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160 Cards in this Set

  • Front
  • Back
Murmur associated with patent ductus arteriosus
Continuous machine like murmur
Venous hum
Infraclavicular hum, continuous R/L
Murmur associated with ASD
soft, blowing, upper left sternal border
CHD with down syndrome
Atrioventricular septal defect
VSD
ASD
CHD with DiGeorges
Aortic arch anomalies
CHD with Noonan syndrome
Pulmonary stenosis
CHD with osteogenesis imperfecta
Aortic incompetence
CHD associated with Turner
Coarctation
Bicuspid aortic valve
Risk of having CHD if previous baby had one?
2-4%
CHD associated with DMII
TGA
CHD associated with SLE
Complete heart block
CHD associated with phenylketonuria
TOF
CHD associated with alcohol consumption
VSD
ASD
CHD associated with Phenytoin Use
VSD, ASD, PS, AS, Coarctation
Boot shaped heart on Xray
TOF
Egg shaped heart
TGA
Snowman heart
Total anomalous pulmonary venous return
Most common cancer occurring in first year of life?
Neuroblastoma
Cervical spinal nerves affected in Erb's Palsy?
C5-C6
When to refer a patient to a urologist if he has an undescented testicle?

Medical name for this condition
6 Months

Cryptocorshidism
Children typically manifest anxiety towards strangers at what age?
9 months
Advantage of Pneumococcal 7 valent vaccine Vs Pneumovax in children < 1 year
It is more immunogenic.

Pneumovax causes a good immunogenic response in individuals > 2 years
Radiologic sign of Croup
Steeple's sign
Treatment of Croup/Faux croup
1. Racemic epinephrine
2. Dexamethasone
3. Ventilation assistance if necessary
Association between eczema/atopic dermatitis and asthma?
They both increase the risk of asthma compared to the general population.
Most suggestive sign of selective mutism?
Child who does not speak with teachers and classmates
Criteria for selective mutism
No speaking in social / specific situations
Child is able to speak in specific environments
> 1 month
No underlying communication disorder (i.e. stuttering)
Social and school dysnfunction
Most common cause of neonatal death in children of mothers known to have diabetes mellitus before pregnancy?
Congenital anomalies
APGAR
Appearance
Pulse
Grimace (nothing / grimace / cry)
Activity (nothing / flexion / active)
Respiration
Treatment of femoral anteversion
Observation.

Treatment is only warranted children 8-10 years old who still have cosmetically unacceptable, dysfinctional gaits.
Management of congenital heart block caused by SLE?
Permanent pacemaker
Bone age vs heigh age vs chronologic in :
- hypothyroidism
- cystic fibrosis
- genetic syndromes
HypoT4 : BA< HA = CA

FKP : BA = HA < CA

Genetic : HA < BA
Most common cause of central cyanosis in newborns
Lung disease > cardiac disease > sepsis
Is head banging normal in children < 3 years old?
Yes. It should stop before 3 years old.

If other signs are present, suspect abuse.

Head banging is increased in children with developmental disorders (T21, Lesch-Nyhan, autism)
Presentation of radial head sub luxation
arm in flexion and hand in pronation.

innocent injury commonly inflicted by lifting the child by one arm.
Management of lice in children?
Management of pediculosis :
1) Permethrin 1% (cream or shampoo)
2) comb hair with fine toothed comb using dilute vinegar solution to remove nits
3) repeat in 7 days
4) bedding, clothing and towels should be changed and washed with detergent in hot water cycle then machine dried.
Prophylaxis of ophtalmia neonatorum
Erythromycin ointment
Most common cause of newborn ophtalmia?
Chlamydia > gonorrhea

PO erythromycin is better than ointment
Is it safe to administer MMR vaccine to children with egg allergies?
Give the child the MMR vaccine under medical supervision.

The current MMR vaccine does not contain a significant amount of egg proteins. The benefits of the vaccine outweigh the risks.
Initial presentation of Duchenne's dystrophy?
Difficulty walking. Late walking.
Unfavorable risk factors in ALL
Age < 2 or > 10
L2 or L3 morphologies or PAS staining
Very low platelet count (<100 000)
Hb > 10

Favorable
age between 2 and 10
L1 morphology
What does a normal PCO2 in acute asthma exacerbation indicate?
It may indicate that the patient is going into respiratory failure, because the pCO2 should be low since the patient should be hyperventilating.
When is DEET safe to use?
(mosquito repellant)
DEET (10-30%) is safe to use in children over 2 months of age and is associated with a very rare incidence of major adverse effects.

Do not use over 30%.
Genetic disease associated with rectal prolapse
FKP (20%)
Most successful intervention for obese children?
Those that are family based and behaviour oriented
When should birth weight be regained?
within 2 weeks
Most common cause of neonatal death in children of mothers known to have diabetes mellitus before pregnancy?
Congenital anomalies
APGAR
Appearance
Pulse
Grimace (nothing / grimace / cry)
Activity (nothing / flexion / active)
Respiration
Treatment of femoral anteversion
Observation.

Treatment is only warranted children 8-10 years old who still have cosmetically unacceptable, dysfinctional gaits.
Management of congenital heart block caused by SLE?
Permanent pacemaker
Bone age vs heigh age vs chronologic in :
- hypothyroidism
- cystic fibrosis
- genetic syndromes
HypoT4 : BA< HA = CA

FKP : BA = HA < CA

Genetic : HA < BA
Most common cause of central cyanosis in newborns
Lung disease > cardiac disease > sepsis
Is head banging normal in children < 3 years old?
Yes. It should stop before 3 years old.

If other signs are present, suspect abuse.

Head banging is increased in children with developmental disorders (T21, Lesch-Nyhan, autism)
Presentation of radial head sub luxation
arm in flexion and hand in pronation.

innocent injury commonly inflicted by lifting the child by one arm.
Management of lice in children?
Management of pediculosis :
1) Permethrin 1% (cream or shampoo)
2) comb hair with fine toothed comb using dilute vinegar solution to remove nits
3) repeat in 7 days
4) bedding, clothing and towels should be changed and washed with detergent in hot water cycle then machine dried.
Prophylaxis of ophtalmia neonatorum
Erythromycin ointment
Symptoms of congestive heart failure in infants are often related to feedings. Only small feedgins may be tolerated and dyspnea may develop with feedings.

Profuse perspiration with feedings is characteristic.
---
Treatment of milk protein allergy
Breastfeeding + mother not taking milk

or

Hydrolated casein formulas (nutramigen or pregestimil)
Presentation of milk protein allergy
chronic diarrhea
poor weight gain

+ sometimes associated to :
- eczema
- occult blood in stool
- intolerance to soy milk
Classic presentation of slipped femoral epiphysis
adolescent male who has probably had a recent growth spurt.

Pain with activity is the most common presenting symptom. Typically in the anterior thigh, but can be referred elsewhere.

Limited internal rotation of the hip, especially with the hip in 90 degrees flexion, is a reliable and specific finding for SCFE.
Management of caustic chemical burns
Wash with water then ER.

Do not bandage or put anything that increases that allows the chemical agent to stay in touch with the skin.
Most common cause of hemoptysis in 6 year olds?
Foreign bodies
Most common posterior mediastinal tumour in children?
Neuroblastoma
Most common cause of proteinuria in children
Orthostatic proteinuria
Puberty stages in girls
Thelarche
Adrenarche
Pubarche
Growth spurt
Mearche (mean 13 years, 2 years after breast development)
Most common cause of visual loss in children?
Amblyopia - often related to strabismus, in which the image from one wye is suppressed in order to eliminate diplopia.
CXR of TTPN
Diffuse parenchymal infiltrates.

Most common cause of neonatal respiratory distress. It is a benign condition due to residual pulmonary fluid remaining in the lungs after delivery.
Possible significant side effect of pertussis vaccine
hypotonic-hyporesponsive episodes
Antibiotic used for the treatment of Acne
Tazarotene
RIsk factors associated with child sexual abuse
Female

Physical disabilities (blindness, deafness, mental retardation)

Family constellation :
- absence of one or both parents
- presence of step father in home doubles the risk for girls.
Rx causes of gynecomastia
Hormones (androgens, anabolics, estrogen)
Antiandrogens
Antibiotics (INH, Ketoconazole, metronidazole)
Anti-ulcer (cimetidine)
Chemotherapy
Captopril
Digitalis
Presentation of lead intoxication
Microcytic anemia with basophilic stippling.

Drops : feet and wrists
Encephalopathy
Lead lines on gingivae and epiphysis of long bones

Abdominal colic
Treatment of lead intoxication (what and when)
When Lead levels > 45 ug/dl

dimercaptol
EDTA
chelation (succimer)
Until what age is nocturnal enuresis considered normal?
Until the age of 6
Marcus Gunn Pupil
During the swinging flashlight test, the patient's pupil constrict less (therefore appearing dilate) when the light swings from the unaffected eye to the affected eye.
Who should receive U/S after UTI?
Every child except girls > 6 years old
Who should receive retrograde cystography after UTI?
Every child except girls > 6 years old
When should a Mag3-furosemide be prescribed?
To differentiate between obstructive and non obstructive hydronephrosis
Treatment of UTI in children < 3 months
Ampi-Genta
Hospitalize
IV ad 48 hours no fever, then PO, total 10-14 days (ampi-clavu)
Gentamycin dosage
Treatment of UTI in children 3 months - 6 years
Ampi+Genta
IV ad 48 hours no fever, then PO 10-14 days (ampi-clavu)
Hospitalize if severe- moderate
Genta dosage

If no signs of dehydration or fever or... PO can be tried initially
Treatment of UTI in children > 6 years old
Pyelonephritis
- According to severity, same as 3 months-6 years
- 15-18 years old : Ciprofloxacin or Bactrin

Acute cystitis
- Bactrin / Cipro / Cephalexin 3-4 days (10 if congenital anomalies)
Presentation of necrotizing enterocolitis
NE is typically seen in the distressed neonate in ICU (at most at 2 weeks of life).

The child appears ill, with symptoms including irritability, poor feeding, a distended abdomen and bloody stools.

AXR : pneumatosis intestinalis
Imaging for pyloric stenosis
U/S
Most common cause of stridor in children < 2years
Laryngomalacia
Supplementation necessary for exclusively breastfed infants?
Vitamin D
nursemaid's elbow
Sub luxation of the radial head
Most common form of child abuse in Canada
Child neglect
Most common cause of asymmetric red reflex in newborns?
Congenital cataract

ddx
-retinoblastoma
-congenital glaucoma
Most common cause of amblyopia
Starbismus
Coronary artery aneurysm prevention in Kawasaki disease?
Aspirin + immunoglobulins
Mesenteric lymphadenitis
Inflammation of the lymph nodes on the wall of the mesentery.

It is very similar to appendicitis and it is difficult to differentiate them.

Colicky abdominal pain which just resolves momentarily without any intervention. Characteristically, the pain moves from one spot to the other on the abdomen.

Asking the child to turn to the left side will demonstrate this shift as the area of pain and tenderness will move along with the bowel to the left.
Leading cause of congenital hearing loss
CMV infection
Most common congenital infection
CMV 2.2%
Only antidepressant approved for the treatment of depression in children 8-17 years old?
Fluoxetine (Prozac)
DTaP
Diphteria
Tetanus
Pertusis

< 7 years old
DT vaccine
Diphteria
Tetanus

< 7 years old
Td vaccine
Tetanus
Diphteria

Booster for adolescents and adults every 10 years or after exposure to tetanus
Tdap vaccine
Tetanus
Diphteria
Pertussis

Booster for adolescents and adults every 10 years or after exposure to tetanus
% of auto resolutive congenital hip dysplasia
60% after 1 week
90% after 2 months
Management of congenital hip dysplasia
Orthopedic referral
- closed reduction and immobilization in a Pavlik Harness, with ultrasonography of the hip to ensure proper positioning.
Developmental milestones : 12 months
Walk with support
Pincer grasp
Throw objects
Speak in single words
Developmental milestones : 6 months
Tripod sit
Object transfer from hand to hand
Babble
Stranger anxiety
Developmental milestones : 2 years
2 word sentences
Understand 2 step commands
Up/down steps
Developmental milestones : 3 years
3 word combos
3 digit repeat
rides ticycle
Developmental milestones : 4 years
Counts 4 objects
Knows 4 colours
Draws 4 sided object (square)
Developmental red flags
Not smiling at 3 months
No peek-a-boo at 9 months
Exhibits handedness < 10 months
Not walking and < 3 words at 18 months
Is cipro safe for children?
no.
It is no approved for patients < 18 years old
Palivizumab indications
MAB administered IM for childern with RSV infection to reduce the risk of hospitalization.

It is indicated if :
- chronic lugn disease
- preterm birth
- congenital heard disease
Role of ipratropium added to ventolin in acute asthma exacerbation in children
lessens the need for hospitalization
double bubble sign
duodenal atresia
Treatment of severely symptomatic salmonella gastroenteritis
< 18 years old : Bactrim
> 18 years old : Cipro
Management of seborrheic dermatitis
Mild tar shampoo
Oatmeal baths
Avoidance of soaps
Mild topical sterois
Baby oil applicant to scalp
Keep diapers as dry as possible
What is Reye syndrome
Acute encephalopathy associated with high ammonia levels.

It occurs after administration of aspirin following a viral illness
Hyperoxic test interpretation
With 100% FiO2 :
PaO2 < 150 = cardiac lesion

- if PaO2 < 50 : cardiac lesion with restricted pulmonary flow or a separate venous and arterial circulation

- if PaO2 50-150 : no restriction of pulmonary blood flow.
McIsaac Criteria
No cough
Fever > 38
Cervical Lymphadenopathy
Sore throat with exudates
Age 3-14

Score 0-1 : No culture, no treatment

Score 2-3 : Culture, treat if positive

Score 4: Antibiotics

(First, rapid antigen test, if negative : throat culture)
Treatment of GAS pharyngitis
1) Amoxil 40/kg bid x 10 days

PCN allergy : erythromycin

Can prevent rheumatic disease if treated within 9-10 days

No effect on prevention post streptococcal GN
Relating to baby car seats, until when should the baby face rearward?
Until he weighs 9 kgs
When can a child put on a seatbelt in a car?
When he weighs 36 Kgs or is 8 years old
Treatment of prepubertal labial adhesions
Local estrogen application
When should screening for type II diabetes begin in children?
Children at risk should be screened at age 10.

At risk =

BMI > 85th percentile +
- family history, or
- race risk, or
- signs / symptoms of insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, PCOS)


Screening should be done every 2 years.
Most common cause of sudden cardiac death in young athletes?
Hypertrophic cardiomyopathy
Treatment of impetigo
1 : Muciprocin topical or Fucidin x 10 days

2 : Oral cloxacillin or cephalexin
Anticonvulsant resistant seizures in meningitis patient
Hyponatremia from SIADH
Most significant risk factor for the development of childhood asthma?
Parental asthma
Example of positive reinforcement
Reward for a negative or undesirable behaviour
Example of negative reinforcement
"Time out" for a negative or undesirable behaviour
Fetal Alcohol syndrome characteristics
Thin upper lip
Smooth philtrum
Flat nasal bridge
Clinodcatyly
Prenatal and postnatal growth retardation
Functional or structural CNS abnormalities
Management of inguinal hernias in children
Herniorrhapy should be scheduled at the earliest convenient time
Median age of closure of anterior fontanelle
13.8 months
Treatment for nocturnal enuresis that has both the highest cure rate and the lowest relapse rate?
Bed wetting alarm
Grades of intraventricular hemorrhage
grade 1 : isolated subependymal hemorrhage
grade 2 : intraventricular hemorrhage without ventricular dilatation
grade 3 : intraventricular hemorrhage with ventricular dilatation
grade 4 : intraventricular hemorrhage with parenchymal extension
Tuberous Sclerosis
Autosomal dominant disorder characterized by :
- ash leaf spots (flat, hypopigmented macules)
- shagreen patches (areas of anormal skin thickening)
- sebaceous adenomas (confused with acne)
- facial angiofibromas

Can be associated with mental retardation and seizures
Sturge Weber syndrome
Port-wine lesions on the face in the distribution of the trigeminal nerve.
Associated with vascular proliferation within the brain leading to hemiatrophy and seizures as well as vascular proliferation in the eye which may lead to glaucoma.
Von Hippel-Lindau disease
Characterized by vascular hamartomas in the eye and brain
+ renal cell tumours
+ pheochromocytoma
Neurofibromatosis
Multiple Café au Lait macules on the skin + fibromas
+ hypertension secondary to renal artery stenosis
How to differentiate between Asperger's and autism
In both condition, children have significant difficulties with social interactions, although the impairment is more severe and sustained in autism. Both Asperger's and autism may be associated with symptoms of repetitive motor mannerisms, restricted patterns of interest, or preoccupation with parts of objects.

However, unlike children with Asperger's syndrome, autistic children have serious problems with communication skills, either in the development of speech itself on in the ability to carry on a conversation.

Normal, age appropriate language skills in a 3 year old would r/o a diagnosis of autism.
Age where an abdominal hernia should disappear
1-3 years of age
Piaget's stages
Sensorimotor stage (0-2) : children learning by activity, explanation and manipulation of environment.
Preoperational stage (2-7) : the child engages in symbolic representation of the world
Concrete opearations (7-11) : the child is capable of limited, logical thought process
Formal operations (12-adult) : the child can reason logically and abstractly
Eye pathology associated with pauci-articular JRA
Uveitis
Most common posterior fossa tumours in children
Medulloblastoma
Cerebellar astrocytoma
Ependymoma
Most common Brain tumour in children
Low grade pilocytic astrocytoma
Most common brain cancer in children
Medulloblastoma
Three most common knee conditions in children
Patellar sub luxation
Tibial apophysitis
Patellar tendonitis
Most common cause of hypertension in adolescents
Essential hypertension
At what age are tears produced?
3 weeks of age
Pubertal stages in boys
1. Growth of scrotum and testes
2. Lengthening of penis + growth of prostate
3. Pubarche
4. Axillary and facial hair (2 years after pubic hair)
5. Growth spurt (1 year after pubarche)
6. ejaculation
What is infantile esotropia
constant inward turning of the eyes that develops before 6 months of age. It often runs in families and tends to be severe.

Exotropia is a constant outward turning of the eye.
Tests to order for suspected early puberty in boys?
Testosterone
DHEA and DHEA-S
Bone age X-Ray
Urinary 17-Ketosteroids
What does C1 esterase inhibitor deficiency signify?
Hereditary angioedema
At what age can cow milk be started?
12 months
Human milk conservation
10 hours at room temperature
8 days in refrigerator
12 months in freezer
When frozen, it should be thawed slowly
Should not be refrozren
Human milk naturally separates and can be easily re-emulsified by shaking
Characteristics of growing pains?
Age 9 - 14
Pain is poorly localized
Can awaken child at nigh
Pain abates with reassurance and massage
Osgood Schlatter disease
irritation of the patellar tendon at the tibial tuberosity.

Mainly in patients 10-15 years of age.
ACtive in sports that involve a lot of jumping.

2nd to repetitive microtrauma and traction apophysistis of the tibial tuberosity.

Bilateral symptoms can be present.

Self limited condition.

Treat with rest, NSAIDs, physio and infrapatellar strap during activities.
What is a post traumatic air-fluid level in the sphenoid sinus associated with?
Basilar skull fracture
Myelomeningocele is associated with which allergy?
Latex
Most likely cause of hearing loss in newborns?
Genetic disorders
Complications of NRDS
Bronchopulmonary dysplasia
Persisten ductus arteriosus
Interventiruclar hemorrhage
Necrotizing enterocolits
Prematurity retinopathy (because of Oxygen supplementation for NRDS)
West syndrome
Infantile Spasms
Arrest of psychomotor development
Hypsarrhythmia pattern on EEG
Lesh Nyhan syndrome
X linked recessive

Causes build up of uric acid

Neuro + Renal symptoms

Allopurinol for renal

Usually at 1 year old
Neurodegenerative disease that affects children when they get 5 months olds causing loss of acquired skills
Rett syndrome