BRS - Peds Flashcards
what are causes pf acquired microcephaly?
perinatal asphyxia, IVH, craniosynostosis, late prenatal/perinatal infxn
what are the causes of congenital microcephaly?
TORCH (toxo, other-syph, Rubella, cmv, hsv) T1, drugs or tox in utero, chromosome abnormalities, congenital
which children are at risk for lead poisoning and which homes increase risk?
less than 6 yo, homes before 1978
what increases risk for dental caries in babies?
areas of low fluoride or sleeping while nursing with non-water products
what do most kids with lead intoxication present with?
asymptomatic
what is the age range for delayed eruption of teeth?
after 16 months
What is Kernicterus?
Hyperbilirubinemia –> induces brain damage
At what age is it appropriate to see preference of hand use? What if onset is earlier?
Unusual to see preference before 18 months. If early hand preference may indicate weak/spastic upper extremity
What are behaviors that are similar in autism and Asperger’s? What can help distinguish the two?
- Social isolation
- repetitive behaviors (flapping, waving)
- -> in asperger’s there is no significant language delay
When should apnea be more formally assessed in children?
Breath holding spells associated with exercise and physical activity–> require echo/ekg
What can potentially distinguish a 10 month old from 12 mo old child?
10 mo may only be able to say mama or dada, whereas 12 mo can say up to 3 words.
What is metrorrhagia and menometrorrhagia?
Metro - menses at irregular intervals
Menometro - heavy menses at irregular intervals
What are indications for doing a pelvic exam in females?
- Bleeding that is associated with pain, is prolonged or associated with anemia.
- Sexually active
- Age >18
What are indications for hospitalization in patients with PID?
- Situations where compliance may be problematic: homeless, runaway, unstable home environment, drug abuse etc.
- Pregnant teens
- Adnexal mass (tuboovarian abscess)
- Failure of outpatient management
What are the physical and growth characteristics of patients with anorexia?
- Amenorrhea,
- weight 15% below ideal
- delays in puberty and growth
What causes chancroid genital ulcers and how do they appear?
Haemophilus Ducreyi - painful ulcers, irregular borders and purulent base
How do HSV1/2 ulcers appear?
Multiple painful shallow ulcers, nonpurulent base
What are the main presenting signs of galactosemia? What are these patients vulnerable to?
- Hypoglycemia and hepatomegaly (vomit/diarreha after milk)
2. E. coli sepsis, may die in early infancy
What are the main presenting features of Gaucher’s disease?
Neurodegeneration, splenomegaly, bony changes (erlenmeyer flask shaped distal femur)
What is the difference between breastfeeding vs. breastmilk jaundice?
Breast feeding = first week of life, not enough PO intake
Breast milk = after first week, from lipases and beta-glucorinadase
What are the main differences between omphalocele vs. gastroschisis?
- Omphalocele has greater association with congenital defects and genetic abnormalities (trisomy 13, and 18) and is covered by peritoneum tissue and exudes from central abdominal ring (gastro is lateral abdominal wall)
What is one of the most common causes of persistent pulm HTN of newborn? Which kids get it most?
Perinatal asphyxia or Meconium aspiration syndrome –> very high PVR –> significant R to L shunting from PFO or PDA
Equal prevalence in all newborns
When does benign physiologic indirect hyperBRinemia peak in newborns?
FT - day 3-4 of life
Pre-term - day 5-7
What is the difference in 100% O2 therapy between congenital heart conditions like TOF vs. truncus arteriosis? Primary respiratory illness?
TOF has low pulm flow -> small rise
Truncus has high flow -> modest rise
Respiratory has normal flow but no heart defects -> very large rise >150mmHg
What are the main presenting signs of galactosemia?
Hypoglycemia and hepatomegaly (vomit/diarreha after milkl)
What are the main presenting features of Gaucher’s disease?
Neurodegeneration, splenomegaly, bony changes (erlenmeyer flask shaped distal femur)
What are the presenting features of Hurler disease?
Developmental delay, coarse facies, corneal clouding, and dysostosis multiplex
What are the main principles involved in the acute management of inborn errors of metabolism?
- Supply source of energy that can be utilized
- remove toxic metabolites
- prevent continued exposure to offending substance
What should be provided initially to aid in excess ammonia excretion?
Sodium benzoate
What genetic disorder has a similar presentation to Marfan syndrome, and how do they differ?
Homocystinuria - marfanoid body w/o arachnodactyly, downward lens subluxation (vs. upward in Marf), MR or AR (Ao dilation in Marf); development delay and retard (NOT present in Marf)
-Decreased upper to lower segment ratio in both
What lab abnormality will be found in patients with Grave’s disease? What are young girls with this condition at risk of?
- High T3/T4
- High thyroid stimulating immunoglobulins (cause of thyrotoxic state)
- Delayed menarche
What growth deficiencies present with bone age less than expected for chronological age?
GH deficiency, constitutional growth delay, hypothyroidism and hypercortisolism
What growth deficiencies would present with bone age same as chronologic age?
-Genetic short stature, skeletal dysplasias, intrauterine growth retardation and Turner syndrome
What is the presentation of McCune-Albright Syndrome and what type of mal-development may occur with this?
- bony changes (polyostotic fibrous dysplasia), skin findings (coast of Maine cafe au lait spots) and endocrinopathies (Peripheral precocious puberty or hypertyroidism)
What features should make one suspicious of congenital hypopituitarism?
Any newborn with midline defect (e.g. cleft palate), hypoglycemia and microphallus
What should be considered in newborns with hypoglycemia for >4 days?
Hyperinsulinemia (nesidioblastosis - beta cell hyperplasia) and Beckwith-Wiedmann syndrome
What are the signs of Beckwith-Wiedmann syndrome?
LGA w/ visceromegaly, hemihypertrophy, macroglossia, umbilical hernias, distinctive ear creases
What is the management for fever (>38C) in an infant younger than 28 days?
Very serious - complete w/u for SBI (blood, urine, csf) empiric IV abx and hospitalization
What may result if a child with mono is given amoxcillin?
Diffuse pruritic rash
What is the initial management for presumed bacterial meningitis?
Third generation cephalosporin + Vancomycin (until sensitivities are available)
What may be the presentation of a child with Giardia lamblia infection?
Bulky, foul-smelling stools, weight loss, and day care attendance
What is the most common complication of measles and cause of mortality?
Bacterial PNA
When is a tubuerculin skin test positive in the pediatric population? What test(s) should be done?
Patient younger than 4 or if living in area endemic for TB
Get CXR and if + get gastric aspirates
What may be the cause of a 3 yo boy presenting with acute onset high fevers, bloody diarrhea and generalized tonic clonic seizures and why?
Shigella sonnei, caused by release of neurotoxin
What may be the presentation of staphylococcal scalded skin syndrome?
Infant/child with fever, erythematous tender skin rash, widespread bullae with a positive Nikolsky sign
What may be the presentation of staphylococcal scalded skin syndrome?
Infant boy with fever, erythematous tender skin rash, widespread bullae with a positive Nikolsky sign
What is another name for erythroblastosis fatalis and what is the cause?
Alloimmune hemolytic disease - mismatch between fetal/maternal blood types (Coombs+ and hyperBR)
How can malformation and midgut volvulus be diagnosed?
Upper GI series “:
- If ligament of treitz on R side of abd think malrotation
- If corkscrew pattern think volvulus
How can you beat distinguish impetigo from HSV infection?
Impetigo will spread across the face while HSV is usually informed to orolabial region
What are the clinical features of prader Willi syndrome? What is it caused by?
-hypotonia and poor suck as infant
-hyperphagia, obesity and short stature
-hypogonadism and dysmorphic face
-intellectual disability
Deletion of paternal 15q11
What does brief LoC, HA and vomiting following a fall most suggest? What should be done?
Mild TBI or concussion
Get non con CT or monitor for 4-6 hrs in ED
What is indication for brain MRI in girls with late onset of absent puberty?
Hx of HA or visual disturbance
If normal uterus and FSH levels are low
What is the cause of edema in babies with Turner syndrome?
Congenital lymphedema from abnormal development of lymphatic structures
What should be done for an immunocompetent child that has been exposed to chickenpox and is currently asymptomatic? Immunocompromised?
- administer VZV vaccine
- administer VZIG
How can HUS be distinguished from henoch-schonlein purpura?
HUS - has low platelets and Hx of bloody diarrhea
HSP - has joint pain, purpura on buttocks
What puts kids with congenital heart diseases at increased risk for systemic infections like brain abscess?
Presence of VSD, which may bypass pulmonary circulation where bacteria would normally be phagocytosed and removed
which congenital heart disease presents with a snow man appearance on CXR?
TAPVR
what is a likely cause of pericarditis post cardiac surgery? what findings are present?
postpericardiotomy
friction rub and pulsus paradoxus
what is the most likely exam finding for a small VSD? what is the prognosis?
loud murmur, will resolve on its own
when is the onset of CHF in newborns with critical severe AS?
very fast, within first 24hrs
what may be a cause of late onset CHF in an infant?
large VSD (ddx any outflow obstruction or valvular abnormalities)
What findings are consistent with a PDA?
loud machinery like murmur and brisk pulses
what is the only cyanotic congenital heart disease that presents with LVH at birth?
tricuspid atresia
What may be seen on CXR in epiglottitis?
Thumbprint sign
What is the most common cause of pneumonia in adolescents?
Mycoplasma pneumoniae and Chlamydia pneumoniae
What are the classic bugs that colonize the lungs of patients with CF?
Staph aureus initially and P. aeruginosa subsequently
What is classically seen on electrolyte exam of patients with CF?
Hyponatremic, hypochloremic, hypokalemic metabolic alkalosis
What are the PFT patterns of disease seen in patients with CF?
Obstructive lung disease early on, restrictive lung disease later in the course
What is the chance of a sibling of a patient with CF to get the disease?
Recessive pattern of inheritance, therefor 25% chance
What are the patterns of disease seen in patients with lung disease from CLD (bronchopulmonary dysplasia) from prolonged mechanical ventilation as a PreMe?
Combination of obstructive disease (from dysplastic and narrowed airways) and restrictive (from lung tissue fibrosis)
What are the signs and symptoms characteristic of epiglottitis? What are the common causative agents?
Fever, toxic appearance (retractions, increased work of breathing), muffled speech, tripod positioning when seated, drooling and neck hyperextension
H. Flu (HIB), Strep/Staph also possible
What is the proper management of epiglottitis?
Avoid excessive stimulation (e.g. examination of pharynx), evaluation of airway and intubation in controlled setting
What is the management of a moderate exacerbation of chronic asthma?
5-10 days of systemic corticosteroids, followed by inhaled corticosteroids and leukotriene inhibitors for long-term management
What are patients with nephrotic syndrome at increased risk of developing and how should they be treated?
Susceptible to infections with encapsulated organisms like pneumococcal –> increased risk of peritonitis, pneumonia, and overwhelming sepsis
Treat empirically with Abx
What is the presentation for Alport’s syndrome, and how is this illness transmitted?
Renal manifestations including HTN, hematuria, and renal failure in males; hearing loss and ocular abnormalities of the lens and retina
X-linked dominant inheritance
What is the effect of infantile botulism on DTRs? What can aid in diagnosing this condition?
Decreased DTRs
Electromyography may show brief, small-amplitude muscle potentials with incremental response during high frequency stimulation
What may be an unusual but significant presentation for Guillain Barre in up to 50% of children?
Low back pain and leg discomfort, with absent DTRs and normal spien imaging
What is the most common form of migraine in children? How long do these usually last?
Migraines WITHOUT aura
last for at least 1 hour
What may be the presentation at 6 months of a patient with congenital myotonic dystrophy?
Hypotonia, facial weakness, areflexia and history of feeding problems since birth
What are the features of chronic benign neutropenia of childhood? How do you distinguish from Chediak higashi and Kostmann syndrome?
Normal appearance and growth, hx of mild infections (sinusitis, cellulitis, otitis media), low ANC and WBC
The others present with more severe infection and growth/skin problems
What can result from a diet containing exclusively goat milk?
Folic acid deficiency and macrocytic anemia
What is transient erythroblastopenia of childhood and what is the likely cause?
Slow onset anemia after the first year of life
Post viral autoimmune reaction
What may result from Parvo B19 infection in Peds?
URTI and slapped cheek rash
NO ANEMIA
What are the most common testicular tumors and what increases risk for these tumors?
Yolk sac tumor, risk increased from cryptorchid testes
What are patients with Beckwith Wiedemann syndrome at risk for?
Wilms tumor, rhabdomyosarcoma and hepatoblastoma
Where is one of the most common locations for rhabdomyosarcoma to occur?
Head and Neck 40% of the time, can involve orbit
How can infantile and childhood eczema be differentiated?
Infantile - extensor surfaces and cheeks, trigger by wool, foods harch chems and extreme temps
Childhood - flexural surfaces
What are the clinical features of Schwachman Diamond syndrome?
Recurrent soft tissue infections characterized by decreased neutrophil activity and cyclic neutropenia
What is concerning in a patient with Kawasakis presenting with RUQ pain?
Hydrops of gallbladder
What is the indication for surgery in scolios?
After growth spurt of puberty if angle >50
