peds all 1
Presentation of volvulus
*Nonspecific signs* that include vomiting and colicky abdominal pain
Presentation of PDA
- "Machine-like" murmur - Wide pulse pressure - Bounding pulses
Presentation of coarctation of the aorta
- *CHF & respiratory distress* (in 1st few months of life) - *Different pressures/pulses b/w upper & lower extremities* (↑ pressure in upper extremities, ↓ pulse in lower extremities)
Presentation of intussussception
- *Colicky abdominal pain* - *Bilious vomiting* - *Currant jelly stool* - Right quadrant sausage-shaped mass - Neurologic signs
Differentiating Croup from Epiglottitis
- *Croup*: hypoxia on presentation - *Epiglottitis*: hypoxia imminent
Best initial test for duodenal atresia, volvulus, & intussussception
- *Duodenal atresia & volvulus*: AXR - *Intussussception*: ultrasound
2 scenarios in which *currant jelly* is seen
- *Klebsiella pneumonia*: currant jelly sputum from lungs - *Intussussception*: currant jelly stool
Difference in how patients w/ mild and severe cases of diarrhea/gastroenteritis are rehydrated
- *Mild*: oral fluids - *Severe*: IV fluids
Difference b/w "true" & "false" diverticulum
- *True*: involves all layers of bowel - *False*: does not involve all layers of bowel
APGAR scoring for Grimace
- 0: No response - 1: Grimace/feeble cry - 2: Sneeze/cough
APGAR scoring for Activity
- 0: None - 1: Some flexion - 2: Active movement
APGAR scoring for Pulse
- 0: aystole or <60 bpm - 1: >60 but <100 bpm - 2: >100 bpm
APGAR scoring for Appearance
- 0: blue all over - 1: normal except extremities - 2: normal all over
Factors produced by Vitamin K
- 10, 9, 7, 2 - Proteins C and S
Presentation of Vitamin B9 (folate) deficiency
- Megaloblastic anemia - Hypersegmented neutrophils
Presentation of Vitamin B12 (cyanocobalamin) deficiency
- Megaloblastic anemia - Hypersegmented neutrophils - Peripheral neuropathy of the dorsal column tracts
Types of diaphragmatic hernias
- Morgagni - Bochdalek
Presentation of Varicella
- Multiple highly pruritic vesicular rash that begins on the face - Possible fever and malaise
Ophthalmia neonatorum can be attributed most commonly to what organisms?
- N. gonorrhoeae - C. trachomatis
Presentation of Wilms tumor
- Nausea, vomiting, abdominal pain, constipation - Large palpable abdominal mass - Aniridia
Elevated AFP levels indicated both
- Neural tube defects - Abdominal wall defects
Why is insulin therapy not the first step in management of an IDM?
- Newborn has ↑ serum glucose, hyperinsulinemia in utero - Upon delivery, maternal glucose no longer available - Hyperinsulinemia causes ↓ in serum glucose upon delivery
Indications for intubation and ABG analysis of a newborn
- Not breathing - Respiratory distress
W/ cryptorchidism, what is indicated to bring the testicle down into the scrotum after the age of 1? Why?
- Orchiplexy - Avoid sterility
Further findings in an IDM associated w/ macrosomia
- Organomegaly (except for brain) - Polycythemia/hyperviscosity - +/- Shoulder dystocia/brachial plexus palsy
Diagnostic tests for Whooping cough
- PCR of nasal secretions - ELISA for B. pertussis toxin
What is oxygenation of blood dependent on in transposition of the great vessels?
- PDA - ASD - VSD
Presentation of rubella
- PDA - Cataracts - Deafness - Hepatosplenomegaly - Thrombocytopenia - Blueberry muffin rash - Hyperbilirubinemia
Presentation of slipped capital femoral epiphysis
- Painful limp - Externally rotated leg
Most common etiology of Croup
- Parainfluenza virus types 1 and 2 - RSV (2nd most common)
Treatment of pharyngitis
- Penicillin (oral, 10 days) - Macrolides (if pencillin allergic)
Signs of hypoxia
- Peripheral cyanosis - Accessory muscle use
Presentation of Vitamin B6 (pyridoxine) deficiency
- Peripheral neuropathy - Must be given w/ INH
Contraindications to barium enema in patient w/ intussussception
- Peritoneal signs - Shock - Perforation
Presentation of CMV
- Periventricular calcifications w/ microcephaly - Chorioretinitis - Hearing loss - Petechiae
Treatment of rickets
- Phosphate, calcium, vitamin D (ergocalciferol & 1,25(OH2)) - Annual blood vitamin D monitoring
Routine management of newborn
- Physical examination - APGAR scoring - Eye care - Disease screening & prevention
Most common conditions causing sepsis
- Pneumonia - Meningitis
Presentation of Vitamin A deficiency
- Poor night vision - Hypoparathyroidism
Presenting features of necrotizing enterocolitis
- Premature, low birth weight - Fever, vomiting, abdominal distention
Types of ASDs
- Primum - Secundum - Sinus venosus
Causes of oligohydramnios
- Prune belly - Renal agenesis
Presentation of Vitamin A toxicity
- Pseudotumor cerebri - Hyperparathyroidism
Causes of low PO2 resulting in PDA
- Pulmonary compromise due to prematurity - Areas of high altitude
Presentation of syphilis
- Rash on palms & soles - Snuffles - Frontal bossing - Hutchinson 8th nerve palsy - Saddle nose
Treatment of CAH
- Replace mineralocorticoids & glucocorticoids - Genital reconstructive surgery
Treatment of Legg-Calvé-Perthes disease
- Rest + NSAIDs - Surgery on both hips
3 major causative agents of viral infectious diarrhea
- Rotavirus - Adenovirus - Norwalk virus
Intussussception is associated with?
- Rotavirus vaccine (previously used) - Henoch-Schonlein purpura
Presentation of kernicterus
- Seizures - Hearing loss - Hypotonia - Choreoathetosis
How is CAH diagnosed at birth?
- Serum electrolytes - ↑ 17-OH progesterone levels
Presentation of Truncus arteriosus
- Single S2 is heard - Systolic ejection murmur - Bounding peripheral pulses - Severe dyspnea - Early/frequent respiratory infections
Pathophysiology of transient hyperbilirubinemia
- Splenic breakdown of excess RBCs that carry Hgb F - ↑ Hgb → ↑ bilirubin
Most common organisms associated w/ late onset sepsis
- Staphylococcus - E. coli - Group B Streptococcus
Presentation of Fifth disease/Erythema infectiosum
- Starts w/ fever + URI - Progresses to rash w/ "slapped cheek" appearance
Diagnostic tests for diarrhea and gastroenteritis
- Stool for blood and leukocyte count - Stool cultures and ova/parasite exam - Sigmoidoscopy
Upper GI series findings associated w/ pyloric stenosis
- String sign - Shoulder sign - Mushroom sign - Railroad track sign
Common pediatric risk factors for vitamin D-*deficient* rickets
- Sunless environment - Low milk intake
What is indicated for all patients w/ symptomatic ASD?
- Surgery - Transcathether closure
What are the TORCH infections?
- T: toxoplasmosis - O: other infections such as Syphilis - R: rubella - C: cytomegalovirus - H: herpes simplex virus
Cyanotic heart defects dependent on PDA
- TGV - Hypoplastic left heart syndrome
Effect of hypocalcemia in an IDM
- Tetany - Lethargy
Set of congenital defects seen w/ VACTERL syndrome
- Vertebral anomalies - Anal atresia (imperforate anus) - Cardiovascular anomalies - Tracheoesophageal fistula - Esophageal atresia - Renal anomalies - Limb anomalies
Presentation of esophageal atresia + TEF
- Vomiting w/ first feeding - Coughing/choking/cyanosis due to TEF - History of polyhydramnios - Recurrent aspiration pneumonia
2 forms of Total anomalous pulmonary venous return (TAPVR)
- W/ obstruction of venous return - Without obstruction of venous return
Diagnostic features of Whooping cough
- Whooping inspiration - Vomiting - Burst blood vessels in eyes
Presentation of Vitamin K deficiency
- ↑ PT/INR - S/Sx of mild-severe bleeding - Analogous to warfarin therapy
Lab values correlated to Scarlet fever
- ↑ antistreptolysin O titer - ↑ ESR/CRP
Most common complications of PDA later in life
- ↑ occurrence of respiratory infxns - Infective endocarditis
Rationale for squatting in Tetralogy of Fallot patients
- ↑ preload & SVR - ↓ right-to-left shunting - ↑ pulmonary blood flow - ↑ blood oxygen saturation
Classic findings w/ Cystic fibrosis
- ↑ sweat chloride - Presence of mutations in CFTR gene - Abnormal functioning in at least 1 organ system
Treatment of G6PD
- ↓ oxidative stress - Specialized diets
What is the maximum single dose of Atropine that should be given to a 6 year old child
0.5 mg
Incidence of congenital hypothyroidism
1 in 4000 infants
Typical duration of infectious diarrhea caused by *Norwalk virus*
1-2 days
Treatment of Epiglottitis
1. *Intubate* in OR 2. *Ceftriaxone* 7-10 days 3. *Rifampin* to all close contacts
3 forms of CAH
1. 21-hydroxylase (90% of cases) 2. 17-hydroxylase 3. 11-β-hydroxylase
Management of necrotizing enterocolitis
1. Antibiotics 2. NPO, IV fluids 3. NGT 4. Surgery (w/ failure of medical management)
Name the stages of Whooping cough
1. Catarrhal stage 2. Paroxysmal stage 3. Convalescent stage
2 major forms of brachial palsy
1. Duchenne-Erb 2. Klumpke
Newborns make three major physiological adaptations at birth that are necessary for survival
1. Emptying fluids from their lungs & beginning ventilation 2. Changing their circulatory pattern 3. Maintaining body temperature
Management of duodenal atresia
1. IV fluids 2. NG tube 3. Surgical duodenostomy
Most important initial steps in management of intussussception
1. IV fluids + electrolytes 2. NG tube
Management of intussussception
1. IV fluids + electrolytes 2. NG tube 3. Barium enema 4. Observation 5. Emergent surgical intervention (w/ failure of barium enema)
3 types of skull fractures in the newborn
1. Linear 2. Depressed 3. Basilar
3 etiologies of holosystolic murmurs
1. Mitral regurgitation 2. Tricuspid regurgitation 3. VSD
7 newborn reflexes
1. Suckling reflex 2. Grasping reflex 3. Babinski reflex 4. Rooting reflex 5. Moro reflex 6. Stepping reflex 7. Superman reflex
3 main etiologies of rickets
1. Vitamin D-*deficient* 2. Vitamin D-*dependent* 3. X-linked hypophosphatemic rickets
Why are patients w/ intussussception typically observed for 24 hours after therapy?
10% recur within 24 hours
Q023. gross motor skills at 4-5 mo
A023. rolls front to back and back/front; sits supported
Q024. gross motor skills at 6 mo
A024. sits unsupported
Q025. gross motor skills at 9 mo
A025. crawls; cruises; pulls to stand
Q026. gross motor skills at 12 mo
A026. walks alone
Q027. gross motor skills at 15 mo
A027. walks backwards
Q028. gross motor skills at 18 mo
A028. runs
Q029. gross motor skills at 24 mo
A029. walks well up and down stairs
Q030. gross motor skills at 3 yrs
A030. rides tricycle; throws ball overhand
Q031. gross motor skills at 4 yo
A031. alternates feet going down stairs; skips
Q032. fine motor skills at 1 mo
A032. follows eyes to midline
Q033. fine motor skills at 3 mo
A033. hands open at rest
Q034. fine motor skills at 4-5 mo
A034. grasps with both hands together
Q035. fine motor skills at 6 mo
A035. transfers hand to hand, reaches with either hand
Q036. fine motor skills at 9 mo
A036. pincher grasp; finger feeds
Q037. fine motor skills at 12 mo
A037. throws, releases objects
Q038. fine motor skills at 15 mo
A038. builds 2 block tower
Q039. fine motor skills at 18 mo
A039. feeds self with utensils
Q040. fine motor skills at 24 mo
A040. removes clothing; builds 5 block tower
Q041. fine motor skills at 3 yrs
A041. draws circle
Q042. fine motor skills at 4 yrs
A042. catches ball; dresses alone
Q043. fine motor skills at 5 yrs
A043. ties shoes
Q044. Simple febrile seizure
A044. between 6mo - 6yr; tonic clonic; associated with fever >100.4; seizure lasts <15 mins; only 1 seizure in 24 hrs; minimal post-ictal state
Q045. complex febrile seizure
A045. 6 mo - 6 yrs; focal seizure; >15 mins; >1 seizure/24 hrs
Q046. management of simple febrile seizure
A046. determine the source of the fever, otherwise, no other w/u is needed
Q047. management of complex febrile seizure
A047. full w/u should be done, but no anti-epileptics, no eeg needed; if patient is <18 mo, LP
Q048. eeg abnormality associated with infantile spasm
A048. hypsarrythmia
Q049. definition of recurrent abdominal pain
A049. >3x in 3 mo
Q050. #1 cause of abdominal pain
A050. gastroenteritis
Q051. mesenteric lymphadenitits
A051. persistent pain following an infection
Q054. complication of Henoch-Schonlein Purpura
A054. intussusception; kidney probs
Q055. clinical features of kawasaki
A055. CRASH and BURN; Conjunctivitis; Rash (on trunk mostly); Aneurysm (coronary); Skin peels off, Strawberry tongue; Hands/Feet edema; BURN = FEVER (x 5d)
Q056. phases of kawasaki disease
A056. acute; subacute (aneurysm formation); convaslescent; takes 2-3 months to resolve
Q057. tx of kawasaki
A057. ASA; IVIG
Q058. when is colicky pain associated with
A058. constipation
Q059. what type of stool is seen with bacterial enterocolitis
A059. bloody, mucinous stool
Q060. when will an appendix perforate in appendicitis
A060. w/i 36 hrs
Q061. which infection can clinically mimic appendicitis
A061. yersinia; campylobacter
Q062. what imaging study for appendicitis
A062. ct
Q063. meds used to tx of perforated appendix
A063. amp, gent, flagyl
Q064. clinical presentation of intussusception
A064. currant jelly stools; lethargy; palpable tubular mass; paucity of gas on xr or evidence of obstruction
Q065. imaging most specific for intussusception
A065. barium (or air) enema; is also therapeutic
Q066. most common location for intussusception
A066. ileocolic; can also develop at meckel's divertic
Q067. major complication of intussusception
A067. there is impaired venous return so bowel edema develops -- > ischemia, necrosis --> perforation
Q068. etiology of intussusception
A068. ileum invaginates into colon at ileocecal valve; a previous viral infection --> hypertrophy of the peyer's patches... this can develop into a lead point; Henoch-Schonlein Purpura can be association with an ileal- ileal intussusception
Q069. tx of intussusception
A069. must do fluid resusc first, if needed; hydrostatic reduction with air/barium
Q070. recurrence rate of intussusception
A070. 0.15
Q071. at what age would a patient present with pyloric stenosis
A071. 1-3 mo
Q072. which medicaation can be associated with pyloric stenosis
A072. erythromycin
Q073. best imaging for pyloric stenosis
A073. u/s; will also see a string sign ugi study
Q074. tx of pyloric stenoSIS
A074. MUST correct fluids and lytes first!; then pyloromyotomy
Q102. complications of developmental dysplasia of hip
A102. Avascular necrosis; degenerative arthritis of hip
Q1020. Next step:; Foreign Body aspiration removal
A1020. RIGID bronchoscopy
Q1021. Define:; Meconium Ileus
A1021. Failure to pass meconium within the first 24 hours of birth
Q1022. MCC of high fever and chills or sepsis in Sickle cell patient
A1022. Strep Pneumococcus; (encapsulated organism that cannot be handled well due to asplenia)
Q1023. Dx:; Sickle cell patient with pain in the hip including restriction of abduction and internal rotation
A1023. Avascular necrosis; (common in sickle cell adolescent)
"Q1024. Dx:; premature neonate with ""increased gastric residues"""
A1024. Necrotizing Entercolitis
Q1025. Dx:; child born normal and asymptomatic until teens, when he began to have delayed muscle relaxation, progressive muscle weakness, thinning cheeks and atrophy of thenar and hypothenar eminences
A1025. Myotonic Muscular Dystrophy
Q103. metatarsus adductus
A103. dorsiflexion and plantarflexion are UNRESTRICTED (diff from clubfoot);; heels go out and toes go in
Q104. tx of metatarsus adductus
A104. stretching or a brace; surgery not usualy needed
Q343. Pyloric Stenosis - Dx
A343. Abdominal US - diagnostic; barium studies - string sign, pyloric beak; hypochloremic, hypokalemic; metabolic alkalosis
Q183. what meds are associated with pseudotumor cerebri
A183. tetracyclines; corticosteroids
Q184. define encephalopathy
A184. generalized cerebral dysfxn, ms change, disorientation
Q185. risk factors for developing retinopathy of prematurity
A185. Body weight <1250 g; age <32 weeks; mechanical ventilation; need for supplemental o2
Q186. causes of leukocoria
A186. retinoblastoma (--> death and visceral metastasis in all cases); cataracts (most common cause); retinopathy of prematurity
Q187. amblyopia
A187. visual impairment not corrected by glasses and not due to an ocular lesion; often from strabismus
Q188. tx of amblyopia
A188. occlusion of better seeing eye forces development of affected eye and visual cortex of affected eye
Q189. at what age will tx not be successful in ambylopia
A189. after 8yo
Q190. tx of retinoblastoma
A190. enucleation (removal of the affected eye); radiation tx; chemo
Q191. complications of neonatal cataracts
A191. if not remoed by 3-4 months, there is irreversible amblyopia
Q192. course of retinopathy of prematurity
A192. most regress spontaneously; if not, cryotherapy can be performed to reduce progression; are still at risk for amblyopia even if treated
Q244. what effect does phenobarb have on jaundice
A244. it improves it by increasing gluocoronyl transferase
Q245. cancer that is associated with (germline) retinoblastoma
A245. osteosarcoma is most common; melanoma; squamous cell ca
Q246. conditions associated with aniridia
A246. congenital glaucoma; surge-weber; marfan; neurofibromatosis
Q247. presentation of malrotation
A247. obstruction; typically normal for first few days of life than malrotation worsens --> abdominal fullness, especially in ruq --> bilious vomiting --> ischemia and necrosis
Q248. #1 malrotation
A248. volvulus
Q298. what effect does sepsis have on bilirubin
A298. disrupts the BBB so it can cause diffusion of bili into the brain
Q299. what effect does temp have on bili
A299. cold temperature can --> bili dissociation from albumin
Q344. Pyloric Stenosis - Tx
A344. First - hydration; correct acid-base & electrolyte abnormalities; NG tube - possible; longitudinal pyloromyotomy
Q339. Intussusception - Dx
A339. Abdominal XR; abdominal US; air contrast barium enema; CBC
Q340. Intussusception - Tx
A340. Correct volume & electrolytes; check CBC; air-contrast barium enema - diagnostic and therapeutic; surgical reduction or resection (if gangrenous)
Q341. Pyloric Stenosis - What is it
A341. Hypertrophy of pyloric sphincter; 1st-born males more affected
Q342. Pyloric Stenosis - History/PE
A342. 1st 2 wks - 4 mos. of life; nonbilious emesis => projectile emesis after each feeding; so, babies feed well initially => malnutrition & dehydration; palpable olive-shaped, mobile, NT epigastric mass; visible gastric peristalsis
CXR findings associated w/ Hypoplastic left heart syndrome
Globular-shaped heart w/ pulmonary edema
Infants and children have a limited store of ____ and ____
Glycogen; glucose
Cause of Wilms tumor
Hemihypertrophy of one kidney due to its increased vascular demands
Characteristics of G6PD deficiency
Hemolytic crisis
What is another name for vitamin K deficient bleeding?
Hemorrhagic disease of the newborn
Most likely cause of conjunctivitis after 3 weeks or more
Herpes
Etiology of Roseola
Herpesvirus types 6 and 7
Treatment of Caput succedaneum & Cephalohematoma
Gradual improvement without treatment over weeks-months
Findings w/ manometry for Hirschsprung disease
High pressures in anal sphincter
Presentation of Diphtheria
Gray highly vascular pseudomembranous plaques on the pharyngeal wall
Vital signs in newborn are always higher or lower?
Higher
How do you do the Barlow maneuver?
Hip adduction + posterior force through knee
Positive Barlow maneuver
Hip dislocation
Why must you ultrasound the contralateral testicle w/ varicocele?
It is a bilateral disease
16-month-old boy, bright red blood in diaper, mild mass palpated in middle left quadrant. What is the most accurate test for this condition?
Meckel's scan [technetium-99m pertechnetate (99mTc) scan]
What are some of the anatomical differences between children and adults?
Larger tongues with smaller and narrower airways
What side do Bochdalek diaphragmatic hernias most commonly occur?
Left side
Condition in which there is a congenital lack of innervation of the distal bowel by the Auerbach plexus
Hirschsprung disease
Important risk factor for Epiglottitis
History of vaccination delinquency
The most common physiology seen in neonates with congenital heart disease involves a(n)
Left to right shunt
How does right ventricular hypertrophy occur in the setting of VSD?
Left-to-right shunt
What is the most likely diagnosis in: a 12-year-old boy found unconscious, awoke on ride to hospital without confusion, and history of uncle who died from "heart condition"?
Long QT syndrome
A 14 year old adolescent is anxious and has tremors and chest pain after smoking crack cocaine. His vital signs are BP 180/100 mm Hg, P 130/min, and RR 20/min. What drug is indicated
Lorazepam
Physical examination finding of Epiglottitis
Hot cherry-red epiglottis
Are 17ɑ-hydroxylase deficiency patients hyper- or hypotensive?
Hypertensive
Metabolic imbalance associated w/ pyloric stenosis
Hypochloremic, hypokalemic metabolic alkalosis
What life threatening condition may be found in a child after ingestion of alcohol
Hypoglycemia
Electrolyte abnormalities associated w/ 17ɑ-hydroxylase deficiency
Hypokalemia
Syndrome consisting of left ventricular hypoplasia, mitral valve atresia, and aortic valve lesions
Hypoplastic left heart syndrome
Reasoning for sending stool in for cultures and ova/parasite exam in the setting of gastroenteritis
Identify the causative agent
Most common cause of pyloric stenosis
Idiopathic
The patient may be very dry. An antidote is a cholinergenic
If a patient ODs on a anticholinergic EX) Atropine , what may they present as?
Best initial diagnostic test for toxoplasmosis
IgM
Why are newborns at most risk for Vitamin K deficient bleeding?
Immature livers do not utilize vitamin K to develop clotting factors
Treatment of gastroschisis
Immediate surgical intervention w/ gradual introduction of bowel and silo formation
What is the best treatment for Duchenne Erb paralysis?
Immobilization
Q376. Atrial Septal Defect (ASD) - Dx
A376. Echo with color flow Doppler - diagnostic; ECG - right-axis deviation; CXR - cardiomegaly and increased pulmonary vascular markings
______ usually becomes evident within the first week of life, with a primary presenting sign of emesis that is filled with bile
Intestinal malrotation
Source of lethargy in Vitamin K deficient bleeding
Intracranial bleeding
Q474. X-linked Agammaglobulinemia; (Bruton's Disease) - What is it
A474. B-cell defect; boys only; may present < 6 mos. of age; at risk for life-threatening Pseudomonas infections
Age x 2 + 70
Lowest Systolic BP
Q475. X-linked Agammaglobulinemia; (Bruton's Disease) - Dx
A475. No B cells; low levels of all Ab classes
Q476. X-linked Agammaglobulinemia; (Bruton's Disease) - Tx
A476. IVIG; prophylactic Antibiotics
Q477. Common Variable Immunodeficiency - What is it
A477. Ig levels drop in 2nd-3rd decade of life; increased risk of lymphoma; increased risk of autoimmune dis.
Q478. Common Variable Immunodeficiency; Dx
A478. Ig levels; antibody titers
Q479. Common Variable Immunodeficiency; Tx
A479. IVIG; prophylactic Antibiotics
Q480. IgA Deficiency - What is it
A480. MC immunodeficiency; usually asymptomatic; may have recurrent infections
Q514. With what immunodeficiency will patients have severe, frequent bacterial infections; chronic candidiasis, and opportunistic organisms?
A514. Severe combined immunodeficiency
Q515. What is the treatment for SCID?
A515. PCP prophylaxis,; bone marrow transplant or stem cell transplant,; IVIG for antibody deficiency
Q516. With what immunodeficiency will patients present with eczema, increased IgE/IgA, decreased IgM, and thrombocytopenia?
A516. Wiskott-Aldrich syndrome
Q517. What is the classis presentation of Wiskott-Aldrich syndrome (3)
A517. Bleeding,; eczema,; recurrent otitis media
Q518. With what immunodeficiency will patients present with anemia, lymphadenopathy, hypergammaglobulinemia, and infections with catalase-positive organisms?
A518. Chronic granulomatous disease
Q519. Pts with chronic granulomatous disease require daily treatment with what antibiotic?
A519. TMP-SMX
Q520. With what immunodeficiency will patients present with oculocutaneous albinism, neuropathy, neutropenia, and increased incidence of overwhelming infections with S. pyogenes, S. aureus, and Pseudomonas?
A520. Chediak-Higashi syndrome
Q521. What is the defect in Chediak-Higashi syndrome?
A521. Neutrophil chemotaxis (Autosomal recessive)
Q522. What is the diagnostic test for chronic granulomatous disease?
A522. Nitroblue tetrazolium test
Q523. What immunodeficiency presents with recurrent episodes of angioedema lasting 2-72 hours and provoked by stress or trauma
A523. C1 esterase deficiency (autosomal dominant)
Q524. What type of immunodeficiencies tend to present at 1-3 months?
A524. T-cell deficiencies
Q525. With what immunodeficiency are patients unable to form membrane attack complexes
A525. Terminal compliment deficiency (C5-C9)
Q526. With what immunodeficiency will patients get recurrent miningococcal or gonococcal infections?
A526. Terminal compliment deficiency (C5-C9)
Q527. What type of immunodeficiencies are characterized by mucous membrane infections, gram-negative enteric organisms, and delayed umbilical cord separations?
A527. Phagocyte deficiencies
Etiology of Diphtheria
Membranous inflammation of the pharynx due to Corynebacterium diphtheriae
Q528. What type of immunodeficiencies are characterized by recurrent bacterial infections with encapsulated organisms
A528. Complement deficiencies
Q529. What are the subacute-phase manifestations of Kawasaki disease? (2)
A529. Thrombocytosis and increased ESR
-size of small finger -Braslow tape - (age in years +16) / 4
Methods for figuring out tube size
Most common location of volvulus in children
Midgut, specifically the ileum
stridor audible with stethoscope
Mild croup presents with....
13-15 GCS
Mild to GCS
9-12 GCS
Moderate GCS
Brachial palsy is most commonly seen in
Macrosomic infants of diabetic mothers
Reasoning for lifelong steroid administration in CAH patients
Maintain adequate levels of mineralocorticoid & glucocorticoid levels
What are some ways to improve communication with pediatric patients?
Make eye contact providing reassurance
Hirschsprung disease is more common in males or females?
Males (4:1 ratio)
Best initial diagnostic test for rubella
Maternal IgM status + clinical diagnosis
Most accurate diagnostic test for Rubeola/Measles
Measles IgM antibodies
Purpose of APGAR
Measures need and effectiveness of resuscitation
What must be assessed before beginning a focused assessment on a pediatric trauma patient?
Mechanism of injury and mental status
Only true congenital diverticulum in which vitelline duct persists in the small intestinal tract
Meckel's diverticulum
What must you consider when presented w/ painless red blood per rectum in a male child under age 2?
Meckel's diverticulum
Reflex where arms spread symmetrically when the baby is scared
Moro reflex
What does the APGAR score not predict?
Mortality
Q631. Dx:; newborn has a mass on the right anterior, superior chest and crepitus on exam; Tx?
A631. Clavicle fracture (MC newborn fracture); Tx: None (will heal on its own)
Q632. MC birthing brachial plexus injury?; what nerve roots?; another name for this injury?
A632. Erb-Duchenne; roots: C5-C6 (C4: if ipsilateral diaphragmatic paralysis also); another name: "waiter's tip" - wrist flexed
Q661. When should Ampicillin be added to the treatment of meningitis?; (2); When should Vancomycin be added?
A661. Ampicillin:; 1. Listeria (as bug); 2. Neonates; Vancomycin: Pneumococcus
Q662. Dx:; Lymphocytic meningitis, rash on wrists and ankles moving centrally; Tx?
A662. Rocky Mountain Spotted Fever; Tx: Doxycycline (and Ceftriaxone for meningitis prophylaxis)
Q663. Differential for Lymphocytic meningitis and next test for each; (3)
A663. Test: IgG and IgM Serology; 1. Rocky Mt. Spotted Fever; 2. Lyme disease; Test: India Ink (or cryptococcal antigen); 3. Cryptococcus
Q664. Treatment for meningitis caused by Cryptococcus
A664. Amphotericin; (then Fluconazole to take home)
Q665. What are the causes of CSF with very high protein and very low glucose?; (2)
A665. 1. TB; 2. fungal
Q666. What should be given prophylactically for a sneaker puncture of a pin that enters the foot?; For what bug?
A666. TMP-SMX; for: Pseudomonas
Q690. What is the specific bug that produces a positive on throat swab culture?; Tx? (3 possible); (2) possible complications?
A690. Group A Strep (A not B); Tx:; 1. Penicillin; 2. Erythromycin; 3. Clindamycin; complications:; 1. Rheumatic Fever; 2. Glomerulnephritis
Q821. What GI complaint can HENOCH-SCHONLEIN PURPURA lead to causing sevre morbidity?
A821. Intussusception
Q822. What is the Tx for a sickle cell patient who presents with anemia and an enlarged spleen?
A822. Blood Transfusion
Q823. What (5)* medications can cause Thrombocytopenia?
A823. PT CCS:; 1. Phenytoin; 2. TMP-SMX; 3. Chloramphenicol; 4. Carbamazepine; 5. Sulfonamides
Q825. How many mL/kg water loss is considered Mild, Moderate and Severe?
A825. Mild = < 50mL/kg; Moderate = 50 - 99mL/kg; Severe = > 100mL/kg
What mechanism of injury accounts for the largest number of trauma deaths in children
Motor vehicle crashes
Source of bright red blood per rectum in Vitamin K deficient bleeding
Mucosal bleeding
What can occur w/ gastroschisis?
Multiple intestinal atresias
Activity in APGAR measures
Muscle tone
Sign observed on upper GI series in pyloric stenosis characterized by *hypertrophic pylorus against the duodenum*
Mushroom sign
What closes a PDA?
NSAIDs (specifically, Indomethacin)
Pedi's have what size airway than adults
Narrow airways
Where do aortic lesions radiate to?
Neck
Condition seen in premature infants where bowel undergoes necrosis and bacteria invade the intestinal wall
Necrotizing enterocolitis
Most likely cause of conjunctivitis from days 2-7
Neisseria Gonorrhoeae
For the first 28 days of life, children are most correctly referred to as a(n)
Neonate
Jaundice usually occurs in
Neonates
Sepsis usually occurs in
Neonates
Are antibiotics effective in treating Diphtheria?
No
Are endoscopy, CT scan, or repeating hemoglobin useful in Meckel's diverticulum?
No
Can an NG tube be passed into the stomach of a patient w/ esophageal atresia?
No
Is a low score on APGAR associated with future cerebral palsy?
No
Is renal agenesis compatible w/ life?
No
Is vomiting a presenting symptom of volvulus, intussusception, biliary atresia, or pyloric stenosis?
No
Are 1-week-olds typically affected by CVAs, Crohn's disease, or Meckel's diverticulum?
No, too early
Hallmark feature of pyloric stenosis
Nonbilious projectile vomiting
Level with the surface or slightly sunken. It may also pulsate
Normal anterior fontanelle
Effect of 11β-hydroxylase deficiency on sex development of boys
Normal at birth
Effect of 17ɑ-hydroxylase deficiency on sex development of girls
Normal at birth
Effect of 21-hydroxylase deficiency on sex development of boys
Normal at birth
Epidemic cause of viral infectious diarrhea
Norwalk virus
Treatment of subconjunctival hemorrhage
Not indicated
Age group affected by slipped capital femoral epiphysis
Obese adolescents
Infants are ___ ___ breathers
Obligated Nose
A great deal of a child's physical exam can be done by
Observing the child's behavior
Which region of a child's head is most prominent?
Occipital
Too little fluid because fetus cannot urinate
Oligohydramnios
Sign that delineates a palpable mass the size of an olive felt in the epigastric region highly associated w/ pyloric stenosis
Olive sign
Defect in which intestines and organs form beyond the abdominal wall w/ a sac covering
Omphalocele
When is congenital hip dysplasia typically discovered?
On newborn exam screening
Why is a single S2 heard w/ Truncus arteriosus?
Only one semilunar valve is present
Most likely process underlying the following patient's stroke: 17-year-old boy who flew from Australia to NY presenting w/ facial droop, altered mental status, left-sided paralysis, took diphenhydramine, and swollen left calf muscle
Paradoxical emboli from deep leg veins
Etiology of Mumps
Paramyxovirus
Etiology of Rubeola/Measles
Paramyxovirus
Etiology of Fifth disease/Erythema infectiosum
Parvovirus B19
Treatment of congenital hip dysplasia
Pavlik harness
Thin layer under their back to raise their airway in a neutral inline position
Pedi less than 3 years old
A folded sheet or towl under the occiput to obtain a sniffing position.
Pedi over 3 years old
Pulse respiration, blood pressure, and temp a BP should cover 2/3 of arm
Pedi vital signs
smaller. This results in a higher potential for hypoxia.
Pediatric O2 reserve is...
Appearance: focus on the mental status and muscle tones Breathing: respiratory rate and respiratory effort Circulation: uses skin signs and color as well as capillary refill as indicators of the patient's circulatory status
Pediatric assessment triangle
18
Pediatric burn index: Head
18 per side
Pediatric burn index: Trunk
9
Pediatric burn index: whole arm
13.5 each
Pediatric burn index: legs
Generally larger with smaller faces and flat noses.
Pediatric head
Peds can maintain BP well and still be at risk for shock. Hypotension is a late sign.
Peds BP in shock
Peds have proportionally higher blood volume
Peds blood volume.
Presentation of Vitamin B3 (niacin) deficiency
Pellagra (diarrhea, dermatitis, dementia, death)
Treatment of syphilis
Penicillin
What does surgical intervention for choanal atresia involve?
Perforate membrane, reconnect pharynx to nostrils
Most likely diagnosis w/ *pear-shaped* cardiac x-ray findings
Pericardial effusion
Q907. A 2-yo boy undergoes end-to-end repair of an aortic coarctation. Seven years later he has HTN symptoms again. Tx?
A907. Angioplasty via balloon; (TOC for re-coarctation)
Q908. Dx:; Marfan features + Thromboembolic events; enzyme deficiency?
A908. Homocystinuria; enzyme: Cystathionine Synthase
Q909. Dx:; Onset of HA with focal neurological sx soon after acute otitis media?
A909. Brain Abscess
Q910. Dx:; A <1-mo child with bilious vomiting, abdominal distention and passage of bloody stools
A910. Midgut Volvuvus
Q911. MCC of Jaundice in premature infant?
A911. TPN-induced jaundice
Q912. Dx:; a child presents with a wide-based gait, decreased vibratory and position sense in lower extremities, absent ankle jerk bilaterally, atrophy of cervical spinal cord and T-wave inversions
A912. Friedreich Ataxia; (Trinucleotide repeats; Autosomal Recessive)
Q913. Dx:; severe dehydration in neonate with HypoN, HyperK and HypoG plus Metabolic Acidosis
A913. Congenital Adrenal Hyperplasia; (21-hydroxylase deficiency)
Q914. A premature infant on a vent has signs of pneumonia. MC bug?
A914. Oxacillin-Resistant Staph Aureus; (MRSA would also cause skin pustules of periumbilical and diaper areas)
Q915. What is the difference in presentation of ABO incompatability and Rh incompatability?
A915. ABO: Fetal anemia and Jaundice; Rh: Hydrops (anemia, edema, ascites, cariomegaly and hepatomegaly)
Q916. What is the difference in Tx wth Ewings Sarcoma and Osteosarcoma?
A916. Ewings: Surgery, Chemo, Radiation; Osteosarcoma: Surgery & Chemo only!
Q917. Aside from blood lead level, what else is increased in the blood with lead poisoning?
A917. Erythrocyte Protoporphyrin; (usually seen w/ > 55mg/dL of lead)
Q918. What is the best way to test for acid-fast bacilli of TB?
A918. Early-morning Gastric Aspiration
Q919. Dx:; A 6-yo female child with constant leaking of urine
A919. Low implantation of Ureter; (into vagina)
Q920. What is the age of precocious puberty in boy and girl?; What is the best Initial test for Evaluation of Precocious puberty?
A920. Boy: < 9-yo; Girl: < 8-yo; test: Radiograph of Hand and Wrist to determine Bone Age
Q921. Tx:; Hereditary Angioedema
A921. Danazol (and Epi if needed)
Q922. Dx:; Superoxide deficiency in Macrophages
A922. Chronic Granulomatous Disease
Q923. Dx test:; Chronic Granulomatous Disease
A923. Nitroblue Tetrazolium
Q924. Dx:; Defect in neutrophil chemotaxis
A924. Chediak-Higashi syndrome
Q925. Dx:; MENTAL RETARDATION with rocker-bottom feet and clenched fist
A925. Edward's syndrome; (Trisomy 18)
Q926. Dx:; MENTAL RETARDATION with midline defects, cleft lip/palate
A926. Patau syndrome; (Trisomy 13)
Q927. Dx:; Tall, infertile, gynecomastia, microtestes
A927. Klinefelter's syndrome; (XXY)
Q928. Age:; Social smile
A928. 1 - 2 months
Q929. Age:; Rolls onto Back
A929. 4 months
Q930. Age:; Rolls onto Stomach
A930. 5 months
Q931. Age:; Walks alone
A931. 15 months
Q932. Age:; Copies Circle
A932. 3 years
Q933. Age:; Copies Cross or Square
A933. 4 years
"Q934. Tanner stage:; Penile ""growth spurt"""
A934. Tanner stage 3
Q935. Dx:; Vaccination that cannot be taken if allergic to eggs
A935. Influenza A
Q936. Dx:; Place of foreign body aspiration in a child that was standing
A936. Right Bronchi in Superior Segment of Lower Lobe
Q937. Dx:; Place of foreign body aspiration in a child that was supine or is an epileptic
A937. Right Bronchi in Posterior Segment of Lower Lobe
Q938. Dx:; possible Kidney problem in Turner's Disease
A938. Horseshoe kidney
Q939. Dx test:; Duodenal Atresia
A939. AXR; (Double bubble)
Q940. Dx test:; Rotavirus
A940. Immunoassay
Q941. Dx test:; steathorrhea plus protozoal cysts in stool
A941. Duodenal Aspirate
Q942. Bacterial Diarrhea:; Ulcerative colitis-like Sx plus Arthritis
A942. Campylobacter; (MCC of infectious diarrhea)
Q943. Bacterial Diarrhea:; Child with acute onset of RLQ pain (like appendicitis) plus diarrhea
A943. Yersinia
Q944. Bacterial Diarrhea:; Daycare outbreak plus child with diarrhea and new onset seizure
A944. Shigella
Q945. Dx test:; Tuberous Sclerosis
A945. CT scan of head; (Calcified periventricular tubers)
Q946. Tx:; West syndrome (Infantile spasms); (2)
A946. ACTH and Prednisone
Q947. Dx:; Anaphylaxis after blood trasnfusion
A947. IgA deficiency
Q948. Dx:; very low T- and B-cells (lymphopenia) with bacterial and fungal infections
A948. SCID
Q949. Prophylaxis needed for SCID
A949. PCP
Q950. Tx:; SCID
A950. Bone Marrow Transplant; (or stem cell transplant with IgG)
Q951. Dx:; baby less then 2-yo presents with tachypnea and wheezing
A951. Bronchiolitis (RSV)
Q952. Dx test:; Bronchiolitis (RSV)
A952. ELISA nasal washings
Q953. Bug:; Assoc with Guillain-Barre
A953. Campylobacter Jejuni
Q954. Dx:; Corneal clouding, cataracts, early renal failure
A954. Fabry's Disease
Q955. Dx:; Optic atrophy, spasticity, Globoid bodies in brain
A955. Krabbe's Disease
Q956. Dx:; Inspiratory stridor, barking cough
A956. Croup (Parainfluenza)
Q957. Tx:; Croup
A957. Steroids and humidified air
Q958. Dx:; Hearing loss, cataracts, microscopic hematuria
A958. Alport's syndrome
Q959. Dx:; salmon-colored rash with daily fever spikes, knee pain, leukocytosis, thrombocytosis, Inc ESR
A959. Still's Disease; (Systemic juvenile RA)
Q960. Dx:; Surfactant deficiency in preterm infant
A960. Respiratory Distress Syndrome; (RDS)
Q961. Dx:; Heart disorder assoc with DiGeorge syndrome
A961. Transposition of the Great Vessels
Q962. Dx:; short, Inc calcium, developmental delay, overly friendly, supravalvular aortic stenosis
A962. Williams syndrome
Q963. Dx:; Heart problem with Kartagener's syndrome
A963. Dextrocardia
Q964. Next step:; positive PPD
A964. Chest X-Ray; (before medicine)
Q965. First test:; Nasal polyps found in child
A965. Pilocarpine Sweat Test; (polyps in child = CF)
Q966. Dx:; Infant gets repeated pneumonias at beginning of life due to exhaustion of maternal IgG in system
A966. Transient Hypogammaglobinemia
Q967. Dx:; child with increased AA in urine, photosensitivity, ataxia and neuro problems
A967. Hartnup Disease
Q968. Dx:; 6-yo boy presents with dark pubic hair, enlarged penis/testis, growth spurt and acne
A968. Hypothalamic tumor; (without growth spurt may be 21-hydroxylase deficiency)
Q969. Dx:; Hereditary eye problem with progressive night blindness, field constriction and loss of acuity
A969. Retinitis Pigmentosa
Q970. First step:; Emergency airway in ER on patient < 12-yo
A970. Needle Cricothyroidotomy
Q972. Dx:; Acanthocytes (spiny RBC)
A972. Abetalipoproteinemia
Q973. Child Brain Tumor:; Originates from cerebellar vermis and grows to the fourth ventricle
A973. Medulloblastoma
Q974. Child Brain Tumor:; Cyst and mural nodule assoc with vonHipple-Lindau
A974. Hemangioblastoma
Q975. Child Brain Tumor:; Cyst with a mural nodule in the cerebellum
A975. PiloCYSTIC Astrocytoma; (similar to Hemangioblastoma)
Q976. Dx:; Delayed passage of meconium, chronic constipation, FAILURE TO THRIVE, air in bowel
A976. Hirschprung's Disease
Q977. Dx:; High fever for 3 days, then macular rash
A977. Roseola
Q978. Virus assoc with Roseola
A978. HSV-6
Q979. another name for Measles
A979. Rubeola; (not Roseola)
Q980. First test:; Infant with seizures
A980. Serum chemistries
Q981. Dx:; BRBPR in infant 1 week to 3 months old
A981. Food Allergy-induced Colitis
Q982. Dx:; slight fever, sore throat, suboccipital and posterior auricular LN enlargement, rash starts on face and moves down body
A982. Rubella
Q983. MC genetic defect in CF
A983. CFTR-508 Deletion on chromosome 7
Q984. Dx:; Sickle cell patient with acute severe anemia without reticulocytes, but with normal platelets and WBC
A984. Aplastic Anemia
Q985. First step:; child is cyanotic from congenital diaphragmatic hernia
A985. Orogastric Tube placement; (with continuous suction to prevent bowel from decompressing lung)
Q986. Dx:; 2-week-old infant presents with jaundice. He is exclusively breastfed, his stool has a lighter color, has hepatomegaly and direct bilirubin of 4
A986. Biliary Atresia; (light stool, hepatomegaly and inc direct bilirubin)
Q987. An increase in what lab in a 2-week-old infant would lead to breastfed jaundice conclusion?
A987. Increased Indirect Bilirubin; (as high as 10 - 30mg/dL)
Q988. Next step:; after confirming Dx of Septic Arthritis
A988. Emergent Surgical Drainage
Q989. Dx:; Jaundice within 24 hours of life and an increased direct and indirect bilirubin, anemia, pallor, HSM and reticulocytosis
A989. Erythroblastosis Fetalis
Q990. Dx:; Jaundice appearing after the 5 days of life, but within the first week
A990. Neonatal Sepsis; (causing Jaundice)
Q991. Dx:; Child of 13-yo with femoral head off the metaphysis, with new bone formation
A991. Slipped Capital Femoral Epiphysis
Q992. First step:; Slipped Capital Femoral Epiphysis
A992. Emergency Surgery
Q993. Tx:; Kawasaki Disease
A993. IV immunoglobulins and Aspirin
Q994. Dx:; IgG, IgM and IgA are all very low, very low B-cells, bacterial infections in the first 5 years of life
A994. X-linked Agammaglobinemia
Q995. Dx:; low IgG, IgM and IgA levels, normal B-cells and T-cells; Sx begin at 15 - 35 years old.
A995. Common Variable Immunodeficiency; (CVID)
What are some causes of increased work of breathing in a pediatric patient who has suffered a traumatic event?
Airway, chest, and abdominal injuries
What drug may initially relieve respiratory distress in a child with bronchiolitis
Albuterol
What may be indicated for the management of severe respiratory distress associated with bronchiolitis
Albuterol, 0.15 mg/kg by inhalation
What is released in response to the hypovolemia associated w/ pyloric stenosis?
Aldosterone
Cyanotic heart defects w/ right-to-left shunts
All of them (Tetralogy of Fallot, TGV, Hypoplastic left heart syndrome, Truncus arteriosus, TAPVR)
What is an appropriate intervention for a child in whom epiglottitis is suspected
Allow the child to assume a comfortable position
0.2 mg/kg min:0.1 max:0.5
Atropine dose
PKU inheritance pattern
Autosomal recessive
Another name for Legg-Calvé-Perthes disease
Avascular necrosis of femoral head
Where do mitral lesions radiate to?
Axilla
Treatment of unconjugated hyperbilirubinemia
Phototherapy
Are more common in pediatric patients who have been subjected to major trauma
Pulmonary contusions
CXR findings associated w/ TAPVR w/ obstruction
Pulmonary edema
Most severe sequela of Truncus arteriosus
Pulmonary hypertension
Pulse in APGAR measures
Pulse rate
What are reliable indicators of cardiac output in pediatric patients?
Pulse rate and quality, skin color and condition, and capillary refill
- Arterial pulse waveform showing alternating strong and weak beats - Sign of *left ventricular systolic dysfunction*
Pulsus alternans
- Relatively normal QRS complexes, each followed by a smaller, abnormal one - Sign of *hypertrophic obstructive cardiomyopathy (HOCM)*
Pulsus bigeminus
Treatment of toxoplasmosis
Pyrimethamine and sulfadiazine
Treatment of moderate-severe Croup
Racemic epinephrine
Although occur less frequently in children they are not uncommon in abuse,
Rib fracture
CXR findings for coarctation
Rib notching
CXR findings associated w/ coarctation of the aorta
Rib notching + "3" sign
Disorder caused by lack of vitamin D, calcium, or phosphate leading to softening and weakening of the bones, making them more susceptible to fractures
Rickets
Presentation of Vitamin D deficiency
Rickets
What is the most likely diagnosis in: a 2-year-old girl who walks abnormally, falls a great deal, does not like milk, withdrew from breastfeeding & cow's milk early, physical exam revealing unsteady gait, bowing of the tibia, and x-rays revealing beading of the ribs & genu varum?
Rickets
What is the most likely finding on EKG in: a 3-month-old female infant that will not eat anymore, has a loud pansystolic murmur on PE, and appears small for her age?
Right ventricular hypertrophy due to VSD
RR > 60 HR > 180 or < 80 under 5 years old HR > 180 or < 60 over 5 years old Cyanosis Fever with petechiae Rispiratory distress Trauma Burns ALOC Seizures
Risks for cardiopulmonary arrest in a pediatric
Reflex where touching a baby's cheek, will result in the baby turning to that side
Rooting reflex
How do you stimulate crying and breathing?
Rubbing/stimulating heels
1-6 months
SIDS usually occurs during what months?
Presentation of Vitamin C deficiency
Scurvy (ecchymoses, bleeding gums, petechiae)
Pathophysiology of bleeding associated w/ Meckel's diverticulum
Searing of nearby small bowel tissue due to gastric acid secretion by ectopic tissue
Helps minimize injury when it happens
Secondary prevention
Most common type of ASD
Secundum defect
Treatment of prune belly
Serial Foley catheter placements
Less than or 8 GCS
Severe GCS
Features of the Catarrhal stage of Whooping cough
Severe congestion and rhinorrhea
Features of the Paroxysmal stage of Whooping cough
Severe coughing episodes with extreme gasp for air (inspiratory whoop) following by vomiting
Cyanosis, loud stridor, high anxiety.
Severe croup presents with....
Warm IV fluids. Rewarm until pt is at 95 degrees or a return of spontaneous circulation.
Severe hypothermia actions
86 degrees or less
Severe hypothermia is...
Severe hypothermia
Shallow breathing, and extreme disorientation or non responsiveness are environmental signs of...
Newborns lack the ability to ____ thus always prevent heat loss and cover the patients head.
Shiver
Why was the technetium-99m pertechnetate (99mTc) scan termed the Meckel scan?
Because of its accuracy
A child is experiencing signs and symptoms of hypoxia while on a home ventilator. On arrival, you should immediately perform what?
Begin ventilation with a bag valve device
For what drug is glucagon given as an antidote
Beta blockers
6-12
Between what months can an infants start to stand and walk?
Prototypic finding of duodenal atresia
Bilious vomiting on the 1st day of life, typically within 12 hours after birth
When should exchange transfusion be considered in the setting of hyperbilirubinemia?
Bilirubin ↑ >20-25 mg/dL
Components of immediate evaluation of sepsis
Blood and urine cultures
Sign observed on upper GI series in pyloric stenosis characterized by *filling defect in the antrum due to prolapse of muscle inward*
Shoulder sign
Surgical connection than runs from the brain to the abdomen to drain CSF and prevent ICP.
Shunt definition:
CSF Hearing loss seizure battle signs
Signs of a basilar skull fracture (4)
Retraction Nasal flaring Head bobbing Grunting Wheezing Gurgling Stridor
Signs of increased respiratory effort
Vitamin K deficient bleeding prophylaxis
Single IM dose of vitamin K
HR of 180
Sinus tach in children is...
HR greater than 220
Sinus tach in infants is..
What injuries should be considered the result of possible abuse
Bruises or burns in unusual patterns
Least common type of ASD
Sinus venosus defect
Menengitis
Bulging Fontanels and nuchal rigidity are signs of....
What is a sign of increasing intracranial pressure unique to an infant
Bulging fontanelle
Presentation of Vitamin B5 (panthotenic acid) deficiency
Burning feet syndrome
Motor vehicle collisions, falls, and drowning are common mechanisms of injury for children. What are some other common mechanisms of injury for children?
Burns, intoxication, and choking
Appearance in APGAR measures
Skin color/complexion
Children have thinner ____ and less ___ than adults, thus having having a larger BSA to weight ratio. Because of this they lose fluid and heat much quicker than adults.
Skin; Subcutaneous fat
Not always a sign of improvement i could mean the patient is tired and will soon not be able to compensate.
Slower breathing rate
Condition associated w/ an IDM that is characterized by a congenitally smaller descending colon leading to distention from constipation
Small left colon syndrome
Treatment of small left colon syndrome
Small, frequent feeds
CXR findings associated w/ TAPVR without obstruction
Snowman or figure 8 sign
Most accurate diagnostic test for PDA
Cardiac catheterization
Most accurate diagnostic test for coarctation of the aorta
Cardiac catheterization
Most definitive diagnostic test for ASD
Cardiac catheterization
hypotension
Cardiac tamponade may only present with...
CXR findings associated w/ ASD
Cardiomegaly + ↑ vascular markings
CXR findings associated w/ Truncus arteriosus
Cardiomegaly w/ ↑ pulmonary markings
A 4 year old child has fatigue, difficulty breathing, and peripheral edema. Crackles are audible in the bases of both lungs. Which illness do you suspect
Cardiomyopathy
0.5-1j/ kg
Cardiovert dose is...
Reflex where baby will automatically suck on a nipplelike object
Suckling reflex
First thing done for a newborn
Suction mouth and nose
A child who has a tracheostomy is dyspneic. The tube appears to be partly obstructed. What is your first intervention?
Suction the Tracheostomy
Reflex when held facing the floor, arms go out
Superman reflex
Infection CNS disorder Increased ICP
Causes of a fever (3)
Location of secundum type ASD
Center of atrial septum
Associate the *Murphy sign* w/ its associated condition
Cessation of breathing due to RUQ tenderness
Most likely cause of conjunctivitis at day 1
Chemical irritation
6 years
Child must be greater than * for an IO
Highest risk group for rickets
Children 6-24 months of age
Who receives Hepatitis B immunoglobulin + Hepatitis B vaccine?
Children w/ HBsAg+ mothers
Most likely cause of conjunctivitis after more than 7 days postdelivery
Chlamydia trachomatis
What is done when medical management of necrotizing enterocolitis fails?
Complete or partial colectomy
Treatment of Fifth disease/Erythema infectiosum
Supportive
Treatment of Roseola
Supportive
Treatment of rubella
Supportive
Treatment of Rubeola/Measles
Supportive treatment
Treatment of bronchitis
Supportive treatment
Treatment of Varicella
Supportive treatment w/ topical ointments
Management of imperforate anus
Surgery
Treatment of TAPVR w/ obstruction
Surgery
Treatment of TAPVR without obstruction
Surgery
Treatment of cyanotic heart defects
Surgery
Treatment of epispadias
Surgical correction
What actually causes the Doughnut/target sign?
Concentric alternating echogenic (mucosa) and hypoechogenic (submucosa) bands
What must you evaluate a patient w/ epispadias for?
Concomitant bladder exstrophy
Treatment of hypospadias
Surgical correction
What does the 1 minute APGAR score evaluate?
Conditions during labor and delivery
Condition in which there is an inherited defect of steroid synthesis
Congenital adrenal hyperplasia
Umbilical hernia is associated w/?
Congenital hypothyroidism
The lack of innervation to the distal bowel seen in Hirschsprung disease causes what in regards to bowel muscle tone?
Constant contracture
Most common surgical procedure and definitive treatment for duodenal atresia
Surgical duodenostomy
Definitive treatment for choanal atresia
Surgical intervention
Only definitive therapy for Tetralogy of Fallot
Surgical intervention
Treatment of omphalocele
Surgical reintroduction of contents
Management of Meckel's diverticulum
Surgical removal
Treatment of coarctation of the aorta
Surgical resection of the narrowd segment
80% of amniotic fluid is a filtrate of the mother's plasma. How does the baby produce the remaining 20%?
Swallowing, absorbing, filtering, and urinarting
Best initial test for Cystic fibrosis
Sweat chloride
Presenting symptoms of volvulus & intussusception
Symptoms of obstruction (distention, failure to pass flatus/stool)
A fever
Tachycardia and Tachypnea might be present with...
Often the first manifestation of respiratory distress in infants.
Tachypnea
What clinical finding may be present in a child who has ingested a large amount of aspirin
Tachypnea
Congenital heart defect associated w/ exercise intolerance and squatting
Tetralogy of Fallot
Most common cyanotic heart defect after the neonatal period
Tetralogy of Fallot
Most likely diagnosis w/ *boot-shaped* cardiac x-ray findings
Tetralogy of Fallot
Hole in the diaphragm that allows the abdominal contents to move into the thorax?
Diaphragmatic hernia
What is the most likely diagnosis in: a premature infant born at 28 weeks in respiratory distress, w/ grunting, nasal flaring, use of accessory muscles, bowel sounds heard upon auscultation of the back, and CXR showing air fluid levels in the chest?
Diaphragmatic hernia
10 stools a day.
Diarrhea is defined as...
Ultrasound findings associated w/ varicocele
Dilatation of the vessels of the pampiniform plexus > 2 mm
Conservative treatment for VSD
Diuretics and digoxin
What should not be done in patients w/ Diphtheria?
Do not scrape pseudomembranes
You are doing an interfacility transport of a pediatric patient whose brain has expanded into a linear crack in his skull widening the fracture. What is this condition known as?
Growing skull fracture
PEEP
Grunting increases what??
Pathophysiology of development of aspiration pneumonia in newborn w/ esophageal atresia w/ tracheoesophageal fistula
Food contents aspirated via fistula in the respiratory system
HR > 180 or < 60
HR for cardiopulmonary arrest over 5 years old
HR >180 or <80
HR for cardiopulmonary arrest under 5 years old
Mainstay of diagnosis for Hirschsprung disease
Full thickness biopsy
Indications for newborn nasogastric tube placement
GI decompression
Omphaloceles result from failure of what?
GI sac retraction at 10-12 weeks gestation
Rare genetic disorder that precludes normal metabolism of galactose
Galactosemia
Treatment of CMV
Ganciclovir w/ signs of end-organ damage
Pedi's are more prone to ____ _____.
Gastric distension
Inflammation of the GI tract secondary to microbiologic infiltrate and spread
Gastroenteritis
Most appropriate next step in management of: a 4-year-old child w/ extreme irritability, refusal to eat, refusal to lean back, muffled speech, extremely ill appearance, drooling, positive thumbprint sign on CXR?
Intubate
Most crucial next step in management of Epiglottitis
Intubate
What is the most likely diagnosis in: a 1-year-old w/ purple jelly stool, recent history of irritability, complaints of pain, episode of vomiting, lethargy, & firm-sausage-shaped mass on PE?
Intussusception
Associate the *doughnut sign* w/ its associated condition
Intussussception
Condition in which part of the bowel telescopes into another segment of bowel distal to it
Intussussception
Pulse associated w/ atrial fibrillation
Irregularly irregular pulse
Yes. It effects children under 2 years.
Is bronchiolitis contagious? What age group does it usually effect?
Wall defect lateral to midline w/ intestines and organs forming beyond the abdominal wall w/ no sac covering
Gastroschisis
Most accurate test for Cystic fibrosis
Genetic analysis of the CFTR gene
Cause of Tetralogy of Fallot
Genetic and environmental factors
Under the car. Head and spine are commonly injured
Where do peds usually go when hit by a car?
C-1 and C-2
Where do spine fractures usually happen in peds?
Under 3- under shoulders Over 3- under head
Where do you put a towel for under and over the age of three years?
Form of bronchitis caused by Bordetella pertussis
Whooping cough
Small purple spots resulting from skin hemorrhages
petechiae
Pathophysiology behind notched appearance of ribs in coarctation of the aorta
↑ pressure in subcostal vessels erodes ribs
Regardless of surgical intervention, cryptorchidism is associated w/ what?
↑ risk of malignancy
Aldosterone's effect on postassium
↑ urinary excretion of K+
Mechanism behind ↓ Na+, Cl-, glucose, & ↑ K+ seen w/ CAH
↓ aldosterone & cortisol production
Effect of asymmetric septal hypertrophy in an IDM
↓ cardiac output
Why are children more vulnerable to liver and splenic injuries
The abdominal musculature is minimal and does not protect these organs
Why is surgery done on both hips in patients w/ Legg-Calvé-Perthes disease?
The contralateral unaffected hip eventually undergoes necrosis
Congenital condition in which there is no venous return b/w pulmonary veins and the left atrium
Total anomalous pulmonary venous return (TAPVR)
What is a bacterial infection of the upper airway & subglottic trachea that occurs during or after Croup
Tracheitis
Something to be considered if you see recurrent aspiration pneumonia
Tracheoesophageal fistula
Common respiratory findings in newborns delivered via cesarean birth
Transient tachypnea of the newborn (excess fluid in the lungs, hypoxia)
Condition characterized by an aorta that orginates from the right ventricle and pulmonary artery that comes from the left ventricle
Transposition of the great vessels
Most common cyanotic lesion during the neonatal period
Transposition of the great vessels
Pressers and Forosemide
Treatment for cardiomyopathy
Ventilation. If not increase of HR, intubate. Consider Epi down the ET tube.
Treatment for unstable bradycardia
A benefit of immediately drying a newborn is that the act of drying also provides gentle stimulation, which may initiate respirations
True
In addition to being the organ of exchange between the mother and fetus, the placenta becomes becomes a temporary endocrine gland, secreting estrogen and progesterone
True
In infants and young children the chief support for the chest wall comes from muscles rather than bones
True
Neonates are obligate nose breathers during the first month of life
True
When using a bulb syringe to suction the nose and mouth of a newborn, it is preferable to suction the mouth first to prevent aspiration in case the infant gasps and begins to breathe when the nose is cleared
True
Congenital heart defect where a single trunk emerges from both right and left ventricles and gives rise to all major circulations
Truncus arteriosus
A hydrocele is a remnant of what?
Tunica vaginalis
Presenting features that are clinically diagnostic for choanal atresia
Turn blue when feeding, pink when crying
Frequent association w/ coarctation of the aorta
Turner syndrome
1st-Chemical mediated release of histamine. 2nd- Inflammation of bronchioles
Two phases of Asthma
Best initial diagnostic test for Herpes
Tzanck smear
Best initial diagnostic test for Varicella
Tzanck smear showing multinucleated giant cells
Treatment of prune belly carries a high risk of what?
UTIs
Most accurate test for varicocele
Ultrasound of the scrotal sac
W/ varicocele, what must you always do on ultrasound?
Ultrasound the other testicle
Congenital weakness of the rectus abdominis muscle which allows for protrusion of vessels and bowel
Umbilical hernia
You are caring for a teenager who was "huffing" toluene. What effects could this produce
Visual disturbances
What is the most likely diagnosis in: a 1-week-old newborn who received no routine newborn care presenting w/ bright red blood per rectum, lethargy, unequal pupils, and gross red blood in his diaper?
Vitamin K deficient bleeding
What does a succussion splash sound similar to?
Waves on a beach
Liver and spleen. Organs are closer together
What 2 organs may most be effected in blunt trauma?
Cholinergenic. (they make you into liquid) Atropine is an antidote.
What are organophosphates and what do you use as an antidote?
The growth plate
What could an IO disrupt?
use it to breath
What do infants do with their diaphragm?
Ethel alchohol ETOH
What is an antidote for antifreeze?
Scolding
What is the most common burn for peds?
Cricoid
What is the narrowest part of the pediatric airway?
Tight or bulged and pulsating might stop
What might fontanelles look like with ICP??
Epiglottis
What presents with drooling?
Sunken
What will fontanelles look like in dehydration?
Toddler 1-3 years
When can you start asking the patients some questions other than just the caretaker?
Anterior 9-18 months Posterior 4 months
When do anterior and posterior fontanelles close?
Preschool 3-5 years
When may a child want to help you with treatment?
Q813. What are (4) developmental milestones at 9 months old?
"A813. ""Pinches Ma-ma's furniture Bye-Bye to cruise""; 1. Pincher grasp; 2. says: Mama or Dada; 3. waves Bye-Bye; 4. Cruises around furniture"
Hallmark findings on imaging for duodenal atresia, volvulus, & intussussception
- *Duodenal atresia*: double bubble sign - *Volvulus*: "bird beak" apperance - *Intussussception*: doughnut/target sign
CAH's general effect on sexual development in boys
- No initial abnormalities - Loss of defining sexual features w/ ↑ age
Treatment of Scarlet fever
- Penicillin - Azithromycin - Cephalosporins
WAGR syndrome
- Wilms tumor - Aniridia - GU malformations - Retardation
Q123. nursemaids elbow
A123. subluxation of radial head
Q169. tx of Meckel's diverticulum
A169. surgical resection
Q314. onset of chlamydia conjunctivitis
A314. DOL 5-14
Q348. Child Abuse - Tx
A348. Document injuries; notify child protective services; hospitalize if necessary
Q380. Ventric Septal Defect (VSD) - Dx
A380. Echocardiogram - diagnostic; EKG - may show RVH or LVH; normal with small VSDs
Q405. Febrile Seizures - Dx
A405. Find source of infection; LP - if signs of CNS infection; No labs if presentation consistent with febrile seizure; Atypical presentation - electrolytes, glucose, BC, UA, CBC with diff, EEG & MRI - complex seizures
Q466. Meckel's Diverticulum - Tx
A466. Surgery
Q498. Terminal Complement Deficiency; (C5-C9) - Tx
A498. Meningococcal vaccine; appropriate Antibiotics
Q549. What congenital defect often presents in childhood with asymptomatic hypertension?
A549. Coarctation of the aorta
Q550. What is the most common childhood malignancy?
A550. ALL
Q554. hyponasal speech plus mouth breathing, think?
A554. NASAL POLYP
Q659. What is the first step in a suspected meningitis of any age?
A659. IV Ceftriaxone
Q692. Dx:; High fever, sore throat and ulcers scattered on the soft palate, tonsils and pharynx; cause?; Tx?
A692. Herpangina; cause: Coxsackievirus; Tx: None...will go away
Suicidal Gestures usually occurs in
Adolescents
20mL/kg
Dose for fluids
Presentation of Herpes in the 3rd week
Encephalitis
When did it start? What is the current temp? Did you try any remedies?
Fever questions to ask
EKG findings associated w/ PDA
LVH 2° to high SVR
Most common extracranial solid malignancy
Neuroblastoma
Contrast enema findings for Hirschsprung disease
Retention of barium > 24 hours
A 10 month old child "didn't wake up from his nap." He is unconscious and has vomited. What other physical finding may indicate abuse
Retinal Hemorrhage
W/ a Morgagni diaphragmatic hernia, where is the defect?
Retro- or parasternal
Signs and symptoms of TAPVR without obstruction
Right heart failure & tachypnea in a 1-2 year-old
For which of the 3 major causative agents of viral infectious diarrhea is there a vaccine available?
Rotavirus
Most common cause of viral infectious diarrhea in the winter
Rotavirus
Which of the 3 major causative agents of viral infectious diarrhea present w/ a viral prodrome?
Rotavirus & Adenovirus
Effect of hypoglycemia in an IDM
Seizures
If tachypnea lasts > 4 hours, what is it considered?
Sepsis
How is perforation excluded in the setting of necrotizing enterocolitis?
Serial AXRs
Presentation of Herpes in the 1st week
Shock and DIC
CXR findings w/ Epiglottitis
Thumbprint sign
Reasoning for sending stool in for blood and leukocyte count in the setting of gastroenteritis
To detect presence of invasive toxins
During your assessment, when should you begin using the Pediatric Assessment?
Upon visual contact
Most accurate test for pyloric stenosis
Upper GI series
Defect in the wall dividing the left and right ventricles of the heart
VSD
D25W -50% dextrose solution with sterile water or saline
treatment for hypoglycemia
Levels of 11-DOC characteristic of *11β-hydroxylase*?
↑
Why does oligohydramnios cause flat facies?
↑ atmospheric pressure → compression of fetus normally buffered by amniotic fluid
Q100. dx of developmental dysplasia of hip
"A100. u/s: see ""false acetabulum"" in lateral ileum"
Q240. clinical presentation of meconium ileus
"A240. vomiting; abdominal distension; distended bowel loops; ""soap bubble"" on XR"
Q325. Neuroblastoma - History/PE
"A325. Can occur anywhere; Sx vary with location; nontender abdominal mass; (may cross midline); Horner's syndrome; HTN; cord compression; anemia; FAILURE TO THRIVE; fever; site-specific metastasis can cause proptosis; periorbital bruising; subq tumor nodules; bone pain with pancytopenia; opsoclonus/myoclonus; ""dancing eyes, dancing feet"""
Q350. Epiglottitis - History/PE
"A350. Sudden-onset high fever; dysphagia; drooling; muffled voice; soft stridor; cyanosis; ""sniffing dog"" position; ""tripod"" position; insist on sitting up in bed; untreated - life-threatening"
Q777. What Non-Hodgekin's Lymphoma presents as an abdominal mass and is associated with EBV?; what is seen on LN bx?; Chromosomal anomaly and gene?
"A777. Burkitt Lymphoma; LN Bx: ""Starry sky"" pattern; Chromosomes: t(8;14); Gene: c-myc"
Q786. Dx:; A child of 2 - 7 months; presents with Recurrent mixed Flexor-Extensor spasms lasting only a few seconds, but repeat more then 100 times in a row; Looks like multiple Startle or Moro response; Dx Test & Result?; Tx? (2 together)
"A786. Infantile spasms (""West syndrome""); Dx Test: EEG: HYPSARRTHYMIA; Tx:; 1. ACTH; 2. prednisone"
Q791. Dx:; Infant with spinal muscular atrophy, Fasciculations, frog-leg posture; Dx Test/results? (3); Tx?
"A791. Werdnig-Hoffman Disease (""Floppy-Baby"" syndrome); Dx Test:; 1. EMG: Fibrillations; 2. Muscle bx: denervation; 3. Nerve bx: slowed conduction; Tx: Supportive"
PE findings for varicocele
"Bag of worms" sensation
Major cardiac abnormality associated w/ an IDM
*Asymmetric septal hypertrophy* due to obliteration of the LV lumen
Presentation of cerebellar injury
*Ataxia* rather than simply an unsteady gait
Specific characteristics in the setting of bilious vomiting on the 1st day of life that point to a diagnosis of duodenal atresia
*Down syndrome-like characteristics* (oblique eye fissures, simian crease, congenital murmur)
Tetralogy of Fallot is characterized by
*Mnemonic*: PROVe - Pulmonary stenosis - Right ventricular hypertrophy - Overriding aorta - Ventricular Septal Defect (VSD)
Best treatment of duodenal atresia, volvulus, & intussussception
- *Duodenal atresia & volvulus*: surgery - *Intussussception*: air enema
Typical onset of duodenal atresia, volvulus, & intussussception
- *Duodenal atresia*: within 1st day - *Volvulus & intussussception*: within 1st year
Presentation of Tetralogy of Fallot
- *Holosystolic murmur* best heart at LLSB - Cyanosis of lips and extremities - Squatting after exertive actrivities
Treatment of Whooping cough
- *Isolation + erythromycin or azithromycin* (ineffective in Paroxysmal stage) - *Macrolides* for close contacts
APGAR scoring for Respiration
- 0: Absent - 1: Weak or irregular - 2: Strong
Signs of pathologic jaundice in the newborn
- Appears on the 1st day of life - Bilirubin ↑ > 5 mg/dL/day - Bilirubin ↑ > 19.5 mg/dL in a term child - Direct bilirubin ↑ > 2 mg/dL at any time - Hyperbilirubinemia persists after the 2nd week of life
What are the most common *wrong* answers for diagnostic testing of imperforate anus?
- Barium study - Rectal manometry
Presentation of Croup
- Barking cough - Coryza - Inspiratory stridor
Presentation of Vitamin B1 (thiamine) deficiency
- Beriberi - Wernicke's encephalopathy
Complications of volvulus
- Bowel necrosis w/ perforation - Life-threatening sepsis
Cyanotic heart defects in which a VSD is present
- Tetralogy of Fallot - Truncus arteriosus
Complication of overly aggressive surgical reintroduction of the bowel in gastroschisis
- Third spacing - Bowel infarction
With regards to the hearing test, why is early detection necessary?
- To maintain speech patterns - Assess the need for cochlear implantation
Treatment of Wilms tumor
- Total nephrectomy for unilateral - Partial nephrectomy for bilateral - Chemotherapy + radiation (based on staging)
Presentation of rickets
- Ulnar/radial bowing - Waddling gait due to tibial/femoral bowing (characteristic sign)
Antibiotics of choice in treatment of necrotizing enterocolitis
- Vancomycin - Gentamicin - Metronidazole
Presentation of non-inflammatory diarrhea
- Vomiting - Crampy abdominal pain - Watery diarrhea
Sodium Bicarbonate
1 mEq/kg per dose
Lidocaine
1 mg/kg
After the delivery, the paramedic should assign an apgar score at ______ minute(s) and ____ minute(s) to evaluate in the infant
1, 5
Normal urine output
1-2 ml/kg/hr
Fetal heart sounds can be auscultated beginning at _____ weeks of gestation
12
Normal newborn HR
120-160 BPM
How many different varietes of long QT syndrome are there?
13
Education, Environmental modification, Enforcement, Engineering.
4 E's of prevention
The current belief is that a blood glucose measurement less than ____ mg/dl in the infant indicates hypoglycemia
40
The period during which the fetus grows and develops within the uterus (gestation) averages ____ weeks from the time of fertilization to delivery of the newborn
40
A 5 year old, 44 lb child is in ventricular fibrillation. What is the correct initial energy level for defibrillation
40 joules
Normal newborn respiratory rate
40-60 BrPM
Q052. clinical features of HENOCH-SCHONLEIN PURPURA
A052. condition preceded by uri; non-thrombocytopenic palpable purpura; hematuria (good prognosis); proteinuria (poor prognosis); spasmodic abdominal pain; ileus, n/v; ugi/lgi bleed
Q053. tx of Henoch-Schonlein Purpura
A053. steroids
Q084. findings in classic hemophilia
A084. bleeding problems + hemarthrosis
Q134. Tx of CF
A134. chest physiotherapy; exercise; frequent cough; recombinant human dnase given through nebs to break down thick mucous complexes
Q136. mesenteric lymphadenitis leads to
A136. persistent pain after infection
Q196. when is it normal for there not to be tears
A196. in the first few weeks of life
Q197. age of onset of gonococcal ophthalmia neonatorum
A197. 2-4 days
Q198. age of onset of chlamydia ophthalmia neonatorum
A198. 4-10 days
Q199. clinical features of gonococcal ophthalmia neonatorum
A199. eyelid edema; chemosis; purulent d/c
Q200. complications of gonococcal ophthalmia neonatorum
A200. sepsis; meningitis; arthritis; corneal ulceration; blindness
Q234. clinical presentation of acute arsenic poisoning
A234. n/v/d, abdominal pain; 3rd spacing; hemorrhage; hypovolemic shock; Ventricular tachycardia; QT prolongation
Q235. narcosis
A235. deep stupor, unconsciousness
Q236. clinical presentation of cerebral palsy
A236. postural hypotonia; failure ot reach for toys; gross and fine motor delay; cognitive and sensory deficits
Q274. Patau's or Edwards syndrome; narrow forehead
A274. Edwards
Q275. Patau's or Edwards syndrome; microphthalmia
A275. Patau
Q276. Patau's or Edwards syndrome; cutis aplasia
A276. Patau
Q317. effect of propanolol in utero
A317. IUGR; decreased ability of asphyxiated newborn to increase heart rate and CO; associated with hypoglycemia and apnea
Q318. when is surgery for cleft lip done
A318. 3 mo
Q355. Croup (Laryngotracheobronchitis) - Dx
A355. Clinical; XR - steeple sign
Q389. Coarctation of the Aorta - Tx
A389. Surgery or balloon angioplasty; endocarditis prophylaxis
Q404. Febrile Seizures - History/PE
A404. Most are simple seizures; simple - high fever, fever onset within hrs of seizure; generalized seizure, lasts < 15 min., 1 in a 24-hr period; complex - low-grade fever, fever for several days before seizure onset, seizure has focal features, can have postictal paresis, lasts > 15 min., > 1 in a 24-hr period
Q406. Febrile Seizures - Tx
A406. Simple - aggressive antipyretics; tx underlying illness; complex - thorough neuro exam, chronic anticonvulsants may be necessary
Q407. Febrile Seizures - Complications
A407. Febrile Seizure will recur in 30%; no increased risk of epilepsy, developmental, intellectual or growth abnormality; those with complex seizures - 10% risk of developing epilepsy
Q417. Double Y males - What is it
A417. XYY; phenotypically normal; very tall; severe acne; antisocial behavior
Q605. presentation of transposition?
A605. blue baby with low sat, no change with 02 given, otherwise looks in no distress; egg on string (narrow mediastinum) chest x-ray...
"Q606. a typical, physiological ""flow"" murmur?"
A606. Still's murmur - heard at left lower sternal border
Q607. systolic murmur heard in ASD is really what?
A607. increased flow across pulmonic valve and tricuspid regurgitation
Q608. systole ejection murmur heard best at upper sternal border but radiating to axilla and back? vs carotids?
A608. axilla and back = peripheral pulmonic stenosis (due to flow past sharp angle of pa and its branches = resolves in 6 mo; carotids = aortic stenosis/bicuspid aortic valve
Q609. Most common congenital heart lesions?
A609. VSD
Q610. what's a positive PPD?
A610. 5mm if CLOSE CONTACTS w/known or suspected cases; 10mm if greater risk for disseminated disease ie <4y/o's, DM, CKD, malnourishment, lymphoma, or at greater risk of exposure to TB, ie born in, parents born in high prevalent regions, travel to these regions, exposure to adults at high risk, (ie HIV infected, homeless, drug abusers); 15mm in normal, age over 4 w/o any risk factors
Q611. What are the 5 portions of the APGAR score?
A611. Appearance; Pulse (HR); Grimace; Activity; Respirations
Q612. Dx:; A lump on the face after a foreceps delivery
A612. Subcutaneous Fat Necrosis
Q613. Dx:; rash that starts after the first day of life as a flat reddish area with a central papule that becomes a pustule and persists for a couple of weeks; Test?
A613. Erythema Toxicum; test: Wright stain of vesicular fluid will show Eosinophils
Q614. Dx;; Strawberry rash of newborn with difficulty breathing
A614. Epiglottic Hemangioma
Q615. Dx:; sharply demarcated bruise-like appearance on sacral area of newborn
A615. Mongolian spots; (do not confuse w/ Abuse, which is not sharply demarcated)
Q616. Dx:; orange/yellow warty lesion on the scalp in newborn that displaces hair growth; Tx?; what can it lead to?
A616. Nevus sebaceous; Tx: leave alone until Adolescence (should go away); leads to: 15% chance to become malignant
Q617. Dx:; scalp swelling that crosses suture lines and goes away in a few days
A617. Caput
Q618. Dx:; scalp swelling that does not cross suture lines and goes away in a couple of months; cause?
A618. Cephalohematoma; cause: Subperiosteal bleed
Q619. When do anterior fontanels normally open and close?; Posterior?
A619. Anterior: opens: birth; closes: 9 - 18 months; Posterior: opens: sometimes at birth; closes: 4 - 5 months
Q620. what is possible diagnosis if:; 1. both fontanels are enlarged?; 2. One fontanel only is enlarged?
A620. 1. Hydrocephalus; 2. Hypothyroidism
Q621. Newborn eye:; White reflex
A621. Retinoblastoma; (another source: MCC is Congenital Cataracts)
Q633. birthing injury where baby has hand extended and fingers flexed; what nerve roots?; another name for this injury?
A633. Klumpke; roots: C8-T1; another name: "claw hand"
Q634. What are the (3) 'diseases' tested for during a newborn screening?
A634. 1. PKU; 2. Galactosemia; 3. Hypothyroidism
Q635. Dx:; baby born with Mental retardation, Eczema, musty odor, fair hair, fair skin and blue eyes
A635. PKU
Q636. Dx:; baby born with Jaundice, Hypoglycemia, and Cataracts; genetic inheritance?; what is contraindicated in this baby?
A636. Galactosemia; (Autosomal Recessive); Contraindication: Breastfeeding
Q637. Dx:; Newborn with Jaundice, mottled, constipation, Large tongue, Umbilical hernia; what is seen on blood test?
A637. Hypothyroidism; blood test: high TSH, low T4
Q638. Dx:; pre-term baby with ground glass appearance on CXR; Tx? (2 in order)
A638. Respiratory Distress Syndrome Tx:; 1. Surfactant; 2. Ventilation
Q639. Dx:; baby delivered by C-section has a Rapid respiratory descent but after 72 hours of Tachypnea, then gets better; CXR shows possible fluid in the fissure
A639. Transient Tachypnea of newborn; (when delivered by C-section that do not get a vaginal squeeze and then don't expel amniotic fluid); patient does not need respiratory support; (a main way to differentiate)
Q640. What are the 3 differences b/t physiologic and pathologic jaundice?
A640. Physiologic:; 1. Appears >24 hours of age; 2. peaks at or below 12.9 by 3 days; 3. resolves by 1 week Pathologic:; 1. Within first day of life; 2. Level >13; 3. Lasts > 1 week
Q641. MC type of pathologic Jaundice?; Tx?
A641. Hemolysis (Rh or ABO incompatibility); Tx: Phototherapy
Q642. Dx:; newborn with Jaundice within 8 hours of birth, a Direct bilirubin increase; Acholic (or clay-colored) stools
A642. Biliary Atresia
Q643. Aside from certain meds, what are the (6)* main contraindications of offering newborn breast milk?
A643. "A Healthy Toddler Gladly Sucks Vitamins":; AIDS;; Herpes if breast lesions;; TB (active, untreated);; Galactosemia;; Syphilis;; Varicella
Q644. How many calories are in baby formula?; When can Whole milk be started?; When should Iron supplementation begin?
A644. Formula: 20 cal/oz; whole milk: > 1 year-old; Iron: > 6 months old
Q645. What test can be done in newborn to test for Turner's syndrome?
A645. Buccal smear; (to test for Barr Bodies)
Q646. definition:; child is short but expect a growth spurt at a later age
A646. Constitutional Delay
Q647. MCC for childhood obesity?
A647. take in too many calories and don't burn enough off; (don't be tricked and look for a pathologic cause)
Q648. when do most reflexes disappear?; which (2) don't at this time?; what time do they disappear?
A648. reflexes disappear: 4 - 6 months; except: Babinski: until 18 months; Parachute: never
Q649. Rule for Cube stacking in child; (give 3 milestones)
A649. 3 cubes at 15 months; 4 cubes at 18 months; 7 cubes at 24 months
Q650. MCC for Enuresis; First Tx?
A650. Primary Nocturnal (usually a male child that is just a deep sleeper); Tx:; 1. Give it Time; 2. Alarms; 3. Meds (Imipramine; DDAVP)
Q651. In the severely immunocompromised, what vaccination do you not give?
A651. MMR
Q652. what 3 vaccinations are contraindicated with an allergy to neomycin?
A652. 1. IPV; 2. MMR; 3. Varicella
Q653. which vaccination do you give:; child > 2 yo who has not been vaccinated if they have immunodeficiency of any kind, are asplenic or lack splenic function (sickle cell)
A653. Pneumococcus spp.
Q654. which vaccination is contraindicated in patient who has streptomycin allergy?
A654. IPV; (also CI if they have neomycin allergy)
Q655. what 2 additional vaccinations are required specifically if patient is asplenic?
A655. 1. Meningococcal; 2. Pneumococcus spp.
Q656. MCC of Meningitis in:; Neonate
A656. Group B Strep; (from mother)
Q657. MCC of Meningitis in:; Patient > 2 months old
A657. Pneumococcus
Q658. MCC of Meningitis in:; College or Military; (sexually active)
A658. N. Meningococcus
Q660. MCC of Meningitis in:; Elderly, HIV+, steroid user; (immunocompromised)
A660. Listeria
Q667. Bug causing septic arthritis from a dog or cat bite?
A667. Pasturella
Q668. Pediatric patient without immunization history has coughing spasms, inspiratory whoop, facial petechiae and leucocytosis with lymphocytosis. (2) possible confirmatory tests; Tx?
A668. Pertussis; tests:; 1. Positive cultured Nasopharyngeal washings; 2. Rapid Fluorescent antibody stain; Tx: Erythromycin
Q669. What can Fifth's disease lead to?; what can it cause in unborn child if mother has it?
A669. leads to: Aplastic Anemia; in unborn child: Hydrops
Q670. Dx:; three-day rash and lymphadenopathy
A670. Rubella
Q671. what 2 test should be run if suspecting acetaminophen toxicity?
A671. 1. Acetaminophen level in blood; 2. LFTs
Q672. A child swallowed a bottle with no lable and has Sx of:; Hypernea/Tachypnea, Fever, N/V, Dehydration, Seizures, agitation, tinnitus; Fastest diagnostic test?
A672. Aspirin toxicity; fastest test: Urine Ferric Chloride Test
Q673. what acid/base problems does Aspirin toxicity cause in a child?
A673. Respiratory Alkalosis w/ Metabolic Acidosis; (high pH, low pCO2 and bicarb); Tx: Charcoal
Q674. A child swallowed a bottle with no lable and has Sx of:; Tachycardia, HTN to Hypotension, confusion, drowsiness, dilated pupils, Seizures, Widened QRS; Ventricular arrhythmia; Tx? (2)
A674. Tricyclic Antidepressant toxicity; Antidote/Tx:; (1) Gastric Lavage/Charcoal; (2) Sodium Bicarbonate (to alkalinize blood for arrhythmias)
Q675. What is the first test if you suspect a TCA toxicity?
A675. ECG; (will show Widened QRS, Ventricular arrhythmia)
Q676. A child presents with swallowing kerosene. What is the primary objective?; What are the first (2) tests?; What are (2) Tx?
A676. objective: Prevent Aspiration resulting in Chemical Pneumonitis; tests:; 1. CXR; 2. Blood Gas; Tx:; 1. Prevent aspiration; 2. avoid gastric lavage
Q677. a child swallows something from an unlabled bottle:; diarrhea, excessive urination, miosis, bradycardia; Test?; Tx?
A677. Organophosphate (insecticide) toxicity; test: Plasma Cholinesterase activity; Tx: Atropine w/ Pralidoxime chloride
Q678. a child swallows an unlabled bottle of pills:; drowsey, delirius, hallucinate, N/V, DRY state, dilated pupils; Test?; Tx?
A678. Antihistamines; Test: Drug screen; Tx: Physostigmine (if severe)
Q679. a child swallows an unlabled bottle of pills:; signs of hemorrhagic gastroenteritis (bloody diarrhea), N/V, diarrhea, acute liver failure, shock, coma; Test?; Tx?
A679. Iron pill overdose; test: Serum Iron level; Tx: Deferoxamine
Q680. MCC of conjunctivitis in newborn (less then 24 hours-old)
A680. Chemical; (from Silver Nitrate drops)
Q681. MCC of infectious conjunctivitis in newborn
A681. Chlamydia
Q682. Medical term:; Conjunctivitis within the first month of life
A682. Ophthalmia Neonatorum
Q683. Difference in presentation b/t viral vs. bacterial conjunctivitis
A683. Viral: Crusting of eyelid; Clear discharge; Bacterial: Mucopurulent discharge
Q684. At what age is strabismus still normal?; What can it lead to if it is prolonged?
A684. Normal: up to 4 months old; leads to: Amblydopia
"Q685. Dx:; 2 yo child has a ""lazy eye""; Dx tests? (2); Tx?"
A685. Amblydopia; tests:; 1. Hirschberg test (shine light directly into eye and look to see if it falls at an angle); 2. Cover test (cover good eye and lazy eye will move straight ahead); Tx: Patch good eye (causes patient to use lazy eye; must be done early in life)
Q686. Child presents with a painful buldging eye; eyeball does not move when testing muscles; Dx test?; Tx? (2 possible)
A686. Orbital Cellulitis; Dx test: CT Scan; Tx:; 1. Cefuroxime with Clindamycin, or; 2. Ampicillin/Sulbactam
Q687. Child presents with swelling of eyelids and surrounding tissue; eye moves when checking ROM
A687. Preorbital cellulitis
Q688. Tx for a large Retinoblastic tumor of the eye
A688. Enucleation
Q689. Definition:; Otitis Media w/ Osteomyelitis of the bony canal or mastoid; Bug?; what Disease is it associated with?
A689. Malignant Otitis Media; bug: Pseudomonas; Assoc Disease: Diabetes
Q709. Dx:; CHF early in life including a feeding difficulty, sweat while feeding and tachypnea; loud harsh pansystolic murmur heard in the Lower left sternal boarder; What is it Associated with?
A709. Endocardial cushion defect; (Subclass of VSD and ASD; also known as "Common AV canal"); Assoc w: Down's Syndrome
Q710. Dx:; Weak/delayed/absent lower extremity pulses, HTN; What is seen on CXR?; What Disease is it assoc with?
A710. Coarctation of the Aorta; CXR: Rib notching; Disease: Turner's Syndrome
Q712. Dx:; Cyanosis; Single second heart sound; Murmur Heard in Upper left sternal border; What is seen on CXR?
A712. Tetralogy of Fallot; CXR: Boot-shaped heart
Q714. Dx:; CHF w/i weeks of birth; Systolic Ejection murmur in the Left sternal border; Single S2; Wide Pulse Pressure; bounding arterial pulses; What Disease is it assoc with?
A714. Truncus Arteriosus (Single arterial vessel arising from the base of the heart that goes to the coronary, systemic AND pulmonary circulation); Assoc with: DiGeorge Syndrome (22q11 microdeletion)
Q715. Dx:; single S2 pansystolic murmur with a CXR showing a Heart that looks like Snowman or Figure 8
A715. Total Anomalous Pulmonary Venous Return; (TAPVR)
Q716. Dx:; Loud, palpable S2 without murmur; Common cause of heart failure in first week of life. What can Patient develop?
A716. Hypoplastic Left Heart; (Underdevelopment of left cardiac chambers, atresia or stenosis of aortic and/or mitral orifices, and hypoplasia of the aorta); Patient develops Metabolic Acidosis
Q717. What are the (5) parts of the Major criteria for Rheumatic Fever?; What is Ailment is it assoc with?
A717. Major (JONES) Criteria: (2 of these = Rheumatic fever); J = Joints; O = carditis (O looks like a heart); N = Nodules (subcutaneous); E = Erythema marginatum; S = Sydenham's chorea; Association with: Strep throat (GAS)
Q718. MCC of HTN in infants or children?
A718. Renal disease
Q719. MCC of Diarrhea in children
A719. Rotavirus
Q729. MCC of GI blood from neonate?; Dx Test?
A729. Anal Fissure; Dx test: Apt test (to confirm Dx: tells if fetal Hb versus mother Hb)
Q730. If a neonate has a positive Apt test, what is the cause of the GI blood?
A730. Swallowing maternal blood
Q731. Dx:; Premature infant with Low Apgar and when fed the baby has bloody stools and abdominal distention; What is seen on Abdominal x-ray?
A731. Necrotizing Enterocolitis; Abd x-ray: Pneumatosis intestinalis (Air in bowel wall)
Q733. Dx:; Painless rectal bleed in 2 yo that can cause intussusception; Dx test?
A733. Meckel's diverticulum; (disease of 2's: 2% of population, 2:1 males, 2 years of age, 2 types of tissue, 2 feet from ileocecal valve, 2 cm in size); Dx Test: Technetium scan (Lights-up gastric tissue)
Q734. Dx:; Hematuria, Edema, Hypertension, Azotemia and Oligouria; What infection does it follow?; Dx Test? (2 plus results)
A734. Acute Glomerulonephritis; follows: Group A Strep infection; Dx Test:; 1. Urine: Red cell Casts; 2. Blood: C3 decreased
Q735. Dx:; Renal failure in child with hearing loss and possible cataracts; Genetics?
A735. Alport's Syndrome; (Mutation coding type IV collagen; Problem in basement membrane); genetics: X-linked Dominant
Q736. Dx:; Periorbital Edema / Ascites, High Proteinuria, Hypoalbuminemia, Hyperlipidemia
A736. Nephrotic Syndrome; (MCC in children: Minimal Change Disease)
Q744. Dx:; child who has painful bones that wake him from sleep but are relieved by aspirin
A744. Osteoid Osteoma
Q751. Patient develops anaphylaxis after IgG exposure. What is the first possibility?
A751. IgA Deficiency; (MC primary immunodeficiency)
Q752. Dx:; recurrent respiratory, GU and GI infections; IgG subclass 2 and IgA are low; eveything else is normal
A752. IgA Deficiency
Q753. What is the deficiency in most cases of Severe Combined Immunodeficiency (SCID)?; The incidence of what cancer is greater in this patient?
A753. Adenosine Deaminase deficiency; cancer: Lymphoma
Q754. Dx:; a patient has a specific component of the complement system that is low and continues to get Neisseria infections.
A754. Complement deficiency in any complement from C5 - C9
Q755. What type of juvenile RA occurs in a few large joints (like knee, hip shoulder)?
A755. Pauciarticular JRA
Q756. What is positive and what sex is predominant in JRA pauciarticular arthritis type 1 versus type 2?
A756. Type 1: ANA+, Females; Type 2: HLA B27+, Males
Q760. Another name for Kawasaki disease?
A760. Mucocutaneous LN syndrome
Q771. What (2) coagulopathies present with:; Normal PT,; High PTT,; Normal Bleeding time; What medication also presents this way?; What else in blood work differentiates it?
A771. Coags:; Hemophilia A and Hemophilia B (X-linked recessive); Med: Heparin; Difference: Thrombocytopenia
Q772. What coagulopathy presents with:; High PT,; High PTT,; High Bleeding Time
A772. DIC; (will also see low platelet count)
Q773. What coagulopathy presents with:; Normal PT,; High PTT,; High Bleeding time
A773. vonWillebrand's Disease; (Autosomal dominant)
Q774. What coagulopathy presents with:; High PT,; Normal PTT,; Normal Bleeding Time
A774. Warfarin toxicity
Q775. Dx:; a boy presents with a high PTT and Hemarthrosis; Tx?
A775. Hemophilia A; Tx: replace Factor VIII
Q776. Dx:; A 3 - 5 yo child w/ an acute onset of Anorexia, pallor, fever, bone pain in 1/4 of patients, Pancytopenia. Dx Test?; Tx? (3); MC places for Relapse? (2)
A776. Acute Lymphocytic Leukemia (MC childhood cancer); Dx test: Bone Marrow biopsy; Tx:; 1. Chemotherapy,; 2. Radiation,; 3. Transplant; Relapse:; 1. TESTES; 2. CNS
Q778. Dx:; Persistant cervical lymphadenopathy, night sweats, otherwise normal adolescent; Dx test?
A778. Hodgkin Lymphoma; Dx test: LN biopsy (Reed-Sternberg cells)
Q779. How is a Neuroblastoma and Wilms Tumor distinguished by CT scan?
A779. Neuroblastoma:; 1. on Adrenal gland; 2. Calcifications seen; Wilm's Tumor:; 1. in Kidney; 2. no calcifications
Q780. Dx:; child with morning Headache, vomiting (causing HA to go away); Ataxia, nystagmus, head-tilt, intention tremor; Specific site?
A780. Cerebellar Astrocytoma (MC childhood brain tumor); site: Infratentorial (posterior fossa)
Q781. Dx:; Child with short stature, Bitemporal hemianopsia and endocrine abnormalities; Dx test?; What can occur post-op?
A781. Craniopharyngioma(Supratentorial); Dx test: X-ray of skull: Large Cella Tursica; Post-op: Diabetes Insipidus
Q782. Dx:; A 3 - 5yo child presents with obstructive hydrocephalus, ataxia and CSF metastasis; Specific site?
A782. Medulloblastoma; site: Infratentorial
Q783. Dx:; Child stares into space in middle of sentence, then 20 seconds later he resumes his sentence; Dx test results?; Tx?
A783. Absence seizure; Dx test: EEG showing 3-Hz Spike and Wave pattern; Tx: Ethosuximide
Q784. MC type of seizure in pediatrics; Tx?
A784. Febrile Seizure; Tx: Acetaminophen (for fever) (check for underlying cause of seizure)
Q785. Dx test for Neonatal seizures; Tx?
A785. test: Continuous Bedside EEG; Tx: Phenobarbital
Q787. Difference in presentation with Niemann-Pick Disease and Tay-Sachs Disease?
A787. Both have Cherry-red spot on Macula; NP: Hepatosplenomegaly; TS: No hepatosplenomegaly
Q788. Dx:; child who constantly clears his throat
A788. Tourette's syndrome
Q789. Dx:; MENTAL RETARDATION, spasticity, aggressive behavior, self-mutilation, Gout arthritis
A789. Lesch-Nyhan
Q790. What are the (2) disorders where infants have Hypotonia or Flaccidity?
A790. 1. Werding-Hoffmann Disease; 2. Infant Botulism
Q792. Dx:; A child presents following a viral illness with Ascending weakness, Paralysis, Loss DTR, may progress to affect Diaphragm (breathing); Tx? (3 possible)
A792. Guillain-Barré; Tx:; (1) Supportive (intubation may be needed); (2) Plasmapheresis; (3) IVIG
Q793. Dx:; A boy 3 - 7 yo with Muscle and Hip girdle weakness and pseudohypertrophy of the calves; Genetics?; Dx Test?; Confirmatory test?
A793. Duchenne muscular dystrophy (MC inherited neuromuscular disease); genetics: X-linked recessive (only boys get it); Dx test: Blood shows greatly elevated Creatine Kinase; Confirmatory test: Muscle Bx
Q794. Name the sign:; a patient w/ DMD is walking their hands up their legs to sit/stand properly
A794. Gower's sign
Q795. Dx:; Café-au-lait spots, axillary/inguinal freckling, Learning disorders, Renovascular HTN, Scoliosis, Lisch nodules (seen on slit lamp); Genetics?; what chromosome has the problem?
A795. Neurofibromatosis (von Recklinghausen); genetics: Autosomal Dominant, chromosome: 17; (Type 2 - Bilateral Acoustic neuromas is chrom: 22)
Q796. Dx:; A child presents with pale hypopigmented areas, facial sebaceous adenomas, areas of abnormal skin thickening, MENTAL RETARDATION and Seizures are common; Genetics?; Dx Test/results?
A796. Tuberous Sclerosis; genetics: Autosomal Dominant; (Ash leaf spot - pale hypopigmented area); (Shagreen patch - areas of abnormal skin thickening); Dx Test: CT scan of Head: periventricular calcified tubers
Q797. Dx:; Facial nevus (port wine stain) with trigeminal distribution, MENTAL RETARDATION, seizures difficult to control, visual impairment; Dx Test/results?
A797. Sturge-Weber Disease; Dx Test: CT Scan of Head: intracranial calcifications
Q798. First sign of Puberty in:; 1. Females; 2. Males
A798. Females: Breast buds; Males: Testicular enlargement
Q799. What is the cause of Hypoglycemia in a newborn from a mother with DM?
A799. Fetal Hyperinsulinemia
Q800. What is the highest risk for a child to be born with developmental displasia of the hip?; What is the confirmatory test for DDH?
A800. Female Breech birth; test: Ultrasound of hip
Q801. Why does a mother with type O blood cause hemolysis in newborn if the child has type A or B?
A801. Type O people have Antibodies to blood types A and B
Q802. When should a child have their electrolytes checked if you suspect dehydration?
A802. Moderate or Severe dehydration; (not Mild dehydration)
Q803. Tx for Mild, Moderate and Severe Dehydration in children?
A803. Mild: Oral rehydration; Moderate/Severe: IV rehydration
Q804. What is considered Moderate dehydration percentage-wise?; Severe?
A804. moderate: 5-10% dehydrated; severe: > 10% dehydrated
Q805. Dx:; Baby is tired when feeding, diaphoretic and breathing strangely
A805. CHF in newborn; (tired when feeding is #1 sign)
Q806. what are the (2) criteria for a Dx of failure to Thrive in a newborn?
A806. 1. failure to regain birth weight by 3 weeks of age; 2. continuous weight loss after 10 days of life
Q807. when a child has a decrease in respirations, what does it suggest?; increase in respirations?
A807. Dec: CNS depression; Inc: Infection
Q808. What are the (5) Tanner stages for Pubic hair?
A808. 1. None; 2. Scant, Fine hair; 3. Curly, extending laterally; 4. Adult-like hair, NOT on medial thigh; 5. Adult hair on medial thigh
Q814. What is the MC malignant tumor in infancy?
A814. Neuroblastoma
Q828. Pediatrics are usually started on 3 insulin injections per day. What is the dosing pattern?
A828. 1. 2/3 of total dose in morning (1/3 rapid or short-acting, 2/3 intermediate-acting); 2. 1/6 of total at dinner (as rapid or short-acting); 3. 1/6 of total before bed (as intermediate-acting)
Q829. A child has a seizure following the immunization. What is the cause?; What is done on the next immunization?
A829. Pertussis; Do NOT ever give that immunization again!
Q830. When a child is bit by a snake, how do you determine the venom dose?
A830. Based on the childs symptoms; (amount of envenomization)
Q831. Dx:; A 6-month-old infant presents to the emergency department with the new onset of weak cry, decreased activity, and poor feeding. The mother also states that the infant has been constipated for the past 2 days. On physical examination, the infant has a very weak cry, poor muscle tone, and absent deep tendon reflexes. Tx?
A831. Botulism; Tx: Supportive care (Airway PRN)
Q832. Dx:; A 16-year-old boy presents with a temperature of 38.4 C (101 F) and low back, wrist, and knee pain. He had a sore throat 1 month earlier. His arthritis is diffuse. Pea-sized swellings are noted over the skin on his knees. He has a serpiginous erythematous area on his anterior trunk. His blood and throat cultures are negative, and his CBC is unremarkable. His antistreptolysin-O (ASO) titer is high. Tx? (2 together)
A832. Rheumatic Fever; Tx:; 1. Penicillin; 2. Aspirin
"Q838. Dx:; A 9-month-old girl has had one serious infection after another since about 3 months of age, including thrush, pneumonias, and diarrhea. The baby is small for age. An older brother died at age 2 of pneumonia. Immunologic evaluation demonstrates lymphopenia and very low gamma globulin levels. Both T and B cell numbers are very low. Radiologic studies demonstrate ""frayed"" long bones, abnormally thick growth arrest lines, and dysplasia of the costochondral junctions"
A838. Severe Combined Immunodeficiency (SCID); (an Adenosine deaminase deficiency)
"Q839. Dx:; A 17-year-old girl presents to the office with a 5-day history of a malodorous vaginal discharge. She is sexually active and uses condoms for sexual intercourse. On examination, a thin, white discharge is seen. A ""fishy"" odor is produced when KOH is added to the discharge. The vaginal fluid has a pH of 5. What is the most likely finding on a microscopic examination of the vaginal fluid?"
A839. Bacterial Vaginosis; micro: Clue Cells
Q840. A 7-yo patient presents with Lyme disease. Tx?
A840. oral Amoxicillin; (doxycycline is not given to kids under age 8)
Q841. In a patient diagnosed with vesicoureteral reflux, what is the first Dx step?; What is the Dx/confirmatory Test (2nd step)?
A841. first: Renal Ultrasound; Dx/confirm Test:; Voiding Cystourethrogram
Q842. Dx:; a 12-yo girl presents with a fever and skin rash of 2 days duration. She complained of a sore throat and mild neck pain several days ago. The PE shows lymphadenopathy of the posterior occipital, retroauricular and cervical LN, plus an erythematous macules on the soft palate and a rash on the face, chest and proximal extremities.
A842. Rubella
Q843. Tx for Candida-induced oral thrush?
A843. Nystatin therapy
"Q844. A child presents with ""cat-scratch Disease.""; what is the bug?; what is the Dx/confirmatory test?"
A844. Bartonella henselae; test: Serum antibody titers
Q845. what is the bone complication of NF-1?
A845. Thinning of the Long Bone Cortex
Q846. what is the difference in RDW levels b/t thalassemia and Iron-deficiency anemia?
A846. RDW:; normal in Thalassemia; High in Iron-deficiency anemia
Q855. Dx:; a child with strep pharyngitis is given penicillin. The next day he develops a fine, papular rash over his body, which is accentuated in his axilla and groin.
A855. Scarlet Fever; (a rash from the penicillin would be urticarial in nature)
Q856. What are the (11)* criteria (of which 4 or more need to be present) to diagnose SLE?
A856. SOAP BRAIN MD:; 1. Serositis (pleuritis/pericarditis); 2. Oral ulcers; 3. Arthritis; 4. Photosensitivity; 5. Blood (any can be low); 6. Renal problems; 7. ANA+; 8. Immunological (ds-DNA+); 9. Nero Sx (psych, seizures); 10. Malar Rash; 11. Discoid Rash
Q857. what is seen in the serum of someone with a pneumonia caused by Mycoplasma?
A857. Cold Agglutinins
Q858. A 13-yo girl presents with lethargy, fever, severe HA and a stiff neck. On exam she has a unilateral fixed, dilated pupil and papilledema. What is the initial step in management?
A858. Intubation and Hyperventilation
Q859. what is antibiotic used for the initial therapy of acute sinusitis?
A859. Amoxicillin-clavulanic acid
Q860. In a child, if the monospot test comes back negative and you think the Dx is Mono, what is the next step?
A860. EBV titer; (heterophil test has a poor response in children)
Q861. How does a child with Breast milk Jaundice present?
A861. Prolonged unconjugated hyperbilirubinemia in first weeks/months of life
Q862. A 4-yo child presents with a platelet count of 30K and you diagnose her with ITP. what is the most appropriate Tx at this time?
A862. No specific therapy; (when platelets go below 20K start on oral prednisone; a splenectomy is done for those with no response to prenisone or those with recurrent ITP)
Q863. Dx:; A 12-yo athelete presents with chest pain and dyspnea on exertion that resolves with rest. First step in Tx?
A863. Asthma (exercise-induced); (<5% of kids have heart problems, aside from congenital anomalies); Tx: Trial of Albuterol inhaler
Q871. A 3000g female is born at 38 weeks to a mother that is positive for GBS. What is the next step in managing the baby?
A871. CBC and blood culture; (in addition to 48 hours of observation in the hospital)
Q872. An infant is crawling around on the floor at home and suddenly become cyanotic. what is the first step?
A872. Back blows followed by chest thrusts; (never perform a blind finger sweep in a child, b/c it can push the aspirated object further)
Q873. why does a CF patient present with Metabolic Alkalosis?
A873. Potassium is lost in urine
Q874. MC presentation of Strep throat?; (4)*
A874. FEAT:; 1. Fever; 2. Exudate on Tonsils; 3. Anterior Cervical lymphadenopathy; 4. Throat pain
Q875. A full-term newborn is born vaginally after a pregnancy complicated by gestational diabetes that was poorly controlled. He is born with scleral icterus. Three hours after birth the baby is plethoric, irritable and cyanotic. Six hours after birth he has a seizure. What hematological abnormality is most likely seen on his CBC?
A875. Polycythemia; (a known complication in the infant of a diabetic mother)
Q876. Dx:; A previously healthy 3-mo term boy presents to ED with tachypnea, poor feeding and pallor for 24 hours. He is tachycardic with a HR of 240 with narrow QRS complexes. Vagal maneuvers are attempted and unsuccessful. What drug should be given?
A876. Supraventricular Tachycardia (SVT); drug: Adenosine (blocks AV conduction and SA-node pacemaker activity; DOC for SVT; if unavailable, can Cardiovert)
Q877. What is the most important risk factor for a PE in children?
A877. Central Venous catheter; (followed by immobility)
Q878. What hormone is responsible for growth plate fusion?
A878. Estradiol
Q879. Dx:; A patient presents with mild MENTAL RETARDATION, prominent lips and a long philtrum, a systolic ejection murmur and hypercalcemia.
A879. Williams syndrome
Q881. What is the MCC of retinopathy in a premie?
A881. Too much Oxygen saturation; (should be <95%)
Q882. What occurs if you correct the following problems too fast?; 1. DI; 2. DKA; 3. SIADH
A882. 1. DI -> Seizures; 2. DKA -> Cerebral edema -> Herniation; 3. SIADH -> CPM
Q883. What additional (3) things are needed in formula for premature infants?
A883. 1. Extra Calories (22kcal/oz); 2. Extra Calcium; 3. Extra Phosphorus
Q884. What is a normal systolic BP in the following ages of children?; 1. Premie; 2. up to 1mo; 3. 1mo - 1yo; 4. > 1yo
A884. 1. Premie = meanBP > gestational age at birth; 2. up to 1mo = >60; 3. 1mo - 1yo = >70; 4. > 1yo = 70 + (2 x age)
"Q885. Diarrhea that is caused by ""chitlins"" at a picnic"
A885. Vibrio
Q886. Dx:; Patient presents with absent LN, tonsils, lymphopenia, no thymus, recurrent infections of oral candida, diarrhea, pulmonary infections and viral infections
A886. SCID; (Severe Combined Immunodeficiency Disease)
Q887. MC heart defect in congenital Rubella
A887. PDA
"Q888. Dx:; An infant presents with noisy breathing and on laryngoscopy the epiglottis is seen ""rolling from side-to-side""; Tx?"
A888. Laryngomalacia; Tx: hold infant upright for 30 minutes after feeding; (most disappear by 2 yo)
Q889. What type of Pneumonia is seen in Hyper-IgM syndrome?
A889. PCP
"Q891. Dx:; a child presents with a slowly developing back pain and neuro degeneration with a ""step-off"" palpated at lumbosacral area"
A891. Spondylolisthesis
Q892. Dx:; an infant presents with Cyanosis, Left Axis Deviation and VSD; what does EKG show?
A892. Tricuspid Atresia; EKG: LVH (and hypoplastic RV)
Q893. Dx:; a cyanotic newborn with a CXR showing cardiomegaly, increased vascular markings and right aortic arch. what does the EKG show?
A893. Truncus Arteriosus; EKG: Biventricular Hypertrophy
Q894. what are the (4)* main features of Beckwith-Wiedmann syndrome?
A894. HOMO:; 1. Hypoglycemia & Hyperinsulinemia; 2. Omphalocele; 3. Macroglossia & Macrosomia; 4. Organomegaly
Q895. If a child presents with asthma and other allergic disorders (allergic rhinitis or eczema), what is the best long term medication?
A895. Mast Cell Stabilizers; (inhaled Cromolyn)
Q896. Dx;; A 12-mo with foul-smelling, non-bloody stool 7-8 times/day, irritable, pre-tibial edema, erythematous vesicles on extensor surfaces of elbows and knees and microcytic anemia
A896. Celiac Disease; (begins at age 12 - 15 mo)
Q897. MCC of Meningitis in following ages:; 1. Newborn; 2. 1-mo to 2-yo; 3. 2-yo to 18-yo; 4. > 18-yo
A897. 1. Newborn = GBS; 2. 1-mo to 2-yo = S. Pneumonia; 3. 2-yo to 18-yo = N. Meningitis; 4. > 18-yo = S. Pneumonia
Q898. Dx:; a few days after birth a mother realizes that her child cannot move his hand on the right side and also has right lid ptosis
A898. Klumpke Paralysis; (birth injury to CN-7,8 and T1)
Q899. What reflex is affected by a child born with E-D palsy?
A899. Moro relex is absent
Q900. What is the test of choice in evaluating a child for Hyperlipidemia?
A900. Screening Total Cholesterol level; (not Fasting Lipid Profile)
Q901. What are the nodular swellings of the irises in NF-1 patients?
A901. Hammartomas
Q902. When does Physiologic Jaundice begin?; Breast milk Jaundice?
A902. Physiologic Jaundice: starts 2nd or 3rd day of life; (resolves in several weeks); Breast milk Jaundice: starts after 1 week-old
Q903. If an infant presents with a fever and no other Sx, what is the best first test?
A903. Catheterized UA with culture
"Q971. Dx:; ""sea-blue"" histiocytes"
A971. Niemann-Pick
Best initial test for duodenal atresia
AXR
What does obstruction refer to in the setting of Total anomalous pulmonary venous return?
Angle at which the veins enter the sinus
Most valuable clue in the diagnosis of Wilms tumor
Aniridia
How do you do the Ortolani maneuver?
Anterior force through greater trochanter + hip abduction
What is the next best step in the management of: a 3-day-old preterm female neonate w/ ↑ gastric residual volume, abdominal distention, heme positive stool, lactate 2.9 mg/dL, AXR showing air in bowel wall?
Antibiotics (when evidence confirms necrotizing enterocolitis)
Color of light used for phototherapy
Blue-green
Subperiosteal hemorrhage that *does not* cross suture lines
Cephalohematoma
What happens to the vast majority of ASDs?
Close spontaneously
What are some causes of abnormal appearance in a pediatric patient who has suffered a traumatic event?
Closed head injury, hypoxia, and pain
Congenital narrowing of the aorta in the area of the ductus arteriosus
Coarctation of the aorta
Most likely diagnosis w/ *"3"-like appearance or rib notching* cardiac x-ray findings
Coarctation of the aorta
What findings are diagnostic for imperforate anus?
Complete failure to pass meconium w/ no anus on PE
Congenital hypothyroidism can result in?
Cretinism
The narrowest part of a young child's airway
Cricoid Ring
Absence of one testicle in the scrotum
Cryptorchidism
There is a decreased incidence of Whooping cough in what population?
DTaP vaccine recipients
Reasoning for NG tube placement in duodenal atresia
Decompress bowel
Features of Convalescent stage of Whooping cough
Decrease of frequency of coughing
Rationale for administering racemic epinephrine in patient w/ RSV
Decrease swelling to prevent asphyxiation & tracheostomy
An early sign of shock.
Decreased skin perfusion
Abdominal x-ray findings associated w/ duodenal atresia
Double bubble sign
Ultrasound findings in a patient w/ intussussception
Doughnut/target sign
Definitive diagnosis of TAPVR w/ obstruction is made by?
Echocardiography
How is diagnosis of TAPVR without obstruction made?
Echocardiography
Less invasive, effective diagnostic test for ASD
Echocardiography
What can a Meckel's diverticulum contain?
Ectopic gastric tissue
Esophagus that ends blindly
Esophageal atresia
Third trimester bleeding occurs in 4% of all pregnancies and is considered normal
False
Meconium staining is a sign of
Fetal defecation
90% of normal infants pass their first meconium within?
First 24 hours
What causes the normalization of hemoglobin in transient polycythemia of the newborn?
First breath increases O2 → ↓ erythropoeitin
When do symptoms of Truncus arteriosus typically present?
First few days of life
What does the Pediatric Assessment Triangle help you with when assessing a pediatric patient?
First impression
Physical features associated w/ oligohydramnios
Flat facies
Stool study findings for necrotizing enterocolitis
Frank or occult blood
Brain tissue decrease. CSF decrease. Blood volume decrease.
How will the brain compensate for increased ICP?
Painless, swollen fluid-filled sac along the spermatic cords within the scrotum that transilluminates upon inspection
Hydrocele
Mechanism behind acidosis seen w/ CAH
Hydrogen ion retention
Your 7 year old patient is lethargic and has a blood pressure of 70/50 mm Hg and a pulse of 138 beats/min. Respirations are 40 breaths/min, and his breath smells fruity. His mother says he has been losing weight and has had increased urination and thirst for several weeks. What condition should be considered
Hyperglycemia
Are 11β-hydroxylase deficiency patients hyper- or hypotensive?
Hypertensive
Metabolic imbalance worsened by aldosterone released in response to hypovolemia associated w/ pyloric stenosis
Hypokalemia
Opening of the urethra found on the ventral surface of the penis
Hypospadias
A late/ominous sign of shock. A pedi PT maybe in shock at normotensive.
Hypotension
Are 21-hydroxylase deficiency patients hyper- or hypotensive?
Hypotensive (salt-wasting shock)
Most common presentation of CAH
Hypotensive child w/ severe electrolyte abnormalities
95 degrees or less
Hypothermia is a body temp of...
Volume status associated w/ pyloric stenosis
Hypovolemia
Pathophysiology of transient polycythemia of the newborn
Hypoxia during delivery stimulates erythropoeitin → ↑ circulating RBCs
Abnormal interictal pattern, consisting of high amplitude and irregular waves and spikes in a background of chaotic and disorganized activity seen on electroencephalogram (EEG)
Hypsarrhythmia
Best first step in management of duodenal atresia, volvulus, & intussussception
IV fluids
Most appropriate next step in management of severe dehydration
IV fluids + electrolytes
What is the most appropriate next step in management of: an 11-month-old girl, in the ED for severe diarrhea, fever of 103°F, lethargy/listlessness/drowsy, not eating, several episodes of diarrhea, last episode was bloody w/ mucus, skin tenting, marked leukocytosis, ↑ BUN & creatinine, ↓ HCO3-, ↑ hematocrit?
IV fluids + electrolytes
What must you differentiate a hydrocele from?
Inguinal hernia
How is Legg-Calvé-Perthes disease diagnosed?
Joint effusion & widening on XRs
Electrolyte often low from vomiting in patients w/ duodenal atresia
K+
Condition associated w/ infertility & situs inversus
Kartagener syndrome
Most serious complication of pathologic jaundice in the newborn where deposition of bilirubin in the basal ganglia occurs
Kernicterus
Cause of vitamin D-*deficient* rickets
Lack of enough vitamin D in child's diet
What does full thickness biopsy of a patient w/ Hirschsprung disease show?
Lack of ganglionic cells in the submucosa (Auerbach plexus)
MVAs
Leading cause of traumatic pediatric death.
When treating a child, it is important to gain their trust. One way to accomplish this is by sitting or lying on the floor with them. What some other techniques you can use to help develop trust?
Let them play with a stethoscope or pen light, and by playing games
Most common type of skull fracture in the newborn
Linear
Most likely diagnosis in a patient w/ hearing loss, syncope, normal vitals/exam, family history of sudden cardiac death
Long QT syndrome
Temp Bark cough stridor
Main presentation of croup (3)
Adrenal medulla tumor similar to pheochromocytoma but w/ fewer cardiac manifestations
Neuroblastoma
Statistically most common cancer in infancy
Neuroblastoma
Pressers and stabilize injury.
Neurogenic shock treatment
When are lumbar puncture w/ CSF analysis and culture done in newborns?
Neurological signs (irritability, lethargy, temperature irregularity, and feeding problems)
Presentation of duodenal atresia
Onset of bilious vomiting within 12 hours of birth
Which two major fuels will NOT be delivered to the brain when there is inadequate profusion?
Oxygen and glucose
Most accurate diagnostic test for Herpes
PCR
Most accurate diagnostic test for toxoplasmosis
PCR
Failure of spontaneous closure of the ductus arteriosus
PDA
Normal cardiac finding in the first 12 hours of life
PDA
Best initial test for varicocele
PE
When does a PDA usually close?
PO2 ↑ 50 mm Hg
Presentation of Legg-Calvé-Perthes disease
Painful limp
sub-q
Peds have less **** fat
Painless, bright red bleeding, with or without uterine contraction, is most suggestive of
Placenta previa
Makes it so it never happened
Primary prevention
What keeps a PDA open?
Prostaglandin E1
Lack of abdominal muscles, so unable to bear down and urinate
Prune belly
Effect of 17ɑ-hydroxylase deficiency on sex development of boys
Pseudohermaphroditism
BG>200 mg/DL
Pt is hyperglycemic at...
- Sign where, on palpation of the pulse, a double peak per cardiac cycle can be appreciated - In *aortic regurgitation*
Pulsus bisferiens
- An abnormally large decrease in systolic blood pressure (> 10 mm Hg) and pulse wave amplitude during inspiration - In *cardiac tamponade* and *tension pneumothorax*
Pulsus paradoxus
- Slow-rising pulse and anacrotic pulse; is a sign where, upon palpation, the pulse is weak/small, and late relative to its expected characteristics - In *aortic stenosis*
Pulsus tardus et parvus
Associate the *string sign* w/ its associated condition
Pyloric stenosis
Condition in which a hypertrophic pyloric sphincter prevents proper passage of GI contents from the stomach into the duodenum
Pyloric stenosis
Projectile vomiting + palpable abdominal mass are characteristic of
Pyloric stenosis
Cholinergenic
SLUDGE is an acronym for what OD?
Where does oxygenated blood instead return in Total anomalous pulmonary venous return?
SVC
Infection characterized by diffuse erythematous eruption that is concurrent w/ pharyngitis caused by erythrogenic toxin
Scarlet fever
Two key areas of development during the _____ years include an increased ability to cocentrate and learn quckly and the onset of puberty. Their psychosocial development varies by individual, but as a rule however, self-concept and moral traits and behavior begin to emerge during thse years
School age
CXR findings w/ RSV
Steeple sign
Reflex characterized by walking-like maneuvers when toes touch the ground
Stepping reflex
Because pediatrics are more susceptible to hypothermia, you should check capillary refill at ____ or _____.
Sternum or forehead.
Treatment of mild Croup
Steroids
Organism that causes Scarlet fever
Streptococcus pyogenes
Sign observed on upper GI series in pyloric stenosis characterized by *thin column of barium leaking through the tightened muscle*
String sign
What is the most likely finding on upper GI series in: a 1-month-old child presenting w/ forceful nonbloody, nonbilious vomitus after feeding that winds up across the nursery and a palpable abdominal mass on PE?
String sign
Minute hemorrhages present in the eyes of infant due to rapid rise in intrathoracic pressure as chest is compressed while passing through birth canal
Subconjunctival hemorrhage
What does auscultation reveal in a patient w/ pyloric stenosis?
Succussion splash
Treatment of Mumps
Supportive
Often the first sign of shock in pediatrics
Tachycardia
Improves outcome after accident
Tertiary prevention
Why are children 6-24 months of age at the highest risk for developing rickets?
Their bones are rapidly growing
Abdominal ultrasound findings associated w/ pyloric stenosis
Thickened pyloric sphincter
Pneumonia
This lower airway disease presents with grunting, crackles or wheezing and anorexia.
Bronchiopulmonary Dysplasia
This respiratory disease is common with premature kids.
Best initial imaging study for Wilms tumor
Ultrasound
Best initial test for intussussception
Ultrasound
Prognosis of smaller VSDs
Usually close in first 1-2 years
4j/kg
V-fib/pulseless V-tach shock
Commonly tested syndrome associated w/ imperforate anus
VACTERL syndrome
Best initial diagnostic test for syphilis
VDRL/RPR
Condition that presents w/ holosystolic murmur and symptoms of failure to thrive
VSD
Varicose vein in the scrotal veins causing swelling of pampiniform plexus and increased pressure
Varicocele
What findings would be your first indication that an infant needs a fluid bolus
Very dry mucous membranes & tachycardia
Levels of Vitamin K in breast milk
Very low
Most accurate diagnostic test for Varicella
Viral culture
Croup Laryngotracheobronchitis
Viral infection that effects child (3 months - 6 years) in fall and winter season.
Effect of 11β-hydroxylase deficiency on sex development of girls
Virilized
Bowel obstruction in which a loop of bowel has twisted on itself abnormally
Volvulus
On the USMLE, hypochloremic, hypokalemic metabolic alkalosis is almost always caused by
Vomiting (vast loss of hydrogen ions)
A significant volume loss can be caused by these
Vomiting and Diarrhea
How is slipped capital femoral epiphysis diagnosed?
Widening of joint space on XRs
Most common abdominal mass in children
Wilms tumor
glucose
With ICP, you should avoid...
When does pulmonary hypertension develop in the setting of Truncus arteriosus?
Within 4 months
Typical duration for resolution of hydrocele
Within 6 months
G6PD deficiency inheritance pattern
X-linked recessive
Best diagnostic test when suspecting clavicular fracture
XRs
Child Abuse usually occurs in
Young Infant, Infant, Toddler, School-Age children, & Adolescent
You are treating an 11-month-old child that has an epidural hematoma. What can occur in a child this age that cannot occur in a child 11 years of age with the same injury?
a. Blood loss creating shock b. Blurred and double vision c. Decreased respiratory rate
CXR findings associated w/ VSD
↑ vascular markings
Treatment of PKU
↓ phenylalanine diet for first 16 years (at least)
Term neonate
≥ 38 weeks
Atropine Sulfate
0.02 mg/kg
Epinephrine (1:10,000)
0.1 mL/kg
Adenosine
0.1 mg/kg
CXR findings associated w/ Transposition of the great vessels
"Egg on a string"
Appearance associated w/ Duchenne Erb paralysis
"Waiter's tip" appearance
Positive Ortolani maneuver
'Clunk' heard as femoral head relocates into acetabulum
About ____ of newborns require some assistance to begin breathing at birth
0.1
Q338. Intussusception - History/PE
"A338. History - colicky abdominal pain in apparently healthy kids; n/v; too young to talk - cry; draw knees up to chest; dyspnea with pain; advanced signs - red ""current jelly"" stool; lethargy; fever; PE - abdominal tenderness, positive stool guaiac, palpable ""sausage-shaped"", RUQ abdominal mass"
Q367. Kawasaki Disease; (Mucocutaneous Lymph Node Syndrome) - History/PE
"A367. ""CRASH and Burn""; Conjunctivitis - b/l; Rash; Adenopathy - cervical lymph; Strawberry tongue; Hands and feet - swollen, red, desquamation; fever > 40C for > 5 days"
Q388. Coarctation of the Aorta - Dx
"A388. EKG - LVH; echocardiography; color-flow doppler; CXR - ""3"" sign: rib notching; aortography - diagnostic (cardiac catheterization)"
Q392. Transposition of the; Great Arteries - Dx
"A392. Echocardiography; CXR - ""egg-shaped sihouette"", ""egg on a string"", ""apple on a string"""
Q421. Gaucher's Disease - (lysosomal storage disease); What is it
"A421. AR; deficiency of B-glucocerebrosidase; glucocerebroside accums in; brain, liver, spleen, bm; Gaucher's cells - ""crinkled paper"" enlarged; cytoplasm; Type I - more common, compa-; tible with normal life span"
Q430. Erythema Infectiosum - (Fifth Disease); Cause; Characteristics
"A430. Cause - parvovirus B19; prodrome none; fever absent or low-grade; ""slapped cheek"" erythematous; pruritic; maculopapular rash; goes to arms; spreads to trunk and legs; worse with fever and sun"
Q439. Varicella - Cause; Characteristics
"A439. VZV; prodrome - mild fever; anorexia; malaise; precedes rash by 24 hrs; generalized, pruritic,; ""teardrop"" vesicular rash; starts on trunk; spreads to periphery; lesions often at different; stages of healing; infectious from 24 hrs; before eruption til; lesions crust over"
Q441. Varicella Zoster - Cause; Characteristics
"A441. Prodrome - reactivation of Varicella; infection; starts as pain along affected; sensory n. pruritic ""teardrop""; vesicular rash; in dermatomal distribution; uncommon unless immunocomp"
Q711. (4) heart defects of the Tetralogy of Fallot; MC presenting Sx?
"A711. ""PROVe""; 1. Pulmonary stenosis; 2. RV hypertrophy; 3. Overriding Aorta; 4. VSD; MC presenting Sx: Cyanosis"
Q713. Dx:; MCC of cyanosis in the first 24 hours of life; loud single S2; What is seen on CXR?; Tx (aside from airway) until surgery?
"A713. Transposition of Great Vessels; CXR: ""Egg on a string""; (ECG will show right axis deviation and RVH); Tx: Prostaglandin (to keep PDA open until surgery)"
Q732. Dx:; a child between the ages of 6 - 18 months presents with crampy abdominal pain, Currant jelly-like stool, Sausage- shaped abdominal mass; Dx test?
"A732. Intussusception; Dx test: Barium Enema (will see ""Coil spring sign""; also treats problem)"
Q738. Dx:; infant with Toes AND heel deviated inward; Cannot place in neutral, dorsiflex or plantarflex; Tx?
"A738. Talipes equinovarus (""Club Foot""); Tx: Serial Casting (only intoeing needing treatment)"
Q742. Dx:; Toddler with sudden traction to arm causing it to hang limp; Tx?
"A742. Radial head subluxation (""nursemaid injury""); Tx: gentle Supination pops it back into place"
Q812. What are (4) developmental milestones at 6 months old?
"A812. ""Six Babbling Strangers Switch Sitting at 6 months"":; 1. Babbles; 2. Stranger recognition; 3. Switches hands (transfers objects); 4. Sitting unsupported"
Q820. What is the difference b/t HUS and TTP?; (2)
"A820. No Fever and Neurological signs in HUS; HUS = ""RAT"" (Renal failure, Anemia, Thrombocytopenia); TTP = ""FAT RN"" (Fever, Anemia, Thrombocytopenia, Renal problems, Neuro problems)"
Q824. In assessing dehydration, what are the (7)* main findings to evaluate?; How many findings equal <5% dehydration?; More then 10% dehydration?
"A824. having Dehydration is ""BUM NEWS"":; 1. BP and HR; 2. Urine output; 3. Mucous membranes and Tears; 4. Neurological status; 5. Eye and Fontanels; 6. Weight; 7. Skin turgor/color and Capillary refill; <5% = <3 findings; >10% = >6 findings"
Q880. What are the erruption times of permanent teeth?; (8)*
"A880. ""Mama Is In Pain, Papa Can Make Medicine"":; 1st Molar: 6 years; 1st Incisor: 7 years; 2nd Incisor: 8 years; 1st Premolar: 9 years; 2nd Premolar: 10 years; Canine: 11 years; 2nd Molar: 12 years; 3rd Molar: 18-25 years"
Q890. what are the (4)* MC congenital problems in infant of a diabetic mother?
"A890. ""A Diabetic Causes Trouble"":; 1. Ancephaly / NT defects; 2. Duodenal Atresia / small left colon; 3. Caudal Regression syndrome; 4. Transposition of the Great Vessels"
Q904. what is the first step in Tx for a patient with Allergic Rhinitis?
"A904. Antihistamines; (do be fooled with ""environmental change"")"
Rule of 2s for Meckel's diverticulum
- 2% of population - 2 feet from ileocecal valve - 2 types of ectopic tissue (gastric and pancreatic) - 2X ↑ prevalence in males - < 2 years of age - 2% of patients are symptomatic - 2 inches long
Treatment of Hypoplastic left heart syndrome
- 3 separate, high-mortality surgeries - Heart transplant
What does APGAR stand for?
- A: Appearance - P: Pulse - G: Grimace - A: Activity - R: Respiration
Best first & initial step in management of choanal atresia
- ABCs - NG tube
Screening for omphalocele
- AFP levels - Ultrasound
Diagnostic tests done for necrotizing enterocolitis
- AXR, CT - Stool studies
W/ Duchenne Erb paralysis, the infant is unable to carry out what motions?
- Abduction - External rotation - Supination
Presentation of Hypoplastic left heart syndrome
- Absent pulses w/ single S2 - ↑ RV impulse - Gray cyanosis (rather than bluish)
Signs of severe dehydration
- Acute renal failure (↑ BUN & creatinine) - Skin tenting - Hemoconcentration
Findings on upper GI series assocated w/ voluvlus
- Air fluid levels - "Bird beak" appearance (at site of rotation)
CT findings for perforated necrotizing enterocolitis
- Air in the portal vein - Dilated bowel loops - Pneumoperitoneum
Levels of aldosterone, cortisol, & sex hormone characteristic of *17ɑ-hydroxylase deficiency*?
- Aldosterone: ↑ - Cortisol: ↓ - Sex hormone: ↓
Levels of aldosterone, cortisol, & sex hormone characteristic of *11β-hydroxylase*?
- Aldosterone: ↓ - Cortisol: ↓ - Sex hormone: ↑
Levels of aldosterone, cortisol, & sex hormone characteristic of *21-hydroxylase*?
- Aldosterone: ↓ - Cortisol: ↓ - Sex hormone: ↑
CAH's general effect on sexual development in girls
- Ambiguous genitalia/virilization - Menstrual abnormalities - Inappropriate facial hair
Treatment of neonatal sepsis
- Ampicillin and gentamicin - Cefotaxime
Presentation of Vitamin B2 (riboflavin) deficiency
- Angular chelosis - Stomatitis - Glossitis
Duodenal atresia associations
- Annular pancreas - Down syndrome
Diseases screened for prior to discharge of neonate
- Biotinidase - β-thalassemia - CAH - Cystic fibrosis - Galactosemia - Hypothyroidism - Homocysteinuria - PKU
CXR findings associated w/ Tetralogy of Fallot
- Boot-shaped heart - ↓ pulmonary vascular markings
When does hypertrophy of the pylorus become pronounced?
- By 1st month of life - Not commonly found at birth
Components of a full sepsis evaluation
- CBC w/ differential - Urinalysis & urine cultures - CXR - Lumbar puncture
Complications of untreated VSD
- CHF - Endocarditis - Pulmonary hypertension
How is the diagnosis of esophageal atresia + TEF made?
- CXR - CT - Esophagram
Levels of calcium, phosphate, 1,25(OH)2, and 25(OH) characteristic for X-linked hypophosphatemic
- Calcium: normal - Phosphate: ↓ - 1,25(OH)2: normal - 25(OH): normal
Levels of calcium, phosphate, 1,25(OH)2, and 25(OH) characteristic for vitamin D-*deficient* rickets
- Calcium: normal or ↓ - Phosphate: ↓ - 1,25(OH)2: ↓ - 25(OH): ↓
Levels of calcium, phosphate, 1,25(OH)2, and 25(OH) characteristic for vitamin D-*dependent* rickets
- Calcium: ↓ - Phosphate: normal - 1,25(OH)2: ↓ - 25(OH): normal
Effect of laying down on RSV patients
- Causes difficulty breathing - May show signs of hypoxia
Causes of conjunctivitis in the newborn
- Chemical irritation - Neisseria gonorrhoeae - Chlamydia trachomatis - Herpes simplex
Presentation of toxoplasmosis
- Chorioretinitis - Hydrocephalus - Multiple ring-enhancing lesions on CT
Pathophysiology of stroke from paradoxical emboli from deep leg veins in 17 y/o
- Clot formed in setting of venous stasis - Traveled to brain through patent ASD
Set of congenital defects seen w/ CHARGE syndrome
- Coloboma of the eye, CNS anomalies - Heart defects - Atresia choanae - Retardation of growth/development - GU, genital defects (hypogonadism) - Ear anomalies, deafness
Presentation of Rubeola/Measles
- Cough, coryza, conjunctivitis - Koplik spots (grayish macule on buccal surface)
Hypospadias is associated w/?
- Cryptorchidism - Inguinal hernias
Characteristics of PKU
- Deficiency in phenylalanine hydroxylase - Leads to mental retardation
Presenting features of Hirschsprung disease
- Delayed (>48 hours) or failure to pass first meconium - Extreme constipation - Large bowel obstruction - Extremely tight sphincter - Failure to pass flatus
Indications for treatment of varicocele
- Delayed growth of testes - Evidence of testicular atrophy
Treatment of Transposition of the great vessels
- Maintenance of PDA w/ prostaglandin E1 - 2 separate surgeries
What is the diagnosis and most common complication in: a 1-day-old child who begins to choke and exhales milk bubbles from her nose upon her first feeding, appears to be in significant respiratory distress, CXR reveals an air bubble in the upper esophagus, no gas pattern in the remainder of the GI tract, and a coiled NGT?
- Diagnosis: esophageal atresia w/ tracheoesophageal fistula - Most common complication: aspiration pneumonia
Diagnostic tests done for suspected pathologic jaundice in the newborn
- Direct & indirect bilirubin levels - Blood type of infant & mother (for ABO & Rh incompatibility) - Peripheral smear & reticulocyte count
Findings on plain x-ray for Hirschsprung disease
- Distended bowel loops - Lack of air in rectum
3 conditions associated w/ bilious vomiting
- Duodenal atresia - Volvulus - Intussussception
Future complications associated w/ ASDs
- Dysrhytmias - Paradoxical emboli from DVTs
Types of esophageal fistulas
- EA + distal TEF - Isolated EA w/o TEF - EA + proximal & distal TEFs - H-type TEF
How is asymmetric septal hypertrophy in an IDM diagnosed?
- EKG - Echocardiography
Presentation of Transposition of the great vessels
- Early/severe cyanosis - Single S2 is heard
Other symptoms associated w/ infectious diarrhea caused by *Norwalk virus*
- Explosive - Cramping, pain
Major findings on exam w/ imperforate anus
- Extreme constipation - Absence of anal orifice
Presentation of Epiglottitis
- Fever - "Hot potato" voice - Drooling in the tripod position - Refusal to lie flat
Presentation of inflammatory diarrhea
- Fever - Abdominal pain - Possible bloody diarrhea
Other symptoms associated w/ infectious diarrhea caused by *Rotavirus & Adenovirus*
- Fever - Emesis - No blood
Presentation of Mumps
- Fever - Parotiditis - Orchitis
Presentation of Scarlet fever
- Fever - Pharyngitis - Sandpaper rash over trunk & extremities - Strawberry tongue - Cervical lymphadenopathy
Presentation of bronchitis
- Fever - Productive coughing (7-10 days)
Presentation of Roseola
- Fever + URI - Progressing to diffuse rash
Presentation of pharyngitis
- Fever above 104℉ - Cervical adenopathy - Petechiae - Other URI symptoms - Acute rheumatic fever - Glomerulonephritis
Findings in an IDM suggestive of renal vein thrombosis
- Flank mass - Bruit - Hematuria - Thrombocytopenia
Treatment of esophageal atresia
- Fluid resuscitation - Antibiotic coverage for anaerobes - 2-step surgical repair
Treatment of CAH
- Fluids + electrolytes - Lifelong steroids - Psychiatric counseling
Without vitamin K-dependent clotting factors, newborn will likely bleed from where?
- GI tract - Belly button - Urinary tract
CXR findings associated w/ esophageal atresia + TEF
- Gastric air bubble + esophageal air bubble - Coiling of NG tube
Treatment of facial nerve palsy
- Gradual improvement over weeks-months - Surgical nerve repair w/ failed recovery
Most common organisms associated w/ early onset sepsis
- Group B Streptococcus - E. coli - Listeria
Most common organisms causing sepsis
- Group B Streptococcus - E. coli - S. aureus - L. monocytogenes
Presentation of VSD
- High-pitched holosystolic murmur over LLSB - Loud pulmonic S2 - Dyspnea w/ respiratory distress
Presentation of Vitamin D toxicity
- Hypercalcemia - Polyuria - Polydipsia
Effect of hypomagnesemia in an IDM
- Hypocalcemia - PTH decrease
Metabolic findings in an IDM
- Hypoglycemia - Hypocalcemia - Hypomagnesemia - Hyperbilirubinemia
Electrolyte abnormalities associated w/ 21-hydroxylase deficiency
- Hyponatremia - Hypochloremia - Hyperkalemia
Electrolyte abnormalities observed w/ CAH
- Hyponatremia - Hypocholoremia - Hypoglycemia - Hyperkalemia - Acidosis
Highly tested hallmark findings associated w/ neuroblastoma
- Hypsarrhythmia (on EEG) - Opsomyoclonus - ↑ VMA & metanephrines (diagnostic)
Treatment of asymmetric septal hypertrophy in an IDM
- IV fluids - β-blockers
Treatment of pyloric stenosis
- IV fluids + electrolytes (esp. *K+*) - NG tube (for decompression) - Surgical myotomy
Effect of hyperbilirubinemia in an IDM
- Icterus - Kernicterus
Causes of intussussception
- Idiopathic (most common) - Polyp - Hard stool - Lymphoma - Viral origin
Treatment of clavicular fracture
- Immobilization - Splinting - Physical therapy
Causes of polyhydramnios
- Inability to swallow (e.g., Werdnig-Hoffman disease) - Atresias (e.g., intestinal atresias)
Type of esophageal fistula present in ≤20% of cases
- Isolated EA w/o TEF - EA + proximal & distal TEFs - H-type TEF
Presenting features of an IDM
- Macrosomia - Plethora - Jitteriness
Findings in infants of diabetic mothers (IDM)
- Macrosomia - Small left colon syndrome - Cardiac abnormalities - Renal vein thrombosis - Metabolic abnormalities
If respirations are inadequate (evidenced by low SpO2 readings) or if the heart rate remains less than ____ beats per minute 30 seconds after administering the initial steps following birth, positive-pressure ventilation should be initiated
100
A fetal heart rate that remains above 160 or below ___ beats/min for more than 60 seconds may be an early sign of fetal distress
110
Duration of Convalescent stage of Whooping cough
14 days
Duration of the Catarrhal stage of Whooping cough
14 days
Duration of the Paroxysmal stage of Whooping cough
14-30 days
Q019. rash pattern for erythema infectiosum
A019. slapped cheek rash;; lacy, reticular
Most likely diagnosis w/ *jug-handle appearance* cardiac x-ray findings
1° pulmonary artery hypertension
Dopamine Hydrochloride
2 to 20 mcg/kg/min
Ophthalmia neonatorum prophylaxis
2 types of antibiotic drops: - Erythromycin or tetracycline ointment - Silver nitrate solution
Spontaneous abortion is the nontherapeutic termination of pregnancy from any cause before ____ weeks of gestation
20
A 20 kg child is lethargic & tachycardic and has dry mucous membranes after a 3 day history of flu. Medical direction asks for a fluid bolus of normal saline. How much will you administer initially
400 mL
≥ 90% of CAH cases are due to deficiency in what enzyme?
21-hydroxylase deficiency
ASD more common in men or women?
2X in women
Children get defribillation at
2j/kg then 4j/kg
Duration of Scarlet fever
3-6 days
Management of Hirschsprung disease
3-stage surgery procedure
Mortality % of necrotizing enterocolitis
30%
Late preterm neonate
34-37 weeks
Drownings
4th leading cause of death from 1-4 years
Amiodarone
5 mg/kg
Mortality rate associated w/ surgical therapy for Transposition of the great vessels
50%
% of neuroblastoma cases presenting w/ metastases
50-60%
What % of amniotic fluid is a filtrate of the mother's plasma?
80%
Pyloric stenosis can present as late as
6 months after birth
Typical duration of infectious diarrhea caused by *Rotavirus & Adenovirus*
< 7 days
After how many hours of life is a PDA considered pathologic?
> 24 hours
> what % of newborn infants are jaundiced?
> 60%
When compared with an adult, how is a child's tongue different?
A child's tongue is larger
An incomplete brake in the boken.
A greenstick fracture is...
Classic migraine
A migraine with an aura is a....
9-12
A moderate brain injury has a GCS of...
scarlet fever
A rash all over the body might be...
8 or less
A severe head injury has a GCS of...
A Fontanelle during dehydrations
A sunken fontenalle
Q020. VZV rash pattern
A020. begins on trunk,; followed by head, face, and extremities
What causes a child to have an increased need for oxygen when injured or ill?
A. Decreased oxygen use** B. Increased metabolism C. Decreased temperature
When using the Pediatric Assessment Triangle, what kind of treatment approach should be used?
A. During transport B. Treat as you go** C. Very aggressive
Q021. gross motor skills at 1 mo old
A021. raises head
Q022. gross motor skills at 3 mo
A022. holds head up
Q017. rash pattern in rubella
A017. rash on face that spreads to the rest of the body
What developmental difference causes children to have increased internal organ damage when suffering blunt chest-wall trauma?
A. Thicker chest wall B. Softer chest wall C. Smaller surface area **
Q018. rash pattern in measles
A018. rash starts at the head and spreads downwards and disappears in the same manner
Q001. vaccinations given at birth
A001. hepatitis B
Q002. vaccinations given at 1 month
A002. hep B, only if not given at birth
Q003. vaccinations given at 2 months
A003. Pediarix (HBV, DTaP, IPV); Prevnar (pneumococc); Rotavirus; Hib
Q004. what is in pediarix
A004. HBV; DTaP; IPV
Q005. vaccinations given at 4 months
A005. Pediarix; Prevnar; Hib; Rotavirus
Q006. vaccinations given at 6 months
A006. Pediarix; Prevnar; Hib; Rotavirus
Q007. vaccinations given at 12 months
A007. DTaP; Hib; MMR; VZV; Prevnar; Influenza; Hep A
Q008. vaccinations given at 24 months
A008. none
Q009. vaccinations given at 4-6 yrs
A009. DTaP; IPV; MMR; Influenza
Q010. vaccinations given at 11 yo
A010. Tdap; Meningococcus vaccine
Q011. what is the schedule for well visits starting from birth
A011. 1 mo; 2 mo; 4 mo; 6 mo; 9 mo; 12 mo; 15 mo; 18 mo; 24 mo; then annually
Q012. why shouldn't babies drink water
A012. because their kidneys aren't mature enough to handle the extra fluid so the babies will become hyponatremic since they can't excrete the water, and then they can have seizures
Q013. plagylocephaly
A013. mishapen head
Q014. sunsetting sign
A014. increased ICP, eyes are half closed secondary to the increased ICP on the cranial nerves
Q015. craniosynostosis
A015. premature closure of the fontanelles
Q016. rash pattern in rocky mountain spotted fever
A016. palms and soles, then spreads to trunk; petechial
Q075. describe malrotation
A075. small intestines rotate abnormally in utero, so there is an abnormal fixation posteriorly to the mesentary; it can twist on its vascular supply --> volvulus
Q076. clinical presentation of malrotation
A076. bilious emesis; possibly abdominal distention/shock; + guiac test = bowel ischemia, poor prognostic sign
Q077. tx of malrotation
A077. surgery ASAP
Q078. tx for scd induced priapism
A078. sedation
Q079. disease that scd can mimic if htere is abdominal pain
A079. appendecitis
Q080. when is frontal bossing seen?
A080. beta-thal or some other hemolytic process that requires rapid hematopoesis
Q081. tx for beta-thal
A081. serial transfusion + chelation therapy (desferoxamine) b/c of fe overload
Q082. consequence of fe overload
A082. hemochromatosis
Q083. complications of g6pd deficiency
A083. rbcs are destroyed but there is increased amounts of hb liberated in the process --> hb-uria
Q085. battle's sign
A085. basilar skull fracture that leads to bleeding/bruise behind the ear
Q086. mechanism behind bell's palsy in neonates
A086. forceps deliver... usually resovles
Q087. social milestones at 5 yo
A087. competetive games; understands rules and abides by them
Q088. social milestones at 4 yo
A088. imaginative play
Q089. social milestones at 3 yo
A089. group play; shares
Q090. social milestones at 2 yo
A090. parallel play
Q091. social milestones at 18 mo
A091. plays around other children
Q092. social milestones at 12 mo
A092. comes when called; cooperates with dressing
Q093. social milestones at 9 mo
A093. pat-a-cake
Q094. social milestones at 6 mo
A094. recognizes strangers
Q095. social milestones at 4-5 mo
A095. enjoys observing environment
Q096. social milestones at 3 mo
A096. reaches for familiar objects/ppl
Q097. social milestones at 2 mo
A097. recognizes parent
Q098. social milestones at 1 mo
A098. fixes on face
Q099. developmental dysplasia of the hip
A099. abnormal relationship between head of femur and acetabulum --> instabilility and dislocation of hip joint; develops secondary to lack of contact of acetabulum and femur during intrauterine development
Q1000. Dx:; Alpha-Galactosidase deficiency
A1000. fAbry's Disease; (fAAAAAbry's)
Q1001. Dx:; Hyperinsulinemia, omphalocele, macroglossia, organomegaly
A1001. Beckwith-Wiedemann syndrome; (HOMO)
Q1002. Dx:; short child with hypoglycemia, lactic acidosis, hyperuricemia and hyperlipidemia. Enlarged liver and kidneys and possible seizures
A1002. Von-Gierke's syndrome; (G6P deficiency)
Q1003. Dx:; G-6-P deficiency
A1003. Von-Gierke's syndrome
Q1004. Dx:; Floppy baby with macroglossia and heart failure
A1004. Pompe's syndrome; (Maltase deficiency)
Q1005. Dx:; Maltase deficiency
A1005. Pompe's syndrome
Q1006. Age:; walks alone, speaks 2 words, throws objects
A1006. 12 months old
Q1007. Age:; walks up and down stairs without help and has 2 - 3 word phrases
A1007. 24 months old
Q1008. First step:; Pyloric Stenosis
A1008. Rehydrate and correct Electrolytes
Q1009. When does stranger anxiety start and peak?
A1009. starts: 6 - 8 months; peaks: 12 - 15 months
Q101. tx of developmental dysplasia of hip
A101. pavick harness (keeps hip abducted and flexed), or body casting on older pts
Q1010. Dx:; IVP shows focal renal parenchymal scarring and blunting of calices
A1010. Chronic Pyelonephritis
Q1011. Dx:; Bilateral ptosis, difficulty getting up from chair and muscle weakness
A1011. Myasthenia Gravis
Q1012. Dx:; palpable purpura, glomerulonephritis, decreased complement, arthralgias, HSM, peripheral neuropathy and positive HCV
A1012. Mixed Essential Cryoglobinemia; (hCv = Cryoglobinemia)
Q1013. MC Sx of mixed Sickle cell trait
A1013. painless Hematuria
Q1014. When is the best time to give VZ-Ig to child who was playing with others that had chickenpox
A1014. within 3 - 5 days of exposure; (otherwise tell parents he will get Sx)
Q1015. Dx:; Non-immunized mother brings 2-week-old in b/c of spasms involving whole body and erythematous, tender umbilical cord and poor suckling
A1015. Tetanus
Q1016. Dx:; newborn lung problem due to right-to-left shunt from PDA or foramen ovale
A1016. Persistent Pulmonary HTN of Newborn
Q1017. Deficient enzyme:; FAILURE TO THRIVE, bilateral cataracts, jaundice and hypoglycemia at birth
A1017. Galactose-1-phosphate
Q1018. Tx:; prevents painful episodes of Sickle cell crisis
A1018. Hydroxyurea
Q1019. MC child brain tumor in cerebrum
A1019. Benign Astrocytoma
Q105. idiopathic talipes equinovarus (aka); appearance
A105. congenital clubfoot; medial rotation of tibia, fixed plantar flexion, inversion of foot, forefoot adduction; CANNOT DORSIFLEX (unlike metatarsus adductus)
Q106. tx of clubfoot
A106. bracing; serial casting
Q107. legg-calve-perthes disease
A107. avascular necrosis of femoral head; ischemic bone is eventually resolved and re-ossification occurs; --> limp, pain referred to thigh/knee
Q108. what movements are restricted in legg-calve-perthes disease
A108. abduction; flexion; internal rotation
Q109. tx of legg-calve-perthes disease
A109. bracing; surgery; observation
Q110. complications of legg-calve-perthes disease
A110. collapse of femoral head
Q111. SLIPPED CAPITAL FEMORAL EPIPHYSIS
A111. gradual or acute separation of proximal femoral growth plate; fem head slipps off of femoral neck and rotates inf-post postition
Q112. etiology of slipped capital femoral epiphysis
A112. common during puberty, could be hormonal
Q113. presentation of slipped capital femoral epiphysis
A113. limp, pain in hip and groin, pain referred to knee
Q114. dx of slipped capital femoral epiphysis
A114. plain film frog-leg, lateral position
Q115. tx of slipped capital femoral epiphysis
A115. goal is to prevent further misalignment; pin fixation is done acutely; chronic cases require osteotomy
Q116. Osgood Schlatter disease
A116. inflammation, swelling and tenderness over tibial tuberosity secondary to tendonitis of distal insertion of infrapatellar tendon
Q117. when does Osgood Schlatter disease occur
A117. During growth spurt, in teens
Q118. tx of Osgood schlatter
A118. conservative, supportive management
Q119. complication related to achondrodysplasia
A119. small foramen magnum seen in homozygotes --> brainstem compression
Q120. what is achondrodysplasia
A120. disorder of cartilage calcifications and remodeling
Q121. why do children have an increased risk of fracture
A121. tendons and ligaments are stronger than bones so in kids injuries often lead to fracture when they would only cause sprain in adult
Q122. types of fracture
A122. spiral (twisting forces on tibia during fall); epiphyseal fracture (use salter classification); stress fracture (hairline crack from repeated activity); torus fracture (at metaphysis)
Q124. define upper airway
A124. nose --> carina
Q125. sx of upper airway disease
A125. inspiratory stridor; tachypnea; respiratory distress
Q126. choanal atresia
A126. most proximal abnormality of airway; bony or membranous septum between 1 or both nasal passages and pharynx, preventing airflow through nose; life threatening if b/l (most young infants are obligate nose breathers); can't pass NG tube
Q127. complications of long-term intubation
A127. subglottal stenosis
Q128. laryngeal or tracheomalacia
A128. floppiness that closes off airway
Q129. how to confirm dx of laryngeal or tracheomalacia
A129. bronchoscopy
Q130. ddx for wheezing and respiratory distress
A130. asthma; bronchiolitis; foreign body aspiration; gerd; TE fistula; vascular sling
Q131. pathophysiology of sx in CF
A131. CFTR is abnormal --> altered cl channel; cl stays in cells and Na/water enter the cell to maintain osmotic balance --> viscous secretions
Q132. GI effects in CF
A132. pancreatic insufficiency; bowel obstruction; rectal prolapse; DM; cirrhosis; large bulky smelly stools; later in life stools --> distal obstruction
Q133. Pathognomonic finding in CF
A133. meconium ileus
Q135. other than respiratory infection, what are some other complications of CF
A135. hemoptysis (>500 cc/d = emergency) tx with embolization; spontaneous ptx (1/2 will recur unless sclerosis is performed, but if that is done then transplant is very difficult)
Q137. GI complication from Henoch-Schonlein Purpura
A137. ileal-ileal intussusception
Q138. Sx of Henoch-Schonlein Purpura
A138. non thrombocytopenic palpable purpura in dependent areas; an IgA mediated vasculitis involving GI, skin, joints, and kidneys
Q139. what is Henoch-Schonlein Purpura usually preceded by
A139. URI
Q140. GI sx of Henoch-Schonlein Purpura
A140. spasmodic pain, ileus, vomiting, ugi/lgi bleed
Q141. Tx of Kawasaki disease
A141. iv Ig; ASA
Q142. 3 phases of kawasaki
A142. acute; subacute (aneurysms form); convalescent (resolution over 2-3 mo)
Q143. which bacterial infection can mimic appendicitis
A143. campylobacter; Yesinia
Q144. sx of intussusception
A144. BOWEL OBSTRUCTION; currant jelly stools; lethargy; palpable tubular mass; paucity of gas on XR or evidence of obstruction
Q145. dx of intussusception
A145. barium (or air) enema
Q146. progression of complications of intussusception
A146. impaired venous return; bowel edema; ischemia; necrosis; perforation
Q147. pathophys of intussusception
A147. most are ileocecal, and occur when the ileum invaginates into colon at ileocecal valve
Q148. lead points in intussusception
A148. hypertrophy in Peyer's patches (often p viral infection); Meckel's divertic; intestinal polyp; lymphoma; foreign body; Henoch-Schonlein Purpura
Q149. at what age would you expect pyloric stenosis
A149. 1-3 months
Q150. what medication if given is associated with pyloric stenosis
A150. erythromycin
Q151. dx of pyloric stenosis
A151. u/s, see hypertrophic pyloris; UGI study shows string sign
Q152. embryology behind omphalocele
A152. when midgut loop fails to return to abdominal cavity; see light gray shiny sac protruding from base of umbilical cord
Q153. embryology behind malrotation of midgut
A153. midgut undergoes partial rotation and --> abnormal position of abdominal viscera, can be assoc with volvulus --> compromised blood flow and gangrene
Q154. gastroschisis
A154. weakness in abdominal wall --> herniation of bowel through the rectus muscle, usually to the right of the umbilicus
Q155. clinical features of malrotation
A155. bilious emesis; possible abdominal distension; XR shows gas in stomach, but no gas in intestines
Q156. risk factors for developing GERD in babies
A156. prematurity; esophageal disease; obstructive lung disease; overdistension of stomach from overeating; meds (theophylline)
Q157. dx of GERD
A157. pH probe placement in esophagus or ugi endoscopy; barium swallow to confirm normal anatomy
Q158. tx of GER/GERD
A158. small frequent feedings; keep head up for 20mins p eating; thicken feeds with cereal; metoclopramide (increases gastric motility); h2 blocker or PPI; last resort: nissen fundlopication (fundus of stomach is wrapped around distal esophagus to increase les pressure)
Q159. tx of diarrhea in children
A159. if no serious complications, feed through the diarrhea --> decreased denudement and faster return to normal stooling patterns; don't give antidiarrheals b/c --> toxic megacolon, unless salmonella, Shigella, c diff, or parasites
Q160. when to do w/u for diarrhea in a child
A160. in infant <3mo, do blood culture; 0-12 mo, do stool culture; do blood and stool culture if >5d of enterocolitis or salmonella exposure; any infant with + stool dx looking toxic or + blood culture should be evaluated for pyelo, meningiits, PNEUMONIA, osteo
Q161. when should a patient with diarrhea be admitted to hospital
A161. >5% dehydration and can't rehydrate effectively at home
Q162. constipations and complications
A162. no bowel movement, if after neonatal pd, #1 cause is voluntary withholding; can be caused by pain, on defecation --> fear of defecation - -> further retention; voluntary holding increases distension of rectum, decreases rectal sensation, requiring increased amounts needed to receive urge
Q163. sx of Hirchsprung's
A163. h/o diarrhea, fecal spotting alternating with constipation
Q164. how to tx functional constipation
A164. increase fluid,; decrease junk food,; increase fiber,; increase ingestion of undiluted juice
Q165. pathophys of Hirchsprung's
A165. failure of ganglion cells of myenteric plexus to migrate down colon in utero; therefore distal colon is tonically contracted and there is obstruction; usually limited to rectosigmoid colon
Q166. when to suspect Hirchsprung's
A166. in any infant who doesn't pass meconium, then --> bilious vomiting, abdominal distension, and poor feeding
Q167. tx of Hirchsprung's
A167. diverting colostomy with bowel that contains ganglion cells; aganglionic segment is removed by pulling ganglionic segment through rectum
Q168. sx of Meckel's diverticulum
A168. remnant of vitilline duct w/i 2 inches of ileocecal valve; bleeding from diverticulum; melena, obstruction (from intussusception), diverticulitis
Q170. dx of Meckel's diverticulum
A170. technetium-99 scan p h2 antagonist to locate hemorrhagic cells
Q171. encephalocele
A171. projection of cranial content through bony skull defect in occiput --> severe mental retardation, seizure, movement disorder
Q172. myelomeningocele
A172. protrusion of neural and meningeal tissue
Q173. meningocele
A173. meninges protrude
Q174. spina bifida II is associated with
A174. Chiari II malformation
Q175. complications of spinal bifida
A175. caudal end of cord is tethered to distal spine and can't ascend to adult position --> scoliosis, sphincter dysfxn, LE deformities
Q176. non-communicating hydrocephalus
A176. block in exiting ventricles;; above blockage, ventricles are big
Q177. causes of non-communicating hydrocephalus
A177. secondary to narrowing at 4th ventricle/aqueduct or malformation at posterior fossa; Chiari II malformation; spina bifida occulta
Q178. communicating hydrocephalus
A178. subarachnoid villi are dysfunctional/obliterated
Q179. sx of motor cerebral palsy
A179. fixed lesion in immature brain -> nonprogressive disorder of movement and posture; spasticity is #1 type from injury to motor tracts in brain; pts are hypotonic in early months then later become spastic; CONDITION IS NOT PROGRESSIVE
Q180. sx of extrapyramidal cerebral palsy; etiology
A180. from basal ganglia damage --> choreoathetoid movement, postural ataxia, spasticity; kernicterus, there is usually some sort of brain insult
Q181. what gcs is required for a head ct to be obtained
A181. <12
Q182. #1 cause of ICH in kids
A182. Arteriovenous malformation
Q193. dacryostenosis
A193. congenital nasolacrimal duct obstruction; causes overflow tearing - 6% of neonates; secondary to failure of distal membranous end of nasolacrimal duct to open
Q194. tx of dacryostenosis
A194. probing of nasolacrimal dut at 12-15 mo; although most resolve spontaneously by 1 yo (in 96% of infants)
Q195. ophthalmia neonatorum
A195. conjunctivitis occurring in first month of life; p/w eyelid edema, conjunctival hyperemia and ocular d/c
Q201. complications of chlamydia ophthalmia neonatorum
A201. corneal scarring; PNEUMONIA
Q202. tx of chlamydia ophthalmia neonatorum
A202. oral and topical erythromycin; tx parents; tx with erythromycin despite the risk of developing pyloric stenosis
Q203. tx of gonococcal ophthalmia neonatorum
A203. topical erythromycin; IV cefotaxime; tx parents
Q204. when should steroid containing eye drops not be given in conjunctivitis
A204. if hsv-1 is suspected etiology; can make disease worse
Q205. hordeolum
A205. acute infection of sebacous tarsal glands; staph aureus is usually cause
Q206. tx of hordeolum
A206. warm compresses
Q207. chalazion
A207. area of sterile lipogranulomatous reaction within meibomian glands that can enlarge; can be chronic and recurrent
Q208. is periorbital or orbital cellulitis an emergency
A208. orbital cellulitis
Q209. sx of periorbital cellulitis
A209. skin around eye is indurated, warm, and tender; no eye pain; may have si/sx of sinus infection
Q210. sx of orbital cellulitis
A210. severe pain with eye movement; proptosis; vision changes; decreased ocular mobility
Q211. dx of orbital cellulitis
A211. ct scan
Q212. organisms to cover with orbital cellulitis
A212. strep; H. flu; M. cat
Q213. tx of periorbital cellulitis
A213. iv antibiotics; can --> meningitis, tx aggressively with vanco, PCN, 1st generation cephalosporin
Q214. orgs to tx in periorbital cellulitis
A214. strep; h flu; m cat
Q215. features of fragile x syndrome
A215. hyperactive; mental retardation; large body; long face; prominent jaw and ears; thickened nasal bridge; large testes; +/- autism
Q216. facial features of 47 XYY
A216. long asymmetric ears; increased length: breadth in hands, feet, and cranium
Q217. nutritional deficiencies in goat's milk
A217. decreased vit d, iron, folate, b12
Q218. infectious disease associated with drinking raw cow's milk
A218. brucellosis
Q219. what supplements should moms receive if they are vegan
A219. b12 to prevent buildup of mma
Q220. effects of excess vit D
A220. hypercalcemia; azotemia; poor growth; n/v/d
Q221. vit E deficiency in premies -->
A221. hemolytic anemia
Q222. b1 deficiency -->
A222. beriberi; (neuritis, edema, CHF); hoarseness; anorexia
Q223. b2 deficiency -->
A223. photophobia; cheilosis; glossitis; corneal vascularity
Q224. b3 deficiency -->
A224. pellagra (dermatitis, dementia, diarrhea)
Q225. pathophys of primary hypophosphatemia
A225. defective po4 resorption; no conversion of 25-vit D --> 1,25-vit D in proximal tubules
Q226. lab studies in primary hypophosphatemia; ca; po4; alkaline phosphatase
A226. low/normal; low; high
Q227. clinical findings in primary hypophosphatemia
A227. smooth LE bowing (not angular, as is seen in Ca deficiency); intraglobulin dentin deformities (ca deficiency --> enamel defects); coarse trabecular bone and fraying
Q228. somogyi phenomenon
A228. nocturnal hypoglycemia manifested as night terrors, early am sweating, then later has hyperglycemia, ketonuria, glucosuria (sugars increase because of glucagon release)
Q229. what is an absolute contraindication for DTaP
A229. if first dose --> encephalopathy or encephalitis
Q230. clinical presentation of pb poisoning
A230. emotional lability; abdominal pain; achy bones; intermittent vomiting and constipation
Q231. at what BLL should tx be initiated
A231. >45
Q232. clinical presentation of acute hg poisoning
A232. GI pain; fever; chills; HA; visual changes; cough; cerebral palsy
Q233. clinical presentation of chronic hg poisoning
A233. gingivostomatitis; tremor; neuropsych features
Q237. complications of cerebral palsy
A237. seizure; mental retardation
Q238. differences in etiology for quadriplegia and paraplegia
A238. quadriplegia results from UMN damage; paraplegia results from LMN or spinal cord damage
Q239. most likely organisms Otitis --> pneumnia in CF
A239. staph or pseudomonas
Q241. pathophys of meconium ileus
A241. obstruction begins in utero --> underdeveloped distal lumen
Q242. tx of meconium ileus
A242. surgical emergency; gastrograffin enema
Q243. vitamin a deficiency -->
A243. pseudotumor cerebri (among other things); will see bulging fontanelles, headache, n/v; may be seen as first presenting sign in a patient with CF
Q249. pathophys of volvulus
A249. cecum fails to move to right lower quadrant and never adheres to abdominal wall; mesentary and SMA are tethered to narrow stalk and twist about itself; band of adhesive tissue can extend from cecum to ruq -> duodenal obstruction
Q250. presentation of children with secondary HTN
A250. ha; epistaxis; visual sx; easy fatiguability
Q251. describe how biliary atresia can occur post-natally
A251. from scarrin gan dinflammation of intrahepatic or extrahepatic biliary ducts; etiology is unclear
Q252. describe findings of prenatal biliary atresia
A252. Gallbladder is absent
Q253. sx of congenital toxoplasmosis
A253. chorioretinitis; hydrocephalus; intracranial calcifications
Q254. complement levels in post-strep GN
A254. decreased c3
"Q255. what are ""currant jelly stools"""
A255. bloody stools; indicative of intussusception
Q256. germinal matrix
A256. embryonic tissue present near caudate nucleus, often gets damaged by hypoxia/ischemia; #1 place for intraparenchymal bleed
Q257. progression of intraparenchymal bleed in a newborn
A257. blood can flow into ventricles w/i 3 days of life
Q258. what blood vessels are damaged in shaken baby syndrome
A258. bridging veins
Q259. what blood vessels are involved in SAH
A259. circle of willis
Q260. signs of SVT
A260. Heart rate 220-270; no P waves
Q261. pathophys of strawberry hemangioma
A261. vascular tissue fails to communicate with adjoining tissue; enlarges --> raised tumor
Q262. most common causes for pneumonia in a child > 6 yo
A262. mycoplasm; strep pneumo
Q263. cardiac complications in Marfan syndrome
A263. aortic root dilatation,; aortic dissection; MVP
Q264. most common orgs in peritonsillar abscess
A264. anaerobes; GAS
Q265. physical findings of Patau syndrome
A265. forebrain fails to develop (holoprosenceph); midface developmental abnormalities; abnormal genitalia; severe mental retardation
Q266. which chromosomes are associated with; 1. Edwards; 2. Patau
A266. Edwards = Election age (18); Patau = Puberty age (13)
Q267. porencephaly
A267. cyst/cavity in brain that communicates with ventricles
Q268. causes of euvolemic hyponatremia
A268. SIADH; glucocorticoid deficiency; hypothyroid; water intoxication
Q269. features of neonatal listerosis
A269. respiratory distress at 5 days; meningitis
Q270. clinical presentation of congenital hypothyroid
A270. constipation; jaundice; FAILURE TO THRIVE; enlarged fontanelle; umbilical hernia
Q271. presentation of neuroblastoma
A271. asymptomatic abdominal mass; Horner's; dancing eyes; dancing feet; blueberry muffin lesions; HTN
Q272. Patau's or Edwards syndrome:; microcephaly
A272. Patau
Q273. Patau's or Edwards syndrome; prominent occiput
A273. Edwards
Q277. Patau's or Edwards syndrome; micrognathia
A277. Edwards
Q278. Patau's or Edwards syndrome; low-set malformed ears
A278. Edwards
Q279. Patau's or Edwards syndrome; cleft lip
A279. Patau
Q280. Patau's or Edwards syndrome; congenital heart disease
A280. both
Q281. Patau's or Edwards syndrome; omphalocele
A281. Patau
Q282. Patau's or Edwards syndrome; clenched hands with overlapping fingers
A282. both
Q283. Patau's or Edwards syndrome; rocker bottom feet
A283. Edwards
Q284. Patau's or Edwards syndrome; polydactyly
A284. Patau
Q285. Patau's or Edwards syndrome; polycystic kidney disease
A285. Patau
Q286. Patau's or Edwards syndrome; horseshoe kidney
A286. Edwards
Q287. Patau's or Edwards syndrome; crytorchidism
A287. Patau
Q288. Patau's or Edwards syndrome; agenesis of corpus callosum
A288. Patau
Q289. genetic changes in Prader Willi
A289. paternal deletion, 2 defective maternal chromosomes
Q290. physical appearance of pts with Prader Willi
A290. obese; almond shaped eyes; downturned mouth; small hands and feet
Q291. genetic changes in Angelman's
A291. maternal deletion, 2 defective paternal chromosomes
Q292. physical appearance of Angelman's
A292. large mouth; short stature; tiptoe walk; seizures
Q293. galactosemia
A293. galactose 1-p builds up and accumulates in liver and brain
Q294. complications of galactosemia
A294. increased risk of e coli sepsis; LD; premature ovarian failure
Q295. tx of galactosemia
A295. eliminate galactose containing foods from diet
Q296. complications of PKU during pregnancy
A296. if diet not followed, baby can develop microcephaly, mental retardation, and congenital heart disease
Q297. physical features of homocystinemia
A297. Marfan like appearance; dislocated lens
Q300. protocol for neonates whose mom developed varicella infection just after delivery
A300. if mom develops sx within 2 days of delivery or during end of pregnancy, treat baby with iv Ig and acyclovir. if greater amt of time is lapsed, no tx needed
Q301. consequences of neonatal asphyxia
A301. cerebral edema; irritability; seizure; cardiomegaly; renal and heart failure; DIC; RDS
Q302. what is the apt test
A302. used to differentiae fetal from maternal blood
Q303. which drugs are contraindicated for breastfeeding
A303. lithium; cyclosporin; antineoplastic drugs; ergots; bromocriptine; tetracyclines
Q304. classic finding on XR for necrotizing enterocolitis
A304. pneumanitis intestinalis
Q305. consequences of cold temperature in a premie
A305. increased metabolic rate in order to raise body temp, but their ventilation rate increased as well; but, because of respiratory problems in premies they can't oxygenate enough so lactic acid accumulates --> metabolic acidosis
Q306. which is worse:; ABO incompatibility or Rh incompat
A306. Rh incompatibility
Q307. lab findings in ABO incompat
A307. increased reticulocyte count; weakly + coomb's
Q308. lab findings in Rh incompat
A308. strongly + coombs
Q309. pathophys of transient apnea of the newborn
A309. immature respiratory centers, especially in premies
Q310. how to id the underlying cause of congenital hypothyroid
A310. iodine uptake scan
Q311. late development of clavicle fracture during delivery... when does this occur?
A311. callous formation in anterior shoulder; 1 week
Q312. physical findings of subgaleal hemorrhage
A312. feels like cephalohematoma that crosses midline; can lose 1/3 of
Q313. onset of gonococcal conjunctivitis in a newborn
A313. DOL 2-5
Q315. what effects does surfactant deficiency have on lung compliance and lung volume; cardiac effect
A315. decreases both; R-->L shunt
Q316. what should be given to newborns whose moms are infected with Hep B
A316. Hep B Ig and HBV
Q319. when does transient tachypnea of newborn resolve
A319. DOL #3
Q320. significance of 5th finger polydactyly
A320. in black infants, no consequence; in white infants, can be associated with cardiac abnormalities, must do an echo
Q321. twin twin transfusion
A321. donor twin --> oligohydramnios, anemia, hypovolemia; recipient twin --> polyhydramnios, larger size (20% difference in body weight), hyperviscocity, respiratory distress, hyperbili, hypocalcemia, renal vein thrombosis
Q322. when does serum bilirubin peak
A322. DOL 3-5
Q323. Top Childhood Cancers - What are they
A323. 1. Leukemia (ALL); 2. CNS tumors; 3. Lymphoma; 4. Neuroblastoma
Q324. Neuroblastoma - What is it; Associated with?
A324. Embryonal tumor of; neural crest cell origin; MC cancer in infants; more than 1/2 kids < 2 y/o; associations - neurofibromatosis; Hirchsprung's; n-myc oncogene
Q326. Neuroblastoma - Dx
A326. Abdominal CT; 24-hr urinary catecholamines; assess extent of disease - CXR; bone scan; CBC; LFTs; BUN/Cr; coag panel
Q327. Neuroblastoma - Tx
A327. Excision - localized tumors; chemo includes - cyclophosphamide, doxorubicin; adjunctive radiation - if tumor spread beyond origin; prognosis improved for kids with low-risk dis., < 1 y/o, no N- myc amplification, localized
Q328. Wilms' Tumor - What is it; Associated with?
A328. Embryonal cancer of kidney; MC renal tumor in kids; 2-4 y/o; associated with - family History, Beckwith-Wiedemann syndrome, WAGR, neurofibromatosis
Q329. Wilms' Tumor - History/PE
A329. Painless, palpable abdominal mass; does not cross midline; n/v; fever; weight loss; hematuria; HTN
Q330. Wilms' Tumor - Dx
A330. Abdominal CT or US - intrarenal mass; check for metas - CXR, chest CT; CBC; LFTs; BUN/Cr
Q331. Wilms' Tumor - Tx
A331. Transabdominal nephrectomy; postsurgical chemo - vincristine, dactinomycin; flank irradiation (for some); prognosis good - depends on staging & histo
Q332. RDS - What is it
A332. MCC of respiratory failure in premies; surfactant deficiency => increased surface tension (poor lung compliance); and alveolar collapse (atelectasis); surfactant made by T2 pneumocytes, mainly ~35th week; dipalmitoyl phosphatidylcholine; risk factors - maternal diabetes, males, 2nd born of twins
Q333. RDS - History/PE
A333. Presents in 48-72 hrs of life; RR > 60/min; intercostal retractions; expiratory grunting; nasal flaring; cyanosis; progressive hypoxemia
Q334. RDS - Dx
A334. ABGs; CBC (to rule out infection); BC (to rule out infection); CXR - bilateral diffuse atelectasis, causing ground-glass appearance with visible air bronchograms; lecithin:sphingomyelin ratio < 2
Q335. RDS - Tx
A335. CPAP or intubation and mechanical ventilation; artificial surfactant to prevent - mom gets corticosteroids; monitor fetal lung maturity (L:S ratio)
Q336. RDS - Complications
A336. Persistent PDA; bronchopulmonary dysplasia; retinopathy of prematurity; intraventricular hemorrhage; NEC
Q337. Intussusception - What is it
A337. MCC of bowel obstruction in 1st 2 yrs. of life; males > females; usually proximal to ileocecal valve; cause - idiopathic, in older kids - mass or intestinal abnormality triggers the telescoping:; adenovirus or rotavirus; parasites; CF; celiac disease; polyps; intestinal lymphoma; Meckel's diverticulum; Henoch-Schonlein purpura
Q345. Child Abuse - What is it
A345. Neglect; physical abuse; sexual abuse; emotional abuse; suspect - if History doesn't match physical findings, if there was a delay in getting medical care
Q346. Child Abuse - History/PE
A346. Infants may have apnea, seizures, FAILURE TO THRIVE Exam findings include; cutaneous - ecchymoses of varying ages, patterned injuries; skeletal - spiral fractures of femur and humerus in kids < 3 = abuse unless prove else; epiphyseal/metaphyseal injuries - can happen in infants from pulling/twisting limbs; rib injuries < 2 y/o; sexual abuse - STDs or genital trauma
Q347. Child Abuse - Dx
A347. Rule out conditions that mimic skeletal survey & bone scan; can show fractures in various stages of healing; if sexual abuse suspected - test for gonorrhea, chlamydia and HIV; to rule out shaken baby syndrome - check for retinal hemorrhages; CT for subdural hemorrhages; MRI for white matter changes
Q349. Epiglottitis - What is it
A349. Serious, rapidly progressive infection of supraglottic; before immunization - from H influ type B; now - Streptococcus, nontypable H flu, viral agents
Q351. Epiglottitis - Dx
A351. Clinical; DON'T EXAMINE THROAT unless anesthesiologist present; definitive Dx - direct fiberoptic visual of cherry-red, swollen epiglottis & arytenoids; lateral XR - thumbprint sign
Q352. Epiglottitis - Tx
A352. Emergency; call anesthesiologist; transfer patient to OR; endotrach intubation or trach; IV Antibiotics - ceftriaxone or cefuroxime
Q353. Croup (Laryngotracheobronchitis) - What is it
A353. Inflammation of larynx and upper airway, mainly subglottic space => narrowing of airway; kids 3 mos. - 3 yrs. MCC - parainfluenza virus 1, also - PIV-2, PIV-3, RSV, rubeola, influenza, adenovirus, Mycoplasma pneumonia
Q354. Croup (Laryngotracheobronchitis) - History/PE
A354. Prodrome - URI Sxs 1-7 days; stridor - worse by agitation; fever - low grade; hoarseness; barking cough
Q356. Croup (Laryngotracheobronchitis) - Tx
A356. Mild - cool mist; moderate - oral corticosteroids; severe - (respiratory distress at rest), admit, nebulized racemic epinephrine
Q357. Bronchiolitis - What is it
A357. Acute inflammation of smallest airways; acute viral bronchiolitis; MCC - RSV; infants & kids < 2 y/o; can progress to respiratory failure; risk for severe RSV - < 6 mos. old, premies, heart or lung dis., immunodeficiency
Q358. Bronchiolitis - History/PE
A358. History - low-grade fever, rhinorrhea, cough, apnea - young infants; PE - tachypnea, wheezing, hyperresonance to percussion
Q359. Bronchiolitis - Dx
A359. CXR - hyperinflation of lungs; interstitial infiltrates; atelectasis; ELISA of nasal washings, for RSV - high sensitivity & specificity
Q360. Bronchiolitis - Tx
A360. Mild - outpatient, fluids, nebulizers, O2 if needed; admit if - marked respiratory distress, O2 saturation < 95%, toxic appearance, dehydration/poor oral feeding, premie (< 34 wks), < 3 mos. old, underlying cardiopulmonary dis., unreliable parents; inpatients - contact isolation, hydration, O2, ribavirin; RSV prophylaxis - RespiGam or Synagis, high-risk patients in winter
Q361. Otitis Media - What is it; Risk Factors
A361. Middle ear infection; MCC - #1 - S. pneumoniae, #2 - H. Flu, #3 - Moraxella catarrhalis; kids predisposed - eusta tube; risk factors - viral URIs, trisomy 21, CF, immunodeficiency, smoke exposure, day-care attendance, bottle feeding, cleft palate, prior otitis media
Q362. Otitis Media - History/PE
A362. Fever; ear tugging; hearing loss; irritability; Erythema; bulging; decreased mobility of tympanic membrane; loss of light reflex and bony landmarks; tympanic membrane may be perforated
Q363. Otitis Media - Dx
A363. Clinical
Q364. Otitis Media - Tx
A364. Amoxicillin - 10 days; Tx failure after 3 days - switch to amoxicillin-clavulanic acid, ceftriaxone or cefuroxime
Q365. Otitis Media - Complications
A365. Mastoiditis; meningitis; hearing loss; cholesteatoma; tympanosclerosis; chronic suppurative OM
Q366. Kawasaki Disease; (Mucocutaneous Lymph Node Syndrome) - What is it
A366. Multisystem acute vasculitis; usually kids < 5 y/o, especially Asian; at risk for coronary artery; aneurysms => MI
Q368. Kawasaki Disease; (Mucocutaneous Lymph Node Syndrome) - Dx
A368. Clinical; thrombocytosis - wk 2 or 3; increased ESR
Q369. Kawasaki Disease; (Mucocutaneous Lymph Node Syndrome) - Tx
A369. High-dose aspirin; IVIG - to prevent aneurysms; corticosteroids are contraindicated (they may increased aneurysms)
Q370. FAILURE TO THRIVE - What is it
A370. Persistent weight; below 3rd to 5th percentile or falling off growth curve; organic - medical condition; nonorganic - psychosocial; nonorganic is MC; risk factors - chronic illness, poverty, low maternal age, chaotic environment, genetic dis. (CF), inborn errors of metabolism, HIV
Q371. FAILURE TO THRIVE - History/PE
A371. Low weight for age and height; minimal weight gain or weight loss; plot on growth chart; check for signs of systemic dis. diet History; observe caregiver-child interaction
Q372. FAILURE TO THRIVE - Dx
A372. Calorie count; CBC; electrolytes; Cr; albumin; total protein; sweat chloride test; UA/UC; stool culture; O&P; assess bone age
Q373. FAILURE TO THRIVE - Tx
A373. Tx depends on cause; supplement nutrition if breastfeeding inadequate; admit if - neglect, severe malnourishment
Q374. Atrial Septal Defect (ASD) - What is it
A374. Opening in atrial septum lets blood flow bet. atria; L to R shunting due to lower R pressure; blood flow to lungs increased
Q375. Atrial Septal Defect (ASD) - History/PE
A375. History - usually presents in late childhood or early adult onset & severity depends on size; large defect - tire easy (DOE); freq. respiratory infections; FAILURE TO THRIVE => CHF => cyanosis; PE - RV heave, wide, fixed split S2, systolic ejection murmur; upper left sternal border
Q377. Atrial Septal Defect (ASD) - Tx
A377. Small defects may close spontaneously (no Tx needed); Antibiotics prophylaxis before dental procedures; surgical closure - infants with CHF, patients > 2:1 pulmonary to systemic blood flow; correct early to prevent - arrhythmia, RV dysfunction, Eisenmenger's syndrome
Q378. Ventric Septal Defect (VSD) - What is it
A378. MC congenital heart defect; More common in patients with - Apert's syndrome; Cri-du-chat; Trisomies 13 & 18
Q379. Ventric Septal Defect (VSD) - History/PE
A379. History - Sxs depends on degree of shunting; small defect usually asymptomatic at birth; large defect - CHF, freq respiratory infections, FAILURE TO THRIVE; PE - pansystolic murmur - lower left sternal border, loud pulmonic S2, in severe defects - systolic thrill, cardiomegaly, crackles
Q381. Ventricular Septal Defect (VSD) - Tx
A381. Most small defects close spontaneously (no Tx needed); Antibiotics prophylaxis before dental or pulmonary procedures; surgical closure - correct early to prevent - Eisenmenger's syndrome, et al; Tx CHF & respiratory infections
Q382. Patent Ductus Arteriosus (PDA); What is it
A382. Failure of DA to close => L-to-R shunt (aorta to pulmonary artery); risk factors - high altitude (low O2), 1st trimester rubella in mom, premies, females (more common)
Q383. Patent Ductus Arteriosus (PDA); History/PE
A383. History - typically asymptomatic (small PDA); slowed growth; recurrent lower respiratory infections; lower extremity clubbing; CHF Sxs; PE - wide pulse pressure, continuous machine murmur, loud S2, bounding peripheral pulses
Q384. Patent Ductus Arteriosus (PDA); Dx
A384. Small - often no signs of cardiomegaly; Large - echocardiogram - LA & LV enlarged; EKG - LVH; CXR - cardiomegaly; color-flow Doppler- diagnostic
Q385. Patent Ductus Arteriosus (PDA); Tx
A385. Indomethacin; (unless need PDA for survival); if indomethacin fails or; child > 6-8 mos. old - surgical closure preferred
Q386. Coarctation of the Aorta - What is it
A386. Narrowing proximal or distal to DA => increased flow above, decreased flow below coarctation; more common in males; Turner's, 25% have bicuspid aortic valve
Q387. Coarctation of the Aorta - History/PE
A387. History - often presents in childhood with asymptomatic HTN, headache, syncope, epistaxis, DOE, claudication; PE - systolic BP higher in upper extremities, may be greater in right arm; femoral pulses weak or delayed; late systolic murmur in left axilla; apical impulse forceful; advanced cases - well-developed upper body, lower extremities wasting
Q390. Transposition of the; Great Arteries - What is it
A390. Pulmonary & systemic circulation in parallel; aorta connected to RV; pulmonary artery connected to LV; incompatible with life unless septal defect or PDA; risk factors - babies of DM moms, Apert's syn, Down's, cri- du-chat, Trisomies 13 & 18
Q391. Transposition of the; Great Arteries - History/PE
A391. Critically ill; cyanosis immediately after birth; tachypnea; progressive respiratory failure; CHF (some patients)
Q393. Transposition of the; Great Arteries - Tx
A393. Prostaglandin E1 (PGE1) - to keep PDA open; balloon atrial septostomy; arterial or atrial switch op
Q394. Tetralogy of Fallot - What is it
A394. VSD; pulmonary stenosis; RVH; overriding aorta; right-to-left shunting => early cyanosis; risk factors - Down's, cri-du-chat, Trisomies 13 & 18
Q395. Tetralogy of Fallot - History/PE
A395. History - cyanosis, dyspnea, fatigability; profound cyanosis = tet spell; squatting for relief; hypoxemia => FAILURE TO THRIVE, mental status changes; PE - SEM at left sternal border, RV lift, single S2, CHF signs possible
Q396. Tetralogy of Fallot - Dx
A396. Echocardiography; catheterization; CXR - boot-shaped heart, decreased pulmonary vascular markings; EKG - right-axis deviation; RVH
Q397. Tetralogy of Fallot - Tx
A397. PGE1 - keep reopen PDA; for cyanotic spells - O2, propranolol, knee-chest position, fluids, morphine; balloon atrial septostomy before surgical correction
Q398. Cerebral Palsy (CP) - What is it
A398. Group of nonprogressive, nonhereditary neurological disorder; disorder in movement and posture; MC movement disorder in kids; MCC unknown - prenatal, perinatal and post insults; risk factors - prematurity, perinatal asphyxia, intrauterine growth retardation, early infection or trauma, brain malformation, neonatal cerebral hemorrhage
Q399. Cerebral Palsy (CP) - What are the categories
A399. Spastic (pyramidal) - spastic paresis of any limb, 75% of cases, MENTAL RETARDATION up to 90%,; athetoid - extrapyramidal, b. ganglia, uncontrollable jerking, writhing, worse with stress, disappears during sleep; ataxic - cerebellum, hard to coordinate movement, wide- based gait; mixed
Q400. Cerebral Palsy (CP) - History/PE
A400. May be associated with - seizure disorder, behavioral disorder; hearing or vision impaired; learning disabilities; speech deficits; hyperreflexia; Babinski; increased tone/contractures; weakness; underdevelopment; toe walking; scissor gait; hip dislocations; scoliosis
Q401. Cerebral Palsy (CP) - Dx
A401. Clinical; rule out metabolic disorder, cerebellar dysgenesis, spinocerebellar degeneration; EKG (if seizures)
Q402. Cerebral Palsy (CP) - Tx
A402. Special education; physical therapy; braces; surgical relief of contractures; for spasticity - diazepam, dantrolene, baclofen; for severe contractures - baclofen pumps, posterior rhizotomy
Q403. Febrile Seizures - What is it
A403. In kids 6 mos. - 6 y/o; no evidence of intracranial infection or other cause; risk factors - rapid rise in temp, History in close relative
Q434. Rubella - Cause; Characteristics
A434. Rubella virus; prodrome - asymptomatic or; tender, generalized; lymphadenopathy; erythematous, tender,; maculopapular rash; slight fever; polyarthritis in adolescents
Q435. Rubella - Complications
A435. Encephalitis; thrombocytopenia; congenital infections associated; with congenital anomalies
Q408. Neonatal Jaundice - What is it; What are the types; What is kernicterus
A408. Increased serum bilirubin from increased production or decreased excretion; conjugated - always pathologic; unconjugated - patholog or physiolog; physiologic jaundice - not present until 72 hrs after birth, bilirubin peaks < 15 mg/dL, resolves by 1 week in term, resolves by 2 weeks in premies; pathologic jaundice - present in 1st 24 hrs of life, bilirubin rises to > 15 mg/dL, persists past 1 week in term, persists past 2 weeks in premies; kernicterus - unconjug hyperbilirubinemia, bilirubin deposits in pons, basal ganglia, cerebellum, irreversible, can be fatal; risk factors - premies, asphyxia, sepsis
Q409. Neonatal Jaundice - History/PE
A409. History - child breastfed or formula? intrauterine drugs; family History of - hemoglobinopathies, enzyme deficiency, RBC defects; Sxs - abdominal distention, delayed passage of meconium, light-colored stools, dark urine, low Apgar scores, weight loss, vomiting; kernicterus - lethargy, poor feeding, high-pitched cry, hypertonicity, seizures; jaundice may be cephalopedal; check for signs of - infection, congenital malformations, cephalohematomas, bruising, pallor, petechiae, hepatomegaly
Q410. Neonatal Jaundice - Dx
A410. CBC; periph blood smear; blood type mom and baby; Coombs' test; bilirubin levels; direct hyperbilirubinemia - LFTs; bile acids; Blood culture; sweat test; tests for aminoacidopathies & a1-antitrypsin deficiency; Sepsis w/u and ICU - jaundice, febrile, hypotensive and/or tachypneic
Q411. Neonatal Jaundice - Tx
A411. Tx underlying cause; unconjugated - severe - exchange transfusion; if mild - phototherapy, start earlier for premies (start at 10- 15 mg/dL)
Q412. Down Syndrome - What is it
A412. Trisomy 21, MC chromosome disorder; #2 cause of congenital MENTAL RETARDATION; risk increased with mom's age, but 80% of kids are born to women < 35 y/o; flat facial profile; prominent epicanthal folds; simian crease; decreased levels of AFP; brushfield spots; duodenal atresia - double bubble on US/XR; congenital heart disease - septum primum-type ASD due to endocardial cushion defect; Alzheimer's > 35 y/o; increased risk of ALL; meiotic nondisjunction
Q413. Edwards' Syndrome - What is it
A413. Trisomy 18 (election age=18); severe MENTAL RETARDATION; rocker bottom feet; low-set ears; micrognathia; congenital heart disease; clenched hands; prominent occiput; death usually < 1 y/o
Q414. Patau's Syndrome - What is it
A414. Trisomy 13 (puberty=13); severe MENTAL RETARDATION; microphthalmia; microcephaly; cleft lip/palate; abnormal forebrain; polydactyly; congenital heart disease; death usually < 1 y/o
Q415. Klinefelter's Syndrome - What is it
A415. XXY (male); inactivated X (Barr body); 1 of MCC of male hypogonadism testicular atrophy; eunuchoid body shape, long extremities; gynecomastia; female hair distribution
Q416. Turner' Syndrome - What is it
A416. XO (No Barr body); short stature; ovarian dysgenesis; webbing of neck; cystic hygroma; coarctaton of aorta; MCC of primary amenorrhea
Q418. Phenylketonuria (PKU) - What is it
A418. Phenylalanine => tyrosine; In PKU, decreased phenylalanine hydroxylase or tetrahydrobiopterin cofactor; tyrosine becomes essential; phenylalanine builds up => excess phenylketones, phenylketones - phenylacetate, phenyllactate, phenylpyruvate; MENTAL RETARDATION; fair skin; eczema; musty body odor; screened for at birth; Tx - decreased phenylalanine (in Nutrasweet) and increased tyrosine in diet
Q419. Fabry's Disease - (lysosomal storage disease); What is it
A419. X-linked recessive; defect of a-galactosidase A; ceramide trihexoside accumulates; renal failure
Q420. Krabbe's Disease - (lysosomal storage disease); What is it
A420. AR (autosomal recessive); deficiency of B-galactosidase; galactocerebroside accums; in the brain; optic atrophy; spasticity; early death
Q422. Niemann-Pick Disease - (lysosomal storage disease); What is it
A422. AR; deficiency of sphingomyelinase; sphingomyelin and cholesterol; build up in reticuloendo-; thelial & parenchymal cells; cherry-red spot on macula; death by age 3
Q423. Tay-Sachs Disease - (lysosomal storage disease); What is it
A423. AR; absence of hexosaminidase A; GM2 ganglioside accums; cherry-red spot on macula; death by age 3; MC lysosomal storage disease; that causes MENTAL RETARDATION
Q424. Metachromatic leukodystrophy - (lysosomal storage disease); What is it
A424. AR; deficiency of arylsulfatase A; sulfatide accums in brain,; kidney, liver, periph n.
Q425. Hurler's Syndrome - (lysosomal storage disease); What is it
A425. AR; deficiency of a-L-iduronidase; corneal clouding; MENTAL RETARDATION
Q426. Hunter's Syndrome - (lysosomal storage disease); What is it
A426. X-linked recessive; deficiency of iduronate sulfatase; mild form of Hurler's; no corneal clouding; mild MENTAL RETARDATION
Q427. Fragile X Syndrome - What is it
A427. X-linked; 3rd MCC of MENTAL RETARDATION; FMR1 gene affected; anticipation; triple repeat of CGG; autism; large testes, jaw, ears; floppy/prolapsed mitral valve
Q428. APGAR Score - Chart
A428. Appearance - skin color 0 = blue all over, 1 = blue at extremities, 2 = normal; Pulse - 0 = none, 1 = < 100, 2 = > 100; Grimace - reflex irritability, 0 = none, 1 = grimace, feeble cry, 2 = sneeze, cough, pull away; Activity - muscle tone, 0 = none, 1 = some flexion, 2 = active movement; Respiration - 0 = none, 1 = weak or irreg, 2 = strong
Q429. APGAR Score - What do total scores mean
A429. Score at 1 min. after birth; then at 5 min. score 8-10 - good cardiopulm adaptation; score 4-7 - possible need for resus; observe; stimulate; possible need for vent support; score 0-3 - resus immed
Q431. Erythema Infectiosum - (Fifth Disease); Complications
A431. Arthritis; hemolytic anemia - aplastic crisis in sickle cell; encephalopathy; associated c hydrops fetalis
Q432. Measles - Cause; Characteristics
A432. Paramyxovirus; prodrome - low-grade fever; conjunctivitis; coryza; cough; Koplik's spots - buccal mucosa after 1-2 days; maculopap rash from ears down
Q433. Measles - Complications
A433. Giant cell pneumonia; otitis media; laryngotracheitis; rare - subac scleros. panencephalitis
Q436. Roseola Infantum - Cause; Characteristics
A436. HHV-6; prodrome - acute onset of high fever; no other Sxs for 3-4 days; maculopap rash as fever breaks; starts on trunk; => face and extremities; often lasts < 24 hrs
Q437. Roseola Infantum - Complications
A437. Rapid fever onset =>; febrile seizures
Q438. Rotavirus - Characteristics
A438. Primary cause of diarrhea; in kids < 2; fever and vomiting; then diarrhea; upper respiratory Sxs; lasts < 1 wk; infection confirmed by Elisa; oral rehydration sufficient
Q440. Varicella - Complications
A440. In immunocompromised kids - progressive varicella with; meningoencephalitis; and hepatitis; congenital infections =>; congenital anomalies
Q442. Varicella Zoster - Complications
A442. Encephalopathy; aseptic meningitis; pneumonitis; TTP; Guillain-Barre; cellulitis; arthritis
Q443. Hand-Foot-and-Mouth Disease - Cause; Characteristics
A443. Coxsackie A; prodrome - fever; anorexia; oral pain; rash - oral ulcers; maculopap vesicular rash on; hands, feet, buttocks
Q444. Hand-Foot-and-Mouth Disease - Complications
A444. None; (self-limited)
Q445. Tracheoesophageal Fistula - What is it
A445. Tract between trachea & esoph; associated with esoph atresia; & VACTERL anomalies - vertebral; anal; cardiac; tracheal; esophagus; renal; limb
Q446. Tracheoesophageal Fistula - Caused by; Presentation
A446. Polyhydramnios in utero; increased oral secretion; inability to feed; gagging; respiratory distress
Q447. Tracheoesophageal Fistula - Dx
A447. CXR after NGT; air in GI tract; bronchoscopy - to confirm
Q448. Tracheoesophageal Fistula - Tx
A448. Surgical repair
Q449. Congenital Diaph Hernia - What is it
A449. GI tract segment protrudes; thru diaph into thorax; 90% are post. lt. Bochdalek
Q450. Congenital Diaph Hernia - Presentation
A450. Respiratory distress from - pulmonary hypoplasia; pulmonary HTN; sunken abdomen; bowel sounds over; lt. hemithorax
Q451. Congenital Diaph Hernia - Dx
A451. US in utero; postnatal CXR - to confirm
Q452. Congenital Diaph Hernia - Tx
A452. Hi-freq ventilation or; extracorporeal membrane; oxygenation (ECMO); (to manage pulmonary HTN); surgical repair
Q453. Gastroschisis - What is it
A453. Herniation of intestine; thru abdominal wall; next to umbilicus; (usually on right); with no sac
Q454. Gastroschisis - Caused by; Associated with
A454. Polyhydramnios in utero; often premie; associated with - GI stenoses; GI atresia
Q455. Gastroschisis - Tx
A455. Surgical emergency; single-stage closure possible; in only 10%
Q456. Omphalocele - What is it
A456. Herniation of abdominal viscera; thru abdominal wall; at umbilicus; into sac covered by; peritoneum and amniotic memb
Q457. Omphalocele - Caused by; Associated with
A457. Polyhydramnios in utero; often premie; associated with; other GI & cardiac defects
Q458. Omphalocele - Tx
A458. C-section - to prevent sac rupture; if sac intact - postpone surg correction; until patient fully resuscitated; keep sac covered/stable; with petroleum & gauze; intermittent NG suction - to prevent abdominal distention
Q459. Duodenal Atresia - What is it
A459. Complete or partial failure; of duodenal lumen; to recanalize; during gestational wks 8-10
Q460. Duodenal Atresia - Presentation; Caused by; Associated with
A460. Bilious emesis within hrs; after 1st feeding; polyhydramnios in utero; associated with - Down's; other cardiac/GI anomalies:; annular pancreas; malrotation; imperforate anus
Q461. Duodenal Atresia - Dx
A461. Double-bubble sign on XR; (prox to site of atresia)
Q462. Duodenal Atresia - Tx
A462. Surgical repair
Q463. Meckel's Diverticulum - What is it
A463. MC congenital GI tract anomaly; vestigial remnant; of omphalomesenteric duct; rule of 2's - 2x's as many males; 2 ft. from ileocecal valve; 2% of people affected; 2 types of mucosa - gastric; pancreatic
Q464. Meckel's Diverticulum - Presentation
A464. MC presentation - painless rectal bleeding; painful diverticulitis; intest. obstruction from - intussusception or volvulus
Q465. Meckel's Diverticulum - Dx
A465. Meckel's scan - for ectopic gastric mucosa; uses IV technetium; pertechnetate
Q467. Hirschsprung's Disease - (Congenital Aganglionic Megacolon); What is it
A467. Absence of autonomic; innervation of bowel wall; inadeq relaxation; and peristalsis; => intest. obstruction
Q468. Hirschsprung's Disease - (Congenital Aganglionic Megacolon); Presentation
A468. Abdominal distention; bilious vomiting; fail to pass meconium in; 1st 24 hrs of life
Q469. Hirschsprung's Disease - (Congenital Aganglionic Megacolon); Dx
A469. Barium enema - dilated prox segment; narrowed distal segment; rectal Bx - to confirm
Q470. Hirschsprung's Disease - (Congenital Aganglionic Megacolon); Tx
A470. Colostomy prior to; corrective surgery
Q471. Hypospadias - What is it
A471. Abnormal urethral opening; on ventral surface of penis; due to incomplete dev of; distal urethra
Q472. Hypospadias - Presentation; Associated with
A472. Chordee; associated with - hernias; cryptorchidism
Q473. Hypospadias - Tx
A473. Circumcision contraindicated; surgical repair uses; preputial tissue
Q629. how long can undescended testis remain undescended before you need to bring them down?
A629. one year
Q481. DiGeorge Syndrome; (Thymic aplasia) - What is it
A481. CATCH-22; Cardiac defects; Abnormal facies; Thymic hypoplasia; Cleft palate; Hypocalcemia; 22 - microdeletions in chrom22; tetany in first days of life
Q482. DiGeorge Syndrome; (Thymic aplasia) - Dx
A482. Absolute lymphocyte count,; mitogen stimulation response; and delayed hypersensitivity; skin testing
Q483. DiGeorge Syndrome; (Thymic aplasia) - Tx
A483. BMT - if severe; IVIG; thymus transplant
Q484. Ataxia-Telangiectasia - What is it
A484. DNA repair defect; oculocutaneous telangiectasias; progressive cerebellar ataxia
Q485. Ataxia-Telangiectasia; Tx
A485. No effective Tx for CNS abnorm; neuro deterioration progresses; death by 30 y/o
Q486. Severe Combined; Immunodeficiency (SCID) - What is it
A486. Severe lack of B & T cells; frequent severe bacterial infections; chronic Candidiasis; opportunistic organisms
Q487. Severe Combined; Immunodeficiency (SCID) - Tx
A487. BMT or stem cell transplant; IVIG; PCP prophylaxis until BMT; gene therapy may be; future option
Q488. Wiskott-Aldrich Syndrome - What is it
A488. X-linked recessive; T & B cell dysfunction; thrombocytopenia; small-sized platelets; eczema; high IgE; high IgA; low IgM; bloody diarrhea; bleeding gums; prolonged nosebleeds
Q489. Wiskott-Aldrich Syndrome - Tx
A489. Protective helmet; IVIG; aggressive Antibiotics for infections; HLA-identical BMT; if no BMT - rarely survive to adulthood
Q490. Chronic Granulomatous Disease-; (CGD); What is it
A490. X-linked or AR; deficient superoxide production by PMNs & M0s; usual sites of infection - skin, lungs (pneumonia), lymph nodes, liver (abscesses, hepatitis), bones (osteomyelitis); swollen collections of infected tissue obstruct intestines (IBD) and urinary tract (UTIs)
Q491. Chronic Granulomatous Disease-; (CGD); Dx
A491. Absolute neutrophil count and adhesion assays - chemotaxic, phagocytic, bactericidal; diagnostic - negative nitroblue tetrazolium dye reduction test (NBT)
Q492. Chronic Granulomatous Disease-; (CGD); Tx
A492. Daily TMP-SMX; judicious Antibiotics use during infections; IFN-g - can decreased incidence of serious infection
Q493. Chediak-Higashi - What is it
A493. AR; giant lysosomal granules dev. in neutrophils lysosomes can't fuse with phagosomes => ingested bact. can't be lysed; oculocutaneous albinism; neuropathy; neutropenia
Q494. C1 Esterase (Inhib) Deficiency - (Hereditary Angioedema); What is it
A494. C1 inhibitor - acute phase protein inhibits proteinases of: complement pathway, clotting pathway, kinin generator pathway, fibrinolytic pathway; deficiency => hereditary angioedema; AD; can affect - hands & feet - local edema, bowel - extreme abdominal pain, mouth/airway - life-threatening edema; usually lasts 3 days; can be precipitated by trauma, virus; aggravated by stress
Q495. C1 Esterase (Inhib) Deficiency - (Hereditary Angioedema); Dx
A495. Total hemolytic C' assay- CH50; if defect in one component - no CH50 reduction, then detect which component
Q496. C1 Esterase (Inhib) Deficiency - (Hereditary Angioedema); Tx
A496. Daily prophylactic danazol; purified C1 esterase and FFP - prior to surgery
Q497. Terminal Complement Deficiency; (C5-C9) - What is it
A497. AR; recurrent N. meningitides & disseminated gonorrhea infections; rarely - systemic lupus
Q499. Hyper IgM Syndrome - What is it
A499. MC - deficiency in CD40 ligand in T Helper => can't class switch; normal or high IgM; low IgG, IgA, IgE; XL recessive (most common), AR (others); severe upper & lower respiratory; diarrhea - Cryptosporidium
Q500. Hyper IgM Syndrome - Tx
A500. IVIG; PCP prophylaxis - TMP-SMX
Q501. What is the most common cause of bowel obstruction in the first two years of life?
A501. Intussusception
Q502. What is the classic triad for intussusception
A502. Abdominal pain, vomiting, blood per rectum
Q503. Red currant-jelly stools are indicative of what?
A503. Intussusception
Q504. What is diagnostic for intussusception
A504. Air-contrast barium enema
Q505. The string sign on a barium study indicates what?
A505. Pyloric stenosis
Q506. What type of acid/base abnormality can occur with persistent emesis, such as that seen with pyloric stenosis?
A506. Hypochloremic, hypokalemic metabolic alkalosis
Q507. What type of immunodeficiency presents after six months of age with recurrent sinopulmonary, GI, and urinary tract infections with encapsulated organisms (H. influenzae, Streptococcus pneumoniae, Neisseria meningitidis)?
A507. B-cell deficiencies
Q508. What immunodeficiency is seen in boys only and presents with frequent pseudomonas infections?
A508. X-linked agammaglobulinemia (Bruton's)
Q509. With what immunodeficiency will there be a drop in immunoglobulin levels to the 20s and 30s, increased pyogenic upper and lower respiratory diseases, and increased risk of lymphoma and autoimmune disease?
A509. Common variable immunodeficiency
Q510. What is the most common immunodeficiency
A510. IgA deficiency
Q511. What does CATCH-22 stand for in DiGeorge syndrome?
A511. Congenital heart disease,; Abnormal facies,; Thymic aplasia,; Cleft palate,; Hypocalcemia,; 22q deletion
Q512. With what immunodeficiency syndrome will patients have increased infections with fungi and PCP?
A512. Thymic aplasia; (DiGeorge syndrome)
Q513. With what immunodeficiency will patients present with cerebellar ataxia and increased incidence of non-Hodgkin's lymphoma and gastric carcinoma?
A513. Ataxia-telangiectasia
Q530. What are the acute-phase manifestations of Kawasaki disease? Hint: Crash and Burn
A530. Conjunctivitis,; Rash,; Adenopathy,; Strawberry tongue,; Hands and feet (red, swollen, flacky skin),; AND Burn=fever >40 for 5 days
Q531. What is the treatment for Kawasaki disease?
A531. High-dose aspirin and IVIG
Q532. What treatment is contraindicated with Kawasaki disease?
A532. Corticosteroids; (may increase aneurysm formation)
Q533. Untreated patients with Kawasaki disease are at risk for what complications?
A533. Coronary artery aneurysms and MI
Q534. What disease is defined as an acute inflammatory illness of the small airways that primarily affects infants and children under 2?
A534. Bronchiolitis; (RSV most common)
Q535. What disease is characterized by the classic barking cough (usually at night)?
A535. Croup; (Laryngotracheobronchitis)
Q536. What is the steeple sign?
A536. Subglottic narrowing of the airway,; commonly seen with Croup
Q537. With what disease will patients age 3-7 present with muffled voice and drooling?
A537. Epiglottitis
Q538. The thumbprint sign on lateral film is characteristic of what?
A538. Epiglottitis
Q539. What three organisms commonly cause otitis media?
A539. S.pneumoniae,; H.influenzae,; Moraxella catarrhalis
Q540. What disease is characterized by a slapped-cheek rash that is worse with fever and sun exposure?
A540. Erythema infectiosum,; caused by Parvovirus B19
Q541. What disease has an acute onset of high fever followed by a maculopapular rash that appears as the fever breaks?
A541. Roseola infantum (HSV-6)
"Q542. An abdominal radiograph showing the ""double-bubble"" sign indicates what?"
A542. Duodenal atresia
Q543. What is the most common cause of respiratory distress in infants?
A543. Respiratory distress syndrome
Q544. Ground-glass appearance and air bronchograms on CXR in an infant indicate what disease?
A544. Respiratory distress syndrome
Q545. What are the five Ts and 1P of cyanotic heart disease?
A545. 1. Truncus arteriosus; 2. Transposition of the great arteries; 3. Tricuspid atresia; 4. Tetralogy of Fallot; 5. Total anomalous pulmonary venous return 6. Pulmonary atresia
Q546. What congenital heart defect presents with a harsh holosystolic murmur heard best at the lower left sternal border?
A546. VSD
Q547. What congenital heart defect presents with a wide and fixed split S2 and a systolic ejection murmur heard best at the upper left sternal border?
A547. ASD
Q548. What drug is given to close a patent ductus arteriosus?
A548. Indomethacin
Q551. household and sex contacts of kids/teens with hepatitis A should receive what?
A551. immunoglobulin to prevent hep A
Q552. intracranial trauma without obvious external findings in baby; think?
A552. shaken baby syndrome
Q553. person who gets hives after bee sting. what NSiM?
A553. give Epi-pen at all times (bc had systemic reaction) as well as give prescription for diphenydramine
Q555. urinalysis of > 1.015 makes what highly unlikely?
A555. diabetes insipidus
Q556. primary vs secondary enuresis
A556. secondary = bedwetting after 3 or more months of dry nights;; is usually due to psych factors or changes
Q557. therapy for child over 6 with enuresis?
A557. consider conditioning therapy with bedwetting alarm (works in 30-60%)
Q558. any UTI in baby with vomiting and dehydration, think? caused by? tx with ? what follow up tests?
A558. pyelonephritis;; e coli; ceftriaxone; need to follow up ANY UTI in girl under 5 and any boy, with renal US and VCUG to rule out v-u reflux
Q559. rash post GAS pharyngitis, think?
A559. Scarlet fever!
Q560. boggy mass on scalp? tx?
A560. most likely kerion = inflammatory form of tinea capitis (Trich. tonsurans or Microsporum canis). tx = 8-12 weeks oral griseofulvin and shampooing with selenium sulfide
Q561. oral, feet, and mouth ulcers, think?
A561. hand foot and mouth disease!; coxsackie A16
Q562. ehrlichosis contracted how?
A562. by tick bite
Q563. adults with e. infectiousum may also have what sx?
A563. ARTHROPATHY
Q564. parvovirus B19 ( slapped cheek/ E. infectiousum )in hemolytic anemias may cause?
A564. aplastic anemia
Q565. high and persistent fever that is not very responsive to normal doses of paracetamol; with red cracked lips and red mucous membranes?
A565. kawasaki's disease
Q566. swelling of one eyelid + proptosis, limited ocular movements?
A566. orbital cellulitis;; if just swelling of eyelid think periorbital cellulitis
Q567. 1 y/o black baby solely breastfed may develop?
A567. ricketts due to VitD def in breast milk and poor skin conversion of vit D
Q568. torsion of testicular appendix vs torsion of testicle?
A568. Torsion of testicle: in kids over 12; testicular appendix: in kids 2-11
Q569. acute pain in scrotum of sexually active teen, think?
A569. epididymitis
Q570. m/c pathogens of otitis media?
A570. S pneum,; H influ,; M catarrhalis
Q630. MC type of Ambiguous genitalia
A630. Congenital Adrenal Hyperplasia; (21-hydroxylase deficiency is the MC of the CAH)
Q571. what constitutes increased risk for post-traumatic seizure? what % get? tx if these?
A571. depressed cranial fracture; intracranial hemorrhage; cerebral contusion; or unconscious > 24 hrs. 75% of these will seizure; so must tx with anticonvulsants prophylactically
Q572. main pathogen causing croup? epiglotitis?
A572. parainfluenza;; s pneum,; aureus or GBS; H influenzae in non vaccinated
Q573. cow milk feeding causes?
A573. iron def anemia!
Q574. hirsutism, deepened voice, acne, clitoromegaly, think?
A574. CAH
Q575. can you have allergic rhinitis that presents with rhinitis with NO seasonal variation?
A575. YES = perenial allergic rhinitis ie exposure to house dust, pet danders that are there year round
Q576. bilateral PURULENT discharge with fever, cough, sinus tenderness?
A576. sinusitis
Q577. 3 common pathogens in human bites?
A577. eikenella corrodens; peptostreptococcus; alpha streptococcus
Q578. during Antibiotics tx , diaper rash due to?
A578. candida dermatitis!
Q579. m/c cause of round pneumonia?
A579. strep pneumonia
Q580. HUS is most common in what age?
A580. under 2 y/o's!
Q581. live vaccines?
A581. MMR; varicella
Q582. Guillan Barre has what CSF finding?
A582. increased protein;; mild mononuclear pleocytosis (<10 cells/ml)
Q583. when do you treat lead poisoning with chelation?
A583. only if levels over 45 ug/mL !; otherwise just treat by removing source, ie investigating house for lead content, etc
Q584. name 4 advantages of OPV? 1 of IPV?
A584. OPV:; costs less; increased mucuosal immunity; fewer shots; herd immunity through secondary transmission; still recommended for global polio eradication; IPV: less paralytic polio
Q585. m/c cause of HTN in kids?
A585. secondary (not essential) Renal causes!! ie infection, PCKD, glomerulonephritis, vascular anomalies, tumors
Q586. 2 tx's for Increased ICP
A586. intubation with hyperventilation; Mannitol to induce osmotic shift
Q587. after what type of wounds/pts do you give Td, vs Td + Tet Immune Globulin, vs DTaP?
A587. DTaP: give only in kids under age 7; Td only: if patient has had < 3 immunizations or status unknown AND: minor wound w/o contamination; Td + TIG: if patient has had < 3 immunizations or status unknown AND contaminated wounds
Q588. only 2 exceptions to IC kids NOT receiving varicella vacc (b/c it is live)
A588. ALL kid in remission with lymphocyte count over 700;; HIV infected kid in CDC class I =CD4 lymphocytes>25%. All other immunodeficiencies, don't give!!
Q589. live viruses not to be given to ?
A589. IC pts (see exceptions above) or pregnant women
Q590. m/c organism causing ANY otitis externa?
A590. P. aeruginosa
Q591. causes of intoeing?
A591. adducted great toe,; metatarsus adductus,; medial tibila torson,; femoral anteversion
Q592. m/c back deformity in kids?
A592. idiopathic scoliosis
Q593. tx of b pertussis?
A593. e-mycin
Q594. hacking cough + absolute lymphocytosis, + thick, clear n/p mucus?
A594. think b pertussis
Q595. TCA poisoning?
A595. anticholinergic sx,; mental status changes,; arrhythmias
Q596. otherwise normal 7 y/o with hypospadias. What next step in tx?
A596. renal US to check for enlarged prostatic utricle which predisposes to UTI's
Q597. snuffles =?; acral rash?
A597. mucocutaneous lesions producing persistent, purulent, often bloody nasal discharge!!; acral = on extremities ie hands and feet = syphilis
Q598. febrile seizures do/don't increase risk for epilepsy?
A598. DO! but by only 7%
Q599. painful swollen fingers and toes for 2 days?
A599. think sickle cell hand-foot syndrome
Q600. most common manifestation of sickle cell disease?
A600. acute PAINFUL episodes ie in legs, arms, in younger kids;; head, chest, back, abdomen in older kids
Q601. shortness from GH deficiency usually shows by how many yrs?
A601. 3 yrs old!
Q602. chest pain in young 12 y/o girl athlete during exercise?
A602. asthma!; give inhaled albuterol
Q603. 5 days of high fever; bilateral bulbar non-exudative conjunctivitis, rash, hand and foot edema-->desquamation, strawberry tongue and mouth erythema, cervical lad?
A603. kawasaki's!
Q604. m/c cyanotic heart disease in newborn?
A604. Transposition!
Q622. Newborn eye:; lens opacity
A622. Cataracts; (possible Galactosemia)
Q623. Newborn eye:; Aniridia and hemihypertrophy (one side of body larger then other)
A623. Wilms Tumor
Q624. Dx:; blue baby pinks up on crying; confirmatory test?
A624. Choanal Atresia; test: Catheter doesn't pass thru nose
Q625. MC abdominal mass in newborn
A625. Polycyctic Kidney disease
Q626. when should an umbilical hernia close?
A626. by 5 months
Q627. which has a sac--Omphalocele or Gastroschisis?
A627. Omphalocele; ("O" is like a closed sac)
Q628. what should be avoided in a patient with Epispadias or Hypospadias?
A628. do NOT circumsize
"Q691. Dx:; High fever, tonsil bulges, uvula deviates to non-involved side, ""hot potato voice""; Bug?; Tx? (2 together)"
A691. Peritonsillar Abscess; bug: Group A Strep; Tx:; 1. Drain abscess; 2. Penicillin (Erythromycin if allergy)
Q693. Dx:; High fever, sore throat and ulcers scattered on the soft palate, tonsils and pharynx, plus similar lesions on palms and soles
A693. Hand-Foot-and-Mouth disease; (Coxsackievirus)
Q694. Dx:; child with sudden onset respiratory distress, wheezing; hyperinflated lung on one side and tracheal deviation to the opposite side
A694. Foreign body aspiration
Q695. Dx:; 4 year-old that presents with a Barking cough with Inspiratory stridor; Dx Test?; Tx? (2 together); Tx if advanced or an emergency?
A695. Croup (Parainfluenza virus); Test: P/A neck film: STEEPLE SIGN; Tx:; (1) Humidified air; (2) Steroids beneficial; Emergency: Racemic Epinepherine
Q696. Dx:; Dysphagia, Drooling, muffled voice, leaning forward to maximize air entry; Bug?; Dx test?; Tx? (2)
A696. Epiglottitis (EMERGENCY); Cause: H. flu type b (HIB); Dx Test: Lateral Neck: THUMBPRINT SIGN; Tx:; (1) Secure Airway: CHERRY RED EPIGLOTTIS (seen w/ intubation); (2) antibiotics
Q697. Dx:; patient less then 2yo had a cold, then Wheezing, rales, tachypnea, Accessory muscles are used during respiration; MCC?; Dx test? (2); Prevention (for those predisposed)?
A697. Bronchiolitis; MCC: RSV; Dx test:; (1) Rapid assay from Nasal secretions; (2) CXR (Hyperinflation); Prevention: Palivizumab - Monoclonal antibodies
Q698. MCC of death in 1 - 12 month-old children
A698. SIDS
Q699. What are the (3) main Right-to-Left shunt developmental Heart disorders?
A699. 1. Tetralogy of Fallot;; 2. Transposition of the great vessels;; 3. Tricuspid Atresia
Q700. What are the (3) main Left-to-Right shunt developmental Heart disorders?
A700. 1. VSD; 2. ASD; 3. PDA
"Q701. What are the (3) main ""Mixed"" developmental Heart disorders?"
A701. 1. Truncus Arteriosus; 2. TAPVR; 3. Hypoplastic LH
Q702. Dx:; Continuous murmur w/ wide pulse pressure heard in the upper left sternal border; Tx?
A702. PDA; Tx: Indomethicin
Q703. Dx:; Apical Click followed by a late-systolic murmur
A703. Mitral Prolapse
Q704. Dx:; Holosystolic murmur best heard at the Apex
A704. Mitral Regurgitation
Q705. Dx:; Mid-diastolic murmur followed by opening Snap
A705. Mitral Stenosis
Q706. Dx:; Systolic ejection murmur best heard at the left upper sternal border and a mid-diastolic murmur at the lower left sternal border; Fixed S2
A706. ASD
Q707. Dx:; Loud harsh pansystolic murmur heard in the Lower left sternal border; What can it lead to?
A707. VSD (MC heart defect); Leads to: Eisenmenger's syndrome; (VSD shunt reverses right to left when the PVR exceeds the SVR)
Q708. Dx:; VSD shunt reverses right to left when the PVR exceeds the SVR
A708. Eisenmenger's syndrome
Q720. Dx:; watery to bloody Diarrhea, N/V, fever, possible neurologic Sx, caused by ingesting poultry or raw eggs; Tx?
A720. Salmonella; Tx: Hydration only (no Antibiotics - they prolong Disease)
Q721. Tx for diarrhea from Shigella
A721. TMP-SMX
Q722. Tx of diarrhea from Campylobacter
A722. Erythromycin
Q723. Tx for diarrhea from C. Difficile; (2 together)
A723. 1. Metronidazole; 2. Vancomycin
Q724. First test if suspecting Hirshprung's Disease; Diagnostic test?
A724. First: Barium Enema; Dx test: Colon Biposy
Q725. Dx:; chronic problem in infant consisting of cough, vomiting and apnea; Dx test?
A725. GERD; Dx test in infant: pH probe
Q726. Dx:; Bilious vomiting and Double-bubble sign on abdominal X- ray; What is it assoc with?
A726. Duodenal Atresia; assoc with: Down's Syndrome
Q727. Dx:; Nonbilious, Projectile vomiting; RUQ pain in infant; First Dx test?
A727. Pyloric Stenosis; first test: Ultrasound
Q728. what acid/base problem is seen with pyloric stenosis?
A728. Hypochloremic, Hypokalemic Metabolic Alkalosis
Q737. What is the MCC of Nephrotic syndrome in Pediatrics?; Tx?; Main possible Complication?
A737. Minimal Change Disease (MCD); Tx: Steroids; Complication: Spontaneous Peritonitis
Q739. MCC of Limping and hip problem in age 0 - 3 yo; Dx test? (2 together); Tx?
A739. Congenital Hip Dysplasia; Dx test:; 1. Ordalani or Barlows procedure (Hear a click on PE); 2. Ultrasound; Tx: Harness or Casting
Q740. MCC of limping in Age: 4 - 8 years (Begins as Painless limping leading to limping and pain); Dx test?
A740. Legg-Perthes (Avascular necrosis of femoral head); Dx test: Hip x-ray
Q741. MCC of hip problems in a > 11 year-old obese adolescent, that may complain of Knee pain; Dx Test? (2 together)
A741. Slipped Capital Femoral Epiphysis (Will externally rotate leg in an antalgic position); Dx Test:; (1) Hip x-ray; (2) Thyroid, LH and FSH (for obesity; think deficient gonads)
Q743. MC adolescent bone tumor. It occurs in a Metaphyseal area on the Distal Femur, Proximal Tibia or Proximal Humerus; what is seen on x-ray?; Who has an increased risk?
A743. Osteosarcoma; x-ray: Codman triangle (bony sclerosis); Inc risk: patients with Bilateral Retinoblastoma
"Q745. Dx:; Bone tumor causing ""onion-skinning"" of mid-shaft of femur; what chromosomal problem?"
A745. Ewing's Sarcoma; chromosome: t(11;22)
Q819. Dx:; A child presents with a rash that began on his neck and then spread to his trunk. On exam, you notice both new and old vesicles in the same area
A819. Varicella (Chicken pox)
Q746. Dx:; A child presents with recurrent episodes of non-pitting edema on the skin (including swelling of eyelids and lips), GI tract and respiratory system and a family history of the same problem; C4 complement is low; What is the deficiency?; Genetics?; Tx?
A746. Hereditary Angioedema; Deficiency: C1 Esterase Inhibitor; Genetics: Autosomal Dominant; Tx: Epinepherine and airway (like for anaphylaxis)
Q747. Dx:; a male infant between the ages of 6 - 12 months presents with recurrent lung and sinus infections, especially pneumococcus and H.influenzae; All Immunoglobulins are Low and B-cells are low or absent; Tx?
A747. Bruton's Agammaglobinemia (X-linked recessive); Tx: replace IgG
Q748. Dx:; A newborn child presents with hypocalcemia, truncus arteriosus, Fishmouth, tetany and Micrognathia; What is deficient?
A748. DiGeorge syndrome; Deficiency: T-cells (from hypoplasia of 3rd and 4th pharyngeal pouches; thymus)
Q749. Dx:; Chorioretinitis, gingivitis, Granulomas in GI tract, Lupus syndromes; Recurrent Infections of Pneumonia, Abscesses, Lymphadenitis, Osteomyelitis, Bacterimia / Fungemia, and superficial skin infections (cellulitis and impetigo); Dx Test?; Tx?; Cure?
A749. Chronic Granulomatous Disease (Deficiency in a step of NADPH oxidase w/i cells; X-linked recessive); Dx Test: Nitroblue Tetrazolium dye reduction (NBT); Tx: Long-term TMP-SMX (or Dicloxacillin); Cure: Bone Marrow Transplant
Q750. What are the symptoms of Wiskott-Aldrich syndrome?; (5)*
A750. MENTAL RETARDATION. TExT:; Ig(M) deficient;; Recurrent respiratory infections;; Thrombocytopenia;; Eczema;; (x-linked recessive);; T and B-cell deficiency
Q757. What does a baby have a risk of contracting when born to a mother with SLE?
A757. Congenital Heart block
Q758. Immunizations:; 1. less then 1 month; 2. at 2 months; 3. at 4 months; 4. at 6 months
A758. 1. less then 1 month: (B) Hep-B; 2. at 2 months: (DHIP) DTP, HiB, IPV, Pneumo; 3. at 4 months: (BDHIP) Hep-B, DTP, HiB, IPV, Pneumo; 4. at 6 months: (DHP) DTP, HiB, Pneumo
Q759. Immunizations:; 1. at 15 months; 2. at 18 months; 3. at 4 - 6 years
A759. 1. at 15 months: (HeMP) HiB, MMR, Pneumo; 2. at 18 months: (BDIAV) Hep-B, DTP, IPV, Hep-A, Varicella; 3. at 4 - 6 years: (DIM) DTP, IPV, MMR
Q761. Dx:; Child presents with Fever (for at least 5 days) + 4 of 5 of following: Bilateral, non-purulent Conjunctivitis, Mucous membrane changes, hot red Tongue or red, cracked lips, Peripheral extremity changes, Edema or peeling of the skin on fingers, Rash (leather-like) and cervical lymph nodes; Dx test?; Tx? (2 together)
A761. Kawasaki Disease (Mucocutaneous LN syndrome); Dx test: Echocardiogram (rule-out possible Coronary Vasculitis or Anneurysm); Tx:; 1. Aspirin (not high dose); 2. IV-IgG therapy
Q762. Dx:; Child had a viral or Group A Strep infection, then later gets a rash from the Waist downward, Elbows downward and Face, in addition to Sx of Vomiting, Abdominal pain, Ileus, and possible Upper and Lower GI bleeding; Immuno problem?; Tx? (2 together)
A762. Henoch-Schoenlein purpura; Immuno problem: IgA-mediated Vasculitis; Tx:; (1) Supportive (recovery in 4 - 6 weeks); (2) Corticosteroids for GI Sx
Q763. MCC of iron deficiency in newborn?; in child 9 - 24 months?
A763. newborn: Low Birth Weight; 9 - 24 months: Diet
Q764. What can drinking cows milk before 1 year-old cause in an baby?
A764. Iron Deficiency Anemia from gastric bleeding
Q765. Dx;; Young child with pallor, scleral icterus and mild splenomegaly. CBC shows reticulocytosis, anemia with an Increased Mean Corpuscular Hemoglobin (MCH) concentration and indirect hyperbilirubinemia; Genetics?; What can Dx lead to?; Next Dx Test?; Tx? (2)
A765. Hereditary Spherocytosis; genetics: Autosomal Dominant; leads to: Aplastic Anemia (especially after parvovirus B-19); next Dx Test: OSMOTIC FRAGILITY TEST; Tx:; 1. Folic acid supplementation; 2. Splenectomy (in patient > 6yo)
Q766. What is the first test if you suspect you have a Sickle cell patient?; How is Sickle cell Diagnosis confirmed?; Ongoing Tx? (3)
A766. First test: CBC w/ peripheral smear; Dx test: Hemoglobin Electrophoresis; Tx:; 1. Prophylactic Penicillin; 2. Folate supplementation; 3. Hydration
Q767. Dx:; a patient w/ sickle cell begins to have pain in various areas of the body. Tx? (3 together)
A767. Sickle cell crisis; Tx:; 1. Oxygen; 2. IV fluids; 3. Analgesics (Narcotics)
Q768. Dx:; A 2 month-old develops Dactylitis (hand and foot swelling), vaso-occlusion causing Splenic and bone infarcts, multiple Infections
A768. Sickle cell anemia
Q769. Dx:; A child has Sx of Petechiae (that do not blanch), but patient appears well and possible bleeding of mucous membranes; very low platelet count; Bone marrow is normal (or an increase in Megakaryocytes); Tx? (3 together)
A769. Idiopathic Thrombocytopenia (ITP); Tx:; (1) IV-IG; (2) Steroids (must do bone marrow first); (3) Anti-D globulin
Q770. What (2) coagulopathies present with:; Normal PT,; Normal PTT,; High Bleeding time; What else in blood work differentiates the two?
A770. ITP and TTP; Both have low platelets, but TTP also has LOW RBC
Q809. At what age are solids introduced in an infant?; what is the average weight gain for a term infant per day?; when should they be 2x the original weight?; 3x?
A809. Solid foods: 4 - 6 months; Ave weight gain: 20-30g/day; 2x: 4 - 5 months; 3x: 12 months
Q810. What is the only vaccination that can cause a fever 7 days after it is given?
A810. MMR
Q811. when should a child's car seat start facing front?
A811. > 1 yo + > 10 kg
Q815. A child with sickle cell presents to your office with a fever. Next step?
A815. Immediately admit to hospital
Q816. A child with sickle cell presents with a stroke. Tx?
A816. Exchange Transfusion
Q817. What is the first sign of Nephrotic syndrome in a child?
A817. Pitting Edema of the extremities
Q818. Dx:; A child is involved in a MVA and presents with a HR that goes from 110 to 56 and BP that is 156/96, with irregular respirations.
A818. Increased ICP
Q826. in the steps of fluid management in children, when is the only time normal (0.9%) saline is given?; why is it given?; what is given the other times?
A826. 0.9% = Initial 20cc/kg Bolus (continue boluses until patient urinates, except for DKA...for them monitor vitals and neuro status); Given to Restore Intravascular Volume; 0.45% (1/2 normal) saline is used to correct dehydration and for maintenance fluids in a child
Q827. When is the earliest time to initiate testing for Type 2 DM in children?; How frequent do you test?; What is the best test?
A827. Age of Initiation: 10-yo or at onset of Puberty (whichever is first); Frequency: every 2 years; Test: Fasting Plasma Glucose
Q833. On physical examination, the infant is afebrile with stable vital signs. She can lift her head to 90 degrees, her eyes follow past the midline, she laughs, regards her own hand and has slight awareness of her mother. How old is she?
A833. 4 months
Q834. Dx:; A 5-year-old girl presents with a 3-day history of fever, dyspnea, and intermittent joint pain. She has a history of sore throat about 1 month ago. On physical examination, her temperature is 39.6 C (103.2 F), blood pressure is 94/60 mm Hg, pulse is 114/min, and respirations are 22/min. Her knees and elbow joints are swollen and tender to palpation. There is a grade III/VI diastolic murmur best heard at the apex. Multiple fine, pink macules are noted on her trunk. These macules are blanching in the middle. Tx?
A834. Rheumatic Fever; Tx: Penicillin
Q835. A 4-week-old infant presents with tachycardia, tachypnea, and poor weight gain. His arterial blood gas shows a pH of 7.34, a PaCO2 of 41 mm Hg, and a PaO2 of 74 mm Hg. A chest radiograph shows cardiomegaly. Echocardiography reveals a structurally normal heart, left ventricular dilatation, a left ventricular ejection fraction of 20%, and mild mitral and tricuspid regurgitation. What IV med is the best first step in management?
A835. Furosemide; (patient has CHF)
Q836. Dx:; A term male infant is found to be cyanotic shortly after birth and requires endotracheal intubation. On physical examination, his blood pressure is 68/34 mm Hg (equal in all four extremities), pulse is 180/min, and respirations are 32/min. His precordium is dynamic, has a grade III systolic murmur, and a single S2. Chest radiography shows a normal heart size and increased pulmonary vascular markings. An arterial blood gas on an FiO2 of 100% shows pH 7.34; PaCO2, 47 mm Hg; PaO2, 46 mm Hg
A836. Total Anomalous Pulmonary Venous Return; (characterized by the pulmonary veins forming a confluence behind the left atrium, and draining into the right atrium. Complete mixing takes place in the right atrium, with a right- to-left shunt through the foramen ovale to the left side of the heart)
Q837. Dx:; A 1-month-old baby boy has bloody diarrhea. No infectious agent is identified, but the baby is found to be profoundly thrombocytopenic. The baby is also noted to have a skin rash, and a dermatologist diagnoses eczema. By three months of age, the baby begins to develop recurrent respiratory infections. If this child survives until adolescence, he is at particularly high risk of developing what?
A837. Wiskott-Aldrich syndrome; can lead to: Lymphoma
Q847. A patient presents with painful ulcers on his penis. You think it is HSV. What is the Dx test?
A847. Tzanck preparation
Q848. what is the Dx test for RSV?
A848. Nasopharyngeal aspirate
Q849. Dx:; a 9-yo boy presents with increasing clumsiness, change in speech, wide-based unsteady gait, nystagmus and no DTRs. what heart problem can it lead to in the future?
A849. Friedrich Ataxia; leads to:; Hypertrophic Cardiomyopathy
Q850. Dx:; a 20-mo girl presents with loss of developmental milestones, repetitive movements and acquired microcephalopathy
A850. Rett syndrome
Q851. What is the confirmatory test for DMD?
A851. Muscle biopsy
"Q852. What type of exercise induces ""exercise-induced"" asthma?"
A852. High intensity, continuous, prolonged exercise; (ex: a 5-K run)
Q853. what deformities of the head are associated with congenital toxoplasmosis?; (2)
A853. 1. Microcephaly; 2. Hydrocephalus
Q854. What vitamin is most likely to cause a pseudotumor cerebri?
A854. Vitamin A
Q864. A 2-mo is admitted with constipation and an abdominal mass, fever, feeding poorly and vomiting for the past 2 days. A barium enema is ordered and shows Hirschprung's Disease. what is the most important next step?
A864. IV fluid hydration and IV antibiotics; (reestablish IV volume and prevent sepsis)
Q865. What (2) electrolyte disorders accompany Rhabdomyolysis?
A865. 1. Hyperphosphatemia (leading to...); 2. Hypocalcemia
Q866. What are the minor criteria of Rheumatic fever?; (5)
A866. FAILS:; 1. Fever; 2. Arthralgia; 3. Increased CRP or ESR; 4. Long PR interval; 5. Strep culture + or ASO+
Q867. what type of acid/base disorder do you see with a 2 day history of diarrhea?
A867. Hyperchloremic Normal Anion gap Acidosis; (loss of bicarb in the stool stimulates renal tubular reabsorption of chloride ions)
Q868. What (3) malignancies are associated with EBV?
A868. 1. Burkitt Lymphoma; 2. Hodgkin Disease; 3. Nasopharyngeal CA
Q869. What is the difference in AST/ALT initially between Hepatitis B and Hepatitis C?
A869. Hep B: AST/ALT in Thousands; Hep C: minimal or no elevation of AST/ALT
Q870. What electrolyte abnormality is commonly seen in a newborn macrosomic infant from a mother with diabetes?
A870. Hypocalcemia; (and hypomagnesemia)
Q905. what one sign is most suggestive of Primary TB?
A905. Hilar lymphadenopathy
"Q906. Dx:; a 15-yo boy presents with pain in the right knee, History of easy bruising and chronic fatigue. PE shows mild HSM. X-ray of femur shows ""Erlenmeyer Flask deformity."" Labs show anemia and thrombocytopenia. Bone marrow shows ""wrinkled paper"" appearance. Deficient enzyme?"
A906. Gaucher's Disease Type 1 (seen in adolescent ashkenazi jewish population); enzyme: Acid Beta-Glucosidase
Q996. Dx:; infant with Meningitis from Gonorrhea (meningococcemia) begins to get large purpuric lesions on flank
A996. Waterhouse-Friderichsen syndrome; (acute adrenal failure/hemorrhage from meningococcemia)
Q997. COD:; Meningococcemia
A997. Adrenal Failure/Hemorrhage; (from advancing to Waterhouse-Friderichsen syndrome)
Q998. Tx:; Homocystinuria
A998. Vitamin B6
Q999. Dx:; Beta-Galactosidase deficiency
A999. KraBBe's Disease
Hole in the wall b/w both atria
ASD
What are the muscles a child uses to assist in breathing?
Abdominal
Which muscle group protecting major organs is weaker in a pediatric patient than in an adult patient?
Abdominal
Best initial test for pyloric stenosis
Abdominal ultrasound
Why is a systolic ejection murmur heard w/ Truncus arteriosus?
Abnormal valve leaflets
Other than pneumonia, what can aspiration in the setting of esophageal atresia + TEF lead to?
Abscess formation from anaerobic proliferation
A component of an effective EMSC system is
Access to care
Associate the *Bird's beak sign* w/ its associated condition
Achalasia
102 degrees
Active cooling should be discontinued at...
Condition characterized by the acute loss of fluids and electrolytes in the stool due to underlying pathologic process
Acute diarrhea
Second most common cause of infant death worldwide
Acute diarrhea
Treatment of Herpes
Acyclovir + supportive care
An infant who "wasn't acting right" has a heart rate of 230 beats/min. He is awake but lethargic, and his skin is pale with delayed capillary refill. He has SVT, and vagal maneuvers do not convert the rhythm. Your partner has established vascular access. What is the initial treatment of choice for this child
Adenosine
0.1-0.2mg/kg
Adenosine dose
Endemic, year-round cause of viral infectious diarrhea
Adenovirus
With which age group is the paramedic most likely to encounter behavioral emergencies associated with alcohol or other drug use, eating disorders, depression, suicide and suicide gestures, sexually transmitted diseases, pregnancy, and sexual assault
Adolescent
When is surgical intervention indicated for umbilical hernia?
After age 4
When do umbilical hernias spontaneously close by?
Age 3 (90%)
Age group affected by Legg-Calvé-Perthes disease
Ages 2-8
Reasoning for psychiatric counseling in CAH patients
Aid w/ gender identity issues
X-ray findings associated w/ diaphragmatic hernia
Air fluid levels
The most common causes of cardiac arrest in infants and young children.
Airway and respiratory problems
Etiology of bronchitis
Airway inflammation of bacterial/viral origin
What is ALWAYS the wrong answer in the management of diarrhea and gastroenteritis?
Antidiarrheal compounds (loperamide)
Treatment of Diphtheria
Antitoxin
Which component of the pediatric assessment triangle assesses mental status, muscle tone, and body position?
Appearance
Yes
Are peds more at risk for a pneumothorax?
Yes
Are peds more prone to gastric distension?
Fetal circulation includes two umbilical ____ in the cord carrying ____ blood flowing from the fetus to the placenta
Arteries, Deoxygenated
A child with a gastric feeding tube develops respiratory distress. For what complication should you assess?
Aspiration
What is the purpose of a "doorway assessment?"
Assess the patient's urgency
1 year old
Asthma does not effect kids under...
Presentation of ASD
Asymptomatic + *fixed wide splitting of S2*
2/3 the width of the arm
BP cuff size
Larger
BSA to body weight ratio is...
Reflex characterized by toe extension
Babinski reflex
When does shoulder dystocia occur?
Baby's anterior shoulder gets stuck behind mother's pubic bone after delivery of the fetal head
Where do triscuspid and pulmonary lesions radiate to?
Back
Epiglottis
Bacterial infection of the upper airway that effects children 3-7 years old and has no seasonal preference.
Infection of the subglottic region. presents with copious thick secretions.
Bacterial tracheitis. What is it and how does it present?
Unable to be woken up. Does not recognize parents. Unable to console.
Bad signs of septic shock (3)
Management of recurrent stenosis in surgically treated coarctation of the aorta
Balloon dilation
Most accurate test that is both diagnostic and therapeutic in a patient w/ intussussception
Barium enema
Method of diagnosing small left colon syndrome
Barium study
How is congenital hip dysplasia diagnosed?
Barlow and Ortolani maneuvers
Most fatal type of skull fracture in the newborn
Basilar
Linear fracture to the floor of the skull
Basilar skull fracture is a
Most appropriate next step in management of: a 10.5 lb infant born to a mother with Type 1 DM, presenting w/ shaking, holosystolic murmur over precordium, right arm adducted/internally rotated, & ↑ bilirubin?
Blood sugar level
What is the most common type of diaphragmatic hernia?
Bochdalek diaphragmatic hernia
Effect of hypophosphatemia on bone
Bones weaken because adequate bone mineralization cannot take place
How does diaphragmatic hernia impair ventilation?
Bowel contents move into the chest
PE findings associated w/ diaphragmatic hernia
Bowel sounds in the chest
Injuries secondary to births with traction in the event of shoulder dystocia
Brachial palsy
In a distressed patient this may mean hypoxia and is an ominous sing of impending cardiac arrest.
Bradycardia
Mechanism of action of phototherapy in treatment of hyperbilirubinemia
Breaks down bilirubin to excretable components
Respiration in APGAR measures
Breathing
A 6 month old child has respiratory distress. What is the most likely cause of this complaint in this age group
Bronchiolitis
CXR findings w/ Whooping cough
Butterfly pattern
Definitive diagnostic test for VSD
Cardiac catheterization
Swelling of the soft tissues of the scalp that *does* cross suture lines
Caput succedaneum
Blanch the nail bed, base of the thumb, or sole of the foot. 2 seconds or less
Capillary refill
under 6 years
Capillary refill is considered a reliable sign of perfusion for ages...
Spinal cord roots affected by Duchenne Erb paralysis
C5-C6
Any of the several autosomal recessive diseases resulting in errors in steroidogenesis
CAH
Commonly tested syndrome associated w/ choanal atresia
CHARGE syndrome
Most diagnostic test to confirm choanal atresia
CT scan
What diagnostic test is rarely done in the setting of Croup and is always the wrong answer to the most appropriate next step?
CXR
What diagnostic test is rarely done in the setting of Epiglottitis?
CXR
Condition in which infant is born with a buccopharyngeal membrane between the nostrils and pharyngeal space that prevents breathing during feeding causing respiratory distress
Choanal atresia
Tetralogy of Fallot is associated w/ what?
Chromosome 22 deletions
Which component of the Pediatric Assessment Triangle is most affected by hypovolemia?
Circulation
W/ hypospadias, what is contraindicated?
Circumcision
What is done after suctioning the mouth and nose of a newborn?
Clamp and cut umbilical cord
A frantic mother calls you to check her son's central venous catheter because it is leaking. On arrival, you note that the catheter is cracked and leaking. The child's condition is stable. What action should you take?
Clamp the line
What is the steeple sign?
Classic CXR finding w/ RSV representing narrowing air column in trachea
Most common newborn fracture as a result of shoulder dystocia
Clavicular fracture
Best initial diagnostic test for Fifth disease/Erythema infectiosum
Clinical diagnosis
Best initial diagnostic test for Mumps
Clinical diagnosis
Best initial diagnostic test for Roseola
Clinical diagnosis
Best initial diagnostic test for Rubeola/Measles
Clinical diagnosis
How is bronchitis diagnosed?
Clinical diagnosis
How is diagnosis of Caput succedaneum & Cephalohematoma made?
Clinically
How is the diagnosis of Duchenne Erb paralysis made?
Clinically
How is the diagnosis of Scarlet fever made?
Clinically
How is the diagnosis of facial nerve palsy made?
Clinically
How is diagnosis of Epiglottitis made?
Clinically + radiology
How is the diagnosis of Croup made?
Clinically + radiology (if mild symptoms)
Most accurate diagnostic test for Wilms tumor
Contrast-enhanced CT
Classic presentation of Meckel's diverticulum?
Copious, painless, bright red rectal bleeding
Associate the *steeple sign* w/ its associated condition
Croup
Infectious upper airway condition characterized by severe inflammation
Croup
How is Diphtheria diagnosed?
Culture of superficial membrane
Treatment of galactosemia
Cut out all lactose-containing products
A fairly late sign of respiratory failure and is most frequently seen in the mucous membranes of the mouth and nail beds. Peripheral _____ alone is more likely due to shock than respiratory failure
Cyanosis
Autosomal disorder causing abnormally thick mucus
Cystic fibrosis
A result of tiring and is not necessarily a sign of improvement. IT is an ominous sign and usually means tired
Decreasing respiratory rate
Cause of WAGR syndrome
Deletion on chromosome 11
Type of skull fracture that can cause further cortical damage without surgical intervention
Depressed
90+ 2(age) =systolic Highest 70+ 2(age) = Systolic Lowest 2/3 = diastolic
Determining BP
What do infants and children use to breath more than adults?
Diaphragm
Although pedi's have a tidal volume proportionally similar to adolescents and adults. They require ___ ____ _____? Due to this and less oxygen store they are more susceptible to hypoxia.
Double the metabolic oxygen
Genetic condition associated w/ Hirschsprung disease
Down syndrome
Genetic condition associated w/ imperforate anus
Down syndrome
What is done after clamping and cutting the umbilical cord?
Dry, wrap, and place newborn under warmer
Rationale for antibiotic coverage against anaerobes in the setting of esophageal atresia + TEF
Due to high risk of lung abscess formation secondary to aspiration
Most common complaint w/ varicocele
Dull ache + heaviness in the scrotum
Condition in which a lack/absence of apoptosis leads to improper canalization of the lumen of the duodenum
Duodenal atresia
What is the most likely diagnosis in: a 1-day-old child w/ dark green vomiting after 1st feeding, oblique eye fissues w/ epicanthic skin folds, single palmar crease, holosystolic murmur, double bubble sign on CXR?
Duodenal atresia
What is missing in sufficient quantities to make vitamin K in a neonate?
E.coli in neonate's colonic flora
______ has broadly advanced the state of pediatric emergency care nationwide. It has improved the availability of child-size equipment in ambulance and ED's; initiated hundreds of programs to prevent injuries; and provided thousands of hours oftraining to EMT's, paramedics, and other emergency meical care providors.
EMSC (Emergency Medical Services for Children)
Why is it important to use a "treat as you go" approach when treating children?
Each body system may adversely affect another body system causing an inaccurate assessment
Signs and symptoms of TAPVR w/ obstruction
Early in life w/, respiratory distress & severe cyanosis
Treatment of Truncus arteriosus
Early surgery
Best initial diagnostic test for VSD
Echocardiogram
Most accurate diagnostic test for Hypoplastic left heart syndrome
Echocardiogram
Best initial diagnostic test for PDA
Echocardiography
Most accurate diagnostic test for TAPVR without obstruction
Echocardiography
Omphalocele is associated w/ what?
Edwards syndrome (trisomy 18)
Process in which a left-to-right shunt caused by a VSD reverses into a right-to-left shunt due to hypertrophy of the right ventricle
Eisenmenger syndrome
What could a right ventricular hypertrophy from left-to-right shunting due to VSD eventually lead to?
Eisenmenger syndrome
Best initial therapy for volvulus
Emergent endoscopic decompression
Most effective therapy for volvulus (typically done when endoscopic decompression fails)
Emergent surgical decompression
Most common congenital heart defect in Down syndrome
Endocardial cushion defect of AV canal
You arrive on the scene of a four-year-old child who has fallen on the playground. The child is sitting on the ground with a teacher. The child is very upset; it appears he has a broken arm. What is the best position for you to be in when you begin interacting with the patient?
Ensure that you get to the child's level
IV: 0.01mg/kg 1:10,000 ET: 0.1mg/kg 1:1000
Epi dose: IV ET tube
There is stridor arrest, reduction in airflow, retractions.
Epi should be given for airway emergencies when....
Children's tracheas are shorter and narrower than adults'. What are some other parts of a child's airway which are proportionally different from an adult's?
Epiglottis and larynx
Higher than croup
Epiglottis will have a fever
Severe, life-threatening swelling of the epiglottis and arytenoids due to H. influenza type B
Epiglottitis
Truest medical emergency in pediatrics
Epiglottitis
_____ usually begins suddenly. Typically, the child goes to bed without any symptoms and wakes up complaining of a sore throat and pain on swallowing. The child may have a fever, muffled voice, and drooling from the potential saliva that occurs because difficult and painful swallowing
Epiglottitis Signs are: Drooling, Stridor, & Sudden onset of high fever & dysphagia
which drugs are appropriate for an unresponsive child who became bradycardic after endotracheal suctioning after cardiopulmonary resuscitation has been initiated
Epinephrine and Atropine
Opening of the urethra is found on the dorsal surface
Epispadias
Type of esophageal fistula present in 80-90% of cases
Esophageal atresia+ tracheoesophageal fistula (TEF)
Who receives the Hepatitis B vaccination?
Every child
Reasoning for sigmoidoscopy in the setting of gastroenteritis
Examine for pseudomembranes in setting of C. difficile
Rationale for hearing test
Exclude congenital sensory-neural hearing loss
What is the most likely diagnosis in: an unresponsive 6-month-old presenting w/ seizures, fever of 103℉ for the last 3 days, markedly delayed capillary refill, and blood pressure of 80/20?
Febrile seizure secondary to sepsis
The most common cause of new onset of seizure in children is _____
Fever
Electrolyte abnormalities associated w/ 11β-hydroxylase deficiency
Few
ABD thrusts
FBAO for a child older than 1 year...
5 back blows than 5 chest thrusts. check mouth after every round
FBAO for an infant....
Most accurate diagnostic test for syphilis
FTA-ABS or dark field microscopy
Paralysis of structures innervated by the facial nerve caused by trauma secondary to forcep use in delivery
Facial nerve palsy
When trying to help the newborn maintain body temperature, the majority of heat loss can be prevented by covering the newborn's
Head
You are responding to child who has fallen from a tree house. Which part of the child's body is most likely to hit the ground first due to anatomical differences?
Head
In a normal delivery, the paramedic should suction the infants mouth and nose with a bulb syringe after the
Head appears, between contractions
What is a sign of respiratory distress in a child
Head bobbing
What are some of the physiological changes that occur as a child develops?
Heart and respiratory rates; blood pressure increases
Which vital sign is the most reliable indicator of shock in a pediatric patient?
Heart rate
Condition in which the opening to the anus is missing and the rectum ends in a blind pouch w/ conservation of the sphincter
Imperforate anus
Cause of vitamin D-*dependent* rickets
Inability to convert 25-OH to 1,25(OH)2
What is the difference between the skeletal structure of a pediatric patient and an adult?
Incomplete calcification of the skeleton and weaker cartilaginous growth plates
Most common cause for elevated AFP
Incorrect dating
`The fontanelle may be tight and bulging, thus causing the pulsation to diminish or disappear. Common in head trauma or meningitis
Increased ICP fontanelle
Treatment of PDA
Indomethacin
Ingestions usually occur in
Infant, & Toddler
Febrile seizures usually occurs in
Infant, Toddler, & Preschoolers
Falls usually occur in
Infant, Toddler, & School-Age children
Age group affected by congenital hip dysplasia
Infants
Nose breathers
Infants are obligated....
Which age group is considered "obligate nose-breathers?"
Infants under 6 months old
Etiology of pharyngitis
Inflammation of pharynx + adjacent structures caused by *Group A β-hemolytic Streptococci*
Where is the absent testicle w/ cryptorchidism typically found?
Inguinal canal (90% of cases)
Cause of X-linked hypophosphatemic rickets
Innate kidney defect results in the inability to retain phosphate
Most common wrong answer in management of an IDM
Insulin therapy
Opsomyoclonus
Intermittent jerky eye movements + myoclonic jerks and cerebellar ataxia
Treatment of slipped capital femoral epiphysis
Internal fixation w/ pinning
Effect of 21-hydroxylase deficiency on sex development of girls
Virilized
Pathognomonic AXR findings for necrotizing enterocolitis
Pneumatosis intestinalis (air within bowel wall)
These are more common in children following barotrauma
Pneumothorax
Too much fluid secondary to fetus not swallowing
Polyhydramnios
W/ a Bochdalek diaphragmatic hernia, where is the defect?
Posterolateral
What is renal agenesis associated w/?
Potter syndrome
What is a risk factor associated with a higher incidence if SIDS
Premature birth and low birth weight
Drowning or near drowning usually occurs in
Preschooler & School-Age children
Which age group fears bodily injury & mutilation & interprets words literally
Preschoolers
Which type of ASD presents w/ concomitant mitral valve abnormalities?
Primum defect
Presenting symptom of pyloric stenosis
Projectile vomitus
What condition is not likely to cause seizures
Prolonged dehydration
Without an ASD, where would a LE clot embolize?
Pulmonary circulation
What is the most appropriate next step in management of: a 2-year-old child brought in for severe cough (seallike barking), fever, runny nose, respiratory distress, refusal to lie flat, positive steeple sign on CXR?
Racemic epinephrine
Appearance of rickets on CXR
Rachitic rosary-like appearance of costochondral joints w/ cupping & fraying of the epiphyses
Sign observed on upper GI series in pyloric stenosis characterized by *excess mucosa in the pyloric lumen resulting in 2 columns of barium*
Railroad track sign
How is pharyngitis diagnosed?
Rapid DNAse antigen detection test
Cardiac output is dependent on what?
Rate
Which exam strategy can help reduce anxiety in school-age children
Reassure them that they are not being punished
Grimace in APGAR measures
Reflex irritability
What can happen to a child's developmental age during a stressful situation?
Regression
Most important next step in diarrhea and gastroenteritis
Rehydration
Compression of the rib cage by passing through the mother's vaginal canal helps accomplish what?
Removal of fluid from the lungs
Prognosis of larger VSDs
Require surgical intervention
After IV administration of diazepam, you should monitor closely for
Respiratory Depression
A child's body will often mask injuries or illness due to compensatory rates. What are some of the vital signs affected by compensatory rates?
Respiratory and heart rates
What the the 5 minute APGAR score evaluate?
Response to resuscitative efforts
Goal of surgical intervention in TAPVR without obstruction
Restore proper blood flow
A 4 year old girl took 10 tricyclic antidepressant tablets. Her BP is 60 mm Hg, by palpation, P is 130/min, and she is drowsy. What intervention is indicated to improve her cardiac output
Sodium bicarbonate (1 mEq/kg)
Which anatomical difference causes children to be more susceptible to blunt trauma?
Soft chest wall
What is the difference between an adult chest wall and a pediatric chest wall?
Softer
What is a succussion splash?
Sound of stomach contents slapping into the pylorus
In the middle of the night with no prior infection
Spasmodic croup occurs....
Which of the following is an important quality about your voice that you should keep in mind when speaking to a pediatric patient?
Speaking calmly and quietly
Normal PE finding in transient polycythemia of the newborn
Splenomegaly
Treat these as fractures and immobilize them accordingly. Until children reach adolescence, they have softer more porous bones than adults.
Sprains and strains
AAP recommendations for vitamin D supplementation
Start at 2 months of age (in infants exclusively breastfeeding)
What is the most likely diagnosis in: a 5-year-old boy presenting w/ SOB on exertion, bluish hue to his lips after exertion, and squatting while playing outside during recess?
Tetralogy of Fallot
Why is surgical intervention indicated for umbilical hernia past age 4?
To prevent bowel strangulation and necrosis
Rationale for fluid resuscitation prior to surgery in the setting of esophageal atresia + TEF
To prevent dehydration
Why is early surgery critical in the treatment of Truncus arteriosus?
To prevent pulmonary hypertension
A 1-3 year old is most correctly referred to as a(n)
Toddler
8 years old
Uncuffed ET tubes should be used in children under...
What should an unresponsive 6-month-old presenting w/ seizures, fever of 103℉ for the last 3 days, markedly delayed capillary refill, and blood pressure of 80/20 be evaluated for?
Underlying cause of sepsis
Proceed with the rapid secondary assessment, if trauma is suspected then transport is immediately with further assessment and treatment performed en route
Urgent Transport
Epispadias is associated w/?
Urinary incontinence
Most accurate diagnostic test for CMV
Urine/saliva PCR
Best initial diagnostic test for CMV
Urine/saliva viral titers
Which method of palpation is recommended when assessing a pediatric abdomen?
Use the side of your hand and rotate accross the abdomen
Congenital heart defects common in Down (trisomy 21), Edwards (trisomy 18), & Patau (trisomy 13) syndromes?
VSD
Most common congenital heart lesion
VSD
Etiology of Varicella
Varicella zoster virus
Presentation of Herpes in the 2nd week
Vesicular skin lesions
You are on the scene of a two-car, head-on MVC. You are assigned a six-year-old female patient. She was restrained and her airbag deployed. Which injury pattern should you expect?
a. Lower extremities and facial injuries b. Upper and lower extremity fractures c. Head, cervical, eye, and chest injuries
You are on the scene of a child struck by a vehicle traveling at a high rate of speed. Which injuries are associated with this type of mechanism?
a. Lower extremities, head, neck, abdomen b. Lower extremities, head, facial, abdomen c. Upper and lower extremities, head and facial
How do the unique anatomical features of a pediatric patient affect your assessment?
a. Smaller airways require you always assess breathing before airway b. Larger heads, smaller airways and parental separation and anxiety c. Consider predictable injury patterns based on mechanism of injury
1:1,000
concentration for sub-Q or IM Epinephrine in an allergic reaction
1:10,000
concentration for sub-Q or IM Epinephrine in a severe allergic reaction
Mild contraction and mild anxiety
moderate croup presents with....
