小兒科

125 flashcards · Other · by Wanying Koh

1. Cyanotic at birth widely split S1 and S2 EKG right deviation, RA 擴大 Dx

   Ebstein anomaly

2. tetra of fallot 的 hypoxic spells/blue spells cause heart murmur sounds to increase / decrease?

   heart murmur sounds decrease

3. snowman appearance -- supracardiac TAPVC

4. tetra of fallot tetra 包括什麼 有什麼 murmur cause of murmur

   RVOT, overarching aorta, VSD, RV hypertrophy HSM RVOT causing turbulent bloodflow --> murmur

5. most common congenital heart defect in term babies

   VSD

6. VSD types most common type most common in Asians heal spontaneously associated w aortic valve prolapse associated w pulmonary valve stenosis

   type II (perimembranous/subaortic) type II type IV muscular type II type II (perimembranous/subaortic)

7. 有機會癒合的 VSD

   type IV (muscular) -- if small defect

8. Howell-Jolly body seen in what kind of patients

   Howell-Jolly body --> nuclear metabolism 產物, removed by the spleen therefore, seen only in asplenic pts e.g. R atrial isomerism (L isomerism 會多spleen)

9. PGE1 infusion (maintain PDA) required in which CHD

   tetra of fallot hypoplastic L heart syndrome interrupted aortic arch pulm atresia w VSD (VSD 不用)

10. lower limbs BP lower than upper limbs Dx

    coarctation of aorta

11. Dx

    Pulmonary sling (CXR lat view: anterior indentation)

12. CXR: esophageal indentations diagnosis lateral view: post. indent; AP view: bilateral indent lateral view: ant. indent lateral view: normal; AP view: bilateral indent

    double aortic arch pulmonary sling R aortic arch & left PDA

13. QT prolong electrolytes

    hypoCa hypoK hypoMg (Na 不是)

14. QT prolong medications

    Macrolides (clarithro, erythro, azithro) Amiodarone haloperidol

15. arrhythmia in children debrillation 電擊量多

    PALS guideline: 2 J/kg --> 4 J/kg --> >=4 J/kg

16. complications of samonella infection

    reactive arthritis osteomyelitis

17. samonella infection need ABx tx?

    一般 no need ABx tx unless: immunocompromised high fever, very low temperature toxic megacolon 有毒性病容 sepsis sickle cell disease hx (abnormal RBC cause BV infarction --> low immune system --> susceptible to encapsulated bacterial infection e.g. S. pneumoniae, N. meningitidis, H. influenzae)

18. dehydration 如何評估

19. pyloric stenosis 的 visible peristalsis occurs during? feeding before/after? vomiting before/after

    after feeding before vomiting

20. intussusception recurrence rate more common in which gender most common location

    10% M:F 3:1 ileocolic region

21. meckel diverticulum diverticulitis occurs more commonly in younger or older children more common ectopic tissue: pancreas or stomach? more common in which gender

    older stomach ectopic tissue males M:F 2:1 meckel 大男孩的胃

22. meckel diverticulum 好發於

    anti-mesenteric border of ileum

23. Hirschsprung disease define most commonly occurs at? confirm dx using?

    missing nerve cells in the muscles of the baby's colon (congenital aganglionic megacolon) --> colon muscles unstimulated --> unable to pass on bowels through gut （臨床檢查：DRE時手指伸進去較緊，手指移出時大量的糞水隨著噴出） sigmoid colon rectal biopsy

24. risk factors for NAFLD in children

    males obesity hypertriglyceridemia insulin resistance

25. Budd- Chiari syndrome definition (which blood vessels involved)

    hepatic v. <--> IVC 之間發生 thrombosis --> bloodflow obstruction

26. hep B or hep C perinatal transmission rates higher

    hep B

27. vesicoureteral reflux which grade requires ABx prophylaxis which grade requires surgery

    ABx prophylaxis: gr V, gr IV surgery: gr V

28. hydronephrosis, hydroureter, bladder wall thick and irregular Dx:

    posterior urethral valves bladder 以上出問題 so disease must be below bladder level

29. PSGN tx

    usually self-limiting use supportive therapy if HTN: CCB, diuretics NO need use of steroids

30. Henoch-schonlein purpura rash located at what AB deposits at bv / tissues platelet leves

    lower limbs more common IgA at skin, glomerulus, bv normal or increased

31. membranous nephropathy associated w what infections

    HBV, HCV, syphillis, malaria syphillis - discoid-like rash w 脫皮 HBV - rash 不會脫皮

32. children GFR 什麼時候會達到大人normal ranges

    2-3 years after birth

33. acute glomerulonephritis 是哪一種AKI

    intrinsic AKI but stats closer to prerenal (FeNa <1%)

34. which doesnt indicate intrinsic renal problems foamy urine polyuria growth retardation pain of urethral orifice

    pain of urethral orifice indicative of lower urinary tract issues , not renal.

35. TTKG formula

    (Uk / Pk) / (Uosm / Posm)

36. hyperK tx using insulin need glucose infusion 同時？

    yes insulin will cause hypoglycemia, need to replace glucose

37. which is not a tx for hyperK propranolol calcium glucose and insulin sodium bicarbonate

    propranolol = B blocker --> causes hyperK need to use B agonist instead

38. otitis media tx w high dose amoxicillin 有效 what bacteria?

    otitis media bacteria: H. influenzae, M. catarrhalis, S. pneumoniae sensitive to high dose amoxicillin: only S. pneumoniae

39. otitis media infection coupled with posterior ear inflammation Dx diagnostic tool

    area = mastoid suspect mastoiditis (complication of otitis media) using CT

40. H. influenzae bacterial resistant to amoxicillin because

    able to produce B lactamase

41. croup vs epiglottitis breathing patterns

    both have stridor

42. croup vs. epiglottitis presentation xray rx

    epiglottitis can give ABx, NOT for croup epiglottitis: bacterial infection ; croup: viral infection

43. chlamydia trachomatis pneumonia which age group 怎麼感染 features ABx

    1 day old - 3 mo old neonate pregnant mother has chlamydia trachomatis infection pneumonia w NO fever, eosinophilia, CXR hyperinflation w minimal interstitial or alveolar infiltrates macrolides erythromycin, azithromycin

44. 6y/o F, cough, seizures, rash on legs and neck, fine crackles CSF: glucose slightly lower than normal Dx infection by which organism?

    suspect pneumonia - R/O samonella typhi CSF glucose slightly low --> not all consumed by typical bacteria - R/O s. pneumoniae Dx: pneumonia by mycoplasma pneumonia (mycoplasma encephalitis --> acute onset of neurological signs and symptoms) check mycoplasma IgM/IgG

45. H. influenzae tx

    first-line: 3rd gen cepha (cefotaxime, ceftriaxone)

46. <2y/o child, wheezing, coarse crackles, fever CXR: hyperinflation Dx:

    bronchiolitis -- RSV infection

47. enterovirus tx

    supportive care IVIG for 重症 NO acyclovir

48. HFMD caused by what enterovirus type rash locations

    coxsackievirus A16, enterovirus 71 Rash: 口腔黏膜 tongue soft palate gums limbs: palms, soles defining: knees, hips

49. enterovirus which type related to 重症腦幹腦炎 most common seasons can breastfeeding prevent enterovirus infections

    enterovirus 71 summer, autumn (TW climate all year round) 3. yes! (from breast milk antibodies)

50. EB virus serology - what is present during acute infection phase 6-12wk from infection after infection

    IgM-VCA, IgG-VCA 先快速出現，EBEA (early antigen) 也會出現 at slower pace EBNA (nuclear antigen) 出現 IgM-VCA, EBEA decreases, IgG-VCA, EBNA still present （IgM+, EBNA- ----> acute EBV infection EBEA+ -----> recent infection)

51. 4y/o child w high fever, sore throat, given ampicillin but systemic rash appears after dosing 眼皮浮腫 Dx

    EB virus 的 infectious mononucleosis (amoxicillin 也會）

52. strawberry tongue present in which dz

    Kawasaki disease scarlet fever some Staph aureus infections (Strep pneumoniae 沒有 )

53. Strep pneumoniae 能否給予 erythromycin

    no resistant to erythromycin in TW (S aureus, GAS, pneumococcus 都 resistant)

54. DIC platelet levels fibrinogen levels Factor V or VIII levels D-dimer levels

    platelet levels - low fibrinogen levels - low Factor V or VIII levels - low D-dimer levels - inc plt，凝血因子大量消耗而dec 纖維蛋白溶解系統啟動 --> affect D-dimer (inc) and fibronogen (dec)

55. septic arthritis dx

    gram stain and culture

56. TORCH infections include

    Toxoplasmosis 弓蟲症 Others - syphillis Rubella 德國麻疹 CMV 巨細胞病毒 Herpes simplex virus

57. neonate w hypoglycemia + cyanosis 2 hours after birth suspect what dx use what diagnostic tools

    CHD and hypoglycemia 都有可能 cyanosis high hematocrit 也可能造成 overestimation of hypoglycemia therefore 先 check hematocrit

58. premature neonates first day CXR findings 包括 which air bronchogram reticulogranular pattern 纖維化變化 air leakage

    air bronchogram reticulogranular pattern air leakage 無 纖維化變化

59. meconium aspiration syndrome tx

    氣管內插管+抽吸 清除胎便 處理ARDS and hypoxia

60. timing to give surfactant to neonate

    within 8hrs of birth first dose, 特別在肺臟仍有液體存在的時候

61. newborn positions supine position, arms ? prone position, pelvis 會怎麼樣

    arms flexion high pelvis (not flat against bed)

62. newborn normal HR, RR

    HR: 120-160 (注意 Apgar score <100/min: 1 ; >100/min: 2) RR: 40-60

63. 1 個月大 jaundice - 2 wk jaundice -

    1mo jaundice: biliary atresia 2wk jaundice: breast milk jaundice

64. breastmilk vs infant formula any protein vit D vit A fats

    breastmilk - low protein, low vit D (need extra supplement), high vit A, high fats infant formula - high protein

65. milk protein allergy at what age does it occur mechanism what type of immune response is it best way to prevent

    before the age of 1 y/o due to GI tract immune system still immature Ig-E-mediated immune response stick to breast milk, 1-2y/o 再try milk protein (改用 goat milk no use)

66. which is suitable for IV line umbilical a. scalp vein venous cutdown intraosseous infusion

    all except umbilical a. can use umbilical a. - carries waste away from fetus

67. fetal alcohol syndrome s/s

    身長偏小、low weight 臉部發展也異常

68. necrotizing enterocolitis includes which of the following constipation diarrhea vomiting bloody stool

    all except constipation

69. acute flaccid paralysis present in which of the following hypokalemia polio-like syndrome acute transverse myelitis bell's palsy

    all except bell's palsy - 這是臉部的單側顏面神經麻痺 acute transverse myelitis - lower limb 輕癱瘓 ----> later on upper limb 被影響 - 肢體無力變成spasticity

70. gower's sign seen in what dz indicative of

    seen in Duchenne muscular dystrophy, Becker's muscular dystrophy lower limb proximal muscle weakness

71. 7yo boy prior hx of fever and URTI for 2 days CC RLL pain, limping gait, later LLL pain DTR normal, muscle tone normal, CPK increase Dx?

    acute myositis NOT guillain barre syndrome -- 會 CPK normal or slight inc, DTR dec. muscle weakness, muscle tone dec **典型 CSF protein inc, but WBC normal

72. simple febrile seizures 是否有明顯的 family hx？ need EEG test? 少發 before age of 6mo? affects IQ?

    yes 有 family hx NO need EEG - only complex seizures require EEG before age <6mo 少發生 (好發 6mo - 60mo) doesnt affect IQ

73. 2yo fever for 3 days, 躁動不安, 脖子僵硬，昏迷 hands and feet 都有小水泡 BP 50/20 呼吸速率極快 Dx Tx next imaging

    Dx: blisters on hands and feet --> enterovirus caused meningitis / meningoencephalitis Tx: inotropic agent, mannitol (dec ICP), ECMO （不能給fluid challenge！！--> worsen pulm edema and brain edema next imaging: need brain MRI

74. age child can recognize body parts name 4 colours speak 4 work sentence 扶東西站起來 stack 4 blocks

    2 yo 5 yo 2 yo 8-9 months 15 months

75. 18yo male infection 後 HA, 意識混亂，雙腳無力，尿失禁 Dx

    想到 acute disseminated encephalomyelitis 會有 意識混亂 impaired consciousness (Guillain barre 不會)

76. 記得 GCS no response = 1 point 沒有 0 points！

77. Dx

78. s/s of congenital hypothyroidism include which: birth height and weight low birth head circumference small poor sleep, 常常哭鬧 prolonged neonatal jaundice

    prolonged neonatal jaundice poor feeding, 身材矮小 failure to thrive, poor feeding, dry mottled skin, 嗜睡 NO thyroid mass

79. congenital hypothyroidism causes

    most common cause: dysplasia 甲狀腺發育不良 有包括 aplasia, hypoplasia, and ectopia (異位) ectopia MOST Common

80. vitamin D dependent rickets type 1 phosphate level PTH level 25OH-D level 1,25(OH)2-D level

    lack enzyme for 25OH-D ---> 1,25(OH)2-D low high normal low

81. rickets causes

82. 21-hydroxylase deficiency 什麼hormone 無法正常製造

    aldosterone, cortisol --> aldosterone low causes electrolyte imbalance in most children of salt-losing form of CAH (有 75%) (simple virilizing form - 有 25% - 不會有 electrolyte imbalance)

83. hypoNa, hypoglycemia, dehydration, hypotension, loss of conscious, Dx?

    adrenal insufficiency

84. neonate w 17-OH progesterone levels high next step?

    recheck 17-OH progesterone level w 足跟血 as false positive rates high

85. most common autoimmune disease associated w type I DM in children

    chronic lymphocytic thyroiditis (18%) others: celiac dz, addison dz

86. precocious puberty 分類 - 定義為何 central pseudo

    central - e.g. hypothalamic harmatoma pseudo - sex hormones pdtn unrelated to pituitary gonadotrophin secretion e.g. CAH, Leydig cell tumor, hCG secreting pineal tumor

87. McCune albright syndrome 三大特徵

    cafe-au-lait spots fibrous dysplasia precocious puberty (breast developed at early age)

88. first sign of puberty in females which indication breast dvlop 腋毛 初經 陰毛

    breast dvlp --> 陰毛 --> 初經 boys：testis larger --> 陰莖陰毛 dvlp --> 腋毛

89. suspect short stature tests for dx

    insulin-like growth factor insulin-like growth factor binding protein 3 if SEVERE short stature + 以上 low，bone age delayed can confirm if MODERATE short stature: 加做 stimulation test: test for arginine, glucagon, clonidine

90. achondroplasia inherited or spontaneous mutation

    80% spontaneous mutation 20% inherited from parents - autosomal dominant

91. failure to thrive definition

    below 3rd percentile / downward change across 2 major growth percentiles

92. allergic rhinitis pts increase risk of having asthma? comorbid w conjunctivitis and otitis media/sinusitis

    true - Patients with allergic rhinitis have a threefold greater chance of developing asthma false

93. ICS 是否是 first-line therapy for asthma ICS can decrease asthma mortality

    not for all pts. e.g. exercise-induced asthma first-line tx SABA true

94. which med not suitable for mild asthma long term control corticosteroid LABA sustained release theophylline cromolyn sodium

    LABA - increase asthma mortality if used monotherapy 不能單獨使用

95. measurement of asthma severity using which TLC VC peak expiratory flow RV

    peak expiratory flow

96. asthma 3 times /week in the day , one nightly / month asthma grade

    mild persistent

97. 6yo with Gower sign, 眼瞼紅斑，日曬惡化 , creatine kinase inc Dx

    heliotrope rash + CK inc + gower sign --> juvenile dermatomyositis

98. neuroblastoma 4s staging good prognosis?

    good prognosis as spontaneous regression

99. leukemia, lymphoma, brain tumor, neuroblastoma 排列

    most incidence rate ----------> least leukemia --> brain tumor --> neuroblastoma --> lymphoma

100. 味道 phenylketouria isovaleric acidemia tyrosinemia trimethlaminuria

     musty odor sweaty feet odor cabbage like odor rotten fish odor