Pedi Final 3

Front 1

T-Cell Lymphoma

Back 1

Non-Hodgkin
Bulky lymphadenopathy
Mediastinal mass

Front 2

Burkitt's Lymphoma

Back 2

Non-HodgkinIntra-abdominal
diseaseHead/Neck/TonsilsLocalized or
Diffuse

Front 3

Chemotherapy Risks

Back 3

Secondary cancers Cardiomyopathy Pulmonary
Fibrosis
Growth Sexual reproduction
Cognitive effects
Kills ALL rapidly dividing cells - toxic

Front 4

Radiation Risks

Back 4

Thyroid dz/cancerCAD
Breast cancer
Skin cancer
Cognitive effects Growth

Front 5

Most common solid tumors
in kids

Back 5

Brain

Front 6

Most common brain tumors
in kids

Back 6

Low-grade astrocytoma (juvenile pilocytic
astrocytoma)Medulloblastoma (neural cells in brain -
commonly cerebellum)

Front 7

Treatment of Brain Tumors
in Kids

Back 7

Surgical resection: most important prognostic
factorRadiation: wait until >3/old as possibleChemo: delay
radiation, prevent metastasis

Front 8

Late effects of tx of brain tumors in
kids

Back 8

HypopituitarismLearning
disabilities

Front 9

Neuroblastoma presentation

Back 9

Suprarenal massParaspinal
(flaccidity)Eye (Horner's)

Front 10

Neuroblastoma prognosis

Back 10

<18 mos: good (surgery + moderate chemo)>18 mos: high
risk (aggressive, mets to bone, BM, skin)

Front 11

Wilms Tumor Presentation

Back 11

Age 2-5NOT sick
appearing
Flank mass

Front 12

Wilms Tumor Tx

Back 12

High cure rate
Surgical resection of
entire kidney
Minimal local radiation
4-6mos chemo

Front 13

Rhabdomyosarcoma
prognosis

Back 13

Local: 70-97%
Met: 25%
Depends on location, size,
surgical resection, age

Front 14

Ewing's Sarcoma and
Rhabdomyosarcoma Chemo Regimen

Back 14

Vincristine, Adriamycin, CyclophosIfosfamide,
Etoposide+/- IrinotecanCompressed cycling (q2 weeks)

Front 15

Ewing's Sarcoma Diagnosis

Back 15

t(11;22) EWS-FLI-1 gene
product

Front 16

Location of Ewing's
Sarcoma

Back 16

Mostly bone - ANY bone possible;
mets to lung & bone

Front 17

Osteosarcoma location

Back 17

Long bones only - distal femur,
proximal tibia, proximal humerus

Front 18

Treatment of Ewing's
Sarcoma

Back 18

Adjuvant chemo + surgeryMAP
chemo:- MTX - Adriamycin or
Doxorubicin- CisPlatin

Front 19

Partial vs. Generalized

Back 19

seizure
Partial: began in one part of brain and spread (maybe d/t
structural lesion)
Generalized: began in both sides of brain
at same time (often genetic)

Front 20

Simple partial seizure

Back 20

Consciousnessis preserved

Front 21

Complex partial seizure

Back 21

consciousnessis impaired

Front 22

Absence Seizure Petit Mal;

Back 22

Generalized seizure Child stares off, can't get
their attention, goes right back to baseline

Front 23

Tonic Clonic Seizure

Back 23

Generalized
Most dangerous
Tonic
body stiffening, arms, legs
extendedClonic

Hint 23

rhythmic jerking

Front 24

Physical exam to dx
epilepsy

Back 24

Look for signs of neurological injury -
motor, sensory, CNs

Front 25

When to use MRI in dx of
epilepsy

Back 25

indication of partial seizure, hx of CP,
stroke, trauma, or abnl features on
exam

Front 26

Neonatal epilepsy mimics

Back 26

Jitteriness (RARELY seizure)
Eyedeviation
Apnea
Bicycling
Bucco-lingual movements

Front 27

Infancy seizure mimics

Back 27

Tonic posturing (pain reflex)
Myoclonus (nl when trying to fall asleep)

Front 28

Early childhood seizure
mimics

Back 28

Breath-holding spells - need to
determine if there was an inciting event

Front 29

School Age/Adolescent
Seizure Mimics

Back 29

Syncope
Staring spells
Complicated migraine
Movement disorders
Narcolepsy

Front 30

Psychogenic seizures

Back 30

Psychogenic seizures NOT EPILEPTIC strong emotional response causes an
episode that LOOKS like a seizureNOT mutually exclusive
w/ epilepsy

Front 31

Infantile Spasms

Back 31

- clinical 1st year (4-6mos)1-5 second contractions of trunk w/
extension of extremitiesNOT rhythmic Occur in clusters
shortly after wakingMay be irritable
Infantile Spasms EEG
Findings
Hypsarrythmia (disorganized waves w/
no distinct pattern)

Front 32

West's Syndrome

Back 32

Infantile spasms
Hysparrhythmia
Developmental regression

Front 33

Absence Epilepsy clinical

Back 33

Loss of awareness w/ cessation of
activity lasting 2-5 seconds
Repetitive blinking/other movement

Front 34

Absence Epilepsy EEG

Back 34

Bilateral distribution of spike and wave complexes
predominating in the frontal lobes, generalized over the
whole brain

Front 35

Absence Epilepsy Prognosis

Back 35

Outgrow by age 10-14

Front 36

Childhood Absence Epilepsy -
onset/remission

Back 36

Onset: age 3-5
Remits: age 10-12Cognitively normal85%
outgrow, 15% develop juvenile myoclonic epilepsy

Front 37

Childhood Absence
Epilepsy - genetics

Back 37

1/3 have +FHX10% siblings

Front 38

Benign Epilepsy with Controtemporal
Spikes (BECTS) - clinical

Back 38

Develops age 6-8Usually simple partial - motor or
sensory sxs of hand or face (lip weakness, drooling, can't
speak well upon waking)Can be tonic-clonic

Front 39

Most common epilepsy in
children

Back 39

BECTS

Front 40

BECTS prognosis Outgrown by mid-teenage
years (100%)
BECTS EEG Focal spike wave right over
frontotemporal (Rolandic) area
Acute Seizure Management

Back 40

1. ABCs2. Monitor VS, STAT glucose, consider underlying
cause, CNS infection (check nuchal rigidity)3. Benzos

Front 41

Acute Seizure Meds - inpt
vs. outpt

Back 41

Inpt: IV lorazepamOutpt: Diazepam
(valium) PRGive after 5 minutes

Front 42

When to treat epilepsy

Back 42

1 seizure + abnl neuro exam, abnl
EEG, remote symptomatic etiology OR
>1 seizure
Partial Seizure Meds Carbamazepine,
oxcarbazepine

Front 43

Tonic Clonic Treatment

Back 43

Valproate, Lamotrigine,
Levetiracetam

Front 44

Myoclonic Seizure
Treatment

Back 44

Valproate, Levetiracetam

Front 45

Absence Seizure Treatment

Back 45

Before age 12: ethosuximideAfter age
12: Valproate, Levetiracetam,
Lamotrigine

Front 46

Infantile Spasms Treatment

Back 46

ACTHVigabatrin (if tuberous
sclerosis)

Front 47

Treatment of refractory seizures

Back 47

(meds
not working)
Ketogenic Diet
Vagal Nerve Stimulation
Epilepsy Surgery

Front 48

Definition of intellectual
disability

Back 48

Limitation in intellectual functioning and adaptive
behavior; onset before age 18; IQ < 70; global
developmental delay (2+ domains)

Front 49

Prevalence of mild to moderate
ID

Back 49

1.5% - can decreased by environment
and education

Front 50

Prevalence of severeprofound
ID

Back 50

0.5% - fixed independent of population/
environement

Front 51

Diagnostic Testing for ID

Back 51

Chromosomal microarray: highest yield, standard of care
MRI: only if structural abnormality suspected Individual
genetic testing: Fragile X in males, MECP2 in females

Front 52

Fragile X Physiology

Back 52

Inactivated FMR1 gene d/t CGG >200
copies

Front 53

Clinical Symptoms of Fragile
X

Back 53

Narrow, elongated faceLarge,
protruding ears
Macro-orchidismJoint
hyperlaxity
AutismEpilepsy

Front 54

X-Linked Intellectual
disabilities

Back 54

Nonsyndromic mental retardation without other associated
organ involvement or significant dysmorphology

Front 55

Treatment of behavioral
disorders in ID

Back 55

Neuroleptics
Atypical antipsychotics

Front 56

Treatment of hyperactivity in
ID

Back 56

Clonidine Methylphenidate

Front 57

Treatment of Epilepsy in ID

Back 57

Avoid Keppra if mood disorder
(worsening depression, increased
suicide)

Front 58

Causes of sleep
disturbances in ID

Back 58

Central/OSASeizure
activityDisorganized architecture (lack
of input to circadian clock

Front 59

Acute abdomen in ID

Back 59

Significant mortality
May not tell you/
present w/ other sxs

Front 60

Prognosis of mild-moderate
ID

Back 60

Functional attainment at 6 years
represents lifespan Continues to
develop intellectually

Front 61

Morbidity in ID

Back 61

Cardiorespiratory disease
Severe epilepsy

Front 62

Protective factors in
childhood psych

Back 62

Resiliency: IQ, attractiveness,talent, likabilityConnection to
familyConnection to schoolParental behavioral/academic
expectations

Front 63

Risk factors for childhood psych
disorder

Back 63

No sense of belonging: poverty, moving, abuse,
neglectFamily adversity/lack of supervisionFHx of psych
disordersDrugs, alcohol, tobacco experimentation

Front 64

Mainstay of tx for childhood psych
disorders

Back 64

Psychopharmaceutical and
psychotherapy

Hint 64

family therapy, CBT
(anxiety!), pscyhodynamic

Front 65

ANGER is a symptom of...

Back 65

Anxiety
ADHD
Autism
Substanceabuse
Trauma
Bipolar
Depression

Front 66

Clinical presentation of
depression

Back 66

Insomnia, anhedonia
Decreased energy, appetite
Amotivation (quitting)
Guilt, Loss of self worth, Hopeless,
isolative Unrealistic high standardsMissing
school, academic problems

Front 67

Parent perceptions of
depression

Back 67

Defiance Spoiled

Front 68

Treatment of Childhood
Depression

Back 68

EducationAnti-depressants (SSRI,
SNRI)Family/school
involvement CBT Social Activities

Front 69

Most common mental health disorder
in children

Back 69

ANXIETY

Front 70

Cognitive presentation of
anxiety

Back 70

Fearful Nervous Stressed Difficulty
concentrating Inattentive Self-defeating

Front 71

Behavioral presentation of anxiety

Back 71

Restless Clingy Dependent/shy Reluctant Avoidant Withdrawn

Front 72

Physical
manifestations
of anxiety

Back 72

CV: increased HR, BPRespiratorySkin
(sweating)HA/DizzyGI**MSK

Front 73

Treatment of
anxiety

Back 73

Mild: therapyMod: meds + therapy (taper meds after 6 mos)
Severe: intensive combination
therapy
**PCP consult: TFT/Hormone workup

Front 74

Disruptive Mood
Dysregulation
Disorder

Back 74

Severe recurrent temper outbursts out of proportion to the
situation 3+ x/week x12 mos; Age 6-18

Front 75

Highest mortality
mental health
disorder

Back 75

Eating disorders

Front 76

ASD: deficits in social
communication

Back 76

Social-emotional reciprocity
Nonverbal communication
Relationships

Front 77

ASD: restricted/repetitive
behaviors

Back 77

Stereotyped/repetitive speech, motor (echolalia, hand
flapping, body rocking, spinning)
Excessive adherence to routine
Highly restricted, fixated interests, Unusual sensory
interests

Front 78

DSM5 Diagnostic Criteria for
ASD

Back 78

3 Deficits in social communication; 2+ Deficits in behavior,
interest or activitySxs in early childhoodSxs limit/impair
daily fxning

Front 79

AAP Screening Timeline for ASD

Back 79

12 mos18 mos24 mos 3 years

Front 80

Red Flags for ASD

Back 80

12 mos: no babbling, gestures
16 mos: no 1st word
24 mos: cannot combine 2 words

Front 81

Neurobiology of ADHD

Back 81

Under active dopamine in PFC (target of stimulants)
Overactive nor-epi in LC (target of alpha agonists)

Front 82

DSM5 Criteria for ADHD

Back 82

Inattention Hyperactivity & Impulsivity Before age 122+
settings Interfere w/ social, academic, occupational fxning
Not schizophrenic or psychotic

Front 83

Who to evaluate for ADHD?

Back 83

4-18yo w/ academic or behavior problems + sxs of inattention, hyperactivity or impulsivity

Front 84

ADHD Coexisting Emotional/Behavioral Disorders

Back 84

Anxiety Depression ODD OCD

Front 85

Developmental Disorders coexisting w/
ADHD

Back 85

Learning/language
Hearing loss
ASD

Front 86

Physical disorders coexisting with ADHD

Back 86

Sensory impairments; Tics; Sleep disorders; Medications

Front 87

Medical ADHD Mimics

Back 87

Hearing/vision Chronic illness; Medication complication
(asthma beta-agonist)SyndromesSeizure
disordersASDPrematurityCNS injury, infection, toxinOSA

Front 88

Mental Health ADHD Mimics

Back 88

MDD
BPD
Anxiety
ODD/OCD
Adjustment reaction /Substance Use

Front 89

1st Line Medications for ADHD

Back 89

Simulants- Methylphenidate-
Dexmethylphenidate-
Dextroamphatime- Lisdexamfetamine

Front 90

2nd line tx for ADHD

Back 90

SNRI: atomoxetineAlpha agonists: Clonidine XR,
Guanfacine XRAtypical antidepressant: Bupropion
(>16yo)TCAs

Front 91

Main indication of abusive
injury

Back 91

INCONSISTENCIES

Front 92

Areas of bruising concern for abuse

Back 92

Ears Triangle of safety: ear, side of face, top of
shoulderInner aspects of armsBack, side of trunkBlack
eyes (bilat!!)Cheeks; Intra-oral; Groin Inner thigh; Soles of feet

Front 93

Concerns for inflicted burns

Back 93

Multiple; Patterned; Immersion
Concerning fracture TYPES for abuse

Hint 93

Rib (lateral aspect and at attachment to
spine)FemurSkullClassic metaphyseal lesion
(corner/bucket handle fracture)

Front 94

Age-Based Evaluation to r/o occult
injury in potential abuse

Back 94

<6mos: Head imaging, skeletal survey, labs<2y: skeletal
survey, labs<6y: labs>6y: symptomatic w/u