Pedi Final 2

Front 1

Actions of thyroid hormone

Back 1

Nerve: myelination, neuronal connectionsGH production,
secretion, actionProlactin production, secretionIntestinal
glucose absorptionATP productionAdrenal medulla
activityEnzyme synthesis Stimulates BMR

Front 2

Most common, treatable cause of
mental retardation

Back 2

Congenital hypothyroidism

Front 3

Lab values of CH

Back 3

High TSH (>30)Low T4
(<10%)Important to repeat later in
premes (FPs)

Front 4

Clinical presentation of Congenital
Hypothyroidism

Back 4

Macroglossia
Umbilical hernia
Wide posterior fontanelle w/
open sutures
Puffy faceSlow to feed
ConstipationLethargy,
needs to be awakened to feed
Hoarse cry
Cool to
touch
Hypotonic, slow reflexes
Prolonged
jaundice
SNHL
Increased head circumference
Weight >90%but short stature+/- palpable goiter

Front 5

Thyroid Radionuclide
Uptake and Scan

Back 5

most accurate test to determine type of
thyroid dysgenesis

Front 6

Thyroid U/S

Back 6

confirms thyroid aplasia

Front 7

Serum thyroglobin

Back 7

Detects amount of thyroid tissue/ thyroid activity

Front 8

Treatment of
Congenital
Hypothyroidism

Back 8

Levothyroxine(Synthroid) 10-15mcg/kg/day - T4 in upper range of nl during 1st
year of life to prevent retardation

Front 9

Bimodal peaks of
T1DM

Back 9

4-6 years10-14 years

Front 10

Classic New-
Onset T1DM Sxs

Back 10

PolyuriaPolydipsiaEnuresisNocturiaPolyphagiaWeight
loss

Front 11

DKA

Back 11

Ketoacids Beta-hydroxybutyrateAcetoacetate

Front 12

Increased risk of
DKA

Back 12

Very youngLower SES
No FHx of T1DM

Front 13

DKA: early sxs

Back 13

VomitingPolyuriaDehydrationAbdominal pain or
rigidity Profound weight loss

Front 14

DKA: late sxs

Back 14

Kussmaul respirationsAcetone odor on breath

Front 15

DKA Lab Findings

Back 15

Hypertonic dehydrationElevated serum glucose (<1000)Urinary/plasma
ketonesPseudohyponatremiaHyperkalemiaHypophosphatemiaIncreased
BUN/Cr - dehydrationLow BicarbAG Metabolic Acidosis CBC, Blood cx
(if suspect infection)

Front 16

Goals of DKA treatment

Back 16

1st correct dehydrationCorrect
acidosisFix elyte deficits
Correct hyperglycemia

Front 17

1st step of DKA treatment

Back 17

Bolus 20ml/kg (10 in newborns) NSReassess - can give
2nd bolusWill improve hyperglycemia - increased GFR
with improved renal perfusion

Front 18

Potassium repletion in DKA

Back 18

Depletion more evident when acidosis corrected Monitor
EKG while repleting30-40mEq/L KCl or KPhos

Front 19

Phosphate repletion

Back 19

in DKA Depletion becomes more evident when
acidosis correctedMonitor calcium
during repletion

Front 20

Insulin tx in DKA

Back 20

0.1U/kg/hr (NO BOLUS) until acidosis
(not hyperglycemia) is corrected

Front 21

Dextrose tx in DKA

Back 21

Add to IVF when serum
glucose <300

Front 22

Diagnosis of T1DM

Back 22

FPG >126OGTT/Random > 200A1C >6.5%Low insulin/cpeptideAutoAbs:
anti-islet cell, anti-insulin, anti-glutamic
acid decarboxylase

Front 23

Complications of DKA

Back 23

Cerebral edema
Rhabdo Infection
Thrombosis
Cardiac arrhythmia Pulmonary edema (fluid overloaded)
Renal failure Pancreatitis

Front 24

A1C goal for T1DM

Back 24

<7.5%

Front 25

Lab monitoring of T1
Diabetics

Back 25

A1C q3mosTFTs yearlyLipids q5y if nlCeliac panel q 2-
3yUrine Albumin:Urine Cr ratio yearly (<30mg/g)

Front 26

Night pain DDx

Back 26

Benign: benign hypermobility, growing
pains, osteoid osteoma
Malignant: ALL, Neuroblastoma

Front 27

Definition of JIA

Back 27

chronic joint inflammation in childhood NOT part of other
systemic conditions; lasts at least 6 weeks and onset is
before 16 years old

Front 28

Diagnosis of JIA

Back 28

DOE
Oligoarticular Persistent JIA definition < 4 joints affected

Front 29

Oligoarticular JIA
presentation

Back 29

Usually lower extremities (knee) Often monoarticular
Holds affected leg in flexion Hip NEVER presenting joint
Pre-school ageGirls>boys

Front 30

Labs of oligoarticular JIA

Back 30

Low inflammation ANA+RF

Front 31

Complications
of Oligoarticular JIA

Back 31

LLDAnterior Uveitis (esp if <7 and
ANA+)

Front 32

Oligoarticular Extended JIA

Back 32

1st 6 mos: < 4 jointsCumulative joint involvement over
course of dz > 5Often presents in upper extremities, small
jointsAsymmetric

Front 33

Polyarticular,

Back 33

RF+ JIA 5+ JointsRF+ x2 3 months
apart

Front 34

Presentation of
Polyarticular,

Back 34

RF+ JIA
Small & lg jointsSymmetricAdolescent
females

Front 35

Labs of Poly,

Back 35

RF+ JIA RF+Anti-CCP+Rarely ANA+

Front 36

Polyarticular RF-

Back 36

JIA 5+ joints in first 6 mos

Front 37

Presentation of poly,
rf- jia

Back 37

May be asymmetric
Any age
Easier to
control
Rare extra-articular complications
Systemic JIA (Stills Disease)

Front 38

Diagnostic Criteria
Arthritis

Back 38

Quotidian fever for > 2 weeks1+:- Rash: salmon pink
evanescent (w/ fever, on trunk)- Generalized lymphadenopathy-
HSMSerositis (pleuritis or pericarditis)

Front 39

Complications of SJIA

Back 39

Ankylosis/Destruction Micrognathia Macrophage
Activating Syndrome**

Front 40

Macrophage
Activating
Syndrome
Symptoms

Back 40

Bleeding/bruisingFeversHSMFatigueIrritableHASeizure,
comaRespiratory distress

Front 41

Dx of MAS in
SJIA

Back 41

Clinical triad: hepatitis, pancytopenia, DICGOLD STD:
hemophagocytosis on bone marrow aspiration

Front 42

Enthesitis Related
Arthritis (ERA)
Diagnostic Criteria

Back 42

Arthritis AND Enthesitis OR Arthritis OR Enthesitis AND 2+:- SI joint tender, inflam
spinal pain- HLA-B27- FHx of HLA-B27 disease- Acute anterior uveitis- Onset
arthritis in boy >8yo
Boy, age >8,

Front 43

Osgood
Schlatter's,

Back 43

recurrent
toxic hip

Front 44

ERA

Back 44

Get an HLA-B27LabsAsk about fhx back pain

Front 45

Modified Schober Sign

Back 45

<21 cm, inflammation in lower back - requires aggressive tx to prevent
progression of ERA to ankylosing spondylitis

Front 46

Psoriatic Arthritis
Diagnostic Criteria

Back 46

Arthritis & PsoriasisOR
Arthritis & 2+:- Dactylitis (sausage digit)- Nail pitting- FHx psoriasis

Front 47

Arthritis NSAIDs

Back 47

Ibuprofen Naprosyn Meloxicam

Front 48

Arthritis DMARDs

Back 48

MTX Leflunomide Hydroxychloroquine Sulfasalazine

Front 49

Arthritis Biologic
DMARDs

Back 49

Anti-TNF: Enbrel, Humira, RemicadeAnti-IL: good
for SJIA

Front 50

Normal MCV in
Peds <10 years old:

Back 50

70+ageAge 10+: 80-95 (adult)

Front 51

Normal RDW in Peds

Back 51

11.5-14.5%

Front 52

Normal RBC Count in peds

Back 52

3.5-4.7

Front 53

Mentzer's Index

Back 53

MCV/RBC>13 is Fe-deficiency <13 is Thalassemia

Front 54

Thalassemia Lab Values

Back 54

Low MCV (<70)Nl RDW (11.5-
14.5) High RBC count Mentzer's: <13

Front 55

Anemia Lab Values

Back 55

Low MCV
Elevated RW (>14.5%)
Low RBC (<3.5)
Mentzer's: >13

Front 56

Diagnosis of Fe-deficiency
Anemia

Back 56

Low serum ironHigh TIBC% Sat <10%
(Serum Fe/TIBC)Low Ferritin (<20

Front 57

)
Clotting Factor Disorder
Symptoms

Back 57

Joint bleedingMuscle bleeding (warm,
hot, firm)Prolonged PTT

Front 58

Platelet Bleeding Disorder
Symptoms

Back 58

Mucosal bleeding Gum
bleeding Nosebleeds (bilat) Menorrhagia

Front 59

ALL Red Flags Back pain

Back 59

Limp Waking up at night in
pain

Front 60

ALL potential sxs

Back 60

Bone pain Fever HSM BruisingBleeding

Front 61

ALL Labs WBC:

Back 61

often nlPlts: LOW <125Hgb:
LOW <10

Front 62

ALL "Standard Risk"

Back 62

WBC < 50KAge 1-9.9

Front 63

ALL "High Risk"

Back 63

WBC >50KAge >10

Front 64

Minimal Residual Disease
Prognosis

Back 64

<.01% on Day 29

Hint 64

good
prognosis>.01% on Day 29

Front 65

Unfavorable genetics in ALL MLL

Back 65

rearrangement (4,11)Philadelphia
chromosome (9,22) More common in
infants

Front 66

Leukemia

Back 66

is a cancer of Bone marrow

Front 67

Lymphoma

Back 67

is a cancer of Lymph nodes

Front 68

Clinical Presentation of
Lymphoma

Back 68

Enlarged lymph nodes/ bulky
lymphadenopathy - nontender, firm,
immobile, no infection HSM

Front 69

Non-Hodgkin Lymphoma general
characteristics

Back 69

Younger children Acute
onset
Proliferation of T or B cells
Risk of
Tumor Lysis Syndrome

Front 70

Hodgkin Lymphoma general
characteristics

Back 70

Teens and young adults
Subacute, indolent
presentation
Reed Sternberg cells+/- B Sxs: fever, night
sweats, wt lossUsually presents head, down

Front 71

Tx of Hodgkin Lymphoma

Back 71

Chemo and radiation (95%
survival)

Front 72

T-Cell Lymphoma

Back 72

Non-Hodgkin
Bulky lymphadenopathy
Mediastinal mass