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134 Cards in this Set

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What is hyaline membrane disease (respiratory distress syndrome) and what are 7 risk factors? (race, gender, delivery method?)
HMD is due to insufficient surfactant at the time of birth. This increases surface tension and decreases lung compliance.

Risk factors include:
Male, Premature, Caucasian, Gest. Diabetes, C-section, 2nd born twin, FHx.
In infants with HMD, hypoxemia is the result of 3 factors. . .
Right to left shunting via:

shunt vessels in the lung
past atelectatiic air spaces
PDA, PFO
What are some other problems on the DDx for HMD?
TTN - CXR shows higher lung volumes

Bacterial PNA - difficult to distinguish from GBS. Routine to treat all HMD babies with ABX until (-)Cx are received

Pulmonary Edema - many causes

Aspiration PNA - meconium or amniotic fluid.
Treatment of HMD?
1) Prevent premature delivery.
2)If preterm delivery is inevitable, then treat with steroids antenatally
3)Surfactant replacement therapy
What is the most common cause of respiratory distress in newborns?
TTN
What is TTN?
How is it treated?
What are some risk factors?
TTN is a delayed clearance of fetal lung fluid.

Treatment:
self limited with resolution within 48-72 hours. Some treatment includes fluid restriction and oxygen.

Risk factors include:
C-section
Premature
Delayed clamping of the umbilical cord
Maternal sedation
Maternal diabetes
Fetal distress
What are the four levels of cognitive development and the ages at which they occur?
Sensorimotor - 2 years
Preoperational - 2-7 y/o
Operational - 7-12 y/o
Formal - >12 y/o
What are the age ranges of the following in girls:
Breast development begins
Breast development complete
Pubic hair appears
Growth spurt begins
Menarche
1) Breast dev. 8-13
2) Breast dev. complete 12-18
3) Pubic hair appears 8-14
4) Growth spurt 9-14
5) Menarche 10-16
What are the age ranges of the following in boys:
1) Testes growth begins
2) Pubic hair appears
3) Penis growth begins
4) Genital growth complete
5) Growth spurt starts
6) Strength spurt
1) Testes growth begins 9-13
2) Pubic hair appears 10-15
3) Penis growth begins 10-14
4) Genital growth complete 13-18
5) Growth spurt starts 10-16
6) Strength spurt 13-17
How long after the growth spurt does menarche happen? How long after thelarche?
3 years after menarche
2 years after thelarche
How many years does puberty take to complete in girls?
boys?
4 years
3 years in boys
How does FSH and LH relate to pubarche?
Unrelated
What is responsible for pubic hair growth?
DHEA, DHEAS
Average linear growth begins at what age for boys vs. girls?
10 years for girls
11.5 for boys
what is the narrowest point in the pediatric airway?
subglottic trachea
Croup
most common ages?
When is the cough worse?
Management?
6 months - 5 years
Worse at night
-humidification
-cold air
-steroids
-epinephrine aerosols
-heliox
At what ages should you:
double birth weight
triple birth weight
quadruple birth weight?
Double: 5 months
Triple: 12 months
Quadruple 2 years
How is mid parental height calculated?
Boys: FH + (MH + 5)/2
Girls: FH + (MH - 5)/2
What is the most sensitive test for primary hypothyroidism?
TSH
What is the most common thyroid disorder in kids?
Hashimoto's thyroiditis
What is the age cutoff where no permanent intellectual or neurological damage is done during acquired hypothyroidism
3 years old
What is the most common cause of hyperthyroidism in kids?
Graves
What antibodies would be present in:
Graves disease
Hyper phase of hashimotos
Hypo phase of hashimoto
Graves - anti-TSI
Hashimotos, hyper phase - anti-TPO and anti thyroglobulin

Hashimotos hypo phase - same has hyper phase
What are 3 anti-thyroid drug treatments and their side effects (2)
PTU, Methimazole, Cabimazole

Side Effects include: agranulocytosis, hepatitis
What age can children recieve radioactive ablation with no concerns for malignancy?
5
What percent of patients remain hyperthyroid after initial ablation?
25-40%
What are the remission rates after 2 years of medication therapy for hyperthyroid?
25%
What is the most appropriate treatment of a 13 year old with Graves disease?
Methimazole
What is the DDx for a congenital goiter?
Neonatal Graves
Congenital Hypothyroidism
Describe the course of Measles
8-12 day incubation  prodrome (conjunctivitis, coryza, fever, cough, malaise)  koplik spots  maculopapular rash beginning on the head and spreading down. Paramyxovirus. Major complication is subacute sclerosing panencephalitis
Describe the course of Rubella
Caused by Rubellavirus (A Togavirus) When infected postnatally, it is often asx. Sx can include, erythematous maculopap discrete rash, with generalized LAD and fever. Transient polyarthralgias

When infected prenatally, it is much more serious. Sx include, heart/eye/auditory defects, neuro malformations, IUGR, blueberry muffin spots
Roseola infantum
Caused by HHV-6, begins with abrupt fever (103-106) for 1-5 days, child appears well during the fever, after 3-4 febrile days a MP rash develops on trunk and spreads peripherally, fever resolves as rash appears,
Erythema Infectiosum
Parvovirus B19- Mild, self limiting, no prodrome, low grade fever (if any), Rash begins as slapped cheek, erythematous, pruritic MP rash develops on arms and spreads to trunk/legs. Associated with fetal hydrops during pregnancy.
How long are varicella patients contagious for? What test can be used to test for it?
24 hours before rash until all lesions are crusted (1 week)
Tzank prep
Hand Foot Mouth disesase
Coxsackie A virus – prodrome of anorexia, fever, oral pain followed by crops of ulcers on oral mucosa
What is the most common cause of hematogenously spread cellulitis?
S. Pneumo
Treatment of the following Tineas:
Capitis
Corporis/Cruris/Pedis
Oral griseofulvin for 4-6 weeks
topical antifungals for 4 wks
Describe the Dawn Phenomenon
Increasing insulin resistance from 3am-8am. Nocturnal GH secretion. Sugar is normal at 3am and high at 8am
Describe the somogyi phenomenon
Rebound hyperglycemia following hypoglycemia. Low sugar at 3am and high at 8am
Single most critical value in evaluating growth?
Height velocity
Average growth velocities for:
0-12 months
12-24 mo
24-36 mo
36 months – puberty
Puberty
0-12- - 25cm
12-24- - 12cm
24-36- - 8cm
36mo-puberty- - 4-7cm per year
Puberty- - 8-14cm/year
What should be assumed about height deceleration between the ages of 3 and 12 years?
Pathologic until proven otherwise
Definition of short stature
2 SD below mean (,3%ile)
Delayed BA, subnormal growth rate, obesity (2 possibilities)
Cortisol excess or Hypothyroidism
What would you order for lab evaluation of short stature?
CBC w/diff, Complete metabolic panel, T4/TSH, IGF-1/GFBP-3, UA/ESR, Celiac panel (Serum IgA, Anti-endomysial Ab, Tissue transglutaminase), Bone age film
Why can there be a false positive rate on TSH in newborns?
Because of the TSH surge that occurs in the first 24 hours of life.
How is transient hyperthyroidism treated?
Treat vigorously to prevent HF. Hospitalize to monitor HR and EKG
Treat with:
PTU rather than methimazole because PTU decreases conversion of T4 to T3.
Beta Blockers
Lugol’s solution to block release of preformed thyroid hormone
Pharmacological doses of glucocorticoids which block conversion of T4 to T3.
A baby is screened with a total T4 level which is decreased. The TSH is normal. What is the next step?
Free T4. . .if decreased along with normal TSH then you need to rule out central hypothyroidism. If normal, then they have TBG deficiency
When do kids adopt adult stooling patterns?
1 year old
Osmotic Diarrhea. .
-stool sodium?
-Osmolarity?
-Exogenous vs. endogenous DDx?
Stool sodium < 70 meq/L
OSM >2x(Na+K)
Exogenous: laxatives, artificial sweeteners, antacids, excessive CHO, lactulose
Endogenous: disaccharidase deficiency, pancreatic insufficiency, infectious diarrhea, loss of surface area (short gut, IBD, Celiac, milk protein enteropathy, rota)
Secretory Diarrhea
Sodium?
Osmolarity?
DDx?
Stool sodium >70meq/L OSM=2x(Na+K)
DDx: infection with toxigenic organism (Cholera, E. coli, salmonella, C. diff)
Mucosal necrosis or atrophy, bile acid malabsorption, Hormone secreting tumors
Treatments of the following:
Giardiasis
Cryptosporidium
Giardiasis:
Metronidazole, nitazoxanide, furazolinide
Cryptosporidium:
Nitazoxanide, azithromycin
VACTERL
Verterbra (hemivertebrae)
Anus (imperforate)
Cardiac (VSD)
TE fistula
Renal (horseshoe)
Limb (clubfoot)
CHARGE – what each letter means
Coloboma
Heart (ASD)
Atresia choanae
Renal (fused kidneys)
Ear (deafness)
MURCS
Mullerian duct (absent prox 2/3 of vagina)
Renal agenesis
C-Spine defects C5-T1
Turner syndrome: heart defects (2), renal, appearance
Bicuspid aortic valve
coarctation
horseshoe kidney
low set ears
wide nipples
Alagille Syndrome:
-heart defect, liver, eye, vertebral, appearance, cause
PPS
Paucity of intrahepatic bile ducts
Direct hyperbili
Opaque margin of cornea
Butterfly/hemivertebrae, Triangular face
Deep set eyes.

AD inheritance
mutation of JAG1
Prader Willi:
-Appearance in the infant. Appearance of older child.
Infant: hypotonia, poor feeding, small hands/feet, almond shaped eyes
Older child: marked weight gain, MR, unusual eating behaviors, skin picking, rage
Cornelia de Lange: appearance
Growth retardation, long eyelashes, thick eyebrows, upturned nares, hirsutism, hypoplastic nipples, short limbs, missing digits, genital abnormalities. No diagnostic test available
Di George: heart, Endocrine, appearance, inheritance
Left sided heart lesions, hypocalcemia,
prominent nose,
long fingers,
high arched/cleft palate.

Sporadic inheritance,
AD for affected individual
Williams Syndrome: cardiac, endocrine, appearance, inheritance
Supravalvular aortic stenosis,
Hypercalcemia,
Full lips and lower face, Stellate pattern to iris,
mild to moderate MR with cocktail party personality.

AD inheritance for affected individual,
sporadic inheritance.
Features of Trisomy 18
Hypertonic
Overlapping fingers
Most miscarry
90% die within a year
Trisomy 13
Midline abnormalities, most miscarry
What vitamin deficiencies are associated with the following diets?
Vegan?
Goats Milk?
Vegan - B12 deficiency
Goats milk - folate deficiency
What anemias are the following ethnicities associated with?
-African American?
-Mediterranean?
-Southeast asian?
-Northern European?
AA - HbS, HbC, thalassemia, G6PD
Mediterranean - Thalassemia, G6PD
Southeast asian - Thalassemia, HbE
Northern European
Hereditary Spherocytosis
What type of anemia is associated with nail spooning?
Iron Deficient
What are the two types of microcytic anemia?
Iron Deficient
Thalassemia
What are the 4 types of macrocytic anemia?
Aplastic anemia
Diamond-blackfan
Liver disease
Myelodysplastic syndrome
What are the 7 types of normocytic anemia?
Sickle cell, HS, G6PD, AIHA, HUS, Infxn, Renal disease
How is hemophilia inherited?
AR
What lab abnormalities are seen with hemophilia?
aPTT elevated, normal aPTT mix, decreased VIII or IX
Mild/Moderate Hemophilia A may respond to _____
DDAVP
1st line treatment for type I vWD?
DDAVP
What is the typical course for ITP?
50% resolve within 1-2 months
80% resolve within 6 months
At what age would the following actions be cause for concern?
- <15 words
- Unable to use 2 word phrases
15 words - at 18 months
2 word phrases - At 24 months
How old is this kid.
Draws primitive figures, assume others feel same way, ask why questions, uses imagination, pretend play
3 y/o
How old is this kid: past tense, sings songs, knows first/last name, counts to 4, knows colors.
4 years
How old is this kid: future tenst, counts to 10, knows telephone number, recognizes most letters
5 years
Caloric requirement for birth to 6 months? 6-23 months?
108kcal/kg/day and 98kcal/kg/day
Caloric content of human milk?
20 kcal/oz
When is mom usually screened for GBBS?
35-37 weeks
What are the 3 things that are done prophylactically on a newborn?
Vit. K
Eye infxn prophylaxis with erythromycin or tetracycline eye ointment
HepB - mom's status, HBIG vs. vaccine
Define the following and what to do with them:
Cephalohematoma
Caput Succedaneum
Cephalohematoma -
Blood under periosteum
Does not cross suture lines
Leave alone, will go away
Caput Succedaneum
scalp edema from pressure
Diffuse, crosses suture line
Resolves in 1-2 days
At what age do most umbilical hernias close?
3-4 years
In regards to DDH, what age is the Ortolani and Barlow signs no longer positive? What is a diagnostic sign at this point?
after 8-12 weeks, the O/B sign isn't positive and limited abduction is a more reliable sign
What radiology is used for DDH?
Before 4 months - U/S
After 4 months - plain hip xray
At what age do the following reflexes disappear?
Moro
Stepping
Suck and Root
Palmer Grasp
Plantar Grasp
Fencer
Moro - 3 months
Stepping - 6 weeks
Suck and Root - 4 mo. awake 7 mo. asleep
Palmer Grasp - 4 months
Plantar Grasp - 10 months
Fencer - 6 months
What is the ounce requirement for nutrition per pound for an infant?
2-3 oz./pound
How long should a car seat face backwards for?
until 20 lbs or 1 year
What are 4 uses for Cefipime?
1)PNA
2)UTI
3)Skin/Skin structure infxns
4)Empiric tx in febrile neutropenic patients
What is the spectrum of activity of Carbapenems?
G+, G- aerobes, G- anaerobes
How do Meropenem and Imipenem differ?
Meropenem is:
- 2-32x more active against Enterobacter
- 2-4x more active against pseudomonas
- less active against G+
- Equivalent activity agains anaerobes
- MRSA/Enterococcus resistance
What is the monobactam Aztreonam effective against?
G- rods
Aminoglycosides:
- 3 examples?
- spectrum of activity?Explain its synergism
Gentamicin, Tobramycin, Amikacin

G- enterics, MRSA

Synergistic effect with Beta lactams against G+, G-
Spectrum of activity for Vanco?
G+
Macrolides:
2 Examples
7 bugs it can treat well
Erythromycin, Azithromycin

L. Pneumophila
M. Pneumoniae
C. Pneumomoniae
C. Trachomatis
B. Pertussis
M. Cattharalis
Camphylobacter
Lincosamides:
1 Example
Spectrum of activity
Clinda

G+ aerobes
G+/G- anaerobes
TMP/SMX:
Mechanism of action?
Spectrum of activity?
inhibition of folic acid pthwy

G- aerobes
Staph aureus
Tetracyclines:
2 examples
Spectrum of activity
Doxycycline, Minocycline

Rickettsia
M. Pneumo
C. Pneumo
C. Trachomatis
S. aureus MRSA
Quinolones:
Spectrum of activity
1st, 2nd, 3rd, 4th generation?
1st gen: G- rods
2nd gen: G- rods, pseudomonas, Staph aureus
3rd gen: G- rods, pseudomonas, Staph aureus, PCN resistant S. pneumo, Legoinella, Chlamydia, Mycoplasma
4th gen: everything above plus anaerobes
Linezolid
spectrum of activity?
G+ (incl. beta lactam resistant and vanco resistant)
Streptogramins:
2 examples
spectrum
Dalfopristin, Quinupristin

G+ (except enterococcus and those resistant to beta lactams and vancomycin)
Daptomycin
spectrum
skin infections due to strep spp. MRSA and E. Faecalis
Telithromycin
effective against respiratory pathogens
Tigecycline
G+/G- aerobes/anaerobes

Adult soft tissue and intraabdominal infections
for the following fluids, state the amount of NaCl present:
.9 NS
1/2 NS
1/4 NS
LR
D5W
.9 NS. . .154mEq NaCl
1/2 NS. . 77mEq NaCl
1/4 NS. . .38mEq NaCl
LR . . . .147mEq NaCl
D5W. . . .0mEq NaCl
For the following fluids, state the OSM of each:
.9 NS
1/2 NS
1/4 NS
LR
D5W
.9 NS. . .308 mOsm/L
1/2 NS. . 154 mOsm/L
1/4 NS. . 77 mOsm/L
LR. . . . 310 mOsm/L
D5W. . . .250 mOsm/L
What numbers are used to calculate maintenance fluids per kg?
4 2 1
100 50 20
How much Na, K, Cl, and Glucose are required for each 100 ml of water?
3mEq Na
2mEq K
5mEq Cl
5 grams glucose
Calculate MIV req. per day for a 12 kg child.
1000+100 = 1100ml/day
NaCl = (3mEq)(11) = 33mEq
KCl = (2mEq)(11) = 22mEq
Calculate MIV req. per day for a 70 kg child and convert to hourly rate
1000+500+1000 = 2500ml/day
10kg 10kg 50kg

(3mEq Na)(25) = 75mEq Na
(2mEq K)(25) = 50mEq K

2500ml/day = 2 and a half one liter bags of D5 .2NS each with ~20mEq K
What is the max rate to correct serum sodium in hypo/hypernatremic dehydration?
5 mEq/L/hr
What fluids would you order for a 15 month old girl (wt. 20kg)
D5 .2NS at 60ml/hr with 20 mEq K
describe the rapid rehydration method
1) NS bolus at 20ml/kg over 30-60 min. until UOP
2) D5 1/2NS with 20mEq K at:
1.5x MIV for mild dehyd.
2 times MIV for moderate dehyd
2.5x MIV for severe dehyd.
Differentiate between simple and complex seizures
Simple - no change in consciousness
Complex - alteration of consciousness
What meds are used in both generalized and partial seizures?
Valproic Acid
Phenobarbitaol
Phenytoin
Lamotrigine
Topiramate
What med is used only in generalized seizures?
Benzos
What meds are only used in partial seizures?
carbamazepine
oxcarbazepine
felbamate
gabapentin
what is the age range for febrile seizures?
6 months - 6 years
percent recurrence for febrile seizures in kids?
33%
what is the most common physical disability in childhood?
CP
What are the four main options to treat epilepsy?
AEDs
Ketogenic Diet
Surgery
Vagus nerve stimulator
What are the criteria for the asthma severities?
Mild Intermittent: Sx<1x per week, brief flares, nighttime sx<2x per month

Mild persistant: Sx>2x per week but not daily. night sx 2 times per month

Moderate persistant: daily sx, flares limit activity. night sx>1x per week

Severe persistent: continual sx, limit activity, frequent night sx.
What are the treatments for:
Mild intermittent
Mild persistent
Moderate persistent
Severe persistent
Mild intermittent: no daily meds, inhaled B2 agonist prn

Mild persistent: one daily med like an inhaled corticosteroid plus a short acting bronchodilator prn

Moderate persistent: Daily med either inhaled steroid with or w/o long acting beta agonist plus prn bronchodilator

Severe persistent: high dose daily steroid and long acting beta agonist plus prn bronchodilator
what is the most common inherited lethal dz in caucasians? How is it inherited?
CF AR
The first thing to come to mind with rectal prolapse?
CF
Which onset type of JRA is most common?
pauci
Pericarditis is most likely to occur in which type of JRA?
Systemic
Uveitis is most likely to occur in which of the following:
little boys with pauci JRA
little girls with pauci JRA
little girls with pauci JRA
What is the most useful in early diagnosis of uveitis in JRA?
slit lamp
What is the best initial tx for JRA?
NSAID
T/F:
1-In pauci and poly JRA, the ANA test is more likely to be positive than is the RF test
2-In systemic JRA, both the ANA and RF are expected to be negative
3-In pauci JRA, ANA positivity is associated with an increased risk of eventual uveitis
4-RF positivity is just as commin in JRA as it is in adult RA
1)T
2)T
3)F
4)T
When is a child most susceptible to infection?
6-12 wks
Diagnostic criteria for Kawasaki
Fever for 5 days plus 4 of the following:
1)Rash
2)Bilateral Conjunctivitis
3)1.5 cm node
4)changes of lips/oral cavity
5)edema/erythema of extremities