13 ⼀PEDIATRICS Flashcards
What is the treatment for Developmental Dysplasia of Hip?
Pavlik Harness that holds hip in flexion and ABduction
What demographic is affected by Hypertrophic Pyloric Stenosis ?
[3-6 week old boys]
describe Puberty timeline for females (3)
[8-12 yof: breast + pubic hair]
[–(within 2.5y)–> growth spurt] ->
[MENARCHEby 13y or [by 15y if ⊕F∆]]
1º amenorrhea = NO MENSES by 13y or ([15y if ⊕F∆])*
What does Constitutional Short Stature refer to
“late bloomer” but will attain normal adult height later
pts have normal birth wt and ht but ht velocity slows between 6 mo-3 yo, picks back up after and slows again at adolescence. bone radiographs will show delayed bone age
[Genu Varum] is normal during age ⬜ and presents as (⬜3) . When should this correct by?
0-2 yo ; [BL symmetric bow leg, normal stature, no lateral thrust]
_________________
should correct by 2 yo
[varum is nml 0-2 yo] [ValGus = nml in 3-7 yo]
obtain XR if > 2 yo, short stature or uL
Newborn failure to pass meconium within 48 hours of birth likely indicates ⬜
MOD -5
Hirschsprung Disease
________________
[RET gene mutation vs Trisomy 21] →
failure of neural crest cell migration → absence of ganglion cells from [Auerbach/Meissner enteric nervous plexus] in rectosigmoid (confirmed by rectal suction biopsy)]
= transition zone cutoff between
[narrow aganglionic rectosigmoid] and [markedly dilated innervated descending colon]
EARLY AFTER BIRTH
Craniopharyngioma etx
[Calcified low grade malignancy] dervied from epithelial remnants of Rathke pouch within the pituitary stalk of the SUPRAsellar region
Marfan Syndrome and Ehlers Danlos can present similarly
How do you discern the two?-2 ; What is the etx for Ehlers Danlos?
“Marfan BAATHES a lot! “
BUT Ehlers Danlos does NOT have
- Ectopia Lentis
- Arm-to-Height Ratio that’s INC
Ehlers Danlos etx = defective collagen production
diagnostic criteria for suspected septic joint
_________________
empiric abx for septic joint
[WBC >50Kneutrophil predominance] in [aspirated joint synovial fluid]
_________________
Vanc IV
cp for [Measles rubeOla] -6
[fever + conjunctivitis + coryza + Koplik spots + cough] prodrome –(2-4days)–> [maculopapular rash sspreading head to body]
tx = supportive +/- [Vitamin A if hospitalized]
After successfully treating Acute Otitis Media, how should you manage a patient who p/w persistent middle ear fluid build up?
_________________
Explain why
WATCHFUL WAIT X 3 MO after treatment
_________________
serous fluid may persist in middle ear self-limited to 3 mo after AOM treatment (= [SOME - serous otitis media with effusion] )
further w/u if: infection / BL effusion / sx > 3 mo
Risk factors for Developmental Dysplasia of Hip - 3
________________
when should you stop screening for this?
- Breech Delivery - GET HIP IMAGING IF FEMALE AND BREECHED
- Female - GET HIP IMAGING IF FEMALE AND BREECHED
- Fam hx
12 months old
Dx Criteria for Kawasaki Disease
{[4/5 CRASH] + [Burning HIGH Fever ≥ 5 days]}
- Conjunctivitis
- Rash
- Adenopathy uL in cervical region (least likely)
- Strawberry tongue/oral mucosa changes
-
Hand/Feet redness or swelling
THIS IS DX OF EXCLUSION! THERE CAN NOT BE ANOTHER OBVIOUS CAUSE OF PRESENTATION
Meckel’s Diverticulum etx
tx = surgery
failure of vitelline duct to obliterate during first 8 WG ➜ leaves behind RLQ [ectopic gastric tissue in a blind pouch] ➜this blind pouch ectopically produces gastric acid that irritates mucosal lining and → mucosal irritation and bleeding = [NONPAINFUL HEMATOCHEZIA +/- IDA IN 2 Y/O]
also could be: asx / [Intususception] / Diverticulitis / Bowel obstruction
Malrotation and Volvulus are both diagnosed with ⬜
Describe how both would look on this diagnostic?
[UGSBS- Upper GI Series barium swallow]
________________
Malrotation = Ligament of Treitz on the R side of the abd in a gasless abd
________________
Volvulus = corkscrew image
management of
pediatric functional constipation (3)
1st: dietary ∆
2nd: Osmotic Laxatives
ACUTE DISIMPACTION: STIMULANT LAXATIVE
_________________
dietary ∆ = [⇪ fiber/water] | [cow’s milk< 24oz]
How do you manage infants born to Mothers with Active Hepatitis B (4)
_________________
How do you determine if the infant was vertically infected?
infant receives
- [AT BIRTH (within 12h of delivery) [HBVIG and HBVV1]]
- [2 mo HBVV2]
- {[6 mo HBVV3]
- –(3 months later)–> [9 mo obtain HBV Surface antigen]}
_________________
if [HBsAg] positive = HBV VERTICALLY INFECTED!
Annual Influenza vaccine is recommended for kids age ⬜ for what purpose?
≥6 month old ; prevent [infection and spread of infection] to at-risk populations (asthma/chronic illness/<2 yo)
Hypetrophic Pyloric Stenosis cp (6)
- age 3-6 weeks old
- [POSTPRANDIAL PROJECTILE NONBILIOUS EMESIS]
- [“Hungry Vomiter” (hunger immediately after vomiting)]
- [Epigastric Palpable Olive mass]
- Visible peristalsis
- [hypOchloremic hypOkalemic metabolic alkalosis]
_________________
[dx = US] | [tx = IVF ➜ Pyloromyotomy]
FPIAP is a ⬜ reaction to ⬜ that presents in normal infants as ⬜ . The treatment in formula-fed infants is ⬜
FPIAP = Food Protein Induced Allergic Proctocolitis
[non-IgE allergy] ; [milk protein (cow’s milk or soy protein)] ; blood-streaked stools ; Extensively Hydrolyzed Formula
FPIAP = non-IgE rxn to milk protein (casein/whey) = no skin/pulm rxn
Slipped Capital Femoral Epiphysis is a complication of childhood obesity
When does this present?
________________
How does this present?
________________
dx?
puberty (most common hip disorder in fat teens!)
________________
[M: [CHRONIC vague hip/knee pain]
________________
pelvis XRay
“Fat teen Slipped on [ASS, broke Neck] [PIS off Heads]”
[Fat teenchild obesity] during [Slipped Capital Femoral Epiphysis]
–(gradually)– > [ANT SUP Slip femNeck]
which → [POST INF Slip femHead]
➜ [CHRONIC vague hip/knee pain]</sub>
Oligohydraminos –> ⬜ sequence.
Name the 3 most common causes of Oligohydraminos
Oligohydraminos –> POTTER Sequence
POSTERIOR URETHRAL VALVES are the most common cause of obstruction in newborn boys (which causes renal damage –> Oligohydraminos during utero)
What is [Impetigo Diaper Dermatitis]? (3)
________________
Tx? -3
-secondary bacterial diaper infection (by Staph > GASP)
-[PAINFUL honey-crusted papules and pustules]
-in neonates can be c/b sepsis
________________
[: + sepsis s/s]: [Admit for IV Abx and sepsis w/u]
________________
sepsis s/s = [neonatal fever/irritability/lethargy]
Both [Croup Laryngotracheitis] and Epiglottitis cause inspiratory stridor
How do you discern the two?
Epiglottitis causes Drooling!
Language delay in any child warrants ⬜
Audiology
For ⬜ name the ⬜ developmental milestone(s)
1 year old
_________________
Gross motor -3
For ⬜ name the ⬜ developmental milestone(s)
1 year old
_________________
fine motor
For ⬜ name the ⬜ developmental milestone(s)
1 year old
_________________
Language
For ⬜ name the ⬜ developmental milestone(s)
1 year old
_________________
SOCIAL -2
-1 step command
-separation anxiety
[Clubfoot Equinovarus] is a deformity of the ⬜ bone which results in what clinical presentation?
_________________
Tx for this?
Talus; PIA BL feet [Plantar flexed + Inverted + ADDudcted]
_________________
serial Foot Cast
In a neonate, when should chest compressions be started?
HR <60
There are 5 major complications of Kawasaki Disease
In order of GREATEST to least, list them
{[4/5 CRASH] + [Burning HIGH Fever ≥ 5 days]}
[CNS ∆(irritability/aseptic meningitis)] > [CORONARY ARTERY ANEURYSM (within 1-4 wks!)] > Liver dysfxn > Arthritis > GallBladder Hydrops
________________
THIS IS DX OF EXCLUSION! THERE CAN NOT BE ANOTHER OBVIOUS CAUSE OF PRESENTATION
In Infants, what is “Periodic Breathing” ?
BENIGN physiologic breathing pattern in young infants in which they demonstrate
([breath pause x 5-10 seconds] ➜ [rapid shallow breaths x 10-15 seconds] ➜)
x several cycles before returning to normal breathing
Which diseases in kids have [rash involving palms and soles] - 4
“Killer Rashes Entrap Soles”
1. Kawasaki
2. Enteroviruses
3. Syphilis
4. Rocky Mountain Spotted Fever
⬜ is a [pediatric renal tumor that crosses the midline] and presents in the ⬜ year of life
Neuroblastoma
________________
first
Explain why [unconjugated Bilirubin] in newborns is physiologically elevated -3
________________
How does phototherapy treat this?
- liver immaturity
- lack of intestinal bacteria to catabolize bilirubin
- high hgb turnover (will ⇪ if cephalohematoma present)
________________
phototherapy converts bilirubin ➜ [water soluble lumirubin] ➜ excrete in urine and stool
The 2 major causes of [bloody stool < 6 month old are FPIAP] and ⬜
_________________
What is the long term prognosis of an infant with FPIAP?
FPIAP = Food Protein Induced Allergic Proctocolitis
Anal fissure
_________________
[self limited to 2 weeks] & they will be able to tolerate milk protein BY 1 YEAR OLD
_________________
FPIAP = non-IgE rxn to milk protein (casein/whey) = no skin/pulm rxn
A child comes in with neonatal conjunctivitis
DDx?-3
________________
How do you differentiate each?
Based on PECARN rule, name the [high risk Pediatric TBI features] for [2 -18 yo] (6)
high risk Ped TBI = [noncontrast head CT (or 5h obs if med risk)]
List the Vaccines that are Live Attenuated - (12)
“[MY MVP RiB RATS] are live!”
Measles rubeOla
Yellow fever
Mumps
Varicella
PolioSabin
Rubella
influenzaintraNasal
BCG
Rotavirus
Adenovirus
TyphoidPO
Smallpox
_________________
Pregnant Women should NOT get Live attenuated vaccines but their household contacts SHOULD as this is less severe than wild-type
explain why early environmental exposure for newborns is important
Normal newborn immunity is polarized toward [Th2 response ( which will ➜ ATOPY = IgE, mast cell, eosinophil production) = Asthma/Eczema/Allergic Rhinitis]
BUT this is balanced by the [Th1 cytokine profile] you can only develop from exposure to nonpathogenic microorganisms
APGAR is used to assess newborn status immediately postpartum
Describe the grading system for Activity & tone?
APGAR
0 = no motion
1 = arms & legs flexed but not active
2 = Active Motion of extremities
infant presents with refractory candidiasis
suspected diagnosis?
infant HIV
PSGN-PiG is a compliation of ⬜ that typically presents with (⬜3)
_________________
What’s the treatment for PSGN-PiG? (2)
GASP ; [(Hematuriiia with low complement) / Edema/ HTN]
Tx = Supportive + Furosemide
_________________
MOD: [IgG-C3-antigen] lodges into glomerular capillaries and recruits C5a complement ➜ damage ➜ gross hematuria + inappropriate RAA activation ➜ Na+ retention ➜ fluid retention]
Malrotation and Volvulus are both diagnosed with ⬜
What would Volvulus look like on this diagnostic?
[Upper GI series barium swallow]
corkscrew image
Try not to use CT scans in kids
What is the treatment for BreastMilk Jaundice?
OBSERVATION
(BMJ is self limited to 3 mo :-))
Which 3 microbes cause pediatric sepsis in
[age group: ≤28 days old]?
________________
Based on that, name the empiric abxs given for pediatric sepsis [age group ≤ 28 day old] -4
“pediatric sepsis from *LEG-NS “
1-Listeria = Ampicillin
2A- E Coli = [Gentamicin
2B-but → {substitute with CefoTAX vs CefTAZ if meningitis suspected}]
3-GBS = Ampicillin
_________________ _________________
Ampicillin + [Gentamicin (or CefoTAX | CefTAZ if meningitis)]
Precocious puberty is (premature) development of 2º sex characteristics in girls age ⬜ and boys age ⬜
_________________
What’s the treatment of central Precocious puberty?
g< 8 | b< 9
_________________
[GnRH R agonist]
(binds to hypothalamus GnRH Receptors ➜ negative feedback ➜ ⬇︎GnRH secretion ➜ ⬇︎LH/FSH)
clinically associated conditions with Down Syndrome (8)
SHEEPPS & [SHALA Has Down Syndrome]
[SHALA Has Down Syndrome]
1. [SEPTAL ENDOCARDIAL CUSION DEFECT]
2. Hirschsprung’s disease
3. Atlanta-axial instability
4. [Leukemia (LATER IN LIFE!)]
5. [Altered Psyche (Autism/ADHD/Alzheimer-like dementia)]
6. hypOthyroid
7. Duodenal atresia
8. [triSomy 21]
diagnostic criteria for SIDS
________________
Sudden Infant Death Syndrome
[Sudden unexplained (Infant<12 mo) Death with inconslusive autopsy]
What are the recommendations regarding Patient Confidentiality and Adolescents?
MD should honor [Adolescent Patient Confidentiality] for care regarding [SEX, DRUGS and PSYCH]
BUT MUST BREAK AND ALERT PARENTS IF AT RISK FOR HARM TO SELF OR OTHERS
(pregnancy/contraception, STI, substance abuse/mental health)
Kawasaki dx = [4/5 CRASH] + [Burning HIGH fever ≥5d]
Recite the very important caveat regarding incomplete diagnostic criteria for Kawasaki Disease (4)
KD dx normally requires: {[4/5 CRASH] + [Burning HIGH fever ≥5d]}
▶but Because Kawasaki Disease sx do NOT manifest simultaneously → [dx caveat] =
▶if {[<4 CRASH] is present BUT pt does have [Burning HIGH fever ≥5d]}
▶= [“febrile vasculitis of uncertain etiology”]→
⭐[obtain CRP, ESR and f/u daily to reassess for onset (or not) of final criterion]
Congenital Toxoplasmosis is given to baby via ⬜ but acquired by Mom via ⬜-3
________________
Sx-4
Transplacental
- Raw undercooked meat
- unwashed produce (contaminated soil)
- cat feces
________________
Tox- HICH
Hydrocephalus
Intracranial Calcifications
Chorioretinitis
(also Hearing impairment)
child presents with 2º enuresis
DDx? -2
_________________
2º enuresis = bed wetting ≥5 yo after established period of nighttime dryess
DM (order CBC/CMP)
vs
psychological stressor (I.e. parents’ divorce)
What is the most common cause of hip pain in kids?
________________
Dx?
Transient Synovitis
________________
Clinical but obtain Xray to r/o Legg Calve Perthes
may have ⬆︎inflammatory markers but xrays will be normal
Because of serious possible sequelae associated with Kawasaki disease (Coronary artery aneurysms), ⬜ must be performed at ⬜ , ⬜ and ⬜.
TTE; [baseline, 2w after tx, 6w after tx]
[4/5 CRASH] & [Burning HIGH Fever ≥ 5 days] sl;l
What is the mngmt for an ingested coin? - 3
- Obs for up to 1 day after ingestion UNLESS
- Pt is symptomatic = flexible endoscopy
- Pt has no recollection of ingestion time = flexible endoscopy
Risk factors for Developmental Dysplasia of Hip - 3 ; when should you stop screening for this?
- Breech Delivery - GET HIP IMAGING IF FEMALE AND BREECHED
- Female - GET HIP IMAGING IF FEMALE AND BREECHED
- Fam hx
12 months old
Why can’t Ceftriaxone be used during the 1st month of life?
[albumin-boundCeftriaxone] can displace [albumin-bound bilirubin] ➜ allows free [*indirect unconjugated *bilirubin] to cross blood brain barrier ➜ [Kernicterus bilirubin encephalopathy]
Cerebral Palsy is a group of clinical syndromes generally characterized as ⬜
How does it present? - 3
Nonprogressive motor dysfunction (Prematurity>EtOH = RF) ;
“Cerebral Palsy presents SAD on 3 SAD types”
- [Spastic UMN ∆ LE>UE]
- [AMS Retardation]
- [Deformed BL equinovarus club feet (image)]
_________________
types:
Spastic
Ataxic
Dyskinetic
Greatest RF = prematurity ( < 32WG)
In Infants, what is [Apnea of Prematurity]?
[TRUE apnea episodes ≥20 seconds] in premature infants, that resolves by [corrected gestational age 37 WG]
What is Osgood Schlatter Disease
Traction apophysitis of the tibial tubercle from Self-limited irritation of the growth plate at the tibial tuberosity (front of tibia) possibly –> hard nodule, relieved with rest/growth spurt
xray: lifting of tubercle from the shaft
Dx for Intussuception
AIR contrast enema ultrasound guided
Intussuception age = 3-36 mo
Look for the Target Sign on US!
DDx for neonatal rectal bleeding - 5
- FPIAP -[Food (Milk/Soy) Protein-Induced ALLERGIC Proctocolitis] ⭐
- Anal Fissure ⭐
- Meckel Diverticulum = nonpainful Hematochezia
- Volvulus = bloody stool from intestinal ischemia
- Intussuception = (dx:AIR|water contrast enemaUS guided)
APGAR is used to assess newborn status immediately postpartum
Describe the grading system for Grimace & reflex irritability?
APGAR
In response to stimulation (i.e. pinch) baby rxn = …
0 = none
1 = grimace
2 = [grimace AND (cry|coryzasneeze|cough)]
_________________
grimace = ugly twisted facial expression
A: [POTTER Sequence] etx
B: Clinical Presentation - 6
A: [RenalFETAL agenesis/dysfunction BL] –> [Oligohydraminos(NO Amniotic fluid)] ➜
B. POTTER
Pulm hypOplasia
Oligohydraminos
Twisted Face
Twisted shortened Limbs
Ears set low
[RenalFETAL agenesis/dysfunction BL] = cause
by age ⬜ , full term infants should be able to sleep thru the night without overnight feeds
If they can’t, how do you change this?
6 months old
_________________
AVOID OVERNIGHT FEEDS
(do NOT offer feeding during nocturnal awakenings. Just check on baby)
In terms of etiology, what is a difference between Breastfeeding Failure jaundice and Breast Milk jaundice?
BFF jaundice within the First week of life:Feeding inadequately –> inadequate stooling –> ⬇︎bilirubin elimination –> ⬆︎Unconjugated bilirbuin recycling with Failure to thrive/dehydration
Clinical characteristics of Down Syndrome pts - 7
SHEEPPS & [SHALA Has Down Syndrome]
the SHEEPPS of genetics
- Skin excessive at the nape of the neck = nuchal skin
- HypOtonia w/ ⬇︎ Startle Moro reflex
- Epicanthal folds
- Ears that are small
- Protruding tongue w/flat face
- Palpebral fissures are upslanted
- Single palmar crease
these pts also have ⬆︎risk for hypothyroidism
What are the 2 major complications of Mumps
- Orchitis
- Aseptic Meningitis
in newborns, bilirubin greater than ⬜ ➜ ⬜. Describe this condition
________________
management?
[20-25] ➜ [Kernicterus bilirubin encephalopathy] (mvmnt DO and hearing loss)
________________
Exchange Transfusion
exchanging [blood with SEVERE HYPERBILIRUBINEMIA and/or DAT+ maternal Ab] from baby and transfusing baby with replacement RBC
cp for neonatal Lactose Intolerance - 3
- NONBLOODY diarrhea
- Flatulence
- crampy abd pain
Lactose Intolerance = no Lactase ➜ NONBloody Diarrhea & Flatulence
What is the tell tale sign of child abuse
SUDDEN CHANGE IN BEHAVIOR
(RISQUE SEXUAL BEHAVIOR/IRRITABILITY/CONCENTRATION ⬇︎)
[Strabismus ocular misalignment] after the age of ⬜ is abnormal and requires intervention to prevent ⬜
________________
Which intervention is employed for this? - 3
4 mo ; Amblyopia(vision loss from disuse of the deviated eye)
- CTL eye patch to strengthen deviated eye OR
- CTL cycloplegic eye drops (blurs normal eye to strengthen deviated eye)
- Corrective lens
Dx = asymmetric corneal light reflex
At what age should you be concerned for an infant not walking yet?
_________________
What age do infants usually learn to walk?
> 16 mo
_________________
9-16 mo
Pts who’ve recovered from RSV Bronchiolitis are at ⇪ risk for [⬜ +/- recurring]. Ergo, ⬜ should be avoided
WHEEZING; cigarette smoke (and other airway reactivity triggers)
Bronchiolitis:[Wet&Hot👃]/[Wheezing recurrent]/[WOB] - in Winter
Osgood Schlatter Disease tx -3
- NSAIDs
- Ice
- self-limited (stops with end of growth spurt)
xray: lifting of the tibial tubercle from the shaft
Peds with untreated iron deficiency anemia are at INC risk for what 2 comorbidites?
___________________
How is this mitigated? -3
psychomotor delay
neurocognitive impairment
_________________
[universal screening starts age 1 yo]
–(if hgb <11)–> [PO ferrous sulfate]
_________________
IDA is the most common nutritional deficiency in kids
Slipped Capital Femoral Epiphysis is a complication of childhood obesity
MOD
_________________
management?
“Fat teen Slipped [on ASS,broke Neck] [to PIS off Heads]”
[Fat teenchild obesity] during [Slipped Capital Femoral Epiphysis]
–(acutely)– > [ANT SUP Slip femNeck]
which → [POST INF Slip femHead]
➜ [Months of vague hip/knee pain]
________=_________
[surgical pinning within 24 HOURS]
fat teen –acutely– > [ANT SUP Slippage of femoral Neck] ➜ [POST INFERIOR displacement of Femoral head] ➜ [Months of vague hip/knee pain]
Reconstruction of cleft lip is generally performed at (⬜age)
10 weeks old
________________
(in accordance with rule of 10s = 10 lbs|10 weeks old|10 g hgb)
APGAR is used to assess newborn status immediately postpartum
Describe the grading system for Appearance?
APGAR
0 = entirely blue
1 = pink with blue extremities
2 = entriely pink
What is the most common congenital cyanotic heart defect in the neonatal period?
Transposition of Great Vessels
Look for the single Loud second heart sound!
What is Erythema Toxicum Neonatorum ; tx?
benign neonatal rash with blanching erythematous papules and/or pustules ; self limited to 2 weeks after birth
Reye Syndrome
MOD -4
-pediatrics
-with viral illness
-who takes ASA
-develops VELLDSsx
Reye’s = [peds+virus+ASA→VELLDS]
Vomiting, {Encephalopathy from ⇪ICP}, _LIVER❌_, Lethargy, DEATH, Seizures
Reye Syndrome
clinical presentation -6
VELLDS
Reye’s = [peds+virus+ASA→VELLDS]
Vomiting, {Encephalopathy from ⇪ICP}, LIVER❌, Lethargy, DEATH, Seizures
Bronchiolitis is a ⬜ respiratory infection that occurs in the ⬜ by the ⬜ virus
What are the sx ? (3)
lower; Winter ; RSV
_________________
[WET & HOT nose(RHINORRHEA with FEVER)] | [WHEEZING(+/- recurring)] | [WOB⇪]
dx = clinical > nasal/pulmonary antigen test
[T or F]
UNILATERAL cervical LAD in kids (typically from ⬜ bacteria ) is not common and needs further workup
FALSE!
________________
ped uL cervical LAD (typically from Staph > GASP) is common
APGAR is used to assess newborn status immediately postpartum
Describe the grading system for Respiration?
APGAR
0 = not breathing
1 = breathing slow/irregular
2 = crying
Oligohydramnios –> ⬜ sequence.
Describe this clinical presentation for this Sequence
Oligohydraminos –> POTTER Sequence
Pulmonary hypOplasia
Oligohydraminos from renal agenesis/damage (cause)
[Twisted Face & Extremities]
Twisted Skin
Ears set low
Renal agenesis/damage
Based on PECARN rule, name the [high risk Pediatric TBI features] for [ < 2 y/o ] -5
Necrotizing Enterocolitis cp - 3
________________
X ray finding?
- Bloody stools
- feeding intolerance
- abd distension
X-ray = Pneumotosis Intestinalis
Risk factors= prematurity, congenital heart disease, hypotension
What is Legg Calve Perthes Disease?
________________
Demographic?
________________
mngmt-2?
Avascular necrosis of the Capital Femoral Epiphysis ; [Boys 4-10 yo) ;
- Self limited but can –>deformity/degeneration
- contain femoral head within acetabulum during encounter
How do you manage a choking child? (2)
What’s used to keep the PDA Patent?
Prostaglandin E1
McCune-Albright Syndrome
clinical features (3)
McCune Albright Syndrome
1. [Macules (Coast of Maine irregular cafe au lait spots)]
2. [Axillary hair, Pubic hair and Breast develop precociously]
3. [Spongy trabeculae bone undergoes fibrous dysplasia]
A Contrast enema demonstrating microcolon is indicative of what condition? ; etx?
Meconium iLeus 2/2 Cystic Fibrosis
viscous meconium accumulation obstructs terminal iLeum –> underused colon –> contracted microcolon
Typically, for minors, informed consent must be obtained by an ADULT legal guardian
… unless ⬜3
(list the 3 exceptions in which peds pt do NOT need Adult consent)
“peds don’t need Parents for EEEverything
- Emergency(delaying tx could → life/limb❌)
- Emancipated(ped pt is a [Parent|$ independent|HS grad|court📄|etc])
- “Edgybut noncidal” eval [Sex, Drugs, noncidalPsych]
_________________
noncidal = NOT threat to self/suicidal or others/homocidal.
(⚠️PARENTS MUST BE INFORMED OF CIDAL MINORS ⚠️)
cp for Febrile Seizure -4
________________
⬜ is the primary management.
but When do you give [Abortive Antiepileptics]?
- [child [6 month - 5 year old] with [< 15m GTC nonfocal seizure]]
- NO afebrile seizure within prior 24h
- NO CNS infection (meningismus, bulging fontanelles)
- NO metabolic❌ (hypOglycemia)
________________
AntiPyretics
_________________
➜ [Abortive AntiEpileptics if seizure ≥5 min]
Why can Moms breastfeed on methadone treatment, but can NOT breastfeed if actively using recreational substances/opioids?
________________
What is the requirement to be candidate for [breastfeeding on methadone tx] -2
[methadone treatment concentration in breastmilk] is low and unrelated to maternal dose
but
recreational substances have unpredictable pharmacology (mixed with other drugs/inconsistent dosing)
________________
compliant with methadone treatment throughout pregnancy and after pregnancy/postpartum/breastfeeding
+
NO active recreational drug use relapse
Diagnosis? ; Name the major risk factor for this
HIRSCHSPRUNG DISEASE ; [Mom ≥ 35 yo]
markedly dilated descending colon
cp for [Radial head subluxation Nursemaid’s elbow]
_________________
Tx? (3)
sudden refusal to move arm after arm is forcibily pulled
affected arm with forearm pronated
_________________
extendarm ➜ pressureradial head ➜ HYPERPRONATEFOREARM (create “waiter’s tip”)
Describe Metatarsus Adductus
Most common congenital foot deformity in which there is BL medial deviation of the forefoot usually in 1st born infants
Tx = this corrects spontaneously
[Atlantoaxial joint] Instability MOD
________________
Which demographic are at most risk for this?
excessive laxity in the Posterior transverse ligament ➜ ⬆︎mobility between [C2 aXis: dens] and the [C1 atlas] –> spinal cord compression ➜ UMN signs
________________
Down Syndrome (remember pts with down syndrome are usually hypOtonic but not with Atlantoaxial instability!)
{[SHEEPPS]traits & [SHALA Has Down Syndrome]conditions}
What is Primary nocturnal enuresis?
_________________
1st step in evaluation?
lack of nighttime dryness in kids age ≥5 y/o that usually spontaneously resolves over time
_________________
UA (r/o DM, DI, infection)
Name the 7 most common manifestations of Marfan Syndrome
etx = mutation of fibrillin 1 gene
“Marfan BAATHES a lot! “
- Ectopia Lentis
- Arm-to-Height Ratio ⬆︎
- Heart issues (MVP or [idiopathic Aortic cystic medial degeneration]–> Aortic Dissection and Aneurysm)
- Scoliosis vs. Kyphosis
- Breastbone structural abnormalities
- Arachnodactyly (Steinberg thumb & wrist)
- Tall / slender / flat feet
etx = mutation of fibrillin 1 gene
Which 2 microbes cause pediatric sepsis in [age group: > 28 days old]?
________________
Based on that, name the empiric abxs given for pediatric sepsis [age group > 28 day old] -3
“pediatric sepsis from LEG-NS “
- [Neisseria meningitidis ⼀Ceftriaxone (+ Vancomycin if M or M suspected)]
- [Strep Pneumo ⼀Ceftriaxone (+ Vancomycin if M or M suspected)]
_________________
Ceftriaxone (+ Vancomycin if MRSA or meningitis suspected)
[if MRSA suspected⼀ add Vancomycin]
[if Meningitis suspected ⼀add Vancomycin]
the timing of neonatal jaundice differentiates [G6PD deficiency] from [Hemolytic Disease of Newborn] explain
neonatal jaudice presenting within first
24 hours of life = HDN
(⊕direct Coombs | A or B infant born to O mother)
________________
2-3 DAYS of life = G6PD deficiency
Pediatric dyslipidemia is a risk factor for adulthood progression of ⬜ and ⬜.
Because of this, what is the recommended lipid screening for peds?
atherosclerosis / CVD
note: universal [fasting lipid panel] screening should still be obtained ages 9-11 and 17-21 regardless of CV risk factors
3 classic Clinical Manifestations of [Tetralogy of Fallot]
A:
- [Systolic Ejection HARSH Murmur @ L Sternal 2/3 ICS] from [RVOO -R Vt Outflow Obstruction]
- Squatting relieves sx (INC afterload–> [DEC amount of R to L shunt]
- [Cyanotic lethal Tet Spells] (tx: Knee chest positioning and inhaled O2)
“VOIR is to have See + Sight & Cry”
Name the specific signs of congenital syphilis - 3
- Rhinorrhea
- [P&SMaculopapular rash] that dequamates or becomes bullous
- Abnormal long bone xrays (i.e. metaphyseal lucency)
P&S = Palms & Soles
APGAR is used to assess newborn status immediately postpartum
Describe the grading system for Pulse?
APGAR
0 = No HR
1 = < 100 bpm
2 = > 100 bpm
list clinical features of
Intussusception (4)
_________________
how it it diagnosed? treated?
- [6 mo - 3 yo]
- [SEVERE colicky abd pain + emesis]
- CURRANT JELLY STOOL
- [Target sign on US]
_________________
Dx & Tx = [Air or Water contrast enema]
What is the normal age parameters for physiologic genu varum?
_________________
genu valGum?
[0-(varum)-2-(✅)-4-(valGum)-7–>(✅)]
_________________
varum “bow legged” = [onset birth - resolve by 2 year old]
______(should have ✅straight knees 2-4 yo and ≥7 yo)___________
valGum “Knock Kneed” = [onset 4y - resolve by 7y]
obtain imaging only if persist beyond upper age limit
Tx for Neonatal Chlamydia Conjunctivitis?
________________
Tx for Neonatal Gonococcal Conjunctivitis?
ncC = [Macrolide PO]
________________
ncG = [CefTriaxone IM]
________________
nc = neonatal conjunctivitis
Topical macrolides are only PX for Gonococcal conjunctivitis
Demographic for Hypertrophic pyloric stenosis
First Born boys [3-5 wks old]
image showing “oilive mass”
What are the only 2 absolute contraindications to giving the DTaP vaccine?
Anaphylaxis prior
Encephalopathy prior
What is the treatment for Developmental Dysplasia of Hip?
Pavlik Harness that holds hip in flexion and ABduction
Identify possible causes of this rash - 3
THE STRAWBERRY TONGUE!
- [GASP +/- mononucleosis]
- Kawasaki disease
- Toxic Shock Syndrome
Main features of Becker Muscular Dystrophy - 4
- [Xp21 deletion] (X-link recessive deletion on Chromo Xp21)
- Scoliosis
- [peds onset at 5 yo]
- [cardiomyopathy ➜ 40-50 yo DEATH]
What is the most common cause of Chronic renal failure (and urinary tract obstruction) in pediatrics?
[Posterior Urethral membranous valves]
AFFECTS BOYS ONLY - including newborns
tx for [irritant contact diaper dermatitis] -4
[lifestyle ∆ (frequent diaper change, avoid tight diapers)]
+
- Zinc Oxide (topical barrier)
- Petrolatum (topical barrier)
- CTS cream
main characteristics of [Candida Diaper Dermatitis] -3
________________
2nd most common diaper dermatitis
- SKIN FOLD INVOLVEMENT
- beefy red plaques
- satellite lesions
diagnosis?
hypertrophic pyloric stenosis
The 2 major causes of [bloody stool < 6 month old are FPIAP] and ⬜
_________________
how do you manage FPIAP once it’s diagnosed?
FPIAP = Food Protein Induced Allergic Proctocolitis
Anal fissure
_________________
FPIAP = non-IgE rxn to milk protein (casein/whey) = no skin/pulm rxn
Diagnosis?
What other syndrome is this disease a/w?
Hirschsprung disease
________________
DOWN SYNDROME trisomy 21
{[SHEEPPS]traits & [SHALA Has Down Syndrome]conditions}
describe clinical course for this infant
[superficicial infantile hemangioma] proliferate and grow the 1st year of life
BUT REGRESS EARLY CHILDHOOD
= observation only unless cosmetic/bleeding/functional impairment
What is Primary nocturnal enuresis?
_________________
After ⬜ months of Behavioral changes, Enuresis Alarm is recommended. How does the Enuresis Alarm work?
_________________
What medication can be added if this still doesn’t work?
lack of nighttime dryness in kids age ≥5 y/o that usually spontaneously resolves over time
_________________
1st: [Behavior ∆ x 3-6 mo] (⬇︎evening fluids/reward system)
2nd: ENURESIS ALARM (when sensor in pt’s underwear starts detecting moisture ➜ audiovibratory alarm ➜ wakes child right at initiation of their involuntary micturition = before any further bladder emptying occurs. Eventually, alarm conditions the child to wake up just before voiding
_________________
[Desmopressin ADH]
How do you manage UTI in peds less than 2 yo
_________________
what about peds > 2 yo?
after 1st febrile UTI,
in [peds < 2 yo]= abx +[renal/bladder US (to evaluate for anatomic abnl) –(if abnl)–>VCUG]
_________________
[peds > 2 yo] =
abx
➜ {R/B US –+→
{VCUG <-N- [ UTI resolve? ] -Y-> Nothing more}
VCUG = Voiding CystoUrethroGram
Neonatal brachial plexus injuries (like Erb Duchenne palsy) are most commonly a/w shoulder dystocia in infants that have ⬜
________________
management?
[macrosomia > 4 kg]
________________
supportive care (recovers spontaneous)
Why do pts with this condition often have polyhydraminos?
Hernia of Diaphragm compresses esophagus –> polyhydraminos
Congenital Diaphragmatic Hernia
Image = Scaphoid concave abdomen with Barrel Chest
[Croup Laryngotracheitis] treatment (4)
- [mild (no Stridor at rest)] = h +/- C
- [MODERATE/SEVERE (STRIDOR AT REST)] = C + E
h:humidified air / C:CTS / E:Epinephrine-Nebulized-Racemic
[Croup Laryngotracheitis] = paraflu that –> subglottic edema and narrowing = barky brassy cough f/b inspiratory stridor
5 month old female pt presents with apparent leg length discrepancy and is diagnosed with ______
What is the work up for this condition?-2
Developmental Dysplasia of Hip
hip ultrasound < 4 mo < hip xray
Name the 4 major risk factors for Hypertrophic Pyloric Stenosis
“Hypetrophic Pyloric Stenosis _M_mmmakes a tight first in his stomach”
- male firstborn
- [macrolide exposure[anytime from (pregnancy - 2 wks old)]]
- maternal smoking
- mega fam hx
cp Thyroglossal duct cyst
_________________
How should it be managed (2)? why?
[s/p URI, superior to thyroid, fluctuant midline neck mass, in kids that moves superiorly when swallowing]
_________________
1st: [Thyroid imaging (to ensure native thyroid is functional and/or TDC isn’t only site of functioning [ectopic] thyroid tissue)
2nd: ➜ TDC surgical removal]
(TDC may be the only site of functioning [ectopic] thyroid tissue so obtain thyroid imaging prior to definitive surgical removal)
Name the 3 classic sx of [Croup Laryngotracheitis]
- [Barky Brassy cough]
- +hoarseness ➜
- [inspiratory stridor [ mildh +/- C ← (stridor at rest?) ➜ MODERATE/SEVEREC+E ]
[Advanced Maternal Age ≥35] is a risk factor for ⬜, which is a/w with which 8 comorbid conditions?
Down Syndrome Trisomy 21
_________________
{SHALA Has Down Syndrome]conditions}
1. [SEPTAL ENDOCARDIAL CUSION DEFECT]
2. [🍼Hirschsprung disease (dilated Colon)]
3. [Atlanto-axial instability]
4. [Leukemia (Later in life)]
5. [Altered Psyche (ADHD/Autism/Alzheimer-like dementia)]
6. HypOthyroid
7. [🍼Duodenal atresia (double bubble)]
8. [triSomy 21]
🍼 = neonatal onset
{[SHEEPPS]traits
cp for Laryngomalacia
________________
dx?
________________
tx?
[P2: inspiratory stridor that improves when prone]
________________
Direct laryngoscopy
________________
self limited to 18 mo
In peds > 1 yo, ⬜ and/or ⬜ are primary contributors to the development of iron deficiency anemia
How does this present? -2
[excessive milk intake > 24 oz/day] ; [low intake of iron-rich food]
________________
microcytic anemia + elevated RDW
Main features of Duchenne Muscular Dystrophy - 5
- [CALF PSEUDOHYPERTROPHY requiring gower manuever + teenage wheelchair] = [⇪ Creatine Kinase]
- [Xp21 deletion] (X-link recessive deletion on Chromo Xp21)
- Scoliosis
- [peds onset at 2 yo]
- [cardiomyopathy ➜ 20-30 yo DEATH]
etx for Choanal atresia in kids
________________
cp
Congenital falure of posterior nasal passage to canalize –> bony obstruction instead
________________
cyanotic infant whose cyanosis worsens with feeding and relieves by crying
Dx = inability to pass catheter thorugh nares
Precocious puberty is (premature) development of 2º sex characteristics in girls age ⬜ and boys age ⬜
How do you work this up?
g< 8 | b< 9
Tx for Congenital Toxoplasmosis -3
Pyrimethamine
SulfaDiazine
Folinic acid
Meckel’s Diverticulum symptoms-5
________________
How do you diagnose Meckel’s Diverticulum
-[NONPAINFUL HEMATOCHEZIA +/- IDA in 2y/o] ⭐
-asx
-Intussusception
-diverticulitis-
-Bowel obstruction
_________________
[ MT9P scan]
MT9P = [Meckel’s Technetium-99m Pertechnetate]
Newborn failure to pass meconium within 48 hours of birth likely indicates ⬜
how is this diagnosed? -2
Hirschsprung Disease
________________
[Abd XR = contrast enema demonstrating transition zone] ➜ [RECTAL SUCTION BIOPSY (gold standard)]
⬜ is the preferred imaging for Pyloric Stenosis
How does this present?
Abdominal ultrasound
________________
[First born males 3-5 weeks old] ➜ Non-bilious emesis withOUT abdominal distension + epigastric olive mass
Dx
X-ray = Pneumotosis Intestinalis
Necrotizing Enterocolitis
What’s the main difference between [irritant contact diaper dermatitis] and [candida diaper dermatitis]?
[Candida Diaper Dermatitis] INVOLVES [GENITOCRURAL SKIN FOLDS]
Vaccines are given [(Birth/2/4/6/12/15/18mo) + (4/11/16yo) + annual]
Recite the Vaccine Schedule for
Birth
HBV
“Hewa / D P His Hairy Pretty Rectum / “/ “/ He Made Victor Have Pussy / Dick / Head // Victor D P Me /Handed Me T/ Making Me / (fall) “
Vaccines are given [(Birth/2/4/6/12/15/18mo) + (4/11/16yo) + annual]
Recite the Vaccine Schedule for
2 months old
- DTaP
- Polio
- HBV
- Hib
- PCV
- RSV
“Hewa /D P His Hairy Pretty Rectum / “/ “/ He Made Victor Have Pussy / Dick / Head // Victor D P Me /Handed Me T/ Making Me / (fall) “
Vaccines are given [(Birth/2/4/6/12/15/18mo) + (4/11/16yo) + annual]
Recite the Vaccine Schedule for
4 months old
- DTaP
- Polio
- HBV
- Hib
- PCV
- RSV
“Hewa / D P His Hairy Pretty Rectum /“/ “/ He Made Victor Have Pussy / Dick / Head // Victor D P Me /Handed Me T/ Making Me / (fall) “
Vaccines are given [(Birth/2/4/6/12/15/18mo) + (4/11/16yo) + annual]
Recite the Vaccine Schedule for
6 months old
- DTaP
- Polio
- HBV
- Hib
- PCV
- RSV
“Hewa / D P His Hairy Pretty Rectum / “/ “/ He Made Victor Have Pussy / Dick / Head // Victor D P Me /Handed Me T/ Making Me / (fall) “
Vaccines are given [(Birth/2/4/6/12/15/18mo) + (4/11/16yo) + annual]
Recite the Vaccine Schedule for
12 months old
- HAV
- MMR
- V ZV
- Hib
- PCV
“Hewa / D P His Hairy Pretty Rectum / “/ “/ He Made Victor Have Pussy / Dick / Head // Victor D P Me /Handed Me T/ Making Me / (fall) “
Vaccines are given [(Birth/2/4/6/12/15/18mo) + (4/11/16yo) + annual]
Recite the Vaccine Schedule for
15 months old
DTaP
“Hewa / D P His Hairy Pretty Rectum / “/ “/ He Made Victor Have Pussy / Dick / Head // Victor D P Me /Handed Me T/ Making Me / (fall) “
Vaccines are given [(Birth/2/4/6/12/15/18mo) + (4/11/16yo) + annual]
Recite the Vaccine Schedule for
18 months old
HAV
“Hewa / D P His Hairy Pretty Rectum / “/ “/ He Made Victor Have Pussy / Dick / Head // Victor D P Me /Handed Me T/ Making Me / (fall) “
Vaccines are given [(Birth/2/4/6/12/15/18mo) + (4/11/16yo) + annual]
Recite the Vaccine Schedule for
4-6 year old
- Varicella
- DTaP
- Polio
- MMR
“Hewa / D P His Hairy Pretty Rectum / “/ “/ He Made Victor Have Pussy / Dick / Head // Victor D P Me /Handed Me T/ Making Me / (fall) “
Vaccines are given [(Birth/2/4/6/12/15/18mo) + (4/11/16yo) + annual]
Recite the Vaccine Schedule for
11-12 year old
- HPV
- MenACWYD
- TDaP
Men: Meningococcal
“Hewa / D P His Hairy Pretty Rectum / “/ “/ He Made Victor Have Pussy / Dick / Head // Victor D P Me /Handed Me T / Making Me / (fall) “
Vaccines are given [(Birth/2/4/6/12/15/18mo) + (4/11/16yo) + annual]
Recite the Vaccine Schedule for
16 year old
- MenACWYD
- MenB
Men: Meningococcal
“Hewa / D P His Hairy Pretty Rectum / “/ “/ He Made Victor Have Pussy / Dick / Head // Victor D P Me /Handed Me T / Making Me / (fall) “
Vaccines are given [(Birth/2/4/6/12/15/18mo) + (4/11/16yo) + annual]
Recite the Vaccine Schedule for
annual
for all ≥6 month old:
1. [every(fall) → Flu x 1]
2. [COVID x 3] x 1
“Hewa / D P His Hairy Pretty Rectum / “/ “/ He Made Victor Have Pussy / Dick / Head // Victor D P Me /Handed Me T / Making Me / (fall)”
For ⬜ name the ⬜ developmental milestone(s)
18 month old
_________________
Gross motor
For ⬜ name the ⬜ developmental milestone(s)
18 month old
_________________
fine motor -2
For ⬜ name the ⬜ developmental milestone(s)
18 month old
_________________
Language -2
For ⬜ name the ⬜ developmental milestone(s)
18 month old
_________________
SOCIAL -2
For ⬜ name the ⬜ developmental milestone(s)
2 year old
_________________
Gross motor -2
For ⬜ name the ⬜ developmental milestone(s)
2 year old
_________________
fine motor -2
For ⬜ name the ⬜ developmental milestone(s)
2 year old
_________________
Language -2
For ⬜ name the ⬜ developmental milestone(s)
2 year old
_________________
SOCIAL -3
For ⬜ name the ⬜ developmental milestone(s)
3 year old
_________________
Gross motor -2
For ⬜ name the ⬜ developmental milestone(s)
3 year old
_________________
fine motor -2
For ⬜ name the ⬜ developmental milestone(s)
3 year old
_________________
Language -2
For ⬜ name the ⬜ developmental milestone(s)
3 year old
_________________
SOCIAL -3
For ⬜ name the ⬜ developmental milestone(s)
4 year old
_________________
Gross motor -2
For ⬜ name the ⬜ developmental milestone(s)
4 year old
_________________
fine motor
For ⬜ name the ⬜ developmental milestone(s)
4 year old
_________________
Language -2
For ⬜ name the ⬜ developmental milestone(s)
4 year old
_________________
SOCIAL
For ⬜ name the ⬜ developmental milestone(s)
5 year old
_________________
Gross motor -2
For ⬜ name the ⬜ developmental milestone(s)
5 year old
_________________
fine motor -5
For ⬜ name the ⬜ developmental milestone(s)
5 year old
_________________
Language -2
For ⬜ name the ⬜ developmental milestone(s)
5 year old
_________________
SOCIAL -2
APAP
MOA
_________________
During APAP OD, how does it cause damage? ; How is Alcohol related?
reversibly inhibits CNS_COX = antipyretic | analgesic ONLY (NOT ANTIINFLAMMATORY)
_________________
COX = Cyclooxygenase
▶APAP OD forms [TOXIC_NAPQI] → which eventually depletes [protective_Glutathione] = [TOXIC_NAPQI] accumulates to cause hepatic necrosis.
▶EtOH stimulates ([CYP450-2E1] - which catalyzes APAP → [TOXIC_NAPQI].
⭐APAP before ALcohol is ✅
