A-Step 2 Peds

Front 1

kid with croup is deteriorating, what do you do?

Back 1

trial of epinephrine
(alpha effects reduce bronchial secretions, beta effects relax smooth muscle)

intubation if that fails

Front 2

pernicious anemia pathophys

other sx

long-term risk of

Back 2

Ab's to IF

macrocytic anemia
glossitis
peripheral neuropathy (B12 deficiency)

gastric cancer, gastric carcinoid tumors (secondary to atrophic gastritis)

Front 3

ACTH causes release of

Back 3

corticosteroids
androgens

(aldosterone not affected)

Front 4

tx reactive arthritis

Back 4

NSAIDs

nongonococcal urethritis, asymmetric oligoarthritis, conjunctivitis or mouth ulcers, enthesitis (Achilles tendon)

usually sterile synovial fluid, so no abx

Front 5

colchicine MOA

Back 5

decreases leukocyte activity by inhibiting tubulin polymerization

Front 6

*__ is contraindicated in b/l RAS

Back 6

ACEi

Front 7

tx of choice for fibromuscular dysplasia

Back 7

angioplasty and stent placement

surgery if this fails

Front 8

bloody diarrhea, _abd pain, no fever

bloody diarrhea, no abd pain, +fever

Back 8

EHEC
(assoc with HUS, TTP)
(no travel hx necessary)

Shigella, salmonella, campylobater

Front 9

early onset GBS sepsis usually presents in 1st week with

late onset GBS infection usually presents with

Back 9

resp failure, meningitis, DIC, ATN, peripheral gangrene; usually refractory to therapy and --> shock/coma/death

focal infection (meningitis 75%), UTI, osteomyelitis, cellulitis

if mom got abx, culture results may be negative and a latex agglutination test may be more helpful

Front 10

congenital toxo

Back 10

microcephaly
microphthalmia
HSM
chorioretinitis

Front 11

most common cause neonatal sepsis

2nd

3rd

Back 11

GBS

E coli

Listeria - also tends to result in multiple abscesses and pneumonia in addition to meningitis

Front 12

management of congenital diaphragmatic hernia in neonate

Back 12

OG tube to decompress stomach
ET intubation

avoid bag and mask ventilation b/c this can cause the stomach and intestines to become distended with air

Front 13

dullness to percussion + increased breath sounds

Back 13

consolidation of the lung

Front 14

side effect of niacin for lipid therapy

mechanism

Back 14

flushing
pruritis

*drug-induced release of histamine and prostaglandins --> vasodilation, not a true hypersensitivity (b/c aspirin can greatly reduce or prevent this if taken 30 min before niacin)..the 2 are often rx'd together)

Front 15

long term tx for MS

Back 15

b-IFN
glatiramer

cyclophosphamide may arrest course of progressive secondary MS
plasmapheresis may enhance

Front 16

Kawasaki's disease tx

possible complication of dz

Back 16

aspirin + IVIg
(despite risk of Reye's)

coronary artery aneurysm

Front 17

Dystrophin

Back 17

protein found on plasma membrane of muscle fibers

Front 18

difference between DMD and Becker muscular dystrophy

DMD inheritance

non MSK feature

Back 18

DMD presents before age 5 and is more severe; Becker can walk into adulthood

X-linked (also with Becker)

cardiomyopathy (both)

elevated CK up to 100x, elevated aldolase (even before clinical signs)

Front 19

most common cause of croup/laryngotracheobronchitis

x-ray shows

Back 19

Parainfluenza virus

subglottic narrowing

commonly kids <3 - hoarseness, barking cough, varying degrees of respiratory distress

(laryngotracheobronchopneumonitis is different b/c you'd hear wheezing/interstitial changes on xray

Front 20

sudden onset stridor without fever

Back 20

foreign body aspiration

Front 21

which sinuses are present at birth? which develop

Back 21

maxillary, ethmoid

sphenoid, frontal

Front 22

most common predisposing factor for acute bacterial sinusitis is __

Back 22

viral upper respiratory infection (secondary infection of the mucosal sinus lining)

Front 23

tx of acute bacterial sinusitis

dx

Back 23

amox +/- clavulanic acid

sx must last 10-30 days without improvement; high fevers >39, purulent nasal drainage at least 3 days
-can get CT if you need to

Front 24

management of ingested liquid alkali

Back 24

1. maintain airway patency
2. EGD in first 24 hours

note: lavage or attempting to neutralize the alkali with vinegar is dangerous! may increase the extent of injury!

Front 25

myotonic dystrophy inheritance

muscles involved

Back 25

AD

teenagers present with muscle weakness, myotonia, cataracts, cardiac conduction abnormalities

usually facial muscles, intrinsic hand muscles, ankle dorsiflexors

myotonia (delayed muscle relaxation) is a prominent feature

Front 26

Fragile X

Back 26

MR
hyperactivity
long, narrow face with large ears
macroorchidism
joint hyperlaxity

Front 27

types of RTA

Back 27

type 1 (distal) - cannot secrete H+ --> acidotic, hypokalemic, elevated urinary pH; often genetic in children; commonly develop nephrolithiasis

type 2 - defect in bicarb reabsorption in proximal tubule (e.g. Fanconi syndrome)

type 4 - defect in Na/K exchanger in distal tubule --> hyperkalemic, hyperchloremic acidosis

Front 28

Jarisch-Herxheimer reaction; what do you do

Back 28

acute febrile reaction with headaches and myalgias in the first 24 hours of therapy

doxycycline or azithromycin in PCN-allergic pateints

Front 29

Beckwith-Wiedemann syndrome

Back 29

congenital d/o
-neonatal hypoglycemia
-macroglossia
-large size
-visceromegaly
-omphalocele
-characteristic earlobe creases

Front 30

Lesch-Nyhan syndrome deficiency is

Back 30

hypoxanthine-guanine phosphoribosyltransferase

(purine metabolism)

self mutilation
retardation
hyperuricemia
neurologic signs

Front 31

rocker bottom feet

Back 31

Edward

also closed fists with crossed fingers

Edward and Patau don't live past age 1

Front 32

H. flu can cause

Back 32

meningitis
otitis
bronchitis

also penumonia, epiglottitis

Front 33

congenital rubella leads to this heart problem

Back 33

PDA

Front 34

Down syndrome defect that can --> pulmonary hypertension

Back 34

endocardial cushion defects

Front 35

tx for severe hypovolemic hypernatremia

if less severe

what if euvolemic or hypervolemic

Back 35

0.9% saline...then when volume deficit has been restored, such patients are switched to 0.45% saline to better replace the free water deficit; goal rate of correction is no more than 1 mEq/h

5% dextrose in 0.45% saline

D5W

Front 36

PML sx

Back 36

hemiparesis
disturbances in speech, vision, gait

Front 37

primary CNS lymphoma is usually _ focal

Back 37

uni (solitary)

presence of EBV DNA in CSF is quite specific

Front 38

subacute sclerosine panencephalitis associated with

Back 38

measles infection years before

Front 39

__ slows disease progression in PBC

Back 39

ursodeoxycholic acid

Front 40

when peripheral IV access cannot be obtained in peds emergency, __ should be attempted next

Back 40

intraosseous

can be used for 24-48 hours

Front 41

__ is a potential cause of stroke in children that is usually associated with a history of trauma to the soft palate with a foreign body

Back 41

ICA dissection

compression causes a thrombosis that embolizes to the brain or dissection leads to ischemic stroke

Front 42

complication of meconium ileus

Back 42

intestinal perforation

(if after birth --> pneumoperitoneum, if before birth --> calcifications)

Front 43

HOCM has hypertrophied IV septum and

Back 43

abnormal mitral leaflet motion

(systolic anterior motion of the mitral valve SAM)

Front 44

kid has proteinuria on urine dipstick; next move?

Back 44

repeat dipstick on 2 other occasions (transient proteinuria and orthostatic proteinuria are are fairly common in children)

Front 45

type II Vitamin D rickets

Back 45

normal serum calcitriol but mutation of vitamin D receptor

Front 46

labs for X-linked hypophosphatemic rickets

Back 46

everything is normal but low phosphate

Front 47

HSP usually occurs after

Back 47

URI

Front 48

diarrheal cause of HUS

sx

tx

Back 48

E. Coli

plasmapheresis and steroids
dialysis if necessary

hemolysis, uremia, thrombocytopenia

no abx!

Front 49

mild metatarsus adductus (can correct to adduction) tx

Back 49

reassurance

surgery if it doesn't correct by 4 years

often occurs in first born children

if you can only correct to neutral --> orthotics

if you can't move --> plaster casts

Front 50

addison's disease causes __kalemic, __natremic metabolic ___sis

Back 50

hyperkalemic
hyponatremic
acidosis

(due to aldosterone deficiency)

Front 51

breath holding spells

Back 51

holding breath from frustration, anger, pain sometimes --> LOC

self-limited...reassurance

Front 52

14 yo boy with unilateral gynecomastia

Back 52

can be normal phsyiologic pubertal gynecomastia...often tender...usually goes away

seen in 1/2 of adolescent boys

reassurance

Front 53

Wiskott-Aldrich inheritance

low levels of Ig__, high levels of Ig__

Back 53

X-linked

IgM low

IgA and IgE high

Front 54

traction apophysitis

Back 54

Osgood-Schlatter

(pulling of tendon at tibial insertion leading to lifting of tubercle off shaft)

tx is NSAIDs, stretching

Front 55

isolated thrombocytopenia may be the initial presentation in 10% of

Back 55

HIV infection

Front 56

footdrop could be radiculopathy from nerve roots ___ or congenital such as in __

Back 56

L4-S2

Charcot-Marie-tooth

Front 57

weight requirement for HepB vaccine in baby

Back 57

2 kg+

Front 58

roseola infantum

Back 58

HHV-6

fever --> 4-5 days later rash that starts at trunk snd spreads peripherally

Front 59

measles

Back 59

prodrome of coryza, conjunctivitis, cough

Koplik spots

skin rash 48 hours later - face --> entire trunk and extremities

Front 60

parvovirus

Back 60

slapped cheek
fifth disease
erythema infectiousum