October 21st

10/21/2016

1. What is leukocoria? Abnormal white reflex of retina instead of red. Could

be a sign of retinoblastoma, or cataract..etc.
2. Conjugated hyperbilirubinemia also called pathologic jaundice, more
severe and take lower to recover usually requiring surgery than
unconjugated or physiologic jaundice. Also pathologic is due to more
severe causes like atresia, sepsis, and metabolic disorders.
3. Physiologic jaundice is usually due to hemolysis or hemorrhage.
4. Breast feeding syndrome is usually in first to 7 days of newborn, mother
isnt giving enough breast feeding.
5. Breast milk jaundice is when some reason enzyme in breast milk inhibits
conjugation of newborn bilirubin. Rx: also give hydrolyase formula with
breast milk.
6. APGAR score is routinely measured in 1 and 5 minutes at birth. 0 to 10.
Perfect APGAR is completely pink (no blue/pale), > 100 bpm,
cough/cry reaction from stimulation, spontaneous active
movement, regular strong crying.
7. Common for appearance in APGAR to be 1, some blue some pink.
Normally resolve within 1-2 days. If pulse is less than 100 bpm and
respiratory is irregular, positive-pressure ventilation is initiated.
8. Ignoring parent, not paying attention in class, language delayed, and
social isolation is not always ADHD. Consider undetected hearing
impairment first. ADHD doesnt cause language delayed and social
isolation. Autism must include repetitive behaviors in the diagnosis.
9. Fever, parotitis? Mumps. Usually self-limiting, but most common
complication is aseptic meningitis, then orchitis.
10. Enterovirus = Picornavirus
11. Measles is confirmed with PCR, and tx is supportive. Rocky Mountain
Spotted Fever is like Measles with fever, conjunctivitis, and macular rash,
but the rash starts in palms and soles.
12. Erythema infectiosum is parvo B19. Exanthema subitum is roseola.
Roseola has high fever first and rash appears when fever disappears.
13. Thymus is visible in xray in children less than 3 years old. It locates
under right clavicle next to the heart. Absence is suggestive of
diGeorges disease.
14. Minimal change disease has normal kidney biopsy, not thickened GBM.
Thickened GBM and subepithelial spike are pathognomonic for
membranous GN. Only sign of MCD is effacement of foot processes.
15. Nephrotic disease in kids under 10 years old can essentially diagnose
as minimal change disease. MCD Tx is corticosteroid.
16. Parvo B19 is self-limiting. No worry except in sickle cell patient where
aplastic anemia is a potential complication.
17. What is the most serious complication of measles? Subacute
sclerosing panencephalitis (brain injury)

18. Rubella is called German Measles because it is just like Measles, fever,
rash from face and downwards, but less severe and has tender enlarged
lymph nodes.
19. Measles and Rubella are fever AND rash. Roseola is fever (>104)
THEN rash (rash starts at trunk instead of face and spread outwards)
20. Since Roseola reaches high fever very fast, what is a serious
complication? Febrile seizure.
21. Varicella Zoster has rash without fever.
22. Urticaria = allergy rash
23. Anaphylaxis = urticarial + hypotension +wheeze (respiratory
constriction). Gold standard Tx? Epinephrine
24. Tympanoplasty = ear tube to prevent recurrent otitis media. (-plasty =
plastic repair)
25. Treatment for sinsusitis? Supportive, unless very severe, amoxicillin
+ clavulonate
26. Digital trauma = nose picking resulting nosebleed.
27. Croup from parainfluenza, treatment is racemic epinephrine.
28. Uvula deviation = peritonsillar abscess
29. If foreign body stuck in the trachea, since trachea looks like a vagina,
xray AP will be negative and xray lateral view will be positive.
30. If you just meet a new patient and dont know whether patient has
asthma, perform pulmonary function test (FEV1/FVC). Since asthma is
an obstructive disease, asthmatic cannot force out 80% of the total
volume in one second.
31. Oral corticosteroid affects whole body, more side effects, inhaled
steroid just the lung with cough as side effect. Examples: -asone,
prednisolone, prednisone
32. Prednisone is activated into prednisolone. So prednisolone is
preferred, more easily absorbed with hepatic disease.
33. Bronchiolitis, most commonly caused by RSV, during winter months.
34. Bronchiolitis tx is just O2 and IV fluid, supportive. Steroid, antibiotic do
nothing.
35. Diagnosis of CF is usually before birth with prenatal screening. After
birth, meconium ileus is diagnostic. Foreign child with no hx or care,
sweat chloride test.
36. Premature + GI bleeding = Necrotizing Enterocolitis.
37. At first minute of birth, focus is on airway and oxygenation. If HR is
less than 100, administer positive pressure ventilation.
38.
APGAR score does not predict long term outcome. It is a
measurement to see if the baby is improving.
39. If newborn after delivery has less than 60 bpm, start code of CPR and
epinephrine.
40. Acrocyanosis skin tone is AGPAR score is 1 point in appearance.
Irregular breathing is 1 point in respiratory.

41. On chest xray, transient tachypnea in newborn has hyperinflated

lungs, and respiratory distress syndrome has hypoinflated lungs.
42. Passing of meconium is normally within first 24 hours. Not yet by 48
hours, thats abnormal=failure to pass meconium. Potential causes:
imperforate anus, meconium ileus, Hirschsprungs disease
43. f/u = follow-up
44. Imperforate anus you don't go surgery right away, since it usually
comes as a constellation of diseases called VACTERL so check other
potential diseases before surgery.
45. Hirschsprung is loss of inhibitory neuron so colon is constantly
constricted and no stool can pass and proximal piles up.
46. Recommendations to prevent SIDS (sudden infant death syndrome)
are infant sleep on their back, sleep alone no adult, and no
smoking in house.
47. Tx for pediatric meningitis? Ceftriaxone +/- steroid
48. Possible HIV vertical transmission from mother? AZT. Prescribe
HAART only if baby is confirmed HIV positive.
49. Pediatric osteomyelitis cause? Staph aureus, but salmonella in
sickle cell patients.
50. Septic joint from teen is most likely sexually gonorrhea.
51. Pinworm treatment? Albendazole
52. Seizure drug is the same for pediatrics and adult. Most common:
levetiracetam.
53. How to determine innocent vs. pathologic murmur? Anything above
grade 3 systolic and all diastolic mumurs are pathologic.
54. Increased pulmonary artery flow from Left to Right shunt will lead to
increased pulmonary artery pressure thus also increased pulmonary
artery resistance.
55. Fixed split S2 = Atrial septal defect
56. Right to left heart shunt presents with cyanotic baby. To keep the baby
alive until surgery, administer prostaglandin to keep PDA open instead of
indomethacin to close it.
57.