Transcript Pediatrics Review Session

Pediatrics Review Session
Growth
and
Develop
ment
GI, Fluids,
Electrolyt
es
Genetic
Disorders
Grab Bag
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Emergenc
y Care
Dermatol
ogy
Hematolo Malnutrit
gy
ion
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Neurolog
y
Endocrin
ology
Oncology
Infectious
Disease
Neonatol
ogy
Cardiolog
y
Nephrolo
gy
Grab Bag
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Growth and Development 100
What is the average weight of a 6 month-old
child? A one year-old child?
6 months: 6 kg
One year: 10 kg
Growth and Development 200
What are Ebstein pearls and where are they
located?
Ebstein pearls are keratin containing cysts
located in the midline of a neonate’s palate.
They are benign.
Growth and Development 300
• At what age do children usually begin to walk
and use a few words specifically?
Most children walk at 12 months (range 10-15
months). Most children will begin to use
words at 9 months, but will begin to use them
correctly at 12 months.
Growth and Development 400
What is the most common inherited cause of
mental retardation?
The most common inherited cause of mental
retardation is Fragile X syndrome. The most
common genetic cause of mental retardation
is Down Syndrome.
Growth and Development 500
What is the correct sequence of pubertal
development in females: adrenarche, growth
spurt, menarche, thelarche?
Female: thelarche, growth spurt, adrenarche,
menarche
Male: testicular enlargement, penile
enlargement, growth spurt, adrenarche
Emergency Care 100
A 6 year-old male child is brought in after a road
traffic accident. He is bleeding profusely from
an open leg fracture. What is always the
initial step in emergency management?
AIRWAY, BREATHING, CIRCULATION
Emergency Care 200
What is the difference between a second- and thirddegree burn?
First degree burns involve only epidermis.
Second degree burns extend into the dermis.
Third degree burns extend through the dermis (fullthickness)
Fourth degree burns involve fascia, muscle, bone
and joint tissue.
Emergency Care 300
A child presents with respiratory distress and a
hives shortly after eating peanuts for the first
time. What is the most important drug to give
and how?
This child is likely having an anaphylactic
reaction. Give epinephrine (adrenaline) IM
first. You may also give steroids,
chlorpheniramine, salbutamol, and ranitidine.
Emergency Care 400
Name five of nine signs of respiratory distress in children.
Grunting
Flaring
Retractions/Chest wall indrawing
Tachypnea
Hyperpnea
Head bobbing
Cyanosis
Stridor
Wheezing
Emergency Care 500
A 4 year old child presents with fever and altered
mental status. After your initial assessment, you note
that the child is tachycardic, dilated pupils and red,
flushed skin. The mother tells you she thinks the child
took some pills laying around the neighbor’s house.
What class of drug did the child take?
This child is exhibiting the anticholingeric toxidrome:
fever, mydriasis, flushing, dry skin, hypertension,
tachycardic, urinary retention, convulsions, urinary
retention
Dermatology 100
What is the correct treatment?
Tinea corporis: topical clotrimazole
Dermatology 200
What is the correct treatment?
Tinea capitis: oral griseofulvin
Dermatology 300
What is the causative agent for fifth’s disease?
Fifth’s disease (erythema infectiosum) is caused
by parvovirus B19. Classically, there is a
slapped cheek rash which progressed to a
erythematous maculopapular rash that
spreads from the arms to the trunk.
Dermatology 400
This newborn’s mother had a cold during
pregnancy. What congenital syndrome is he
likely to have:
Congenital rubella is
classically associated
with a blueberry muffin
rash.
Dermatology 500
This child recently started bactrim and nevirapine.
What’s the diagnosis?
Stevens Johnson Syndrome. Common causative
agents include: antibiotics, anticonvulsants, and
sulfa drugs. Treat these patients as burn patients.
GI Fluids and Electrolytes 100
What is the hourly maintenance fluid rate for a
26kg child?
Use the 4-2-1 rule: 4 x 10 = 40
2 x 10 = 20
1x6=6
Total = 66 cc/hr
GI Fluids and Electrolytes 200
A 9 year old female presents with two days of
fever, vomiting, and anorexia. She complains
of periumbilical tenderness and had mild
abdominal distention. What is the diagnosis
and first step in management?
This child is highly concerning for appendicitis.
Call surgery immediately.
GI Fluids and Electrolytes 300
An 8 month-old male presents with intermittent
fussiness and drawing up of his legs. You
palpate a mass in the right lower quadrant
during one of these episodes. How would you
manage him?
This case is suggestive of intussusception.
Consult surgery to assist with an air enema.
GI Fluids and Electrolytes 400
What electrolyte abnormalities would you
expect to find in a child with pyloric stenosis?
(Name 3 changes)
Hypochloremic metabolic alkalosis and
hypokalemia. The child is vomiting gastric
contents (HCl) and driving potassium
intracellular.
GI Fluids and Electrolytes 500
Name 4 treatments for hyperkalemia.
Calcium gluconate
Albuterol/salbutamol
Bicarbonate
Insulin/Glucose
Kayexalate (sodium polystyrene sulfonate)
Dialysis
Hematology 100
Daily Double I
Name three hemoglobinopathies associated
with protection from infection with P.
falciparum.
Sickle cell trait
Thalassemia
Hereditary Persistence of Hemoglobin F
G6PD deficiency
Hematology 200
A one week old neonate presents with blood in
the stool. What is the treatment for the most
likely disorder?
Hemorrhagic disease of the newborn can
present with bleeding in the first 2 to 10 days
of life. Give vitamin K IM, especially if it was
not given at birth.
Hematology 300
Name two causes of microcytic anemia.
Severe lead poisoning
Iron deficiency anemia
Thalassemia syndromes
Sideroblastic anemia
Hematology 400
What is the genetic mutation associated with
hemoglobin S?
In the beta globin gene, there is a glutamic acid
(GTG) to valine (GAG) substitution. Many
other mutations exist, causing a variety of
abnormal hemoglobins.
Hematology 500
A 3 year-old child presents with a petechial rash.
The mother reports that the child had a
diarrheal illness 2 weeks before. On the CBC,
everything is normal except for the platelet
count of 35. What is the treatment?
This child likely has Idiopathic
Thrombocytopenic Purpura (ITP). Observe the
child clinically.
Malnutrition 100
What is the WHO recommendation for when to
transfuse a child with malnutrition?
WHO recommends blood transfusion when the
hemoglobin drops below 4g/L or Hb 4-6g/L
AND child is showing signs of life-threatening
heart failure or respiratory distress
Malnutrition 200
List the criteria for diagnosing malnutrition.
Weight-for-height < 70% or <-3 SD
Bilateral pedal edema
Clinical signs of severe malnutrition
Malnutrition 300
Match the vitamin with the manifestation of
deficiency:
Vitamin A
Vitamin D
Zinc
Vitamin C
Dermatitis
Night blindness
Stomatitis
Rachitic rosary
Malnutrition 400
Which is the most reliable sign of dehydration in a
malnourished child?
a. Sunken eyes
b. Tachycardia
c. Poor skin turgor
d. Dry mucus membranes
B. Tachycardia is the most reliable of the choices. Most
malnourished children have limited subcutaneous tissue,
therefore will often have sunken eyes and poor skin
turgor. They can also have atrophic salivary glands, and
therefore dry mouth.
Malnutrition 500
Which electrolyte abnormality can be most deadly
as you start to feed a severely malnourished
child?
Children who have been starved are at risk for
refeeding syndrome. In this occurrence, there
are rapid shifts of electrolytes into deprived cells.
Hypophosphatemia can cause sudden death, as
can hypokalemia and hypomagnesemia less
commonly.
Genetic Disorders 100
What is the mode of inheritance of cystic
fibrosis?
Autosomal recessive
Genetic Disorders 200
Name the cardinal features of DiGeorge
Syndrome?
Cardiac anomalies
Abnormal facies
Thymus absent
Cleft palate
Hypocalcemia
Genetic Disorders 300
Name three health problems that pose a specific
risk to patients with Down Syndrome.
Atlantoaxial instability
Cardiac defects (ASD, VSD, endocardial cushion defects)
Cryptorchidism
Duodenal atresia
Eye anomalies
Hirschsprung’s disease
Hypothyroidism
Leukemia
Genetic Disorders 400
During your newborn exam, you notice that a
female infant has a webbed neck, widely
spaced nipple, and swollen feet. What
physical exam maneuver should you pay
particular attention to?
Turner’s syndrome (45, XO). These women may
also coarctation of the aorta, so checking the
femoral pulses is critical.
Genetic Disorders 500
What enzyme is often mutated in
oculocutaneous albinism?
There are multiple gene defects associated with
albinism. Two types of albinism are
associated with defects in the tyrosinase gene.
Grab Bag I 100
At what age should a child be vaccinated for
measles?
Most children should receive measles vaccine at
9 months of age. During a outbreak , the
vaccine can be given as early as 6 months.
Grab Bag I 200
What is the common age range during which
autism presents?
Autism usually presents between 18month and
3 years of age with verbal and motor delays
and poor attachment.
Grab Bag I 300
A 13 year old male presents with painless
hematuria and lethargy. What pathogen
should you look for under the microscope?
Urinary schistosomiasis can present with
dysuria, or with painless hematuria. Eggs can
be visualized in the urinary sediment.
Grab Bag I 400
What is the most common cause of urinary tract
obstruction in the newborn?
Posterior urethral valves is the most common
cause of urinary tract obstruction in the
newborn. It is associated with renal
dysgenesis in utero, and progression to renal
failure if untreated.
Grab Bag I 500
What is the most appropriate feeding option for
an HIV infected mother?
Breastfeeding remains the best option for HIVinfected mothers, despite the risk of
transmission.
Neurology 200
Name four common causes of neonatal seizures.
Birth asphyxia
CNS malformations
Hypoglycemia
Intracranial bleeding
Metabolic abnormalities
Sepsis/meningitis
Toxin
Neurology 400
What are the common vital sign changes
associated with subclinical status epilepticus?
Commonly, patients with seizures will have
tachycardia, hypoxia, and appear to have
respiratory distress.
Neurology 600
Name the three elements of Cushing’s triad
suggesting increased intracranial pressure.
Bradycardia
Hypertension
Abnormal respiration
Neurology 800
What EEG abnormalities is classically associated
with absence seizures?
3 Hertz spike and wave pattern is classic for
absence seizures.
Neurology 1000
Name four health complications associated with
cerebral palsy.
Frequent (aspiration) pneumonia
Mental retardation
Seizure disorder
Contractures/orthopedic problems
Hearing loss
Vision abnormalities
GERD
Failure to Thrive
Endocrinology 200
What is the total body potassium status of a
patient presenting in DKA (low, normal, high?
Regardless of what the laboratory values
suggest, all patients with DKA are potassium
depleted (LOW). It is critical to replace
potassium as you fix their acidosis.
Endocrinology 400
Name 3 clinical symptoms of hypercalcemia?
“Bones, stones, groans, psychiatric overtones”
Nephrolithiasis
Abdominal pain/constipation
Mental status changes/seizures
Bone pain
Endocrinology 600
What is the initial step in management of a child
in DKA?
Patients with DKA are frequently dehydrated. It
is important to slowly rehydrate first, before
giving insulin.
Endocrinology 800
Your patient is admitted with encephalitis.
Despite constant maintenance IV fluids, the
child is becoming dehydrated. What
hormonal abnormality might you suspect?
SIADH: syndrome of inappropriate antidiuretic
hormone secretion. SIADH is associated with
brain injuries.
Endocrinology 1000
A 3 week old female infant presents with vomiting and
dehydration. His initial laboratory studies are notable for
hypernatremia and hypokalemia. You also notice that
her clitoris seems enlarged. What hormonal abnormality
should you suspect?
Congenital adrenal hyperplasia can present in the newborn
period with ambiguous genitalia (in the female),
dehydration, and shock. It is most commonly due to 21hydroxylase deficiency, which causes overproduction of
DHEA, and decreased mineralocorticoid and
glucocorticoid.
Oncology 200
What TWO viruses are commonly associated
with Burkitt’s lymphoma?
EBV (Ebstein Barr virus) and HIV (Human
Immunodeficiency virus) and both associated
with Burkitt’s lymphoma.
Oncology 400
Describe three clinical findings associated with
Beckwith Wiedemann sydrome?
Wilm’s tumor
Macrosomia
Macroglossia
Hemihypertrophy
Omphalocele
Oncology 600
What lab abnormalities are associated with
tumor lysis syndrome?
Hyperkalemia
Hypocalcemia
Hyperphosphatemia
Hyperuricemia
Oncology 800
A two year old child with an abdominal mass
develops dancing eyes and dancing feet.
What type of tumor might you suspect?
Opsoclonus-myoclonus is a paraneoplastic
syndrome associated with several tumors,
most commonly neuroblastoma. The
symptoms do not always resolve with
treatment of the tumor.
Oncology 1000
Daily Double II
Name two potential life threatening side effects
of cyclophosphamide.
Hemorrhagic cystitis
Bone marrow suppression
Transitional cell carcinoma of the bladder
Infectious Disease 200
What are the most common causative agents for
neonatal sepsis?
Group B Strep
E. Coli
Listeria
(In developing countries, other gram negatives and
staph species are also common)
Infectious Disease 400
Name three common complications of measles
infection.
Pneumonitis/pneumonia
Encephalitis
Diarrhea
Keratitis
Infectious Disease 600
What is the diagnosis and what are the cellular
inclusions called?
P. Falciparum malaria with trophozites visible in
the red blood cells
Infectious Disease 800
After what age can you reliably obtain an HIV
antibody level on a child with perinatal
exposure?
Infants with perinatal exposure can have
maternal antibodies through the first year of
life. Typically, if antibodies persist beyond 18
months, they are believed to be from the
child.
Infectious Disease 1000
What clinical signs might you expect in someone
taking isoniazid for tuberculosis without taking
pyridoxine?
B6 deficiency manifests as peripherial
neuropathy and seizures.
Neonatology 200
A one week old presents with jerking
movements of his extremities, decreased
tone, and inability to suck. What infection
should you suspect?
Neonatal tetanus
Neonatology 400
What lab test should you check if you see this on
the first day of life.
Oral thrush on the first day of life is highly
suspicious for HIV.
Neonatology 600
A 4.5kg newborn is found to have an asymmetric
Moro. His left arm is held in a extended and
internally rotated position. What nerve injury
might he have sustained?
This is suggestive of a Erb’s palsy, an injury to
the fifth and sixth cervical nerves. This injury
results from excessive traction to the arm
during delivery.
Neonatology 800
What laboratory abnormality would you expect
from the infant of a diabetic mother and why?
Infants of diabetic mothers are often born
hypoglycemic due to increased insulin
production while in a hyperglycemic
intrauterine environment.
Neonatology 1000
Name four causes of pathologic jaundice in the
newborn.
ABO/Rh incompatibility
Congenital Hypothyroidism
Defective conjugation (Crigler-Najjar, Gilbert’s)
Prematurity
Red cell enzyme defects (hereditary spherocytosis, G6PD)
Sepsis
TORCH
Cardiology 200
Name the five cyanotic heart lesions
Truncus arteriosus
Transposition of the Great Arteries
Tricuspid Atresia
Tetralogy of Fallot
Total Anomalous Pulmonary Venous Return
Cardiology 400
What are the most common valvular lesions
associated with rheumatic heart disease?
Mitral regurgitation is the most common
valvular lesion. Aortic insufficiency can also
occur.
Cardiology 600
A 4 month old infant presents with poor feeding and
weakness. You note that the heart rate is
persistently 205 with good skin turgor, and moist
mucous membranes. When you check again after
triage, you get the exact same: 205. What cardiac
arrhythmia might you suspect?
This infant might be in poorly compensated
supraventricular tachycardia. Try vagal maneuvers
such as rectal stimulation, ice on the face, elicit the
gag reflex.
Cardiology 800
What are the classic physical exam findings
associated with an ASD?
A systolic murmur audible at the left upper
sternal border with a fixed, split S2.
Cardiology 1000
A child with a known murmur occasionally has
episodes of cyanosis and respiratory distress
relieved by squatting. What are the
abnormalities of his cardiac anatomy?
Overriding aorta
Pulmonic atresia/stenosis
VSD
RVH
Nephrology 200
What constellation of (4) clinical/laboratory
findings define nephrotic syndrome?
Proteinuria
Edema
Hypoalbuminemia
Hyperlipidemia
Nephrology 400
A 5 year old develops hematuria and swelling 2
weeks after being treated with ‘unspecified
antibiotics’. What two types of infection
might you suspect he had?
This history is suggestive of acute poststreptococcal glomerulonephritis, which can
be caused by strep pharyngitis or strep skin
infections (i.e. impetigo)
Nephrology 600
What is the most specific test of the urinalysis to detect
a urinary tract infection?
Nitrites has 88% sensitivity and 98% specificity.
Leukocyte esterase has 84% sensitivity, 78% specificity.
Nephrology 800
A 14 year old female presents with joint pains and hematuria. On
exam, you also note an erythematous rash on her face. Her labs
are further notable for normocytic anemia. She meets diagnostic
criteria for what disease?
Lupus erythematosus is characterized by 4 of 11 findings:
Malar rash
Discoid rash
Photosensitivity
Cytopenia
Oral ulcers
Arthritis
Neurologic disease
Nephritis
Serositis
Autoimmune antibodies
Positive ANA
Nephrology 1000
A 8 year old female presents with a history of
bloody diarrhea one week ago, now with a
petechial rash and oliguria. Name her
syndrome and another associated anomaly.
Hemolytic uremia syndrome can follow
infections with E. coli. It is described by
thrombocytopenia, acute renal failure, and
microangiopathic hemolytic anemia.
Grab Bag II 200
What is the difference between meningitis and
encephalitis clinically?
Meningitis is inflammation of the meninges.
This may cause pain and seizures. Encephalitis
is inflammation of the cerebrum, therefore is
associated with altered mental status.
Grab Bag II 400
After what age should an undescended testis be
repaired?
Undescended testes place a child at risk for
infertility and neoplasm. Most infants’ testes
descend by 12 months. If after 12 months of
age they have not descended, consider
orchidopexy.
Grab Bag II 600
Name three facultative or obligate intracellular
bacterial pathogens
Grab Bag II 800
What is the most appropriate maintenance
medication for intermittent asthma (please
name medication and route).
Inhaled salbutamol is the most appropriate
maintenance medication for intermittent asthma.
Children with most persistent symptoms should take
an inhaled steroid. If inhaled salbutamol is not
available, you may use oral salbutamol.
Grab Bag II 1000
During a blood transfusion for a Hb of 3.2, a
child develops a fever and chills. What are the
most important medications to administer?
This child is having a transfusion reaction. Stop
the transfusion immediately and give
paracetamol and chlorpheniramine or
hydrocortisone.