Pediatrics Clipp

Front 1

How long s/p birth:

-Colustrum available
-Milk available

Back 1

Colustrum: immed
Milk: w/in 40h

Front 2

Infant WCC:

What s/sx is most sensitive indicator of NUTRITIONAL status?

Back 2

WEIGHT

Front 3

S/p birth:

Neonate feeds how many times in first 24h?

Back 3

Immed --> 8-12x

Front 4

What age:

Introduce free H2O?

Back 4

4-6mo

(once taking solid foods)

Front 5

First days of life: does colustrum meet nutritional reqs?

Back 5

YES

Front 6

0-6mo:

Does soy formula have enough protein?

Back 6

yes

Front 7

Is it safe to combine formula concentrate with water in 1:1 ratio?

Back 7

YES - if concentrate

Never safe to dilute non-concentrated formula to "stretch it out"

Front 8

Calorie reqs for infant that is:

-term
-preterm
-very low bw

Back 8

Term: 100-120 cal/kg/d

Preterm: 115-130

Very low bw: 150

Front 9

Do breast-fed infants req vitamin D? Formula fed?

Back 9

ALL infants req supp vitamin D

Front 10

ALL infants (breast & formula) req what supplement?

Back 10

Vitamin D

Front 11

What age:

Introduce solid foods (rice cereal)

Back 11

4-6mos
(IRON-fortified solids)
(many premies NOT ready for solids at 4mos)

Front 12

What age:

Eat STRAINED foods (pasta, toast, banana)

Back 12

9mos

Front 13

9mo: req how many calories/day? What % from milk/formula?

Back 13

100 cal/kg/d

75% breastmilk/formula

Front 14

What age:

Infant feeds themselves

Back 14

9mos

Front 15

What age:

Introduce toast, pasta, banana

Back 15

9mo

Front 16

What age:

Introduce MEAT

Back 16

9mo

Front 17

Infant: how often introduce 1 new food?

Back 17

q5-7 days start 1

(ID allergies)

Front 18

Infant:

when introduce hot dog?

Back 18

NEVER - choke

Front 19

Term infant:

Gains how much wt per day?

Back 19

20-30 g/day

Front 20

4mo: weights ____x birth weight

Back 20

2x bw

Front 21

What age:

Weigh 2x birth weight

Back 21

4mo

Front 22

What age:

Weight 3x birth weight

Back 22

12mo

Front 23

1yo: weighs ___x birth weight

Back 23

3x

Front 24

<1yo:

-# wet diapers per day
-# stools per day

Back 24

6+ wet

6-8 stools

Front 25

What age:

2x birth LENGTH

Back 25

4mo

(same as 2x birth weight)

Front 26

4mo: ___x birth length

Back 26

2x length

Front 27

Red reflex: hold opthalmoscope how far from infant?

Back 27

10 inches

Front 28

Red reflex: what 1st see?

Back 28

at BIRTH

Front 29

Red reflex present or absent?:

Cataracts

Back 29

Absent

Front 30

Red reflex present or absent?:

Glaucoma

Back 30

Absent

Front 31

Red reflex present or absent?:

Retinoblastoma

Back 31

Absent

Front 32

Red reflex present or absent?:

Chorioretinitis

Back 32

Absent

Front 33

Rectal exam on infant:

-when perform? (what scenario)
-what position hold infant?

Back 33

Only if abd mass; not part of routine

Pt SUPINE (on back) --> flex knees

Front 34

Enlarged thyroid common or rare in child?

Back 34

RARE

Front 35

Enlarged LNs:

-common or rare in toddler?
-non/tender?
-shotty located in what areas?

Back 35

Common
NT
Shotty in ANT & POST cervical

Front 36

Murmur in toddler:

-most non/fxnl?

Back 36

FUNCTIONAL

Front 37

NEW murmur: common due to congen HD?

Back 37

No
--rarely 2/2 congen

Front 38

In-toeing in toddler: commonly due to what anatomic variant?

Back 38

Tibial torsion

Front 39

Tibial torsion in toddler: leads to what type of gait?

Back 39

IN-TOEING

Front 40

What is youngest age you administer INFLUENZA?

Back 40

6mo

Front 41

Immunization S/E: fussy + fever

-how long last?
-need to see doc?

Back 41

Commonly last 24h

If >24 --> see doc

Front 42

What age:

Baby sleeps through night

Back 42

4-6mo

Front 43

How position in car:

<1yo

Back 43

carseat, middle back seat, face back

Front 44

How position in car:

<10kg

Back 44

carseat, middle back seat, face back

Front 45

How position in car:

1-4yo

Back 45

Carseat, backseat, face forward

Front 46

How position in car:

4-8yo

Back 46

Booster, back, forward

Front 47

How position in car:

8-12yo

Back 47

Backseat, face forward

Front 48

SURVEY or SCREEN?:

Bright futures

Back 48

Survey

Front 49

SURVEY or SCREEN?:

PEDS test

Back 49

Screen

Front 50

SURVEY or SCREEN?:

M-CHAT

Back 50

Screen

Front 51

What is name for peds SURVEY most commonly used?

Back 51

Bright Futures

Front 52

What age:

Laughs, smiles

Back 52

2mo

Front 53

What age:

Sits unsupported

Back 53

6mo

Front 54

What age:

Look for dropped item

Back 54

6mo

Front 55

What age:

Stranger RECOG

Back 55

6mo

(contrast anxiety- 9mo)

Front 56

What age:

Stand w/support

Back 56

9mo

Front 57

What age:

mama, dada (nonspecific)

Back 57

9mo

Front 58

What age:

Patty-cake

Back 58

9mo

Front 59

What age:

STRANGER ANX

Back 59

9mo

Front 60

What age:

Stands alone

Back 60

1yo

Front 61

What age:

Mama, Dada - SPECIFIC

Back 61

1yo

(contrast non-specific - 9mo)

Front 62

Infant screening: do low measures of social/cog & language --> predict intellectual delays?

Back 62

YES

Front 63

What age:

Tricycle

Back 63

3yo

Front 64

What age:

CIRCLE

Back 64

3yo

Front 65

What age:

Cross

Back 65

3yo

Front 66

What age:

Knows name, age, sex

Back 66

3yo

Front 67

3yo: can draw what shape?

Back 67

Circle, cross

Front 68

What age:

Knows 2 actions, 1 color

Back 68

3yo

Front 69

3yo: knows how many actions? colors?

Back 69

2 actions
1 color

Front 70

What test:

Parents answer illustrated 30-item question at designated intervals

Back 70

Ages & Stages Questionarre (ASQ)

Front 71

What test:

5 key areas (commun, gross & fine motor, prob-solv, personal/social)

Back 71

Ages & Stages (ASQ)

Front 72

Ages & Stages Questionairre (ASQ):

-use what ages?
-how many Qs?
-how long to fill out?
-tests what areas?

Back 72

0-5yo (contrast PEDS - 0-8)
30 Qs
10-15 min
5 areas: communication, gross motor, fine motor, prob-solving, social/personal

Front 73

Low or high sens & spec:

-ASQ
-PEDS test

Back 73

Both high spec & sens

Front 74

What test:

parent answers Y/N/sometimes --> color-coded score --> user guide to assess risk

Back 74

ASQ

Front 75

PEDS test:

-useful what ages?
-how many Qs?
-what are 2 uses?

Back 75

0-8 yrs
10q (3 min)
uses:
1. Develop screen test
2. Assess parent's concerns

Front 76

What test:

10 questions --> use to screen development OR assess parent's concerns

Back 76

Parent's Eval of Developmental Status (PEDS test)

Front 77

What test: used in:

-0-5yo
-0-6yo
-0-8yo

Back 77

0-5: ASQ
0-6: Denver II
0-8: PEDS

Front 78

What test:

Reqs direct observation & parent report

Back 78

Denver II

Front 79

Denver II:

-use what ages?
-tests what areas?
-low,mod or high sens & spec for development delay?

Back 79

0-6yo
Tests (4): gross, fine, language, social
MODERATE sens & spec

Front 80

What test:

TEACHES developmental milestones

Back 80

Denver II

Front 81

What test:

Reqs child cooperation --> time-consuming

Back 81

Denver II

Front 82

Premature birth:

CORRECTED AGE =

Back 82

Chronologic age - days/mos prematurity

Front 83

Neuroblastoma in abdomen <1yo:

-sympto? jaundice?
-how affect G&D?

Back 83

Asympto, no jaundice

May see normal G&D

Front 84

What dz:

Abd CT: heterogeneous, cystic mass with calcifications

Back 84

Neuroblastoma

Front 85

Neuroblastoma in abdomen <1yo:'

2 sites of mets

Back 85

Chest LNs
Posterior mediastinum

Front 86

What dz:

Small round BLUE CELLS

Back 86

Neuroblastoma
(e.g. abdominal)

Front 87

Neuroblastoma in abdomen <1yo:

How appear tumor cells (histo)

Back 87

small round blue cells

Front 88

What dz:

Bone marrow ROSETTES

Back 88

Neuroblastoma

Front 89

What dz:

Tumor cells w/dense, hyperchromic nuclei

Back 89

Neuroblastoma

Front 90

Neuroblastoma in abdomen <1yo:

How affect CBC?

Back 90

BM infiltrate --> ANEMIA, other cytopenia

Front 91

Neuroblastoma in abdomen <1yo:

In/decrease urine HVA:VMA?

Back 91

INCREASE

Front 92

What dz:

Abdominal mass in infant + increased HVA/VMA

Back 92

Neuroblastoma

Front 93

Wilms tumor: see LAD?

Back 93

NO

Front 94

Abdominal neuroblastoma:

CT appears homo/heterogeneous? cysts?

Back 94

HETERO
CYSTS (hemorrh, necrosis)

Front 95

Which has more hemorrhage & necrosis:

Wilms tumor or neuroblastoma?

Back 95

Neuroblastoma

(appears more cystic on CT)

Front 96

What dz:

Abd mass + heterogenous mass (CT) + PSEUDOCAPSULE

Back 96

Wilms tumor

Front 97

Wilms tumor: CT shows demarcation b/w tumor & parenchyma?

Back 97

YES
=pseudocapsule

Front 98

Wilms tumor:

where mets?

Back 98

PULM (see on CXR)

(contrast neuroblastoma - mets to chest LNs & post mediastinum)

Front 99

Wilms tumor: req BM aspiration?

Back 99

NO - only if:
1. pain
2. unfavorable tumor histo

Front 100

Wilm's tumor: affect UA?

Back 100

Yes - hematuria

Front 101

Abdominal TERATOMA in infant: common or rare?

Back 101

RARE

Front 102

Abdominal teratoma:

see jaundice? pallor?

Back 102

No neither

Front 103

Hepatic tumor in infant: common or rare? see jaundice? affect G&D?

Back 103

RARE
jaundice
decreased G&D

Front 104

Anemia in 3yo:

#1 etio

Back 104

Iron-deficiency 2/2 malnutrition

Front 105

Anemia in 3yo:

Is anemia itself a good predictor of Fe2+ deficiency?

Back 105

NO -- poor predictor of iron def in diet

Front 106

HIV in infant: expect anemia?

Back 106

YES (ACD)

Front 107

What dz:

Microcytic anemia with decreased RDW

Back 107

thalasemmia, sickle cell dz

Front 108

Micro/normo/macro anemia:

-SCD
-Thal

Back 108

Both MICRO

Front 109

Mild (>9) or severe (<9) anemia:

Aplastic anemia

Back 109

severe

Front 110

Mild (>9) or severe (<9) anemia:

Folate deficiency

Back 110

severe

Front 111

Mild (>9) or severe (<9) anemia:

B6 deficiency

Back 111

Severe

Front 112

What 3 nutritional defs can cause anemia?

Back 112

Iron
Folate
B6

Front 113

3yo w/IDA: req iron supplement OR can just encourage iron-rich foods?

Back 113

Give Fe2+

Front 114

INITIAL labs in anemia w/u:

-retic?
-smear?

Back 114

YES

Front 115

INITIAL labs in anemia w/u:

-stool blood?
-UA?

Back 115

YES

Front 116

Iron-def anemia:

-micro/macro?
-hypo/hyperchromic?
-DEC/INCREASED retics?

Back 116

Micro, hypo

DECREASED RETICS

Front 117

Hemophilia A or B:

Decreased VIII

Back 117

A

Front 118

Hemophilia A or B:

Decreased IX

Back 118

B

Front 119

Hemophilia A: what def?

Back 119

Decreased VIII (8)

Front 120

Hemophilia B: what def?

Back 120

Decreased IX (9)

Front 121

Hemophilia: how affect:

-PTT
-Bleed time

Back 121

PTT: prolonged

Bleed time: normal

Front 122

What dz:

Prolonged PTT, normal bleed time

Back 122

Hemophilia

Front 123

How inherit:

Hemophilia

Back 123

X- RECESSIVE

Front 124

How inherit:

vWD

Back 124

AD

Front 125

What dz:

-prolonged PTT, normal bleed time
-prolonged bleed time, normal PT

Back 125

HemoPhilia: prolonged PTT, normal bleed time

vWD: prolonged bleeD time, normal PT

Front 126

What dz:

Post-tonsillectomy bleed

Back 126

vWD

Front 127

What dz:

Epistaxis

Back 127

vWD

Front 128

What dz:

Gingival bleed

Back 128

vWD

Front 129

vWD: how inherit

-Type I
-II
-III

Back 129

I&II: AD

III: AR

Front 130

vWD: what is defect in:

-type I
-II
-III

Back 130

I: decreased vWF (mild)
II: QUAL defect
III: undetectable vWF (severe)

Front 131

vWD: which TYPE?

Decreased vWF; MILDEST

Back 131

I

Front 132

vWD: which TYPE?

Most common (70%)

Back 132

I

Front 133

vWD: which TYPE?

inherited AR

Back 133

III

Front 134

vWD: which TYPE?

QUAL defect

Back 134

II

Front 135

vWD: which TYPE?

Undetectable vWF

Back 135

III

Front 136

vWD: which TYPE?

Most severe

Back 136

III (undetectable vWF)

Front 137

vWD: how tx?

Back 137

Intranasal OR IV desmo

Front 138

What dz?:

Tx w/intranasal or IV desmopressin

Back 138

vWD

Front 139

Atopic dermatitis: 2/2 what TWO immune mxns?

Back 139

1. Increased IgE
2. Dysregulated Ab production

(encoded by DIFFERENT gene sets)

Front 140

Atopic dermatitis:

-apply lubricant?
-admin anti-inflamms?

Back 140

Yes- lube

ST anti-inflamms (alternate b/w low & high concens)

Front 141

What age:

Able to eat at table

Back 141

3yo

Front 142

3yo nutrition: normal to prefer BLAND foods?

Back 142

yes

Front 143

What age:

1st dentist visit

Back 143

3yo

Front 144

What age:

d/c bottle

Back 144

1yo

Front 145

3yo: limit how many meals & how many snacks?

Back 145

3 meals, 2 snacks

Front 146

Can you give pre-schooler: H2O w/ice?

Back 146

YES - prefer

Front 147

How determine:

WEIGHT AGE

Back 147

Age at which wt plots @ 50%

Front 148

Predispose to UNDER or OVERweight:

Bardet-Biedl syndrome

Back 148

Over

Front 149

Predispose to UNDER or OVERweight:

Cohen syndrome

Back 149

Over

Front 150

Does high birthweight correl w/childhood obesity?

Back 150

YES

Front 151

What % of 6-19yo are obest?

Back 151

15%

Front 152

Childhood obese: assoc w/SES?

Back 152

Yes -- low SES

Front 153

What % will become obese adults?:

-obese 4yo
-obese adolescent

Back 153

4yo --> 20% obese adults

adol --> 80% obese adults

Front 154

What is increased risk that child will be obese:

-1 obese parent
-2 obese parents

Back 154

1: 3x
2: 10x

Front 155

Normal 3yo: which is stronger predictor of obesity in adulthood:

Child's current wt OR parental obesity

Back 155

Parental obesity

Front 156

Early adolescence: normal to see dec/increase insulin sensitivity?

Back 156

Adol --> DECREASE insulin sensitivity (i.e. normal to see transient insulin resistance) --> increase wt gain

Front 157

Menarche --> increase/decrease risk of obesity?

Back 157

Increase

Front 158

BMI =

Back 158

Kg/m2

Front 159

BMI: what # and %tile:

-overweight
-obese

Back 159

Over: 25-30 (85-95%)

Obese: >30 (>95%)

Front 160

What fraction of obese children are hypertensive?

Back 160

1/3

Front 161

Obesity: assoc with restrictive lung disease? reactive?

Back 161

Restrictive (inc OSA, pickwick)

NOT assoc w/reactive

Front 162

Obesity: assoc w/Blount disease?

Back 162

YES

(outward bowing of tibia)

Front 163

What dz:

Wide physis (hip x-ray)

Back 163

SCFE

Front 164

SCFE: wide or narrow physis?

Back 164

WIDE

Front 165

SCFE: displace what 2 components of femur?

Back 165

HEAD & NECK (thru physeal plate)

Front 166

What dz:

obese kid w/delayed sex maturation & antalsic gait

Back 166

SCFE

Front 167

SCFE: see limited INT or EXT rotation of hip?

Back 167

limited INTERNAL rotation

Front 168

ADHD: sxs for how long? # settings?

Back 168

6+ mos and before 7yo
2+ settings

Front 169

ADHD: req how many sxs (inattn or hyper)?

Back 169

6+
(either type)

Front 170

How distinguish inattention ADHD from sleep disorder (e.g. OSA)?

Back 170

Sleep: decreased sleep & tired

ADHD: poor sleep but NOT over-tired

Front 171

MDD in child: high rate of converting to what psych condition?

Back 171

MANIA

Front 172

ADHD: assoc w/oppositional defiance disorder? conduct disorder?

Back 172

BOTH

Front 173

ADHD: how tx? (1 drug; know dosing)

Back 173

Sustained-release methylphenidate (concerta) 18mg po bid

BIDBIDBID

Front 174

T2DM: accounts what % total child DM?

Back 174

10-50%

Front 175

Childhood DM: inc/decrease appetite?

Back 175

INCREASE (polyphagia)

Front 176

What # to dx DM:

-Random BG
-Fasting
-2h OGT

--Which method preferred to dx DM?

Back 176

Random: >200
Fast: >120
2h OGT: >200

FASTING PREFERRED

Front 177

DM: screen ALL overweight children? when start screen (2 options)? screen how often?

Back 177

Screen if: overwt (85%) + 2 (Fhx, sxs, etc)

Start 10yo OR puberty onset

Screen q2 years

Front 178

How define NORMAL BP in child?

Back 178

Both SBP & DBP <90% (age/gender/ht/wt)

Front 179

What age:

Start routine BP check

Back 179

3yo

Front 180

Name for: SBP & DBP:

-90-95%
-95-99%
->99%

Back 180

90-95%: pre-hypertension
95-99%: stage I HTN
>99: stage II

Front 181

What % SBP & DBP:

Pre-hypertension

Back 181

90-95%

Front 182

What % SBP & DBP:

Stage I HTN

Back 182

95-99%

Front 183

What % SBP & DBP:

Stage II HTN

Back 183

>99%

Front 184

Increased BP in >6yo: most due to 1' or 2' HTN?

Back 184

PRIMARY

Front 185

What dz:

Young child with HTN + no family hx HTN

Back 185

Ao coarctation

Front 186

Childhood HTN: damages which heart chamber?

Back 186

LVH

Front 187

Order what labs: obese child with:

-85-95%, no risks
-85-95%, risks
->95%

Back 187

Order what labs: obese child with:

-85-95%, no risks: fasting lipids
-85-95%, risks: ALT, AST, BG
->95%: BUN, Cr

Front 188

Obese child: how tx:

-85-95%
>95% in pre-teen, teen

Back 188

85-95: slow wt GAIN (until <85%)

95: active wt loss (gradual)
Pre: <1lb/mo
Teen: 1 lb/mo

Front 189

Obese child:

-limit TV hrs?
-amt exercise

Back 189

TV <2h

Exercise: 60min every day

Front 190

Pedigree: try to get how many generations?

Back 190

3rd

Front 191

How inherit:

Marfan

Back 191

AD

(DOM!)

Front 192

How inherit:

neurofibromatosis

Back 192

AD

Front 193

How inherit:

Duchenne's Musc Dys

Back 193

XR

Front 194

How inherit:

MELAS

Back 194

mito

Front 195

Is it EVER possible for male to transmit mito dz?

Back 195

Rare; can see if nuclear gene mutation --> dysreg mito protein

Front 196

How inherit:

CF

Back 196

AR

Front 197

How inherit:

Tay-Sachs

Back 197

AR

Front 198

Name for:

genetic test to determine the effects of a med

Back 198

Pharmacogenetics

Front 199

All states req neonatal screen for what 2 dzs?

Back 199

1. PKU
2. Hypothyroid

Front 200

What imaging:

Posterior fossa

Back 200

MRI

Front 201

#1 SOLID childhood cancer

Back 201

Brain tumor

Front 202

Ped brain tumor:

Neuroectodermal tumor comprise what % ped brain tumors?

Back 202

25%

Front 203

What is most common TYPE of brain tumor (histo)?

Back 203

Neuroectodermal (medulloblastoma) - 25%

Front 204

Astrocytoma: more common in cerebellum or brainstem?

Back 204

Cerebellum

Front 205

Ped brain tumor: which more common:

astrocytoma or glioma

Back 205

astrocytoma

Front 206

How tx: unresectable brain tumor?

Back 206

Surgical histo confirm --> XRT & chemo, possible BMT

Front 207

Non- or Lateralizing ataxia:

Cerebellitis

Back 207

NON (affects entire cerebellum)

Front 208

L cerebellar tumor:

-fall which direction?
-nystagmus which direction?
-past-pointing in which direction?

Back 208

ALL LEFT

Front 209

If pt presents with LEFT-sided nystagmus --> suspect tumor on WHICH HEMI?

Back 209

LEFT CEREBELLUM

Front 210

Basilar migraine: see:

-vomit?
-vision change?
-increased ICP?

Back 210

Vomit & vision change

NO INCREASE ICP

Front 211

#1 etiology ataxia in child

Back 211

CEREBELLITS

(No increase ICP)

Front 212

Can toxins/meds increase ICP? See non/lateralizing ataxia?

Back 212

YES! Can increase ICP --> NON-lateralizing ataxia & nystagmus

Front 213

Delivering bad news: is it OK to TOUCH pt?

Back 213

YES

Front 214

Teen interview: should you set up expectation for interview at beginning?

Back 214

Yes

Front 215

Teen: start with specific OR open-ended questions?

Back 215

SPECIFIC

Front 216

Teen interview: if parent refuses to leave --> should you advocate for adolescent privacy?

Back 216

Yes

Front 217

T/F offer HIV test to ALL sexually-active >13yo

Back 217

TRUE

Front 218

Normal range puberty:

-F
-M

Back 218

F: 8-13yo

M: 10-15yo

Front 219

Tanner staging: assess what 2 features (M, F)?

Back 219

M: pubes, testes
F: pubes, breasts

Front 220

Name for:

Measure of BODY COMPOSITION

Back 220

anthropometry

Front 221

Which measure:

Most sensitive indicator of growth abnormalities

Back 221

growth VELOCITY

Front 222

PTT: intrins or extrins?

Back 222

Extrins

Front 223

EBV: what % 35-40yo infected?

Back 223

95%

Front 224

EBV: infection in adol --> what % develop mononucleosis?

Back 224

35-50%

Front 225

EBV:

-fever?
-LAD?
-sore throat?
-how long is incubation?

Back 225

fever + sore throat + swollen LNs

Incubates 4-6w

Front 226

HIV+ mother --> what % risk infection (if untreated)?

Back 226

25-30%

Front 227

Maternal HIV: increase risk transmission if:

-SVD or C/S?
-ROM > ___h
-what gestation?

Back 227

SVD
ROM >4h
<37w

Front 228

Mother w/unknown HIV risk --> would you perform newborn screen?

Back 228

YES

Front 229

Neonatal HIV: see splenomeg?

Back 229

possibly

Front 230

TORCH: what stand for?

Back 230

Toxo
Other: HIV, HBV, parvo, syph
Rub
CMV
HSV-2

Front 231

Congenital toxo: how screen:

-0-6mo
->1yo

Back 231

0-6mo: infant IgM or IgA

>1yo: IgG

Front 232

Does presence of maternal HBcAb predict risk transmit? HBsAg?

Back 232

HBcAb: no (could indic past infnx)

HBsAg: yes

Front 233

Next step: presence of HBsAg in mother --> ?

Back 233

Give mother AND neonate:
1. HBV vaccine
2. HBIg

Front 234

Detect via what test:

Maternal HIV

Back 234

PCR

Front 235

Congenital rubella: how test:

-0-6mo
->1yo

Back 235

0-6mo: IgM

1yo: IgG

Front 236

Congenital CMV: how detect in neonate? next management step?

Back 236

URINE CULTURE in weeks 0-3

(if pos --> routine hearing test)

Front 237

Which congenital infection:

if positive --> routine hearing test

Back 237

CMV

Front 238

CMV:

-hearing loss abrupt or progressive?
-occurs birth or 1yo?

Back 238

Progressive

Can occur birth OR up to 1yo (continuously monitor)

Front 239

What dz:

Infant w/microcephaly, intracranial Ca2+, lissencephaly, rash

Back 239

congenital CMV

Front 240

CMV:

-what structure see Ca2+?
-in/decrease # gyri?
-assoc w/eye findings?

Back 240

Ca2+ esp in frontal horns of lat vents
Lissenceph: decrease gyri, increase cortex thickness
Chorioretinitis

Front 241

congenital CMV: how tx neonate?

Back 241

Antivirals ONLY IF BABY IS IMMUNOCOMPROMISED

Front 242

Routine neonate meds:

-how admin vitamin K?
-Erythro eye drops covers which STD?

Back 242

IM vitamin K

Gonococcus

Front 243

Another name for:

Pediculosis capitis

Back 243

Lice

Front 244

Nits =

- firm or loose attach to hair shaft?

Back 244

egg CASES of lice

firm attach --> difficult to remove

Front 245

What dz:

5-10mm linear lesions

Back 245

Scabies

Front 246

Scabies: related to cleanliness?

Back 246

NO

Front 247

What dz:

SARCOPTES

Back 247

Scabies

(Sarcoptes scabiei)

Front 248

Scabies: how acquire?

Back 248

Close contact

Front 249

Scabies: what causes itchiness? When is itching worst?

Back 249

Laying of eggs (NOT mite bites)

Worse at night

Front 250

Scabies: common locations?

Back 250

wrist
elbow
finger
toe

Front 251

Scabies: how dx?

Back 251

Scrape MULTIPLE lesions (burrows or papules) --> mineral oil --> light micro --> see mite, egg or FECAL PELLET

Front 252

What dz:

Diagnose by scraping lesion --> mineral oil --> see FECAL PELLETS

Back 252

Scabies

Front 253

What dz:

Scaling, cracks & fissures b/w toes

Back 253

Tinea pedis

Front 254

Tinea versicolor: infection with what form of fungus?

Back 254

YEAST form

Front 255

Tinea versicolor: predisposed by excess HUMIDITY or DRYNESS?

Back 255

humidity

Front 256

Tinea versicolor: do lesions have scale?

Back 256

YES - fine scale

Front 257

What dz:

Lesion turns pink --> brown --> white; fine scale

Back 257

Tinea versicolor

Front 258

Tinea versicolor: how tx?

Back 258

Selenium sulfide lotion

Front 259

Selenium sulfide lotion:

tx what dz?

Back 259

Tinea versicolor

Front 260

Tinea versicolor:

-recurrence common?
-how long for pigment to normalize?

Back 260

Common

May take mos to return pigment to normal

Front 261

Tinea capitis:

-How tx? (drug, duration)
-2 alt txs

Back 261

SYSTEMIC griseofulvin (6-8w)

Alts: terbinafine, itraconazole

Front 262

What is dz:

Skin lesions dx as eczema & treated w/steroids --> worse lesion

Back 262

TINEA

(misdx as eczema --> steroids worsen tinea)

Front 263

Name for:

Allergic response --> inflamed, weepy boggy lesion

Back 263

Kerion

Front 264

Kerion: what is underlying mxn? HOW TX?

Back 264

Allergic response --> inflammed, weepy boggy lesion

Tx: ORAL steroids

Front 265

Which is more predictive of LT neuro outcomes:

Umbilical artery blood sample OR APGAR

Back 265

Umb art

Front 266

Perinatal asphyxia: detect via sampling which blood vessel in cord?

Back 266

Umb ARTERY --> detect hypoxia, acidosis

(NOT vein)

Front 267

GDM: predispose neonate to:

-hypo or hypergly?
-hypo or hyperCa?

Back 267

Hypogly (due increased insulin)

HypoCa2+

Front 268

GDM: is neonate at increased risk of resp distress?

Back 268

YES

Front 269

Fetal glucose: normally what fraction of maternal glucose?

Back 269

2/3 maternal glucose

(glucose crosses placenta)

Front 270

GOAL BLOOD GLUCOSE IN NEONATE

Back 270

41-50

Front 271

Persistent pulmonary HTN of newborn:

-underlying etio
-where does blood divert?

Back 271

Due elevated pulm vasc R

Blood divers through ductus arteriosus & PFO (bypasses lungs)

Front 272

Persistent pulmonary HTN of neonate: presents with tachy/bradycardia?

Back 272

Tachy

(also tachypnea)

Front 273

Cyanotic newborn: order an O2 challenge test?

Back 273

YES

Front 274

Acrocyanosis at birth:

-usu resolves after how long?
-when start to suspect congenital HD?

Back 274

Usu resolves 4-5h

After 8h warming --> suspect congen HD

Front 275

#1 etio respiratory distress in preterm

Back 275

Resp Distress Syndrome (RDS)

aka Hyalien Membrane Dz

Front 276

Respiratory Distress Syndrome in neonate:

underlying etio

Back 276

Surfactant deficiency

Front 277

Name for:

Neonatal dz caused by surfactant deficiency

Back 277

Respiratory distress syndrome

Front 278

Respiratory Distress Syndrome in neonate:

-genetic component?
-M or F?
-C/S or SVD?

Back 278

More common if siblings w/RDS
M > F
C/S w/out labor > SVD

Front 279

Respiratory Distress Syndrome in neonate:

If mother has GDM --> may see RDS in infant up until how many weeks gest?

Back 279

37

Front 280

Neonatal with resp distress: which is more common if healthy mother and gest >34w:

RDS or transient tachypnea of newborn

Back 280

TTN

Front 281

How distinguish (what test):

RDS vs. TTN

Back 281

CXR

RDS: air bronchograms, ground glass

Front 282

What dz:

Newborn with resp distress & CXR w/bronchograms & ground glass

Back 282

RDS

Front 283

Transient tachypnea of newborn:

More common term or preterm?

Back 283

TERM !!!!

Front 284

Transient tachypnea of newborn:

Underlying etio

Back 284

Delayed fluid clearance

Front 285

Transient tachypnea of newborn:

Early or late onset?
Mild or severe distress?

Back 285

Early onset, mild distress

Front 286

Transient tachypnea of newborn:

-M or F?
-C/S or SVD?
-micro or macrosomy

Back 286

M > F (same as RDS)
C/S (same as RDS)
MACROSOMY (esp DM)

Front 287

What dz:

Neonate w/resp distress & CXR w/perihilar streaking, coarse densities and WET LOOKING lungs

Back 287

TTN

(contrast RDS: bronchograms, ground glass)

Front 288

TTN or RDS:

Male

Back 288

BOTH

Front 289

TTN or RDS:

Perihilar streaking

Back 289

TTN

Front 290

TTN or RDS:

Fluffy densities

Back 290

TTN

(contrast RDS: ground glass)

Front 291

TTN or RDS:

Lateral view shows fluid in pleural space, fissures

Back 291

TTN

Front 292

TTN or RDS:

WET LOOKING LUNGS

Back 292

TTN

Front 293

Pneumothorax:

More common in premie?

Back 293

YES

Front 294

Neonatal sepsis/PNA: assoc w/PROM?

Back 294

Yes - may have subtle early findings like poor feed, lethargy

Front 295

Meconium aspiration: occurs when in birth process?

Back 295

In utero

OR

1st breath

Front 296

TTN: expect to resolve after how long?

Back 296

12h

Front 297

APGAR:

-how many categories?
-points?

Back 297

5 categories - appear, pulse, grimace, activity, resp

2pts each

Front 298

Are low 1- & 5-min Apgars markers of intrapartum hypoxia?

Back 298

NO - not conclusive

Front 299

Which is better predictor of neonatal death:

1- or 5-min apgar

Back 299

5-min

(although best is umb art sample)

Front 300

What birthweight #s:

Extremely low bw

Back 300

<1,000 g

(contrast very low: 1k - 1,499)

Front 301

What birthweight #s:

Very low bw

Back 301

1,000-1,499

Front 302

What birthweight #s:

Low bw

Back 302

1,500 - 2,499

(contrast very low: 1,000-1,499)

Front 303

What birthweight #s:
NORMAL

Back 303

2,500 - 4,000

Front 304

Ballard score: estimates what? includes what criteria?

Back 304

Gestational age (s/p birth)

Criteria: neuromuscular & physical maturity

Front 305

Dubowitz exam: what 3 categories?

Back 305

Estims gestational age (alternative to Ballard score; older tech)

1. Preterm (<37w)
2. Term
3. Post (>42)

Front 306

Cephalohematoma: 2/2 what device?

Back 306

VACUUM

Front 307

If baby is LGA --> risk hypo or hypergly?

Back 307

HYPO

(same if baby is SGA --- inadeq glycogen stores)

Front 308

If baby is SGA --> risk hypo or hyper gly?

Back 308

Hypo (2/2 low glycogen store)

Same if baby is LGA (2/2 overproduction of insulin)

Front 309

SGA neonate: expect pale or ruddy?

Back 309

RUDDY --- due polycythemia --> increased viscosity

Front 310

Premature infant: do you need to establish breast-feeding before discharge?

Back 310

YES

(risk hypothermia, decreased glycogen stores)

Front 311

Newborn:

Is 1st phys exam (at birth) a good indication of successful transition to extrauterine?

Back 311

YES

Front 312

Newborn:

1st breath --> where does fluid in lungs go?

Back 312

Squeezed out (cxns, air) --> absorbed by PULMONARY LYMPHOCYTES

Front 313

0-1h life: normal V/S:

-pulse
-rr

Back 313

p 160-180
rr 60-80

Front 314

2h life: normal V/S:

-pulse
-rr

Back 314

p 120-160

rr 40-60

Front 315

2h neonate: suspect resp distress if RR > ____

Back 315

rr > 60

Front 316

Neonate:

Use glucometer to confirm hypogly?

Back 316

NO - use to SCREEN
(NOT confirm)

Front 317

Neonate glucometer read:

If neonate BG <40 ---> what is next step?

Back 317

Meas serum BG (to confirm neonatal hypogly)

START TX WHILE WAITING

Front 318

Neonate glucometer:

Start tx if neonatal BG < ___

Back 318

<40

Front 319

If neonate with RDS --> order what 3 tests?

Back 319

1. CBC w/diff
2. Blood cx
3. LP

Front 320

Tx hypoglycemic neonate if:

-symptomatic and BG <___
-asympto and BG <___

Back 320

sympto & <45

asympto & <35

Front 321

Hypoglycemic neonate: how tx?

Back 321

5% dextrose in WATER --> then feed breast/formula (prevent rebound hypogly) --> monitor until BG > 40 & stable

If no respond H2O --> IV dextrose

Front 322

How define:

Microcephaly (what %s)

Back 322

HC <10% for GA

Front 323

Jaundice: accum bili in what skin layer?

Back 323

Epiderm

Front 324

Jaundice:

Occurs what % newborns?

Back 324

60%

Front 325

How does bilirubin travel in blood?

Back 325

Binds ALBUMIN

Front 326

Bilirubin:

Transported by albumin to what site?

Back 326

LIVER

Front 327

Bilirubin:

Conjugated in liver by WHAT ENZYME?

Back 327

UDPGT

Front 328

UDPGT: fxn?

Back 328

Conjugates bilirubin (transported from blood to liver) with glucoronide

Front 329

Bilirubin:

Conjugated to WHAT MOLECULE in liver?

Back 329

glucoronide (via UDPGT)

Front 330

Conjugated bilirubin is excreted into bile in WHAT FORM?

Back 330

Stercobilirubin

Front 331

Unconj (indirect) or Conj (direct):

Physiologic jaundice

Back 331

Unconj

Front 332

Unconj (indirect) or Conj (direct):

Breast milk jaundice

Back 332

UNconj

Front 333

Unconj (indirect) or Conj (direct):

Breast feed jaundice

Back 333

Unconj

Front 334

Unconj (indirect) or Conj (direct):

Direct Coombs jaundice

Back 334

Unconj

Front 335

Unconj (indirect) or Conj (direct):

Jaundice 2/2 spherocytosis

Back 335

Unconj

Front 336

Unconj (indirect) or Conj (direct):

PK deficiency

Back 336

Unconj

Front 337

Unconj (indirect) or Conj (direct):

Jaundice due G6PD

Back 337

Unconj

Front 338

Unconj (indirect) or Conj (direct):

Jaundice 2/2 cephalohematoma

Back 338

Unconj

Front 339

Unconj (indirect) or Conj (direct):

Jaundice 2/2 bruising

Back 339

Unconj

Front 340

Unconj (indirect) or Conj (direct):

Jaundice 2/2 swallowed blood

Back 340

UNconj

Front 341

Unconj (indirect) or Conj (direct):

Crigler-Naijjar

Back 341

Unconj

(decreased bili clearance)

Front 342

Unconj (indirect) or Conj (direct):

Galactosemia

Back 342

Unconj

(decreased bili clearance)

Front 343

Unconj (indirect) or Conj (direct):

Hypothyroid

Back 343

Unconj

(decreased bili clearance)

Front 344

Unconj (indirect) or Conj (direct):

Jaundice 2/2 neonatal asphyxia

Back 344

Conj

(due liver ischemia)

Front 345

Unconj (indirect) or Conj (direct):

Jaundice 2/2 sepsis

Back 345

Conj

(liver isch)

Front 346

Unconj (indirect) or Conj (direct):

Jaundice 2/2 congenital metabolic toxins

Back 346

Cong

(liver isch)

Front 347

Unconj (indirect) or Conj (direct):

Jaundice 2/2 biliary atresia, intestinal malrotation

Back 347

COng

Front 348

Physiologic jaundice:

-occurs in bili <___
-peaks what day? resolves what day?

Back 348

Bili <15

Peaks d3-4 --> resolves d4-5

Front 349

Physiologic jaundice: what 2 mxns?

Back 349

Lack gut flora & increased activity beta-glucoronidase --> convert bili to unconj and reabsorb

Front 350

Leads to what dz:

Neonate lacks gut flora & has increased beta-glucoronidase --> converts bili to unconj form --> reabsorbs

Back 350

Physiologic jaundice (normal, benign)

Front 351

How disting:

Physiologic vs. breast milk/feed jaundice?

Back 351

Physio appears d0 --> peaks at d3 -- resolves d4

Breast: appears d4

Front 352

Breast-milk/feed jaundice: underlying mxn?

Back 352

INHIBITORY SUBSTANCE in milk --> increase enterohepatic circulation

Front 353

Do RBC membrane defects (sphero) & enzyme defects (PK, G6PD) cause un/conj jaundice?

Back 353

UNCONJ

Front 354

3 etios of hepatobiliary dysfxn that can cause conjugated jaundice

Back 354

Ischemia induced by: asphyxia, sepsis, congen metabolic toxins

Front 355

Biliary atresia in neonate:

Absent INTRA or EXTRA hepatic bile ducts?

Back 355

EITHER

Front 356

Biliary atresia in neonate:

Assoc with what 2 other conditions?

Back 356

Congenital HD

Intestinal malrotation

Front 357

Biliary atresia in neonate:

If no tx --> what complication --> how long until die?

Back 357

Develop cirrhosis --> die 2yo

Front 358

Suspect what dz:

Neonate w/2 weeks of progressive jaundice

Back 358

Biliary atresia

Front 359

What dz:

Acholic stools, hepatomegaly, dark urine, increased alk phos

Back 359

Biliary atresia (conj/direct jaundice)

Front 360

Conj or Unconj jaundice:

See dark urine, acholic stools

Back 360

DIRECT/CONJ

Front 361

Biliary atresia in neonate: assoc w/elevation of which LFT?

Back 361

ALK PHOS

Front 362

Biliary atresia of neonate: possible to see increase in INDIRECT BILIRUBIN?

Back 362

NO -- ALWAYS SEE INCREASED DIRECT BILI

Front 363

Affect risk of severe hyperbili in newborn?:

-jaundice at d0-1

Back 363

Earlier jaundice --> higher risk of severe hyperbili

Front 364

What GESTATIONAL AGE:

highest risk of severe hyperbilirubinemia

Back 364

35-38!!!

Front 365

Jaundice: increased risk:

Breast or formula

Back 365

Breast

Front 366

Jaundice: increased risk:

M or F?

Back 366

Male

Front 367

Jaundice: increased risk:

White or Asian?

Back 367

Asian (esp East Asian)

Front 368

Jaundice: increased risk:

young or old mom

Back 368

>25yo mom

Front 369

Require further w/u?

Neonatal jaundice + VOMIT

Back 369

Yes

Front 370

Require further w/u?

Neonatal jaundice + fever

Back 370

Yes

Front 371

Require further w/u?

Neonatal jaundice + ONSET AFTER D3

Back 371

YES

Front 372

Require further w/u?

Neonatal jaundice + high-pitched cry

Back 372

YES

Front 373

Require further w/u?

Neonatal jaundice + bili <15

Back 373

NO - suspect physio

Front 374

Jaundiced neonate:

Does normal CBC rule out hemolytic dz?

Back 374

NO ---- order retic to check for anemia

Front 375

Breast milk:

Contain growth factors?

Back 375

Yes

Front 376

#1 carbohydrate in breast milk

Back 376

Lactose

Front 377

See lactose intolerance in neonates?

Back 377

Uncommon 0-1yo

Front 378

Breast milk:

Fats comprise what % calories? Most fat at beginning or end of feed?

Back 378

50%

Most fat at end (encourage baby to drain boob)

Front 379

Breast milk:

Contains what 2 proteins?

Back 379

Whey
Casein

Front 380

Breast milk:

More or less protein than cowmilk?

Back 380

3x cow > breast

Front 381

Do not give regular milk until what age?

Back 381

>1yo

Front 382

Colostrum: produced which days? slowly or rapidly replaced by milk?

Back 382

d0-5

Slowly replaced by milk

Front 383

Which has more: colostrum or breastmilk:

-minerals
-protein
-fats
-carbs
-IgA

Back 383

Minerals: col
Protein: COLOSTRUM

Fat: milk
Carb: milk
IgA: milk

Front 384

Breast-feeding: affect incidence of:

-SIDS?
-Allergies?
-DM?

Back 384

Breast --> decrease incidence all

Front 385

Should mother expect menses while breastfeeding?

Back 385

NO - no ovulate

Front 386

Breast-feed: increase or decrease risk breast cancer in mother? ovarian cancer? osteoporosis?

Back 386

Decrease all

(since suppresses estrogen)

Front 387

Breastfeed:

Is it common for infant to fall asleep before finish feed?

Back 387

YES

Front 388

Breastfeed:

How many feeds per day? How frequently? How many minutes each breast?

Back 388

8-12 feeds/day
Every 2-3h
15mins/breast

Front 389

Breast milk contains all vitamins EXCEPT _____

Back 389

Vitamin K

Front 390

Do breast-fed babies req suppl Vitamin D?

Back 390

Only if <15 min sun /week

Front 391

Fluoride: supplement at what age? Under what conditions?

Back 391

Suppl all infants >6mos if <0.3ppm

Front 392

Kernicterus: stain what structures?

Back 392

Basal ganglia & hippocampus

Front 393

Kernicterus: highest risk if 1st or subsequent episode of jaundice?

Back 393

Highest risk if FIRST episode of jaundice

Front 394

Bilirubin encephalopathy:

see HYPO or HYPERtonia?

Back 394

TRICK

Hypotonia early --> hypertonia late

Front 395

What dz:

yellow baby with hypotonia, vomit --> hypertonia, szs, ataxia

Back 395

Bilirubin encephalopathy

Front 396

Bilirubin encephalopathy: early OR late?:

Hypotonia

Back 396

Early

Front 397

Bilirubin encephalopathy: early OR late?:

Hypertonia

Back 397

Late

Front 398

Bilirubin encephalopathy: early OR late?:

Opisthotonous

Back 398

Late

Front 399

Bilirubin encephalopathy: early OR late?:

Szs

Back 399

Late

Front 400

Bilirubin encephalopathy: early OR late?:

Deafness

Back 400

Late

Front 401

Bilirubin encephalopathy: increased risk in whites or Asians?

Back 401

Asians

Front 402

Bilirubin encephalopathy:

Assoc w/prematurity?

Back 402

Increased risk if premature

Front 403

Bilirubin encephalopathy:

Assoc w/altitude?

Back 403

Increase risk at high alt

Front 404

Bilirubin encephalopathy:

What other medical problem is a risk factor?

Back 404

Small bowel obstruction

Front 405

How tx:

Breast + jaundice + bili 16-25

Back 405

Cont breast + observe

OR

Suppl formula 24-48h + phototx

Front 406

How tx:

Term + jaundice + hemolysis + bili 17.5-23

Back 406

Exchange transfusion

Front 407

Can you administer phototx while breast-feeding?

Back 407

YES

Front 408

Neonate w/hyperbili: can you lower via admin H2O/dextrose?

Back 408

NO

Front 409

Neonate:

What day stop meconium --> yellow BM

Back 409

day 3

Front 410

Neonate: what day:

3-4 stools/day

Back 410

By d3-4

Front 411

By d3-4 life: how many stools per day? how many wet diapers?

Back 411

3-4 stools

3-4 wet diapers

Front 412

By d6 life: how many stools per day? how many wet diapers?

Back 412

3-4 stools

6 diapers

Front 413

Return to birth weight at what age?

Back 413

2w

Front 414

At d5 life:

-at what % of birthweight?
-require w/u at what %?

Back 414

At d5: 7-10% below birthweight

If >10% or no regain bw by w2 --> further w/u

Front 415

How obtain FONTANELLE SIZE?

Back 415

Avg length & width

Front 416

Anterior fontanelle:

-suspect what problem if barely open at birth?
-what is avg diam?

Back 416

Over-riding sutures (benign; separates w/in few days)

Avg: 2.5 - 5.0 cm

Front 417

Name for:

Edema/serum over presenting part of scalp

Back 417

Caput succedaneum

Front 418

Caput succedaneum: where located?

Back 418

PRESENTING part of scalp (=edema)

Front 419

Caput succedaneum:

Leads to hyperbili?

Back 419

NO -- overlies periosteum

Front 420

Anatomic difference b/w:

Caput succedaneum & cephalohematoma

Back 420

Caput: edema overlies periosteum --> NOT increase bili

Cephalo: SUBperiosteal hemorr (not extend suture line) --> can cause hyperbili

Front 421

Cephalohematoma:

-where located in re: periosteum
-cross suture lines?

Back 421

SUBperiosteal

NOT cross suture lines

Front 422

Can you approximate the bilirubin level based on the extent of jaundice?

Back 422

YES

Front 423

Normal amount of breast tissue (mm) in term infant

Back 423

5-6mm

Front 424

Suspect what problem:

Neonate 0-72h & anorexia/vomit/sz

Back 424

Inborn error of metab

Front 425

What fraction of sick, full-term neonates without infection risks have an underlying metabolic dz?

Back 425

20% !!! (1/5) --- that's a lot

Front 426

Inborn error of metabolism: can appear insidiously?

Back 426

Yes

Front 427

Neonate screen: all states screen what 2 dzs? What method?

Back 427

PKU
Hypothyroid

via tandem mass spec

Front 428

Red reflux: see from how far away?

Back 428

1 foot

Front 429

Spleen: normally how far below L costal? Should you push to find tip?

Back 429

1-2 CENTIMETER below L costal

Never push to find tip

Front 430

Ortolani & Barlow: 1st perform at what age?

Back 430

BIRTH

Front 431

Developmental Dysplasia of Hip:

More common L or R?

Back 431

3x L > R

Front 432

Developmental Dysplasia of Hip:

F or M?
White or black?

Back 432

F
White

Front 433

Developmental Dysplasia of Hip:

Assoc w/birth position?

Back 433

More common BREECH

Front 434

Developmental Dysplasia of Hip:

Genetic component?

Back 434

Higher risk if FHx DDH

Front 435

Neonate phys exam:

Perform hip exam at what ages? (to assess DDH)

Back 435

0-3mos

Front 436

What test:

Thumb on lesser trochanter --> flex hip --> downward pressure

Back 436

Barlow Test

Front 437

Barlow test:

-where is thumb?
-flex or extend hip? what degree?
-ab/duct?

Back 437

Thumb on LESSER trochanter --> flex to 90 --> ADDuct & down

Front 438

What test:

Abduct hip & push femoral head anteriorly

Back 438

Ortolani

Front 439

Ortolani maneuver:

-ab/duct hip?
-push fem head ant or post?

Back 439

ABDUCT (contrast Barlow - adduct)

Push fem head ANTERIORLY over greater troch

Front 440

Barlow or Ortolani:

Feel CLUNK

Back 440

Ortolani

Front 441

T/F Every IUGR infant is SGA

T/F Every SGA infant was IUGR

Back 441

T: every IUGR --> SGA

F: SGA may be 2/2 ethnicity, maternal ht, etc (not necessarily IUGR)

Front 442

IUGR: poor wt gain in which TM is a risk factor?

Back 442

TM3

Front 443

IUGR: due to fetal abns?

Back 443

Possible; can see with chromo abns, metabolic dz, congen infxn

Front 444

What is safe amt of EtOH in preg?

Back 444

NO SAFE AMT

Front 445

Smoking --> what facial abns?

Back 445

none

just low bw

Front 446

How does cocaine/stimulant affect birth weight? (mxn)

Back 446

Vasocon --> placental insuff --> low bw

Front 447

What drug:

s/e fetal hydantoin syndrome

Back 447

Phenytoin

(see in 30% exposed infants)

Front 448

Phenytoin: safe in preg? safe in breastfeed?

Back 448

S/E Fetal Hydantoin Synd (30% exposed fetuses)

SAFE IN BREAST FEED

Front 449

Suspect what etiology:

Neonate with: hypoplastic nails & distal phalanges, cardiac defects, cranio deforms, IUGR, M.R.

Back 449

Phenytoin --> fetal hydantoin syndrome

Front 450

Higher risk in young or old moms:

-GHTN
-Preeclampsia

Back 450

ADOLESCENT moms

--> low birth wt neonates

Front 451

What is most ominous finding of respiratory distress?

Back 451

PARADOXICAL BREATHING

Front 452

Paradoxical breathing: see what? indicates what condition?

Back 452

Inspire --> chest draws inward

See in resp distress

Front 453

Name for sound:

Forced expiration against a closed glottis

Back 453

Grunting

Front 454

Grunting: due to what action?

Back 454

Forced EXPIRATION against closed glottis

Front 455

Grunting: see in what 3 lung dzs?

Back 455

1. Atelectasis
2. PNA
3. Pulm edema

Front 456

Head-bobbing in resp distress: synchronized with INSP or EXP?

Back 456

INSP

Front 457

Name for resp sound:

musical, CONSTANT PITCH, loudest at neck

Back 457

STRIDOR

Front 458

Stridor:

-constant or variable pitch?
-where ausc loudest?
-lower or upper aw?

Back 458

Constant pitch (musical)
Loudest at neck
Upper aw

Front 459

Stridor: see with insp, exp or both?

Back 459

INSP ONLY

(according to CLIPP)

Front 460

Difference between:

Wheeze vs. rhonchi

Back 460

Basically same mxn

Wheeze: high pitch
Rhonci: low

Front 461

Wheeze/rhonchi:

-due to RESONANCE?
-see w/insp, exp or both?
-where loudest?

Back 461

NOT due resonance; due to VIBRATION of narrowed aws

EXP (or exp+insp; never insp alone)

loudest at chest

Front 462

What resp sound:

Only here during EXP or EXP+INSP (never insp alone)

Back 462

Wheeze/rhonchi

Front 463

Wheeze/rhonchi: does longer & higher pitch indicate more severe dz?

Back 463

YES

Front 464

Crackles: dis/continuous?

Back 464

DISCON

Front 465

Crackles: sound differences b/w coarse & fine

Back 465

Coarse: low pitch, loud, few

Fine: high pitch, quiet, many

Front 466

Lower or upper aw obstrution:

Wheeze

Back 466

Lower

Front 467

Lower or upper aw obstrution:

Prolonged expiratory phase

Back 467

Lower

Front 468

Lower or upper aw obstrution:

VIRAL URI

Back 468

LOWER!!!!

(see wet cough, no wheeze)

Front 469

Viral URI: common to see wheeze?

Back 469

NO

Front 470

Asthma: is wheeze severity correlated with asthma severity?

Back 470

NO

If severe asthma with no air exchange --> no wheeze (BEWARE)

Front 471

Severe asthma --> what CV change?

Back 471

Pulsus paradox

Front 472

What dz: CXR shows:

Bilat hyperinflation, flat diaphs, atelectasis

Back 472

Asthma

Front 473

Lower or upper aw obstrution:

Acute bronchiolitis

Back 473

LOWER

Edema/mucuus --> obstruct bronchioles

Front 474

Lower or upper aw obstrution:

Pertussis

Back 474

LOWER

Front 475

Acute bronchiolitis:

What % due RSV?

Back 475

50%

Front 476

Acute bronchiolitis:

In addition to RSV - what other viruses?

Back 476

para/influ

Front 477

Acute bronchiolitis:

See what temps? (#)

Back 477

38.5 - 39

Front 478

Acute bronchiolitis:

See wheezing?

Back 478

YES

(contrast VIRAL URI)

Front 479

Acute bronchiolitis:

How appear CXR?

Back 479

Bilat hyperinflat (sim asthma) w/scattered atelect

Front 480

Asthma: due inflamm/edema of mucosa or parenchyma?

Back 480

Mucosa

(contrast PNA - parenchyma)

Front 481

Pneumonia: what BACTERIAL pathogen:

-5-6yo (#1)
-school age (#1-2)

Back 481

5-6yo: Strep pneumo

School: MYCOPLASMA #1, Strep pneumo #2

Front 482

Viral pneumonia: what 4 viruses common?

Back 482

RSV, para/influ, adeno

Front 483

Indicates what dz:

Crackles

Back 483

PNA (bact or viral)

Front 484

Chlamydia trachomatis PNA: presents how long after birth?

Back 484

3-4w

Front 485

Whooping cough: what pathogen?

Back 485

Bordatella pertussis

Front 486

Bordatella pertussis: vaccine is how effective? (%)

Back 486

70-90%

Front 487

What pathogen/dz:

3 stages (catarrhal, paroxysmal, convalescent)

Back 487

Bordatella pertussis

Front 488

Bordatella pertussis: 3 stages & duration of each

Back 488

1. Catarrhal: 1-2w (URI sxs)
2. Paroxysmal: 4-6w (staccato)
3. Convalescent: mos cough

Front 489

What dz:

Staccato cough

Back 489

Bordatella pertussis (whooping)

Front 490

Bordatella pertussis: cough may persist how long?

Back 490

Paroxysmal cough 4-6w --> regular cough for mos

Front 491

Lower or upper aw obstruct:

Foreign body

Back 491

Upper

Front 492

Lower or upper aw obstruct:

Epiglottitis

Back 492

Upper

Front 493

What dz:

Assymetic wheeze in 5yo w/out hx aw dz

Back 493

foreign body

Front 494

Foreign body asp: most common location

Back 494

R mainstem bronchus

Front 495

Epiglottitis: what age group?

Back 495

2-5yo

Front 496

Lower or upper aw obstruct:

Croup

Back 496

TRICK - both (subglottic)

Front 497

Croup: caused by 6 pathogens

Back 497

Para/influ
Adeno
RSV

MYCOPLASMA
MEASLES!!!!

Front 498

Indicates what dz (general name):

Insp stridor + barking cough

Back 498

Croup

Front 499

Cerebral palsy:

incidence

Back 499

2:1,000

Front 500

Cerebral palsy:

Progressive?

Back 500

No

Front 501

Cerebral palsy:

Defining feature

Back 501

Decreaesed motor control

Front 502

Cerebral palsy: is spasticity dependent on velocity?

Back 502

YES - greater resistance w/rapid movement

Front 503

Cerebral palsy: is resistance greater with SLOW or RAPID movement?

Back 503

RAPID

Front 504

Cerebral palsy: in/decreased tendon jerks

Back 504

INCREASED

Front 505

What dz:

See spastic diplegia

Back 505

C.P.

Front 506

Name for:

Increased tone, esp in lower extrems

Back 506

Spastic diplegia

Front 507

Spastic diplegia: assoc w/prematurity?

Back 507

Yes

Front 508

Leads to what TYPE of cerebral palsy:

-birth asphyxia
-kernicterus

Back 508

Both lead ot DYSKINETIC cerebral palsy

(NOT other types)

Front 509

Cerebral palsy: see pts with GLOBAL developmental delay?

Back 509

No - just motor

GDD = cogn disabl/MR

Front 510

MR/cognitive disability: possible to see FHx?

Back 510

Yes - if 2/2 inborn error metab

Front 511

Abn development 2/2 neglect:

See improvement if stop abuse?

Back 511

YES

Front 512

Do premature babies have increased risk of abuse?

Back 512

Yes

Front 513

Myopathy: p/w gross or fine motor abns?

Back 513

BOTH

Front 514

What class of dz:

abn tone, fasciculations, weakness

Back 514

Myopathy

(NOT CP - see spasticity, increased tendon jerks)

Front 515

Cerebral palsy: how dx?

Back 515

MRI & assessment by developmental specialist (use Bayley scales of infant development)

(determines etio of abn neuro exam)

Front 516

Infant UTI: how obtain urine sample?

Back 516

CATH

(NOT bag specimen)

Front 517

Fever: #

Back 517

100.5 (38)

Front 518

Name for:

Viable bacteria in circulation

Back 518

Bacteremia

(no necess systemic dz)

Front 519

Name for:

Systemic dz 2/2 microorgs in circ

Back 519

Septicemia

Front 520

Difference b/w:

Fever w/out source AND fever unknown origin

Back 520

W/out source: no focus despite H&P

Unknown origin: 2weeks fever with 1w failed w/u

Front 521

Fever of unknown origin: present for how long?

Back 521

2w

(with 1w of failed w/u)

Front 522

Occult bacteremia: definition (what tests)

Back 522

Pos blood cx despite normal:
1. CXR
2. UA
3. LP

Front 523

Occult bacteremia: see in what age range?

Back 523

0-3yo

Front 524

Qualify as SERIOUS bacterial illness (SBI)?:

Enteritis

Back 524

Yes

Front 525

Qualify as SERIOUS bacterial illness (SBI)?:

PNA

Back 525

Yes

Front 526

Qualify as SERIOUS bacterial illness (SBI)?:

Cellulitis

Back 526

Yes

Front 527

Qualify as SERIOUS bacterial illness (SBI)?:

Osteomyelitis

Back 527

Yes

Front 528

Qualify as SERIOUS bacterial illness (SBI)?:

Otitis Media

Back 528

No

Front 529

Meningismus: due to stretching of nerves in what SPACE?

Back 529

Subarachnoid

Front 530

Nuchal rigidity: in/vol?

Back 530

INVOL

Front 531

Name for:

Extreme nuchal rigidity --> hyperextend entire spine

Back 531

Opisthotonus

Front 532

What is it?:

Opisthotonus

Back 532

Extreme nuchal rigidity --> hyperextend entire spine

Front 533

Name for:

flex hip & extend knee --> pt resists knee extens

Back 533

Kernig

Front 534

Name for:

flex neck --> pt flexes knee & hip

Back 534

Brudzinski

Front 535

Difference b/w:

Kernig
Brudzinski

Back 535

Kernig: flex hip --> resist knee EXTENSION

Brud: flex neck --> automatic flex knee & hip

Front 536

If you plan to tx infant w/IV abx for presumed bacterial infxn --> do you require a LP?

Back 536

YES - RULE

If want to use IV abx --> get LP first

Front 537

LP contraindication: platelets <___ (#)

Back 537

<50k

Front 538

Must perform LP if fever <__ (what age)?

Back 538

1yo

Front 539

Does normal CSF definitively r/o meningitis?

Back 539

YES

Front 540

Febrile infant:

Suspect UTI in what ages?

Back 540

2mo - 2yo

Front 541

Gastroenteritis: see low or high fever with:

-viral
-bact

Back 541

HIGH FEVER with both

Front 542

Upper resp infxn: see low or high fever?

Back 542

Can see high fever

Front 543

Work-up of BACTERIAL infxn: low or high predictive value:

>15,000 WBC w/left ****

Back 543

LOW predictive value

Front 544

Viral infection: do most have ab/normal WBC?

Back 544

Most have NORMAL

Front 545

UA: nitrites have high or low:

-spec
-sens

Back 545

HIGH SPEC (few FPs)

LOW SENS (many FNs)

Front 546

UA: is a positive LE enough to dx UTI?

Back 546

No - only indicates that WBCs are in urine

Front 547

Voiding cysturethrogram (VCUG): order in which infants?

Back 547

ALL infants w/FIRST uti

Front 548

VUR: is most mild/mod/severe? req tx?

Back 548

Most mild --> spont resolve

Front 549

UTI in <1yo:

what % have vesicourethral reflux?

Back 549

50%

Front 550

VUR: affect risk of UTI? req ppx abx?

Back 550

Increase risk of UTI --> GIVE PPX ABX (until VUR resolves or surg)

Front 551

VUR: what is alt way to monitor (if not want VCUG)?

Back 551

Periodic radionuclide cystograms

Front 552

1st UTI --> order what imaging tests?

Back 552

1. VCUG
2. Abdominal U/S (renal structure, dilation)

Front 553

UTI in infant:

-required in ALL cases?
-duration?
-route?
-repeat urine cx?

Back 553

ALL pts w/1st UTI (even if asympto)
7-14d
po --> IV if severe dehydr

Repeat urine cx if no response after 2d

Front 554

Pyelo: 2 most common pathogens

Back 554

E coli > enterococcus

Front 555

Pyelo:

-2 best abx & route for INPATIENT
-outpatient

Back 555

Gent + Amp INTRAVENOUS

-->

TMP-SMZ bid (total 7-14d)

Front 556

Pyelo: what is disadvantage of:

-Ceftriaxone
-Ciprofloxacin

Back 556

Ceftriax: no cover enterococci (#2), pseudomonas

Cipro: damages articular cartilage (esp knees)

Front 557

Nitrofurantoin: use in what type of UTI?

Back 557

Lower UTI (cystitis)

NOT pyelo

Front 558

Sulfisoxazole: used to tx pyelo?

Back 558

No - resistance

Front 559

Always consider what dz:

HIGH fever x 5d....

Back 559

Kawasaki

Front 560

Always consider what dz:

HIGH fever x 5d....

Back 560

Kawasaki

Front 561

Kawasaki: usually <___yo

Back 561

<4yo

Front 562

Kawasaki: requires how many findings?

Back 562

4 (in addition to fever)

Front 563

Kawasaki: usually <___yo

Back 563

<4yo

Front 564

3 dzs with palmar rash

Back 564

Kawasaki
Syphilis
RMSF

Front 565

Kawasaki: requires how many findings?

Back 565

4 (in addition to fever)

Front 566

Kawasaki: where see rash (2)?

Back 566

Groin
PALMS

Front 567

3 dzs with palmar rash

Back 567

Kawasaki
Syphilis
RMSF

Front 568

Kawasaki: what 2 eye findings?

Back 568

1. Conjuncitivitis w/out discharge
2. ANTERIOR uveitis (slit lamp)

Front 569

Kawasaki: where see rash (2)?

Back 569

Groin
PALMS

Front 570

Anterior uveitis 2/2 Kawasaki:

-how detect (what test)?
-minority or majority of pts?

Back 570

Slit-lamp

80% pts in 1st week

Front 571

Kawasaki: what 2 eye findings?

Back 571

1. Conjuncitivitis w/out discharge
2. ANTERIOR uveitis (slit lamp)

Front 572

Strawberry tongue: what 3 dz?

Back 572

1. Kawasaki
2. Strep pharyngitis
3. Infectious mono

Front 573

Anterior uveitis 2/2 Kawasaki:

-how detect (what test)?
-minority or majority of pts?

Back 573

Slit-lamp

80% pts in 1st week

Front 574

Strawberry tongue: what 3 dz?

Back 574

1. Kawasaki
2. Strep pharyngitis
3. Infectious mono

Front 575

Kawasaki: see LAD?

Back 575

YES

Front 576

Kawasaki: see LAD?

Back 576

YES

Front 577

What dz:

HIGH FEVER x5d, groin rash, conjuncitivitis, strawberry tongue, puffy/peeling hands & feet

Back 577

Kawasaki

Front 578

What dz:

HIGH FEVER x5d, groin rash, conjuncitivitis, strawberry tongue, puffy/peeling hands & feet

Back 578

Kawasaki

Front 579

Kawasaki: low or high fever?

Back 579

HIGH x 5d

Front 580

4 causes of UNILATERAL cervical adenitis (non-cancerous)

Back 580

1. Kawasaki
2. Cat Scratch
3. Pharyngeal infection --> reactive node
4. Mycobacteria

Front 581

Kawasaki: see uni/bilat LAD?

Back 581

UNILAT

Front 582

SJS:

-see conjuncitivitis?
-what type of rash (name)?

Back 582

Conjunctivitis

Erythema multiform

Front 583

#1 fatal tick dz

Back 583

RMSF

Front 584

RMSF: how transmit?

Back 584

Tick

Front 585

RMSF: what type of rash? where located?

Back 585

Petichial rash on palms

Front 586

What dz:

Petechial rash, HEADACHE, fever, myalgia

Back 586

RMSF

Front 587

Kawasaki: see change in CBC?

Back 587

1. INCREASE WBC, esp PMNs

2. Normocytic, normochromic anemia

3. Increase platelets (week 2)

Front 588

Kawasaki: would you still suspect if negative ESR?

Back 588

no

Front 589

Kawasaki: see changes in LFTs?

Back 589

INCREASE (nonspecific)

decrease albumin

Front 590

Suspect what dz:

Increased WBC (esp PMNs), normo normo anemia, increased platelets, increased LFTs, STERILE PYURIA

Back 590

Kawasaki

Front 591

Kawasaki: what UA change? how collect UA?

Back 591

STERILE PYURIA (2/2 sterile urethritis)

Collect via CLEAN CATCH (would not detect pyuria by cath)

Front 592

Kawasaki: order what imaging test?

Back 592

Baseline ECHO --> repeat ECHO 4 weeks

Front 593

Kawasaki: how tx? (2)

Back 593

HIGH-dose ASA (other antipyretics not effective)

HIGH-dose intravenous Ig (only tx ot decrease coronary art sequel)

Front 594

Kawasaki: see CNS complications in what % pts?

Back 594

90%: lethargy, aseptic meningitis

Front 595

Kawasaki: see coronary art aneurysm in what % untx pts?

Back 595

25%

Front 596

Kawasaki: what GI complication? (2)

Back 596

Liver dysfxn (40%)

Gallbladder hydrops (10%)

Front 597

Kawasaki: after discharge --> when RTC for repeat ECHO?

Back 597

Echo at weeks 0 & 4

(usually RTC 2 weeks after discharge for repeat)

Front 598

What pathogen:

Vesicular rash on hands & feet; ulcers in mouth

Back 598

COXSACKIE (enterovirus) --> hand-foot-mouth dz

Front 599

What pathogen:

Hand-foot-mouth dz

Back 599

Coxsackie (enterovirus)

Front 600

What pathogen:

Prodrome fever >101 --> cough, runny nose, conjunctivitis --> maculopap rash behind ears --> reaches feet

Back 600

MEASLES

3Cs

Front 601

Measles: describe rash lesions & distrib

Back 601

Maculopap

Starts behinds ears --> reaches feet w/in 2 days

Front 602

Meningococcal rash: itchy?

Back 602

YES

Front 603

What pathogen:

High fever 3d --> fever ends --> rash on trunk --> spreads arms, neck

Back 603

Rubeola

Front 604

Rubeola: which see first:

Rash or fever

Back 604

Fever --> fever ends --> trunk rash

Front 605

Rubeola: describe rash lesions & distrib

Back 605

Maculopap on trunk --> spreads arms/neck

**Fever ends before rash appears

Front 606

Rubeola: usu <__yo

Back 606

<2yo

Front 607

Strep pharyngitis (GAS): 2 systemic comps

Back 607

1. Scarlet fever (blanching sandpaper)

2. Rheum heart disease

Front 608

What pathogen:

Blanching sandpaper rash & high fever

Back 608

Strep pharyngitis --> Scarlet fever

Front 609

Scarlet fever: low or high fever?

Back 609

HIgh

Front 610

Scarlet fever: describe rash

Back 610

blanching sandpaper

starts groin/ax/neck --> spreads

Front 611

Scarlet fever: rash resolves how long?

Back 611

<10d

Front 612

Rheumatic fever: develops how long after strep infection?

Back 612

18 days

Front 613

What disease?:

Jones Criteria

Back 613

Rheumatic fever

Front 614

Rheumatic fever: was diagnostic criteria (eponym)? req how many (#) criteria?

Back 614

Jones criteria

1 major + 2 minor
2 major + 1 mintor

Front 615

What dz:

Migratory polyarthritis, peri/myocarditis, erythema marginatum, subQ nodules & chorea

Back 615

Rheumatic fever (2/2 strep pharyngitis)

Front 616

Rheumatic Fever:

-what type of arthritis?
-name for classic rash
-what neuro disorder

Back 616

MIGRATORY polyarth

Erythema marginatum

Sydenham's chorea

Front 617

Rheumatic Fever: what EKG finding?

Back 617

Prolonged PR

Front 618

What viral exanthem:

EKG - prolonged PR

Back 618

Rheumatic Fever

Front 619

What dz:

Complication: peritonsilar abscess

Back 619

Strep pharyngitis

Front 620

VZV: starts where on body?

Back 620

Trunk

Front 621

VZV: resolves after how long?

Back 621

1 week

Front 622

What dz:

Upslanted palpebral fissures

Back 622

Downs

Front 623

What dz:

-small ears
-low-set ears

Back 623

Small: Downs

Low: Turner's

Front 624

What dz:

Epicanthal folds

Back 624

Downs

Front 625

What dz:

Redundant nuchal skin

Back 625

Downs

Front 626

#1 M.R. involving genetic material

Back 626

Downs (21)

Front 627

Down's: 3 genetic mxns

Back 627

Trisomy (#1, regardless mat age)

Unbalanced translocation

Mosaic for 21

Front 628

Down's: ABSOLUTE risk higher in young or old mothers?

Back 628

YOUNG

(relative risk higher in old)

Front 629

Downs: how dx?

Back 629

Leukocyte karyotype

Front 630

What dz:

Micropthalmia, microceph, polydact, cleft lip & palate, umbilical hernia, CUTIS APLASIA

Back 630

Patau (13)

Front 631

Patau (13): defects in what organs? (2)

Back 631

Cardiac
Renal

Also: microceph, polydact, clefts, umbilical hernia, cutis aplasia

Front 632

#1 FAMILIAL cause of M.R.

Back 632

Fragile X

Front 633

Fragile X: what repeat?

Back 633

CGG outside FMR1 coding regions

Front 634

What dz:

larges testes; large everted ears; long face w/large mandible

Back 634

Fragile X

Front 635

Turner's syndrome: see physical differences at birth?

Back 635

Yes

Front 636

What dz:

See lymphedema in utero

Back 636

Turner XO

Front 637

What dz:

web neck, low ears, hyperconvex nails, shield chest

Back 637

Turner XO

Front 638

Turners:

What is feature of nails?

Back 638

Hyperconvex

Front 639

Turners:

Ao coarctation in what %?

Back 639

20%

Front 640

Turners:

How affect IQ?

Back 640

NORMAL IQ

Front 641

How dx:

Benign Neonatal Hypotonia

Back 641

Dx of EXCLUSION

Front 642

Benign Neonatal Hypotonia: px?

Back 642

Good; gradual increase tone

Front 643

Down's: what is most consistent finding at birth?

Back 643

HYPOTONIA --> poor feeding

Front 644

Down's: recommended imaging at birth?

Back 644

ECHO

Front 645

Down's: recommended blood test?

Back 645

TSH

(6mo --> q 1 year)

Front 646

Down's: what skeletal abn?

Back 646

Atlanto-axial instab

Front 647

Down's: predisp what cancer?

Back 647

Leukemia

Front 648

Hypotonia in infant:

Tend to FLEX or EXTEND extrems?

Back 648

Extend (passive)

(noxious stim --> won't flex)

Front 649

Hypotonia in infant: see in/decreased primitive reflexes?

Back 649

DECREASED

(since hypotonic)

Front 650

Hypoxic-ischemic encephalopathy 2/2 perinatal injury:

more commonly see HYPO or HYPERtonia?

Back 650

HYPER

(although can see hypo)

Front 651

Suspect what dz:

Normal neonate --> 2-4w later see lethargy, fever, HYPOTONIA

Back 651

SEPSIS 2/2 GBS

Front 652

Congenital hypothyroidism: how affect ammonia level?

Back 652

No change (normal NH4)

Front 653

Newborn metabolic screen: uses what lab technique?

Back 653

Mass spec

Front 654

Screens for what dz:

Measure immunoreactive trypsinogen

Back 654

Cystic fibrosis

Front 655

How define:

Lethargy

Back 655

1. Decreased eye movements

OR

2. fail to recog parents or interact w/environ

Front 656

Name for:

Decreased eye movements & fail to interact w/parents or environ

Back 656

LETHARGY

Front 657

How define:

FTT

Back 657

Fail to regain bw by 3 WEEKS or continuous wt loss after 10d life

Front 658

#1 sudden death adol athlete

Back 658

Hypertrophic Obstructive Cardiomyopathy (HCOM)

Front 659

Hypertrophic Obstructive Cardiomyopathy (HCOM):

-p/w what sx?
-what % have abn EKG?

Back 659

SYNCOPE

90% abn EKG

Front 660

Child w/chest pain: higher suspicion of cardiac etio if:

present at rest OR exercise only?

Back 660

Exercise only

Front 661

Chest pain due myocardial ischemia:

-sharp or dull?
-how long last?

Back 661

Dull pressure
10-20 mins

Front 662

What dz:

Sharp/stabbing chest pain REPRODUCIBLE w/direct sternal pressure

Back 662

Costochondritis

Front 663

Costochondritis: how long does pain last?

Back 663

few seconds of stabbing over hrs-days

Front 664

Costochondritis: chest pain assoc w/exercise?

Back 664

NO - sporadic

Front 665

What is dz:

Chest pain worse with deep inspiration

Back 665

Costochondritis

Front 666

Costochondritis: worse with insp or exp?

Back 666

Deep insp

Front 667

Which more common:

Precordial catch OR costochondritis

Back 667

Precordial catch

Front 668

#1 chest pain in child

Back 668

Precordial catch

Front 669

Precordial catch: assoc w/exercise?

Back 669

No

(occurs equally at rest or exercise)

Front 670

Precordial catch:

-diffuse or well-localized? where most common?
-sharp or dull?

Back 670

sharp, well-localized at LOWER STERNAL BORDER

Front 671

Precordial catch: how long pain last?

Back 671

secs-mins

Front 672

Precordial catch: worse w/insp or exp?

Back 672

Deep insp

(same as costochondritis)

Front 673

What dz:

Chest pain that pt can BREAK with forced deep insp

Back 673

Precordial catch

Front 674

Name for:

Inadeq cerebral BF --> transient LOC & loss of postural tone

Back 674

Syncope

Front 675

Syncope: underlying mxn?

Back 675

Decreased cerebral BF

Front 676

3 general etios of syncope in child

Back 676

1. Neurocardiogenic (vasovagal; #1)
2. Neuropsych (szs, orthostatic, drugs)
3. Cardiac (arryth, structure defect)

Front 677

Syncope 2/2 orthostatic hypotension: classify as NEUROPSYCHIATRIC or CARDIOGENIC?

Back 677

Neuropsychiatric

Front 678

What drug class:

S/E prolonged QT --> neuropsychiatric syncope

Back 678

Antihistamines

Front 679

Antihistamines: S/E what EKG change?

Back 679

Prolonged QT

Front 680

Difference b/w 1' and 2' cardiac syncope

Back 680

1': structural defect --> obstruct ventricular outflow

2': ventricle DYSFXN or ARRYTH

Front 681

3 types of arryths that can cause syncope

Back 681

1. SVT
2. VT
3. Heart block (2/2 Lyme)

Front 682

Syncope in child: EKG which pts?

Back 682

ALL

Front 683

Syncope in child: which is more serious:

Pallor OR warm/flushed skin

Back 683

WARM/FLUSHED

Front 684

Syncope during exercise: mandatory refer to cardio?

Back 684

YES

Front 685

Are murmurs COMMON in healthy adols?

Back 685

Yes

Front 686

Teen physical:

Palp which 2 pulses?

Back 686

Femoral
Radial

--> assess Ao coarct

Front 687

HCM: murmur louder supine OR standing?

Back 687

STANDING

Front 688

Murmur: evaluate if louder than ___ (what grade?)

Back 688

III/IV

Front 689

Teen physical:

How long should orthopedic exam take?

Back 689

2min

Front 690

Teen physical:

Require chaperone for GU?

Back 690

always

Front 691

What Tanner Stage:

Testes <1.5 mL

Back 691

1

Front 692

What Tanner Stage:

No pubes

Back 692

1

Front 693

What Tanner Stage:

Testes 1.6 - 6 mL

Back 693

2

Front 694

What Tanner Stage:

Red, thin scrotum

Back 694

2

Front 695

What Tanner Stage:

Thin pubes at base of penis

Back 695

2

Front 696

What Tanner Stage:

Testes 6-12 mL

Back 696

3

Front 697

What Tanner Stage:

Curly, coarse hair

Back 697

3

Front 698

What Tanner Stage:

Testes 12-20

Back 698

4

Front 699

What Tanner Stage:

Darken & increase size of scrotum

Back 699

4

Front 700

What Tanner Stage:

Adult pubes but absent on thighs

Back 700

4

Front 701

What Tanner Stage:

>20 ml testes

Back 701

5

Front 702

What Tanner Stage:

Pubes on medial thighs

Back 702

5

Front 703

What is difference and which most common:

1' vs. 2' vs. 3' hypothyroidism

Back 703

1': thyroid dysfxn (95%)
2: pit
3: hypothal

Front 704

Congenital hypothyroidism: most common what ethnicities? (2)

Back 704

Native Am
Hisp

Front 705

Mxns of congenital 1' hypothyroidism

Back 705

Thyroid ectopy
A/hypoplasia
Errors of thyroid hormogenesis

Front 706

1' hypothyroidism: low or high TSH?

Back 706

HIGH

(HPA intact; prob is thyroid)

Front 707

1' or 2/3' hypothyroidism:

Low TSH

Back 707

2/3 (pit/hypothal not producing TSH --> low T4)

Front 708

Does maternal thyroid hormone cross placenta?

Back 708

YES

Infant with congenital hypothyroid appears normal at birth due maternal thyroid

Front 709

Congenital hypothyroidism: when do s/sx present?

Back 709

6 WEEKS OF AGE

Front 710

Congenital hypothyroidism:

Constip or diarrhea?

Back 710

Constip

Front 711

Congenital hypothyroidism:

How does skin appear?

Back 711

JAUNDICED, mottling

Front 712

Congenital hypothyroidism:

Small or large fontanelles

Back 712

LARGE

Front 713

Congenital hypothyroidism:

Hypo or hypertonia

Back 713

HYPO

Front 714

Congenital hypothyroidism:

Hypo or hyperthermia

Back 714

Hypo

Front 715

Congenital hypothyroidism:

What abdominal defect?

Back 715

Umbilical hernia

Front 716

Infant hypo or hyperthyroidism:

See umbilical hernia

Back 716

Hypo

Front 717

What dz:

Normal neonate --> 6w age p/w feeding probs, jaundice, large fontanelle, hypotonia --> large tongue, puffy myxedematous face & M.R.

Back 717

congenital hypothyroid

Front 718

What is next step:

Newborn screen shows low T4, high TSH --> ?

Back 718

START L-THYROXINE

then resend blood to confirm (do NOT wait to start tx)

Front 719

Congenital hypothyroid: initiate L-thyroxine --> what is goal TSH? T4?

Back 719

TSH: 1 mU/ml

T4: upper 1/2 normal

Front 720

Congen hypothyroid: measure T4/TSH how often?

Back 720

2w --> 4w --> q1-2 mos until 1yo --> q2-3mos until 3yo --> q3-12 mos until complete growth

Front 721

#1 etio ambiguous female genitalia

Back 721

Congen Adrenal Hyperplasia

Front 722

Congen Adrenal Hyperplasia: how inherit (pattern)?

Back 722

AR

Front 723

Congen Adrenal Hyperplasia: defect what hormone?

Back 723

Cortisol synth

Front 724

Congen Adrenal Hyperplasia: #1 type

Back 724

21-OH deficiency

Decrease cortisol, aldo

Increase 17-OH progest --> increase androgens

Front 725

21-OH deficiency:

-decrease production which hormones? (2)
-increase production which hormone? effect?

Back 725

Decrease cortisol, aldo

Increase 17-OH progest --> increase androgens --> verilize fems

Front 726

Difference b/w:

CLASSIC and NONCLASSIC congen adrenal hyperplasia

Back 726

Classic: complete enz def --> adrenal crisis --> hypoNa, hyperK --> shock at 1-2w

Nonclassic: NON-VIRILIZING; partial enz def --> manifests under stress

Front 727

Classic CAH: sxs appear what age?

Back 727

1-2w

Front 728

CAH: what lyte abns? (2)

Back 728

HypoNa+

HyperK+

Front 729

Non-classic CAH: virilizing?

Back 729

NO

partial enz def --> manifests under stress

Front 730

See proteinuria with:

-acute glomerulonephritis?
-intersitital nephritis?

Back 730

YES BOTH - but not as high as nephrotic syndrome

Front 731

What dz:

1+/2+ protein during FEVER or EXERCISE

Back 731

Benign proteinuria

Front 732

Benign proteinuria: how define?

Back 732

1+/2+ protein during fever or s/p exercise

Front 733

What dz:

Only excrete protein when standing (1,500mg/d)

Back 733

Orthostatic proteinuria

Front 734

Orthostatic proteinuria: indicate renal dz?

Back 734

NO - common in adols

Front 735

Orthostatic proteinuria: see in AM?

Back 735

NO - first AM urine should be negative since lying down --> not spillling protein

Front 736

Common to see generalized tonic-clonic szs in newborn?

Back 736

NO - contrast older infants

Front 737

Neonatal sz: see horizontal or vertical deviation?

Back 737

Horiz

Front 738

Suspect what phenomenon:

Neonate w/eye jerking, lip-smacking, tonic limb posturing, APNEA

Back 738

SEIZURE

(subtle s/sx)

Front 739

Ankle clonus: what is normal # beats?

Back 739

<10

Front 740

Clonus: what is abn # beats in a 1-2mo old?

Back 740

>3 beats is abnormal

Front 741

Indicates what process:

-schistocytes
-helmets

Back 741

Hemolysis (both)

Front 742

If atopic parent --> what is risk to child? (%)

Back 742

30% risk

Front 743

Has rate of asthma increased in recent years?

Back 743

2x increase in 15 years

Front 744

#1 chronic dz in peds

Back 744

asthma

Front 745

Asthma: how long last & what cells involved:

-early rxn
-late rxn

Back 745

Early (0-1h): masts & eosinos --> increase perm/mucus & bronchocon

Late (2-3h later): eosino, PMN, leuko --> epi destruct & remodel SM

Front 746

Asthma:

-how many hrs until late rxn peaks? resolves?
-how long does aw hyperresponsiveness persist after late rxn?

Back 746

peaks 4-8h --> resolves 24h

aw hyperresponsive for days-wks

Front 747

Asthma: wheeze in what part of resp?

Back 747

End-exp

Front 748

How do allergies --> chronic cough?

Back 748

Allergy --> nasal congest --> PND --> noct cough

Front 749

What dz:

COBBLESTONE post pharyxn

Back 749

PND --> lymphoid hyperplasia

Front 750

Allergic rhinitis: what TYPE of hypersens rxn?

Back 750

Type 1 (immed)

Front 751

Allergic rhinitis: how tx? (2)

Back 751

Antihistamine
topical nasal steroids

Front 752

Sinusitis: req sxs how long?

Back 752

1week purulent nasal discharge

Front 753

Sinusitis: see fever?

Back 753

YES

Front 754

Sinusitis: nose & throat swabs useful?

Back 754

No

Front 755

Sinusitis: 4 most common bact

Back 755

S pneumo
H flu
M catar
Strep PYOGENES

Front 756

Sinusitis: tx with what class?

Back 756

B-LACTAMS
-cefuroxime
-augmentin

Front 757

When develop:

-ethmoid sinuses
-max sinuses
-frontal

Back 757

Ethmoid & max: at birth

Frontal: 6-8yo

Front 758

Bronchitis: s/sx worse day or night?

Back 758

EQUAL

(no change w/temp,exercise)

Front 759

Think what dz:

Rhonchi

Back 759

Bronchitis

Front 760

Atypical/viral PNA: s/sx change w/temp, exercise?

Back 760

MAY WORSEN

(contrast viral URI)

Front 761

Atypical/viral PNA: expect cough for how long?

Back 761

8-12w

Front 762

How does GERD --> nasal congestion?

Back 762

NASAL reflux --> congest

Front 763

Habitual cough: what is initial trigger?

Back 763

Viral URI

Front 764

What dz:

Brassy, short, dry spasmodic cough; no change w/exercise, cold; resolves w/sleep

Back 764

Habitual cough

Front 765

Fungal pulm infxn: dry or wet?

Back 765

DRY

Front 766

Chlamydia PNA: intermittent or paroxysmal cough?

Back 766

Parox!

Front 767

Mycoplasma PNA: intermittent or paroxysmal cough?

Back 767

Parox

Front 768

Suspect what dz:

Chronic cough + palpitations

Back 768

CHF

Front 769

Suspect what dz:

Chronic cough + abdominal pain

Back 769

PNA

Front 770

Insp:Exp ratio:

-normal
-restrictive lung dz
-obstructive

Back 770

I:E

Norm: 1:2
Restrict: 1:1
Obstruct: 1:3 (due air-trapping)

Front 771

Due obstruction in small/med/large aw:

Wheeze

Back 771

Mod

Front 772

Due obstruction in small/med/large aw:

Rhonchi

Back 772

Large

Front 773

Due obstruction in small/med/large aw:

Rales

Back 773

Small

(contrast rhonchi: large)

Front 774

Difference between:

Variable & fixed obstruction

Back 774

Variable: insp or exp ONLY

Fixed: BOTH insp & exp

Front 775

If immunized child w/chronic cough --> suspect pertussis?

Back 775

Unlikely

Front 776

Fungal PNA:

-is cough productive? disturb sleep?
-chest pain?

Back 776

Non-productive cough not disturb sleep

PLEURITIC chest pain

Front 777

What type of cancer can present with chronic cough?

Back 777

Mediastinal lymphoma

Front 778

Child with 1' TB:

See what changes on CXR?

Back 778

FEW/NO CHANGES

(little evidence of initial focus)

May see focal hyperinflat, atelect

Front 779

Suspect what dz:

*Large regional lymphadenitis + non-productive cough + FTT + f/c

Back 779

1' TB

Front 780

Pediatric Tb: see small or large regional lymphadenitis?

Back 780

LARGE

Front 781

Pediatric TB: which lobar segments at increased risk?

Back 781

EQUAL RISK

2+ foci in 25% pts

Front 782

Pediatric TB: see local effusions on CXR?

Back 782

YES

Front 783

If suspect TB and pt is symptomatic --> how officially dx?

Back 783

sputum cx OR 1st AM gastric asp

(positive PPD also useful in ped)

Front 784

What size:

Positive PPD in low-risk child

Back 784

>15mm

Front 785

Asthma: how tx:

Mild intermittent

Back 785

B-agonist

Front 786

Asthma: how tx:

Daily persistent asthma

Back 786

B-agon + inhaled cortico

Front 787

Inhaled corticosteroid: how long until see improvement?

Back 787

few weeks

Front 788

Asthma: if LT inh corticosteroids --> monitor what 4 things?

Back 788

1. BP (HTN)
2. BG
3. Growth
4. Cataracts

Front 789

Asthma: does administration of leuko-synth inhibitor affect the req dose of inh steroid?

Back 789

allows lower dose steroid

Front 790

Asthma: which more effective:

Inh steroid or leuko-inh

Back 790

STEROID

Front 791

Asthma: can you use leuko-inh as monotherapy?

Back 791

NO

Front 792

If see CXR with mediastinal/hilar adenopathy --> think what 3 dzs?

Back 792

1. TB
2. Fungal PNA
3. malig

Front 793

Cystic fibrosis: restrictive or obstructive

Back 793

Obstructive (mucus plug traps air)

Front 794

Obstructive or restrictive:

Decrease FEV1/FVC

Back 794

Obstruct

Front 795

Asthma: decrease or normal FEV1/FVC

Back 795

Decrease

Front 796

Obstructive or restrictive:

SLE

Back 796

Restrictive

Front 797

Obstructive or restrictive:

Normal FEV1/FVC

Back 797

Restrict

Front 798

Nephrotic syndrome:

-what age?
-M or F?

Back 798

1.5-8yo
M >F

Front 799

Nephrotic syndrome:

#1 etio

Back 799

MCD

Front 800

Nephrotic syndrome:

Fluid moves from ___ to ____

Back 800

Lose albumin in urine --->

Fluid moves from VASC to INTERSTITIUM --> hypovolemia

Front 801

Nephrotic syndrome:

How affect BP?

Back 801

NORMAL BP

Retain H2O but fluid moves out of vasc into interstitium

Front 802

How affect BP:

-Nephrotic syndrome
-Acute glomerulonephritis

Back 802

Nephrotic: normal BP

Acute GN: HTN

Front 803

Acute glomerulonephritis: #1 presenting s/sx

Back 803

Tea colored urine

Front 804

Nephrotic synd and/or acute glomerulonephritis:

Gross hematuria

Back 804

acute nephritis

Front 805

Nephrotic synd and/or acute glomerulonephritis:

preceded by URI

Back 805

acute nephritis

Front 806

Nephrotic syndrome: what lyte change? 2 mxns for change

Back 806

HYPONATREMIA

1. Lose vasc fluid to interstitium --> retain excess H2O & Na in kidney
2. HYPERLIPID --> pseudohyponatremia

Front 807

Nephrotic syndrome: how affect cholesterol?

Back 807

Lose albumin in urine --> Liver increases lipid production --> HYPERCHOLESTEROL

(also see decreased lipid clearance from circ)

Front 808

Nephrotic synd:

Consider what imaging?

Back 808

Renal U/S

Front 809

Nephrotic synd: order C3/C4?

Back 809

Yes - r/o collagen vasc dz

Front 810

Nephrotic synd:

Order what test to r/o post-strep glomerular dz

Back 810

Streptozyme

Front 811

Nephrotic synd:

Tx w/albumin infusion in what 2 scenarios?

Back 811

1. Ascites/effusion -->resp problems

2. Scrotal edema

Front 812

Nephrotic synd:

Can you tx with diuretic monotherapy? How admin?

Back 812

Albumin infusion --> THEN intravenous furesomide

*Never diuretic alone --> hypovol

Front 813

Nephrotic synd:

Steroids useful?

Back 813

Yes

Front 814

Nephrotic synd:

How much salt per day?

Back 814

restrict 1,500 - 2,000 mg daily

Front 815

Nephrotic synd:

Admin what ppx vaccine

Back 815

PCV

Front 816

Nephrotic synd: what 2 drugs prevent relapse?

Back 816

cyclophosphamide x 8-12w

Calcineurin inhibitor (tacro, cyclospor) x 2 years

Front 817

Nephrotic synd:

See what complication (esp if tx with steroids)

Back 817

Spontaneous peritonitis

Front 818

Nephrotic synd:

Most common pathogen in spont peritonitis (comp)

Back 818

Strep Pneumo

(also GNs)

Front 819

Nephrotic synd:

Do minority or majority kids outgrow?

Back 819

Majority

Front 820

PID: what age?

Back 820

15-19yo F

Front 821

PID: G&C --> also infect uterus w/what 4 pathogens?

Back 821

1. E coli
2. Bacteroids
3. Mycoplasma
4. Ureaplasa

Front 822

What dz:

16yo F with suprapubic pain --> RUQ pain radiating to R shoulder

Back 822

Fitz-Hugh-Curtis (2/2 PID)

Front 823

PID: is pain most commonly uni/bilat?

Back 823

BILAT

Front 824

PID: order what tests?

Back 824

Cervical cx
Urine PCR

Front 825

PID: req to tx partners?

Back 825

Yes

Front 826

Low or high fever?:

Appendicitis

Back 826

Low

Front 827

Low or high fever?:

Acute cholecystitis

Back 827

Low

Front 828

Low or high fever?:

Pneumonia

Back 828

HIgh

Front 829

Low or high fever?:

UTI

Back 829

High

Front 830

Low or high fever?:

Septic cholangitis

Back 830

HIgh

(contrast acute cholecystitis: low)

Front 831

Low or high fever?:

Gyn infxn (e.g. PID)

Back 831

High

Front 832

Hypo-, normo- or hyperactive bowel sounds:

Ileus

Back 832

Hypo

Front 833

Hypo-, normo- or hyperactive bowel sounds:

Gastroenteritis

Back 833

Hyper

Front 834

Hypo-, normo- or hyperactive bowel sounds:

SBO

Back 834

Hypo <--> high-pitched hyper (peristalsis)

Front 835

What dz:

Bowel sounds: quiet --> high-pitched and hyper --> quiet

Back 835

SBO w/peristalsis

Front 836

Abd exam: what does hyperresonance indicate?

Back 836

Gaseous distension

Front 837

What dz:

Involuntary guarding

Back 837

Peritonitis

Front 838

Hepatitis:

-see vomit? diarrhea?
-fever?
-mandatory finding?

Back 838

Vomit; no diarrhea
Fever
Usu see JAUNDICE

Front 839

Hepatitis: well-localized or vague abd pain?

Back 839

Vague (sometimes RUQ)

Front 840

What dz:

Epigastric pain radiating to back

Back 840

Pancreatitis

Front 841

Pancreatitis:

-vomit?
-diarrhea?

Back 841

Vomit yes
Diarrhea no

(same as hepatitis, appenditicits)

Front 842

Appendicitis:

-vomit?
-diarrhea?

Back 842

Vomit yes, diarrhea no

(same as hepatitis, pancreatitis)

Front 843

Does sexual debut affect risk of UTI?

Back 843

Yes - increased risk at debut

Front 844

Low or high fever:

Ectopic pregnancy

Back 844

TRICK - no fever

Front 845

What dz:

Acute INTERMITTENT sharp abdominal pain radiating down extremitin; n/v

Back 845

OVARIAN TORSION

Front 846

Ovarian torsion: is pain intermittent or constant

Back 846

INTERMITTENT

Front 847

Ovarian torsion usually idiopathic or 2/2 cyst/neoplasm?

Back 847

2/2 cyst/neoplasm

Front 848

Ovarian torsion:

-vomit?
-diarrhea?

Back 848

Vomit

no diarrhea

Front 849

Ovarian torsion: see bilateral torsion?

Back 849

See bilat in INFANT

Front 850

Testicular torsion: what finding on phys exam?

Back 850

Lose cremasteric

Front 851

Testic torsion: irrevers damage after how long?

Back 851

4h

Front 852

Crohn's: 1st line drug

Back 852

Mesalamine (5-ASA)

Front 853

Mesalamine (5-ASA): 1st line in what dz?

Back 853

Crohn's

Front 854

Infliximab: what dz?

Back 854

IBD

Front 855

What dz:

Chronic abd pain + bloody stools + failure to grow

Back 855

IBD

Front 856

IBD: is pain localized?

Back 856

YES (red flag)

Front 857

IBD: does pt p/w urinary sxs?

Back 857

DYSURIA

Front 858

IBD: will pain awaken pt from sleep?

Back 858

Yes

Front 859

IBD: what % pts have positive FHx?

Back 859

30%

Front 860

IBD: what CBC abnormalities? (2)

Back 860

Anemia
HIGH PLATELETS

Front 861

IBD: see hypo or hyperalb?

Back 861

Hypo

Front 862

IgA tissue transglutinase Ab (TTG): sens? spec?

Back 862

Sens & spec for celiac

Front 863

Tissue transglutinase: what CLASS of Ab? (Ig_)

Back 863

IgA

Front 864

Celiac: un/common?

Back 864

Uncommon

Front 865

What dz:

6mo-2yo with chronic abd pain + ABDOMINAL DISTENSION + vomit/diarrhea + NO GROSS BLOODY STOOLS

Back 865

Celiac dz

Front 866

Celiac dz: what is youngest age you may see?

Back 866

6mo!

Front 867

Celiac: see gross blood loss? occult?

Back 867

OCCULT --> anemia

(no gross BRBPR)

Front 868

Peptic ulcer dz: common in child?

Back 868

NO

Front 869

Peptic ulcer: see diarrhea? gross bloody stool?

Back 869

NO - p/w pain & occult loss

Front 870

#1 intestinal PARASITE in US

Back 870

Giardia

Front 871

Giardia: best dx test?

Back 871

SPECIFIC ANTIGEN TEST

(NOT O&P)

Front 872

What dz:

Abdominal pain & palpable mass & bloody streaks on stool & guaic pos

Back 872

Constipation

Front 873

HSP:

-diarrhea?

Back 873

NO

Although most pts p/w collicky pain & bloody stools

Front 874

What dz:

Collicky abdominal pain + bloody stools + RASH + no diarrhea

Back 874

HSP

Front 875

HSP: abd pain is constant or intermittent?

Back 875

COLLICKY

Front 876

#1 etio chronic abdominal pain in child

Back 876

Functional abd pain (dx of exclusion)

Front 877

Functional abd pain: see bloody stool?

Back 877

NO - if blood --> cannot be fxnl

Front 878

Functional abd pain: how tx?

Back 878

Reassurance

Front 879

IBD: 1st imaging test to perform? 2nd? risks?

Back 879

Colo --> THEN barium enema (delays colo)

UC: enema --> increase risk toxic megacolon

Front 880

#1 intestinal PARASITE in US

Back 880

Giardia

Front 881

Giardia: best dx test?

Back 881

SPECIFIC ANTIGEN TEST

(NOT O&P)

Front 882

What dz:

Abdominal pain & palpable mass & bloody streaks on stool & guaic pos

Back 882

Constipation

Front 883

HSP:

-diarrhea?

Back 883

NO

Although most pts p/w collicky pain & bloody stools

Front 884

What dz:

Collicky abdominal pain + bloody stools + RASH + no diarrhea

Back 884

HSP

Front 885

HSP: abd pain is constant or intermittent?

Back 885

COLLICKY

Front 886

#1 etio chronic abdominal pain in child

Back 886

Functional abd pain (dx of exclusion)

Front 887

#1 intestinal PARASITE in US

Back 887

Giardia

Front 888

Functional abd pain: see bloody stool?

Back 888

NO - if blood --> cannot be fxnl

Front 889

Giardia: best dx test?

Back 889

SPECIFIC ANTIGEN TEST

(NOT O&P)

Front 890

Functional abd pain: how tx?

Back 890

Reassurance

Front 891

What dz:

Abdominal pain & palpable mass & bloody streaks on stool & guaic pos

Back 891

Constipation

Front 892

IBD: 1st imaging test to perform? 2nd? risks?

Back 892

Colo --> THEN barium enema (delays colo)

UC: enema --> increase risk toxic megacolon

Front 893

HSP:

-diarrhea?

Back 893

NO

Although most pts p/w collicky pain & bloody stools

Front 894

What dz:

Collicky abdominal pain + bloody stools + RASH + no diarrhea

Back 894

HSP

Front 895

HSP: abd pain is constant or intermittent?

Back 895

COLLICKY

Front 896

#1 etio chronic abdominal pain in child

Back 896

Functional abd pain (dx of exclusion)

Front 897

Functional abd pain: see bloody stool?

Back 897

NO - if blood --> cannot be fxnl

Front 898

Functional abd pain: how tx?

Back 898

Reassurance

Front 899

IBD: 1st imaging test to perform? 2nd? risks?

Back 899

Colo --> THEN barium enema (delays colo)

UC: enema --> increase risk toxic megacolon

Front 900

#1 intestinal PARASITE in US

Back 900

Giardia

Front 901

Giardia: best dx test?

Back 901

SPECIFIC ANTIGEN TEST

(NOT O&P)

Front 902

What dz:

Abdominal pain & palpable mass & bloody streaks on stool & guaic pos

Back 902

Constipation

Front 903

HSP:

-diarrhea?

Back 903

NO

Although most pts p/w collicky pain & bloody stools

Front 904

What dz:

Collicky abdominal pain + bloody stools + RASH + no diarrhea

Back 904

HSP

Front 905

HSP: abd pain is constant or intermittent?

Back 905

COLLICKY

Front 906

#1 etio chronic abdominal pain in child

Back 906

Functional abd pain (dx of exclusion)

Front 907

Functional abd pain: see bloody stool?

Back 907

NO - if blood --> cannot be fxnl

Front 908

Functional abd pain: how tx?

Back 908

Reassurance

Front 909

IBD: 1st imaging test to perform? 2nd? risks?

Back 909

Colo --> THEN barium enema (delays colo)

UC: enema --> increase risk toxic megacolon

Front 910

What dz:

Cobblestone mucosa of GI tract

Back 910

Crohn's

Front 911

What dz:

GI mucosa friable & erythematous

Back 911

UC

(contrast Crohn's - cobblestone)

Front 912

What dz:

GI PSEUDOPOLYPS

Back 912

Ulcerative Collitis

Front 913

CD or UC:

ALWAYS involves rectum

Back 913

UC

Front 914

Sickle cell:

-what AA substitution?
-which Hgb chain?

Back 914

Switch VAL to GLUTAMIC ACID

Beta chain

Front 915

Sickle cell:

De/increase retic count?

Back 915

INCREASE retics

Front 916

What electrophoresis pattern in:

-fetus --> normal adult
-sickle TRAIT
-SCD

Back 916

Normal: FF --> AF

Trait: FSC (mild sickling)

Dz: FS

Front 917

What dz: electrophoresis shows:

FSC

Back 917

sickle TRAIT

(dz: FS)

Front 918

What dz: electrophoresis shows:

FS

Back 918

Sickle DISEASE

(trait: FSC)

Front 919

Sickle cell:

-what is baseline color of pt?
-what does pallor indicate?

Back 919

Baseline jaundice (2/2 hemolysis)

Pallor due: spleen sequestor RBCs and/or aplastic crisis

Front 920

Sickle cell:

Murmur?

Back 920

Flow murmur 2/2 anemia

Front 921

Sickle cell:

Is parental monitoring of spleen effective ppx?

Back 921

YES

Front 922

Sickle cell:

How evaluate for stroke? (what test)

Back 922

Transcranial Doppler

Front 923

Sickle cell:

What UA finding?

Back 923

Hematuria 2/2 papillary necrosis

Front 924

#1 death in sickle pts

Back 924

Acute chest synd

Front 925

What dz:

Sickle pt with fever, cough, SOB, hypoxia

Back 925

Acute chest syndrome

Front 926

Acute chest syndrome:

Single or multiple lobules affected?

Back 926

Multilobular

Front 927

Acute chest syndrome:

How appear CXR?

Back 927

NEW INFILTRATES; effusion, atelectasis

Front 928

Acute chest syndrome:

Specific etiology identified in what % pts?

Back 928

40%

Often develops in child hospitalized for painful vasooculsion crisis

Front 929

What complication:

-Sickle + chest pain + decreased breath sounds
-Sickle + CP + normal bs

Back 929

Decreased bs: ACS

Normal bs: Rib infarct

Front 930

What complication:

Sickle + cardiomegaly + lower lobe infiltrates + tachypnea; no chest pain

Back 930

CHF (2/2 chronic anemia)

Front 931

Aplastic crisis in sickle: may be due what infxn?

Back 931

Parvo B19

Front 932

Sickle: is EVERY fever an emergency?

Back 932

YES - may be only sign of serious infxn

Front 933

Sickle: susc to what 3 pathogens?

Back 933

Strep pneumo
H flu
N mening

Front 934

Sickle: what gallbladder complication?

Back 934

Cholelithiasis

(often perform lap chole BEFORE develop gallstones)

Front 935

Sickle: see precocious puberty?

Back 935

NO - see delayed sex maturation

Front 936

Sickle: why do pts snore?

Back 936

Fxnl asplenia --> hypertrophy WALDEYERS RING

Front 937

Sickle: what eye dz?

Back 937

Proliferative retinopathy

Front 938

Sickle: ppx lap chole?

Back 938

YES - remove GB before develop G-stones --> infxn

Front 939

Sickle: cure?

Back 939

BMT

Front 940

Sickle: tx w/what drug?

Back 940

Hydroxyurea

Front 941

Hydroxyurea: tx what dz?

Back 941

Sickle (decrease freq & severity)

Front 942

Sickle: give what vaccines if:

-<2yo
->2yo

Back 942

Hib ALL pts

<2yo: PCV-23
>2yo: PCV-13 (polysacch)

Front 943

Sickle:

-if sepsis --> what abx?
-what age initiate ppx?

Back 943

Penicillin

Start ppx at 5-6yo

Front 944

0-4mos: infant gains how much wt per day?

Back 944

20-30 g/d

Front 945

Malnutrition: decreased HC is early or late finding?

Back 945

LATE

(brain usu spared)

Front 946

FTT: definition:

-wt <____%
-wt for height <___%

Back 946

Wt <3%

Wt for ht <3%

Front 947

FTT: what % cases are NON-organic?

Back 947

90%

Front 948

How present: (what finding)

True milk-protein allergy w/FTT

Back 948

BLOODY STOOLS

Front 949

Lead level:

-toxic
-acute encephalopathy (#)

Back 949

Toxic >10

Encephalo >100-150

Front 950

Lead: suspect in what 2 types houses

Back 950

<1950
Renovatd 1978

Front 951

Lead screen: screen CAP or VENOUS?

Back 951

CAPILLARY lead level --> confirm w/venous

Front 952

Lead: universal screen in what 2 scenarios (community scenarios)? Screen what ages?

Back 952

1. Prevalence >11%
2. >25% houses older than 1950

Screen 9-12mo --> repeat 2yo

Front 953

What dz:

Microcytic anemia w/stippling

Back 953

Lead poison

Front 954

Lead poison: micro/normo/macrocytic anemia?

Back 954

Micro

Front 955

Lead poison: how affect:

-BP
-pulse
-rr

Back 955

Increase ICP --> CUSHING

HTN
bradycardia
resp distress

Front 956

Lead: see hypo or hyperphosphatemia?

Back 956

HYPO

Front 957

What dz:

Hypophosphatemia + urine coproporphyrin + glycosuria

Back 957

Lead poison

Front 958

Lead poison: see what molecule in urine?

Back 958

Coproporphyrin

Front 959

What dz:

CXR: hyperdense flecks

Back 959

Lead poison

Front 960

Tx what dz:

Dimercaprol

Back 960

Lead poison

Front 961

Tx what dz:

Calcium EDTA

Back 961

Lead poison

Front 962

Tx what dz:

Succimer

Back 962

Lead poison

Front 963

Tx what dz:

Penicillinamine

Back 963

Lead poison

Front 964

Lead poison: admit to hosp if lead what level?

Back 964

>100 + sxs

Front 965

Lead poison: how tx (what drugs):

-inpt (2)
-outpt (2)

Back 965

Inpt:
1. Dimercaprol
2. INTRAVENOUS Ca2+ EDTA

Outpt:
1. Succimer
2. Penicillinamine

Front 966

What drug:

Stims vomit center in brain --> vomit w/in 20 minutes

Back 966

Ipecac

Front 967

Ipecac:

-mxn
-how long until vomit?
-useful if poison w/in what time frame?

Back 967

Stims vomit center in brain --> vomit in 20 mins

Useful if poison <30min

Front 968

Ipecac: need to consult poison center first?

Back 968

YES

Front 969

Ipecac: contra-indicated in what age?

Back 969

<6mo

Front 970

Ipecac: contraindicated if infant ingests:

-LOW or HIGH viscosity hydrocarbon?

Back 970

LOW

Front 971

Ipecac: safe to use in pt w/coagulation disorder?

Back 971

No - contraindicated

Front 972

Poisoning:

Perform gastric lavage?

Back 972

No clinical benefit

Front 973

Activated charcoal:

Useful w/in how long from poison ingestion?

Back 973

<1hr

Front 974

Toxin ingestion: see fever?

Back 974

Usu not

Front 975

Reye's syndrome: affect ICP?

Back 975

Increase ICP --> papilledema, change mental status --> diffuse encephalopathy

Front 976

Metabolic dzs: p/w fever? Focal neuro findings?

Back 976

No fever or focal neuro

P/w diffuse encephalo

Front 977

ICH: focal or diffuse neuro?

Back 977

FOCAL

Front 978

Meningitis: see papilledema? focal neuro s/sx?

Back 978

NO

Front 979

Seizure disorder: see what lyte abns? (2)

Back 979

Low Ca
Low Mg

Front 980

Infant with mental status change: if high suspicion of etiology --> is head CT mandatory?

Back 980

YES - GET HEAD CT

Front 981

Cystic fibrosis:

How inherit? How many mutations?

Back 981

AR
1,500 mutation

Front 982

Cystic fibrosis:

Deficiency in what enzyme responsible for malabsorption?

Back 982

Defic lipase

Front 983

Cystic fibrosis:

Admin what % daily recommended cals?

Back 983

120-150%

Front 984

Recommended daily calories (kcal/kg/d):

-9w normal
-9w cystic fibrosis

Back 984

normal: 100 kcal/kg/d

CF: 130-160

Front 985

Cystic fibrosis:

What % calories should be fat?

Back 985

40%

(contrast normal: 30%)

Front 986

Cystic fibrosis:

Do minority or majority of teens develop CHRONIC PNA?

Back 986

MAJORITY

Front 987

Cystic fibrosis:

Replace what 3 enzymes? 4 vitamins?

Back 987

Lipase
Amylase
Protease (Creon)
vitamin ADEK

Front 988

Cystic fibrosis:

Sweat test --> how long until results?

Back 988

DAYS

Front 989

Cystic fibrosis:

MAIN dx test

Back 989

Sweat test
(genotype is adjunctive)
(>60 is diagnostic)

Front 990

Sweat chloride test:

-normal
-CF

Back 990

Normal <60

>60 diagnostic

Front 991

Cystic fibrosis:

Is genetic test diagnostic?

Back 991

NO - req further testing (preferably sweat test)

Front 992

Cystic fibrosis:

Vitamin E deficiency --> what complication?

Back 992

HEMOLYSIS

Front 993

Cystic fibrosis:

Hemolysis due to what deficiency?

Back 993

Vitamin E deficiency

Front 994

Cystic fibrosis:

In/decreased haptoglobin?

Back 994

DECREASE (due hemolysis 2/2 vit E def)

Front 995

Cystic fibrosis:

-in/decrease plts?
-retics?

Back 995

Hemolysis (2/2 vit E def)-->

-increase plts
-increase retics

Front 996

#1 bowel obstruction in 6mo-6yo

Back 996

Intusseption

Front 997

Intussception: what ages?

80% <___yo?

Back 997

6mo - 6yo

80% <2yo

Front 998

Intussception: M or F?

Back 998

M>F

Front 999

Intussception: which invaginates into other - prox vs. distal

Back 999

Prox ALWAYS invaginates into distal

Front 1000

Intussception: intermittent or constant pain?

Back 1000

PAROXYSMS of pain

Front 1001

What dz:

paroxysmal abd pain + inconsolable + sausage in R abd

Back 1001

Intussception

Front 1002

Intussception: vomit? diarrhea?

Back 1002

Vomit: YES

Stool is CURRANT (blood & mucus)

Front 1003

Intussception: most common location

Back 1003

Ileocecal jxn

Front 1004

Intussception: underlying mxn (what stimulates telescope)?

Back 1004

Hypertrophied lymph tissue

Front 1005

Intussception: what dx imaging (2)?

Back 1005

Air or contrast enema

Front 1006

Name for:

Mid ear fluid + s/sx ear infxn (bulg, drainage)

Back 1006

ACUTE OM

(contrast OME - no s/sx)

Front 1007

How different:

AOM vs. chronic OME

Back 1007

AOM: fluid + s/sx

Chronic OME: fluid - s/sx

Front 1008

AOM: 4 most common bact pathogens

Back 1008

Strep pneumo
H flu
M cattarhalis
STREP PYOGENES

Front 1009

AOM: 3 common VIRAL pathogens

Back 1009

Influ
RSV
Rhino

Front 1010

AOM: higher bottle or breast? Assoc w/pacifier? genetic component?

Back 1010

Bottle
Increase risk if pacifier
FHx

Front 1011

AOM: M or F?

Back 1011

M > F

Front 1012

AOM: assoc w/SES?

Back 1012

Increased in LOW SES

Front 1013

AOM: highest what ethnicity?

Back 1013

Native American

Front 1014

What dz:

TMs retracted & amber & decreased mobility

Back 1014

Chronic OME

Front 1015

Ear exam to r/o AOM: which is more reliable:

TM color OR position/mobility

Back 1015

Position/mobility

Front 1016

Ear exam:

Is RED TM alone a good predictor of AOM?

Back 1016

NO

Front 1017

What test:

Objective eval TM mobility

Back 1017

Tympanogram

Front 1018

What test:

Audio thresholds via EARPHONES

Back 1018

Conventional audiometry

Front 1019

What test:

Audio threshold via SPEAKERS

Back 1019

Visual Reinforcement audiometry (VRA)

Front 1020

How different:

Conventional audiometry vs. Visual Reinforcement Audiometry

Back 1020

Conventional: earphones; >4yo

Visual: speakers; 6mo - 2.5yo

Front 1021

Conventional audiometry: can perform in what ages?

Back 1021

>4yo

Front 1022

Visual Reinforcement Audiometry: perform in what ages?

Back 1022

Speakers

6mo - 2.5yo

Front 1023

What test:

PHYSIOLOGIC test of COCHLEAR response to stimulation

Back 1023

Otoacoustic Emissions (OAE)

Front 1024

What test:

Use in newborn to assess hearing

Back 1024

Otoacoustic Emissions (OAE)

-physio test of cochlear response

Front 1025

AOM: what % resolve spontan?

Back 1025

50-80%

Front 1026

AOM: how tx DEFINITE dx in:

-0-2yo
->2yo

Back 1026

0-2: abx
>2: abx if SEVERE (39', pain)

Front 1027

UNCERTAIN AOM: must give abx if <___ (age)

Back 1027

<6mo

If 6mo -2yo --> you can observe (abx if 39', severe pain)

Front 1028

Chronic OME: assoc w/hearing loss?

Back 1028

YES --> lang delay

Front 1029

Chronic OME: how tx? (2 options)

Back 1029

watch & wait

if hearing loss --> TUBES

Front 1030

Name for:

Edges of optic disc blurred; narrow BVs

Back 1030

Papilledema

Front 1031

TTH or Migraine:

LATE in day

Back 1031

TTH

Front 1032

TTH: occur AM or PM?

Back 1032

PM

Front 1033

TTH or Migraine:

Triggered by stress

Back 1033

BOTH

Front 1034

TTH or Migraine:

Occipital

Back 1034

TTH

Front 1035

TTH or Migraine:

Tender neck muscles

Back 1035

TTH

Front 1036

TTH or Migraine:

BILATERAL

Back 1036

TTH

Front 1037

TTH or Migraine:

Any time of day

Back 1037

Migraine

Front 1038

Migraine: AM or PM?

Back 1038

Any time of day

Front 1039

TTH or Migraine:

Unilateral

Back 1039

Migraine

Front 1040

TTH or Migraine:

Can be triggered by foods

Back 1040

Migraine

Front 1041

TTH or Migraine:

Relieved with sleep

Back 1041

Migraine

Front 1042

What type of HA:

Bilateral vision changes + parasthesias + mental status changes

Back 1042

BASILAR migraine

Front 1043

Basilar migraine: how present?

Back 1043

Bilateral vision loss
Parasthesias
Mental status change

Front 1044

Suspect what type of pathology:

HA + developmental delay

Back 1044

Intracranial process

Front 1045

Febrile szs:

Occur EARLY or LATER in course of fever?

Back 1045

EARLY (1st day)

Front 1046

Febrile szs:

See with temp >___ C

Back 1046

>38C

Front 1047

Febrile szs:

Consider LP if <___ (age)

Back 1047

1st sz <12yo

(OR atypical sz w/slow return to baseline)

Front 1048

SIMPLE or COMPLEX febrile sz:

More common

Back 1048

Simple

Front 1049

SIMPLE or COMPLEX febrile sz:

GENERALIZED

Back 1049

SIMPLE!!!

(complex is focal)

Front 1050

SIMPLE or COMPLEX febrile sz:

<15mins

Back 1050

Simple

Front 1051

What is difference:

Simple vs. Complex febrile sz

Back 1051

Simple: <15min x 1; generalized

Complex: >15min x multi; focal

Front 1052

Febrile sz: what is % recurrence if 1st sz:

-<12mo
->12mo

Back 1052

<12mo: 50% recurrence

>12mo: 30% recurrence

Front 1053

Febrile sz:

increase risk epilepsy?

Back 1053

SLIGHT increase (esp if early & recurrent)

Front 1054

Febrile sz:

FHx?

Back 1054

Yes

Front 1055

True seizure: see PINTPOINT or DILATED pupils?

Back 1055

Pinpoint

Front 1056

What % infants w/meningitis p/w szs?

Back 1056

30%

Front 1057

Can a BENIGN VIRAL SYNDROME be responsible for fever without source?

Back 1057

YES

(may be indisting from occult bacteremia)

Front 1058

#1 pathogen in OCCULT BACTEREMIA

Back 1058

Strep pneumo

Front 1059

Infant with fever of unknown source: catheterize if:

-M <__(age)
-F <__(age)

Back 1059

M<6mo (after 6mos start to think less about occult UTI)

F<12mo

Front 1060

What % infants w/bacterial meningitis have fever?

Back 1060

95%

Front 1061

Infant w/bact meningitis: top 2 pathogens in IMMUNIZED:

-<2mo
-2mo - 12yo

Back 1061

<2mo: E coli & GBS

2mo-12yo: Strep pneumo + N mening

Front 1062

Bact meningitis: suspect GBS if under what age?

Back 1062

<2mo

Front 1063

Bact meningitis: initiate what abx?

Back 1063

IV cephalo + vanco

Front 1064

Bacterial meningitis: may lead to what HORMONAL complication?

Back 1064

SIADH

Front 1065

Bact meningitis: is it RARE or COMMON for txed mening to be fatal?

Back 1065

RARE

Front 1066

#1 VIRAL meningitis

Back 1066

Enterovirus

Front 1067

Viral meningitis: what cells predom CSF:

-0-48h
->48h

Back 1067

0-48h: PMNs

>48h: lymphocytes

Front 1068

Viral meningitis: see predom LYMPHOS in CSF after how many hours?

Back 1068

>48h

Front 1069

Viral meningitis: what VIRUS --> RBCs in CSF?

Back 1069

HSV

Front 1070

HSV meningitis: what CSF feature?

Back 1070

See RBCs

Front 1071

Shock: initial bolus (size & fluid)

Back 1071

20 cc ISOTONIC NS

Front 1072

Shock:

When initiate INTRAOSSEOUS access?

Back 1072

Fail periph: 90 seconds or 3 attempts

Front 1073

IV access in SHOCK:

What TYPE of central line is an approp alternative to periph line in older child

Back 1073

FEMORAL

(NOT subclavian or arterial)

Front 1074

Meningococcemia: 1st choice abx

Back 1074

IV PENICILLIN

Front 1075

Meningococcus: how prophylx:

-adult contacts
-children

Back 1075

Adult: cipro

Children: rifampin

Front 1076

Meningococcemia: admin what abx at discharge to elim carrier state?

Back 1076

CEFTRIAX

Front 1077

MCV4: safe what ages?

Back 1077

11-18yo

Front 1078

Meningococcemia:

-what % adols die? total die?
-what % have comps?

Back 1078

Fatal 25% adols, 10% total

10-20% comps

Front 1079

Hypernatremia: slow or rapid replace fluid?

Back 1079

SLOW!

Decrease Na 1 mEq / 2h

(10 mEq/d)

Front 1080

Leads to what lyte abn:

Drink boiled milk

Back 1080

Hypernatremia

Front 1081

Leads to what lyte abn:

Drink free H2O

Back 1081

Hyponatremia

Front 1082

How calculate:

Degree of dehydration (#)

Back 1082

Previous wt - current wt

(assumes all wt loss is free H2O)

Front 1083

Expect hypo/iso/hypernatremic loss:

Gastroenteritis

Back 1083

ISOnatremia

(not req to meas lytes)

Front 1084

Gastroenteritis: required to measure lytes?

Back 1084

No - only if mod/severe dehydr

(assume isonatremic loss)

Front 1085

Dehyrdation: give what SIZE BOLUS over what AMT TIME? repeat boluses how often?

Back 1085

20 cc NS over 20-60min

Repeat until normal UOP & HR

Front 1086

How calculate:

Fluid deficit (cc) =

Back 1086

wt (g) x % dehydration

Front 1087

Dehydration: if replace fluids ORALLY --> how many CCs per how much TIME?

Back 1087

5-10cc q 1-5min

Front 1088

Give how much maintenance fluid?:

8kg

Back 1088

8x100 = 800cc/d

Front 1089

Give how much maintenance fluid?:

14 kg

Back 1089

10x100=1,000
4x50=200

1,200

Front 1090

Give how much maintenance fluid?:

25 kg

Back 1090

10x100=1,000
10x50=500
5x20=100

1,600

Front 1091

Fluid balance:

Need to replace HOW MUCH fluid for stool loss? What type of fluid?

Back 1091

>5g per 4h

Use 1/2NS + 20KCl (no dextrose)

Front 1092

Normal saline: how much Na+? Cl?

Back 1092

154 each

Front 1093

Oral replacement therapy: able to use in MODERATE dehydration w/out vomit?

Back 1093

YES

Front 1094

Dehydration: when reintroduce breastmilk/full formula?

Back 1094

If no vomit & tolerates 1-2 ozs of ORT per feed

Front 1095

Give how much maintenance fluid?:

8kg

Back 1095

8x100 = 800cc/d

Front 1096

Give how much maintenance fluid?:

14 kg

Back 1096

10x100=1,000
4x50=200

1,200

Front 1097

Give how much maintenance fluid?:

25 kg

Back 1097

10x100=1,000
10x50=500
5x20=100

1,600

Front 1098

Fluid balance:

Need to replace HOW MUCH fluid for stool loss? What type of fluid?

Back 1098

>5g per 4h

Use 1/2NS + 20KCl (no dextrose)

Front 1099

Normal saline: how much Na+? Cl?

Back 1099

154 each

Front 1100

Oral replacement therapy: able to use in MODERATE dehydration w/out vomit?

Back 1100

YES

Front 1101

Dehydration: when reintroduce breastmilk/full formula?

Back 1101

If no vomit & tolerates 1-2 ozs of ORT per feed

Front 1102

Where is pathology:

BILLIOUS vomit

Back 1102

POST-AMPULLA

Front 1103

Where is pathology:

Bloody vomit

Back 1103

Above ligament of Treitz

Front 1104

#1 etio gastroenteritis

Back 1104

Rotavirus

Front 1105

Pyloric stenosis:

When present?

Back 1105

3w (1w - 5mo)

Front 1106

Pyloric stenosis:

Bilious?

Back 1106

No - immed vomit

Front 1107

Pyloric stenosis:

Where palpate olive?

Back 1107

Above & right umbilius

Front 1108

Pyloric stenosis:

See skin changes?

Back 1108

Often see jaundice

Front 1109

Pyloric stenosis:

What lyte abn?

Back 1109

Hypochloremic metabolic alkalosis

Front 1110

Pyloric stenosis:

What imaging? (2)

Back 1110

Abd U/S --> (if not avail) --> upper GI WITH CONTRAST

Front 1111

What dz:

Upper GI: STRING SIGN

Back 1111

Pyloric stenosis

Front 1112

Pyloric stenosis:

Does LACK of palpable olive --> affect suspicion?

Back 1112

YES --- speaks strongly AGAINST P.S.

Front 1113

Pyloric stenosis:

See diarrhea?

Back 1113

No

Front 1114

UTI:

see vomit? diarrhea?

Back 1114

Vomit yes,

no diarrhea -- may see loose stools

Front 1115

Gastroesoph reflux: see poor wt gain?

Back 1115

Baby can develop food aversion --> FTT

Front 1116

Baby w/normal growth --> acute vomit:

Suspect metabolic disorder?

Back 1116

Not if previously normal growth

Front 1117

HSP:

-peaks what age?
-M or F?

Back 1117

4-6yo (range 2-17)

2x M > F

Front 1118

HSP: underlying mxn?

Back 1118

viral/bact URI (50% pts )---> IgA-mediated

Front 1119

HSP: how affects platelts?

Back 1119

NORMAL PLATELETS!!!!

Front 1120

What dz:

URI --> IgA deposition --> leukocytic vasculitis

Back 1120

HSP

Front 1121

What dz:

erythematous macules/wheals --> petechiae --> purpura

Back 1121

HSP

Front 1122

HSP: where see purpura? (distrib)

Back 1122

Gravity-dependent & pressure-sensitive areas

ELBOWS, LOWER EXTREMS

Front 1123

HSP: what % pts have skin s/sx?

Back 1123

100%

Front 1124

HSP: order what 2 labs?

Back 1124

UA: ALWAYS; assess renal involve
(if see blood/protein --> order BUN, CR)

CBC: see NORMAL PLATELETS

Front 1125

HSP: see splenomeg?

Back 1125

No

Front 1126

HSP: req PT? PTT? Blood cx?

Back 1126

NO

Front 1127

HSP:

-resolves how long? what % recur?
-how tx?
-risk what GI comp?

Back 1127

4-6w; 30% recur

NSAIDs; STEROIDS FOR ABD PAIN

risk GI bleed & ileoilial intuss

Front 1128

ITP: more or less common than HSP?

Back 1128

LESS COMMON

(5:100k compared to 10:100k)

Front 1129

ITP:

-age?
-M or F?

Back 1129

2-5yo (younger than HSP)

M=F

Front 1130

What dz:

non-specific viral infxn --> anti-plt Abs that bind plt surface --> liver & spleen destroy plts

Back 1130

ITP

Front 1131

HSP or ITP:

YOUNGER

Back 1131

ITP (2-5yo)

(contrast HSP 4-6)

Front 1132

HSP or ITP:

M > F

Back 1132

HSP

Front 1133

HSP or ITP:

M = F

Back 1133

ITP

Front 1134

HSP or ITP:

IgA deposits

Back 1134

HSP

(contrast ITP: anti-plt Abs)

Front 1135

HSP or ITP:

Anti-platelet Abs

Back 1135

ITP

(contrast HSP: IgA deposits)

Front 1136

HSP or ITP:

Usually preceded by viral infxn

Back 1136

BOTH

HSP: viral/bact URI

ITP: non-specific viral infxn

Front 1137

ITP: presents with petech/bruising and what OTHER sxs?

Back 1137

NONE

(may see epistax, ICH)

Front 1138

ITP:

-hepatosplenomeg?
-arthralgia?

Back 1138

NO

Front 1139

ITP is intracranial hemorrhage common?

Back 1139

NO - 0.5%

Front 1140

ITP: plts <___?

Back 1140

<20k

Front 1141

ITP: do most pts develop significant bleed?

Back 1141

NO

Front 1142

What dz:

viral infxn --> PETECHIA, BRUISING --> normal WBC, platelets <20k

Back 1142

ITP

Front 1143

ITP: how tx? (3)

Back 1143

Steroid
IVIg
Rhogham (anti-D)

Front 1144

Leukemia: see change in platelets?

Back 1144

Decrease (<100k)

(BM infiltrate --> see other cytopenias)

Front 1145

What dz:

Petech/purp + bone pain + hepatosplenomeg

Back 1145

Leukemia

Front 1146

To percuss liver:

Child in what position?

Back 1146

Supine w/knees bent

Front 1147

Normal liver size:

-neonate
-child

Back 1147

Neonate: 3.5cm

Child: 2.0cm

Front 1148

Leukemia: see hepatomeg?

Back 1148

YES - due infiltration

Front 1149

Glycogen storage dz: see small or large liver?

Back 1149

Hepatomeg

Front 1150

Spleen palpable in what %:

-neonates
-children
-adols

Back 1150

Neonate: 33%

Child: 10%

Adol: 2%

Front 1151

Spleen: what size is ABNORMAL?

Back 1151

>2cm

Front 1152

See splenomegaly?:

Endocarditis

Back 1152

Yes

Front 1153

See splenomegaly?:

SLE

Back 1153

Yes

Front 1154

Which storage disease:

See splenomegaly

Back 1154

GAUCHER

Front 1155

LNs: abn if what size?

Back 1155

>2cm

Front 1156

Palpable LNs are considered NORMAL in what 3 areas?

Back 1156

Cervical
Ax
Inguinal

--> anywhere else is abn

Front 1157

DKA: see OSMOTIC DIURESES once BG is above what #?

Back 1157

180

Front 1158

T1DM: comprises what % total DM?

Back 1158

5-10%

Front 1159

T2DM: insulin level is low, normal or high?

Back 1159

Normal-high

(tissues are insulin-resistant --> need higher levels of insulin)

Front 1160

DM: screen if overweight (WHAT BMI %) and HOW MANY SXS?

Back 1160

BMI >85% and 2 s/sx

(FHx 1-2', race, HTN, dyslipid,etc)

Front 1161

DM: screen beginning what age? how often?

Back 1161

puberty --> q3 yrs

Front 1162

Pediatric insulin: how many injections per day? how distribute doses?

Back 1162

3-4 injxns/day

2/3 total in AM (1/3 rapid + 2/3 intermed) --> 1/6 dinner (rapid) --> 1/6 bed (intermed)

Front 1163

DKA: follow what LAB to monitor response to insulin?

Back 1163

SERUM ketones

Front 1164

What dz:

Increased beta-hydroxybutyrate

Back 1164

DKA

Front 1165

DKA: monitor URINE KETONES how often?

Back 1165

Every void until no ketones

Front 1166

DKA: how decide when to switch from IV to SQ insulin?

Back 1166

Switch once NO KETONES In serum or urine

Front 1167

DKA: how affect BUN, CR?

Back 1167

Usually normal

Increase if severely dehydrated

Front 1168

DKA: how affect:

-serum Na+?
-K?

Back 1168

HYPONATREMIA: due renal loss & osmotic movement of H2O into extracell

K+ low/normal/high (despite total body hypoK) --> provide K in IVF

Front 1169

DKA: admin K+ in IVF?

Back 1169

YES - give K+

Front 1170

DKA: cont insulin drip until:

-pH > #
-bicarb > #

Back 1170

pH > 7.3

Bicarb > 15

Front 1171

DKA: add DEXTROSE to IVF if BG <___

Back 1171

<300

Front 1172

DKA: what is tx goal:

-RATE of BG drop
-Target BG

Back 1172

Decrease 80-100 mg/dl per HOUR

Goal: 120-250

Front 1173

DKA: #1 reason of death

Back 1173

Cerebral edema 2/2 overrapid glucose correction

Front 1174

What dz:

Child w/DKA --> give insulin drip --> HA & mental status change --> death

Back 1174

Cerebral edema 2/2 overrapid correction

Front 1175

Cerebral edema 2/2 overrapid correct DKA:

-admin what drug to prevent?

Back 1175

MANNITOL IV 0.25-1mg/kgDue

Front 1176

Do children have lower or higher % total body H2O?

Back 1176

HIGHER

(increases risk of dehydration)

Front 1177

Dehydration: low or high sensitivity?:

Decreased UOP

Back 1177

HIGH

Front 1178

Dehydration: low or high sensitivity?:

Dry mucus membranes

Back 1178

HIGH

Front 1179

Dehydration: low or high sensitivity?:

Absent tearing

Back 1179

HIGH

Front 1180

Hypo/iso/hypernatremic dehydration:

Gastroenteritis

Back 1180

ISO

Front 1181

Dehydration: correct over how many hours?:

-hyponatremic
-iso
-hyper

Back 1181

Hypo: 24h
Iso: 12h
Hyper: 24h

Front 1182

How define (what seurm Na+):

-hyponatremic
-hyper

Back 1182

Hypo: <130

Hyper: >150

Front 1183

If severe hyponatremia (<120): think what 3 etios?

Back 1183

1. Free H2O
2. Dilute formula
3. Adrenal insuff

Front 1184

Hypo/iso/hypernatremic dehydration:

D.I.

Back 1184

Hyper (>150)

Front 1185

Insensible losses account for what % daily H2O req?

Back 1185

40%

(other 60% is UOP)

Front 1186

DKA: do you replace ongoing urine loss?

Back 1186

NO - mobilizing extracellular fluid

(you do replace stool losses)

Front 1187

How distinguish:

Trans synovitis of hip VS septic hip

Back 1187

DEGREE of inflamm (based WBC, ESR, CRP)

Front 1188

Transient synovitis of hip:

Common?

Back 1188

YES

Front 1189

Transient synovitis of hip:

LT sequela?

Back 1189

None

Front 1190

Transient synovitis of hip:

Low or high fever?

Back 1190

Low

Front 1191

Transient synovitis of hip:

Affect ROM?

Back 1191

DECREASED ROM

Front 1192

Transient synovitis of hip:

How long until resolve?

Back 1192

3-4d

Front 1193

Transient synovitis of hip:

How tx?

Back 1193

rest + ibuprofen --> f/u 2d to recheck CBC (r/o leukemia)

Front 1194

Can septic arthritis lead to avasc necrosis?

Back 1194

Yes - accum pus --> pressure --> decrease BF fem head

Front 1195

Septic arthritis: which pathogen common in neonate?

Back 1195

GBS

Front 1196

Septic arthritis: which pathogen in adol?

Back 1196

N gonorr

Front 1197

Septic arthritis: which species of strep?

Back 1197

Strep pyogenes
Strep pneumo

Front 1198

Septic arthritis: see joint warmth? redness?

Back 1198

Not always (since deep infxn)

Front 1199

Septic arthritis: joint asp has DECREASED or INCREASED viscosity?

Back 1199

DECREASED viscosity indicates infxn

Front 1200

Septic arthritis: how tx?

Back 1200

I & D! --> IV abx --> repeat asp

Front 1201

JRA: difference between:

Pauci & polyarticular

Back 1201

Pauci: <4 (usu large)

Poly >4 (usu small)

Front 1202

JRA: are all subtypes assoc w/fever?

Back 1202

No, only some

Front 1203

JRA: common to see rash?

Back 1203

YEs

Front 1204

JRA: dx requires s/sx to be present for how long?

Back 1204

6+ weeks

Front 1205

What dz:

Infxn --> Abs against joint

Back 1205

REACTIVE (post-infectious) arthritis

(NOT transient syno: inflamm of lining - no actual Abs)

Front 1206

Reactive arthritis:

Presents how long after initial infxn?

Back 1206

Few weeks

Front 1207

Reactive arthritis: due to what PATHOGENS:

-GI infxn (2)
-GU infxn
-Pharyngitis

Back 1207

GI: Yersinia, Shigella
GU: Chlam
Strep

Front 1208

What dz:

Joint pain + asp w/inflammatory cells + NEGATIVE asp cx

Back 1208

Reactive arthritis

(contrast septic: pos asp cx)

Front 1209

Reactive arthritis:

How tx?

Back 1209

ABX IF INFXN STILL PRESENT

otherwise NSAIDs for few wekes

Front 1210

Reactive arthritis:

More common lower or upper extrems? small or large joints?

Back 1210

Lower
Small

Front 1211

Sprain: what anatomic injury?

Back 1211

Tear ligament

Front 1212

See SPRAIN after fall?

Back 1212

NO

Req tearing motion

Front 1213

Occult fx: see how long s/p injury?

Back 1213

3-4w

Front 1214

Osteomyelitis: #1 pathogen

Back 1214

Staph aureus

Front 1215

Osteomyelitis: ACUTE or INDOLENT pain?

Back 1215

INDOLENT!!!

Delays abx 5-10d

Front 1216

Osteomyelitis: what % pts present with fever but no pain?

Back 1216

50%

Front 1217

Suspect what dz:

Limp + jaw pain

Back 1217

Leukemia w/BM infil

Front 1218

VSD: why not present in neonate?

Back 1218

High pulm vasc R in neonate --> no reason for blood to shunt to pulm vasc rather than systemic

Front 1219

VSD: how result in poor feeding?

Back 1219

LV overload --> CHF --> increased RR --> difficult feeding

Front 1220

What dz:

Sweat during feed; tire during feed

Back 1220

CHF (e.g. 2/2 VSD)

Front 1221

CHF: #1 phys finding

Back 1221

TACHYPNEA

Front 1222

What dz:

Tachycardia w/gallop rhythm

Back 1222

CHF

Front 1223

VSD: is murmur intensity correl with size of defect?

Back 1223

NO

Front 1224

What MURMUR:

Loud, blowing holosystolic at LLSB

Back 1224

VSD

Front 1225

VSD: when present?

Back 1225

Few days s/p birth

Front 1226

VSD: where best ausc?

Back 1226

Lower left sternal border

Front 1227

VSD: does magnitude of shunt affect the age of presentation?

Back 1227

YES

larger defect --> earlier CHF

Front 1228

VSD: defect becomes smaller or larger with time?

Back 1228

SMALLER

(75% small & 50% total will close)

Front 1229

VSD: what % total close?

Back 1229

50%

(75% small VSDs)

Front 1230

VSD: expect abn EKG?

Back 1230

YES - see RV dominance

Front 1231

4 defects that cause murmur AND CHF

Back 1231

1. VSD
2. Ao stenosis
3. Ao coarct
4. large PDA

Front 1232

Lead to CHF?:

PDA

Back 1232

Yes (if large)

Front 1233

Lead to CHF?:

ASD

Back 1233

No

Front 1234

Lead to CHF?:

TOF

Back 1234

No

Front 1235

Infant CHF: req inpatient tx?

Back 1235

YES

Front 1236

How tx:

-CHF due VSD
-CHF due cardiomyopathy

Back 1236

VSD: digoxin + furesomide

Cardiomyo: ACE-I

Front 1237

VSD: decide surgery at what age?

Back 1237

6mo

Front 1238

Shaken Baby Syndrome:

-what % die? what % poor neuro outcome?
-account what % child abuse death?

Back 1238

25% die, 40% poor neuro outcome

10% child abuse death

Front 1239

Shaken Baby Syndrome:

Pinpoint OR dilated pupils?

Back 1239

DILATED

Front 1240

Shaken Baby Syndrome:

Stiff or limp?

Back 1240

STIFF

Front 1241

Shaken Baby Syndrome:

Higher mortality if <1yo or >1yo?

Back 1241

<1yo

Front 1242

Shaken Baby Syndrome:

What TYPE of brain bleed?

Back 1242

Subdural

Front 1243

Subdural bleed in neonate: 2 main etios?

Back 1243

1. Shaken baby
2. Vacuum

NOT szs

Front 1244

Increased ICP in neonate: how affect breathing?

Back 1244

See APNEA

Front 1245

Bacterial mening in neonate: what % have hearing loss?

Back 1245

20%

Front 1246

Arrythmia: common to see apnea?

Back 1246

NO

See: decreased feed, irritable, lethargic

Front 1247

Suspect increased ICP if:

SLOW or RAPID rr?

Back 1247

SLOW

Front 1248

R/o subdural bleed: what imaging 1st?

Back 1248

CT --> serial CT to monitor

Front 1249

Which brain imaging best for:

Shearing injury

Back 1249

MRI

Front 1250

Shaken Baby Syndrome:

-Administer what ppx meds?
-what imaging (aside from brain)?

Back 1250

Anti-epileptics

Skeletal survey

Front 1251

Apnea: definition (2)

Back 1251

1. No breathe >20s

2. No breath (<20s) plus brady (<100) or pallor-cyanosis

Front 1252

#1 problem in prematures

Back 1252

Apnea

Front 1253

Gallop: common in peds?

Back 1253

No

Front 1254

What murmur:

Continuous diastolic murmur

Back 1254

PDA

(PATHOLOGIC)

Front 1255

Common or rare?:

Endocarditis

Back 1255

Rare

Front 1256

Common or rare?:

Cardiomyopathy

Back 1256

Rare

Front 1257

Innocent murmurs: common what age? due to defect?

Back 1257

3-7yo

NOT defect (due vibration)

Front 1258

#1 innocent murmur

Back 1258

Still's

Front 1259

What murmur:

musical, vibratory murmur in LSB while supine

Back 1259

Still's (innocent)

Front 1260

Still's murmur: best heard standing or supine?

Back 1260

SUPINE

Front 1261

What murmur?:

Widely split, fixed S2

Back 1261

ASD

Front 1262

ASD: presents what ages?

Back 1262

3-5yo

(contrast VSD: few days s/p birth)

Front 1263

What murmur:

Presents 3-5yo

Back 1263

ASD

Front 1264

What murmur?:

Initially syst ejection murmur --> early diast murmur

Back 1264

Ao stenosis

(leads to Ao insuff)

Front 1265

What murmur?:

S1 --> systolic ejection click --> harsh systolic murmur

Back 1265

Pulmonic stenosis

Front 1266

PDA: louder in dias or syst?

Back 1266

SYST loudest
(although continuous)

Front 1267

What murmur?:

Holosystolic, blowing

Back 1267

VSD

Front 1268

What murmur?:

PROGRESSIVE; detect any age; p/w HTN in upper extrems

Back 1268

Ao coarct

Front 1269

Detect what age:

Bicuspid Ao valve

Back 1269

Adol/adult

Front 1270

1st & most subtle sign of inadequate circulation

Back 1270

tachycardia

Front 1271

Femoral pulse: represents periph or central pulse?

Back 1271

Central

(sim carotid)

Front 1272

What type of shock:

WARM EXTREMS

Back 1272

Septic

Front 1273

Can viral infection lead to septic shock?

Back 1273

Yes (via toxin production)

Front 1274

What type of shock:

ADEQUATE UOP

Back 1274

Septic

Front 1275

What type of shock:

Bounding pulse

Back 1275

Septic

Front 1276

Septic shock:

How tx? (2 immed management steps)

Back 1276

Boluses --> Vasopressors (E/NE/DA)

Front 1277

Leads to what type of shock?:

Cardiomyopathy

Back 1277

Cardiogenic

Front 1278

Leads to what type of shock?:

Tamponade

Back 1278

Cardiogenic

Front 1279

Cardiogenic shock:

Cool or warm extrems?

Back 1279

Cool

Front 1280

Cardiogenic shock: how affect UOP?

Back 1280

Decrease UOP

Front 1281

Leads to what type of shock?:

Anaphylaxis

Back 1281

Distributive shock

Front 1282

Leads to what type of shock?:

SIRS

Back 1282

Distributive shock

Front 1283

Hypoglycemia: see fever?

Back 1283

No

Front 1284

Encephalitis: how affect resp rate?

Back 1284

NORMAL --- tachypnea uncommon!

(contrast meningitis)

Front 1285

PNA in infant: expect mental status change?

Back 1285

No

Front 1286

Toxic shock syndrome: how does rash appear?

Back 1286

Sunburn-like sandpaper

Front 1287

What dz:

Pastia's Sign

Back 1287

Scarlet Fever

(linear petechia in body folds)

Front 1288

Scarlet Fever: see desquam?

Back 1288

Yes (5d after rash)

Front 1289

Name for:

Scarlet Fever --> linear petechia in body folds

Back 1289

Pastia's sign