What physical exam findings and murmur are characteristic of a Patent Ductus Arteriosus?

Continuous, rough 'machine-like' murmur loudest at the left infraclavicular area, bounding peripheral pulses, and wide pulse pressure.

What is the genetic defect and sweat chloride threshold in Cystic Fibrosis?

Autosomal recessive mutation in the CFTR gene (most commonly delta-F508 deletion on chromosome 7) encoding an ATP-gated chloride channel. Diagnosed by quantitative pilocarpine iontophoresis (sweat test) demonstrating sweat chloride concentration >=60 mmol/L.

What speech and gross motor milestones characterize a 2-year-old child?

Language: 2-word purposeful phrases ('want milk'), 50+ word vocabulary, 50% intelligible to strangers. Gross motor: Kicks a ball, jumps with both feet, runs, walks up and down stairs two feet per step. Fine motor: Builds tower of 6 cubes, copies a vertical line.

What medication must be immediately administered to maintain patency of the ductus arteriosus in ductal-dependent congenital heart lesions?

Prostaglandin E1 (Alprostadil IV). It keeps the ductus arteriosus open to maintain pulmonary or systemic blood flow until definitive surgical intervention.

What is the clinical presentation and management of acute Epiglottitis?

Caused historically by Haemophilus influenzae type b (Hib); sudden onset high fever, severe sore throat, drooling, dysphagia, and inspiratory stridor in the 'tripod' sniffing position; lateral neck X-ray shows 'thumbprint sign'. Management: Maintain calm airway, prepare for emergent intubation in OR, IV Ceftriaxone + Vancomycin.

Why is Aspirin strictly avoided in children with acute viral illness (such as influenza or varicella)?

Reye Syndrome. Mitochondrial injury caused by aspirin during viral illness leads to acute hepatic failure (microvesicular fatty change/steatosis) and fulminant cerebral edema/encephalopathy, with marked hyperammonemia, elevated transaminases, and normal bilirubin.

What is the most common cause of intestinal obstruction in children aged 6 to 36 months, and what is the classic presentation?

Intussusception (telescoping of proximal bowel into distal segment, commonly ileocecal). Classic triad: Episodic severe colicky abdominal pain with knees drawn up, palpable 'sausage-shaped' right upper quadrant mass, and 'currant jelly' stools (blood and mucus).

What is the classic radiographic sign of Transposition of the Great Arteries (TGA)?

'Egg-on-a-string' heart on chest X-ray (narrow mediastinum due to overlapping great vessels and thymic hypoplasia with enlarged cardiac silhouette).

What is the embryologic origin and diagnostic rule of twos for Meckel's Diverticulum?

Failure of complete obliteration of the vitelline (omphalomesenteric) duct. Rule of 2s: 2% of population, 2 inches long, within 2 feet of ileocecal valve, 2 types of ectopic tissue (gastric and pancreatic), presents around age 2 with painless lower GI bleeding; diagnosed by Technetium-99m pertechnetate scan.

What are the major motor and social milestones expected of a 2-month-old infant?

Lifts head/chest while prone, tracks past midline, exhibits social smile in response to voices, and coos (reciprocal vocalizations).

What is the congenital embryologic defect in Hirschsprung Disease and how is it confirmed histologically?

Failure of neural crest cells to migrate into the distal bowel wall, resulting in congenital aganglionosis of the submucosal (Meissner) and myenteric (Auerbach) plexuses. Confirmed by suction rectal biopsy demonstrating absence of ganglion cells and hypertrophied nerve fibers.

Why do children with Tetralogy of Fallot instinctively 'squat' during hypercyanotic 'tet spells'?

Squatting kinks the femoral arteries, increasing systemic vascular resistance (SVR). Increased SVR reduces right-to-left shunting across the VSD and forces more desaturated blood through the stenotic pulmonary outflow tract into the lungs for oxygenation.

What medication is administered to induce closure of a hemodynamically significant Patent Ductus Arteriosus (PDA) in premature infants?

Indomethacin or Ibuprofen (cyclooxygenase inhibitors that decrease prostaglandin E2 synthesis, promoting ductal closure).

Which routine childhood vaccines are live-attenuated and therefore contraindicated in severely immunocompromised children or pregnancy?

MMR (Measles, Mumps, Rubella), Varicella, Rotavirus (oral), and Live Attenuated Influenza Vaccine (nasal LAIV).

What is the diagnostic and therapeutic procedure of choice for ileocolic Intussusception?

Air or ultrasound-guided pneumatic/contrast (saline) enema. Effectively reduces the intussusception non-operatively in >80% of uncomplicated cases.

What physical exam findings are pathognomonic for Coarctation of the Aorta in an adolescent or child?

Brachial-femoral pulse delay, elevated upper extremity blood pressure with relative hypotension in the lower extremities, and inferior rib notching on CXR (due to enlarged intercostal collateral arteries).

What is the diagnostic clinical criteria for Kawasaki Disease (mucocutaneous lymph node syndrome)?

Fever for >=5 days PLUS at least 4 of 5 'CRASH' features: Conjunctivitis (bilateral, non-purulent); Rash (polymorphous polymorphous trunk); Adenopathy (cervical, usually unilateral >1.5 cm); Strawberry tongue / oral erythema / cracked lips; Hand and foot changes (erythema, edema, periungual desquamation).

What is the causative agent and clinical presentation of Erythema Infectiosum (Fifth Disease)?

Parvovirus B19. Presents with bright red, confluent erythema on both cheeks ('slapped cheek' appearance), followed days later by a lacy, reticular erythematous macular rash on the extremities and trunk.

What is the only vaccine administered at birth in healthy newborns?

Hepatitis B vaccine (HepB dose 1). (Plus Hepatitis B Immune Globulin [HBIG] within 12 hours if maternal HBsAg is positive or unknown).

What viral exanthem starts with a high fever lasting 3–5 days, which abruptly breaks right before a maculopapular rash appears on the trunk?

Roseola Infantum (Exanthem Subitum), caused by Human Herpesvirus 6 (HHV-6). Classic scenario: fever disappears, followed immediately by rose-colored maculopapular rash that spares the face.

What is the etiology and classic clinical presentation of Pyloric Stenosis in an infant?

Hypertrophy of the pyloric sphincter circular muscle presenting at 3–6 weeks of life with non-bilious projectile vomiting, visible gastric peristaltic waves, palpable 'olive-shaped' mass in right upper quadrant, and hypochloremic hypokalemic metabolic alkalosis.

What are the '5 Ts' of Cyanotic Congenital Heart Defects (right-to-left shunts)?

1. Truncus arteriosus (1 vessel); 2. Transposition of the Great Arteries (2 switched vessels); 3. Tricuspid atresia (3 leaflets absent); 4. Tetralogy of Fallot (4 classic defects); 5. Total anomalous pulmonary venous return (TAPVR, 5 words).

What milestones are expected of a 4-year-old child?

Hops on one foot, catches a bounced ball, copies a cross and square, draws a 3-part person, speaks in complex sentences with 100% intelligibility to strangers, and engages in cooperative imaginary play.

What physical exam maneuvers screen for Developmental Dysplasia of the Hip (DDH) in infants?

Barlow maneuver (adducts and directs posterior force to dislocate an unstable femoral head) and Ortolani maneuver (abducts the flexed hip with gentle anterior pressure to reduce a dislocated femoral head with a palpable 'clunk').

What is the cause and acute management of Nursemaid's Elbow (radial head subluxation)?

Sudden longitudinal traction on an extended, pronated arm (e.g., pulling a toddler by the hand), causing the Annular Ligament to slip and become entrapped over the radial head. Reduced by gentle supination of the forearm while flexing the elbow to 90 degrees.

What congenital heart lesion is characteristically associated with Down syndrome (Trisomy 21)?

Complete Atrioventricular Canal Defect (Endocardial Cushion Defect), followed by Ventricular Septal Defect (VSD) and Atrial Septal Defect (ASD).

What are the four anatomic components of Tetralogy of Fallot (PROVe)?

1. Pulmonary infundibular stenosis (primary determinant of prognosis/cyanosis); 2. Right ventricular hypertrophy; 3. Overriding aorta; 4. Ventricular Septal Defect (VSD).

What exanthem presents with 'sandpaper-like' erythematous rash, circumoral pallor, and strawberry tongue?

Scarlet Fever, caused by pyrogenic exotoxins produced by Streptococcus pyogenes (Group A Strep) pharyngitis. Treated with oral Penicillin V or Amoxicillin to prevent rheumatic fever.

What is the most serious potential complication of untreated Kawasaki Disease, and what is the treatment?

Coronary artery aneurysms and thrombosis/MI. Treatment: Intravenous Immunoglobulin (IVIG, single high dose 2 g/kg) plus high-dose Aspirin (one of the rare pediatric indications for aspirin).

What gross motor and social milestones are expected at 6 months of age?

Sits unsupported (momentarily), rolls both directions (front-to-back and back-to-front), transfers objects hand-to-hand, babbles consonant sounds, and exhibits stranger anxiety.

What is the management of moderate-to-severe Croup (laryngotracheobronchitis) in the emergency department?

Single dose of oral or intramuscular Dexamethasone (0.6 mg/kg) plus nebulized Racemic Epinephrine (which induces alpha-1 mucosal vasoconstriction, reducing subglottic laryngeal edema rapidly).

What language, motor, and cognitive milestones are achieved by 12 months (1 year) of age?

Gross motor: Stands alone, takes first independent steps. Fine motor: 2-finger neat pincer grasp. Language: Says 1–2 words other than 'mama/dada'. Cognitive: Understands object permanence and responds to simple commands.

Pediatrics — Milestones, Vaccines, Congenital Heart Defects, Immunodeficiencies & Exanthems

Developmental milestones, CDC immunization schedule, cyanotic vs acyanotic heart lesions, pediatric rashes, and pediatric emergency conditions.

Level: basic
Languages: en → en
Cards: 32
Markdown: Pediatrics — Milestones, Vaccines, Congenital Heart Defects, Immunodeficiencies & Exanthems (.md)

Flashcards (32)

#	Front (Term / Question)	Back (Definition / Answer)
1	What physical exam findings and murmur are characteristic of a Patent Ductus Arteriosus?	Continuous, rough 'machine-like' murmur loudest at the left infraclavicular area, bounding peripheral pulses, and wide pulse pressure.
2	What is the genetic defect and sweat chloride threshold in Cystic Fibrosis?	Autosomal recessive mutation in the CFTR gene (most commonly delta-F508 deletion on chromosome 7) encoding an ATP-gated chloride channel. Diagnosed by quantitative pilocarpine iontophoresis (sweat test) demonstrating sweat chloride concentration >=60 mmol/L.
3	What speech and gross motor milestones characterize a 2-year-old child?	Language: 2-word purposeful phrases ('want milk'), 50+ word vocabulary, 50% intelligible to strangers. Gross motor: Kicks a ball, jumps with both feet, runs, walks up and down stairs two feet per step. Fine motor: Builds tower of 6 cubes, copies a vertical line.
4	What medication must be immediately administered to maintain patency of the ductus arteriosus in ductal-dependent congenital heart lesions?	Prostaglandin E1 (Alprostadil IV). It keeps the ductus arteriosus open to maintain pulmonary or systemic blood flow until definitive surgical intervention.
5	What is the clinical presentation and management of acute Epiglottitis?	Caused historically by Haemophilus influenzae type b (Hib); sudden onset high fever, severe sore throat, drooling, dysphagia, and inspiratory stridor in the 'tripod' sniffing position; lateral neck X-ray shows 'thumbprint sign'. Management: Maintain calm airway, prepare for emergent intubation in OR, IV Ceftriaxone + Vancomycin.
6	Why is Aspirin strictly avoided in children with acute viral illness (such as influenza or varicella)?	Reye Syndrome. Mitochondrial injury caused by aspirin during viral illness leads to acute hepatic failure (microvesicular fatty change/steatosis) and fulminant cerebral edema/encephalopathy, with marked hyperammonemia, elevated transaminases, and normal bilirubin.
7	What is the most common cause of intestinal obstruction in children aged 6 to 36 months, and what is the classic presentation?	Intussusception (telescoping of proximal bowel into distal segment, commonly ileocecal). Classic triad: Episodic severe colicky abdominal pain with knees drawn up, palpable 'sausage-shaped' right upper quadrant mass, and 'currant jelly' stools (blood and mucus).
8	What is the classic radiographic sign of Transposition of the Great Arteries (TGA)?	'Egg-on-a-string' heart on chest X-ray (narrow mediastinum due to overlapping great vessels and thymic hypoplasia with enlarged cardiac silhouette).
9	What is the embryologic origin and diagnostic rule of twos for Meckel's Diverticulum?	Failure of complete obliteration of the vitelline (omphalomesenteric) duct. Rule of 2s: 2% of population, 2 inches long, within 2 feet of ileocecal valve, 2 types of ectopic tissue (gastric and pancreatic), presents around age 2 with painless lower GI bleeding; diagnosed by Technetium-99m pertechnetate scan.
10	What are the major motor and social milestones expected of a 2-month-old infant?	Lifts head/chest while prone, tracks past midline, exhibits social smile in response to voices, and coos (reciprocal vocalizations).
11	What is the congenital embryologic defect in Hirschsprung Disease and how is it confirmed histologically?	Failure of neural crest cells to migrate into the distal bowel wall, resulting in congenital aganglionosis of the submucosal (Meissner) and myenteric (Auerbach) plexuses. Confirmed by suction rectal biopsy demonstrating absence of ganglion cells and hypertrophied nerve fibers.
12	Why do children with Tetralogy of Fallot instinctively 'squat' during hypercyanotic 'tet spells'?	Squatting kinks the femoral arteries, increasing systemic vascular resistance (SVR). Increased SVR reduces right-to-left shunting across the VSD and forces more desaturated blood through the stenotic pulmonary outflow tract into the lungs for oxygenation.
13	What medication is administered to induce closure of a hemodynamically significant Patent Ductus Arteriosus (PDA) in premature infants?	Indomethacin or Ibuprofen (cyclooxygenase inhibitors that decrease prostaglandin E2 synthesis, promoting ductal closure).
14	Which routine childhood vaccines are live-attenuated and therefore contraindicated in severely immunocompromised children or pregnancy?	MMR (Measles, Mumps, Rubella), Varicella, Rotavirus (oral), and Live Attenuated Influenza Vaccine (nasal LAIV).
15	What is the diagnostic and therapeutic procedure of choice for ileocolic Intussusception?	Air or ultrasound-guided pneumatic/contrast (saline) enema. Effectively reduces the intussusception non-operatively in >80% of uncomplicated cases.
16	What physical exam findings are pathognomonic for Coarctation of the Aorta in an adolescent or child?	Brachial-femoral pulse delay, elevated upper extremity blood pressure with relative hypotension in the lower extremities, and inferior rib notching on CXR (due to enlarged intercostal collateral arteries).
17	What is the diagnostic clinical criteria for Kawasaki Disease (mucocutaneous lymph node syndrome)?	Fever for >=5 days PLUS at least 4 of 5 'CRASH' features: Conjunctivitis (bilateral, non-purulent); Rash (polymorphous polymorphous trunk); Adenopathy (cervical, usually unilateral >1.5 cm); Strawberry tongue / oral erythema / cracked lips; Hand and foot changes (erythema, edema, periungual desquamation).
18	What is the causative agent and clinical presentation of Erythema Infectiosum (Fifth Disease)?	Parvovirus B19. Presents with bright red, confluent erythema on both cheeks ('slapped cheek' appearance), followed days later by a lacy, reticular erythematous macular rash on the extremities and trunk.
19	What is the only vaccine administered at birth in healthy newborns?	Hepatitis B vaccine (HepB dose 1). (Plus Hepatitis B Immune Globulin [HBIG] within 12 hours if maternal HBsAg is positive or unknown).
20	What viral exanthem starts with a high fever lasting 3–5 days, which abruptly breaks right before a maculopapular rash appears on the trunk?	Roseola Infantum (Exanthem Subitum), caused by Human Herpesvirus 6 (HHV-6). Classic scenario: fever disappears, followed immediately by rose-colored maculopapular rash that spares the face.
21	What is the etiology and classic clinical presentation of Pyloric Stenosis in an infant?	Hypertrophy of the pyloric sphincter circular muscle presenting at 3–6 weeks of life with non-bilious projectile vomiting, visible gastric peristaltic waves, palpable 'olive-shaped' mass in right upper quadrant, and hypochloremic hypokalemic metabolic alkalosis.
22	What are the '5 Ts' of Cyanotic Congenital Heart Defects (right-to-left shunts)?	1. Truncus arteriosus (1 vessel); 2. Transposition of the Great Arteries (2 switched vessels); 3. Tricuspid atresia (3 leaflets absent); 4. Tetralogy of Fallot (4 classic defects); 5. Total anomalous pulmonary venous return (TAPVR, 5 words).
23	What milestones are expected of a 4-year-old child?	Hops on one foot, catches a bounced ball, copies a cross and square, draws a 3-part person, speaks in complex sentences with 100% intelligibility to strangers, and engages in cooperative imaginary play.
24	What physical exam maneuvers screen for Developmental Dysplasia of the Hip (DDH) in infants?	Barlow maneuver (adducts and directs posterior force to dislocate an unstable femoral head) and Ortolani maneuver (abducts the flexed hip with gentle anterior pressure to reduce a dislocated femoral head with a palpable 'clunk').
25	What is the cause and acute management of Nursemaid's Elbow (radial head subluxation)?	Sudden longitudinal traction on an extended, pronated arm (e.g., pulling a toddler by the hand), causing the Annular Ligament to slip and become entrapped over the radial head. Reduced by gentle supination of the forearm while flexing the elbow to 90 degrees.
26	What congenital heart lesion is characteristically associated with Down syndrome (Trisomy 21)?	Complete Atrioventricular Canal Defect (Endocardial Cushion Defect), followed by Ventricular Septal Defect (VSD) and Atrial Septal Defect (ASD).
27	What are the four anatomic components of Tetralogy of Fallot (PROVe)?	1. Pulmonary infundibular stenosis (primary determinant of prognosis/cyanosis); 2. Right ventricular hypertrophy; 3. Overriding aorta; 4. Ventricular Septal Defect (VSD).
28	What exanthem presents with 'sandpaper-like' erythematous rash, circumoral pallor, and strawberry tongue?	Scarlet Fever, caused by pyrogenic exotoxins produced by Streptococcus pyogenes (Group A Strep) pharyngitis. Treated with oral Penicillin V or Amoxicillin to prevent rheumatic fever.
29	What is the most serious potential complication of untreated Kawasaki Disease, and what is the treatment?	Coronary artery aneurysms and thrombosis/MI. Treatment: Intravenous Immunoglobulin (IVIG, single high dose 2 g/kg) plus high-dose Aspirin (one of the rare pediatric indications for aspirin).
30	What gross motor and social milestones are expected at 6 months of age?	Sits unsupported (momentarily), rolls both directions (front-to-back and back-to-front), transfers objects hand-to-hand, babbles consonant sounds, and exhibits stranger anxiety.
31	What is the management of moderate-to-severe Croup (laryngotracheobronchitis) in the emergency department?	Single dose of oral or intramuscular Dexamethasone (0.6 mg/kg) plus nebulized Racemic Epinephrine (which induces alpha-1 mucosal vasoconstriction, reducing subglottic laryngeal edema rapidly).
32	What language, motor, and cognitive milestones are achieved by 12 months (1 year) of age?	Gross motor: Stands alone, takes first independent steps. Fine motor: 2-finger neat pincer grasp. Language: Says 1–2 words other than 'mama/dada'. Cognitive: Understands object permanence and responds to simple commands.