Peds 1

ismailalmokyad's version from 2015-05-30 22:19


Question Answer
antidote for iron poisoningdeferoxamine
sodium bicarb is antidote for?tca or asa overdose
lead poisoning, antidote?calcium edta or oral succimer (chelating agents)
pneumatosis intestinalisair within the bowel wall, suggests necrotizing enterocolitis
what are howell jolly bodies and what do they indicate?bodies are nuclear remnants w/in rbcs that are typically removed by the spleen, they show up as single/round/blue inclusions on wright stain, indicate physical absence of spleen, functional hyposplenism, infiltration of spleen or congestion
oxidized hgb that forms insoluble precipitants in rbcs =?heinz bodies (g6pd def.), appear on peripheral smear after staining with dye like crystal violet
pts w/viral pharyngitis as opposed to strep have what sxs?conjunctivitis, rhinorrhea, viral exanthem, lots of overlap tho btwn the 2 (confirm w/rapid strep)
purpose of antimicrobial tx of strep pharyngitisw/pcn- hasten recovery, prevent transmission, reduce complications (rheumatic fever)
pellagra due to?niacin deficiency
beefy red tongueniacin deficiency (pellagra)
riboflavin deficiencycheilosis, glossitis, seborrheic dermatitis, pharyngitis
dermatitis of pellagrausually bilateral/symmetric, in sun-exposed areas usually resembling a sunburn, as rash progresses skin becomes hyperpigmented and thickened
CD3 vs CD193 is for tcells, 19 is bcells
fluid choice for resuscitation of hypernatremic hypovolemia?.9% saline (never use 1/2NS in these cases b/c overly rapid correction of Na can occur)


Question Answer
vitamin that should be used in tx of measles?vit A (reduces time to recovery from diarrhea/pneumonia, length of hospital stay, risk of death)
vit A deficiencynight blindness, xerophthalmia, bitot's spots (abnL squamous cell prolif and keratinization of conjunctiva), corneal perforation
bug and tx for resp infxn in CF pt?likely pseudomonas, ues anti-pseudomonals like ceftazidime or pcn like piperacillin + aminoglycoside (tobra etc)
traction apophysitis of tibial tubercle?Osgood schlatter dz (radiographs show anterior soft tissue swelling, lifting of tubercle from the shaft), worse with repetitive running/jumping etc
patellofemoral stress syndrome in?overuse injury common in runners, pain localized to patella
diagnose fanconi anemia?made by chromosomal breaks on genetic analysis along with clinical findings
complications of congenital toxointracranial calcifications, hydrocephalus, chorioretinitis, microcephaly, hepatosplenomeg., jaundice
congenital rubellaclassic triad= cardiac/cataracts/deafness, microcephaly, sensorineural deafness, cardiac anomalies (pda, asd), congenital glaucoma, cataracts
rash that occurs after giving amoxicillin, what dx?ebv- generalized maculopapular rash
newborn male with oliguria and midline mass...?posterior urethral valves (mc congenital obstructive lesion in newborn males), dx with voiding cystourethrogram
wilms tumor mc in what age?2-5y, large palpable flank mass
Guthrie test of urine is for?pku- detects metabolic products of phenylalanine
transient proteinuria due to?stress, fever, exercise, sz, volume depletion


Question Answer
dx transient proteinuriaget multiple urine dipsticks that show initial proteinuria and then none (if rpt shows same result then see ped neph for further workup)
mc anemia in preterm/lbw infants?anemia of prematurity- due to combo of lower rbc production, shorter rbc lifespan, and blood loss, peripheral smear with normocytic normochromic anemia, low retic, nL wbc/plates
confirm dx of DMD?with m. biopsy
object permanence develops when?6mo (realize when objects or ppl are not present)
when can kids play peek-a-boo and wave bye bye9mos
initial step in management of kid with a speech delay is?audiology eval
dx pyloric stenosis?u/s of abd
a buccal smear is helpful in diagnosing?turners
next step in newborn with enlarged mammary glands and blood-tinged vaginal discharge?normal transient physiologic events- observe and routine care
golden yellow vesicopustules on exposed areas of face/extremities, dx?impetigo due to group a strep or staph, tx is topical mupirocin or oral erythro
Osteo imperfect associated findingsblue sclera, hearing loss, joint hypermobility, frequent fractures
horseshoe kidney, what condition?turners
timecourse of breastfeeding failure jaundice vs breast milk jaundiceformer in first week, latter into 3rd week and +


Question Answer
klumpke's paralysis manifestationbrachial palsy from excessive traction on the arm- hand paralysis and ipsi horners (ptosis/miosis), secondary to injury of 7th/8th cranial nn. and first thoracic n.
NF2bilateral acoustic neuromas, cataracts (NF1 is macrocephaly, café-au-lait, feeding probs, short, learning disability)
SIDS risk factorsmale, 2-4mo, low SES, sleeping prone, poor prenatal care, maternal tobacco/alcohol use, prenatal drug use
hypothyroidism in infantsweak, hypotonia, jaundice, apathy, large tongue, abd bloating, umbilical hernia
standard newborn screening includesthyroid, pku, galactosemia
dx adhd?meet criteria before age 7, sxs for at least 6mo
use racemic epi in setting of?croup, not useful in asthmatic
infant with meningococcemia, watch out for what serious complication?waterhouse fridreichsen syndrome (adrenal hemorrhage--> vasomotor collapse and skin rash)
intraventricular hemorrhage in newborn, risk factors?prematurity (lbw), hypoxia or ischemia, need transfontanel u/s to r/o
when can an infant sit well unsupported?6mo
when can an infant throw an object12mo
when can an infant imitate an action/come when called?12mo
when can an infant play with other kids?18mo
parallel play when?24mo
when can a kid walk up/down stairs w/o help24mo


Question Answer
when can a kid hold their head up3mo
kid with brain mass and multiple colon polypsturcots- relationship between brain tumors (usually medulloblastomas and gliomas) and FAP or HNPCC
tx congenital long qt syndromebeta blocker
jervell lange Nielsen?long qt syndrome (due to molecular defects in ion channels)
measles caused by what virus?paramyxovirus
abd xray with intramural airpnneumatosis intestinalis (necrotizing enterocolitis)
freidrichs ataxia and heart?necrosis and degen of cardiac m.--> myocarditis, myocardial fibrosis and CM, arrhythmias and chf ontribute to a lot of deaths
age at which kids can copy circle, square/rectangle, triangle3, 4, 5yo
14yo black male, hx of painful sickle cell crisis 3mo ago, now pain in hip that gradually progressesavascular necrosis is common complication of sickle cell
preferred tx absence szethosuximide, valproate
wiskott Aldrichthrombocytopenia (due to decreased platelet production), recurrent infxns usually w/strep pneumo/Neisseria/h flu, eczema common, skin infxns common
meconium ileusdiagnostic of cf, bilious vomiting, failure to pass meconium at birth, ground glass appearance on abd xray
HIV testing in neonatesserologic testing not useful b/c of passage of maternal Abs thru placenta, dx with PCR, viral culture and p24 Ag testing
bone xray w/sunburst patternosteosarcoma (codmans triangle from periosteal elevation)


Question Answer
presentation osteoid osteomasclerotic cortical lesion w/central nidus of lucency, pain worse at night unrelated to activity, pain resolves with nsaids
mc location of osteosarcoma in bone?metaphyses of long bones
mc causes of viral meningitis?non-polio enteroviruses like echo or coxsackie
major components of HSPlower ext. palpable purpura, arthritis/arthralgias, abd pain, renal dz
mc cause hip pain in kids?transient synovitis, usually after viral infxn or trauma--> pain, decreased rom, limp
tx transient synovitisrest and nsaids (no aspirin)
septic arthritis criteriafever >101, inability to bear weight, wbc >12K, esr >40, crp>2
manifestations of cfanemia, heat intolerance, steatorrhea, wheezing, recurrent infxn, hemoptysis, clubbing, rectal prolapse
tx gonococcal vs chlamydia conjunctivitis in newbornceftriaxone vs SYSTEMIC erythro (not topical)
time course gonococcal vs chlamydial conjunctivitisgonococcal on 2nd-5th day of life (highly purulent), chlamydia 5th-14th day (scant or mucoid or frankly purulent discharge)
increased gastric residual volume in preterm neonate suggests?necrotizing enterocolitis (due to bowel wall injury from asphyxia)
atopic dermatitis in infantsaffects face/scalp/extensor surfaces (due to decreased skin barrier function, tx is mild cleanser, thick emollients and mild topical anti-inflamm. ointment)
common sites of ewings sarcoma?metaphysis and diaphysis of femur, then tibia and humerus
dx/tx ewings?radiographs with onion skin periosteal rxn, moth-eaten mottled appearance and extension into soft tissue, tx is sx, radiation, chemo


Question Answer
first step in management of infant w/suspected congenital diaphragmatic hernia?placement of orogastric tube
premature adrenarche, vs thelarche, vs pubarche, which is most concerning?premature pubarche is most concerning for a cns disorder (thelarche and adrenarche not as clinically significant)
coag factors likely deficient in cf pt?2, 7, 9, 10 (vit K def.)
what dz gives false + RPR ?sle
tx of pertussis in what stage shortens sx durationcatarrhal (tx after this decreases transmission)
tx of pertussis in what stage to decrease transmission?tx after catarrhal stage
decreasing transmission to close contacts of pertussis-infected kid?chemopx for all close contacts with macrolide for 14d (regardless of age/immunizations/sxs), close contacts should also be immunized if not already
resp isolation for how long in pt with pertussis?first 5 days of tx with erythromycin
little boy prone to staph infxns, maternal uncle died from recurrent infxns, dz?CGD- lack NADPH oxidase making them more prone to catalase+ orgs like staph aureus
c3 deficiency, predisposes to what infxns?encapsulated bacteria (no opsonin)
TORCH infxns cause what general things in neonate?microcephaly, hepatosplenomeg, deaf, chorioretinitis, thrombocytopenia
reye syndrome sxs?n/v, HA, delirium, combative, hypoglycemia, liver failure, progressive cns damage
liver in reye syndrome?extensive fatty vacuolization w/o inflammation
tx reye's?give glucose, ffp, mannitol to decrease cerebral edema
kids with congenital heart dz and r-l shunts at higher risk for what in the brain?abscess


Question Answer
why do kids go into a knee-chest position in tetralogy to improve sxs?increases SVR--> more blood goes from RV to pulm circulation rather than to systemic circuit
tx sebhorreic dermatitismoisturizer, antifungal, topical steroid
bedwetting normal until?5yo
3mo pt with doll like face, thin extremities, short, protuberant abdomen, hypoglycemia, lactic acidosis, hyperuricemia, hyperlipidemia?von gierkes dz, glucose-6-phosphatase deficiency
short palpebral fissure, epicanthal folds, long philthrum, thin upper lip?FAS
12yo presenting with 3+ proteinuria, no meds or pmhx, normal labs, next step?steroids--> minimal change dz
risks for RDS?prematurity, also maternal DM, male, C-section, perinatal asphyxia
dx ALL?>25% lymphoblasts in BM
mccune Albright?café-au-lait, precocious puberty, multiple bone defects (polyostotic fibrous dysplasia)
supravalvular aortic stenosis assoc w/?Williams syndrome
dx celiac dz?ELISA for IgA Abs against gliadin or immunofluorescence for IgA to endomysium, Abs against tissue transglutaminase
celiac presentationbulky foul stools, loss of m. mass/subcut. fat, pallor from iron deficiency, bone pain from osteomalacia, easy bruising (vit k def.), hyperkeratosis (vit a def.)
pt with malabsorption and iron deficiency anemia?suspect celiac
anti-endomysial Abs?celiac


Question Answer
use what to prevent pda closure?PGE1 (vasodilator maintains pulm blood flow and improves oxygenation until sx)
why do pts with sickle cell get megaloblastic anemiahigh rbc turnover- not enough folate
pt 6mo with UTI, next?get renal U/S to eval for anatomy causes predisposing to VUR (any kid with first UTI ages 2-24mo or for kids w/recurrent febrile UTIs)
pathogen for rubellatogavirus
cardiac defects in congenital rubellaPDA, ASD
prevention of congenital rubella?no immunization in pregnancy itself for mom b/c of theoretical risk to fetus, give rubella vaccine to all F of child-bearing age, if immuno status unknown get rubella titers in 1st trimester
sturge-weber characteristicsport wine stain (trigeminal distribution), glaucoma, sz, MR
blueberry muffin spotsrubella
highest risk of vertical ransmission of rubella?first 4 weeks pregnancy 50% (later in pregnancy risk decreases)
differentiate preseptal cellulitis from orbital cellulitis?latter could have diplopia, pain with extraocular movements, proptosis, ophthalmoplegia (in addtn to eyelid erythema/edema, fever, leukocytosis)
tx of scarlet fever ?PCN V 10-days, can use erythromycin or clinda if allergic
pcn tx for prevention of post-strep gn in scarlet fever?pcn doesn't prevent GN
physical exam findings transposition of great vesselscyanosis, single loud 2nd heart sound, usually no murmur
negative nitroblue tetrazolium testindicates that pt has cgd (defect in intracellular killing due to impaired resp burst in phagocytes)
defective fibrillin gene?marfans (tall, crowded teeth, long arms/legs, less subcut. fat, prominent sternum, lens dislocation, aortic root dilation)
defective collagen production?ehler danlos--> hypermobile joints, easy bruising, poor wound healing


Question Answer
steroid use, what effects?testicular dysfunction (decreased size), erythrocytosis due to hepatic dysfunction, HDL decreases, psych probs (aggression), acne, gynecomastia (T--> E)
differentiating complex partial sz vs partial sz with secondary generalization in an unwitnessed sz?if tongue-biting or incontinence then likely partial with secondary generalization
first line tx enterobius infxn?anal itching- use albendazole
tx of clubfootstretching, manipulation, serial casting asap, operative management if conservative fails before 12mo
pt with sickle cell, acute severe anemia and low/absent retics?aplastic crisis
pt with sickle cell, rapidly enlarging spleen, reticulocytosissplenic sequestration- vasoocclusion and pooling of rbcs w/in spleen--> severe hypotensive shock
acute chest syndrome in sickle cell ?fever, chest pain, cxr infiltrate, etiology multi-factorial
rsv infxn increases risk of what later in life?asthma
young boy, headaches, vomiting, calcified lesion above sella, loss of peripheral visual fieldscraniopharyngioma (as opposed to pituitary adenoma more common in women, prolactinoma, and no calcification)