Exam 2 Review Flashcards: GI, Cardiac, Hematologic/Immunologic, and Skin Disorders

Flashcards cover key topics from GI disorders, congenital and acquired cardiac diseases, hematologic/immunologic conditions, and common skin disorders as presented in the lecture notes.

What is diarrhea and what are its key characteristics?

A symptom from disorders of digestive, absorptive, and secretory function with abnormal water/electrolyte transport; can be acute (

What are the major risk factors for acute diarrhea in children?

Lack of clean water, crowding, poor hygiene, nutritional deficiencies, and poor sanitation.

How is acute infectious diarrhea typically managed in children?

Assessment of fluid/electrolyte balance, rehydration with oral rehydration therapy (ORT/ORS), replacement of stool losses 1:1 with ORS (10 mL/kg for infants; 150-240 mL for older children when volume unknown), maintenance fluids, possible probiotics, and reintroduction of an adequate diet.

What causes antibiotic-associated diarrhea and its typical treatment?

Antibiotics disrupt normal gut flora, leading to overgrowth of bacteria such as Clostridium difficile; treated with metronidazole or vancomycin; probiotics may help restore normal flora.

What are the common complications of diarrhea?

Dehydration, acidosis from fluid/electrolyte imbalance, and shock.

How is vomiting defined and categorized in pediatric patients?

Forceful ejection of gastric contents; categorized as nonbilious or bilious; often accompanied by nausea and retching.

What does bilious vomiting suggest about the GI tract?

A disorder of motility or a distal (post‑gastric) physical blockage, warranting evaluation for obstruction.

Name two common antiemetic drugs used in pediatrics.

Ondansetron (Zofran) and trimethobenzamide (Tigan).

What is gastroesophageal reflux disease (GERD) in children and how is it diagnosed?

GERD is symptoms or tissue damage from GER; diagnosed with a 24-hour intraesophageal monitoring study or barium swallow when indicated; management depends on severity and may include lifestyle modifications, feed adjustments, and medications or surgery in extreme cases.

What are nonpharmacologic management strategies for GERD in infants?

Small, frequent feedings; thickened feeds; feed upright with head elevated after feeding; weight management; avoidance of certain foods if applicable; continuous feeding may be used in some cases.

What is Failure to Thrive (FTT) in pediatrics?

Growth failure due to inadequate caloric intake or utilization; weight <5th percentile for age; multifactorial etiology; evaluation includes growth patterns, diet history, allergens, activity, and family/mealtime environment; management aims to reverse the cause and provide adequate calories and nutritional supplements.

How is colic defined and what is its typical course?

Abdominal pain with loud crying and drawn legs, lasting >3 hours/day for >3 weeks; symptoms often rise in late afternoon/evening; self-limiting and commonly resolves around 12-16 weeks; nursing focus is reassuring and supporting families.

What is gluten‑induced enteropathy and how is it diagnosed and treated?

Celiac disease; gluten triggers an immune-mediated response causing villous atrophy and malabsorption; diagnosed by serologic testing (tissue transglutaminase and anti-endomysial antibodies, especially after 18 months) followed by small bowel biopsy showing villous atrophy; treated with a lifelong gluten-free diet.

What are typical feeding considerations for a child with cleft lip and/or palate?

Feeding often requires specialized bottles or nipples, suctioning as needed, cheek support, and careful post-operative feeding and wound care if surgery is performed; lip repair is usually around 2-3 months, palate repair around 6-12 months.

What is Meckel diverticulum and its classic presentation?

True diverticulum at 40-50 cm from the ileocecal valve; most common congenital GI malformation; presents with painless rectal bleeding or signs of obstruction; diagnosed with Meckel scan and treated with surgical removal.

How does Crohn’s disease differ from ulcerative colitis in pediatric patients?

Crohn’s disease can affect any part of the GI tract with transmural, skip lesions and fistulas; UC involves only the colon/rectum with continuous mucosal inflammation; both may require steroids, immunomodulators, antibiotics, and nutritional support, but Crohn’s can have fistulas and strictures while UC may lead to toxic megacolon.

What are common management strategies for constipation in children?

Assessment of bowel habits, increasing dietary fiber and fluids, stool softeners (e.g., docusate, lactulose), laxatives (e.g., PEG), and establishing regular bowel routines; management of encopresis focuses on preventing stool withholding and promoting regular bowel movements.

What is pyloric stenosis and its classic signs?

Thickening of the pyloric sphincter causing gastric outlet obstruction; presents at 2-5 weeks with projectile, nonbilious vomiting and a palpable olive-shaped mass in the epigastric region; treated with pyloromyotomy; hydration is essential pre-op.

What are the typical features of intussusception and its treatment?

Telescoping of one bowel segment into another, usually at the ileocecal valve; sudden episodic abdominal pain with drawing of knees to chest, vomiting, red currant jelly stools, and a palpable sausage-shaped RUQ mass; treated with IV fluids, NG decompression, and enema reduction; surgery if enema is unsuccessful.

What are the key features and management considerations for esophageal atresia with tracheoesophageal fistula (EA/TEF)?

Esophagus fails to form a continuous passage and/or TEF is present; may occur with VACTERL associations; symptoms include excessive oral secretions, coughing, choking, cyanosis, and inability to pass an orogastric tube; management is surgical correction; preoperative stabilization and airway protection are critical.

What are the typical signs of acute appendicitis in children and its management?

Periumbilical pain migrating to the right lower quadrant (McBurney’s point), fever, nausea, vomiting, and anorexia; management includes hydration, antibiotics, and surgical appendectomy; rupture risk increases if not treated promptly.

How is Hepatitis A transmitted and what vaccines are used?

Transmitted via the fecal-oral route; incubation about 15-50 days; routine vaccination with a two-dose series; virus shed before/after jaundice; generally self-limiting; HBIG is not used for Hepatitis A exposure.

What are the key features of Hepatitis B in children and its vaccination strategy?

Transmitted by blood, semen, and other body fluids; incubation about 45-165 days; vaccination begins at birth (within 24 hours); HBIG given to newborns of HBsAg-positive mothers; can become chronic in children.

Is there a vaccine for Hepatitis C in children?

No vaccine currently available; transmission is parenteral (blood/blood products); chronic infection risk with potential liver disease.

What are the major sources of lead exposure and the importance of blood lead level (BLL) screening?

Exposure from lead-based paint, contaminated dust/soil, water, pottery or traditional remedies; risk higher in poverty, young children, urban living; universal screening at 1 and 2 years and again 3-6 years if not previously screened; target BLL <5 mcg/dL; higher levels require chelation therapy.

What is iron deficiency anemia in children and its common dietary contributors?

Most common pediatric anemia; risk 12-36 months; excessive cow’s milk intake can displace iron-rich foods; breastfed infants require iron supplementation by about 4 months; management includes iron-rich foods and oral iron with vitamin C; severe cases may need PRBC transfusion.

What are the typical crises in sickle cell disease and their management?

Vaso-occlusive crisis (VOC) causes pain from ischemia; sequestration crisis involves pooling of blood causing hypovolemia; aplastic crisis from viral infection; hyperhemolytic crisis with rapid RBC destruction; Acute chest syndrome; management includes rest, hydration, electrolytes, analgesia (often PCA), infection treatment, vaccination, and possible blood transfusions.

What are the major components of sickle cell disease management and prevention?

Hydration, rest, pain control, electrolyte management, antibiotics for infections, vaccination (pneumococcal, meningococcal, flu), and chronic transfusion therapy for some complications; avoid dehydration and extreme cold.

What are the common hemophilias and von Willebrand disease and their basic treatments?

Hemophilia A (factor VIII deficiency) and Hemophilia B (factor IX deficiency); von Willebrand disease involves defective/absent von Willebrand factor; treatments include factor replacement, desmopressin (DDAVP) for mild Hemophilia A, and avoidance of NSAIDs; prevention of bleeding and prompt treatment of bleeds.

What is aplastic anemia and its treatment approach?

Bone marrow failure with pancytopenia; treatment may involve antithymocyte globulin (ATG/ALG), cyclosporine, and bone marrow transplant as the definitive therapy; management focuses on preventing infection and supporting hematopoiesis.

How is HIV diagnosed in children and what are the general management goals?

Diagnosis uses HIV ELISA and Western blot for children ≥18 months; PCR for proviral DNA in ≤18 months; management aims to slow viral growth, prevent opportunistic infections, provide nutritional support, and manage symptoms with antiretroviral therapy (often 3-drug regimens) and prophylaxis.

What are the key features and diagnostic approach to meningitis in children?

Bacterial meningitis presents with fever, headache, neck stiffness, photophobia, nausea/vomiting; aseptic (viral) meningitis is more benign; diagnosis via lumbar puncture with CSF analysis, Gram stain, culture, cell count, glucose, protein, viral studies; treatment based on organism with antibiotics (bacterial) and supportive care.

What are the basics of immunizations and their types?

Active immunity: vaccine-induced antibody production; Passive immunity: antibodies given from another person/animal; barriers to immunization include access, education, beliefs; vaccines have contraindications (e.g., severe allergic reaction, SCID, moderate/severe illness, recent IVIG) that may be temporary.

What are the key features and management of varicella (chickenpox) in children?

Varicella-zoster virus (VZV) causes varicella; contagious from 1 day before rash until crusting; fever, malaise, pruritic vesicular rash; management includes acyclovir for certain cases, varicella immune globulin after exposure for high-risk children, symptomatic care, and skin care; avoid aspirin due to Reye syndrome risk.

What are the clinical features and management of diphtheria?

Corynebacterium diphtheriae; transmission via droplets/contact; treatment includes equine antitoxin, penicillin G procaine or erythromycin; droplet/contact precautions; airway protection and bed rest.

What are the key signs and management considerations for measles (Rubeola)?

Viral infection with prodrome of fever, malaise, cough, coryza, conjunctivitis and Koplik spots followed by a maculopapular rash; management includes isolation, antipyretics, vitamin A, eye care, and supportive care.

What are the key features of mumps and its management?

Paramyxovirus with parotitis (swelling of salivary glands); transmission via saliva; isolation with droplet/contact precautions; supportive care and analgesia.

What are the key features of rubella (German measles) and its management?

Rubella virus; incubation ~14-21 days; precautionary vaccination; rash begins on face and spreads downward; droplet precautions; supportive care and vaccination to prevent.

What is pertussis and its typical clinical course and treatment?

Bordetella pertussis; affects the upper respiratory tract with catarrhal, paroxysmal stages; paroxysmal stage features nocturnal coughing fits and a whoop; treated with macrolides (erythromycin, azithromycin, clarithromycin); droplet precautions.

What is fifth disease and how is it managed?

Parvovirus B19 infection presenting with facial 'slapped cheek' rash followed by a lacy body rash; contagious before symptoms; management is supportive (antipyretics, analgesia); isolation only for immunocompromised or during aplastic crisis.

What is tuberculosis (TB) in children and the general diagnostic approach?

Mycobacterium tuberculosis infection; TB testing via tuberculin skin test (PPD); positive test indicates infection, not necessarily active disease; chest X-ray and clinical evaluation; LTBI treated with isoniazid; active TB treated with multi-drug therapy.

What are the stages and treatment considerations for Lyme disease in children?

Caused by Borrelia burgdorferi; tick-borne illness; early stage often presents with erythema migrans; treated with amoxicillin in children <8 or doxycycline in older children; duration typically 14-21 days.

What are the characteristic features of systemic lupus erythematosus (SLE) in children?

Chronic multisystem autoimmune disease with butterfly (malar) rash; positive antinuclear antibodies (ANA); management includes corticosteroids, antimalarials, NSAIDs, immunosuppressants, antihypertensives as needed.

What is juvenile idiopathic arthritis (JIA) and its typical treatment approach?

Chronic autoimmune inflammatory joint disease in children; girls more than boys; management includes NSAIDs, methotrexate, corticosteroids, biologics (e.g., etanercept, adalimumab, abatacept), physical/occupational therapy, and addressing functional/psychosocial aspects.

What are common birthmarks and skin lesions to recognize in pediatrics (Cafe-au-lait spots, port-wine stain, etc.)?

Cafe-au-lait spots: light to dark brown flat macules; port-wine stains: capillary malformations; other birthmarks include flat/transient macular stains (stork bite), strawberry hemangiomas, and various nevi (junctional/compound).

What is acne and its typical treatment options in adolescence?

Common skin condition due to androgen-driven sebaceous activity; treatments include topical retinoids (tretinoin), benzoyl peroxide, topical antibiotics, systemic antibiotics, hormonal therapy (oral contraception), and isotretinoin for severe cases; emphasize proper skin care and avoiding picking.