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charlietri818
on FreezingBlue Flashcards.
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For kids being treated for hypothyroidism, what would cause both TSH and fT4 to be elevated?
Not taking thyroid hormone (as directed); disconcordance between thyroxine and TSH suppression causes elevated TSH (missed a dose) and then elevated fT4 (extra synthroid was taken)
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Target pattern lesions in the form of erythematous papules or plaques with central VIOLACEOUS discoloration; no mucosal involvement - diagnosis?
Erythema multiforme
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Prodrome of fever, headache, malaise, cough, sore throat x1-14 days followed by eruption of nontargetoid erythematous or violaceous macules/patches that blister and rupture; mucosal involvement at conjunctiva, mouth, urethra, and rectum - diagnosis?
Stevens-Johnson syndrome or toxic epidermal necrolysis
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What is the difference between SJS and TEN?
- Less than 10% epidermal loss is SJS
- 10-30% epidermal loss is TEM
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Neonate with h/o IUGR, microcephaly, seizures, hepatopathy, bone marrow suppression should make you think of what diagnosis?
TORCH infection (in utero infection)
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What TORCH stand for?
- 1) Toxoplasmosis
- 2) Other (Syphillis, VZV, parvovirus, HIV)
- 3) Rubella
- 4) Cytomegalovirus
- 5) Herpes simplex virus
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What is the risk of transmission of HIV to an infant from an infected mother who breastfeeds?
Approximately 20% to 45%
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What category of bacteria does pseudomonas sp. fall under?
Gram-negative bacilli
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In a sick patient (i.e. cystic fibrosis) with suspected pseudomonal sepsis, what is first line empiric therapy?
- 1) 2 antipseudomonal agents
- PLUS
- 2) Aminoglycoside
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Name 3 beta-lactams that are effective against pseudomonas?
- 1) Cefipime
- 2) Ceftazidime
- 3) Pipericillin +/- tazobactam
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Furosemide usage leads to urinary loss of what 3 electrolytes?
- 1) Sodium
- 2) Chloride
- 3) Potassium
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How does furosemide work?
Blocks Na+/K+/2Cl- transporter in the loop of Henle
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How does furosemide cause sensorineural hearing loss?
Inhibition of the Na+/K+/2Cl- transporters in marginal cells of cochlear duct of inner ear leads to reduced endocochlear potentials
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How does chronic furosemide increase risk for kidney stones?
Hypercalciurua
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In a person with history of allergy to beta-lactams, which cephalosporin is MOST likely to elicit cross-reaction?
First generation cephalosporins
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(T/F) Negative skin testing to major (penicilloyl) and minor (penicilloate) determinants of penicillin can exclude almost all IgE-mediated reactions to penicillins
True
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What is the best thing you can do for a person with an avulsed tooth?
Reimplant tooth gently back into socket and have the patient hold in place during transport
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What are good liquid solutions for preservation of an avulsed tooth?
- 1) Balanced salt solution
- 2) Milk
- 3) Saliva (in buccal vestibule)
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Neonatal lupus erythematosis is caused by transplacental passage of what 3 maternal antibodies?
- 1) Anti-Ro (SSA)
- 2) Anti-La (SSB)
- 3) Anti-U1 RNP
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What do the skin lesions of neonatal lupus erythematosis (NLE) look like?
Erythematous annular plaques located in sun-exposed areas (face)
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What is the initial work-up for an infant with neonatal lupus erythematosis? (3)
- 1) EKG: evaluate heart block
- 2) CBC: eval heme issues
- 3) LFT: eval for hepatopathy
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Early-onset (neonatal) GBS infection occurs within what time frame?
First 24 hours of life
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Late-onset (neonatal) GBS infection occurs within what time frame?
First 7 days of life
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What are 4 clinical manifestations of early-onset GBS infection?
- 1) Pneumonia
- 2) Pulmonary hypertension
- 3) Septic shock
- 4) Meningitis (<10%)
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What are 3 manifestations of late-onset GBS (that are less likely in early-onset GBS)?
- 1) Meningitis
- 2) Cellulitis
- 3) Septic arthritis
- 4) Osteomyelitis
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How does GBS bacteremia cause pulmonary hypertension?
GBS toxin can mediate pulmonary vascular constriction
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Hypertensive crisis should be suspected in the face of markedly elevated BP PLUS any of the 3 following clinical manifestations:
- 1) CNS symptoms (HA, vision changes, seizure)
- 2) Epistaxis
- 3) Congestive heart failure (HSM, pulm edema)
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What are 3 likely causes of hypertensive crisis?
- 1) Drug ingestion (sympathomimetics)
- 2) Renal disease
- 3) Unrecognized progressive hypertension
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For all women capable of becoming pregnant, what is the CDC's recommendation for prevention of neural tube defects?
0.4 mg of folic acid daily
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For women who had a previous pregnancy affected by neural tube defect, what is the CDC's recommendation for prevention of future neural tube defects?
4 mg folic acid daily from time of trying to get pregnant through first trimester
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(T/F) Research indicates that adolescents are more likely to disclose sensitive information if clinicians make explicit statements about confidentiality.
True
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(T/F) State laws mandate that adolescents in all states may receive confidential treatment for alcohol and other drugs.
False - state laws vary in extent to which they protect confidentiality of minors; can't cover every situation
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(T/F) Billing policies of an outpatient or inpatient facility are always confidential in regard to STI testing in adolescents.
False - EMR may not always have safeguards for confidentiality
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What are the 3 most common side effects of methimazole and propylthiouracil?
- 1) Rash
- 2) Arthralgia
- 3) Arthritis
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What are rare but serious side effects of methimazole and propylthiouracil?
- 1) Hepatitis
- 2) Neutropenia
- 3) Agranulocytosis
- 4) Vasculitis (more for PTU)
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What 3 treatment options for people with hyperthyroidism?
- 1) Antithyroid medication
- 2) Ablative therapy with radioactive iodine
- 3) Surgical thyroidectomy
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Regarding treatment of skin abscesses, beyond what size do most experts recommend starting antibiotics?
5 cm or greater (start abx after I & D)
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What is recurrent (functional) abdominal pain syndrome?
Unexplained abdominal pain severe enough to interfere with school; can be precipitated by stress
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What does the palpation of a prominent precordial lift indicate?
Right heart volume overload
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Loud systolic ejection murmur over LUSB indicates what heart lesion?
Pulmonic stenosis
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What are antibiotic choices for outpatient treatment of Lyme disease?
- Less than 8 yo: doxycycline
- 8 yo and older: amoxicillin
- Penicillin-allergic: cefuroxime
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What are antibiotic choices for inpatient treatment of Lyme disease?
Ceftriaxone or penicillin
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What are 3 indications for parenteral antibiotics for Lyme disease?
- 1) Persistent/recurrent arthritis after trial of oral abx
- 2) Carditis
- 3) Meningitis/encephalitis
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What are beta-lactamases?
Enzymes produced by gram-negative bacilli that hydrolyze beta-lactam ring
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Extended spectrum beta-lactamases (ESBL) confer resistance to which 4 antibiotics?
- 1) 3rd gen cephalosporins
- 2) Monobactam (aztreonam)
- 3) Aminoglycosides
- 4) Fluoroquinolones
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Which organisms typically develop ESBL?
- 1) Klebsiella sp
- 2) E. Coli
- 3) Proteus mirabilis
- 4) Pseudamonas sp
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What is the study of choice to evaluate for UPJ obstruction?
MAG-3 radioisotope scan - shows delayed "washout" with lasix infusion
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What is the study of choice to evaluate for duplex collecting system with ureterocele?
VCUG - filling defect in bladder
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What are 6 clinical manifestations of Jimson weed exposure?
- Anticholinergic effects:
- 1) Bizarre behavior
- 2) Tachycardia
- 3) Hypertension
- 4) Dry skin
- 5) Flushing
- 6) Dilated pupils
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What are 2 clinical features of hand-foot-and-mouth disease?
- 1) Cutaneous findings: erythematous papule/vesicle on palms or soles
- 2) Oral-mucosal findings: ulcers on soft palate, uvula, tonsillar pillars and tongue
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What are clinical features of herpangina?
Ulcers or vesicles in posterior pharynx including: tonsillar pillara, soft palate, uvula
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In a term infant, when does physiologic anemia occur?
6 weeks to 3 months (you can reassure parents that anemia will resolve by 4 months)
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In preterm infants, when does "physiologic" anemia occur?
As early as 3-6 weeks
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In term infants, how low does hemoglobin get at nadir?
Usually no less than 9 g/dl
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In preterm infants, how low does hemoglobin get at nadir?
Down to 7 g/dl
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Normal MCV in kids 6 month and older?
70-75 fl
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What are the 5 major Jones criteria for the diagnosis of rheumatic fever?
- 1) Carditis
- 2) Erythema marginatum
- 3) Syndenham chorea
- 4) Polyarthritis
- 5) Subcutaneous nodules
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What are the 4 minor Jones criteria for the diagnosis of rheumatic fever?
- 1) Fever
- 2) Arthralgia
- 3) Acute phase reactants up
- 4) Prolonged PR interval
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What counts as evidence of prior GABHS infection? (2)
- 1) Throat culture+
- 2) Rising ASO titer
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How do you make the diagnosis of rheumatic fever?
- 1) 2 major Jones criteria
- 2) 1 major + 2 minor Jones criteria PLUS evidence of past GABHS infection
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What is the number 1 cause of death in teenagers?
Motor vehicle crash
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For a child with first-time unprovoked seizure, what is his recurrence risk in the next 12 months if he is otherwise healthy?
1 in 3
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For a child with first-time unprovoked seizure, what is his recurrence risk in the next 5 years if he has a history of developmental delay, MR, CP, or other CNS problem?
70%
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What the 3 key factors in preventing/delaying complications of diabetes?
- 1) Glycemic control
- 2) Blood pressure control
- 3) Smoking cessation
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Yersinia enterolytica infection is associated with meat product?
Pork
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Escherichia coli O157:H7 infection is associated with meat product?
Beef
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Which diarrheal pathogen is associated with consumption of raw seafood, ice, salads, and cruise ships?
Norovirus (Norwalk virus or Norwalk-like virus)
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What differentiates adenoviral diarrhea from rotaviral diarrhea?
Adenovirus associated with ingestion of contaminated foods, while rotavirus is not (both occur in kids <4yo)
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How long does it take to develop diarrhea from ingesting food contaminated with Staph aureus or Bacillus cereus?
1 to 8 hours (FAST ONSET!); other pathogens take days to develop symptoms
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What is the MOST common explanation for a palpable abdominal mass in a newborn?
Multicystic dysplastic kidney
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Using the 4 clinical features of describing asthma severity, what are the cut-offs for diagnosing persistent asthma?
- Daytime symptoms >2 times/wk
- Nighttime symptoms >2 times/mo
- FEV1 >80%
- Peak flow variability >20%
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For infant CPR, which method of chest compressions is superior: 2 thumb-encircling hands technique or 2 fingers on sternum technique?
2 thumbs-encircling hands technique
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What is the depth you should achieve for chest compressions on an infant?
One third to half the AP diameter
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When do you need to pause between breaths and chest compressions?
When definitive airway has not been established - 15:2 for 2 person CPR, 30:2 for 1 person CPR
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Why is it important to allow full chest recoil after each compression in CPR?
To enable cardiac refilling
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What is the treatment for labial adhesions?
Estrogen cream (followed by zinc oxide paste or petrolatum)
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What level of direct (conjugated) bilirubin do you consider cholestasis or biliary obstruction?
2 mg/dl or 20% of TSB
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The following should make you think of what diagnosis?
- -Intrahepatic cholestasis
- -Posterior iris embryotoxin
- -Vertebral anomalies
- -Peripheral pulmonic stenosis
- -Big forehead, pointed chin, hypertelorism
- Allagille syndrome
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What is the most common brachial plexus palsy in newborns?
Erb-Duchenne palsy
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Which palsy affects the upper arm?
Erb-Duchenne palsy
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Which palsy affects the lower arm?
Klumpke palsy
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Which brachial plexus palsy has poorer prognosis?
Klumpke palsy - affecting lower arm
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Aside from arm weakness, what are 3 other clinical manifestations of brachial plexus palsy?
- 1) Diaphragmatic weakness
- 2) Shoulder drop
- 3) Horner syndrome
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For brachial plexus palsy isolated to the arm, what is he mainstay of management?
- 1) Occupational therapy
- 2) Physical therapy
- 3) Surgical repair for severe
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(T/F) Hemolysis due to ABO or Rh incompatibility can persist for weeks?
True - maternal IgG has a long half-life
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What is the main cause of "intoeing" during early infancy?
Metatarsus adductus: incurving of the forefoot
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What is the main cause of "intoeing" during toddlerhood?
Tibial torsion
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What is the main cause of "intoeing" during early childhood?
Femoral anteversion
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What are clinical signs of femoral anteversion?
- 1) Reduced external hip rotation
- 2) Sitting in the "W"'position"
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What are classic findings on radiograph that would suggest Blout disease?
Downsloping of the medial metaphysis of the proximal tibiae (leading to bowed legs)
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Late systolic ejection murmur heard best at the apex in a tall teenager - what's the heart lesion?
Mitral valve prolapse
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Ejection click best heard at the right upper sternal border - what's the heart lesion?
Aortic valve stenosis
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What is the first-line anti-seizure medicine is used for treatment of partial epilepsy?
Carbemazepine or valproic acid
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What is the first-line anti-seizure medicine is used for treatment of generalized primary absence seizure?
Ethosuximide or valproic acid
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What is the first-line anti-seizure medicine is used for treatment of status epilepticus?
- 1) Diazepam to abort seizure
- 2) Phenobarbital or phenytoin for maintenance
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Why should power lifting and body building be discouraged in children and young teens?
To prevent injury to an immature skeleton
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Poor weight gain (or weight loss) in a kid with adequately controlled diabetes mellitus type 1 should make you think of what diagnosis?
Celiac disease (DM1 has higher risk for autoimmune disease)
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Poor weight gain (or weight loss) is a kid with POORLY controlled diabetes mellitus type 1 should make you think of what 2 diagnoses?
- 1) Mauriac syndrome (associated with hepatomegay and very high glucose concentrations; HgbA1c 12-14%)
- 2) Diabetic ketoacidosis (in the setting of acidosis)
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When should a child be starting to sleep through the night?
6-15 months
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How can parents promote better nighttime sleeping for their infant? (3)
- 1) Limit daytime naps to 3-4 consecutive hours
- 2) Allow infant to calm self
- 3) Limit nighttime feeding
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