Case 2- stupid baby

Question 1

Must not miss diagnoses in infant abdominal pain?

Answer 1

obstruction, allergy, reflux, infection

Question 2

Why is this baby crying?

Answer 2

1. drug ingestion/overdose
2. skin- hair tourniqut (WTF parent), or diaper pin in skin (WTF parent)
3. eye issues
4. ear infection, congestions, thrush
5. CV- HF, supraventricular tachycardia, Left coronary
6. GI- intussesceptions, constipations, gastroeneteritis, anal fissures, inguinal hernia, GERD, volvulus
7. Urinary- UTI, meatal ulcer, torsion of testis (or ovary..?)
8. Skeletal- break/fracture osteomyeltis
9. Neuro- head injury, meningitis

Question 3

Is it more likely that kid has atypical presentation of something common or that he has a crazy rare disease?

Answer 3

weird presentation. Simplest answer.

Question 4

GI disease or obstruction?

Answer 4

bilious vomit, GI bleed, projectile vomit, constipation, vomit post 6 months, diarrhea, abd tenderness/distension

Question 5

Systemic/neuro?

Answer 5

hepatosplenomegaly, fat fontanelle, head size is fucked up, seizures, trisomy 21, chronic infection (HIV)

Question 6

Projectile vomit/olive in epigastrum=

Answer 6

pyloric stenosis

Question 7

Intussusception?

Answer 7

Most common cause of intestinal obstruction between 3 mo. and 6 yr. 60% < 1 yr.

Question 8

X-ray bubble signs

Answer 8

Volvulus

50% of kids diagnosed before 1 month

Question 9

Baby is vomiting–what should you avoid?

Answer 9

Prone position can lead to SIDS (i don’t believe this is an “accident’)

Question 10

Baby keeps vomiting, what up?

Answer 10

Check for other warning signs (bilious, forceful, abd tenderness, fever, etc)

Question 11

No warning signs with vomit, what next?

Answer 11

look for poor weight gain, bloody shit, gets angry from eating, exzema–yes one of those is there? then assess feeding adequacy, sleeping habits, mom-kid bond. Also check for cow milk allergy

Question 12

Don’t think its from cow milk?

Answer 12

give it thick feedings (no idea wtf this is–sounds gross). Doesnt work, then switch to no cow milk.

Question 13

Think it’s cow milk issues?

Answer 13

take it out of the diet. no help, then do the thick food diet.

Question 14

No luck after thick food and no cow milk?

Answer 14

acid suppression for 2 weeks. Still being a shitty baby? then do a million other tests for other issues.

Question 15

Most common allergy in young children

Answer 15

cow milk allergy. can resolve if not IgE mediated. If IgE= casein and whey protein

Question 16

cow milk allergy can do these things

Answer 16

IgE response–> angioedema, mixed IgE/non IgE= eczema, esophagitis, no IgE at all- GI issues that are delayed

Question 17

how to test/diagnose milk allergy?

Answer 17

skin prick and “careful history”

Question 18

Atopy means what?

Answer 18

out of place. refers to eczema, asthma, allergic rhiniits

Question 19

Eczema likes what parts of the body? Acne?

Answer 19

places with creases (neck, elbow, knee, groin, ankle)

On face. dunno why this is a slide.

Question 20

Erythema toxicum neonartorum

Answer 20

whitish/yellow papules on trunk and extremities. resolves in 5-7 days. Will not be on soles/palms

Question 21

Cradle cap

Answer 21

gross crusty head. Brush it off with a tooth brush…. yeah, def don’t ever want kids.

Question 22

What if he’s lactose intolerant?

Answer 22

Nope, rare in babies. autosomal recessive inheritance. But, if the kid starts squirting out diarrhea from day 1, its possible.

Question 23

Sx of lactose intolerance. Lactase enzyme does what?

Answer 23

Lactase breaks lactose into galactose and glucose.

gas, bloating, diarrhea. This is what Mimi’s oatmeal cookies do too.

Question 24

Infant colic criteria

Answer 24

birth-4 months

crying for no reason (all babies do this, this is pretty bad criteria), no failure to thrive.

Question 25

What if it cries for more than 2 hours a day?

Answer 25

That is what babies do, get over it.

Question 26

Colic rules of 3

Answer 26

> 3 hours/day, >3 days/week, lasts 3 weeks. Baby is normal when not colicky… NO FAILURE TO THRIVE.

Question 27

Youtube video for hypertonia is really awful. What’s that about?

Answer 27

stiff arms, clenched fingers, distended abdomen, flushed face, legs are drawn up. Oh, and the kid is crying which is why it’s doing all that shit.

Question 28

How common is infant colic

Answer 28

UP TO 40%. WTF. THATS THE WORST NEWS EVER TO ANYONE THAT WANTS KIDS. 3-4 months of pure torture. After 9 months of pure torture, followed by 18 years of pure torture….

Question 29

Patients kid has colic- what do you do?

Answer 29

be supportive, send to therapy, try to keep them from killing it.
oh and don’t let them drug the bastard either. nothing can help, just wait it out.

Question 30

This makes Bryan think of burritos, but it might help the colic. Also, some other things

Answer 30

swaddle the baby, carry it, change feeding position, give it a pacifier, take it for a ride in the car. Don’t do herbal remedies.

Question 31

whats the most deadly form of child abuse

Most common?

Answer 31

I swear this shit is meant for idiots. Dont shake the damn baby. (shaken baby syndrome) . Most common is sticking it in hot water. WTF.

Question 32

Stress+ crying baby=?

Answer 32

SBS. Look for post partum depression, marital issues, mother giving up on breast feeding

Question 33

Red eye reflex?

Answer 33

Make the baby look demonic, but make sure it’s symmetrical. Can screen for cataracts or corneal opacity, retinoblastoma

Question 34

Moro reflex

Answer 34

make baby think its falling and it does “superman” arms. Normal up to 4 months. If not there then spine/brain problem. Or it’s never watched superman….

Question 35

preeclampsia

Answer 35

high bp. Risk factors- first birth, diabetes, obesity, fam hx, more than one parasite chilling in you.

Diagnosis: new hypertension, proteinuria at 20weeks

Question 36

Preeclampsia can cause lots of issues==how to treat ?

Answer 36

If mild- bed rest, delivery at 37 weeks. If severe- deliver it no matter what or mother will die.

Question 37

Group B strep

Answer 37

gram +, vertical transmission to child, 25% of pregnant women have this, IV antibiotics during labOr if +

Question 38

Group B strep in infants

Answer 38

early onset-0-6 days, fever, feeding, lethargy, etc. Late onset 4-5 weeks from horizontal transfer (after birth).

Can cause deafness and dev disabilites.

Question 39

My APGAR score was higher than yours!

Answer 39

Not really indicative of any long term development. Taken at 1 minute and 5 minutes. If <7 at 5, keep doing it until its 7+ (somehow i bet tons of babies have scores of 7 just because of that…)