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36 Cards in this Set
- Front
- Back
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What causes physiologic jaundice? When does it present? When does it disappear? |
Causes - (1) increased fragile fetal RBCs at birth leading to increased heme breakdown, (2) natural def. in UDP GLucuronsyltransferase leading to decreased conjugation, (3) Increased enterohepatic circulation of bili Presentation: B/w 2-4 days of life. Decreases by day 10 |
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How does Breast Milk Jaundice differ from Breastfeeding Jaundice? |
Breast Milk Jaundice - breast milk causes increased intestinal absorption of bili. Onset of 2-4 days with prolonged duration (> 10 days). Breastfeeding Jaundice - baby not eating enough or mom is making enough leading to dehyrdation that causes ↓ BM's and thus less bili excretion in stool |
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What characteristics suggest pathologic jaundice in a newborn? |
- any jaundice in 1st 24 hrs or after 2-3 wks of age - any direct hyperbili (could indicated biliary atresia!) - Rise in total bili by more than 0.5 mg/dL/hr or more than 5 mg/dL/day - Any total bili > 13 |
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How is RDS prevented and managed? |
- Give steroids for a labor before 34 wks * Lecithin/Spingomyelin ration > 2 = maturity - CPAP for all RDS babies - If weak resp. drive or FiO₂ > 0.4, intubate and give exogenous surfactant |
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When should suction be preformed on newborns to prevent Meconium Aspiration Syndrome? |
Only on non-vigorous infants (depressed respiration, decreased tone, HR < 100) * NOT during labor (ie as soon as head is delivered) * NOT on vigorous infants |
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What are some the pharm treatments used for CF kids? |
- CFTR Modulators (Ivacaftor, Lumacaftor) - Bronchodilators - Deoxyribonuclease - ↓'s sputum viscosity - Hypertonic Saline - for chronic cough - Liberal use of Azithro and Flouroquionolones |
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What is the most common cause of croup? How is it treated? |
MCC - Parainfluenzae type 1 Trx = cool mist, 1x Dexamethasone, Nebulized epi if very severe |
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What is the treatment for RSV bronchiolitis? |
Supportive care only! * Steroids, ABX, antivirals NOT effective - Prevent in premies w/ Palivizumab |
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A child has a mild fever for 1 day followed by a red, tender maculopapular rash that starts on the face and spreads downward and does NOT darken. Dx? Type of LAD seen? Presentation in adults? |
Rubella (German Measles) - LAD = suboccipital and post-cervical LN - Adults = polyarthritis |
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A child has a sudden, high fever (> 102°F) for 3-4 days but seems unfazed by the fever and plays normally. The fever breaks and then a red rash starts on the trunk and spreads out and is gone in 24 hrs. Dx? What is commonly misdiagnosed as? Trx? |
Roseola Infantum (HHV-6) - Mis-Dx = acute otitis media and subsequent ABX allergy - Trx = Antipyretics |
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How can you differentiate b/w the different causes of cervical LAD? |
- Acute and Bilateral → Viral - Acute and Unilateral → Bacterial - Chronic and Unilateral → Bartonella, Toxoplasmosis, TB, Actinomyces israeli - Noninfections → Kawaski, Hodgekins |
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What causes desquamtion of the hands and feet? |
Scarlet fever Kwaski Toxic Shock Syndr Steven-Johnson Synd Mercury Toxcity |
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What causes Pancytopenia + Hypopigmented spots or cafe-au-lait spots + abnormal thumbs? What will labs and BM biopsy show? Trx? What are these pts at risk for? |
Fanconi Anemia - Labs - ↑ AFP and pancytopenia. BM is hypocellulr w/ ↑ chromosomal breakage in Lymphos - Trx - BM transplant - Increased risk of leukemia + Head & Neck cancers |
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What causes Macrocytic anemia + heart and craniofacial defects + Thumb abnormalities? What will labs and BM biopsy show? Trx? |
Diamond-Blackfan Anemia - Labs - macrocytic anemia, decreased reticulocytes, BM is normocellular but has decreased erythrocyte precursors - Trx - Steroid and blood transfusion |
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A child has a palpable abdominal mass as well as sustained HTN, weight loss, and periorbital bruising. Dx? Location? Other possible locations? Labs? |
Neuroblastoma - Location - Adrenal medulla. Can occur anywhere along sympathetic chain including chest - Labs - ↑ Vanillylmandelic acid (VMA) & Homovanillic acid |
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How does the management of Slipped Capital Femoral Epiphysis, Legg-Calve-Perthes disease, and Osgood-Schlatter disease differ? |
SCFE - operative pinning and NO weight bearing Legg-Calve-Perthes - non-weight bearing, but no surgery required Osgood-Schlatter - Ice, NSAIDs, stretches. Can continue sport and knee immobilizers contraindicated |
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What is the treatment for Duchenne Muscular Dystrophy? What disease has a very similar presentation but is less severe? |
Duchenne Trx = Daily prednisone starting at age 5, yearly echos starting at age 10 due to risk of developing dilated cardiomyopathy Less severe = Becker Muscular Dystrophy |
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How does rickets differ from osteomalacia? What are the 2 types of rickets? How is it prevented? |
- Rickets is deficient mineralization at growth plate, Osteomalacia is at bone matrix - (1) Calcipenic - due to Ca2+ def from Vit D def, (2) Phosphopenic - due to phosphate def from phosphate wasting at kidney from ↑ PTH - Prevented by 400 IU/day of Vit D to kids |
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Where is spondylolisthesis most commonly located? What symptoms does it present with? |
L5 over S1 Present with subacute back pain worse with exertion and a knee and hip flexed gait |
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What are the 3 types of Juvenile Idiopathic Arthritis? How is it treated? |
(1) Pauciarticular - only a few large jts are effected sparing the hip. Uveitis common (2) Polyarticular - many jts involved, including small jts such as the hand (3) Systemic Onset - develop systemic symptoms before developing arthritis - Trx = NSAIDs, steroids, Anakinra, Canakinumab, Methotrexate |
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What is recommended supplement dosage of folic acid that should be given to women to prevent NTD's in their infants? |
400 mcg (0.4 mg) Folic Acid /day *4 mg if woman is on an anticonvulsant |
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What is the difference between communicating and noncommunicating hydrocephalus? What meds can be used until a VP shunt can be placed? |
Communicating - dysfxn of subarachnoid cisterns or arachnoid granulations (ie can't reabsorb CSF) Noncommunicating - obstruction of CSF at 4th ventricle Meds = Acetazolamide or Furosemide |
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What are the 2 types of Arnold-Chiari malformation? |
Type 1 - most common, often asymptomatic herniation of cerebellar tonsils and medulla Type 2 - Usually has neuro symp and often associated w/ Lumbar Meningomyelocele |
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A child has normal development for the 1st 6mths of life, followed by loss of dev. milestones, blindness, deafness, mm weakness and dies by age 4. Dx? What causes this? |
Tay-Sachs Disease - deficiency of hexosaminidase A |
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When is a Renal and Bladder US indicated in a child with a UTI? When is a Voiding Cystourethrogram indicated? |
US - kid < 2 yrs of age, recurrent febrile UTI's, any kid with FMH of urologic disease/poor growth/HTN, UTI not responding to ABX VCUG - ≥ 2 febrile UTI's, 1st febrile UTI w/ anomalies on US or temp > 39 C with a pathogen other than E. coli/Poor Growth/HTN |
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Compare and contrast Epi- and Hypospadias. |
Epispadias - opening on dorsal side of penis. Associated w/ bladder extrophy Hypospadias - opening on ventral side of penis |
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When should an undescended testis be relocated in the scrotum? Where is the most common location for them to get stuck? |
Age 6 - 12 mths Inguinal Canal |
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A child (age 2 - 4) has a palpable flank mass + Hematuria + HTN. Dx? What 2 syndromes is it associated with? |
Wilms Tumor - Associated with Beckwidth-Widman and WAGR Synd. (Wilms, Aniridia, GU abnormalities, Retardiation) |
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What are the 2 most common causes of infxn in dog/cat bites? Human bites? How are each closed? |
Dog/Cat Bites = S. aureus + Pasteruella multocida Human Bites = S. aureus + Group A Step Close facial wounds. Leave hand wounds and cat-inflicted wounds open. |
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What is the pathophysiology of drowing? |
Submersion + Reflex Laryngospasm → Hypoxemia and washout of surfactant → ARDS and Cerebral Edema → ↑ ICP and Resp. Arrest |
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How do the trx for blackwidow spiders and brown recluse spiders differ? |
Black Widow - Anitvenin administration w/in 30 min., observe for 24 hrs for systemic symp ("Latrodectism") and give Benzo's if mm spasm occurs Brown Recluse - Wound Care + Erythromycin if signs of wound infxn + Dapsone if necrosis is extensive |
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What are the tetanus vaccination recommendations? |
DTaP x 5 as kid → Tdap at age 11 or 12 → Tdap booster b/w ages 19-64 + Td every 10 yrs Clean wound - no trx if ≥ 3 tetanus shots and last Td w/in 10 yrs. If not, then Td booster Dirty Wound - no trx if ≥ 3 tetanus shots and last Td w/in 5 yrs. If not, then Td. If insufficient immunization status, then Td + TdIVIG |
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What is the difference between the 2 types of 2nd degree burns? |
Superficial Partial-Thickness - painful, red, +blisters, cap. refill intact Deep Partial-Thickness - same but cap. refill NOT intact as evidence by no blanching w/ pressure |
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What is the Parkland Burn Formulat |
4 x (body mass in kg) x (%BSA) Calculates ressussitative fluids for burns. ½ given in 1st 8 hrs, remaining ½ given in 16 hrs |
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How does Heat Stroke differ from Heat exhaustion? |
Heat Exhaustion - ↑ HR, ↓ BP, sweaty, mm cramps, body temp up to 104 F. Trx'ed by cooling pt and PO or IV hydration Heat Stroke - same symptoms but temp > 104 F and pt has signs of "brain dysfxn" (confusion, coma, disoriented). Trx w/ ice water immersion, water and fans, cold IV fluids |
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What EKG finding is characteristic of hypothermia? |
J-wave (osborn wave) |
