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134 Cards in this Set
- Front
- Back
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What is hyaline membrane disease (respiratory distress syndrome) and what are 7 risk factors? (race, gender, delivery method?)
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HMD is due to insufficient surfactant at the time of birth. This increases surface tension and decreases lung compliance.
Risk factors include: Male, Premature, Caucasian, Gest. Diabetes, C-section, 2nd born twin, FHx. |
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In infants with HMD, hypoxemia is the result of 3 factors. . .
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Right to left shunting via:
shunt vessels in the lung past atelectatiic air spaces PDA, PFO |
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What are some other problems on the DDx for HMD?
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TTN - CXR shows higher lung volumes
Bacterial PNA - difficult to distinguish from GBS. Routine to treat all HMD babies with ABX until (-)Cx are received Pulmonary Edema - many causes Aspiration PNA - meconium or amniotic fluid. |
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Treatment of HMD?
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1) Prevent premature delivery.
2)If preterm delivery is inevitable, then treat with steroids antenatally 3)Surfactant replacement therapy |
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What is the most common cause of respiratory distress in newborns?
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TTN
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What is TTN?
How is it treated? What are some risk factors? |
TTN is a delayed clearance of fetal lung fluid.
Treatment: self limited with resolution within 48-72 hours. Some treatment includes fluid restriction and oxygen. Risk factors include: C-section Premature Delayed clamping of the umbilical cord Maternal sedation Maternal diabetes Fetal distress |
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What are the four levels of cognitive development and the ages at which they occur?
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Sensorimotor - 2 years
Preoperational - 2-7 y/o Operational - 7-12 y/o Formal - >12 y/o |
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What are the age ranges of the following in girls:
Breast development begins Breast development complete Pubic hair appears Growth spurt begins Menarche |
1) Breast dev. 8-13
2) Breast dev. complete 12-18 3) Pubic hair appears 8-14 4) Growth spurt 9-14 5) Menarche 10-16 |
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What are the age ranges of the following in boys:
1) Testes growth begins 2) Pubic hair appears 3) Penis growth begins 4) Genital growth complete 5) Growth spurt starts 6) Strength spurt |
1) Testes growth begins 9-13
2) Pubic hair appears 10-15 3) Penis growth begins 10-14 4) Genital growth complete 13-18 5) Growth spurt starts 10-16 6) Strength spurt 13-17 |
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How long after the growth spurt does menarche happen? How long after thelarche?
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3 years after menarche
2 years after thelarche |
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How many years does puberty take to complete in girls?
boys? |
4 years
3 years in boys |
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How does FSH and LH relate to pubarche?
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Unrelated
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What is responsible for pubic hair growth?
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DHEA, DHEAS
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Average linear growth begins at what age for boys vs. girls?
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10 years for girls
11.5 for boys |
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what is the narrowest point in the pediatric airway?
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subglottic trachea
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Croup
most common ages? When is the cough worse? Management? |
6 months - 5 years
Worse at night -humidification -cold air -steroids -epinephrine aerosols -heliox |
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At what ages should you:
double birth weight triple birth weight quadruple birth weight? |
Double: 5 months
Triple: 12 months Quadruple 2 years |
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How is mid parental height calculated?
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Boys: FH + (MH + 5)/2
Girls: FH + (MH - 5)/2 |
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What is the most sensitive test for primary hypothyroidism?
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TSH
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What is the most common thyroid disorder in kids?
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Hashimoto's thyroiditis
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What is the age cutoff where no permanent intellectual or neurological damage is done during acquired hypothyroidism
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3 years old
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What is the most common cause of hyperthyroidism in kids?
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Graves
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What antibodies would be present in:
Graves disease Hyper phase of hashimotos Hypo phase of hashimoto |
Graves - anti-TSI
Hashimotos, hyper phase - anti-TPO and anti thyroglobulin Hashimotos hypo phase - same has hyper phase |
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What are 3 anti-thyroid drug treatments and their side effects (2)
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PTU, Methimazole, Cabimazole
Side Effects include: agranulocytosis, hepatitis |
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What age can children recieve radioactive ablation with no concerns for malignancy?
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5
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What percent of patients remain hyperthyroid after initial ablation?
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25-40%
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What are the remission rates after 2 years of medication therapy for hyperthyroid?
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25%
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What is the most appropriate treatment of a 13 year old with Graves disease?
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Methimazole
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What is the DDx for a congenital goiter?
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Neonatal Graves
Congenital Hypothyroidism |
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Describe the course of Measles
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8-12 day incubation prodrome (conjunctivitis, coryza, fever, cough, malaise) koplik spots maculopapular rash beginning on the head and spreading down. Paramyxovirus. Major complication is subacute sclerosing panencephalitis
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Describe the course of Rubella
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Caused by Rubellavirus (A Togavirus) When infected postnatally, it is often asx. Sx can include, erythematous maculopap discrete rash, with generalized LAD and fever. Transient polyarthralgias
When infected prenatally, it is much more serious. Sx include, heart/eye/auditory defects, neuro malformations, IUGR, blueberry muffin spots |
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Roseola infantum
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Caused by HHV-6, begins with abrupt fever (103-106) for 1-5 days, child appears well during the fever, after 3-4 febrile days a MP rash develops on trunk and spreads peripherally, fever resolves as rash appears,
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Erythema Infectiosum
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Parvovirus B19- Mild, self limiting, no prodrome, low grade fever (if any), Rash begins as slapped cheek, erythematous, pruritic MP rash develops on arms and spreads to trunk/legs. Associated with fetal hydrops during pregnancy.
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How long are varicella patients contagious for? What test can be used to test for it?
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24 hours before rash until all lesions are crusted (1 week)
Tzank prep |
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Hand Foot Mouth disesase
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Coxsackie A virus – prodrome of anorexia, fever, oral pain followed by crops of ulcers on oral mucosa
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What is the most common cause of hematogenously spread cellulitis?
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S. Pneumo
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Treatment of the following Tineas:
Capitis Corporis/Cruris/Pedis |
Oral griseofulvin for 4-6 weeks
topical antifungals for 4 wks |
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Describe the Dawn Phenomenon
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Increasing insulin resistance from 3am-8am. Nocturnal GH secretion. Sugar is normal at 3am and high at 8am
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Describe the somogyi phenomenon
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Rebound hyperglycemia following hypoglycemia. Low sugar at 3am and high at 8am
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Single most critical value in evaluating growth?
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Height velocity
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Average growth velocities for:
0-12 months 12-24 mo 24-36 mo 36 months – puberty Puberty |
0-12- - 25cm
12-24- - 12cm 24-36- - 8cm 36mo-puberty- - 4-7cm per year Puberty- - 8-14cm/year |
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What should be assumed about height deceleration between the ages of 3 and 12 years?
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Pathologic until proven otherwise
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Definition of short stature
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2 SD below mean (,3%ile)
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Delayed BA, subnormal growth rate, obesity (2 possibilities)
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Cortisol excess or Hypothyroidism
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What would you order for lab evaluation of short stature?
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CBC w/diff, Complete metabolic panel, T4/TSH, IGF-1/GFBP-3, UA/ESR, Celiac panel (Serum IgA, Anti-endomysial Ab, Tissue transglutaminase), Bone age film
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Why can there be a false positive rate on TSH in newborns?
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Because of the TSH surge that occurs in the first 24 hours of life.
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How is transient hyperthyroidism treated?
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Treat vigorously to prevent HF. Hospitalize to monitor HR and EKG
Treat with: PTU rather than methimazole because PTU decreases conversion of T4 to T3. Beta Blockers Lugol’s solution to block release of preformed thyroid hormone Pharmacological doses of glucocorticoids which block conversion of T4 to T3. |
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A baby is screened with a total T4 level which is decreased. The TSH is normal. What is the next step?
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Free T4. . .if decreased along with normal TSH then you need to rule out central hypothyroidism. If normal, then they have TBG deficiency
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When do kids adopt adult stooling patterns?
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1 year old
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Osmotic Diarrhea. .
-stool sodium? -Osmolarity? -Exogenous vs. endogenous DDx? |
Stool sodium < 70 meq/L
OSM >2x(Na+K) Exogenous: laxatives, artificial sweeteners, antacids, excessive CHO, lactulose Endogenous: disaccharidase deficiency, pancreatic insufficiency, infectious diarrhea, loss of surface area (short gut, IBD, Celiac, milk protein enteropathy, rota) |
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Secretory Diarrhea
Sodium? Osmolarity? DDx? |
Stool sodium >70meq/L OSM=2x(Na+K)
DDx: infection with toxigenic organism (Cholera, E. coli, salmonella, C. diff) Mucosal necrosis or atrophy, bile acid malabsorption, Hormone secreting tumors |
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Treatments of the following:
Giardiasis Cryptosporidium |
Giardiasis:
Metronidazole, nitazoxanide, furazolinide Cryptosporidium: Nitazoxanide, azithromycin |
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VACTERL
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Verterbra (hemivertebrae)
Anus (imperforate) Cardiac (VSD) TE fistula Renal (horseshoe) Limb (clubfoot) |
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CHARGE – what each letter means
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Coloboma
Heart (ASD) Atresia choanae Renal (fused kidneys) Ear (deafness) |
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MURCS
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Mullerian duct (absent prox 2/3 of vagina)
Renal agenesis C-Spine defects C5-T1 |
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Turner syndrome: heart defects (2), renal, appearance
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Bicuspid aortic valve
coarctation horseshoe kidney low set ears wide nipples |
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Alagille Syndrome:
-heart defect, liver, eye, vertebral, appearance, cause |
PPS
Paucity of intrahepatic bile ducts Direct hyperbili Opaque margin of cornea Butterfly/hemivertebrae, Triangular face Deep set eyes. AD inheritance mutation of JAG1 |
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Prader Willi:
-Appearance in the infant. Appearance of older child. |
Infant: hypotonia, poor feeding, small hands/feet, almond shaped eyes
Older child: marked weight gain, MR, unusual eating behaviors, skin picking, rage |
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Cornelia de Lange: appearance
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Growth retardation, long eyelashes, thick eyebrows, upturned nares, hirsutism, hypoplastic nipples, short limbs, missing digits, genital abnormalities. No diagnostic test available
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Di George: heart, Endocrine, appearance, inheritance
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Left sided heart lesions, hypocalcemia,
prominent nose, long fingers, high arched/cleft palate. Sporadic inheritance, AD for affected individual |
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Williams Syndrome: cardiac, endocrine, appearance, inheritance
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Supravalvular aortic stenosis,
Hypercalcemia, Full lips and lower face, Stellate pattern to iris, mild to moderate MR with cocktail party personality. AD inheritance for affected individual, sporadic inheritance. |
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Features of Trisomy 18
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Hypertonic
Overlapping fingers Most miscarry 90% die within a year |
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Trisomy 13
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Midline abnormalities, most miscarry
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What vitamin deficiencies are associated with the following diets?
Vegan? Goats Milk? |
Vegan - B12 deficiency
Goats milk - folate deficiency |
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What anemias are the following ethnicities associated with?
-African American? -Mediterranean? -Southeast asian? -Northern European? |
AA - HbS, HbC, thalassemia, G6PD
Mediterranean - Thalassemia, G6PD Southeast asian - Thalassemia, HbE Northern European Hereditary Spherocytosis |
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What type of anemia is associated with nail spooning?
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Iron Deficient
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What are the two types of microcytic anemia?
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Iron Deficient
Thalassemia |
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What are the 4 types of macrocytic anemia?
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Aplastic anemia
Diamond-blackfan Liver disease Myelodysplastic syndrome |
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What are the 7 types of normocytic anemia?
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Sickle cell, HS, G6PD, AIHA, HUS, Infxn, Renal disease
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How is hemophilia inherited?
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AR
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What lab abnormalities are seen with hemophilia?
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aPTT elevated, normal aPTT mix, decreased VIII or IX
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Mild/Moderate Hemophilia A may respond to _____
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DDAVP
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1st line treatment for type I vWD?
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DDAVP
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What is the typical course for ITP?
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50% resolve within 1-2 months
80% resolve within 6 months |
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At what age would the following actions be cause for concern?
- <15 words - Unable to use 2 word phrases |
15 words - at 18 months
2 word phrases - At 24 months |
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How old is this kid.
Draws primitive figures, assume others feel same way, ask why questions, uses imagination, pretend play |
3 y/o
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How old is this kid: past tense, sings songs, knows first/last name, counts to 4, knows colors.
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4 years
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How old is this kid: future tenst, counts to 10, knows telephone number, recognizes most letters
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5 years
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Caloric requirement for birth to 6 months? 6-23 months?
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108kcal/kg/day and 98kcal/kg/day
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Caloric content of human milk?
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20 kcal/oz
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When is mom usually screened for GBBS?
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35-37 weeks
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What are the 3 things that are done prophylactically on a newborn?
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Vit. K
Eye infxn prophylaxis with erythromycin or tetracycline eye ointment HepB - mom's status, HBIG vs. vaccine |
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Define the following and what to do with them:
Cephalohematoma Caput Succedaneum |
Cephalohematoma -
Blood under periosteum Does not cross suture lines Leave alone, will go away Caput Succedaneum scalp edema from pressure Diffuse, crosses suture line Resolves in 1-2 days |
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At what age do most umbilical hernias close?
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3-4 years
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In regards to DDH, what age is the Ortolani and Barlow signs no longer positive? What is a diagnostic sign at this point?
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after 8-12 weeks, the O/B sign isn't positive and limited abduction is a more reliable sign
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What radiology is used for DDH?
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Before 4 months - U/S
After 4 months - plain hip xray |
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At what age do the following reflexes disappear?
Moro Stepping Suck and Root Palmer Grasp Plantar Grasp Fencer |
Moro - 3 months
Stepping - 6 weeks Suck and Root - 4 mo. awake 7 mo. asleep Palmer Grasp - 4 months Plantar Grasp - 10 months Fencer - 6 months |
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What is the ounce requirement for nutrition per pound for an infant?
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2-3 oz./pound
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How long should a car seat face backwards for?
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until 20 lbs or 1 year
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What are 4 uses for Cefipime?
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1)PNA
2)UTI 3)Skin/Skin structure infxns 4)Empiric tx in febrile neutropenic patients |
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What is the spectrum of activity of Carbapenems?
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G+, G- aerobes, G- anaerobes
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How do Meropenem and Imipenem differ?
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Meropenem is:
- 2-32x more active against Enterobacter - 2-4x more active against pseudomonas - less active against G+ - Equivalent activity agains anaerobes - MRSA/Enterococcus resistance |
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What is the monobactam Aztreonam effective against?
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G- rods
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Aminoglycosides:
- 3 examples? - spectrum of activity?Explain its synergism |
Gentamicin, Tobramycin, Amikacin
G- enterics, MRSA Synergistic effect with Beta lactams against G+, G- |
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Spectrum of activity for Vanco?
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G+
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Macrolides:
2 Examples 7 bugs it can treat well |
Erythromycin, Azithromycin
L. Pneumophila M. Pneumoniae C. Pneumomoniae C. Trachomatis B. Pertussis M. Cattharalis Camphylobacter |
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Lincosamides:
1 Example Spectrum of activity |
Clinda
G+ aerobes G+/G- anaerobes |
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TMP/SMX:
Mechanism of action? Spectrum of activity? |
inhibition of folic acid pthwy
G- aerobes Staph aureus |
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Tetracyclines:
2 examples Spectrum of activity |
Doxycycline, Minocycline
Rickettsia M. Pneumo C. Pneumo C. Trachomatis S. aureus MRSA |
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Quinolones:
Spectrum of activity 1st, 2nd, 3rd, 4th generation? |
1st gen: G- rods
2nd gen: G- rods, pseudomonas, Staph aureus 3rd gen: G- rods, pseudomonas, Staph aureus, PCN resistant S. pneumo, Legoinella, Chlamydia, Mycoplasma 4th gen: everything above plus anaerobes |
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Linezolid
spectrum of activity? |
G+ (incl. beta lactam resistant and vanco resistant)
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Streptogramins:
2 examples spectrum |
Dalfopristin, Quinupristin
G+ (except enterococcus and those resistant to beta lactams and vancomycin) |
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Daptomycin
spectrum |
skin infections due to strep spp. MRSA and E. Faecalis
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Telithromycin
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effective against respiratory pathogens
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Tigecycline
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G+/G- aerobes/anaerobes
Adult soft tissue and intraabdominal infections |
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for the following fluids, state the amount of NaCl present:
.9 NS 1/2 NS 1/4 NS LR D5W |
.9 NS. . .154mEq NaCl
1/2 NS. . 77mEq NaCl 1/4 NS. . .38mEq NaCl LR . . . .147mEq NaCl D5W. . . .0mEq NaCl |
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For the following fluids, state the OSM of each:
.9 NS 1/2 NS 1/4 NS LR D5W |
.9 NS. . .308 mOsm/L
1/2 NS. . 154 mOsm/L 1/4 NS. . 77 mOsm/L LR. . . . 310 mOsm/L D5W. . . .250 mOsm/L |
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What numbers are used to calculate maintenance fluids per kg?
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4 2 1
100 50 20 |
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How much Na, K, Cl, and Glucose are required for each 100 ml of water?
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3mEq Na
2mEq K 5mEq Cl 5 grams glucose |
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Calculate MIV req. per day for a 12 kg child.
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1000+100 = 1100ml/day
NaCl = (3mEq)(11) = 33mEq KCl = (2mEq)(11) = 22mEq |
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Calculate MIV req. per day for a 70 kg child and convert to hourly rate
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1000+500+1000 = 2500ml/day
10kg 10kg 50kg (3mEq Na)(25) = 75mEq Na (2mEq K)(25) = 50mEq K 2500ml/day = 2 and a half one liter bags of D5 .2NS each with ~20mEq K |
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What is the max rate to correct serum sodium in hypo/hypernatremic dehydration?
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5 mEq/L/hr
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What fluids would you order for a 15 month old girl (wt. 20kg)
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D5 .2NS at 60ml/hr with 20 mEq K
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describe the rapid rehydration method
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1) NS bolus at 20ml/kg over 30-60 min. until UOP
2) D5 1/2NS with 20mEq K at: 1.5x MIV for mild dehyd. 2 times MIV for moderate dehyd 2.5x MIV for severe dehyd. |
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Differentiate between simple and complex seizures
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Simple - no change in consciousness
Complex - alteration of consciousness |
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What meds are used in both generalized and partial seizures?
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Valproic Acid
Phenobarbitaol Phenytoin Lamotrigine Topiramate |
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What med is used only in generalized seizures?
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Benzos
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What meds are only used in partial seizures?
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carbamazepine
oxcarbazepine felbamate gabapentin |
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what is the age range for febrile seizures?
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6 months - 6 years
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percent recurrence for febrile seizures in kids?
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33%
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what is the most common physical disability in childhood?
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CP
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What are the four main options to treat epilepsy?
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AEDs
Ketogenic Diet Surgery Vagus nerve stimulator |
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What are the criteria for the asthma severities?
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Mild Intermittent: Sx<1x per week, brief flares, nighttime sx<2x per month
Mild persistant: Sx>2x per week but not daily. night sx 2 times per month Moderate persistant: daily sx, flares limit activity. night sx>1x per week Severe persistent: continual sx, limit activity, frequent night sx. |
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What are the treatments for:
Mild intermittent Mild persistent Moderate persistent Severe persistent |
Mild intermittent: no daily meds, inhaled B2 agonist prn
Mild persistent: one daily med like an inhaled corticosteroid plus a short acting bronchodilator prn Moderate persistent: Daily med either inhaled steroid with or w/o long acting beta agonist plus prn bronchodilator Severe persistent: high dose daily steroid and long acting beta agonist plus prn bronchodilator |
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what is the most common inherited lethal dz in caucasians? How is it inherited?
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CF AR
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The first thing to come to mind with rectal prolapse?
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CF
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Which onset type of JRA is most common?
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pauci
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Pericarditis is most likely to occur in which type of JRA?
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Systemic
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Uveitis is most likely to occur in which of the following:
little boys with pauci JRA little girls with pauci JRA |
little girls with pauci JRA
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What is the most useful in early diagnosis of uveitis in JRA?
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slit lamp
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What is the best initial tx for JRA?
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NSAID
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T/F:
1-In pauci and poly JRA, the ANA test is more likely to be positive than is the RF test 2-In systemic JRA, both the ANA and RF are expected to be negative 3-In pauci JRA, ANA positivity is associated with an increased risk of eventual uveitis 4-RF positivity is just as commin in JRA as it is in adult RA |
1)T
2)T 3)F 4)T |
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When is a child most susceptible to infection?
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6-12 wks
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Diagnostic criteria for Kawasaki
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Fever for 5 days plus 4 of the following:
1)Rash 2)Bilateral Conjunctivitis 3)1.5 cm node 4)changes of lips/oral cavity 5)edema/erythema of extremities |
