Em Pediatrics

Front 1

Most common GI emergency in neonates?

Back 1

Necrotizing enterocolitis

Front 2

Common x-ray findings for necrotizing enterocolitis

Back 2

pneumoatosis intestinalis

Front 3

#1 and 2 for viral infections in 3-15 month olds

Back 3

1 - Rotavirus
2- Adenovirus

(Winter months)

Front 4

Most common (2) of bloody diarrhea in infants?

Back 4

Salmonella and Shigella

Front 5

Bloody diarrhea + high fevers + seizures =?

Back 5

Shigella

Front 6

Most common cause of bowel obstruction between 3 mo -6 yr

Back 6

Intussusception

Front 7

Where is the most common point for intussusception?

Back 7

Ileocecal valve (junction at the small and large bowel)

Front 8

Symptoms of intussusception

Back 8

- abd pain (3mo-6yr)
- Sudden pain with sudden relief of pain
- Current Jelly stool (late finding)
- Sausage tumor in right abdomen or epigastrium

Front 9

4 classic x-ray findings for Intussussception?

Back 9

1. Target sign
2. Cresent sign
3. Absent liver edge
4. Bowel obstruction

Front 10

Neonatal chlamydia (pneumonia)

Back 10

afebrile, tachypnea, staccato cough, conjunctivis

Front 11

Bochdalek

Back 11

Left-sided diaphragmatic hernia (most common)

Front 12

Morgagnis

Back 12

Right-sided diaphragmatic hernia

Front 13

CXR in diaphragmatic hernia

Back 13

1. Air-filled loops of bowel in chest
2. absence of diaphragmatic margin
3. Displacement of heart and mediastinum
4. Hypoplastic lungs

Front 14

Treatment of diaphragmatic hernia

Back 14

1. Immediate intubation (avoid bag-mask ventilation)
2. Placement of OG tube
3. IV hydration
4. Surgery

Front 15

Tracheoesophageal Fistula

Back 15

Fistula between the trachea and distal esophagus

Front 16

Omphalocele

Back 16

Defect in umbilical ring => protrusion of intestines (covered by peritoneal sac) outside of the abdominal wall

Front 17

Gasroschisis

Back 17

Defect in the abdominal wall =>antenatal evisceration of abdominal contents WITHOUT peritoneal sac

Front 18

Symptoms of central cyanosis

Back 18

Bluish discoloration:
-Tongue
- Mucous membranes
- Peripheral skin

Front 19

Symptoms of peripheral cyanosis

Back 19

Bluish color of extremities only

(Vasomotor instability secondary to cold environment)

Front 20

5 Causes of central cyanosis

Back 20

1. Cyanotic Heart disease (R=>L shunt)
2. Primary Lung disease
3. Hypoventilation due to a CNS lesion (severe intracerebral hemorrhage)
4. Alveolar hypoventilation secondary to shock or sepsis
5. Methemoglobinemia

Front 21

5 causes of right to left shunt cyanotic heart disease

Back 21

1. Transposition of the great vessels
2. Tricuspid atresia
3. Truncus arteriosus
4. Tetralogy of Fallot
5. Total anomalous pulmonary venous return

Front 22

Most common cause of pediatric CHF

Back 22

Congenital Heart Disease

Front 23

Treatment of pediatric CHF

Back 23

1. Supplemental oxygen
2. Semireclining position
3. Restriction of fluid intake
4. Digoxin
5. Furosemide 1-3 mg/kg IV
5. Intropic spport: dopamine and dobutamine for cardiogenic shock

Front 24

Contraindications for digoxin in pediatric CHF?

Back 24

Tetralogy of Fallot, IHSS, myocarditis, and HR <100

Front 25

Most common type of cyanotic congenital heart disease in children >1 year of age

Back 25

Tetralogy of Fallot

Front 26

Four anatomy components of tetrology of Fallot

Back 26

1. VSD
2. Pulmonic stenosis
3. Dextroposition and overriding aorta
4. Right ventricular hypertrophy

Front 27

2 major hemodynamic process with tetrology of Fallot?

Back 27

1. Pulmonary stenosis
2. VSD

Front 28

Physical Findings or Tetrology of Fallot?

Back 28

1. Cyanosis
2. Clubbing of digits
3. Normal pulses
4. Harsh, diamond shaped SYSTOLIC murmur (2nd IC @ LSB)
5. Loud, second heart sound

Front 29

CXR findings of Tetrology of Fallot?

Back 29

1. boot-shaped heart
2. Diminished pulmonary markings

Front 30

EKG and CBC findings in Tetrology of Fallot?

Back 30

Right axis deviation and RVH

Polycythemia

Front 31

Treatment of Tetrology of Fallot?

Back 31

1. Knee-chest position
2. Oxygen and morphine
3. Bicarbonate
4. Propranolol or phenylephrine

Front 32

Most common congenital heart anomaly?

Back 32

VSD

Front 33

Physical findings for VSD (2)

Back 33

1. Holosystolic mumur at LLSB
2. Normal peripheral pulses

(W/ large lesions - fatigue with feeding)

Front 34

Bounding pulses, continouous "machinary murmur" and a suprasternal notch thrill....

Back 34

Patent ductus arteriosus

Front 35

HTN in the upper extremities and decreased or absent pulses in the lower extremities...

Back 35

Coarctation of the aorta

Front 36

Stridor obstruction at each of the following phases:
1. Inspiratory
2. Biphasic
3. Expiratory

Back 36

1. Obstruction at or above larynx
2. Obstruction below the larynx
3. Bronchial or lower tracheal obstruction

Front 37

Child sitting upright with chin thrust forward, mouth open and neck slightly extended. +toxic/ apprehensive, +DROOLING, difficulty swallowing, and cough usually absent...

Back 37

Epiglotitis

Front 38

Most common cause of epiglottitis and age range?

Back 38

H. influenza (2-6 yrs)

Front 39

Treatment/ ABX treatment for epiglottitis?

Back 39

ENT intubation

2nd or 3rd cephalosporins (cefuroxime, cefotaxime, or ceftriaxone) or ampicilling-sulbactam

Front 40

Barky "seal-like" cough that is worst at night and may cause respiratory distress; fever absent or low-grade (non-toxic appearing)...

Back 40

Croup

Front 41

Most common cause of croup and age group?

Back 41

Parainfluenza virus 6mo- 6yrs

Front 42

Xray finding of croup

Back 42

Steeple sign

Front 43

X-ray finding of epiglottis

Back 43

"Thumb print" sign

Front 44

Treatment for Croup?

Back 44

Cool mist
Oxygen PRN/ Hydration
Racemic epinephrine (must be observed for 3-4 hours)
STEROIDS (dexamethasone)

Front 45

High fever, stridorous, and appears toxic; Sxs of viral croup past few days but took a turn for the worst over past hour.....

Back 45

Bacterial tracheitis

Front 46

Most common pathogen in Bacterial tracheitis and age group?

Back 46

Staph Aureus
<3 years

Front 47

Toxic child that is drooling and refusing to eat

Back 47

Retropharyngeal Abcess

Front 48

Most common organism for bronchiolitis?

Back 48

RSV

Front 49

Pathophysiology of bronchiolitis

Back 49

Infection =>submucosal edema, peribronchiolar cellular infiltrate and mucous plugging =>narrowing of the bronchi and bronchioles =>increased airway resistance => wheezing and fine rales

Front 50

Tachypneic infant with nasal flaring, intercostal retractions, wheezing, rales, and a prolonged expiratory phase?

Back 50

Bronchiolitis

Front 51

Treatment for bronchiolitis?

Back 51

Humidifyed oxygen
Nebulized epinephrine
Aerosolized ribavirin (hospitalized)

Front 52

Fever + low WBC <5000? (3)

Back 52

1. meningococcemia
2. Septic shock
3. DIC

Front 53

Pediatric poisonings associated with fever? (6)

Back 53

1. Anticholinergics (atropine)/ antihistamines
2. Salicylates
3. Amphetamiens
4. LSD, PCP, cocaine
5. Phenothiazines
6. Tricyclics

Front 54

Most common organism/ treatment for bacteremia in neonatal (<1mo)?

Back 54

GBS, E. Coli, and Listeria

Gentamycin/ Ampicillin/ Cefotaxime

Front 55

Most common organism/ treatment for bacteremia in > 1month

Back 55

Strep pneumonaie and meningitis

Rocephin (Ceftriaxone) and vancomycin (also give steroids prior to abx to decrease risk of senorineural hearing loss)

Front 56

Most common organism/ treatment for bacteremia in sickle cell disease

Back 56

Strep pneumoniae and H. influenza

Ceftriazone and Vancomycin

Front 57

Prophylaxis with XXX for contacts of patients with meningococcal meningitis

Back 57

Rifampin

Front 58

Child with history of URI symptoms with gradual onset of lower respiratory tract symptoms and low-grade fever...

Back 58

viral pneumonia

Front 59

Afebrile infant 1-2 week mild upper respiratory symptoms with now severe PAROXYSMAL COUGH and inspiratory whoop with posttussive emesis...

Back 59

Bordetella pertussis

Front 60

family spread of respiratory tract infection + nonproductive hacking cough + inspiratory rales + multiple organ involvement (otitis media/bullous myringitis, pharyngitis)...

Back 60

Mycoplasma pneumonia

Front 61

Staccato cough with tachypnea and afebrile; conjunctivitis and nasal congestion

Back 61

Chlamydia pneumonia

Front 62

Older while with abrupt onset of high fever, cough, and tachypnea

Back 62

Pneumococal pneumonia

Front 63

X-ray findings of pneumothorax and empyema (or pypneumothorax)

Back 63

Staphylococcal pneumonia

Front 64

What are the three phases of Bordetalla pertussis

Back 64

1. Catarrheal sage
2. Paroxysmal stage
3. Convalescent stage

Front 65

Treatment for Pertussis?

Back 65

Erythromycin

Front 66

Complications from pertussis

Back 66

1. Secondary bacterial infection
(These are due to increased intrathoracic pressures)
2. Rectal prolapse
3. Ruptured diaphragm
4. Hernias

Front 67

Prophylaxis treatment for pertussis?

Back 67

Erythromycin

Front 68

Most common organism for otitis media?

Back 68

Strep pneumo (#1), H. influenza, Moraxella catarrhalis

Front 69

Most reliable sign of AOM?

Back 69

Decreased mobility of the tympanic membrane on pneumatic otoscopy

Front 70

Three common complications of AOM

Back 70

Hearing loss, TM perforation, and Meningitis

Front 71

Treatment for AOM?

Back 71

Amoxicillin (PCN allergy: TMP-SMZ)

For H. flu or M. catarrhalis: Augmentin or cefuroxime

Front 72

Phimosis

Back 72

Distal foreskin cannot be retracted

Front 73

Paraphymosis

Back 73

The foreskin is swollen and retracted

Front 74

The most common cause of dysuria in males 2-5 years of age?

Back 74

Meatal stenosis

Front 75

Pathogenesis of Reye syndrome

Back 75

- universal disruption of mitochondrial function that is most profound: liver and brain
- Following a viral infection (VZV or Influenza A/B)
- Aspirin ingestion

Front 76

Lab findings in Reye Syndrome

Back 76

SERUM AMMONIA ELEVATED
AST/ALT elevated
CPK elevated
PT prolonged
Bilirubin may be elevated

Front 77

What are the clinical stages called in Reye Syndrome?

Back 77

Lovejoy stages (5 total)

Front 78

First lab finding in Reye Syndrome?

Back 78

elevated ammonia level

Front 79

An acute multisystem vasculitis of small and medium sized arteries with predilection for coronary arteries...

Back 79

Kawasaki Disease

Front 80

Diagnostic criteria for Kawasaki disease?

Back 80

Fever for last 5 days plus at least 4 of the following:
- Bilateral non-exudative conjunctivitis
- Changes of lips/oral mucosa (fissured lips; strawberry tongue)
- Changes in extremities (erythema of palms/soles, edema, periungal desquamation)
- Polymorphous rash
-Cervical lymphadenopathy (at least one node >1.5 cm)

Front 81

Complications from Kawasaki's?

Back 81

Coronary artery aneurysm; MI, hydrops of gallbladder

Front 82

Treatment of Kawasaki's?

Back 82

ASA (80-100mg/kg/day)
Single infusion of IVIG (2g/kg)

DO NOT GIVE STEROIDS

Front 83

What is the most common cause of acquired pediatric cardiac disease in US?

Back 83

Kawasaki's

Front 84

IgA mediated vasculitis involving the small vessles of skin, GI tracts, nad MSK symptoms

Back 84

HSP

Front 85

What is the most common acute vasculitis is children?

Back 85

Henoch-Scholein Purpura

Front 86

Presentation of HSP?

Back 86

ARENA
A= Abdominal pain (bloody stool/intussusception)
R= Rash, purpuric in dependant areas (legs and butt)
E= Edema
N= Nephritis (microscopic hematuria)
A= Arthralgias

Front 87

Treatment of HSP?

Back 87

Arthralgias - NSAIDS
Renal/GI/ Joint involvement - steroids and IVIG

Front 88

Characteristic features of febrile seizures?

Back 88

1. Associated with rapidly rising fever
2. Lasts <10-15 minutes
3. Are general (not focal)
4. Single event in a 24 hour period
5. Postictal neurologic deficits are absent
6. Can have family history
7. EEG = no epileptic activity

Front 89

Age group common for febrile seizures?

Back 89

3 months - 6 years

Front 90

Common presenting signs of increased intracranial pressure

Back 90

Headache with AMS; nausea/vomiting

Front 91

Clinical findings of increased CSF pressure

Back 91

Papilledema, 6th nerve palsy; diplpia; bulging fontanelle; upward gaze; Cushings triad

Front 92

Common infectious organism (2) for ventricular shunts

Back 92

Staph (S. epi and S. Aureus)

Front 93

Fever+ Bloody diarrhea + Seizures =?

Back 93

Shigella

Front 94

Meckel's diverticulum

Back 94

Painless rectal bleeding (massive) <5 years of age

Front 95

Sudden onset of bilious vomiting in a <1 year old (commonly 1rst month)

Back 95

Malrotation with volvulus

Front 96

Xray for midgut volvulus?

Back 96

Double bubble sign

Front 97

Complication and treatment for midgut volvulus?

Back 97

Gangrene of midgut

Prompt surgical consult

Front 98

Most common cause of intestinal obstruction in 3mo - 5yrs?

Back 98

Intussussception

Front 99

Triad of symptoms for Intussussception?

Back 99

Intermittent colicky abdominal pain
Vomiting
Current jelly stool (late finding)

Front 100

Exam finding for Intussussception? Radiographic study and finding?

Back 100

Sausage shaped mass in the RUQ
"Coiled spring sign" on barium enema

Front 101

Nonbilious projectile vomiting in a newborn (2-6 weeks)?

Back 101

Pyloric stenosis

Front 102

Physical finding and metabolic disturbance in pyloric stenosis?

Back 102

Olive shaped mass in the RUQ and Hypochloremic, hypokalemic metabolic alkalosis

Front 103

Most common site in intestines for intusussception to occur?

Back 103

Ileocecal valve