Peds FC.txt

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Author:
gm1147
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165156
Filename:
Peds FC.txt
Updated:
2012-09-13 10:21:22
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Step2 Peds Pediatrics
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Kaplan
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  1. Newborn vital signs
    • RR 40-60
    • HR 120-160
  2. Apgar
    • Appearance: blue, extremities, normal
    • Pulse: <60, 60-100, >100
    • Grimace: No response, grimace, sneeze
    • Activity: No tone, flexion, active
    • Resp: none, weak, strong
  3. Newborn conjunctivitis by days
    • 1: chemical irritation
    • 2-7: N gonorrhea
    • >7: Chlamydia trachomatis
    • 3 weeks: herpes
  4. Newborn eye care
    Erythro or tetracycline ointment, silver nitrate solution
  5. Screening tests for newborns
    • PKU,
    • CAH,
    • biotinidase,
    • beta thal,
    • galactosemia,
    • hypothyroid,
    • homocysteinuria
  6. Phenylketonuria
    • PAH (phenylalanine hydroxylase) deficiency
    • Mental retardation
  7. Newborn tachypnea
    • Transient is <4 hours and is due to not enough fluid pushed out of lungs
    • Over 4 hours, evaluate for sepsis with blood and urine cultures
  8. Birth skull fractures
    • Most common is linear
    • Depressed needs surgery
    • Basilar is most fatal
  9. Birth scalp injuries
    • Caput succedaneum: crosses suture lines
    • Cephalohematoma: subperiosteal hemorrhage, doesn't cross
  10. Erb paralysis
    • C4-C6
    • Waiter's tip: can't abduct, external rotate, or supinate
  11. Klumpke paralysis
    • C7-C8, +/- T1
    • Claw hand with horner syndrome
  12. Polyhydramnios causes
    • Werdnig-hoffmann: neurological inability to swallow
    • Intestinal atresias
  13. Oligohydramnios causes
    • Prune belly: no abdominal muscles to bear down to urinate
    • Renal agenesis, Potter syndrome
  14. Diaphragmatic hernia types
    • Morgagni: midline defect
    • Bochdalek: bilateral defects
  15. Omphalocele associations
    • Has a sac
    • Inc AFP, assoc with Edwards (Tri18)
  16. Umbilical hernia associations, tx
    • Hypothyroidism
    • 90% close on own by 3, surgery after 4
  17. Wilms tumor presentation, dx, tx
    • Palpable. WAGR (wilms, aniridia, GU malformations, retardation. Chrom 11 deletion). Constipation, N/V, abdominal pain.
    • Best initial U/S, most accurate is CT
    • Total nephrectomy, chemo, radiation
  18. Neuroblastoma
    signs
    metastasis rate
    • Hypsarrythmia (dancing eyes), opsoclonus (dancing feet)
    • 50-60%
  19. Cryptochordism risks
    • Surgery can decrease risk of infertility
    • Malignancy risk cannot be decreased
  20. Associations of hypo and epispadias
    • Hypo: cryptorchidism, inguinal hernias, don't circumcise
    • Epi: Urinary incontinence, bladder exstrophy
  21. Tetralogy of Fallot chromosome, presentation
    • Chrom 22 deletions
    • Cyanosis, holosystolic murmur at left sternal, Squatting
  22. Holosystolic murmurs
    • Mitral regurg
    • Tricuspid regurg
    • VSD
  23. Transposition murmur, CXR, tx
    • Single S2
    • Egg on a string
    • 2 surgeries each with 50% mortality
  24. Pulses:
    Pulsus alternans,
    bigeminus,
    tardus et parvus,
    paradoxus
    • Pulsus alternans: LV systolic dysfunction. Alternating strong and weak beats
    • Bigeminus: Hypertrophic obstructive cardiomyopathy. 2 beats together then a pause
    • tardus et parvus: Aortic stenosis. weak and late
    • paradoxus: cardiac tamponade and tension pneumothorax. dec with inspiration
  25. Hypoplastic left heart syndrome:
    components,
    presentation,
    tests
    • LV hypoplasia, Mitral atresia, aortic valve lesions
    • No pulse, single S2, gray
    • CXR: globular heart, pulm edema. Echo is most accurate
  26. Truncus arteriosus tx
    Surgery early since pulmonary HTN develops by 4 months
  27. TAPVR CXR
    • If no obstruction: CHR shows snowman/figure 8 sign
    • Obstruction: pulm edema
  28. ASD types
    • Primum: has mitral valve abnormalities
    • Secundum: commonest, center of septum
    • Sinus venosus defect: least common
  29. PDA timing, pulses, tests, tx
    • Up to 12 hrs is normal, >24 hrs is pathologic
    • Wide pulse pressure, bounding
    • Echo is initial, cardiac cath is most accurate, EKG shows LVH to high systemic resistance
    • Indomethacin
  30. CXR:
    Pear,
    Jug handle,
    3 like,
    rib notching
    • Pear: pericardial effusion
    • Jug: Primary pulm artery HTN
    • 3: Coarctation
    • Rib: Coarctation
  31. Coarctation of the aorta presentation and tests
    • CHF, resp distress, different pressures and pulses
    • CXR, cath is most accurate
  32. Pathologic jaundice
    • 1st day
    • bili rises >5/day
    • above 19.5 in term
    • direct >2
    • after 2nd week
  33. Kernicterus presentation
    • Hypotonia
    • Sz
    • Choreoathetosis
    • Hearing loss
  34. Pyloric stenosis dx
    • initial test is US
    • Accurate test is upper GI series which shows string sign, shoulder sign, mushroom sign, and railroad track sign (excess mucosa)
  35. CHARGE syndrome
    • Coloboma of eye, CNS anomalies
    • Heart defects
    • Atresia of choanae
    • Retardation of growth
    • GU defects
    • Ear anomalies and/or deafness
  36. Choanal atresia presentation and dx
    • Blue with feed, pink with cry
    • CT scan
  37. VACTERL syndrome
    • Vertebral anomalies
    • Anal atresia
    • CV anomalies
    • TEF
    • Esophageal atresia
    • Renal anomalies
    • Limb anomalies
  38. Intussuception tx
    • Fluids
    • Electrolytes
    • Then NGT decompression
    • Barium enema is dx and curative
    • 10% recur
    • Surgery if no cure with barium
  39. IDM complications
    • Macrosomia
    • Septal hypertrophy
    • Small left colon
    • renal vein thrombosis (mass, bruit, hematuria, thrombocytopenia)
    • Hypoglycemia - sz
    • HypoCa - tetany lethargy
    • HypoMg - HypoCa and PTH dec
    • Hyperbili
  40. CAH defects, metabolic abnormalities
    • 21 hydroxylase, 17 hydroxylase, 11b hydroxylase
    • HypoNa, HypoCl, Hypoglycemia, HyperK, acidosis
  41. Rickets types
    • Vit D deficiency
    • Vit D dependent: cant convert
    • X-linked hypophosphatemic rickets - cant retain P in kidney
  42. Vit D supplements
    Exclusive breastfed at 2 months
  43. TORCH
    • Toxo
    • Other - syphilis
    • Rubella
    • CMV
    • HSV
  44. Neonatal Toxoplasmosis: presentation, tests, tx
    • Chorioretinitis, Hydrocephalus, Ring enhancing lesions
    • Initial: IgM, Accurate: PCR
    • Pyrimethamine and sulfadiazine
  45. Neonatal rubella: presentation, tests, tx
    • PDA, cataracts, deafness, hepatosplenomegaly, thrombocytopenia, blueberry muffin, hyperbili
    • Maternal IgM
    • Supportive
  46. Neonatal CMV: presentation, tests, tx
    • Periventricular calcifications, chorioretinitis, hearing loss, petechiae
    • Initial urine or saliva viral titers. Accurate urine or saliva PCR
    • Ganciclovir if signs of end organ
  47. Neonatal herpes presentation, tests, tx
    • Week 1: shock and DIC. Week 2: vesicular skin lesions. Week 3: encephalitis
    • Initial tzanck, Accurate PCR
    • Acyclovir
  48. Rubeola/measles: etiology, presentation, dx, tx
    • Paramyxovirus
    • Cough, coryza, conjunctivitis. Koplik spots
    • CLinical. IgM Ab
    • Supportive
  49. Fifth disease/Erythema Infectiosum: etiology, presentation, dx, tx
    • Parvovirus B19
    • Fever, URI, slapped cheek rash
    • Clincal
    • Supportive
  50. Roseola: etiology, presentation, dx, tx
    • Herpes 6 and 7
    • Fever, URI, rash
    • Clinical
    • Supportive
  51. Mumps: etiology, presentation, dx, tx
    • Paramyxovirus
    • Fever, parotid swelling, orchitis
    • Clinical
    • Supportive
  52. Croup: etiology, presentation, dx, tx
    • Parainfluenza 1 and 2, or RSV
    • Barking, coryza, inspiratory stridor, hypoxia when flat, steeple sign on CXR
    • Clinical
    • Steroids if mild, if severe racemic epinephrine
  53. Epiglottitis: etiology, presentation, dx, tx
    • HiB
    • Hot potato, Fever, drooling, tripodding, cherry red epiglottis
    • Clinical, thumb print on xray
    • Intubate, ceftriaxone for 7-10d, Rifampin to close contacts
  54. Whooping cough: etiology, presentation, dx, tx
    • Bordetella pertussis
    • Catarrhal- congestion and rhinorrhea for 14 days. Paroxysmal: coughing episodes with whoops and vomiting for 14-30d, Convlescent stage for 14 days
    • Clinical, butterfly CXR, PCR or ELISA
    • Erythromyci or azithromycin in catarrhal stage, isolate, macrolides for close contacts, DTaP
  55. Diptheria: etiology, presentation, dx, tx
    • Corynebacterium diphtheriae
    • Pharyngitis, gray vascular pseudomembranes
    • Dont scrape, Culture
    • Antitoxin
  56. Legg-Calve Perthes disease: etiology, presentation, dx, tx
    • Avascular necrosis of femoral head
    • Age 2-8. Painful limp
    • Xray with joint effusions and widening
    • Rest, NSAIDs, bilateral surgery
  57. Slipped capital femoral epiphysis
    • Obese teens, painful limp, external rotation
    • Xray with widening of joint space
    • Tx with internal fixation

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