Pediatrics II (PEDIA32) Lecture Review Flashcards

Flashcard practice set based on PEDIA32 Pediatrics II lecture material covering pediatric gastrointestinal, hepatobiliary, nutritional, and critical care topics.

What are the layers of the anterolateral abdominal wall from superficial to deep?

Skin → subcutaneous tissue (Camper's then Scarpa's fascia) → external oblique → internal oblique → transversus abdominis → transversalis fascia → parietal peritoneum.

Which peripheral vein is preferred initially for pediatric IV access?

Dorsal veins of the hand.

What is the medial-to-lateral relationship of the femoral neurovascular bundle represented by the mnemonic VAN?

Medial-to-lateral: Vein, Artery, Nerve.

Which muscle is separated in the midline by the linea alba?

Rectus abdominis.

What are common intraosseous (IO) access sites in children?

Proximal tibia, distal tibia, distal femur, and iliac region/ASIS depending on age and technique.

What are major contraindications to intraosseous access?

Fracture/crush injury near the site, fragile bone (e.g., osteogenesis imperfecta), previous IO attempt at the same site, and overlying infection.

What structures are derived from the embryonic foregut?

Esophagus, stomach, and duodenum up to the insertion of the common bile duct.

What structures are derived from the embryonic midgut?

The remaining small bowel and large bowel up to the mid-transverse colon.

What structures are derived from the embryonic hindgut?

The remaining colon (distal to mid-transverse colon) and upper anal canal.

By what gestational week is normal midgut rotation completed?

By the 8th week of gestation.

When should intraosseous access be considered during pediatric resuscitation?

When IV access cannot be rapidly obtained in a child with shock or cardiopulmonary arrest, especially after repeated unsuccessful attempts.

What is the initial dose of adenosine for pediatric supraventricular tachycardia (SVT)?

$0.1\,\text{mg/kg}$ rapid IV push, maximum $6\,\text{mg}$.

What is the second dose of adenosine for pediatric SVT if the initial dose is ineffective?

$0.2\,\text{mg/kg}$ rapid IV push, maximum $12\,\text{mg}$.

What epithelial transition occurs at the gastroesophageal junction?

Nonkeratinized stratified squamous epithelium changes to simple columnar epithelium.

What initiates primary esophageal peristalsis versus secondary esophageal peristalsis?

Primary peristalsis is initiated by swallowing beginning in the oropharynx; secondary peristalsis originates in the upper esophagus without an oral component, typically triggered by retained material or reflux.

Which segment of the small intestine is the major site for nutrient absorption?

The jejunum.

Which specific intestinal segment absorbs bile salts and vitamin B12?

The ileum, especially the terminal ileum.

How do absorbed lipids enter the system circulation initially?

Through intestinal lacteals into the lymphatic system.

Which embryologic pancreatic anlage forms the majority of the head of the pancreas?

The ventral pancreatic anlage.

Which pancreatic cells secrete a bicarbonate-rich fluid?

Centroacinar and duct cells.

How does regurgitation differ from vomiting?

Regurgitation is passive expulsion of gastric or esophageal contents without nausea or retching; vomiting is forceful expulsion and is usually an active reflex.

How is visceral abdominal pain characterized compared to parietal abdominal pain?

Visceral pain arises from hollow-organ distention or solid-organ capsule stretching, is poorly localized, and often midline; parietal pain arises from inflammation of the parietal peritoneum, is steady, severe, sharply localized, and aggravated by movement.

What clinical stool finding is classically associated with biliary obstruction?

Acholic or clay-colored stool.

How long must an examiner listen before classifying bowel sounds as absent?

Prolonged auscultation of roughly $3\text{--}5\,\text{minutes}$.

What does high-pitched rushing or tinkling bowel sounds suggest?

Mechanical intestinal obstruction with fluid and air under tension.

What liver edge measurement below the right costal margin is suspicious for hepatomegaly in infants and toddlers?

A liver edge extending more than about $3\,\text{cm}$ below the right costal margin.

What physical exam finding is defined as right lower quadrant pain elicited by palpation of the left lower quadrant?

Rovsing sign.

What are positive Psoas and Obturator signs suggestive of in appendicitis?

Psoas sign indicates irritation of the psoas muscle (classically retrocecal appendix); Obturator sign indicates pelvic appendiceal irritation causing pain with internal rotation of the flexed hip.

What physical exam sign is associated with acute cholecystitis?

Murphy sign (inspiratory arrest during right upper quadrant palpation).

What is the most common anatomical type of esophageal atresia and tracheoesophageal fistula (TEF)?

Proximal esophageal atresia with distal tracheoesophageal fistula (Type C).

What radiographic finding indicates pure esophageal atresia without a TEF?

A coiled tube in the proximal esophageal pouch with a gasless abdomen.

What are the classic clinical presentation, mass finding, and metabolic abnormality in infantile hypertrophic pyloric stenosis?

Progressive projectile non-bilious vomiting around 2–8 weeks of age, an olive-shaped epigastric mass, and hypochloremic hypokalemic metabolic alkalosis.

What is the first-line imaging modality for diagnosing hypertrophic pyloric stenosis?

Abdominal ultrasonography.

What is the underlying embryologic mechanism and classic plain radiograph sign of duodenal atresia?

Failure of duodenal recanalization during fetal development; classic radiograph shows the 'double-bubble' sign.

What is the main pathogenic mechanism of jejunoileal atresia?

An intrauterine vascular accident causing ischemia and necrosis of the developing bowel.

What is the Type IIIB deformity in jejunoileal atresia called?

Apple-peel or Christmas-tree deformity, featuring proximal jejunal atresia and distal bowel spiraling around a single nutrient vessel.

What surgical procedure is used to treat intestinal malrotation?

Ladd procedure.

What is the classic radiographic sign associated with sigmoid volvulus?

Coffee-bean or bent inner-tube sign.

What is the underlying pathophysiology of Hirschsprung disease?

Congenital failure of neural crest cells to migrate into distal bowel, resulting in an absence of submucosal (Meissner) and myenteric (Auerbach) ganglion cells.

What is the classic neonatal clinical presentation of Hirschsprung disease?

Failure to pass meconium within the first $24\text{--}48\,\text{hours}$ of life.

What is the gold standard diagnostic test for Hirschsprung disease?

Rectal suction biopsy showing the absence of enteric ganglion cells.

What feature distinguishes gastroschisis from omphalocele?

Gastroschisis is a full-thickness defect usually to the right of the umbilicus without a covering sac; omphalocele is a midline defect at the base of the umbilical cord with herniated viscera covered by a sac.

What syndrome is classically associated with omphalocele, macroglossia, and neonatal hypoglycemia?

Beckwith-Wiedemann syndrome.

What is the embryologic origin of Meckel diverticulum and its classic presentation?

Persistence of the omphalomesenteric (vitelline) duct; presents as intermittent painless lower GI bleeding due to ectopic gastric mucosa.

What nuclear medicine study detects ectopic gastric mucosa in Meckel diverticulum?

Technetium-99m pertechnetate scan.

What is the classic clinical triad of intussusception?

Intermittent colicky abdominal pain, a sausage-shaped abdominal mass, and currant-jelly stool.

What is the diagnostic imaging modality of choice and first-line treatment for uncomplicated ileocolic intussusception?

Abdominal ultrasonography (showing target/doughnut sign); first-line treatment is hydrostatic or pneumatic enema reduction.

What are the key clinical features of Peutz-Jeghers syndrome?

Autosomal-dominant hamartomatous polyposis with mucocutaneous hyperpigmentation around lips/oral mucosa and risk of small-bowel intussusception.

What extraintestinal ocular finding is associated with Familial Adenomatous Polyposis (FAP)?

Congenital hypertrophy of the retinal pigment epithelium (CHRPE).

What is the first-line nonpharmacologic management for physiologic GER in a thriving infant?

Parental reassurance and feeding modifications.

What surgical procedure is performed for severe, medically refractory GERD?

Nissen fundoplication.

What diagnostic finding establishes a diagnosis of Eosinophilic Esophagitis (EoE)?

At least $15\,\text{eosinophils/HPF}$ on esophageal mucosal biopsy.

What distinguishes Curling ulcers from Cushing ulcers?

Curling ulcers are acute stress ulcers associated with severe burn injuries; Cushing ulcers are acute stress ulcers associated with severe CNS/intracranial injury.

What features distinguish Crohn disease from Ulcerative Colitis?

Crohn disease features patchy skip lesions with transmural inflammation and perianal disease; Ulcerative Colitis features continuous mucosal inflammation starting in the rectum and extending proximally.

Which extraintestinal hepatobiliary disease is strongly associated with Ulcerative Colitis?

Primary Sclerosing Cholangitis (PSC).

What diagnostic threshold defines Celiac Disease histologically and genetically?

Intestinal villous atrophy triggered by gluten, strongly associated with HLA-DQ2 and HLA-DQ8 haplotypes.

How are secretory and osmotic diarrhea distinguished by stool fasting response and stool ion gap?

Secretory diarrhea continues during fasting with an ion gap $<100\,\text{mOsm/kg}$; Osmotic diarrhea improves/stops during fasting with an ion gap $>100\,\text{mOsm/kg}$.

Which diarrheal pathogen causes pseudoappendicitis characterized by terminal ileitis and mesenteric lymphadenitis?

Yersinia enterocolitica.

Why are antibiotics and antimotility agents avoided in Enterohemorrhagic E. coli (EHEC/STEC) infections?

They increase the risk of developing Hemolytic Uremic Syndrome (HUS).

What physical finding is classically pathognomonic for Enteric (Typhoid) Fever?

Rose spots (transient pink macules on the abdomen/chest).

What criteria define neonatal cholestasis?

Pathologic direct/conjugated hyperbilirubinemia where direct bilirubin is $>20\%$ of total bilirubin or absolute direct bilirubin is elevated.

What noninvasive ultrasound sign is associated with Biliary Atresia?

Triangular cord sign at the porta hepatis.

What is the optimal timing for a Kasai portoenterostomy in biliary atresia?

Ideally before $8\,\text{weeks}$ of life to restore bile flow and slow hepatic fibrosis.

What constellation of symptoms characterizes Alagille syndrome?

Intrahepatic bile duct paucity, peripheral pulmonary artery stenosis, posterior embryotoxon, butterfly vertebrae, and characteristic facial features (prominent forehead, deep-set eyes).

Which form of progressive familial intrahepatic cholestasis (PFIC) presents with elevated gamma-glutamyl transferase (GGT)?

PFIC Type 3 (due to MDR3/ABCB4 dysfunction).

What liver pathology is distinguished by PAS-positive, diastase-resistant globules in hepatocytes?

Alpha-1 antitrypsin deficiency.

How should an infant born to an HBsAg-positive mother be managed immediately after birth?

Administer Hepatitis B vaccine and Hepatitis B Immune Globulin (HBIG) within $12\,\text{hours}$ of birth at separate anatomical sites.

What autoantibody is characteristically positive in Type 2 Autoimmune Hepatitis?

Anti-Liver Kidney Microsome-1 (anti-LKM1) antibody.

What is the cornerstone management strategy for pediatric NAFLD?

Gradual weight loss and lifestyle modifications.

What is the preferred antidote for acetaminophen toxicity?

N-acetylcysteine (NAC).

What device is used to measure recumbent length in children under 2 years of age versus standing height in children over 2 years?

An infantometer for children under 2 years; a stadiometer for children over 2 years.

What growth parameters define Severe Acute Malnutrition (SAM) in children 6–59 months of age?

Mid-upper arm circumference (MUAC) $<11.5\,\text{cm}$, weight-for-height Z-score $<-3\,\text{SD}$, or presence of bilateral pitting edema.

What is the hallmark electrolyte disturbance in Refeeding Syndrome?

Severe hypophosphatemia.

What are the three components of the Pediatric Assessment Triangle (PAT) initial impression?

Appearance/consciousness, Work of Breathing, and Circulation to Skin (color).

What formula is used to calculate the estimated internal diameter of an uncuffed endotracheal tube in pediatric patients?

$$\text{Size (mm)} = \frac{\text{Age in years}}{4} + 4$$

What causes of acute intubation deterioration are represented by the mnemonic DOPE?

Displacement of tube, Obstruction of tube, Pneumothorax, Equipment failure.

What formula is used to calculate fluid resuscitation requirements in pediatric burns according to the Parkland formula?

$4\,\text{mL} \times \text{body weight (kg)} \times \%\text{TBSA burned}$ over the first $24\,\text{hours}$ (half given in first 8 hours, half over remaining 16 hours).

What specific physical sign indicates Vitamin A deficiency?

Bitot spots (keratinized conjunctival plaques) and xerophthalmia.

Which vitamin deficiency causes rickets in children?

Vitamin D deficiency.