Pediatrics

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Anonymous
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1080
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Pediatrics
Updated:
2009-11-18 13:55:34
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Peds Shelf Exam
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Cards to study for my Shelf Exam in Pediatrics
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  1. Features of an infant with failure to thrive
    Low weight, normal length and head circumference
  2. Criteria for failure to thrive
    Growth below 5th percentile or crossing two major growth percentiles in a short time
  3. Broad causes of inadequate weight gain (4)
    • 1. Inadequate caloric intake
    • 2. Altered growth potential
    • 3. Caloric wasting
    • 4. Increased caloric requirements
  4. Causes of inadequate caloric intake (3)
    • 1. Lack of appetite due to depression or chronic disease
    • 2. Difficulty of ingestion - feeding disorder, cerebral palsy, facial abnormality, tracheoesophageal fistula
    • 3. Food not available
  5. Causes of altered growth potential in infancy (3)
    • 1. Prenatal insult
    • 2. Chromosomal abnormality
    • 3. Endocrine disorder
  6. Causes of caloric wasting (3)
    • 1. Emesis due to GI disorder, toxin, or CNS pathology
    • 2. Malabsorption due to GI disorder, infection, or toxin
    • 3. Renal loss due to DM or tubular acidosis
  7. Causes of increase in caloric requirements (2)
    • 1. Increased metabolism
    • 2. Defective use of calories
  8. Causes of increased metabolism in infants (5)
    • 1. Congenital heart disease
    • 2. Chronic respiratory disease
    • 3. Neoplasm
    • 4. Chronic infection
    • 5. Hyperthyroidism
  9. Causes of defective use of calories in infants (2)
    • 1. Metabolic disorder
    • 2. Renal tubular acidosis
  10. Laboratory tests in failure to thrive (7)
    • 1. CBC
    • 2. Lead level
    • 3. Calcium
    • 4. BUN
    • 5. Creatinine
    • 6. TB test (maybe)
    • 7. HIV test (maybe)
  11. Calories required by an infant in the first year of life
    120 kCal per kg per day
  12. Calories required by an infant after the first year of life
    100 kCal per kg per day
  13. By what percentage should caloric intake be increased in an infant to treat failure to thrive?
    50-100%
  14. Retention of EtOH in urine for screening
    10-13h
  15. Retention of EtOH in blood for screening
    7-10h
  16. Retention of marijuana in urine for screening
    • 3-10d (occasional users)
    • 2mo (chronic users)
  17. Retention of cocaine in urine for screening
    2-4d
  18. Retention of methamphetamines or Ecstasy in urine for screening
    2d
  19. Retention of opiates in urine for screening
    2d
  20. Retention of PCP in urine for screening
    8d
  21. Retention of barbiturates in urine for screening
    • 1d (short-acting)
    • 2-3wk (long-acting)
  22. Drug causing pupillary dilation
    Cocaine
  23. Drugs causing pupillary constriction (2)
    • 1. Opiates
    • 2. Barbiturates
  24. Drug causing hypersalivation
    PCP
  25. Maternal age and Down Syndrome
    Increased rate of DS for each year after age 35
  26. Bradydactyly
    Shortened tubular bones of hands and feet. Sign of Down Syndrome
  27. Clinodactyly
    Inward curving of a digit. Clinodactyly of the 5th digit is a sign of Down Syndrome
  28. VATER Symptoms
    • Vertebral problems
    • Anal anomalies
    • Trachea problems
    • Esophageal abnormalities
    • Renal abnormalities
  29. Maternal blood screening results in Trisomy 21 (3)
    • 1. Low alpha-fetoprotein
    • 2. High hCG
    • 3. Low estriol
  30. Physical signs of Down Syndrome (12)
    • 1. Upslanting palpebral fissures
    • 2. Brushfield spots (in the iris)
    • 3. Flat facial profile
    • 4. Small, rounded ears
    • 5. Excess nuchal skin
    • 6. Widespread nipples
    • 7. Pelvic dysplasia
    • 8. Hyperflexible joints
    • 9. Simian crease
    • 10. Hypotonia
    • 11. Clinodactyly of 5th finger
    • 12. Poor Moro reflex
  31. Cardiac defects common in Down Syndrome (3)
    • 1. Endocardial cushion defect (most common)
    • 2. VSD
    • 3. Tetralogy of Fallot
  32. GI defects common in Down Syndrome
    Intestinal atresia (especially duodenal atresia). May present with polyhydramnios.
  33. Ocular and auricular defects common in DS (4)
    • 1. Hearing loss
    • 2. Strabismus
    • 3. Cataracts
    • 4. Nystagmus
  34. Endocrine defect common in Down Syndrome
    Hypothyroidism
  35. Tetralogy of Fallot (4)
    • 1. Pulmonary stenosis
    • 2. Overriding aorta
    • 3. VSD
    • 4. RVH
  36. Features common in Edwards Syndrome
    • 1. Weak cry
    • 2. Single umbilical artery
    • 3. Micrognathia (small mouth, high arched palate)
    • 4. Clenched hand (2nd finger overlaps the 3rd finger)
    • 5. Simian crease
    • 6. Rocker-bottom feet
    • 7. Small pelvis
    • 8. Short sternum
  37. Genetic cause of Edwards Syndrome
    Trisomy 18
  38. Features of Patau Syndrome (9)
    • 1. Microcephaly with sloping forehead
    • 2. Deafness
    • 3. Scalp cutis aplasia
    • 4. Microphthalmia
    • 5. Coloboma
    • 6. VSD
    • 7. Omphalocele
    • 8. Single umbilical artery
    • 9. Hypersensitive to atropine and pilocarpine
  39. Genetic cause of Patau Syndrome
    Trisomy 13
  40. Signs and symptoms of meningitis in an infant
    • 1. Inconsolable crying; worse when picked up (paradoxical irritability)
    • 2. Altered mental status
    • 3. High fever
    • 4. Bulging fontanelle
  41. Signs and symptoms of meningitis found in older children, but often absent in infants (4)
    • 1. Nuchal rigidity
    • 2. Photophobia
    • 3. Kernig / Brudzinski signs
    • 4. Headache
  42. Common causes of meningitis in neonates (5)
    • 1. Group B strep
    • 2. Gram negative rods (especially E. Coli)
    • 3. S. Pneumoniae
    • 4. Listeria
    • 5. N. Meningiditis
  43. Common causes of meningitis in non-neonates (2)
    • 1. Coxsackievirus
    • 2. Echovirus
  44. CSF in viral meningitis (4)
    • 1. elevated WBCs, but below 1,000 per hpf
    • 2. < 50% PMNs
    • 3. normal glucose
    • 4. normal protein
  45. CSF in bacterial meningitis (4)
    • 1. >1,000 WBCs per hpf
    • 2. >90% PMNs
    • 3. Glucose < 20
    • 4. Protein > 100
  46. Empiric treatment of bacterial meningitis (2)
    • 1. Gentamycin
    • 2. Ampicillin
  47. Treatment of bacterial meningitis in non-neonates (3)
    • 1. IV penicillin
    • 2. 3rd-generation cephalosporins (if PCN-resistant)
    • 3. Vancomycin
  48. Common complication of meningitis in neonates
    SIADH
  49. Sepsis
    Clinical signs due to inflammatory response; often leads to changes in organ function
  50. Clinical findings in sepsis (5)
    • 1. Hypo or hyperthermia
    • 2. Hypotension with wide pulse pressure (diastolic less than 1/2 of systolic)
    • 3. Tachycardia
    • 4. Increased respiratory rate (due to metabolic acidosis)
    • 5. Altered mental status
  51. Lab values in sepsis
    • 1. Increased WBCs with left shift
    • 2. Reduced platelets (due to DIC)
    • 3. Reduced hemoglobin and hematocrit (due to hemolysis and marrow suppression)
    • 4. Reduced HCO3 and CO2 (ion gap acidosis)
  52. Infections causing sepsis in neonates (4)
    • 1. Listeria
    • 2. GNRs
    • 3. Group B strep
    • 4. Herpes simplex virus
  53. Infections causing sepsis in non-neonates (2)
    • 1. S. Pneumoniae
    • 2. N. Meningitidis
  54. Supportive treatments for sepsis (3)
    • 1. Maintain airway and give O2
    • 2. Give fluids: 20 mL/kg by IV or intraosseous injection per bolus
    • 3. Give pressors if 2-3 boluses of fluids do not raise BP enough
  55. Antibiotics used in sepsis (4)
    • 1. Ampicillin (drug of choice)
    • 2. Penicillin G
    • 3. 3rd generation cephalosporins
    • 4. Gentamycin
  56. Bone alignment in a septic hip
    Hip is flexed, externally rotated, and abducted
  57. Lab values in a septic joint (4)
    • 1. Increased sed rate
    • 2. Cloudy joint fluid
    • 3. > 50,000 WBCs per HPF in joint fluid
    • 4. Positive culture of joint fluid 50-60% of the time
  58. Bacteria of septic joints in neonates (3)
    • 1. E. Coli
    • 2. Listeria
    • 3. Group B Strep
  59. Bacteria of septic joints in non-neonates (2)
    • 1. S. Aureus
    • 2. S. Pneumoneae
  60. Septic joint vs. synovitis on physical exam
    Synovitis has no erythema or appreciable swelling
  61. Lab values in synovitis (4)
    • 1. Normal to slightly high sed rate
    • 2. Normal to slightly high WBCs
    • 3. Clear-to-cloudy joint fluid
    • 4. < 50,000 WBCs per HPF in joint fluid
  62. Course of synovitis
    2/3 to 3/4 resolve spontaneously within 2 weeks
  63. Leg-Calve-Perth's Disease
    Ischemic necrosis of the femoral head, leading to collapse of the femoral head
  64. Leg-Calve-Perth's Disease on physical exam (3)
    • 1. Painless limp
    • 2. Pain in groin, knee, and thigh with external rotation or abduction of the hip
    • 3. Discrepancy in leg lengths
  65. Treatment of Leg-Calve-Perth's Disease
    NSAIDs and activity restriction
  66. Slipped Capital Femoral Epiphysis (SCFE)
    Slippage of the epiphysis from the femur due to high stress to the hip
  67. Symptoms of SCFE
    • Dull, achy pain for > 3 months
    • Found deep in the groin and may refer to leg and thigh
  68. SCFE on physical exam (4)
    • 1. Pain when walking
    • 2. Reduced internal rotation
    • 3. Reduced flexion
    • 4. Atrophy of the thigh
  69. Treatment of SCFE
    Surgical placement of pins
  70. Presentation of growing pains
    Pain in long bones, not joints, lasting > 3mo. May awaken from sleep
  71. Presentation of Osgoode-Schlatter
    Pain at tibial tuberosity, at the patellar insertion; occurs in active and growing children

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