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Pediatrics SHELF

Blueprints common favorite X


Pretest one of better of the series *
BRS best but longest *
UW
Case files

Dont go overboard on vaccine schedules and developmental


milestones. You can sink a lot of time into that for little to no benefit
o You should know a couple of big milestones per age group.
Know the contraindications for vaccines; dont learn the actual
timelines.

1. Vaccinations given at birth - Hep B


2. Vaccinations given at 1 month - Hep B, only if not
given at birth
3. Vaccinations given at 2 months - Pediarix (HBV, DTaP,
IPV) ,Prevnar
(pneumococc), Rotavirus,
Hib

4. What is in pediarix - HBV\nDTaP \nIPV


5. Vaccinations given at 4 months -
Pediarix\nPrevnar \nHib \nRotavirus
6. Vaccinations given at 6 months - Pediarix \nPrevnar
\nHib\nRotavirus
7. Vaccinations given at 12 months - DTaP ,Hib, MMR, VZV,
Prevnar,
Influenza, Hep A
8. Vaccinations given at 24 months - None
9. Vaccinations given at 46 yrs - DTaP \nIPV
\nMMR\nInfluenza
10. Vaccinations given at 11 yo - Tdap
\nMeningococcus vaccine
11. What is the schedule for well visits starting - 1 mo, 2 mo, 4 mo, 6
mo, 9 mo, 12 mo
from birth 15 mo, 18 mo, 24 mo,
then annually
12. Why shouldn't babies drink water - Because their
kidneys aren't mature
enough to handle the extra
fluid so the
babies will become
hyponatremic since
they can't excrete the water,
and then
they can have szs
13. Plagylocephaly - Mishapen head
14. Sunsetting sign - Increased icp, eyes
are half closed
2ndary to the increased icp on
the
cranial nerves
15. Craniosynostosis - Premature closure of the
fontanelles
16. Rash pattern in RMSF - Palms and soles,
then spreads to trunk,
petechial
17. Rash pattern in rubella - Rash on face that
spreads to the rest
of the body
18. Rash pattern in measles - Rash starts at the
head and spreads
downwards and disappears in
the
same manner
19. Rash pattern for erythema infectiosum -slapped cheek rash;
lacy, reticular
20. VZV rash pattern -begins on trunk, followed by head, face, and
extremities
21. Gross motor skills at:
a. 1 mo old -Raises head
b. 3 mo -Holds head up
c. 45 mo -Rolls front to back and back/front\nsits
supported
d. 6 mo -Sits unsupported
e. 9 mo -Crawls\ncruises\npulls to stand
f. 12 mo -Walks alone
g. 15 mo -Walks backwards
h. 18 mo -Runs
i. 24 mo -Walks well up and down stairs
j. 3 yrs -Rides tricycle\nthrows ball overhand
k. 4 yo -Alternates feet going down stairs \nskips
22. Fine motor skills at:
a. 1 mo -follows eyes to midline
b. 3 mo -hands open at rest
c. 45 mo -grasps with both hands together
d. 6 mo -transfers hand to hand, reaches with either hand
e. 9 mo -pincher grasp\nfinger feeds
f. 12 mo -throws, releases objects
g. 15 mo -builds 2 block tower
h. 18 mo -feeds self with utensils
i. 24 mo -removes clothing \nbuilds 5 block tower
j. 3 yrs -draws circle
k. 4 yrs -catches ball\ndresses alone
l. 5 yrs -ties shoes
23. Simple febrile sz -Between 6mo 6yr: tonic clonic; associated with
fever >100.4
sx lasts <15 mins
Only 1 sx in 24 hrsminimal postictal state
a. Management: Determine the source of the fever, otherwise, no
other w/u is needed
24. Complex febrile sz -6 mo 6 yrs
a. Management: full w/u should be done, but no antiepileptics, no
EEG needed ; if pt is <18 mo, LP
25. Focal sz -15 mins; >1 sz/24 hrs
26. EEG abnormality associated with infantile spasm
-Hypsarrythmia
27. Definition of recurrent abdominal pain ->3x in 3 mo
28. #1 cause of abdominal pain -
Gastroenteritis
29. Mesenteric lymphadenitits -Persistent pain
following an infx
30. Clinical features of HSP -Condition
preceded by URI, nnon
thrombocytopenic palpable
purpura,
hematuria (good prognosis),
proteinuria (poor prognosis) ,
spasmodic abdominal pain,
ileus,
n/v, Upper GI/Lower GI bleed
31. Tx of Henoch-Schonlein Purpura (HSP) -steroids
a. Inflammation and bleeding in the small blood vessels in your
skin, joints, intestines and kidneys.The most striking feature of
Henoch-Schonlein purura is a purplish rash, typically on the lower
legs and buttocks
32. Complication of HSP -
Intussusception ,kidney probs
33. Clinical features of Kawasaki
a. -CRASH and BURN
i. Conjunctivitis
ii. Rash (on trunk mostly)
iii. Aneurysm (coronary)
iv. Skin-peels off, Strawberry tongue,
v. Hands/Feet edema,
vi. BURN = FEVER (x 5d)
34. Phases of kawasaki dz -acute, subacute
(aneurysm
formation) convaslescent
-takes 23 months to resolve
35. Tx of Kawasaki dz -ASA, IVIG
36. What is colicky pain associated with
-Constipation
37. What type of stool is seen with bacterial enterocolitis -Bloody,
mucinous stool
38. when will an appendix perforate in appendicitis -W/in 36
hrs
39. Which infx can clinically mimic appendicitis -Yersinia;
campylobacter
40. What imaging study for appendicitis -CT
41. Meds used to tx of perforated appendix -Ampicillin,
Gentamicin, Flagyl
42. Clinical presentation of intussusception -Currant jelly stools,
lethargy, palpable
tubular mass, paucity of gas on
X-ray or
evidence of obstruction
43. Imaging most specific for intussusception -Barium (or air)
enema; is also
therapeutic
44. Most common location for intussusception -Ileocolic; can also
develop at meckel's
diverticulum
45. Major complication of intussusception -There is impaired
venous return so bowel
edema develops > ischemia,
necrosis
> perforation
46. Etiology of intussusception -Ileum
invaginates into colon at ileocecal
valve
-Previous viral infx >
hypertrophy of the
peyer's patches... this can
develop into a
lead point; HSP can be
association with
an ilealileal intussusception
47. Tx of intussusception -Must do fluid
resuscitation first, if
needed, hydrostatic reduction
with
air/barium
48. Recurrence rate of intussusception -15%
49. At what age would a pt present with -13 mo
pyloric stenosis
50. Which medication can be associated with -erythromycin
pyloric stenosis
51. Best imaging for pyloric stenosis -u/s; will also see a
string sign Upper GI
study
52. Tx of pyloric stenoSIS -MUST correct fluids and lytes
first! Then
pyloromyotomy
53. Describe malrotation -Small intestines rotate
abnormally in utero,
so there is an abnormal fixation
posteriorly
to the mesentery; it can twist on its
vascular supply > volvulus
54. Clinical presentation of malrotation -Bilious emesis\npossibly
abdominal
distention/shock; + guiac test =
bowel
ischemia, poor prognostic sign
55. Tx of malrotation -Surgery ASAP
56. Tx for SCD induced priapism -Sedation
57. Dz that SCD can mimic if there is -Appendicitis
abdominal pain
58. When is frontal bossing seen? -Betathal or some
other hemolytic process
that requires rapid hematopoesis
59. Tx for betathal -Serial transfusion +
chelation therapy
(desferoxamine) b/c of fe overload
60. Consequence of Fe overload -Hemochromatosis
61. Complications of G6PD deficiency -RBCs are
destroyed but there is increased
amounts of Hb liberated in the
process >
Hburia
62. Findings in classic hemophilia -Bleeding problems +
hemarthrosis
63. Battle's sign -Basilar skull fx that leads to
bleeding/bruise
behind the ear
64. Mechanism behind bell's palsy in neonates -Forceps deliver...
usually resovles
65. Social Milestones at:
a. 5 yo -Competitive
games;

understands rules and


abides
by them
b. 4 yo -imaginative
play
c. 3 yo -group
play\nshares
d. 2 yo -parallel play
e. 18 mo -plays around
other children
f. 12 mo -comes when
called;
cooperates with

dressing
g. 9 mo -patacake
h. 6 mo -recognizes
strangers
i. 45 mo -enjoys
observing environment
j. 3 mo -reaches for
familiar objects/ppl
k. 2 mo -recognizes
parent
l. 1 mo -fixes on face

66. developmental dysplasia of the hip -abnormal relationship


between head of
femur and acetabulum >
instabilility and
dislocation of hip joint develops 2ndary
to
lack of contact of acetabulum and
femur
during intrauterine devevlopment
67. Dx of developmental dysplasia of hip -u/s see "false acetabulum"
in lateral ileum
68. Tx of developmental dysplasia of hip -Pavick harness (keeps hip
abducted and
flexed), or body casting on older pts
69. Complications of developmental -AVN (avasc nec.), degen
arthritis of hip
dysplasia of hip
70. Metatarsus adductus -Dorsiflexion and plantarflexion are
UNRESTRICTED (diff from clubfoot);
heels go
out and toes go in
71. Tx of metatarsus adductus -Stretching or a brace \nsurgery
not usualy
needed
72. idiopathic talipes equinovarus (aka) -Congenital clubfoot \nmedial
rotation of tibia, appearance fixed plantar
flexion, inversion of foot, forefoot
adduction CANNOT DORSIFLEX
(unlike
metatarsus adductus)
73. Tx of clubfoot -Bracing; serial casting
74. Leggcalveperthes dz -AVN of femoral head;
ischemic bone is
eventually resolved and re
ossification occurs
> limp, pain referred to thigh/knee
75. What movt's are restricted in
-Abduction\nflexion\ninternal rotation
leggcalveperthes dz
76. Tx of leggcalveperthes dz -Bracing, surgery,
observation
77. Complications of leggcalveperthes dz -Collapse of femoral
head
78. SCFE -Gradual or acute separation
of proximal
femoral growth plate \nfem head
slipps off of
femoral neck and rotates infpost
position
(Slipped Capital Femoral Epiphysis)
79. Etiology of SCFE -Common during
puberty, could be hormonal
80. Presentation of SCFE -Limp, px in hip +
groin, px referred to knee
81. Dx of SCFE -Plain film frogleg,
lateral position
82. Tx of SCFE -Goal is to prevent
further misallignment ; pin
fixation is done acutely
-Chronic cases require osteotomy
83. when does osgood schlatter dz occur -During growth spurt, in
teens
84. Osgood schlatter dz -inflammation, swelling and
tenderness
over tibial tuberosity 2ndary to
tendonitis
of distal insertion of infrapatellar
tendon
85. tx of osgood schlatter -Conservative,
supportive management
86. complication related to achondrodysplasia -Small foramen
magnum seen in
homozygotes > brainstem
compression
87. What is achondrodysplasia -d/o of cartilage calcifications
and
remodeling
88. Why children have an inc risk of fx -Tendons and ligaments
are stronger than
bones so in kids injuries often lead
to fx
when they would only cause sprain
in adult
89. Types of fx -Spiral (twisting forces
on tibia during fall) ;
epiphyseal fx (use salter
classification) ;
stress fx (hairline crack from
repeated
activity) ; torus fx (at metaphysis)
90. Nursemaids elbow -Subluxation of radial
head
91. Define upper airway -Nose > carina
92. Sx of upper airway dz -inspiratory stridor ;
tachypnea; respiratory
distress
93. Choanal atresia -Most proximal
abnormality of airway ;
bony or membranous septum btwn
1 or
both nasal passages and pharynx,
preventing airflow through nose;
life
threatening if B/L (most young
infants are
obligate nose breathers); can't
pass ng tube
94. Complications of longterm intubation -Subglottal stenosis
95. Laryngeal or tracheomalacia -floppiness that closes
off airway
(RAMROD)
96. How to confirm dx of laryngeal or -Bronchoscopy
tracheomalacia
97. Ddx for wheezing and respiratory distress -Asthma\nbronchiolitis,
foreign body
Aspiration, GERD, TE fistula,
vascular sling
98. Pathophysiology of sx in cf -Cftr is abnormal >
-
altered cl channel, Cl
stays in cells and Na+/water enter
the cell to
maintain osmotic balance >
viscous
secretions
99. GI effects in cf -Pancreatic insufficiency,
bowel obx, rectal
Prolapse, dm, cirrhosis, lage bulky
smelly
stools, later in life stools > distal
obstruction
100. Pathognomonic finding in cf -Meconium ileus
101. Tx of cf -Chest pt, exercise, frequent
cough,
recombinant human DNAse given
through
nebs to break down thick mucous
complexes
102. other than respiratory infx, what are -Hemoptysis (>500
cc/d = emergency) tx w
some other complications of cf
embolization\nspontaneous ptx (1/2 will
recur unless sclerosis is
performemd, but if that is done
then transplant is very difficult)

103. Definition of recurrent abdominal pain ->3x in 3 months


104. Mesenteric lymphadenitis leads to -Persistent pain after infx
105. GI complication from HSP -Ilealileal intussusception
106. Sx of HSP -Non thrombocytopenic palpable
purpura in
dependent areas, an IgA mediated
vasculitis
involving GI, skin, joints, and
kidneys
107. Tx of hsp -Steroids
108. What is HSP usually preceded by -URI
109. GI sx of HSP -Spasmodic pain, ielus,
vomiting, Upper
GI/lower GI bleed
110. Embryology behind omphalocele -When midgut loop fails to
return to
abdominal cavity; see light gray
shiny sac protruding from base of
umbilical cord
111. Embryology behind malrotation of midgut -Midgut undergoes
partial rotation and >
abnormal position for abdominal
viscera,
can be assoc with volvulus >
compromised blood flow and
gangrene
112. Gastroschisis -Weakness in abdominal wall
>
herniation of bowel through the
rectus muscle, usually to the right
of the umbilicus
113. Clinical features of malrotation -Bilious emesis,
possible abdominal
distension, X-ray shows gas in
stomach, but
no gas in intestines
114. Risk factors for developing GERD in babies -Prematurity,
esophageal dz, obx lung dz,
overdistension of stomach from
overeating, meds (theophylline)
115. Dx of GERD -pH probe placement in
esophagus or ugi
endoscopy, barium swallow to
confirm
nml anatomy
116. Tx of GER/GERD -Small frequent feedings,
keep head up for
20mins p eating, thicken feeds with
cereal, metoclopramide (increases
gastric
motility), h2 blocker or ppi\nlast
resort: nissen fundlopication
(fundus of stomach is wrapped
around distal esophagus to
increase les pressure)
117. Tx of diarrhea in children -If no serious
complications, feed through
the diarrhea > decreased
denudement
and faster return to nml stooling
patterns;
don't give antidiarrheals b/c >
toxic
megacolon, unless salmonella,
shigella, c
diff, or parasites
118. When to do w/u for diarrhea in a child -In infant <3mo, do
blood cx ,012 mo, do
stool cx; do blood and stool cx if
>5d of enterocolitis or salmonella
exposure; any infant with + stool
dx looking toxic or + blood cx
should be eval for pyelo,
meningiits, pna, osteo
119. When should a pt with diarrhea be ->5% dehydration and can't
rehydrate
admitted to hospital effectively at home

120. Obstipation and complications -no bm, if after


neonatal pd, #1 cause is
voluntary witholding\ncan be
caused by
pain, on defacation > fear for
defecation
> further retention; voluntary
holding
increases distension of rectum,
decreases
rectal sensation, requiring
increased
amounts needed to receive urge
121. Sx of hirschprung's -h/o diarrhea, fecal spotting
alternating
with constipation
122. Effect on incresaed bll on bm -Constipation
123. How to tx functional constipation -incresae fluid, decrease junk
food, increase
fiber, increase ingestion of
undiluted juice
124. Pathophys of hirschsprung's -Failure of ganglion cells of
myenteric
plexus to migrate down colon in
utero therefore distal colon is
tonically contracted and there is
obx \nusually limited to
rectosigmoid colon
125. When to suspect hirschsprung's -In any infant who
doesn't pass meconium,
then > bilious vomiting,
abdominal distension, and poor
feeding
126. Tx of hirschsprung's -diverting colostomy with
bowel that
contains ganglion cells aganglionic
segment is removed by pulling
ganglionic segment through rectum
127. Sx of meckel's diverticulum -remnant of vitilline duct w/i
2 inches of
ileocecal valve; bleeding from
divertic;
melena, obx (from
intussusception),
diverticulitis
128. Tx of meckel's diverticulum -Surgical resection
129. Dx of meckel's divertic -Technetium99 scan p
h2 antagonist to
locate hemorrhagic cells
130. Encephalocele -Projection of cranial content
through bony
skull defect in occiput > severe
mr, sz,
mov't do
131. Myelomeningocele -Protrusion of neural and
meningeal tissue
132. Meningocele -Meninges protrude
133. Spina bifida II is associated with -Chiari II malformation
134. Complications of spinal bifida -Caudal end of cord is
tehtered to distal
spine and can't ascend to adult
position > scoliosis, sphincter
dysfxn, LE deformities
135. Noncommunicating hydrocephalus -Block in exiting
ventricles; above blockage,
ventricles are big
136. Causes of noncommunicating -Secondary to
narrowing at 4th
hydrocephalus ventricle/aqueduct or
malformation at
posterior fossa; chiari II
malformation; spina bifida occulta
137. Communicating hydrocephalus -Subarachnoid villi are
dysfunctional/obliterated
138. Sx of motor cp -Fixed lesion in immature
brain >
nonprogressive d/o of mov't and
posture; spasticity is #1 type from
injury to motor tracts in brain; pts
are hypotonic in early months then
later become spastic; CONDITION
IS NOT PROGRESSIVE
139. Sx of extrapyramidal cp; etiology -From basal ganglia damage
>
choreoathetoid mov't, postural
ataxia, spasticity; kernicterus,
there is usually some sort of brain
insult
140. What GCS is required for a head ct to -<12
be obtained
141. #1 cause of ICH (intracereb. Hemor.) in kids -AVM (arteriovenous
malformation)
what meds are associated with pseudotumor -Tetracyclines;
corticosteroids
cerebri
142. Define Encephalopathy -Generalized cerebral
dysfxn, MS change,
disorientation
143. Risk factors for developing retinopathy -bw <1250 g; age <32
weeks; mechanical
of prematurity ventilation; need for
supplemental o2
144. Causes of Leukocoria -Retinoblastoma (> death
and visceral
mets in all cases); cataracts (most
common cause); retinopathy of
prematurity
145. Amblyopia -Visual impairment not
corrected by glasses
and not due to an ocular lesion;
often from strabismus
146. Tx of amblyopia -Occlusion of better seeing
eye forces
development of affected eye and
visual cortex of affected eye
147. At what age will tx not be successful -After 8yo
in ambylopia
148. Tx of retinoblastoma -Enucleation (removal of the
affected eye);
radiation tx\nchemo
149. Complications of neonatal cataracts -If not removed by 34
months irreversible
amblyopia
150. Course of retinopathy of prematurity -Most regress
spontaneously; if not,
cryotherapy can be performed to
reduce progression; are still at risk
for amblyopia even if treated
151. Dacryostenosis -Congenital nasolacrimal duct
obstruction;
causes overflow tearing 6% of
neonates; 2ndary to failrue of distal
membranous end of nasolacrimal
duct to open
152. Tx of dacryostenosis -Probing of nasolacrimal duct
at 1215 mo;
although most resolve
spontaneously by 1 yo (in 96% of
infants)
153. Ophthalmia neonatorum -Conjunctivitis
occurring in first month of
life; p/w eyelid edema, conjunctival
hyperemia and ocular d/c
154. When is it normal for there not to be tears -In the first few weeks
of life
155. Age of onset of gonococcal ophthalmia -24 days
neonatorum
a. Clinical features: Eyelid edema; chemosis; purulent d/c
b. Complications: sepsis; meningitis; arthritis; corneal ulceration;
blindness
c. Tx: Topical erythromycin; IV cefotaxime; tx parents
156. Age of onset of chlamydia ophthalmia -410 days
neonatorum
a. Complications: Corneal scarring \nPNA
b. Tx: Oral and topical erythromycin (despite the risk of developing
pyloric stenosis) ; tx
parents
157. When should steroid containing be -If hsv1 is suspected
etiology \ncan make
avoided in conjunctivitis dz worse
158. Hordeolum -Acute infection of sebacous
tarsal glands;
staph aureus is usually cause
159. Tx of hordeolum -Warm compresses
160. Chalazion -area of sterile
lipogranulomatous reaction
within meibomian glands that can
enlarge; can be chronic and
recurrent
161. Is periorbital or orbital cellulitis -Orbital cellulitis
an emergency
162. Sx of periorbital cellulitis -skin around eye is
indurated, warm, and
tender; no eye pain; may have si/sx
of sinus infx
163. Sx of orbital cellulitis -Severe pain with eye
movement
proptosis; vision changes;
decreased ocular mobility
164. Dx of orbital cellulitis -CT scan
165. Organisms to cover with orbital cellulitis -Strep; h. flu; m. cat
166. Tx of periorbital cellulitis -IV ABX; can >
meningitis, tx agressively
with Vanco, PCN, 1st gen
cephalosporin
167. Orgs to tx in periorbital cellulitis -Strep; h. flu; m. cat
168. Features of fragile x syndrome -Hyperactive; Mental
Retardation; large
body; long face; prominent jaw and
ears; thickened nasal bridge; large
testes; +/ autism
169. Facial features of xyy -Long asymmetric ears;
incresaed length:
breadth in hands, feet, and
cranium
170. Nutritional deficiencies in goat's milk -Decreased Vit D, Fe2+,
folate, B12
171. Infectious dz associated with drinking -Brucellosis
raw cow's milk
172. What supplements should moms receive -B12 to prevent buildup of
MMA
if they are vegan
173. Effects of excess Vit D -Hypercalcemia; azotemia;
poor growth;
n/v/d
174. Vit E deficiency in premies leads to -Hemolytic anemia
175. B1 defic Beriberi; (neuritis, edema,
chf);
hoarseness; anorexia
176. B2 deficiency Photophobia; cheilosis;
glossitis; corneal
vascularity
177. B3 deficiency -Pellagra (dermatitis,
dementia, diarrhea)
178. Pathophys of primary hypophosphatemia -Defective po4
resorption\nno conversion
of 25vit D > 1,25vit D in
proximal
tubules
179. Lab studies in primary hypophosphatemia 1. Ca2+ (LOW)
2. PO42- (LOW)
3. Alk phos (HIGH)

180. Clinical findings in primary -Smooth LE bowing (not angular, as


is seen
hypophosphatemia in ca defic) \nintraglobulin dentin
deformities (ca deficiency >
enamel defects) \ncoarse
trabecular bone and fraying
181. Somogyi phenomenon -Nocturnal hypoglycemia
manifested as night terrors, early
am sweating, then later has
hyperglycemia, ketonuria,
glucosuria (sugars increase
because of glucagon release)
182. What is an absolute contraindication -if first dose >
encephalophaty or
for DTaP encephalitis
183. Clinical presentation of pb poisoning -Emotional lability; abdominal
pain; achy
bones; intermittent vomiting and
constipation
184. At what BLL should tx be initiated ->45
185. Clinical presentation of acute hg poisoning -GI pain; fever; chills;
HA; visual changes;
cough; cp
186. Clnical presentation of chronic hg poisoning -Gingivostomatitis;
tremor; neuropsych
features
187. Clinical presentation of acute -N/V/D, abdominal pain; 3rd
spacing;
arsenic poisoning Hemorrhage; Hypovolemic
shock; vtach ;
QT prolongation
188. Narcosis -Deep stupor,
unconsciousness
189 Clinical presentation of cerebral palsy -Postural hypotonia;
failure to reach for
toys; gross and fine motor delay;
cognitive and sensory deficits
190. Complications of cerebral palsy -Seizures and mental
retardation
191. Differences in etiology for quadriplegia -Quadriplegia: UMN damage;
Paraplegia:
and paraplegia LMN or spinal cord damage

192. Most likely organisms PNA in CF -Staph or Pseudomonas


193. Clinical presentation of meconium ileus -Vomiting; abdominal
distension; distended
bowel loops; "soap bubble" on Axial
X-ray
194. Pathophys of meconium ileus -Begins in utero >
underdeveloped distal
lumen
195. Tx of meconium ileus -Surgical emergency;
gastrograffin enema
196. Vitamin A deficiency -pseudotumor cerebri
(among other things);
will see bulging fontanelles, HA,
n/v; may be seen as first
presenting sign in a pt with CF
197. What effect does phenobarb -It improves it by increaseing
gluocoronyl
have on jaundice transferase

198. Cancer that is associated with (germline) retinoblastoma 1.


Osteosarcoma (MC)

2. Melanoma
3. Squamous cell ca
199. Conditions associated with aniridia -Congenital glaucoma;
surgeweber;
marfan; neurofibromatosis
200. Presentation of malrotation -Obstruction typically normal
for first few
days of life than malrotation
worsens > abdominal fullness,
especially in RUQ > bilious
vomiting > ischemia and necrosis
201. #1 malrotation -Volvulus
202. Pathophys of volvulus -cecum fails to move to RLQ
and never
adheres to abdominal wall;
mesentary and SMA are tethered to
narrow stalk and twist about itself;
band of adhesive tissue can extend
from cecum to RUQ > duodenal
obx
203. Presentation of children with 2o HTN -HA; epistaxis; visual
sx; easy fatiguability
204. Describe how biliary atresia can -From scarring and
inflammation of
occur postnatally intrahepatic or extrahepatic biliary
ducts;
etiology is unclear
205. Describe findings of prenatal biliary atresia -Gall Bladder is absent
206. Sx of congenital toxoplasmosis -Chorioretinitis;
hydrocephalus; intracranial
calcifications
207. Complement levels in poststrep -Decreased C3
glomerular nephritisn
208. What are "currant jelly stools" -bloody stools;
indicative of intussusception
209. Tx of intussusception -Barium/air enema
210. Germinal matrix -Embryonic tissue present
near caudate
nucleus, often gets damaged by
hypoxia/ischemia; #1 place for
intraparenchymal bleed
211. Progression of intraparenchymal bleed -Blood can flow into
ventricles w/in 3 days
in a newborn of life
212. What blood vessels are damaged in -Bridging veins
shaken baby syndroem
213. What BV are involved in SAH -Circle of Willis
214. Signs of SVT -HR 220270\nno p waves
215. Pathophys of strawberry hemangioma -Vascular tissue fails to
communicate with
adjoining tissue; enlarges >
raised tumor
216. MCC for PNA in a child > 6 yo -Mycoplasma;
S.Pneumoniae
217. MC orgs in peritonsillar abscess -Anaerobes\nGAS
218. Physical findings of patau syndrome -Forebrain fails to
develop;
holoprosenceph; midface
developmental abnormalities;
abnml genitalia; severe MR
219. Which chromosomes are associated with
a. Edwards Edwards Edwards = Election age (18)
b. Patau Patau = Puberty age (13)
220. Porencephaly -Cyst/cavity in brain that
communicates
with ventricles
221. Causes of euvolemic hyponatremia -SIADH; glucocorticoid
deficiency;
hypothyroid; water intoxication
222. VACTERL -Vertebral; Anal; Cardiac;
Trach;
Esophageal; Renal; Limb
223. Gastrografin -Way to dx meconium ileus;
is demonstates
unused microcolon and pellets of
meconium higher up; can draws
water into lumen and meconium
gets unplugged (dx and tx)
224. Features of neonatal listerosis -Respiratoyr distress at
5 days; meningitis
225. Clinical presentation of congenital -Constipation; jaundice; ftt;
enlarged
hypothyroid fontanelle; umbilical hernia
226. Presentation of neuroblastoma -Asymptomatic
abdominal mass; horner's ;
dancing eyes; dancing feet;
blueberry muffin lesions; HTN

227. Patau's or Edwards syndrome or both:


Microcephaly -patau
Prominent occiput -edwards
Narrow forehead -edwards
Microphthalmia -patau
Cutis aplasia -patau
Micrognathia -edwards
Lowset malformed ears -edwards
Cleft lip -patau
Congenital heart dz -both
omphalocele -patau
clenched hands with overlapping fingers -both
rocker bottom feet -edwards
polydactyly -patau
polycystic kidney dz -patau
horseshoe kidney -edwards
crytorchidism -patau
agenesis of corpus callosum -patau

228. Genetic changes in prader willi -Paternal deletion, 2


defective maternal
chromosomes
229. Physical appearance of pts with prader willi -obese; almond
shaped eyes; downturned
mouth; small hands and feet
230. Genetic changes in angelman's -Maternal deletion, 2
deffective paternal
chromosomes
231. Physical appearance of angelman's -Large mouth; short
stature; tiptoe walk; szs
232. Galactosemia -Galactose 1p builds up and
accumulates
in liver and brain
233. Complications of galactosemia -Increased risk of e coli
sepsis; LD;
premature ovarian failure
234. Tx of galactosemia -eliminate galactose foods
from diet
235. Complications of PKU during pregnancy -If diet not followed,
baby can develop
microcephaly, MR, and congenital
heart dz
236. Physical features of homocystinemia -Marfan like
appearance; dislocaed lens
237. What effect does sepsis have on bilirubin -Disrupts the BBB so it
can cause diffusion
of bili into the brain
238. What effect does temp have on bili -Can cause bili
dissociation from albumin
239. Protocol for neonates whose mom -Mom has sx w/in 2 days of
delivery or
developed varicella infection just after delivery during end of pregnancy
treat baby with
IVIG and acyclovir.
-If > Amt of time no tx needed
240. Consequences of neonatal asphyxia -Cerebral edema;
irritability; sz;
cardiomegaly; renal and heart
failure ; DIC; RDS
241. What is the APT test -Used to differentiae fetal
from maternal
blood
242. Which drugs are contraindicated for 1. lithium 2. cyclosporine 3.
antineoplastic
breastfeeding drugs 4. ergots 5.
bromocriptine 6.
6. tetracyclines

243. Classic finding on X-Ray for necrotizing -Pneumanitis
intestinalis
enterocolitis
244. Consequences of cold temparature -Increased metabolic rate in
order to raise
in a premie body temp, but their ventilation
rate
increased as well; but, b/c of
respiratory problems in premies
they can't oxygenate enough so
lactic acid accumulates >
metabolic acidosis
245. Which is worse: ABO incompat or -Rh incompat
Rh incompat
246. Lab findings in ABO incompat -Increased retic count;
weakly + coomb's
247. Lab findings in Rh incompat -strongly + coombs
248. Pathophys of transient apnea of the newborn -immat. respiratory
centers, esp in premat
249. How to ID the underlying cause of -Iodine uptake scan
congenital hypothyroid

250. Late development of clavicle fx during -Callous formation in


anterior shoulder; 1
delivery... when does this occur? week
251. Physical findings of subgaleal hemorrhage -Feels like
cephalohematoma that crosses
midline; can lose 1/3 of
252. Onset of gonococcal conjunctivitis in a newborn -DOL 25
253. Onset of chlamydia conjunctivitis -DOL 514
254. What effects does surfactant deficiency -Decreases both; R>L
shunt
have on lung compliance and lung volume and
cardiac effect
255. Newborn w/mom + for HepB give: -Hep B Ig and HepB vaccine
256. Effect of propanolol in utero -IUGR; decreased ability of
asphyxiated new
born to incresae hr and CO;
associated with hypoglycemia and
apnea
257. When is surgery for cleft lip done -3 months
258. When does transient tachypnea of new -DOL #3
born resolve
259. Significance of 5th finger polydactyly (in black infants)no
consequence
Significance of 5th finger polydactyly (in white infants)Can be
associated with cardiac
abnormalities, must do an
echo
260 . Twin twin transfusion:
a. donor twin > oligohydramnios, anemia, ypovolemia
b. Recipient twin > polyhydramnios, larger size (20% difference in
body weight), hyperviscocity, respiratory distress, hyperbili,
hypocalcemia, renal vein thrombosis
261. When does serum bili peak -DOL 35

Friedreich Ataxia Wide based gait; dec. vib sense in LE; dec. reflexes in
LE; atrophy of spinal cord along with cerebral atrophy; Autosomal recessive
excess trinucleotide repeats results in abnormal tocopherol protein;
wheelchair bound by 25 dead by 35. DO GENETIC COUNSELING FOR
PARENTS WITH ONE AFFECTED CHILD.

12 mo mama dada follow simple commands with gestures


15 mo - mama dada +3 OTHER WORDS, understand simple
commands WITHOUT gesture
18 mo 5-20 words
24 mo combine words into short sentences and half understood by stranger
36 mo 1000 words; 75% understood by stranger, 3-5 word sentences
Thalassemia Absent or deficient >or= 1 alpha or beta-globulin chains of
Hb

Factor V Leiden Autosomal Dominant w/incomplete penetrance. Prone to


blood clots. V activates X to form thrombin. In def. pts. Protein C cannot
cleave the leiden form for factor V leading to hypercoagulability (potentially).

OBXObstruction

-Pathophysiology of Reye syndrome: Swelling of mitochondria

-Points for DKA tx: IV insulin 0.1 U/kg/hr +/- bolus; Add dextrose when
glucose<250; Replace HCO3- if pH<7.2; When ketones get clear or HCO3-
>20: stop IV n give SQ insulin

-Ant mediastinal mass: Thymoma, thyroid CA, Teratoma, T cell lymphoma

-Lacunar cells: Hodgkins lymphoma nodular sclerosis type

-Kid w/ known cardiac defect now presents w/ fever, seizure and


focal neurologic deficit : brain abscess; dx by brain CT, tx is surgical
drainage and IV antibiotics. If abscess <2.5cm n pt is stable: antibiotics &
observe

-70-75% of kids w/ HTN have renal etiology so check BUN & creatinine

-Intussusception: dx & tx is barium enema


-Meconium ileus: dx & tx is gastrografin enema

-Contact dermatitis covering 15-20% of body surface: tx is PO steroids

-Infant w/ sinus tachycardia (QRS complexes -Bag of ice on face for 5


sec
w/ no preceding p waves) initial best step:

-Tx of peritonsillar abscess: -IV antibiotics (PCN; if


allergic: clindamycin
& metronidazole) & needle
aspiration in ER setting

-Patau syndrome or Trisomy 13 : -Associated w/


holoprosencephaly (failure
of forebrain to dev. Into 2
hemispheres)

-Infant abdominal difficulties & CF TOW: -Meconium ileus

-Alpha drugs given for nasal congestion can -Rebound congestion &
rhinits
have SE of: medicamentosa

-William syndrome: Overfriendly pt w/ supravulvular aortic stenosis


-DiGeorge syndrome: Associated w/ truncus arteriosus & total anomalous
pulmonary venous
return

-Surgery for cleft lip prerequisites -Rule of 10 (age10wks,


weight 10 lb, Hb10)

-Tx for tet spell of TOF: -Knee chest position,


phenylepherine drip,
oxygen

-To know if TOF pt is in trouble: -Check O2 oximetry (E.g., pH


7.38> ok, but if
pt has metabolic acidosis> means
not enough O2 to tissues)

-Normal newborn Hb 50 Polycythemia >65.


-Conginetal cyanotic disease of polycythemia (twin-twin transfusion,
Intrauterine hypoxia, DM infants) mostly asx but can get stroke.
-Dx : Heel stick blood.
-Tx: Partial exchange transfusion (taking whole blood out n putting in
saline)

-Reactive Mantoux and positive CXR in 2 yr old, next step? Early morning
Gastric aspiration to id acid fast bacilli swallowed at night.

-As a general rule gm-ve organisms need to be covered with 2 antibiotics.


E.g, CF pt w/ pneumonia (suspected pseudomona infect) needs 2 IV drugs
w/anti-pseudomonal activity like ceftazidime & tobramycin; an alternative
combo is ticarcillin & tobramycin. Adjunctive tx w/chest physical therapy &
bronchodilators is also used.

-Precocious puberty w/ normal ht & wt, next step? XR of head & wrist
-Tx of hypophosphatemic rickets: combined oral phosphate & 1,25-
dihydroxyvitamin D3

-Short PR interval & delta waves w/ slow QRS upstroke : Wolf-Parkisnson-


White syndrome. Tx: ablation of bypass tract

-Neuroblastoma: small round cell tumor w/ Homer-Wright Rosettes

-sickle cell pt w/ dilute urine & dehydration : think secondary enuresis

-Decrease C3: SLE, Membranoproliferative GN, Post strep GN

-Alport syndrome: X linked D, AD, mutations; biopsy> glomerular sclerosis,


lamellation of basement membrane (onion layers w/breaks)

-MCC of non-anion acidosis in kids: diarrhea

-Bartter syndrome: (opposite of renal tubular acidosis type 4) hyper-renin,


hyperaldosteronism, hypokalemia, normal BP, Jexta-glomerular apparatus
doesnt work, hypocholeremic metabolic acidosis

-Most common cause of ARF in kids: Hemolytic-Uremic syndrome

-No stool pass in the nursery: think CF, kid of DM (microcolon),


Hirshsprung

-All kids w/ rectal prolapse should get a sweat chloride test

-Werdnig Hoffman: Autosomal Recessive, survival motor neuron gene


(SMN) 5q13

-Pes cavum: high arched foot, peroneal muscle atrophy, recurrent ankle
sprains

-Allelic expansion ( I allele has too many copies) seen in: Fragile X
synd, myotonic dystrophy, Huntingtons chorea

TEMP
Cystic fibrosis flareup tx - IV Ceftazidime and gentamicin to cover P.
aeroginosa

Intussuception - Most common cause of intestinal obstruction in first 2


yrs of life
-Red currant jelly stools, severe sudden onset abd pain

Meckel's diverticulum - Presents at 2 yo w/ painless rectal bleeding


Duodenal atresia - Bile stained vomitus, no abd distension, dehydration,
Down syndrome
Tx: decompress w/ NG tube, correct electrolytes+ surgery

Tracheoesophageal fistula - Presents in infancy w/ coughing, vomiting,


gagging after feeding; Resp distress and frothy bubbles in oral cavity
VACTERL association

Malrotation - Distended abdomen w/ dilated loops of bowel

Ewing's sarcoma - *Onion skin periosteal reaction!*


-Lytic, central and accompanied by endosteal scalloping
-Moth eaten mottled appearance + extension into soft tissue.

Osteomyelitis - Central lytic bone defect w. sclerosis= Brodie's abscess

Chondrosarcoma - Not common as 1 tumor


-Mostly in *older people*
-Fusiform defect w/ scalloping

Fibrosarcoma - Malignant spindle cell neoplasm in ??*30-60 yo*


presenting as painful mass

Manifestations of CF - anemia, recurrent infections, rectal prolapse,


clubbing, hemoptysis, heat intolerance, wheezing, steatorrhea

Most common mutation in CF - Deletion of a 3base pair encoding for


phenylalanine in the CFTR gene located obn chromosome 7

Meconium ileus - Diagnostic for CF


Obstruction of the small intestine in the newborn caused by impaction of
thick, dry, tenacious meconium.

Chlamydial conjunctivitis - Most common causative agent of neonatal


conjunctivitis
Presents few days-->weeks post birth
-Can present w/ pneumonia w/ rales, but no fever and no wheezing
- May present w/ comjunctivits as well as pneumonia

Gonococcal conjunctivitis - Purulent eye discharge between 2-5 days


post birth
Pertussis prevention - All close contacts should be given erythromycin
for 14 days *regardless of age, immunisation or symptoms*

RSV infection - Increase risk of asthma later in life

Bronchiolitis - First wheezing episode associated w/ a URI

Failure to pass stool in first 24 hrs of life - Meconium ileus

Epinephrine
1= arteries constrict
2= Bronchiles relax
1 agonist that vasoconstricts to increase BP
2 agonist- SM relaxation to counter bronchospasm

Night Terrors - seen between ages 2-12


Occur during REM sleep and are caharcterised by fear, crying,
consciousness, amnesia

Pyelonephritis - fever, chills, N/V, flank pain, suprapubic pain, CVA


tenderness
Tx: hospitalisation and IV antibiotics

Acquired torticollis - relatively common in kids, usually caused by URI,


minor trauma, cervical lymphadenitis, or retropharyngeal abscess, first step
is xray to rule out cervical spine injury

Treat Meningitis in adolescents d/t DETERIORATION


- SHiN : N. meningitidis, S. pneumo, H. flu
*N. meningitidis:*-QUICK DETERIORATION, associated rash/mucosal
hemorrhage+ DIC (thrombocytopenia, PT/PTT, bleeding from IV sites)
Tx: Ceftriaxone 2g IV and Vanc (to cover resistant S. pneumo)
-Get an LP (CSF glu low; protein ), Blood culture, CT scan;
chemoprophylaxis of close contacts

Growth in infants
Weight: Double by 5 months; triple by 1 yr
Height: Double by 4 years; triple by 13 yrs
Other: Say 1 or 2 words; walk at least dependently

Hypophasphatemic Rickets
- X-linked dominant.
- Deficiency in PHEX. Messed up bone formations.
MCC of short stature and pubertal delay
- Constituional grwoth delay: dealyed growth spurt, delayed puberty, delayed
bone age

Viral meningitis
- Nothing in Gram stain; fever+ URI sx; Normal glucose (40-80) and protein
(10-30); Increased lymphocytes; Tx is supportive and sx will resolve in 7-10
days
Common cause: echo, non-polio, cocksackie

Fetal alcohol syndrome


- *MCC of MR in children*;
- Facial hypoplasia, epicanthal folds, palpebral fissures, heart abnormalities,
long philtrum, thin upper lip; normal karyotype (ruling out Down syndrome)

Congenital rubella
- Hearing defects, Cataract defects + CHD defects (PDA), microcephaly
(CataractHeart&HearingDefects-CHD)

Vit D deficiency rickets - Thickening of bones


Wide open anterior fontanelle, rachitic rosary, craniotabes, rachitic rosary,
thickening of the lower end of the long bones

Spondylolisthesis - forward slip of vertebrae (usually L5 slips over S1)


that usually manifests in preadolescent children w/ back pain, a palpable
step off, possible urinary incontinence

Iron poisoning - Symptoms: Vomiting & Diarrhea (often bloody) -


Massive blood and fluid loss; Remission (may be asymptomatic for up to 12
hrs); Shock, seizures, Liver failure and death
Tx: deferoxamine

Risk factors for neurological damage from hyperbilirubinemia


1. Hypoalbuminemia- Having a decreased albumin, means there will be more
free unconjugated bilirubin which would normally bind to albumin. More free
UCG bili-->free bili in body which can easily cross BBB to cause neurological
damage
2. Neonatal sepsis: Sepsis makes the BBB more crossable, and as such, there
is an increased chance for neurological damage in such infants
3. Metabolic acidosis decreases bilirubin binding, and as such, this free bili
can cause an increase in neurological damage.

Choanal Atresia
- Blocked posterior nostrils on one or both sides due to congenital septum.
Feedings by mouth are either difficult or impossible b/c infant would have to
breathe through their mouth. Crying makes respiration better b/c they use
their mouths Surgery opens the airways.

When to not breastfeed


- HIV infection, active pulmonary TB, malaria, typhoid fever, septicemia,
women undergoing cancer tx.
-Very few contraindications. Everything else, BREASTFEed

Apt test
- Used to differentiate fetal blood (alkali resistant) from maternal blood (alkali
reactant)
Qualitative test used in simple cases of vaginal bleeding

Symptomatic congenital disease


- Occurs when a mother has a primary CMV infection in the 1st trimester of
pregnancy-->death of baby

Asymptomatic congenital disease


- Occurs in the event of reactivation of CMV infection during pregnancy,
maternal IgG passes transplacentally, protecting the infant from serious
infection

Phenobarb on bili
- Phenobarb--> UGDP enzyme--> conjugation of bilirubin-->
unconjugated bilirubin. Using phenobarb can help neonatal jaundice

Beck's triad
- Test set for cardiac tamponade: BP, muffled heart sounds over
pericardium, distended neck veins

Scarlet fever and tx


- fever, pharyngitis, sandpaper rash, strawberry tongue
-Caused by Grp A strep
-Tx: Penicillin V

Lyme Disease, RMSF, , trat


- Give Doxycycline. If pt is <9yo, give Amoxicillin for 21 days

Angiofibroma
- *Nasal obstruction, visible mass, frequent nosebleeds* -benign tumor of
nasal mucosa composed of large blood vessels and fibrous tissue; only seen
in adolescent males***
-presents with profuse epistaxis

Measles
- Cephalocaudal rash + leukopenia +thrombocytopenia
-Vit A helps decrease mortality and morbidity

Biliary Atresia
- light colored stools, hepatomegaly, increased direct hyperbilirubin (direct
hyperbilirubinemia)
Direct hyperbilirubinemia (>2) is an indication for evaluating neonatal
jaundice even if the infant seems normal otherwise

Crigler Najjar
- Absence of UDGP causing an increase in indirect bilirubin. These infants
present in the first 24 hrs and die within the 1st yr of life
(Gilbert's syndrome-milder form of this)

Whooping cough
- Coughing spells lasting 20-30mns. These spells are so severe that they can
cause rectal prolapse, epistaxis, or even pneumothoraces
-May worsen w/ eating/drinking cold liquids

Parathyroid hormone
- phosphate trashing hormone, increased phosphate in urine. in rickets,
calcium and phophate pulled into blood, but phosphate is wasted in urine
(hypocalciuria)

Milstones:
Gross Motor
2 - lifts head
4 - front to back 5 back to front ( just think back to front is more muscle)
6 - imagine the "6" as baby sitting
9 - number "9" doesnt have good base so crawls
11 - "11" has 2 good base so baby is able to stand/cruise/walk
12 - now good base plus 2 legs can walk for sure (alone)
15 - "5" is mirror image of "2" so baby can walk backwards
2yr - u need to use both legs to go up/down stairs
3yr - "TRI-cycle"
4yr - HOPS 4 letters

Fine Motor
"9ince12" = PINCER Before pincer comes raking which is more immature
9 mo = non specific ( 3 finger) also nonspecific mom and dad
12 mo = specific (2 fingers) also specific mom and dad
15 mo = 2block
18 = 3blocks
2yr = 6 blocks
Also playstation controler 0 --> X --> Square --> triangle 3 4 5 6 yrs
Language/social
2 coos and smiles because recognizes parents.
4 coos and laughs
6 babbles and anxiety, because recognizes strangers
1 yr alone so plays ALONE/ follow ONE step command, One word besides mom dad
2 yrs now 2 so PARALELL play, follows TWO step command, 2 word PHRASES
3 4 5 6 number of sentences with years
Bowel control at 4 Pee control at 5

Birthweight x 2 every 6mo/ 1 yr Then x2 the next year = so x4 by 2yrs


Lenght doubles every 4 yrs so x4 by puberty

Reflex
Palmar is first to come ( US baby always has his palm close)
Rooting is first to go
Parachute always stays