Case Files 2 Flashcards
Most commonly used stool softener in young children
Oral polyethylene glycol - odorless and flavorless powder
Mickey diverticulum remnant of
Omphalomesenteric duct
Lower GI bleeding most often presents with
Hematochezia (bright red)
2 diff dx of painless rectal bleeding with hx of normal stopping and no associated symptoms
Juvenile polyp or Meckel diverticulum
3 things that would indicated coagulopathy is underlying cause of rectal bleeding
Hepatosplenomegaly, petechiae, or purpura
Anal fissures bleed enough to cause anemia?
Nah
If constipation resolves but an anal fissure recurs, what could be the cause
Look into possible chron disease
MCC of hematochezia in children
Anal fissures
First indication that bleeding is causing anemia
Tachycardia
3 otitis media bugs
S pneumo, H flu, moraxella
Acute OM tx
Amoxicillin - 80-90 mg/kg/d for 7-10 days
Add b-lactamase inhibitor if no change after 3 days
AOM with ear lobe pushed superiorly and laterally
Mastoiditis
Irritability and lethargy in 1 year old
Admit for sepsis workup
MC childhood movement disorder? What is also seen
Cerebral palsy
1/3 have seizures and 60% have MR
Most likely cause of CP
Antenatal insults, and subsequent difficulties during the pregnancy
What is hemiplegia? diplegia?
Hemiplegia: single lateral side of body w/ greater def in upper
Diplegia: four limp involve with greater impairment in LE
What is the motor quotient
divide normal milestone by time CP child starts milestone to asses impairment
2 MCC of bronchiectasis
Asthma and infections
CF MCC of chronic
Metabolic state in CF? Unique bug to worry about?
Hyponatremic, hypochloremic alkalosis
pseudomonas unique
CF dx requires?
Two positive sweat tests in conjunction with any of the other features
ALL peak incidence? 2 genetic syndromes that increase risk?
2-4 year old boys
- Down’s and fanconis increase risk*
- Dont let WBC count
Blast level to confirm ALL in marrow biopsy
At least 25%
less than 5% normal
Suspected ALL workup
CBC w/ diff and platelets, LP, CXR to look for mediastinal mass
What patients are likely to develop asthma
RSV bronchiolitis
Why inc wheezing sometimes after asthma treatment
Increased airflow over areas that were previously closed
Long term asthma drugs
Mast cell stabilizers (cromyln) and leukotriene modifiers (montileukast)
What is a late phase reaction in asthma
Typically occurs 2-4 hours after initial wheezing episode, caused by accumulation of inflammatory cells in airway
Responsible for chronic inflammation seen in asthma
Peak SIDS
2-4 month AA or native american boys
3 odd things that seem to reduce SIDS
Breast feeding, immunizations, and pacifier use
Investigation for SIDS
History, post-mortem exam, and death scene investigation
VSD murmur
Holosytolic at LL sternal border
ASD murmur
Fixed, wild split S2
Coarctation of aorta murmer
Systolic murmur in the left axilla
Majority of cyanotic lesions result in change in
Volume load (left to right shunt)
Most common heart lesions in children? Features of a large one
VSD
Dyspnea, feeding diff, growth failure, profuse perspiration
3 things a large ASD can cause
Growth failure, frequent URIs, exercise intolerance
Diff needed to to dx shunt across ductus
3-5% diff above and below ductus
Single S2 can be heard with
Pulmonary valve atresia or truncus arteriosis
3 CHD that decreased pulmonary vascularity can be seen with
Atretric tricuspid valve, atretic pulmonary valve, or TOF
“egg-on-a-strin” or narrow mediastinum seen with
Transposition of great artery
“Snowman” appearance seen in
Total anomalous pulmonary venous return (supra cardiac shadow caused by anomalous pulmonary veins entering the innominate vein and persistent left superior vena cava)
Seizures, neurologic changes, and abdominal complaints in child? what else can you see?
Lead poisoning
May also see hyperirritiability, altered sleep patterns, and loss of play
Next step in kid with lead level of 15-19
Lead education and follow up BLL 3 months later
What lead level to start chelation therapy
> 45
Infants exposed to in utero methyl mercury ay display?
Low birth weight, microcephaly, and seizures
Top 3 neonatal meningitis bugs
GBS, E. coli, listeria
Top 2 causes of bacterial meningitis in older children
S pneumonia and Neisseria
Recommendation for bacterial meningitis tx? In neonates?
3rd gen cef + vanc
In neonates: amp + 3rd gent ceph
Most common long term complication of meningitis
Hearing loss
Nuchal rigidity is not a reliable finding in meningitis until
12-18 months old
CSF findings of bacterial meningitis
Elevated protein, reduced glucose, lots of wbc’s
Salmonella features
Gram neg bacilli (non motile facultative anaerobic)
When is salmonella more common
Warmer months
Two infections that can cause SJS in kids? SJS risk factors?
Mycoplasma and Herpes viridae
Risk factors include HIV and underlying genetic disorder (Slow N-acetyltransferase)
How long for SJS to manifest after drug? What if 2nd exposure?
2 weeks for skin lesions, 48 hours if around 2nd exposure
Most common mucocutaneous finding in SJS
Ocular -> risk of corneal abrasion and eventual blindness (consult optho**)
4 antiepileptis known to cause SJS
Carbamazepine, phenytoin, lamotrigine, phenobarbital
SJS needs mucosal involvement in 2 or more areas
SJS SCORTEN risks
Age > 40, ass malignancy, HR > 120, BUN >27, >10% body surface, Bicarb 250
Cardinal features of salmonella gastroenteritis
N/v, watery diarrhea, fever w/in 8-72 hours
Why is shigella easily transmitted
Less susceptible to acid than other bacteria
CBC in shigella infection
Wbc’s usually normal but left shift with lots of bands seen
Why ab for shigella
Shortens illness and decreases duration that organisms are spread
MCC of acute childhood renal failure
HUS from 0157:H7
Brain injury most common with
Subdural
Seizures seen more commonly with them
Features of subdurals in kids under 1
One third have associated fracture
75% are bilateral, seizures in up to 90%
Subdural hematomas by timing
Acute: symptoms in 48 hours
Subacute: 3-21 days
Chronic: after 21 days (more common in older children)
Schedule for athletes returning from concussion
Graduated return to play schedule that begins with light, non impact activity
Best test to asses subdural hematoma
MRI - can determine the age of the insult
Age for febrile seizures
6 months - 6 years
Simple vs complex febrile seizures
Simple: generalized lasting no more than 15 minutes, no post-ictal state, and no recurrence in 24 hours (80% of febrile seizures)
Positive Brudzimki sign
While supine, passive neck flexion results in involuntary hip and knee flexion)
Associated mutation with febrile seizures
SCN1A sodium channels
Ongoing seizures with no response to benzos can be treated with
Fosphenytoin
All children with seizures must have what on differential unless proven otherwise
Meningitis (esp under 1 year when exam is unreliable)
