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101 Cards in this Set
- Front
- Back
Definitive evidence of sexual abuse in children
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N. gonorrhea culture
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Definitive signs of shaken baby syndrome
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Retinal hemorrhage, subdural hemorrhage
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VSD associations
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Apert's, Down's, FAS, TORCH, cri-du-chat, trisomy 13 and 18
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Small VSD presentation
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Harsh holosystolic murmur at lower left border; asymptomatic
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Large VSD - presentation
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Softer holosystolic murmur with thrill, narrow S2; resp infections, dyspnea, FTT, CHF
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CXR findings in VSD
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Cardiomegaly, increased pulmonary vascular markings
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Down syndrome - heart defect association
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ASD and endocardial cushion defects; VSD
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Congenital rubella - heart defect association
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PDA
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Turner's syndrome - associated heart defect
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Coarctation of aorta, bicuspid aortic valve
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Kawasaki disease - associated heart defect
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Coronary artery aneurysms
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Neonatal lupus - associated heart defect
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Congenital heart block
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Williams syndrome - associated heart defect
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Supravalvular aortic stenosis
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Lithium use - associated heart defect
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Ebstein's (tricuspid valve leaflets displaced towards apex)
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Neonatal thyrotoxicosis - associated heart condition
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Heart failure
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Maternal diabetes - associated heart defect
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Transposition of great vessels; asymmetric septal hypertrophy
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Indications for VSD repair
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Pts who fail medical rx
Pts <1yo with pulm HTN Older pts with patent VSDs |
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ASD associations
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Down's, FAS, Holt-Oram syndrome (absent radii, ASD, heart block)
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Difference in presentation of ostium primum and secondum defects
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Primum - early childhood
Secondum - late childhood |
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ASD presentation
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Asymptomatic, or fatigue, resp infections, FTT; systolic ejection murmur at upper left sternal border
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ASD cardiac exam findings
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Systolic ejection murmur at upper left sternal border; *wide and fixed, split S2*
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ECG findings in ASD
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RVH, RA enlargement, PR prolongation
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Indications for ASD surgical/catheter closure
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Infants with CHF
Ps with >2:1 ratio of pulm-to-systemic blood flow |
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PDA cardiac exam
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Continuous machine-like murmur at 2nd IC space of sternal border; wide pulse pressure, bounding peripheral pulses
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PDA
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Patency of ductus arteriosus to remain open after birth, causing blood from aorta to travel to pulm artery
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Tx for PDA
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Indomethacin unless PDA is needed for survival
Surgery if child is >6-8months, or if indo fails |
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Common location of coarctation
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Below lt subclavian artery, above DA
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Common exam findings of coarctation
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Upper limb HTN, weak femoral pulses, systolic murmur in back, lt axilla
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Compensatory findings in older children with coarctation
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LVH on ECG, "3 sign" and "rib notching" on CXR
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Transposition of great vessels
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Aorta is connected to RV, pulmonary artery is connected to LV
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Compensatory defects needed for life in TGV
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ASD/VSD and PDA
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Risk factors for developing TGV
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Diabetic mothers, DiGeorge
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Classic presentation of TGV
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Cyanosis within first 24 hours of life; reverse differential cyanosis if coarctation is present
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Examination findings of TGV
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Tachypnea, hypoxemia, cyanosis; loud, single S2, VSD murmur if present
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CXR findings of TGV
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"Egg-shaped" silhouette, increased pul vascular markings
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Management of TGV
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IV PGE1 (to keep DA patent); balloon atrial septostomy to create ASD until surgery (definitive)
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DiGeorge - associated heart defect
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Transposition of great vessels
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Tetralogy of Fallot
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Overriding aorta
VSD Pulm stenosis RVH |
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Severity of ToF depends on?
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Pulmonary stenosis
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ToF presentation
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Cyanosis after 2yo (due to pulm. stenosis), dyspnea, diaphoresis with feeding; "tet spells"
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Cardiac exam findings in ToF
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Systolic ejection murmur at upper left sternal border, rt ventricular heave, single S2
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CXR findings in ToF
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"Boot-shaped" heart with decreased pulm vascular markings
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ECG findings in ToF
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Rt axis deviation, RVH
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Management of hypercyanotic "tet spells"
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O2, propranolol, phenylephrine, knee-chest position
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Management of tetralogy of fallot
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Manage tet spells
Balloon atrial septostomy to stabilize pt before Blalock-Taussig shunt |
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Language development milestones from 0-5yrs
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Babbles @ 6m
1 word @ 1 yr 2 word phrases @ 2 yrs 3-word phrases @ 3 yrs Proficient @ 5 yrs |
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Gross motor milestones from 0-1 yr
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Lifts head @ 2m
Rolls @ 4m Sits @ 6m Crawls @ 9m Walks @ 1yr |
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Gross motor development from 1-5 yrs
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Walks @ 1yr
Up/down steps @ 2yrs Rides tricycle, climb stairs @ 3yrs Proficient @ 5yrs |
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Fine motor milestones from 1-5 yrs
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2-finger grasp @ 1yr
Builds tower of 6 blocks @ 2yrs Circle @ 3yrs Cross/square @ 4yrs Triangle @ 5yrs |
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Social/cognitive milestones from 0-5yrs
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Social smile @ 2m
Stranger danger @ 6m Follows 1-step commands @12m Follows 2-step commands @ 2yrs |
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Average age of puberty and menarche in girls
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Puberty - 10.5yo
Menarche - 12.5yo |
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Average age of puberty in boys
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11.5
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Precocious puberty
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Secondary sexual maturation in girls <8yo and boys <9yo
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Constitutional growth delay
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Normal variant of growth - consistent growth curve lags; children catch up eventually; positive fhx
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Delayed puberty
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No puberty in girls >13yo and in boys >14yo
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Lesch-Nyhan syndrome
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X-linked HGPRT deficiency, hyperuricemia; mental retardation, spasticity, dystonia, self-mutilation, gout
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Homocystinuria
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Cystathionine beta synthase deficiency; increased methionine, homocysteine; mental retardation, seizures, Marfinoid, ectopic lens, thromboemboli
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Down's syndrome associated conditions
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Duodenal atresia, Hirschprung's disease, congenital HD (ASV, VSD); ALL, hypothyroidism, Alzheimer's
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Edward's syndrome
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Trisomy 18; rocker-bottom feet, micrognathia, clenched hands; death before 1yo
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Patau's syndrome
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Trisomy 13; microphthalmia, microcephaly, cleft lip/Palate, holoprosencephaly, Polydactyly; death before 1yo
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Klinefelter's syndrome
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47XXY; primary testicular hypogonadism; testicular atrophy, eunuchoid, tall, gynecomastia, female hair distribution
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Presentation of Turner's syndrome in newborns
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Lymphedema of hands/feet, widely spaced nipples, webbed neck, decreased femoral pulses
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PKU
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AR-phenylalanine hydroxylase (or tetrahydrobiopterin cofactor) deficiency; fair hair/skin, mousy odour, increased risk of heart disease
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Fragile X syndrome
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X-linked dominant FMR1 gene mutation; CGG repeats; large jaw, testes, and ears with ASD behaviours
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Respiratory presentation of CF
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Chronic cough, recurrent S. aureus + Pseudomonas infections, digital clubbing, nasal polyposis; common in children
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Abd presentation of CF
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*Meconium ileus*, pancreatitis, steatorrhea, rectal prolapse, jaundice, fat-sol vit deficiency; common in infancy
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Non-resp/abd signs/symptoms of CF
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Type II DM, *salty skin*, male infertility (vas def agenesis), hyponatremia
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Screening and confirmatory test for CF
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Screening: sweat chloride test >60mEq/L in peds, >80mEq/L in adults
Confirmatory: genetic testing |
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Acid-based disorder common in CF
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Hypochloremic alkalosis
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Most common cause of bowel obstruction in under 2yos
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Intussusception
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Risk factors for developing intussusception
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Meckel's diverticulum, intestinal lymphoma, Henoch-Schonlein purpura
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Presentation of intussusception
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Sudden-onset colicky abd pain, vomiting, bloody mucus in stool (current jelly)
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Exam finding in intussusception
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"Sausage-shaped" RUP abd tenderness, absence of bowel in RLQ
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Test of choice and finding for intussusception
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US - shows "target" sign
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Diagnostic and therapeutic test for intussusception
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Air-contrast barium enema
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Contraindications for air-contrast barium enema in intussusception
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Shock, peritoneal perforation/peritonitis
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Pyloric stenosis
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Pyloric sphincter hypertrophy leading to gastric outlet obstruction
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Presentation and exam findings in pyloric stenosis
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Projective, nonbilious emesis @ 3wks; palpable olive-shaped epigastric mass
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Diagnostic test of choice for pyloric stenosis
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US
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Acid-base disorder in pyloric stenosis
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Hypochloremic, hypokalemic metabolic alkalosis
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Tx of pyloric stenosis
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Pyloromyotomy
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Meckel's diverticulum
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Failure of omphalomesenteric duct to obliterate
Ectopic gastric, pancreatic tissue Ulcers and bleeding |
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Meckel's rule of 2s
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Most common in <2yos
2x more common in males 2 tissue types (gastric, pancreatic) 2 inches long Within 2 ft of ileocecal valve 2% of population |
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Classic presentation of Meckel's
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Sudden, intermittent, painless rectal bleeding
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Diagnostic test for Meckel's
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Tchnetium-99m tertechnetate - scintigraphy scan (detects ectopic gastric tissue)
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Tx of Meckel's
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Excision of diverticulum with adjacent ileal segment
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Hirschprung's disease
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Congenital lack of ganglionic cells in colon leading to decreased peristalsis
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Presentation of Hirschprung's in neonates
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Failure to pass meconium within 48 hrs of birth, with bilious vomiting and FTT
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Exam findings in Hirschprung's
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Abd distention, *POS squirt sign* (explosive stool discharge with DRE)
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Diagnostic test of choice and finding in Hirschprung's
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Barium enema - narrowed distal colon with proximal distention
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Confirmatory test and findings in Hirschprung's
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Rectal biopsy - absence of myenteric/Auerbach) and submucosal (Meissner) plexi; hypertrophied nerve trunks seen with AchE stain
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Tx of Hirschprung's
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2 stages: diverting colostomy followed by definitive "pull-through" of remaining colon to rectum
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Malrotation with volvulus
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Congenital abnormal positioning of midgut - cecum in Rt hypochondrium; Ladd's bands (fibrous bands) predispose to obstruction, constriction
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Presentation of malrotation with volvulus
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Bilious emesis in first month of life, crampy abd pain, distention, passage of blood in stool
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Characteristic AXR finding
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"Bird-beak" appearance and air-fluid levels
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Study of choice in malrotation with volvulus
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Upper GI endoscopy showing abnormal ligament of Treitz
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Tx of malrotation with volvulus
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Emergency surgical repair if volvulus is gastric; surgery or endoscopy if volvulus is intestinal
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Necrotizing enterocolitis presentation
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Nonspecific - formula intolerance, delayed gastric emptying, abd distention, bloody stools, fever/vomit
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Complications of necrotizing enterocolitis
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Intestinal perforation, peritonitis, abd erythema, shock
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Pathognomonic finding on AXR for NEC
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Pneumatosis intestinalis (intramural air bubbles)
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Complications of NEC
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Intestinal strictures, short-bowel syndrome
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Tx of NEC
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Supportive (NPO, orogastric tube, TPN, IV fluids, electrolyte correction); ileostomy with mucous fistula for perforation or worsening serial plain films
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