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Peds 4
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84
Anatomy
Kindergarten
01/16/2011

Additional Anatomy Flashcards

 


 

Cards

Term

Polyuria, polydipsia, and weight loss

 

Hyperglycemia and glucosuria with or without ketonuria

Definition
Diabetes mellitus
Term
No disease other than __________ presents with continued frequent urination in spite of a dry tongue.
Definition
diabetes or insiprdus
Term
How do you diagnose DM in peds? (ie. random blood glucose levels)
Definition
A random blood glucose level above 300 mg/dL (16.6 mmol/L) or a fasting blood glucose level above 200 mg/dL (11 mmol/L) is sufficient to make the diagnosis of diabetes.
Term
Why do you give insulin to DM patient? What are its functions?
Definition
Insulin has three key functions: (1) it allows glucose to pass into the cell; (2) it decreases the physiologic production of glucose, particularly in the liver; and (3) it turns off ketone production
Term

  • Arthritis, involving pain, swelling, warmth, tenderness, morning stiffness, and decreased range of motion of one or more joints, lasting 6–12 weeks.
  • May have associated systemic manifestations, including fever, rash, uveitis, serositis, anemia, fatigue, and growth failure

Definition
Juvenile rheumatoid arthritis
Term
What do labs values for juvenile rheumatoid arthritis typically show?
Definition
significantly elevated markers of inflammation including ESR, C-reactive protein (CRP), white blood cell count, and platelets
Term

What is tx for juvenile RA?

 

first line?

second line?

Definition
first line: NSAIDS
second line: methotrexate
Term
Look at salter fractures
Definition
Term
Talipe equivonarus is also called...
Definition
club foot
Term
What are the three features of talipes equivonarus?
Definition
(1) plantarflexion of the foot at the ankle joint (equinus), (2) inversion deformity of the heel (varus), and (3) medial deviation of the forefoot (varus)
Term
What is tx for club foot?
Definition
Treatment consists of manipulation of the foot to stretch the contracted tissues on the medial and posterior aspects, followed by splinting to hold the correction. When treatment is instituted shortly after birth, correction is rapid. When treatment is delayed, the foot tends to become more rigid within a matter of days. After full correction is obtained, a night brace is necessary for long-term maintenance of correction.
Term
What time of year is rotovirus annoying?
Definition
winter
Term

ALL

 

What is an associated syndrome?

How do you diagnose?

Definition
What is an associated syndrome? Down Syndrome
How do you diagnose? bone marrow confirms

The diagnosis of ALL is made by bone marrow examination, which shows a homogeneous infiltration of leukemic blasts replacing normal marrow elements. The morphology of blasts on bone marrow aspirate can usually distinguish ALL from acute myeloid leukemia
Term
What is tx for ALL?
Definition
The drugs most commonly used in induction include oral prednisone or dexamethasone, intravenous vincristine and daunorubicin, intramuscular asparaginase, and intrathecal methotrexate. For T-cell ALL, intravenous cyclophosphamide may be added during induction.

Consolidation is the second phase of treatment, during which intrathecal chemotherapy along with continued systemic therapy and sometimes cranial radiation therapy are given to kill lymphoblasts "hiding" in the meninges. Several months of intensive chemotherapy follows consolidation. This intensification has led to improved survival in pediatric ALL.
Term

  • Painless cervical (70–80%) or supraclavicular (25%) adenopathy; mediastinal mass (50%).
  • Fatigue, anorexia, weight loss, fever, night sweats, pruritus, cough

Definition
Hodgkin's lymphoma
Term
What type of cells are associated with Hodgkin's lymphoma?
Definition
The diagnosis of Hodgkin disease requires the histologic presence of the Reed-Sternberg cell or its variants in tissue. Reed-Sternberg cells are germinal-center B cells that have undergone malignant transformation.
Term
Whats's the difference between hemophilia a and b?
Definition
Hemophilia A: congenital deficiency of coagulation factor VIII

Hemophilia B: congenital deficiency of coagulation factor IX
Term

  • Anemia and jaundice.
  • Splenomegaly.
  • Positive family history of anemia, jaundice, or gallstones.
  • Spherocytosis with increased reticulocytes.
  • Increased osmotic fragility.
  • Negative direct antiglobulin test 

Definition
congenital hemolytic anemia
Term

What cells are common to see in hemolytic anemia?

 

What is treatment?

Definition
Spherocytes are frequently present in persons with immune hemolysis.

give folic acid to prevent the development of red cell hypoplasia due to folate deficiency
Term

  • Greasy, bulky, malodorous stools; failure to thrive.
  • Recurrent respiratory infections.
  • Digital clubbing on examination.
  • Bronchiectasis on chest imaging.
  • Sweat chloride > 60 mmol/L

Definition
cystic fibrosis
Term

CR

 

what type of genetic disease?

 

What is virtually diagnostic of CF at birth?

Definition
autosomal recessive disease
chromosome 7

virtually diagnostic: meconium ileus
Term

What is the cornerstone of tx for CF (specifically related to GI?)

 

What vitamin supplementation?

Definition
pancreatic enzyme supplementation. Persons with CF are required to take pancreatic enzyme capsules immediately prior to each meal and with snacks.

Individuals should also take daily multivitamins that contain vitamins A, D, E, and K. Moreover, caloric supplements are often added to the patient's diet to optimize growth.
Term
What is tx for CF related to pulmonary?
Definition
inhaled mucolytic agent, recombinant human DNAse (Pulmozyme), inhaled tobramycin (TOBI), and oral azithromycin for those with chronic Pseudomonas infection.
Term

Infantile spasms

aka ??

 

what is usual age of onset?

Clinical manifestation?

Causative factors?

Definition
West Syndrome

what is usual age of onset? 3-18 months
Clinical manifestation? sudden symmetrical adduction or flexion of limbs with flexion of had and trunk; occur in clusters
Causative factors? acuired CNS injury, symptomatic, TORCHES, etc.
Term

What organism causes erythasma?

 

How do you diagnose?

 

Clinical findings:

 

Tx:

Definition
Corynebacterium minutissimum

Diagnosis: Clinical findings, absence of fungi on direct microscopy, positive Wood lamp examination

Clinical findings: Distribution: intertriginous areas of webspaces of feet, groins, axillae, submammary areas
Clinical findings: well-demarcated red or tan patches, ± scale

Tx: Benzoyl peroxide (2.5%) gel daily, after showering, for 7 days. Topical erythromycin or clindamycin solution twice daily for 7 days. Sodium fusidate ointment, mupirocin ointment or cream. Topical antifungal agents; clotrimazole, miconazole, or econazole.
Term

What is it?

Where does it typically occur?

How do you treat?

 

group A streptococcal cellulitis involving the skin to the level of the dermis. The plaque is typically erythematous, edematous, and painful, with an elevated, well-demarcated border. The associated edema tends to make the plaque appear shiny.

Definition
erysipelas

typically occurs: face and lower extremities

tx:Mild presentations may be treated on an outpatient basis with oral dicloxacillin, penicillin, or erythromycin. More severe illness or toxicity requires hospitalization and intravenous antibiotics (nafcillin, oxacillin, cefazolin, or penicillin).
Term
loss of hair in a localized area is called:
Definition
alopecia areata

most common cause of hair loss in children. An immunologic pathogenic mechanism is suspected because dense infiltration of lymphocytes precedes hair loss.

tx: 95% of pts will regrow hair in 12 months
Term
painful grouped vesicles or erosions on a red base suggest
Definition
herpes simplex
Term

What is test done to diagnose herpes simplex infection?

 

Where are HSV 1 lesions most commonly seen in infants and children?

Definition
tzanck smear

HSV 1 children and infants: gingiva, lips, and face
Term

Klinefelter is what type of syndrome?

 

How would patient present?

 

Treatment?

Definition
sex chromosome abnormality

The characteristic findings after puberty include microorchidism associated with otherwise normal external genitalia, azoospermia, sterility, gynecomastia, normal to borderline IQ, diminished facial hair, lack of libido and potency, and a tall, eunuchoid build

Treatment: males require testosterone replacement therapy
Term
Newborns with ______ syndrome may have webbed neck, edema of the hands and feet, coarctation of the aorta, and a characteristic triangular facies. Later symptoms include short stature, a shield chest with wide-set nipples, streak ovaries, amenorrhea, absence of secondary sex characteristics, and infertility. Some affected girls, particularly those with mosaicism, have only short stature and amenorrhea, without dysmorphic features.
Definition
Turner Syndrome
Term
What is tx for Turner Syndrome?
Definition
estrogen replacement therapy will permit development of secondary sex characteristics and normal menstruation and prevent osteoporosis
therapy for teenage pts
Term

What is normal serum calcium?

 

What are typical symptoms of hypocalcemia?

Definition
normal serum calcium concentration is approximately 8.9–10.2 mg/dL,

hypocalcemia: tetany, photophobia, blepharospasm, and diarrhea. The symptoms of tetany are numbness, muscle cramps, twitching of the extremities, carpopedal spasm, and laryngospasm. Tapping the face in front of the ear causes facial spasms (Chvostek sign).
Term
What is tx for hypocalcemia?
Definition
administration of intravenous calcium gluconate or calcium chloride; 10 mg/kg is the usual dose in acute treatment.
Term
What is Rickets?
Definition
term describing the characteristic clinical and bony radiologic features associated with vitamin D deficiency. Vitamin D deficiency caused by lack of sunlight exposure or dietary deficiency is the most common cause of rickets. Occult vitamin D deficiency is probably more common than is presently recognized. Rickets can also be caused by defects in the metabolism of vitamin D including liver disease (impaired 25-hydroxylation), kidney disease (impaired 1-hydroxylation of 25-(OH) vitamin D), genetic deficiency of 1α-hydroxylase (vitamin D–dependent rickets), or end-organ resistance to vitamin D (vitamin D–resistant rickets).
Term

Nervousness, emotional lability, hyperactivity, fatigue, tremor, palpitations, excessive appetite, weight loss, increased perspiration, and heat intolerance.

Goiter, exophthalmos, tachycardia, widened pulse pressure, systolic hypertension, weakness, and smooth, moist, warm skin.

TSH is suppressed. Thyroid hormone levels (T4, FT4, T3, T3RU) are elevated.

Definition
hyperthyroidism
Term

What are initial meds used for tx of hyperthroidism?

 

What disease is associated with hyperthyroism?

Definition
grave's disease

Methimazole is initiated at a dose of 10–60 mg/d (0.5-1 mg/kg/d) given once a day. PTU is started at a dose of 150–600 mg/d (5-10 mg/kg/d) in three divided doses.

Beta adrenergic therapy is indicated as adjunct therapy
Term

skin-colored papules with rough surfaces. They are intraepidermal tumors caused by infection with human papillomavirus (HPV). 

 

What is it?

How do you treat?

Definition
Verrucae (means rough)

Liquid nitrogen is often used to treat common (vulgaris) warts. The treated lesion should stay white for 20 seconds. The patient should be seen at treatment intervals of 2–3 weeks. Longer times between treatments result in lower efficacy.
Term
Whats the patho causing Acute Rheumatic Fever?
Definition
When a susceptible host encounters a group A streptococcus, an autoimmune reaction results, which leads to damage to human tissues as a result of cross-reactivity between epitopes on the organism and the host
Term

What valve is usually affected by acute rheumatic fever?

 

What is the hallmark of the disease?

Definition
mitral

hallmark: valvular involvement

Over ensuing years, usually as a result of recurrent episodes, leaflet thickening, scarring, calcification, and valvular stenosis may develop. Pericarditis most commonly causes a friction rub or a small effusion on echocardiography and may occasionally cause pleuritic central chest pain.
Term

What is this?

 

Intraocular pressure will be elevated (20 mm Hg). The cornea will appear enlarged, and, often, cloudy and edematous. Children <1 year of age should not have a corneal diameter >12 mm, and no child should have a corneal diameter >13 mm.11 There is associated blepharospasm, red infected eye, and myopia. The globe may appear enlarged. If the optic disc can be visualized, abnormal cupping or asymmetry may be found

Definition
congenital glaucoma
Term
What's the tx for congenital glaucoma?
Definition
Medical therapy of pediatric glaucoma is temporizing to decrease intraocular pressure while awaiting definitive surgical repair. Acetazolamide (3 milligrams/kg, PO every 6 hours) can be used for short periods of time but may cause metabolic acidosis. Pediatric doses are prepared by crushing the tablets used for adults.
Term

What is it? What do you do?

 

Leukocoria, poor fixation, and strabismus or nystagmus (or both) may be the presenting complaints. Absence of a red reflex in the newborn should suggest the possibility of _______

Definition
CATARACT

This requires an urgent referral to an ophthalmologist.
Term

The fascia of the eyelids joins with the fibrous orbital septum to isolate the orbit from the lids.

The orbital septum helps to decrease the risk of an eyelid infection from extending into the orbit.

Infections arising anterior to the orbital septum are termed preseptal.

Orbital cellulitis denotes infection posterior to the orbital septum and may cause serious complications, such as an acute ischemic optic neuropathy or cerebral abscess.

Definition
periorbital cellulitis
Term
present with erythematous and edematous eyelids, pain, and mild fever. The vision, eye movements, and eye itself are normal. 
Definition
preseptal cellulitis
Term
How do you tell the difference between preseptal and orbital cellulitits?
Definition
Decreased vision, restricted eye movements, and an afferent papillary defect suggest orbital cellulitis.

Children with preseptal cellulitis often present with erythematous and edematous eyelids, pain, and mild fever.
Term
What's the tx for preseptal and orbital cellulitits?
Definition
Therapy for preseptal and orbital cellulitis infection is with systemic antibiotics. Treatment of orbital infections may require surgical drainage for subperiosteal abscess in conjunction with intravenous antibiotics. Drainage of infected sinuses is often part of the therapy.
Term

What medications can you use for allergic rhinitis?

 

what are you asking about when pt says they think they have a cold?

Definition
ask about: nasal congestion, sneezing, rhinorrhea, and itchy nose, palate, throat, and eyes.

everal classes of medications have proven effective in treating allergic rhinitis symptoms, including intranasal corticosteroids, oral and intranasal antihistamines, leukotriene antagonists, and decongestants.
Term

Hyperdynamic precordium.

Widened pulse pressure.

Hypotension.

Presence of a systolic heart murmur in many cases.

Definition
patent ductus arteriosus
Term

What are some intranasal corticosteroids for allergic rhinitis?

 

Whats good if six months?

Definition
Flonace
Nasonex
Nasocort AQ--good if 6 months
Term
Enteropathogens elicit noninflammatory diarrhea through enterotoxin production by some bacteria, destruction of villus (surface) cells by viruses, adherence by parasites, and adherence and/or translocation by bacteria. Inflammatory diarrhea is usually caused by bacteria that directly invade the intestine or produce cytotoxins with consequent fluid, protein, and cells (erythrocytes, leukocytes) that enter the intestinal lumen. Some enteropathogens possess more than one virulence property. Some viruses, such as rotavirus, target the microvillous tips of the enterocytes and can enter the cells by either direct invasion or calcium-dependent endocytosis. This can result in villus shortening and loss of enterocyte absorptive surface through cell shortening and loss of microvilli
Definition
Term
Clinically determine the etiology of diarrhea for institution of prompt antibiotic therapy, if indicated. Although nausea and vomiting are nonspecific symptoms, they are indicative of infection in the upper intestine. Fever is suggestive of an inflammatory process but also occurs as a result of dehydration or co-infection (e.g., urinary tract infection, otitis media). Fever is common in patients with inflammatory diarrhea. Severe abdominal pain and tenesmus are indicative of involvement of the large intestine and rectum. Features such as nausea and vomiting and absent or low-grade fever with mild to moderate periumbilical pain and watery diarrhea are indicative of small intestine involvement and also reduce the likelihood of a serious bacterial infection.
Definition
Term

What age group is usually affected by absence seizures?

 

What is tx?

 

Definition
age group 3-12 years

tx: valproic acid, lamotrigine or ethosuximide
Term

What age group is affected by febrile seizures?

 

what is tx?

Definition
age group three months to 5 years

tx: treat underlying illness

diazepam orally

if prolonged seizures: diastat rectally
Term
Contraindications to Breastfeeding:
Definition
HIV infection
Active TB
certain types of chemo
meds: iodine, SSRI
Breast Cancer
Illicit drug use
galactosemia: part of newborn drug screen
Term
Causes of diarrhea in newborn:
Definition
celiac disease
Toddler's diarrhea: juice
AGE: acute gastroenteritis
Milk protein intolerance
Allergies
CF: affects ability to absorbe in GI tract
Term

what is 5 2 1?

 

Definition
five servings fruits and veggies
2 hours screen time
1 hour physical activity
Term

At what age can a toddler typically start to be potty trained?

 

why is that? whats going on developmentally?

Definition
toddlers have the sensory capacity for awareness of a full rectum or bladder and are physically able to control bowel and urinary tract sphincters.

18 months
Term
What medications are used for depression in  a child six yers and older?
Definition
fluoxetine (prozac)
Term
what is the black box working on SSRIs in children? What is tx for depression?
Definition
—SSRI’s (black box warning)-suicidality/increase in suicidal thoughts-SSRI kicks in 2-3 weeks
FDA approved; fluoxetine (Prozac) MDD (>8yo), OCD (>7yo), start at 5 or 10mg titrate up slowly. Max-30mg/daily. Taper to d/c.
escitalopram (Lexapro) MDD (>12yo) Max-20mg/daily. Taper to d/c.
Term
Newborn screening tests
Definition
PKU
Galactosemia
congenital hypothyroidism
sickle cell diseas
cystic fibrosis
hearing screening
Term
What are the two types of pathologic unconjugated hyperbilirubinemia?
Definition
can be grouped into two main categories: overproduction of bilirubin or decreased conjugation of bilirubin
Term

WHen is puberty considered precocious in females?

 

caucasians

African Americans

Hispanic

Definition
Puberty is considered precocious in girls if the onset of secondary sexual characteristics occurs before age 8 years (7 years for African-American and Hispanic girls
Term
What's the difference btw GnRH dependant and GnRH independant causes for precocious puberty?
Definition
GnRH dependant: activation of the hypothalamic GnRH pulse generator, an increase in gonadotropin secretion, and a resultant increase in production of sex steroids
examples: hypothalamic hamartomas, CNS tumors, cranial irradiation, hydrocephalus, and trauma

GnRH independant: occurs independent of gonadotropin secretion
Examples: ovarian or adrenal tumors, ovarian cysts, congenital adrenal hyperplasia, McCune-Albright syndrome, or exogenous estrogen.
Term
What's the normal progression of female development/puberty?
Definition
reast development, followed by pubic hair growth and menarche

telarche, pubarche, menarch
Term
Whats the tx for central precocious puberty?
Definition
Girls with central precocious puberty can be treated with GnRH analogues that downregulate pituitary GnRH receptors and thus decrease gonadotropin secretion. Currently, the two most common GnRH analogues used are (1) leuprolide, which is given as a monthly intramuscular injection or (2) histrelin subdermal implant, which is replaced annually.
Term
What labs/tests do you do if you suspect precocious puberty?
Definition
One of the first steps in evaluating a child with early pubertal development is obtaining a radiograph of the left hand and wrist to determine skeletal maturity (bone age).

In central precocious puberty, the basal serum concentrations of FSH and LH may still be in the prepubertal range. Thus, documentation of the maturity of the hypothalamic-pituitary axis depends on demonstrating a pubertal LH response after stimulation with a GnRH agonist.

In peripheral precocious puberty, basal serum FSH and LH are low, and the LH response to GnRH stimulation is suppressed by feedback inhibition of the hypothalamic-pituitary axis by the autonomously secreted gonadal steroids
Term
At what age in a male is it considered precocious puberty?
Definition
Puberty is considered precocious in boys if secondary sexual characteristics appear before age 9 years.
Term
In all boys with central precocious puberty, what tests should be done?
Definition
cranial MRI should be obtained to evaluate for a CNS abnormality. Ultrasonography may be useful in detecting hepatic, adrenal, and testicular tumors.
Term
When can you diagnose failure to thrive? whats criteria?
Definition
The diagnosis also is warranted if a child younger than age 6 months has not grown for 2 consecutive months or if a child older than age 6 months has not grown for 3 consecutive months.
Term
What are the 3 types of failure to thrive?
Definition
Type I: the head circumference is preserved and the weight is depressed more than the height. This most common type results from inadequate caloric intake, excessive loss of calories, or inability to use calories peripherally. Most cases of type I deficiencies are the result of poverty, lack of caregiver understanding, poor caregiver-child interaction, abnormal feeding patterns, or a combination of factors.

Type II growth deficiency, which is associated with genetically determined short stature, endocrinopathies, constitutional growth delay, heart or renal disease, or various forms of skeletal dysplasias, is characterized by normal head circumference and proportionate diminution of height and weight.

Type III growth deficiency, all three parameters of growth—head circumference, weight, and height—are lower than normal. This pattern is associated with central nervous system abnormalities, chromosomal defects, and in utero or perinatal insults.
Term
What does the rash of Rocky Mountain Spotted Fever look like? When in the course of the illness doe sit present?
Definition
On approximately the fourth day of fever, an eruption of erythematous blanching macules 2 to 6 mm in diameter appears on the wrists, ankles, palms, and soles. It spreads centripetally to the trunk, face, axillae, and buttocks. In 2 or 3 days, the lesions become maculopapular, assume a deep-red color, and finally become petechial hemorrhages that resolve with the usual color changes
Term
What is the tx for chemical conjunctivitis?
Definition
Irrigation with NS and should be treated after irrigation with erythromycin ointment four times daily and referred for an ophthalmologic examination in 24 to 48 hours. These patients are considered to have "chemical conjunctivitis."

A topical cycloplegic agent should be used three times daily for pain reduction if an epithelial defect is present. Avoid phenylephrine as a cycloplegic, as it will constrict blood vessels, causing further ischemia to the limbus. Apply erythromycin ophthalmic ointment four times daily to affected eyes. Administer tetanus toxoid as appropriate.
Term
What is tx for bacterial conjunctivitis in someone who wears contacts? in someone who doesnt wear contacts?
Definition
Trimethoprim and polymyxin B is very effective and avoids potential allergies to sulfa and neomycin preparations. Wearers of soft contact lenses should be treated with a fluoroquinolone (Ciloxan, Ocuflox) or aminoglycoside (Tobrex) to treat Pseudomonas.
Term
Continuous machinery type murmur
Definition
patent ductus arteriosis
Term
Grade I–III/VI systolic ejection murmur at the pulmonary area
Definition
atrial septal defect
Term
Holosystolic murmur at lower left sternal border with RV heave
Definition
ventral septal defect
Term
What is most common tx for bacterial endocarditis?
Definition
Vancomycin, with or without gentamicin, for a 6-week course is the most common regimen
Term
What is ITP? What is tx?
Definition
Decreased paltelet and rest of blood levels are normal. tx: prednisone, avoid aspirin
Term
What is this? What is tx?
Characteristically, a thriving infant 3–12 months of age develops recurring paroxysms of abdominal pain with screaming and drawing up of the knees. Vomiting and diarrhea occur soon afterward (90% of cases), and bloody bowel movements with mucus appear within the next 12 hours (50%). The child is characteristically lethargic between paroxysms and may be febrile. The abdomen is tender and often distended. A sausage-shaped mass may be palpated, usually in the upper mid abdomen
Definition
intussusception

Barium enema and air enema are both diagnostic and therapeutic.
Term
What are the perinatal congenital infectiosn you worry about?
Definition
•Toxoplasmosis
•Other (syphilis)
•Rubella
•Cytomegalovirus (CMV)
•Herpes simplex virus (HSV)
Term
What do you use to treat pseudomonas infections in patients with cystic fibrosis?
Definition
inhaled tobramycin (TOBI), and chronic oral azithromycin for those with chronic Pseudomonas infection.
Term
When do neonatal seizures typically present?

What are causes?
Definition
Usual onset at 12–48 hours.
Seizure types include subtle (characterized by variable findings), tonic, and multifocal clonic.
Most common causes include hypoxic-ischemic enceph-alopathy, intracranial bleeds, and infection.
Term
What's the difference between petechiae, purpura and echymosis?
Definition
Bleeding under the skin or into mucosal membranes is called purpura and may be an innocent finding related to mild childhood trauma or may be the presenting sign of a life threatening disease. Purpura can be subdivided based on size into petechiae and ecchymoses. Pinpoint areas (less than 2 mm) of hemorrhage, which are reddish-purple lesions are called petechiae while larger confluent lesions are referred to as ecchymoses
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