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400 Cards in this Set
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98 % of chronic constipation in early childhood is due to?
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functional constipation = find a dilated,stool filled anal canal with poor sphincter tone; VS: Hirschsprung's = no stool in rectum, sphincter tone is normal, seen in first few weeks of life,
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dx of hirschsprungs?
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either rectal manometry or biopsy
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nocturnal abd pain and fecal occult blood in pt with similar family hx
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peptic ulcer disease
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conclusive dx of peptic ulcer?
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endoscopy
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5 y/o with grossly bloody stools and iron def anemia? DX?
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mECKEL'S!!!
dx is with Meckel's (technecium 99) scan in RLQ |
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sx of necator americanus/ ancylostoma duodenale?
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these are HOOKWORMS;
sx = abd px,weakness, dizziness, eosinophilia, pica, guaiac-+ stools (not grossly bloody) |
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CF pts require what enzyme/vit supplementations?
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require pancreatic enzymes as well as fat sol vit's (KADE)
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dx confirmation of midgut volvulus in 1week old? tx?
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Barium upper and lower (enema) GI radiograph show cecum in wrong position. tx = surgery!!
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common and serious complication of TPN?
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TPN via central line may frequently cause SEPSIS.....
also thrombi, etc. |
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complication of short bowel syndrome?
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chronic diarrhea
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pyloric stenosis causes what electrolyte changes?
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Hypochloremic met alkalosis
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3 YEAR/o child with intractable chronic constipation since birth?
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think Hirschsprung's!!
dx = manometry or rectal biopsy |
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acute cholecystitis may be seen in late childhood with what other diseases?
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Sickle cell, other hemolytic anemias
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intussusception usually occurs in what age group?
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4mo-10mo
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blood, mucusy, currant jelly stool, acute onset of colicky px in 8 month old...? Dx/Tx?
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intussusception! Dx AND Tx done by air contrast enema (75% reduced during exam)
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Tx for gerd?
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usually none; just tell mother to give smaller feeds, thicker foods, and avoid high-fat meals
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Chron's often first presents as?
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ANAL fissure/fistulas!
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kwashiokor def? marasmus?
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Low protein in diet = low albumin prod = loss of fluid to interstitial tissue ie edema; skin depig, and hair depigmentation = edema and pot belly
Marasmus = low prot AND carb from overall inadequate caloric intake = skinny, wasted limbs, pot belly |
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protein should be at least what % in a 6mo old's diet?
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at least 8% should be protein
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best test to detect GERD? H.pylori PUD?
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esoph. pH probe.
(to confirm/detect h.pylori gastritis = endoscopy) |
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are intestinal lactase levels normal for all individuals at birth?
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YES!! they then may decrease as the genetic predisposition kicks in
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workup for lactase deficient suspicion?
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first, stop lactose ingestion to see if subsides; + returns when reintroduce lactose. To confirm, may do breath test for hydrogen (more specific); or acidic stool pH in the presence of reducing substances
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def of obstructive jaundice?
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direct bilirubin > 20%
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waht to consider in any 6w/o with obstructive jaundice? workup?
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CF, alpha anti trypsin deficiency, choledocal cyst. Do ultrasound to check for obstr; as well as HIDA scan to check biliary tree
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chronic hep C in kids tx?
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interferon + ribavirin
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fluid loss of what %: muscles may become spastic, skin may shrivel and wrinkle, vision may dim, urination will be greatly reduced and may become painful, and delirium may begin.
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10-15%. >15% are fatal
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fluid loss of what %:
groggy or sleepy, experience headaches or nausea, and may feel tingling in one's limbs (paresthesia) |
5-9%
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inital bolus to give patient with hypernatremic hypovolemia/dehydration?
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Normal saline
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often seen in hypernatremic dehydration due to insulin changes?
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hyperglycemia due to decreased insulin secretion
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tx for hypernatremia?
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initial bolus of normal saline, then slow rehydration over 48 hrs to prevent significant fluid shifts and increased ICP
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order of teeth eruption?
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5-7 mo, mandibular central incisors
6-8 mo, maxillary " " 7-11mo, lateral incisors 10-16 mo, first molars 20-30 mo , second molars |
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extensive frontal maxillary tooth decay but no frontal mandibular decay?
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Excessive bottle feeding of sweet liquids ie juices in bottles
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congenital inguinal hernia in baby due to?
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patent processus vaginalis
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what percent of 2ndary teeth that are avulsed are able to be successfully replanted?
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If in first 30 mins = 90%
if after 2 hrs = 5%!!! |
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emergency tx of alkaline drain cleaner ingested?
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just endoscopic exam w/in 12-24 hrs...not induce vomiting (this will reexpose mucous membranes to agent again) or give copious liquids -(will cause vomiting and reexposure also)
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what toxins may be tx'd with charcoal ingestion?
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Phenobarbitol
Antidepressants (tricyclics) Theophylline, long release |
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initial dx plan for suspected NEC? and test/looking for what???
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abd radiograph series!!
Pneumatosis intestinalis!!!!!! (and/or perforation/air under diaphragms/liver) |
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hemorrhagic E.coli (EHUC) must be cultured on?
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sorbital-MacConkey agar
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impaired wound healing, diffuse tenderness, evidence of hemorrhage, swelling, tachypnea, poor appetite,bone atrophy, epiphyseal separation?
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scurvy/vit C deficiency
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night blindness, and dry, scaly skin?
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probably due to vit A deficiency
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greenstick fracture due to?
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riketts! (vit D def)
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6 y/o child with vomting, seizures, coma, and liver failure 6 days after varicella infection?
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Reyes syndrome = fatty degen of liver with acute encephalopathy
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sudden onset crying in 3mo old for several hours, then abd gets distended and tense, then legs drawn up to abdomen, and passing of gas... what condition? tx?
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Colic
Tx = feeding in upright position, frequent burping, gentle rocking, assistance in passing stool/flatus |
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gold standard of dx for pt with celiac's?
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small bowel biopsy
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genital ulcers, apthous ulcers, uveitis, and conjunctivitis?
plus fevers, e. nodosum, |
think Behcet's syndrome = autoimmune vasculitis
"betcha you've got oral and genital ulcers!!" |
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KUB showing calcification of adrenal gland in infant with hsm, diarrhea, FTT
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Wolfman syndrome
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urinary reducing substances found. what metabolic disorder may kid have?
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galactosemia, fructosemia
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acute liver failure due to what metabolic disorder in infancy?
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tyrosinemia type I (tyrosinosis)
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ftt, hypoglyc, hmegaly acidosis in 3-4 mo old?
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G6PD def!
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chronic hepatitis with cirrhosis and portal hypertension in childhood; or cholestasis, bleeding into CNS/GI, umbilical stump, and elevated transaminases
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alpha-1 antitrypsin def
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dx of gaucher's disease?
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ABSENCE OF GLUCOCEREBROSIDASE IN LEUKOCYTES!!!!
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aseptic necrosis of femur causing erlenmyer flask femur head, and hepatosplenomegaly?
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Gaucher's disease
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cause of irritable, microcephalic, tachycardic neonate whose mother had heat intolerance?
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neonatal thyrotoxicosis = usually wears off afterr 2months when Thyroid stimulating IgG's from mother have dissipated. May cause heart failure! must treat
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tx drugs for neonatal thyrotoxicosis?
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carbimazole (blocks coupling of iodothyronine), lugol's iodine (blocks thyroid hormone synthesis ), and propanolol (to reduce adrenergic symptoms)
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causes of true precocious puberty in boys? girls?
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boys - CNS lesion ie hypothal hamartoma causing increased GnRH release
girls - early maturation of hypothal axis |
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short kid at puberty with normal sized sex organs, what can you ruleout?
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rule out pituitary or hypothalamic lesion, which would cause both decreased growth and decreased sex hormone prod.
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constitutionally short stature vs. familial short stature?
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const: BONE AGE corresponds to height age, both are decreased.
familial: BONE AGE is normal and equal to chronological age, height is decreased. |
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constitutionaly short stature comes with what?
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PUBERTY DELAYS
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INCREASED LEVELS of leutenizing hormone in 12 y/o boy with < 50% upper/lower body segment ratio, think?
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Kleinfelters!!!
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bilateral subluxation of lenses + dilated aortic root?
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Marfan's!!
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m/c cause of goiter in 13 y/ o?
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hashimoto's thyroiditis
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low set ears, downslanting palpebral fissures webbed neck, shield chest, cryptorchidism, edema over hands and feet in MALE?
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Noonan syndrome = "male turner syndrome" but noonan also occurs in females
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CF dx'd in kid. what test to do for family/ bro's sisters?
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do DNA analysis , not chloride test
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which gene to check for mutation in CF
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delta 508 phenylalanine arm
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tx for labial vaginal adhesion in infant/kid?
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estrogen cream
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common cause of vulvovaginitis and UTI's in infants
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labial adhesion
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upper:lower normal ratios for ages:
birth? 3 yrs, 6 yrs, 10 yrs? |
birth: 1.3-1.7
3yr: 1.3 6 yrs 1.1 10 yrs: 1.0 |
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most common genetic skeletal dysplasia?
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achondroplasia
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marfan syndrome has incr or decr upper/lower body segment ratio?
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decreased (less than 1.0)
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GROWTH HORMONE DEF HAS INCR OR DECR UPPER/LOWER BODY SEGMENT RATIO?
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NORMAL
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THYROID DEF HAS INC OR DECR UPPER/LOWER BODY SEG RATIO
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persisting increased (PERSISTING immature body ratios = increased ratio)
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trisomy 18?
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Edwards
Ears low set, malformed Election age Clenched hands and overlapping digits |
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Retinoblastoma 2ndarily causes what other cxr?
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osteosarcoma!! think ie eye and leg removed in parent
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m/c intraocular tumor in kids?
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retinoblastoma
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retinoblastoma associ with what chromosomal mutation
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mut/deletion of long arm of chr 13
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NSiM of kid with thyroid nodule
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thyroid fx tests.
then US, then antithyroid AB levels, then radionuc uptake and scan |
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Hurler''s syndrome?
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mucopolysaccharidosis type I :
deposition of mp's in body tissue and derm/hep sulfate deposition in urine. normal birth with later developmental delay and HEPATOSPLENOMEGALY |
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brachydactyly, increased bone density of cranium, delayed bone age, short stature, obesity with round facies, perivascular calcifications of basal ganglia, and short neck with low calcium and high phosphate?
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pseudohypoparathyroidism = Albright hereditary osteodystrophy (PTH resistance) = high PTH but low ca resorpt and low phosph excretin
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precocious puberty +
bone problems (fibrous dysplasia) + cafe-au lait spots? |
McCune Albright syndrome
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kid post fracture who starts getting listless?
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think encephalopathic changes of IMMOBILIZATION HYPERCALCEMIA
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post - accident, kid with constipation, anorexia, polyuria, hypertension, convulsions, encephalopathy?
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immobilization hypercalcemia
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complications of immobilization hypercalcemia?
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nephropathy, nephrocalcinosis, hypertension, convulsions, encephalopathy
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test if suspect immobilization hypercalcemia?
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CA - Creatinine ratio over .2 establishes hypercalciuria
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tx of hypercalcemia (immobilization)
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vigoroous IV hydration with balanced salt sol; restrict dairy; +/- diuretics or calcitonin
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low sodium, high pot, hypotonicity, and hyperpigmentation?
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CAH due to 21 hydroxylase def!! = salt losing
or adrenal insufficiency crisis |
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who is gynecomastia normal for?
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adolescent males in tanner 2 or 3
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gynecomastia in what drug use?
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marijuana
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black wet diaper with reducing substances in it? and tx?
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ALKAPTONURIA = increased homogentisic acid .
No specific tx. affected children are otherwise asx |
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bilat inguinal hernias in 2 w/o GIRL?
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testicular feminization due to androgen insensitivity (over 50% of males w/testicular feminiization have inguinal hernias)
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any baby exclusively breastfed w/o supplementatal vit's; expect what vit def?
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VIT D = nutritional riketts, causing decreased ca and phosph intest absorption -- transient hypocalcemia --PTH stim's increased ca and phosph resorption from bone and increased ca reabsorption and Phosph excretion in urine and nutritional rickets/ soft bones
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extreme tallness with no mental retardation?
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= most likely marfan's
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normal birth glucose?
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over 40 mg/dL
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elevated Mg in newborn may cause what?
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sedation, and apnea but not tetany /seizures seen in hypoca
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hypoca in newby is caused by? causes?
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Caused by:
#1 idiopathic, mat diabetes or hyperPTHism, neonatal RDS, may causetetany, seizures |
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rickets like but not responsive to vit D supp?
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= vit-D resistant rickets = due to defect in renal reabsorp of Phosph only. therefore normal Ca and HIGH phosph seen
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o imperfecta serum ca and po4 change?
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all normal!! problem is with MATRIX of bone
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presentation of hypoparathyroidism?
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tingling and numbness, plus later seizures due to hypocalc. and hyperphosphatemia
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obesity, mental retardation, hypogonadism, polydactyly, and retinosa pigmentosum and night blindness
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laurence-moon-biedel syndrome
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night blindness ddx?
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lmb syndrome
vit A deficiency |
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tx for pseudohypoparathyroidism?
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LARGE DOSE vit D and reduction of phosphate load
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when does PCOD present?
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shortly after puberty
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obesity, hirsutism, secondary amenorrhea, with later infertility?
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PCOS
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three general characteristics of DM II?
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increased ins resistance in skel muscles
increased hepatic glucose prod decreased ins secretion in response to elevated glu levels |
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shoulderpads permanently staining a football player's neck, think?
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actually acanthosis nigricans of dm II
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why may na and k be low in G6PD pt?
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b/c hypertriglyceridemia causes pseudo hypo nat/ kal emia
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CAH and adrenal crisis both have what?
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hyponatremia (in 21OH def CAH = salt wasting), hyperkalemia
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examlpe of an X-linked dominant disease?
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hypophosphatemic vit-D resistant rickets
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Dubin johnson vs
Fanconi vs Steven Johnson syndromes? |
DJ: conj. hyperbilirubinemia due to inability of hepatocytes to secrete bilirubin into bile
Fanconi: PCT problem reabsorbing nutrients causing RTA II = hyper - glu, AA, ua, po4, hco3 - URIA, low in blood Steven Johnson syndrome: more severe form of e. multiforme having \ 10% involvement..(?) and 1+ mucous membrane involvement |
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lackign a paternal part of chrom 15 may cause? lacking a maternal part may cause?
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PW
Angelmann's |
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No pubic hair at all; testic vol less than 1.5 ml, penis 3 cm or less, no glandular tissues
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Tanner I
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Small long, downy hair with slight pigmentation at base of penis and scrotum or on labia majora; skin on scrotum thins, reddens, no change in penis size; breast buds form in female
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tanner II
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More coarse and curly pubic hair; penis begins to lengthen; testic vol 6-12 ml, female breast extends beyond border of areola
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tanner III
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incr br size and elevation; areola and papilla form a secondary mound projecting from the contour of the surrounding breast; penis to length 10 cm; adult pubic hair extending across pubis but sparing medial thighs
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Tanner IV
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hair extends to medial surface of the thighs; testicular volume greater than 20 ml; adult scrotum and penis of 15 cm in length; breast reaches final adult size; areola returns to contour of the surrounding breast, with a projecting central papilla. [
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Tanner V
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what drugs may induce nephrotic syndrome?
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Trimethadione, penicillamine, captopril, lithium, NSAIDSetc =dmgopathy= #1 cause notic syndrome in adults (kids = min change)
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lax, wrinkled abd wall plus dilated urinary tract plus abdom testes in kid born with oligohydramnios due to renal dysplasia?
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prune belly syndrome
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pulmonary hemmorrhage + hematuria and proteinuria?
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Goodpasture syndrome
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causes of Fanconi syndrome?
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gentamicin, outdated tetracycline, valproic acid, azathioprine. these cause ATN..!!! which causes Fanconi's
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drug that can cause RTA and nephrogenic DI?
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Lithium
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drug that causes nephrotic syndrome OR TIN?
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NSAIDS
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phimosis (inability to retract foreskin) normal when?
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in first few years of life. beyond age 3 think pathologic phimosis
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paraphimosis
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when foreskin gets retracted and trapped behind glansand cannot be relocated to normal position due to edema and venous congestion
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is phimosis associated with other GU abnormalities?
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No.
uncircumcision can lead to higher risk for uTI or STD's |
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tx of vesicoureteral reflux in 1 y/o?
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if not severe = daily AB's and urinalysis every 2-3 mo's.
If severe = surgical reimplantment of ureter |
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obstruction and proximal dilation of the bladder ?
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'posterior urethral valves'
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bone abnormalities may see 2ndary to chronic kid disease?
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Osteomalacia due to hypovitaminosis D 2ndary hyperpthism causing decreased bone formation
Osteoporeosis due to increaesed H+ buffering bone OFC (brown cysts) due to hypovitaminosis D and etc. rickets due to hypovitaminosis D |
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growth retardation or precocious puberty seen in CKD?
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growth retardation due to malunutrition
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CKD what changes in RBC's?
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normocytic anemia due to low EPO production
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hyperglyc or hypo glcyemia in CKD?
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hyperglycemia due to increased resistance to insulin in skm
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routine testing for hypertension done on what age groups?
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over 3 y/o's and
undr 3 y/o with recurrenet uti's, umbilical art caths, etc |
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hypertension in kids is usually sx or asymptomatic?
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asymptomatic
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severe htn sx?
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facial nerve palsy (may be only one!)
dizziness, ataxia seizures increased LVH decreased urine output abd bruit |
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orchipexy (surg to descend a testicle) changes risk for what in males
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does not change risk for testicular cxr, uti, sperm count changes, or epididymitis but does decrease risk for torsion
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urine count indicating infection in suprapubic tap? in clean catch from asx child? in clean catch from sx child?
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significant infection if:
1) sp tap = 1000-10,000 2) clean catch asx = over 100,000; 3)sx = over 10,000. |
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when after GAS throat inf does PSGN develop?
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8-14 days
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burning on urination with brown-gree fetid odor discharge of vagina?
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vulvovaginitis; 70% is chemical, non infectious. due to tight fitted clothing or prolonged bubble baths or fecal matter from wipin back to front
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significant vaginal itching in kid, with rectal itching?
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pinworms in vagina
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heliotrope rash?
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DERMATOMYOSITIS
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What rash may precede PSGN?
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Impetigo, or scarlet fever (NOT AS COMMON) rash
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ONLY COMPLICATION OF VARICOCELE?
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MAY SEE DECREASED SPERM COUNTS
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tx of tense, fluid filled area surrounding right testicle?
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= hydrocele; observation only
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iga nephropathy vs psgn in onset after urti?
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iga neph occurs w/in 24 hrs of urti, psgn occurs 8-10 days after
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idiopathic calciuria can caus what nephro problems?
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gross hematuria, recurrent; persistent microscopic hematuria,
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enuresis tx
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reassurance of parents of self-limiting nature; possible DDAVP which helps in 65% of cases, but often recurs after removing tx
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next step after stabilizing a newby's with RDS born with oligohydramnios?
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renal ultrasound to rule out renal dysgenesis as cause of oligohydramnios
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juxtaglomerular hyperplasia causing hypokalemia, hypercalciuria, alkalosis, hyperaldost, and clin sx of constip, weakness, vomiting, polyuria, and polydipsia
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Bartter syndrome
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1 y/o with low wt and ht, severe polydipsia, polyuria, an constipaton and dehydration bouts?
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Bartter's syndrome
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during or after receiving anasthesia, development of very high fever and muscle rigidity? tx?
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malignant hyperthermia
TX WITH DANTROLEN SULFATE |
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blood behind a tympanic membrane after fall?
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basilar skull fracture
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if tymp membrane ruptures and csf otorrhea occurs, how tx?
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sit in upright position;
observe for 72hrs for signs of increased ICP drainage beyond 72 hrs may require surg closure |
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acute hemiplegia in kid with slow develp delays? Tx for this condition?
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Hemocysteinuria!!!
tx: B6 pyridoxine may be helpful but wil need for life; otherwise restrict methionine intake |
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early closure of sag suture =? tx?
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primary craniosynostosis;
may tx with surgery |
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pontine hemmorrhage, OP poisoning, nerve gas, horner's all cause what to eyes?
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pinpoint constriction
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thromboembolic occlusion of mca causing hemiplegia with eyes looking away from the side of paralysis
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actute infantile hemiplegia
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Fabry disease? what def?
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alpha-galactosidase deficient causing angiokeratomas in bathing trunk area causing severe pain episodes
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frontal balding, catracts, testicular atrophy, sustained grip, increased CK, facial weakness seen in ?
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MYOTONIC dystrophy
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proximal muscle weakness with hypertrophy; clumsiness and difficulty standing up?
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DUSCHENNES muscular dystrophy
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CT finding in very, very low glucose and high lymphocyte CSF pt with meningial signs?
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= TB meningitis. look for enhancement of the basal cisterns due to exudate
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psychoneurological deterioration, consisting of personality change, seizures, myoclonus, ataxia, photosensitivity, ocular abnormalities, spasticity, and coma in child with persistent-measles?
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Subacute sclerosing panencephalitis
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pts with R-L shunts commonly get what type of infections of the brain? dx?
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brain abscess. Must to brain mri/ct
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top three brain tumors in kids?
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cerebellar astrocytoma
medulloblastoma brainstem glioma all are infratentorial |
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what in infants may first present with acute constipation , then leading to weakness/ facial diplegia?
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botulism (from honey)
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cherry red spot at birth vs 6mo later?
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at birth = GM1 gangliosidosis = beta galactosidase deficiency.
at 6 mo+ sx = hexosaminidase A deficiency |
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cong toxoplasmosis cns lesions are?
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basal ganglia calcif's;
cortex cacif's (scattered and soft appearin intercranial calcif's) |
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hypotonia + weakness and delayed dev milestones due to ANTERIOR horn disorder?
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Werdnig Hoffman
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intrinsic foot muscl atrophy, then intrinsic hand muscle atrophy, and prox leg muscle atrophy?
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Charcot-Marie-Tooth
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sx of black widow bite
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Black widow:
acute aBd px + sx (n, v) sBasms Bite mark site tx with MeBBBeridine + antivenin |
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scorpion bite sx? tx?
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Scorpion with a BARB:
swelling, shock, salivation, seizures, stinging tx with pheonoBARBitol + antivenin |
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brown recluse bite?
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Recluse:
Redness and necRosis/ ulceRation at site |
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adhd, ocd, and motor and vocal tics in kid?
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Tourette's
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tx of dystonia caused by phenothiazine/ chlorpromazine?
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diphenhydramine
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6 mo old with blindness on same side as large facial lesion?
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PHACE syndrome:
post. fossa malformations, hemangiomas arterial anomolies coarctation and cardiac defects eye abnorms |
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14 y/o with precocious puberty, cafe aulait spots, bon abnormalities, and goiter?
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McCune Albright
|
|
|
TORCHES are associated with what pl and Hb findings?
|
Thrombocytopenia and anemia in newbys.
|
|
|
Aspirin taken by mother during birth may cause?
|
NOT TCP but normal platelet levels WITH bleeding in newborn
|
|
|
what is HbA1, A2, and A3?
|
HbA1 = 2alpha/2beta
HbA2 = 2alpha/2delta HbF = 2alpha/2gamma |
|
|
tx for petechial rash + 20k platelets and no other sx?
|
this is ITP.
Tx = observation +/- steroids or IVIG |
|
|
pallor, fever, bleeding, HSM, lcytosis, tcp?
|
ALL
|
|
|
kids with SCC also give what?
|
(PCV 7 valent (normal) )
PCV 23 valent at 2 yrs Folic acid (all Hemolytic anemia pts need it) Meningococcal vaccine at 2yrs Prophylactic penicillin daily |
|
|
m/c cause of jaundice in first 24 hrs?
|
ABO HDN = mommy has O and baby has A/B/AB
|
|
|
indications of poorer prognosis in ALL kids? Most of these have what type of ALL?
|
mediastinal mass;
age less than 12 o or greater than 10 yrs WBC over 100,000 CNS leukemia most of these have the T-cell type ALL (this is cd 1-8 + and NOT CD10 + as in B-cell ALL) |
|
|
shock, decreased fnogen, increased f split products? tx?
|
DIC!
Tx by txing underlying disorder!! if nec, give 1- FFP for coag factor def's and 2- packed RBC's for anemia and 3- platelet concentrates for tcp |
|
|
does allergic rhinitis usually cause systemie eosinophilia?
|
no...just eosinophilia in nasal washings.
|
|
|
2nd most common bone cxr in kids, see mottled moth-like projections on xray?
|
Ewing's
|
|
|
m/c bone cxr in kids? what see on xray?
|
Osarcoma...see sunburst appearance
|
|
|
predisposing factors to Osarcoma development
|
Paget's, retinoblastoma, radiotherapy
|
|
|
chemotherapeutic agent causing gi mucositis
|
mtx
|
|
|
vincristine toxicities?
|
SIADH, jaw pain,"", constipation, peripheral neuropathy
|
|
|
prednisone side effects?
|
cushing's , salt and water retentsion, hypertension, Oporeosis, susc to infection
|
|
|
adriamycin side effects?
|
alopecia,
stomatitis, tissue necrosis CARDIOTOXICITY!!! if over 550 mg/m2 |
|
|
first step if suspect hodgkin's?
|
do CXRAY!!
|
|
|
howell jolly bodies seen in ?
|
asplenic pts ie Sickle Cell!!
|
|
|
target cells seen in a normal, asx pt getting a routine CBC screen
|
hemoglobin C disease
|
|
|
3 main endocrine causes of short stature? ht and wt changes in these?
|
hoth, low GH, low ACTH
in all of these, should have depressed ht while normal wt; vs malnutrition = decr ht and wt |
|
|
def of short stature?
|
below 3rd %ile or 2 SD below target ht
|
|
|
don't give MMR to whom?
|
Cxr, AIDS, or low CD4 pts (b/c its a live vaccine)
OR if allergic to gelatin or neomycin |
|
|
DTaP side effects?
|
fever w/in 3 days, encephalopathy, uncontrollable crying
|
|
|
don't give DTaP to?
|
High fever pt, seizure pt, encephalopathy pt
|
|
|
rotavirus vaccine...when give?
|
4 and 6 mo's
|
|
|
how give Poliovirus vaccine (IPV)?
|
injected (dont' give oral/live anymore except for global eradication)
|
|
|
who/when give meningitidis vaccine?
|
over 2 y/o who's asplenic;
11-12 y/o pre-college who hasn't had it yet |
|
|
which peaks earlier, CRP or ESR?
|
CRP
|
|
|
O TO P RATIO...what is it?
|
CSF WBC (predicted) = CSF WBCs Detected - (WBC in Blood * RBC in CSF / RBC in Blood).
Use for traumatic tap to still be able to rule out bacterial meningitis. if greater than 1, = chance of bact meningitis |
|
|
what also can give in 1st 2 hrs post acetaminophen poisonoing?
|
charcoal
|
|
|
what type poisoning occurs from multivitamin ingestion?
|
iron!
|
|
|
iron antidote?
|
deferoxamine
|
|
|
sx of iron ingestion toxic ingestsion (ie from multivitamins)
|
bleeding to GI
|
|
|
classic finding in OP poisoning?
|
fasciculations
|
|
|
number one effect of OP poisoning?
|
CNS toxicity
|
|
|
dose of tylenol that may cause toxicity in adolescent?
|
over 7.5 g/day
|
|
|
when must you plot a normogram for acetaminophen poisoning
|
4 hrs after ingestion
if within 2 hrs, may give charcoal |
|
|
top 2 causes of chronic diarrhea in dev country?
|
viral GE, celiac's
|
|
|
what sx do most Celiac's disease pts present with?
|
shortness, abd px,"", chronic diarrhea (comes later!)
|
|
|
what is fxnal diarrhea of childhood caused by?
|
chronic diarrhea caused by
increased juice intake, decreased fat intake |
|
|
algorithm for chronic diarrhea
|
1 rectal exam
2 stool exam 3 24 hr fast, if secretory, d will continue, if osmotic, will stop 4 if osmotic, do celiac's test and check for pancr insuff (CF) |
|
|
what diarrheas do probiotics shorten the length of?
|
ab-induced c. difficile p.colitis
rotavirus diarrhea |
|
|
hypochromic?
|
central pallor is greater than 1/3 the size of rbc
|
|
|
basophilic stippling is seen in?
ringed sideroblasts seen in? howell jolly bodies? heinz bodies? |
1 lead poisoning
2 All sideroblastic anemia = alcoholism, B6 def, Pb pois 3 in asplenic pts ie Sickle cell 4 oxidized Hb in G6PD |
|
|
types of influenza virus?
|
nasal ( live, may spread) and injected (dead)
|
|
|
does flu vaccine cause the flu?
|
no
|
|
|
what give mother during labor to prevent GBS tmission to kid?
|
penicillin prophylaxis
|
|
|
when give pneumovax?
|
2,4,6, **23** mo
and give 23 serovalent vaccine for asplenic pts!! |
|
|
Hep B shots when?
|
birth, 1mo, 6mo
|
|
|
what age start giving HPV vaccine to girls?
|
at age 10
|
|
|
side effect of ceftriaxone?
|
biliary sludging
|
|
|
when does croup/stridor present during a 24 hr day?
|
usually in evening
|
|
|
tx for stridor seen in preme?
|
just flip over on stomach...this stops stridor in most of cases
|
|
|
2 y/o gets fuo from mother w/fever, kissing her ?
|
EBV
|
|
|
over what age is monospot test useful in?
|
only useful over age 40!
|
|
|
sinus TC in babies, + fever think?
|
SBE,
pneumonia SEPSIS! abscess |
|
|
Hotension def?
|
up to 1 mo : less than 60
up to 1yr: less than 70 up to 10yr: less than 70+2xage over 10 yr: less than 90 |
|
|
fuo def?
|
over 38.3, for over 2 weeks
|
|
|
anti-endomyseal ab's in?
|
celiacs
|
|
|
how to measure fever if think may be facticious?
|
place therm in urine sample
|
|
|
each increase of temp by 1degC should increase HR by?
|
15 bpm!
|
|
|
Only type of fever with bradycardia?
|
Typhoid fever
|
|
|
if ever see acute mastoiditis -like reaction without O.M.?
|
isn't mastoiditis, but is external O.M.
|
|
|
m/c cause of neonatal fever?
|
dehydration!
|
|
|
acute swelling of mouth, tongue lips, hands, gi cramping, hereditary? tx?
|
Hereditary angioedema. Tx = danazol; or CI INH infusion; may need intubation to keep a/w patent
|
|
|
what AB given for severe blitis? why?
|
Azithro...not for bacteria but to decrease mucus secretions!!
|
|
|
RSV or non-RSV blitis more severe?
|
RSV
|
|
|
RSV vaccine for?
|
all babies less than 31 wks, or with CLD taht are over 31 wks, or less than 1 year by november
|
|
|
BPD def?
|
36 w/o preme that still needs O2
|
|
|
tx for BPD/
|
STEROIDs, diuretics for edema; nutrition
|
|
|
late sepsis bugs?
|
staph epid, MRSA, saureus
|
|
|
US findings in preme brain ischemia?
|
periventricular calcifications
|
|
|
cysts/ hollow places in brain tissue in preme less than 30 wks gest?
|
periventricular leukomalacia
|
|
|
percent of PVL that will result in CP?
|
100%
|
|
|
all preme's get what routine procedure, to check for what?
|
brain US to check for PVL
|
|
|
psycho/neural problems almost ALL preme's get?
|
learning disabilities,
ADHD |
|
|
pt with sx of acute asthma attack but O2sat = 100%?
|
psychogenic asthma
|
|
|
white vs gray exudate on tonsils?
|
white = c dipth; GAS.
gray = necrosis = Mono/EBV |
|
|
why does vulvovaginitis occur more freq in babies/elderly?
|
b/c don't have estrogen, and estrogen causes aciduria which prevents fungal candidiasis
|
|
|
what orgs are resistant to all ceph's 1, 2, and 3rd gen? so how to treat these?
|
enterobacter, citrobacter, proteus, p. aeruginosa
treat with tmp-smx or for p aeruginosa, may use AG's |
|
|
what to give for strept. faecalis (enterococci)
|
amp + gent ; or vanco
|
|
|
Ladenitis give what AB's
|
amoxy + clav acid
|
|
|
if RR in blitis pt is over 50, what other tx must you consider?
|
baby probably cant eat/drink well; consider IV fluids
|
|
|
crackles in baby's lung, most likely a sign of?
|
bronchiolitis, not bacteria
|
|
|
Under what # diapers / day do you consider a baby dehydrated?
|
3
|
|
|
avg HR, RR in newby? older child?
|
newby: 140-160; 40-60
older child: 120; 15-25 |
|
|
BW in what intervals should be doubled, tripled, qadrupled?
|
doubled at 4-6 mo
tripled at 12 mo quad'd at 2 yrs |
|
|
Ht should be what at what ages?
|
1 yr = 30 inches
3 yr = 3 feet 4 yr = 40 inches |
|
|
childhood avg growth (wt and ht ) / yr?
|
5lbs/year and 2.5 "/ year from ages 4-13
|
|
|
2 m/c sites of central venous line in babies?
|
femoral, int. jug
(subclav not used) |
|
|
pros and cons of fem; int jug
central venous lines? |
fem = easy infection with fecal flora; poor CVP measurement
Int Jug: risk of PTx! good cvp measurement; contaminaton rare |
|
|
fever immediately post burn...tx?
|
no; observe. fever w/in 1 day of burn is usually due to burn; if continues to 2 days, give AB's
|
|
|
burn infection pathogens?
|
Staph A, GAS, pseudomonas( if after 1st wk)
|
|
|
give AB's to burn victims prophylactically?
|
Not indicated! only if pt gets fever persisting over 2 d
|
|
|
see septic emboli on skin of kid, what pathogen?
|
meningococci
|
|
|
sub cutaneous hemorrhages = name?
|
purpura = petechia or ecchymoses
|
|
|
erysipelas presents like?
|
diffuse redness with distinct borders
|
|
|
cellulitis presentation
|
diffuse redness with INDISTINCT borders
|
|
|
strawberry tongue plus rash and fever? (3)
|
scarlet fever, TSS, Kawasaki's!!
|
|
|
pathogen causing gingivostomatitis?
|
HSV
|
|
|
measles vs rubella?
|
measles = 3 d pre-prodrome sickness of Cough, Coryza, Conjunctivitis and fever; h-toe, stays for 6 days
rubella = no prodrome; just retroauricular or post-cerv or postoccipital LAD; rash lastign 3 days only; rash h-t then disappears h-t |
|
|
pos-circumcision vesicular, oozing, diffuse rash
|
SSSS; tx is AB's and elytes
|
|
|
M. Furfur is pathogen of what type fungus?
|
tinea versicolor
|
|
|
tx for FMF?
|
colchicine
|
|
|
opsoclonus myoclonus=?
|
dancing eyes, dancing feet = affects 2% of kids w/neuroblastoma
|
|
|
what does amoxi-clav cover for that you dont get with 2nd gen ceph's?
|
g - 's
|
|
|
abdominal peritonitis seen in patient with recurrent fever, think?
|
FMF!!!! 95% get peritonitis at some point! also see pleuritis, causing chest attacks, or pericarditis
|
|
|
Famililal Hibernian Fever?
|
like FMF but get Tnf-R Assoc Periodic Fever = TRAPS
|
|
|
retinitis pigmentosum = what disease?
|
abetalipoproteinemia
|
|
|
Hog seen in LGA's to DM mothers AND?
|
and preme's or SGA's due to underdeveloped liver!
|
|
|
hyp0albuminemia complicates?
|
causes decreased wound healing in burns
|
|
|
surfactant is inhibited by? stimulated by?
|
insulin;
corticosteroids; cortisol (stress), thyroxine hormone; prolactin |
|
|
kcal and prot / day
RDA's? |
kCal / kg/day: 115 0-6mo
105 6-12mo up to 200% for LGA's/FTT's to catch up! prot = 2.2g/kg/day |
|
|
ingestion of cow's vs human milk?
|
cow: may lead to hypernatremia b/c higher Na; has excess caseins; no taurine; no lipase; LESS lactose = constip; fewer Ig's = more infections.
Human: less caseins; Taurine; greater unsat fats;contains lipase;more lactose= softer stools; more Ig's = less inf's |
|
|
blind loop sx?
|
chronic diarrhea b/c reinfection of blind loop
|
|
|
milk allergy seen with what signs?
|
FOB in stool; may see eosinophilia
|
|
|
abetalipoproteinemia may have what sx and signs?
|
retinosa pigmentosum;
acanthosis (spiky abnormal cells) on smear |
|
|
tx of abetalipoproteinemia?
|
low fat diet or pt may die!
|
|
|
depressed fontanelle + decr urine output in 5m/o?
|
dehydration
|
|
|
#1 diarrhea pathogen?
|
RotaV
|
|
|
salm vs shigella?
|
salm = GEitis + pea soup colored diarrhea
shig = colitis + red diarrhea |
|
|
giardia affects what part of GI?
|
proximal Small intestine
|
|
|
only tx's for acute diarrhea? (3 cases)
|
1) traveler's d - cipro prophylactic
2) Giardia - metronidazole 3) Salmonella in 6m/o or younger, or IC pt - AB's to cover g- ie amp+gent |
|
|
osteomyelitis due to Salmonella infection is much more common in this disease than in the general population
|
Sickle cell anemia
|
|
|
thumbprint sign in bowel seen in what conditions?
|
ischemic bowel, C. difficile, HSP, HUS
|
|
|
nocturnal cough?
|
asthma
|
|
|
#1 cough in kids?
|
asthma
|
|
|
#2 cough in kids?
|
PNDrip 2ndary to chronic rhinitis
|
|
|
other causes of cough in kids?
|
bectasis; hypertrophied tonsils; GERD;
|
|
|
best test to check for pl effusion in kid?
|
US is gold standard
or may use CT or decubitus Cxray |
|
|
best test for empyema? tx?
|
VATS = video assisted thorascopy.
tx = chest tube +/- surg drainage; AB's; streptokinase |
|
|
hot potato sound on breathing/talking?
|
stridor/epiglottitis
|
|
|
spinal muscular atrophy (SMA)?
|
=Werdnig Hoffman
|
|
|
Pectus cavernatum, think?
|
Ricketts!
|
|
|
avg birth head circ/
|
35CM
|
|
|
normal head circ growth?
|
1cm/mo for first year; so by year 1 should be 47 cm
|
|
|
precocious puberty def?
|
puberty by age:
7y/o (6y/o black) female 9 y/o male |
|
|
non-cyanotic hd's?
|
VSD, ASD, PDA ( unless erlenmenger's sets in)
|
|
|
cyanotic hd's?
|
TF, transp, trunc art, Tricusp atresia, TAPVR,
|
|
|
m/c pathogen, and tx for o.media?
|
S. pneumonia; H. influ (strain causing O.media is not decreased by vaccine)
amoxy; if resistant use amoxy + clav acid |
|
|
if give amoxy and pt gets full body rash, what may patient actually have?
|
may have EBV and be getting rash from tx
|
|
|
pink liquid drug, probably?
|
amoxicillin
|
|
|
pathogen causing OMyelitis? #2 pathogen is ?
|
s. aureus
king kingella! (or GBS in neo's) also p. aeruginosa if foot puncture |
|
|
% of Omyelitis causing a single vs multiple site infection? in neonates?
|
90% single loc unless neonate = 50% single, 50% multiple sites!!
|
|
|
dx and tx o Omyelitis?
|
Bcultures; Aspirate + take culture; bichemistry to check WBC's and ESR; xray of metaphysis; mr/ct; Technetium BONE SCAN!!
|
|
|
tx of Omyelitis?
|
oxacillin/nafcillin (anti staph) + cover GBS and g-'s in neonates with cefotaxime
|
|
|
normal wt should be?
|
8 +2xage; ie in 7 y/o = 22kg
|
|
|
less than 3 mo with blitis, also do what in workup?
|
full sepsis workup = BC, LP, CBC, suprapubic urine C
|
|
|
what may occur 2ndary to pneumonia in 7w/old?
|
GBS or HI meningitis
|
|
|
m/c uti in kids?
|
ecoli; 5% = enterococci
|
|
|
m vs female uti?
|
m more common up to 6 mo; then femal more common 10:1
|
|
|
apnea or excessive sleeping in infant may be sign of?
|
sepsis! do full workup
|
|
|
headache + unilateral tearing;better with O2 administration?
|
cluster headache OR sinusitis
|
|
|
when administer rotateq vaccine?
|
6-12 WEEKS OLD; IF OLDER MAY CAUSE INTUSS.
|
|
|
daily vit D intake for all kids?
|
400iu's
|
|
|
only c/i's to flu shot for all kids?
|
less than 6mo or older than 18y;
anaphylactic shock hx; Guillan Barre |
|
|
biomarker for SBI (serious bact infection)
|
procalcitonin
|
|
|
gestational DM hinders what in offspring?
|
expressive language..!
|
|
|
why give oxacillin and not an AG in osteomyelitis?
|
AG has less effectivity on bones and low O2 tissues
|
|
|
first step in txing kid with iron def?
|
try stopping cow's milk consumption to increase iron absorption
|
|
|
when and how to introduce new foods to baby?
|
1 new food / week starting at 5 mo to test for allergies
|
|
|
Epstein heart anomaly may be caused by?
|
lithium taken during pregnancy
|
|
|
#1 cong heart anomaly seen in kids of DM I mothers?
|
transposition
|
|
|
#1 cong heart anomaly seen in kids of gest DM mothers?
|
Hocomp that resolves
|
|
|
rubella in mom during what trimester affects baby?
|
1st trimester or especially if before and during conception!!
|
|
|
type of murmur from rubella
|
PDA; PULM STEN; vsd, asd
|
|
|
most important q's to ask mother to det/n if cong heart dis may be present?
|
is baby feeding normally(ask # of feeds/day); is baby gaining weight.
In congheart defect, will have problem feeding; and increased energy use may cause decreased wt gain |
|
|
% of kids born to mother with cong heart disease that will also have?
|
8%
|
|
|
% cong heart diseas in pop?
|
1%
|
|
|
ASD murmur is really just?
|
increased flow across Pvalve and tricuspid valve
|
|
|
noonan's (male turner's) heart defect?
|
HOCOMP
|
|
|
chest px in kid, think?
|
1st asthma; but think aslo of kawasaki's
|
|
|
doughy, soft muscles and shallow breathing are signs of?
|
hypotonia
|
|
|
cause of hypotonia?
|
any CNS defect ie malformations, b damage, umn or lmn lesion, neural tube defects, Guillan barre; also Tay-Sachs, Prader Willi, Down's
|
|
|
peripheral weakness/hypotonia caused by neurons?
n-m jxn? muscles? |
GB, trauma, SC lesion
Mgravis, botulism, tick paralysis Myotonic or Duchennes MD |
|
|
congential lymphangiectasia that causes protein-losing enteropathy.[1] It is also known as intestinal lymphangiectasia with peripheral lymphedema.
causes unilat/bilat lower extremity edema in young girls? |
Milroy disease
|
|
|
hypoalbuminemia in kids?
|
less than 3.0 g/dL
|
|
|
causes of hypoalb in kids?
|
Milroy's (protein losing enteropathy); Notic syndrome; CHF; liver failure
|
|
|
strep/ecoli peritonitis tx?
|
3rd gen ceph
|
|
|
who are children at special risk that require covalent (7-valent) pneumovax more frequently if under 2y/o?
|
asplenic ie Sickle Cell
|
|
|
Vaccin 1x with 23 valent pneumovax for?
revaccin with 23 valent pneumovax every 5-10 years for? |
adults only; or asplenic/ kids over 2
asplenic or nephrotic pts |
|
|
#1 cause of death in kids with nephrotic syndrome?
|
Strep pneumonia peritonitis!!!!!!!!! so must give 23 valent vaccine to all kids with notic syndrome, give every 5-10 yrs;
|
|
|
why does nephrotic syndrome predispose to inf with strep pneumonia?
|
Notic syndrome causes hypogammaglobulniemia = low IgG levels = low opsonization of spneum
|
|
|
1st line drug for kids with htn?
|
captopril
|
|
|
captopril s/e's?
|
angioedema, cough, rash, may cause notic syndrome due to diffuse membranous glomerulopathy
|
|
|
captopril contraindicated for?
|
preg girl in 2nd/3rd trim
|
|
|
cang ive captopril to what ages?
|
ALL: ages as young as neonates are ok
|
|
|
use of ranitidine?
|
is h2 blocker; use in GERD; also for anaphylaxis to prevent delayed reaction
|
|
|
% notic syndrom that will recur in lifetime?
|
66% (2/3)
|
|
|
percent notic syndrom will respond to steroid therapy?
|
90%!!
|
|
|
cause of 2ndary htn in kids?
|
v-u reflux syndrome; rastenosis;nephritic syndrome (rarely notic), hyperth, cushing's, a-genital syndrome
|
|
|
% of CAH caused by 21oh deficiency?
|
95%!!
|
|
|
This causes salt-wasting, with life-threatening vomiting and dehydration occurring within the first weeks of life. and is also the most common cause of ambiguous genitalia due to prenatal virilization of genetically female (XX) infants.
|
CAH caused by 21 0h def (95%)
|
|
|
hypertension in kids classif? NSiM?
|
90-95th = pre htn: follow
95-99th = stage I: check in 2 weeks; if still high, refer +99th = stage II: refer |
|
|
shiny bald patches on edges/tip of tongue and recurring cough?
|
think asthma = tongue of asthma
|
|
|
blurred, widened limbus of eye?
|
bruxism think asthma or chronic rhinitis
|
|
|
three vessels in umbilicus?
|
2 arts, one vein
|
|
|
single umb art is associated with?
|
increased cong anomalies
|
|
|
epigastric peristaltic waves l-r during feeding?
|
think pyloric stenosis
|
|
|
diminshed femoral pulses, think?
|
coa of aorta
cong anomaly if over 3, rheumatic disease causing ao sten |
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all 5 T's (cyanotic cong heart disease) have what type murmurs?
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systolic; usually on leftsternal border
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lactose, protein in soymilk?
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no lactose;
soy protein (still 10-30% of milk allergy pts allergic to this) |
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for lactose intol, give what?
milk allergy, give what? |
soy;
try soy; if still allergic, give casein hydrolyzate formula ie nutramigen, progestemil |
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progestemil has what char's?
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casein hydrolyzate PLUS MCTriglycerides = easier breakdown
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m/c SBO in toddlers less than 2 y/o?
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intussusception!!!
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good way to tell central vs periph hypotonia?
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central = hyperreflexia; caan withdraw to pain but need strong stimulus); do brain CT
periph hot: can't withdraw to pain; absent reflexes; don't need brain CT; just neuromuscular studies |
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fast onset; increased Na retention causing pulm edema and h2o overload seen in nitic or notic?
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nitic syndrome
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slow onset; liver tries to compensate for low albumin by increasing prod of all products ie triglycerides, etc....seen in nitic or notic?
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notic syndrome
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non-albumin proteinuria caused by?
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Multiple myeloma (can't detect the type of proteinuria on dipstick, though)
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VIRAL VS BACT GI INFECTION?
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viral: no blood, mucus, or leukocytes on slide;
bact: may have + all |
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don't give what to v-u reflux pt?
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cipro! but do give ceftriaxone if UTI
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less than 1000g preme's need what prophylactically to tx what?
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fluconazole to prevent invasive candida
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contents are described as "blood and/or mucus",[2] and sometimes "blood and mucus".[3] In either case, it represents the consequences of mucosal INVASION of the intestine.
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dysentery
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kcal and prot / 100 ml human milk?
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67 kcal/ 1.2 g prot
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phosphorous excess in cow's milk may cause?
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feedback to inhibit PTH to cause hypocalcemia and chvostek's/trousseau sign/tremors/tetany
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humanized cow's milk has?
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less protein; less phosph and na; increased lactose; supplemented with vitA
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viral genteritis does what to lactose?
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viruses cause decrease of lactase at brush border SI=temporary lactose intolerance= colonic lactic acid causes acidosis and osmotic shift = diarrhea
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if viral genteritis causes lactose intolerance in baby breastfeeding, how tx?
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stop bfeeds and give lactose - formula (ie soy).
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migraine with aura vs without?
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with: unilat; 1-3hrs; familial 90%
without: 5-60mins, blurry vision; light flashes in eyes |
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cyclic severe vomiting plus recurrent GI px?
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think abdominal migraine!!
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EEG during a migraine shows what?
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no abnormalities
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tx for migraine?
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lifestyle changes unless significantly affects daily life; give ie sumatriptan, cyproheptadine, etc.
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headache, NON throbbing, stress induce, due to caffeine, etc, may have underlying depression?
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tension headaches
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headache with psychosis, behav changess
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basilar migraine
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% of SGA's that eventually catch up?
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98
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drugs causing short stature?
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asthma steroids/ other disesae needing steroids
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