis and viruses
Rubella
CMV
HSV
9
Q

What percentage of childhood obesity is due to organic causes like cushings?

A

5%

10
Q

Define failure to thrive

A

growth below 5th percentile for age

11
Q

Most common case of failure to thrive

A

psychosocial reasons

12
Q

Hearing screening should be done

A
  • at birth

- every 2 years from 4 years old to adolescence

13
Q

Vision should be screened

A

every few years starting at age 3

14
Q

Absent red reflex may be sign of

A
CATARACTS
- congenital rubella 
- other TORCH infections
- galactosemia
RETINOBLASTOMA
15
Q

When is lazy eye normal

A

never, if persistant; may be occational until 3 months of age

16
Q

2 infections classically associated with hearing loss

A
  • meningitis

- recurrent otitis media

17
Q

Who should always get iron supplements?

A

pre-term breastfed babies

18
Q

First step in lead poisoning

A

stop the exposure

19
Q

Classic behaviors/situations for lead poisoning

A
  • eating paint chips

- living by battery recycling

20
Q

Concerning lead level

A

if >10 ug/dl need close f/u

21
Q

Treatment of severe lead poisoning

A

succimer or DMSA (chelation therapy)

22
Q

First dentist appointment by age

A

3 years

23
Q

Do you need to supplement fluoride?

A

no, almost always in the water

24
Q

When should you start Vit D supplements?

A

6 months

25
Q

High risk for INFANTS for Vit D defeciency

A
  • inadequate maternal intake
  • little sun
  • exclusive breast feeding after 6 months
26
Q

Screening for TB

A

only in high risk area or immigrant

  • at 4-6 years AND
  • at 11-16 years
27
Q

Timing of Hep B vaccine

A

3 doses:

  • 0-1 month
  • 1-4 months
  • 6-18 months
28
Q

Timing of DTP vaccine

A
5 doses:
- 2 months
- 4 months
- 6 months
- 15-18 months
- 4-6 years
AND Td booster every 10 years
29
Q

Timing of HiB vaccine

A

4 doses:

  • 2 months
  • 4 month
  • 6 month
  • 12-15 months
30
Q

Timing of polio vaccine

A

4 doses:

  • 2 months
  • 4 months
  • 6 months
  • 4-6 years
31
Q

Timing of MMR vaccine

A

2 doses:

  • 12-15 months
  • 4-6 years
32
Q

Timing of pneumococcus vaccine

A

4 doses:

  • 2 months
  • r months
  • 6 months
  • 12-15 months
33
Q

Timing of varicella vaccine

A

1 dose:

- 12-18 months

34
Q

Avoid MMR vaccine in

A
  • egg allergy
  • neomycin allergy
  • immunodeficiency (HIV ok)
35
Q

If mom has Hep B, at birth give

A

both Hep B vaccince and immune globulin

36
Q

Avoid polio vaccine in

A
  • neomycin or streptomycin allergy
37
Q

Avoid varicella vaccine in

A
  • neomycin allergy

- immunodeficiency

38
Q

What peds populations should (especially) get influenza vaccine?

A
  • 6+ mo old with immunodefeciency
  • severe heart/lung disease
  • chronic ASA therapy
39
Q

What peds populations should get pneumococcus vaccine?

A

If older than 2 years give if:

  • immunodefeciency
  • asplenic
  • sickle cell disease
40
Q

Screening test for sexually active female teens

A
  • PAP smear

- GC/Chlamydia

41
Q

Peds screening for urinary malformations is indicated when? What is test of choice?

A
  • boys: 1st UTI if less than 6 years
  • girls: 2nd UTI if less than 6 years
  • use voiding cystourethrogram or renal US
42
Q

When are Apgars done?

A

1 and 5 min (1 minute meaning immediately)

43
Q

General categories of for Apgar

A

each with 2 points:

  • HR
  • Respiratory effort
  • Muscle tone
  • Color
  • Reflex irritability
44
Q

Apgar for HR

A

0- absent
1- less than 100
2- more than 100

45
Q

Apgar for respiratory effort

A

0- no cry
1- weak cry
2- strong cry

46
Q

Apgar for muscle tone

A

0- limp
1- some flexion
2- active motion

47
Q

Apgar for color

A

0- blue all over
1- pink body, blue extrem
2- pink all over

48
Q

Apgar for reflex irritabilty

A

0- none
1- grimace
2- grimace and strong cry/cough/sneeze

49
Q

Important number on Apgar

A

resustitate/monitoring or to ICU until Apgar above 7

50
Q

If only one umbilical artery is present, look for

A

renal malformations

51
Q

At birth check the umbilical cord for

A
  • 2 arteries
  • 1 vien
  • absence of urachus
52
Q

swelling of scap at birth that crosses the midline =

A

caput succedaneum, benign

53
Q

True or false: cephalohematomas from birth trauma do not cross the midline

A

true

54
Q

What eval needs to occur with cepahlhematomas

A
  • usually benign but may indicate underlying skull fracture, consider x-ray
55
Q

Time course of cavernous hemangioma

A
  • noticed a few days after birth

- increases in size then rapidly resolves within few years

56
Q

Treatment of cavernous hemangioma

A

nothing, just wathc

57
Q

Anterior fontanelle closes by

A

18 month

58
Q

4 causes of delayed anterior fontanelle closure

A
  • hypothyroidism
  • hydrocephalus
  • rickets
  • IUGR
59
Q

Moro reflex disapears at

A

6 months

60
Q

Palmar grasp reflex disappears by

A

6 months

61
Q

In premature infants, subtract the time for developmental milestone up until what age?

A

2 years

62
Q

Age for social smile

A

1-2 months

63
Q

Age for cooing

A

2-4 months

64
Q

Age for lifts head to 90 degrees when prone

A

3-4 months

65
Q

Age for rolls front to back

A

4-5 months

66
Q

Age for voluntary grasp (no release)

A

5 months

67
Q

Age for stranger anxiety

A

6-9 months

68
Q

Age for sitting no support

A

7 months

69
Q

Age for pulls to stand

A

9 months

70
Q

Age for pat-a-cake

A

9-10 months

71
Q

Age for first words

A

9-12 months

72
Q

Age for imitates others’ sounds

A

9-12 months

73
Q

Age for voluntary grasp and voluntary release

A

10 months

74
Q

Age for waves bye’bye

A

10 months

75
Q

Age for separation anxiety

A

12-15 months

76
Q

Age for walking

A

13 months

77
Q

Age for build tower of 2 cubes

A

13-15 months

78
Q

Age for understands 1 step command

A

15 months

79
Q

Age for good use of cup and spoon

A

15-18 months

80
Q

Age for runs well

A

2 years

81
Q

Age for build tower of 6 cubes

A

2 years

82
Q

Age for ties shoe laces

A

5 years

83
Q

Average age of puberty for girls

A

10.5

84
Q

Average age of puberty for boys

A

11.5

85
Q

First event for male puberty

A

testicular enlargement

86
Q

First event for female puberty

A

breast development

87
Q

Tanner stage is based on what?

A
  • pubic hair for both
  • boys: testicular and penile growth
  • girls: breast growth
88
Q

Definition of delayed puberty in boys

A

No testicular enlargement by 14 years old

89
Q

Definition of delayed puberty in girls

A

No breast or pubic hair by 13 years old

90
Q

Most common cause of delayed puberty

A

constitutional delay (normal variant)

91
Q

Most common cause of precocious puberty

A

idiopathic

92
Q

McCune-Albright syndrome =

A

girls with:

  • cafe’au’lait spots
  • fibrous dysplasia
  • precocious puberty
93
Q

girls with:

  • cafe’au’lait spots
  • fibrous dysplasia
  • precocious puberty
A

McCune-Albright syndrome

94
Q

Causes of precocious puberty

A
  • McCune-Albright syndrome
  • ovarian tumors
  • testicular tumors
  • CNS disease/trauma
  • adrenal neoplasm
  • congenital adrenal hyperplasia
95
Q

Congenital adrenal hyperplasia in boys is usually

A

21-hydroxylase deficiency

96
Q

Congenital adrenal hyperplasia in girls usually causes

A

ambiguous genitalia

97
Q

Risk of precocious puberty

A

premature closure of epiphyseal plate

98
Q

Treatment of otherwise untreatable precocious puberty

A

GnRH agonists

99
Q

Boys with recurrent nose bleeds and blood dyscrasia =

A

nasopharyngeal angiofibromas

100
Q

Most common cause of nosebleeds

A

trauma

101
Q

Fever, anemia and nosebleed =

A

leukemia

102
Q

Rate of African Americans heterozygous for sickle cell in US

A

8%

103
Q

Diagnosis of sickle cell disease

A

blood smear with sickles, high retic count; Hb electrophoresis

104
Q

Aplastic crisis in sickle cell, look for

A

parvovirus B19

105
Q

Look for this site problem in sickle cell with bone pain

A

osteonecrosis of femoral head

106
Q

Renal complication of acute sickle cell crisis

A

papillary necrosis

107
Q

When do symptoms of sickle cell start?

A

around 6 months (this is when adult Hb production starts)

108
Q

When are antibiotics given in sickle cell prophylactically

A

From diagnosis until age 5 years

109
Q

Classic presentation of sickle cell anemia in children

A

dactylitis (hand-foot syndrome)

110
Q

Biggest key points for HUS

A
  • children

- diarrhea

111
Q

Biggest key points for Henoch-Schonlein purpura

A
  • rash
  • abdominal pain
  • arthritis
  • melena
112
Q

Biggest key points for TTP in peds

A
  • CNS changes

- young adults

113
Q

Biggest key points for ITP

A
  • antiplatelet antibodies
114
Q

Most common age for HUS

A

children

115
Q

Most common age for HSP

A

children

116
Q

Most common age for TTP

A

young adults

117
Q

Most common age for ITP

A

children or adults

118
Q

Common previous infection for HUS

A

E. coli diarrhea

119
Q

Common previous infection for HSP

A

URI

120
Q

Common previous infection for TTP

A

none

121
Q

Common previous infection for ITP

A

viral, esp in children

122
Q

RBC count in HUS

A

Low

123
Q

RBC count in HSP

A

Normal

124
Q

RBC count in TTP

A

Low

125
Q

RBC count in ITP

A

Normal

126
Q

Platelet count in HUS

A

low

127
Q

Platelet count in HSP

A

Normal

128
Q

Platelet count in TTP

A

low

129
Q

Platelet count in ITP

A

low

130
Q

Features of peripheral smear in HUS

A

Hemolysis

131
Q

Features of peripheral smear in HSP

A

Normal

132
Q

Features of peripheral smear in TTP

A

Hemolysis

133
Q

Features of peripheral smear in ITP

A

Normal

134
Q

Kidney manifestations in HUS

A
  • ARF

- hematuria

135
Q

Kidney manifestations in HSP

A
  • hematuria
136
Q

Kidney manifestations in TTP

A
  • ARF

- proteinuria

137
Q

Kidney manifestations in ITP

A

none

138
Q

Treatment of HUS

A

supportive (may need transfusion or dialysis)

139
Q

Treatment of HSP

A

supportive (may need transfusion or dialysis)

140
Q

Treatment of TTP

A
  • Plasmaphoresis
  • NSAIDs
  • DO NOT give platelets
141
Q

Treatment of ITP

A
  • steroids

- splenectomy if meds fails

142
Q

When do you give steroids in ITP?

A
  • bleeding

- counts below 20-40

143
Q

What do you NOT do for TTP

A
  • do not give plts, they are likely to form clots
144
Q

Constant machine like murmur in upper left sternal border

A

PDA

145
Q

How do you close a PDA?

A

indomethacin, surgery

146
Q

How do you keep a PDA open?

A

PGE 1

147
Q

PDA is associated with

A
  • Rubella

- high altitudes

148
Q

Associated symptoms with PDA

A
  • dyspnea

- possible CHF

149
Q

Holostyolic murmur next to sternum

A

VSD

150
Q

True or false: most VSDs resolve on their own?

A

true

151
Q

What is the most common congenital heart defect?

A

VSD

152
Q

What heart defect is asymptomatic until adulthood?

A

ASD

153
Q

What heart defect often presents with palpitations?

A

ASD

154
Q

What heart defect has a fixed split s2

A

ASD

155
Q

Treatment of ASDs

A

No treatment unless very large

156
Q

The 4 anomalies of tetrology of fallot

A
  1. VSD
  2. Right ventricular hypertrophy
  3. pulmonary stenosis
  4. overriding aorta
157
Q

Most common cyanotic congenital heart defect

A

tetrology of fallot

158
Q

Kids who squart after exertion likely have

A

tetrology of fallow

159
Q

Upper extremity HTN =

A

coarctation or aorta

160
Q

Radiofemoral delay =

A

coarctation or aorta

161
Q

Systolic murmur heard over mid-upper back

A

coarctation or aorta

162
Q

Heart defect with rib notching on x-ray

A

coarctation or aorta

163
Q

Heart defect associated with Turner syndrome

A

coarctation or aorta

164
Q

What heart defects need endocarditis prophylaxis?

A

All except asymptomatic secundum-type ASDs

165
Q

What % of ASDs are asymptatic secundum-type?

A

80%

166
Q

3 syndromes to think about in patient with VSD

A
  • fetal alcohol syndrome
  • TORCH infections
  • Down syndrome
167
Q

Teenager with sudden cardiac death =

A

hypertrophic obstructive cardiomyopathy

168
Q

Treatment of hypertrophic obstructive cardiomyopathy

A
  • B-blockers

- consider pacemaker placement

169
Q

Where is fetal circulation O2 highest?

A

Umbilical vein

170
Q

Where is fetal circulation O2 lowest?

A

Umbilical artery

171
Q

In fetus, which has highest O2 content, blood to arms or legs?

A

Blood to arms

172
Q

Resting HR over 100 is normal up to age

A

10 years

173
Q

Medications that are contraindicated in obstructive hypertrophic cardiomyopathy

A
  • positive ionotropes
  • diuretics
  • vasodilators
174
Q

How does the foramen ovale close?

A

Increase in left-side heart pressures

175
Q

Heart pressure changes at time of birth

A
  • 1st breaths cause lung inflation and decreased pulmonary vascular resistance
  • -> increased arterial flow –> increase left sided pressures
176
Q

What triggers closure of the ductus arteriosis?

A

increased O2 shuts off prostaglandin production

177
Q

EKG finding of Wolff-Parkinson-White syndrome

A

delta wave

178
Q

Delta wave on EKG =

A

Wolff-Parkinson-White syndrome

179
Q

What causes symptoms in Wolff-Parkinson-White syndrome?

A

Transient arrhythmias conducted on accessory pathways

180
Q

Treatment of pyloric stenosis

A

surgical

181
Q

Treatment of duodenal atresia

A

surgical

182
Q

Treatment of tracheoesophageal fistula

A

surgical

183
Q

Treatment of Hirschsprung disease

A

surgical

184
Q

Treatment of anal atresia

A

surgical

185
Q

Treatment of choanal atresia

A

surgical

186
Q

Presenating age of pyloric stenosis

A

0-2 months

187
Q

2 month old with nonbilious projectile emesis likely has

A

pyloric stenosis

188
Q

Gender predominance of pyloric stenosis

A

males MUCH more than females

189
Q

“double-bubble” sign =

A

duodenal atresia

190
Q

duodenal atresia is associated with this syndrom

A

Down syndrome

191
Q

palpable olive shaped mass in epigastrium

A

pyloric stenosis

192
Q

electrolyte findings in pyloric stenosis

A
  • low chloride
  • low potassium
  • metabolic alkalosis
193
Q

Presenting age of duodenal atresia

A

0-1 week

194
Q

newborn with down syndrome and bilious emesis may have

A

duodenal atresia

195
Q

Presenting age for tracheoesophageal fistula

A

0-2 weeks

196
Q

1 week old with food regurgitation = concern for

A

tracheoesophageal fistula

197
Q

Describe the most common variant of tracheoesophageal fistula

A

85% of cases have a fistula from bronchus to distal esophagus

198
Q

CXR with NG tube coiled in esophagus and large air filled stomach is classic for

A

esophageal atresia

199
Q

Age of presentation of Hirschsprung disease

A

0-2 years

200
Q

2 year old with feculent emesis =

A

Hirschsprung disease

201
Q

No ganglia seen on rectal biopsy =

A

Hirschsprung disease

202
Q

Classic clinical features of Hirschsprung disease

A
  • feculent emesis
  • abdominal distention
  • obstipation
203
Q

Gender distribution of Hirschsprung disease

A

boys much more than girls

204
Q

Presnting age of anal atresia

A

0-1 week; usually detected on exam in nursery

205
Q

Gender distribution of anal atresia

A

boys much more than girls

206
Q

Cyanosis with feeding that is relieved by crying =

A

choanal atresia; cannot pass NG tube

207
Q

Presentation age of choanal atresia

A

0-1 week

208
Q

Presenting age for intussusception

A

4 mo to 2 years

209
Q

Presenting age for necrotizing enterocolitis

A

0-2 months

210
Q

Presenting age for meconium ileus

A

0-2 weeks

211
Q

Presenting age for midgut volvulus

A

0-2 years

212
Q

Presenting age for meckel diverticulum

A

0-2 years

213
Q

Presenting age for strangulated hernia

A

any age

214
Q

2 GI manifestations of cystic fibrosis

A
  • meconium ileus

- rectal prolapse

215
Q

Current jelly stools (blood and mucus) is likely

A

intussusception

216
Q

5month old with palpable sausage like mass

A

intussusception

217
Q

Treatment of intussusception

A

air or barium enema (both diagnostic and therapeutic)

218
Q

In what population does necrotizing enterocolitis occus?

A

premature infants

219
Q

1 month old premie with fever, rectal bleeding, air in bowel wall

A

necrotizing enterocolitis

220
Q

Treatment of necrotizing enterocolitis

A
  • make NPO
  • OG tube
  • IV fluids
  • antibiotics
221
Q

Difference in radiographic findings in volvulus in peds vs. adults

A
  • finding is “bird’s beak” in both but..

- small bowel in peds, large bowel in adults

222
Q

2 year old with bilious emesis, sudden onset abd pain, distention and rectal bleeding

A

midgut volvulus

223
Q

Treatment of midgut volvulus

A

surgery

224
Q

What is the rule of 2s for meckel diverticulum

A
  • 2% of population
  • 2 inches long
  • within 2 feet of ileocolic junction
  • presents in first 2 years of life
225
Q

Meckels diverticulum usually presents with

A

bleeding, GI ulceration

226
Q

Treatment of Meckels diverticulum

A

surgery

227
Q

Character of emesis with strangulated hernia

A

bilious

228
Q

Gender predominance of diaphragmatic heria

A

boys more than girls

229
Q

Diaphragmatic hernia is more common on what side?

A

the left (this is Bochdalek type)

230
Q

Bochalek is a type of

A

diaphragmatic hernia

231
Q

Why is diaphragmatic hernia a problem in peds?

A

Can cause pulmonary hypoplasia

232
Q

Patient presents with respiratory distress and bowel sounds in chest

A

diaphragmatic hernia

233
Q

Treatment of diaphragmatic hernia

A

surgery

234
Q

Prognosis in diaphragmatic hernia is based on

A

lung development (not on the hernia)

235
Q

Meckel diverticulum is a remnant of

A

the omphalomesenteric duct

236
Q

Features of omphalocele

A
  • midline location
  • sac with multiple abdominal organs
  • no umbilical ring
  • other anomolies are common
237
Q

Features of gastroschisis

A
  • on right side
  • only small bowel exposed (no sac)
  • umbilical ring is present
  • other anomalies rare
238
Q

Which process, omphalocele or gastroschisis, has the location midline

A

omphalocele

239
Q

Which process, omphalocele or gastroschisis, has the location on right side

A

gastroschisis

240
Q

Which process, omphalocele or gastroschisis, has the sac containing multiple abdominal organs

A

omphalocele

241
Q

Which process, omphalocele or gastroschisis, has no sac and has small gowel exposed

A

gastroschisis

242
Q

Which process, omphalocele or gastroschisis, has no umbilical ring

A

omphalocele

243
Q

Which process, omphalocele or gastroschisis, has the umbilical ring

A

gastroschisis

244
Q

Which process, omphalocele or gastroschisis, has associated anomolies

A

omphalocele

245
Q

Which process, omphalocele or gastroschisis, has no associated anomolies

A

gastroschisis

246
Q

Treatment of Henoch-Schoenlein purpura is

A

supportive

247
Q

GI manifestations of Henoch-Schoenlein purpura

A
  • GI bleed
  • abdominal pain
  • possible GI infection
248
Q

Rash of Henoch-Schoenlein purpura is classically

A

on lower extremities and buttocks

249
Q

Classic features of Henoch-Schoenlein purpura

A
  • GI bleed/pain
  • antecetent infection (URI or GI)
  • swelling hands and feet
  • rash on LE and buttocks
  • arthritis
  • hematuria/proteinuria
250
Q

True or false: GI upset, nausea and vomiting with systemic illness is more common in kids vs. adults

A

true

251
Q

Two categories of neonatal jaundice

A
  • physiologic

- pathologic

252
Q

First diagnostic step in neonatal jaundice

A

measure bilirubin (total, direct and indirect)

253
Q

Main concern in neonatal jaundice

A

Kernicterus

254
Q

What is Kernicterus

A

deposit of unconjugated bilirubin in the basal ganglia

255
Q

5 classic symptoms that go with neonatal jaundice

A
  • poor feeding
  • seizures
  • flaccidity
  • opisthotonos
  • apnea
256
Q

Jaundice present at birth is

A

pathologic

257
Q

Describe bilirubin findings in physiologic jaundice in term infant

A
  • mostly unconjugated
  • less than 12 mg/dl
  • peak at day 2-5
  • normal by 2 weeks
258
Q

Describe bilirubin findings in physiologic jaundice in premature infant

A
  • mostly unconjugated
  • less than 15 mg/dl
  • normal by 3 weeks
259
Q

How common is physiologic jaundice?

A
  • 50% of newborns

- higher in premature infants

260
Q

6 general categories of pathologic jaundice in newborn

A
  • breast milk
  • illness
  • hemolysis (Rh incompatibility)
  • metabolic
  • biliary atresia
  • medications
261
Q

Features and treatment of neonatal jaundice from breast milk

A
  • bilirubin peaks 10-20 at 2-3 weeks of age

- hold breast milk until resolved

262
Q

How does illness effect neonatal jaundice?

A
  • prolong the jaundice
  • lower threshold of kernicturis
  • the youngest sickest infants are the most at risk
263
Q

4 classic illnesses associated with higher risk of kernicteris in neonatal jaundice

A
  • sepsis
  • hypothyroidism
  • liver disease
  • cytic fibrosis
264
Q

List 4 examples of metabolic causes of neonatal jaundice

A
  • high uncojugated bili:
  • Criggler-Najjar (very high)
  • Gilbert (mildly high)
  • high conjugated bili:
  • Rotor disease
  • Dubin-Johnson disease
265
Q

Newborn presents with jaundice and clay colored stools

A

biliary atresia

266
Q

Treatment of biliary atresia

A

surgery

267
Q

Risk of sulfa drugs in newborns

A
  • kernicterus

sulfa drugs displace bilirubin from albumin

268
Q

Treatment of unconjugated hyperbilirubinemia in the neonate

A
  • phototherapy

- last resort is exchange transfusion (bili over 20 or phototherapy failed)

269
Q

Babies with ambiguous genitailia are usually _____ and 90% have _____

A
  • girls

- 21-hydroxylase deficiency

270
Q

Ambiguous genitalia often also has

A

adrenal insuffeciency

271
Q

Female child with “bunch of grapes” from vagina

A
  • sarcoma botryoides (malignant)
272
Q

Newborn with ambiguous genitalia, hyponatremia, kyperkalemia and hypertension

A

adrenogenital syndrome

273
Q

This hormone is elevated in adrenogenital syndrome

A

17-hydroxyprogesterone

274
Q

Treatment of adrenogenital syndrome

A

steroids and IV fluids to prevent death

275
Q

Boys with 21-hydroxylase deficiency experience

A

perecocious sexual development

276
Q

Most vaginitis in peds is

A

nospecific/physiologic

277
Q

Causes of pediatric vaginitis to look for on boards

A
  • foreign body
  • sexual abuse
  • candida as presentation of diabetes
278
Q

Vaginal bleeding in the neonate

A
  • usually from withdrawl from maternal estrogen

- resolves in a few days

279
Q

Most common primary immunodeficiency

A

IgA deficiency

280
Q

What should you look for in patient with frequent respiratory and GI infections?

A

IgA deficiency

281
Q

What should you look for if patient has anaphylaxis with immunoglobulin exposure?

A

IgA deficinecy

282
Q

What therapy should be avoided in patients with IgA deficiency?

A

immunoglobulins

283
Q

X-linked agammaglobulinemia is also known as

A

Bruton agammaglobulinemia

284
Q

6 month old boy with Strep infections, low B-cells

A

Bruton agammaglobulinemia (x-linked)

285
Q

Features of X-linked agammaglobulinemia

A
  • X-linked recessive, so seen in boys
  • low or absent B cells
  • infections begin at 6 months (maternal antibodies dissapear)
  • recurrent lung or sinus infections
  • usually strep or HiB
286
Q

Hypocalcemia and heart defect 24 hours after birth =

A

DiGeorge syndrome

287
Q

Features of DiGeorge syndrome

A
  • 3rd and 4th pharyngeal pouches don’t form
  • hypocalcemia
  • tetany
  • heart defects
  • immunodeficiency from absent/small thymus
288
Q

Inheritance of severe combined immunodefiency

A
  • autosomal recessive or

- X-linked

289
Q

Common cause of severe combined immunodefiency

A

adenosine deaminase deficiency (autosomal recessive)

290
Q

Patient with severe recurrent infections early in life with both B and T cells low =

A

severe combined immunodefiency

291
Q

Skin finding in patients with severe combined immunodefiency

A

usually have cutaneous anergy

292
Q

Lymph nodes and thymus in severe combined immunodefiency are usually

A

hypoplastic or absent

293
Q

Inheritance of Wiskott-Aldrich deficiency

A
  • x-linked recessive
294
Q

Triad of eczema, thrombocytopenia and reccurent infections =

A

Wiskott-Aldrich deficiency

295
Q

Wiskott-Aldrich deficiency classic tria

A

eczema, thrombocytopenia and reccurent infections

296
Q

Inheritance of chronic granulomatous disease

A
  • usually x-linked recessive
297
Q

Give 2 examples of catalase-positive organisms

A
  • Staph aureus

- Pseudomonas

298
Q

Test for chronic granulmoatous disease

A

deficient nitroblue tetrazolium dye reduction by granulocytes

299
Q

nitroblue tetrazolium dye reduction test measures

A

respiratroy burst

300
Q

2 organisms common in infections with chronic granulomatous disease

A
  • Staph aureus

- Pseudomonas

301
Q

Inheritance of Chediak-Higashi syndrome

A
  • usually autosomal recessive
302
Q

Oculocutaneous albinism with giant granules in neutrophils =

A

Chediak-Higashi syndrome

303
Q

Chediak-Higashi syndrome findings

A
  • Oculocutaneous albinism

- giant granules in neutrophils

304
Q

Pathology of Chediak-Higashi syndrome

A

defect in microtubule polymerization

305
Q

Recurrent neisserial infections likely have

A

complement deficiencies (C5 through C9)

306
Q

complement deficiencies (C5 through C9) usually have

A

Recurrent neisserial infections

307
Q

Cadidiasis with hypothyroidism may be

A

chronic mucocutaneous candidiasis

308
Q

chronic mucocutaneous candidiasis is often associated with

A

hypothyroidism

309
Q

Hyper-IgE syndrome is called

A

Job-Buckley syndrome

310
Q

Job-Buckley syndrome is called

A

Hyper-IgE syndrome

311
Q

Look for ______ in recurrent staph infections of the skin

A

Hyper-Ig E (Job-Buckley) syndrome

312
Q

Features of hyper-Ig E (Job-Buckley) syndrome

A
  • reccurent staph infections (usually skin)
  • Very high IgE
  • red hair
  • fair skin
  • eczema
313
Q

3 most common organisms in otitis media

A
  • Strep pneumoniae
  • H. influenzae
  • Moraxella ctarrhalis
314
Q

8 classic complications of otitis media

A
  • tympanic membrane perforation
  • mastoiditis
  • labyrinthitis
  • CN VII and VIII palsies
  • meningitis
  • cerebral abscess
  • venous thrombosis
  • chronic otitis media
315
Q

In what time frame does mastoiditis usually occur after otitis media

A

2 weeks

316
Q

Treatment of cholesteatomas with marginal perforations

A

surgical excision

317
Q

Antibiotics to use in otitis media

A
  • amoxicillin
  • 2nd gen cephalosporin
  • TMP/SMX
318
Q

Prolonged secretory otitis is from

A

an unresolved otitis

319
Q

2 malformations to look for in kids under 5 with UTI

A
  • vesicoureteral reflux (boys and girls)

- posterior urethral valves (boys)

320
Q

Highest incidence of meningitis in kids is in what age group?

A

neonates

321
Q

10 classic findings in neonatal meningitis

A
  • lethargy
  • fever or hypothermia
  • poor muscle tone
  • bulging fontanelle
  • emesis
  • photophobia
  • altered consciousness
  • hypotension
  • jaundice
  • respiratory distress
322
Q

3 classic associated features of sepsis in neonates

A
  • hypotension
  • jaundice
  • respiratory distress
323
Q

What if you can’t get a lumbar puncture in a kid you suspect of meningitis

A

treat with IVF and antibiotics (here treatemnt trumps diagnosis)

324
Q

Herpes encephalitis in neonates is due to

A

HSV II

325
Q

Herpes encephalitis in older kids and adults is due to

A

HSV I

326
Q

Treatment of HSV encepalitis

A

acyclovir

327
Q

Imaging findings in HSV encephalitis

A

temporal lobe abnormalities on CT or MRI

328
Q

What do you need to do if a kid has Neisseria meningitis?

A

treat contacts prophylactically

329
Q

Choices of antibiotics for Neiserria meningitis prophylaxis

A
  • rifampin
  • ceftriaone
  • cipro (in adults)
330
Q

Fever followed 3 days later by white spots on buccal mucosa

A

Measles

331
Q

Measles is also known as

A

rubeola

332
Q

rubeola is also known as

A

measles

333
Q

Koplik spots are found in

A

Measles

334
Q

Head to toe progression of rash with fever, conjunctivitis =

A

Measles

335
Q

Progresion of rash in measles is

A

head to toe

336
Q

4 classic complications of measles

A
  • penumonia (giant cell)
  • otitis media
  • encephalitis (acute)
  • subacute sclerosing panencephalitis
337
Q

Classic finding in rubella

A

suboccipital and postauricular lymphadenopathy

338
Q

What do you do if a pregnant woman has not had rubella immunization?

A
  • DON’T give immunization during pregnancy

- follow and do titers if she has a febrile illness

339
Q

Rash in rubella

A

milder than measles, but same progression of head to toe

340
Q

High fever for 4 days, return to normal, rash on chest and abdomen =

A

Roseola infantum

341
Q

Roseola infantum

A

HHV 6 (DNA virus)

342
Q

Age group of roseola infantum

A

less than 3 years old

343
Q

Roseola infantum aka

A

Exanthem subitum

344
Q

Exanthem subitum aka

A

Roseola infantum

345
Q

Erythema infectiousum aka

A

Fifth disease

346
Q

Fifth disease aka

A

Erythema infectiousum

347
Q

Erythema infectiousum caused by

A

parvovirus B19

348
Q

2 things that parvovirus B19 causes

A
  • Erythema infectiousum

- aplastic crisis in sickle cell disease

349
Q

low fever and aches with red checks, next day rash on arms, legs and trunk =

A

Erythema infectiousum

350
Q

Pathological findings in varicella

A
  • do Tzanck smear from base

- shows multinucleated giant cells

351
Q

Discrete macules on trunk that occur in crops and crust over =

A

varicella

352
Q

When can you use varicella-zoster immunoglobulin?

A
  • very debilitated patient (AIDS, leukemia, etc) within 4 days
  • exposure of newborn if mom has chickenpox
353
Q

Can a person with zoster causes chickenpox?

A

Yes in an uninfected/unimmunized person

354
Q

How long are you contagious with chicken pox?

A

Until the last lesion crusts over

355
Q

Organisms for scarlet fever

A

streptococcus (pharyngitis)

356
Q

Sandpaper rash with circumoral pollar

A

scarlet fever

357
Q

Strawberry tongue with rash on abdomen and trunk

A

scarlet fever

358
Q

Erythrogenic toxin is from ____ and can cause ____

A
  • streptococcus

- scarlet fever

359
Q

Treatment of scarlet fever

A

PCN

360
Q

Complication of scarlet fever

A

rheumatic heart disease

361
Q

Mucocutaneous lymph node syndrome is aka

A

Kawasaki syndrome

362
Q

Typical age for Kawasaki syndrome

A

under 5 years

363
Q

Treatment of Kawasaki disease

A
  • ASA
  • immunoglobulin
  • follow with ECHO for cardiac abnormalities
364
Q

Diagnosis of Kawasaki disease

A
    • fever for 5+ days
  • trunk rash 1 day after fever (polymorphous)
  • conjuctival injection
  • changes in oral mucosal
  • changes in extremities
  • cervical lymphadenopathy
  • arthritis
  • cardiac issues
365
Q

Infectious mononucleosis is causes by

A

EBV

366
Q

Tests for EBV

A
  • heterophile antibodies (monospot)
  • EBV vial capsid antigen
  • EBV nuclear antigen
367
Q

EBV is associated with these neoplasms:

A
  • nasopharyngeal carcinoma

- African Burkitt lymphoma

368
Q

How do you differentiate mononucleosis from step pharyngitis?

A

Mono has:

  • splenomegaly
  • hepatomegaligy
  • atypical lymphocytes
  • anemia/thrombocytopenia
  • heterophile anitbodies
369
Q

Rocky mountain spotted fever is caused by

A

Rickettsia rickettsii

370
Q

Rickettsia rickettsii causes

A

Rocky mountain spotted fever

371
Q

Tick bite, fever, chills, rash

A

Rocky mountain spotted fever

372
Q

Rash for Rocky mountain spotted fever

A

palms/wrist and soles/ankles and rapidly spreads to trunk and face (often pechitial)

373
Q

Treatment of Rocky mountain spotted fever

A
    • doxycycline

- chloramphenicol

374
Q

Weeping skin lesion with yellow crust

A

impetigo

375
Q

Most common organisms for impetigo

A

Staph and step

376
Q

Treatment of impetigo

A

antistaph PCN

377
Q

Acute laryngotracheitis is aka

A

croup

378
Q

Typical age for croup

A

1-2 years old

379
Q

Main organism causing croup

A

50-75% are parainfluenza virus, rest are influenza

380
Q

Season typical for croup

A

fall/winter

381
Q

Steeple sign =

A

croup

382
Q

Radiologic finding for croup

A

steeple sign (subglottic edema)

383
Q

Treatment of croup

A
  • humidified O2

- racemic epinephrine

384
Q

Typical age for epiglottitis

A

2-7 years old

385
Q

3 major organisms for epiglottitis

A
  • HiB (less w/ immunization)
  • Strep pneumo
  • Staph aurues
386
Q

Sick kid with no prodrome, high fever, drooling =

A

epiglottitis

387
Q

Is there cough with epiglottitis?

A

no

388
Q

Thumb sign on x-ray

A

epiglottitis

389
Q

X-ray finding for epiglottitis

A

thumb sign on lateral neck x-ray

390
Q

Treatment of epiglottitis

A
  • establish airway if needed

- 3rd generation cephalosporin

391
Q

Bronchiolitis is usually caused by

A

RSV causes 75% of causes; rest by parainfluenza and influenza

392
Q

Typical age for RSV

A

less than 18 months

393
Q

Season for RSV infections

A

fall/winter

394
Q

Viral URI follow 1-2 days later by rapid respirations, intercostal retraction and expiratory wheezing in 15 month old

A

RSV bronchiolitis

395
Q

Classic x-ray findings in bronchiolitis

A

hyperinflation with flattening of diaphragms

396
Q

General treatment for RSV

A
  • supportive

- use Ribavarin only in severe cases or high risk

397
Q

Prophylaxis for RSV

A

Palivizumab (use in premature or chonic lung disease during RSV season)

398
Q

Diphtheria is caused by

A

Corynebacterium diphtheriae

399
Q

Whooping cough is caused by

A

bordetella pertussis

400
Q

oropharynx with gray pseudomembrances

A

diptheria

401
Q

Diptheria is associated with

A

myocarditis

402
Q

Treatment of diphtheria needs to include an

A

anti-toxin

403
Q

Classic complications of strep pharyngitis

A
  • rheumatic fever
  • scarlet fever
  • glomerulonephritis
404
Q

Diagnosis of Rheumatic fever

A

history of Streptococcal pharyngitis and Jones criteria

  • migratory polyarthritis
  • carditis
  • chorea
  • erythema marginatum
  • subcutaneous nodules
  • minor criteria
405
Q

List the minor Jones criteria

A

(rheumatic fever)

  • elevated ESR
  • elevated CRP
  • elevated WBC
  • elevated strep anitbody titer
  • prolonger PR on EKG
  • arthralgia
406
Q

Treatment of rheumatic fever

A
  • anti-inflammatories

- if carditis: steroids

407
Q

Flat erythematous annulur rash, consider

A

rheumatic fever

408
Q

Time course of strep infection to glomerulonephritis

A
  • usually 1-3 weeks after strep skin infection or pharyngitis
409
Q

Features of poststreptococcal glomerulonephritis

A
  • abrupts hematuria
  • mild proteinuria
  • RBC casts
  • smoke colored urine
  • HTN
  • edema (periorbital)
  • elevated VUN/Cr
410
Q

Treatent of post-strep glomerulonephritis

A

supportive; control BP, can use diuretics for severe edema

411
Q

Smoke colored urine =

A

post-strep glomerulonephritis

412
Q

Can glomerulonehpritis after strep by prevented by antibitotic therapy?

A

no

413
Q

Most common cause of neonatal meningitis and sepsis

A

Group B strep (strep agalactiae)

414
Q

Treatment of mom’s with group B strep

A

amoxicillin

415
Q

7 classic effects from TORCH infections

A
  • mental retardation
  • microcephaly
  • hydrocephalus
  • hepatosplenomegaly
  • jaundice
  • anemia
  • IUGR
416
Q

Defects specific to toxoplasmosis prenatal infection

A
  • intracranial calcifications

- chorioretinitis

417
Q

Maternal exposure to cats is a risk for

A

toxoplasmosis

418
Q

Prenatal infection with varicella-zoster is associated with

A
  • limb hypoplasia

- scarring of the sin

419
Q

Prental infection with syphilis is associated with

A
  • rhinitis
  • saber shins
  • Hutchinson teeth
  • interstitial keratitits
  • skin lesion
420
Q

Newborn with Hutchingson teeth and interstitial keratitis likely had perinatal infection with

A

syphilis

421
Q

4 defects specific to congenital rubella

A
  • cardiovascular (PDA, VSD)
  • deafness
  • cataracts
  • microphthalmia
422
Q

Most common TORCH infection

A

CMV

423
Q

3 defect specific to congenital CMV infections

A
  • deafness
  • cerebral calcifications
  • microphthalmia
424
Q

inheritance of Werdnig-Hoffman disease

A

autosomal recessive

425
Q

Describe Wednig-Hoffman disease

A
  • heritable
  • degeneration of anterior horn cells
  • slow and progressive
  • all affected by 6 months
  • treatment is supportive
426
Q

Typical age of presentation of muscular dystrophy

A

3-7 years old

427
Q

5 year old boy with weakness, elevated CPK and large calves

A

duchenne muscular dystrophy

428
Q

inheritance of duchenne muscular dystrophy

A

X-linked recessive

429
Q

What is the Gower sign?

A

Muscular dystrophy - walk hands up body in order to stand up

430
Q

Life span of duchenne muscular dystrophy

A

most die by age 20

431
Q

Inheritance of Becker muscular dystrophy

A

X-linked recessive

432
Q

Myopathy with ragged red fibers on biopsy

A

mitochondrial myopathies

433
Q

Mitochondrial myopathies classically have what feature on physical exam

A

ophthalmoplegia

434
Q

inheritance of myotonic dystrophy

A

autosomal dominant

435
Q

Age of onset of myotonic dystrophy

A

20-30

436
Q

Define myotonia

A

inability of muscle to relax

437
Q

3 classic co-features of myotonic dystrophy

A
  • mental retardation
  • baldness
  • testicular or ovarian atrophy
438
Q

Young patient with weakness and cramping after exercise should be considered for

A

McArdle disease

439
Q

Triangular patch of hair over the lumbar spine

A

spina bifida occulta

440
Q

Difference between meningocele and myelomenigocele

A

myeleomenigocele includes both meninges and CNS tissues outside the spinal canal

441
Q

5 classic signs of hydrocephalus in peds

A
  • increasing head circumference
  • increased ICP
  • bulging fontanelle
  • scalp vein engorgement
  • paralysis of upward gaze
442
Q

3 most common causes of hydrocephalus in peds

A
  • congenital malformations
  • tumore
  • inflammation/infection
443
Q

Most common malignancy in children

A

ALL

444
Q

Child with pancytopenia must be evaluated for

A

ALL

445
Q

Syndrome risk factor for ALL

A

Down syndrome

446
Q

Most common brain tumors in children

A
  • crebellar astrocytoma
  • medulloblastoma
  • ependymoma
447
Q

Most brain tumors in children are located where?

A

posterior fossa

448
Q

Major differential diagnosis of flank tumor in a child

A
  • Wilms tumor (kidney)

- neuroblastoma (usually adrenal)

449
Q

Peak incidence of Wilms tumor in peds

A

2 years

450
Q

Peak incidence of neuroblastoma in peds

A

2 years

451
Q

True or false, neuroblastomas may regress spontaneously

A

true

452
Q

Most common primary liver malignancy in children

A

hepatoblastoma

453
Q

Most common kidney malignancy in children

A

Wilms tumor

454
Q

Most common adrenal malignancy in children

A

neuroblatoma

455
Q

Feature of inherited retinoblastoma

A

can be bilateral

456
Q

Simple bone cyst is aka

A

unicameral bone cyst

457
Q

10 year old wtih well-demarcated lesion in the proximal humerous likely has a

A

unicameral bone cyst

458
Q

Typical age for osteosarcoma

A

10-20 year olds

459
Q

Usual location of osteosarcoma

A

about the knee (distal femur, proximal tibia)

460
Q

15 year old with leg pain with sunburst appearance on x-ray =

A

osteosarcoma

461
Q

3 major causes of neonatal conjunctivitis

A
  • chemical reaction
  • gonorrhea
  • chlamydial infection
462
Q

Neonate with conjuantivitis within 24 hours after birth has

A

chemical reaction (often from drops for preventing gonorrhea)

463
Q

Infant with extremely purulent conjunctivits 2-5 days after birth =

A

gonorrhea

464
Q

Treatment of infant gonorrhea conjunctivitis

A
  • erythromycin ointment

- IV or IM ceftriaxone

465
Q

Mild to severe conjunctivitis that begins 5-14 days after birth, consider

A

Chlamydial infection (mom often asymptomatic)

466
Q

Infant chlamydial conjunctivitis is aka

A

inclusion conjunctivtis

467
Q

Common complication of infant chlamydial conjunctivitis is

A

chlamydial pneumonia

468
Q

Treatment of infant chlamydial conjunctivitis

A

oral erythromycin

469
Q

For the 3 most common forms of infant conjunctivitis, give the causes based on time of presentation after birth

A
  • under 24 hours = chemical
  • 2-5 days = gonococcal
  • 5-14 days = chlamydial
470
Q

Cataracts in infant =

A
  • TORCH infections

- inherited metabolic disorder like glactosemia

471
Q

Features of orbital cellulitis

A
  • ophthalmoplegia
  • proptosis
  • severe eye pain
  • decrased visual acuity
472
Q

Most common causes of orbital and pre-orbital cellulitis

A
  • Step pneumo
  • Staph
  • Strep
473
Q

Complications of orbital cellulitis

A
  • extension into the skull
  • dural sinus thrombosis
  • blindness
474
Q

Treatment of preorbial or orbital cellulitis

A
  • IV antibiotics
  • blood cultures to direct therapy
  • surgery if abscess
475
Q

Age of presentation for congenital hip dysplasia

A

birth

476
Q

Epidemiology of congenital hip dysplasia

A
  • female
  • first born
  • breech delivery
477
Q

Signs for congenital hip dysplasia

A
  • Barlow’s

- Ortolani’s

478
Q

Treatment of congenital hip dysplasia

A

harness

479
Q

Age of presentation for Legg-Calve’-Perthes disease

A

4-10 years

480
Q

Epidemiology of Legg-Calve’-Perthes disease

A
  • male
  • short stature
  • delayed bone age
481
Q

Symptoms of Legg-Calve’-Perthes disease

A

knee, thigh and groin pain

limb

482
Q

Treatment of Legg-Calve’-Perthes disease

A

orthoses

483
Q

Age of presentation of slipped capital femoral epiphysis

A

9-13 years old

484
Q

Epidemiology of slipped capital femoral epiphysis

A
  • overweight
  • male
  • adolescent
485
Q

s/s of slipped capital femoral epiphysis

A
  • knee, thigh groin pain

- limb

486
Q

Treatment of slipped capital femoral epiphysis

A

surgical pinning

487
Q

Pediatric hip problems present in adults as

A

arthritis

488
Q

Age of presentation of Osgood-Schlatter disease

A

10-15 years

489
Q

Describe Osgood-Schlatter disease

A
  • osteochondritis of tibial tubercle

- often bilateral

490
Q

13 year old boy with pain, swelling and tenderness to palpation of the knee should be considered for

A

Osgood-Schlatter disease

491
Q

Treatment of Osgood-Schlatter disease

A
  • rest/activity restriction

- NSAIDs

492
Q

In juvenile rheumatoid arthritis, RF is often

A

negative

493
Q

Most cases of mental retardation are

A

idiopathic

494
Q

IQ range for mild mental retardation

A

55-70

495
Q

Number one preventable cause of mental retardation

A

fetal alcohol syndrome

496
Q

TORCH cause of autism

A

congenital rubella

497
Q

Antisocial personality disorder must have what diagnosis as child

A

conduct disorder

498
Q

Classic conduct disorder

A
  • fire starting
  • cruelty to animals
  • lying
  • stealing
  • fighting
499
Q

Child that is hostile towards adults but normal with peers may have

A

oppositional-defiant disorder

500
Q

3 criteria for anorexia

A
  • 15% below weight
  • intense fear of gaining weight
  • amenorrhea