Case Files 4 Flashcards
Why are pts with retropharyngeal abscess usually 4 or younger
When retropharyngeal lymph nodes are present, after they atrophy
Most common type of abscess in per population
Peritoneal lar
Imaging for pt with suspected neck abscess
Lateral cervical x-Ray
Look for widening of retropharyngeal space
Thyroglobulin duct cyst features
Midline, move with tongue protrusion, and often noted after URI
Tooth abscess bacteria
S mutants, fusobacterium nucleatum
Unique complication for retropharyngeal abscess
Mediastinitis from lymphatic spread
What is trismus
Inability to open the mouth secondary to pain of inflammation or mass effect involving facial neuromusculature
2 complications of SCFE
Osteonecrosis and chondrolysis
DDH risk facors
Breech presentation, oligohydramnios, and large for gestational age infants
Work up for suspected septic arthritis
CBC, ESR, CRP, and blood culture, as well as joint aspiration and culture
SCFE key physical? first steps in workup
Pain during external rotation
Make patient non weight bearing and obtain bilateral hip films (due to high rate of both hip involvement)
What is status migrainosus
Migraine lasting more than 72 hours
Pseudotumor cerebri CN palsies
III, IV, or VI
First line for abortive therapy for migraines? 2nd line?
NSAIDs, then triptans
Most important diagnostic tool for headaches
thorough H and P
Good migraine prophylaxis in younger kids
Cyproheptadine
Also topiramate, valproic acid, B blockers
Imaging of choice to evaluate 2ndary headaches
MRI (unless hemorrhage or fracture suspected)
Most common cause of death from inhalant use
Sudden death from dysrhythmias
What is cubitus valgus
Physical finding in which the angle between the shaft of the ulna and humerus is increased greater than 15% in females
MCC of turner syndrome
Nondisjunction
Majority of 45x sAb in first trimester
Most common heart defect with Down’s
Endocardial cushion defects
Baby with webbed neck and edematous feed but not Turners could be
Noonan syndrome (seen in both sexes as well)
How many criteria needed to dx lupus
4
Drug for children with mild lupus
Hydroychloroquine
Lab not to forget in all new lupus workups
UA w/ microscopy
Thoracic lupus manifestations
Pleuritis and pericarditis
PSGN labs
Low C3
Normal C4
ASO and Anti-DNaseB
Do strep Ab help with rheumatic fever or PSGN
Rheumatic fever, not PSGN
How to treat PSGN HTN
Calcium channel blockers
HSP triad
Purpuric rash, arthritis and abdominal pain
IgA nephropathy
Painless hematuria 2 days after URI
C3 and C4 in lupus
Both low
Crohn’s or UC for strictures, fistulas, and abscesses
Crohn (also think skip lesions)
Most common site for Crohn’s
Terminal ileum
Biliary dz associated with UC
Primary sclerosing cholangitis
X-ray “lead pipe” appearance seen in
UC
Unique Crohn’s Ab
anti-Saccharomyces cervisisea ab
pANCA more common in UC
Most significant complication of UC
Toxic megacolon
Celiac disease dx requires what
biopsy of the distal duodenum
2 most common causes of rectal bleeding in the infant period
Milk protein allergy and anal fissure
What is the psoas sign? obturator? rovsing?
Psoas: passive right hip extension pain
Obturator: passive internal rotation of right thigh painful
Rovsing: palpation of LLQ causes pain in RLQ
Best method to check for rebound tenderness?
Gentle finger percussion to check for peritoneal irritations
Why is UA important in suspected appendicitis
To check for glucose and large ketones
Or pyuria w/ nitrites and bacteria
EBV structure? What does it infect
dsDNA herpes virus –> infections human oropharyngeal and salivary tissues and B lymphocytes
Mono big triad
Fever, posterior cervical adenopathy, and sore throat
How old for mono spot to be reliable
5+ years
Ab that form only as EBV establishes latency
IgG Ab to EBV nuclear antigen
LFTs and platelets in mono
LFTs mildly elevated but jaundice is uncommon
Mild thrombocytopenia but bleeding uncommon
When to use steroids in mono
Only when tonsillar hypertrophy threatens airway
Electrolyte that is low in rhabdomyolysis
Hypocalcemia
Most common cause of AUB in young ones? Key feature of AUB?
Immaturity of HPA, specifically LH surge causing anovulation
Key feature is that it’s painless
Papule vs nodule
Papule’s are inflamed bumps under skin
Nodules are papules > 5mm deep
two first line acne meds
Topical benzoyl peroxide or topical retinoid (at night)
What is adapalene
Retinoid formulation that causes less irritation and photosensitivity and has more activity
Odd accutane effects
Blood dycrasias, hyperlipidemia, elevated liver enzymes, conjunctivitis
Acne in a farm worker likely
Tina barbae, tx w/ anti fungal
What do you recommend in teenager on BC and tetracycline
secondary form of BC (ab may reduce effectiveness)
3 big features of ADHD
Inattention, hyperactivity, and impusitivity
ADHD caveats
Several features before 12
Symptoms present in 2 or more settings (school, home)
Interferes with functioning
What do you do for kid who’s mom says he “daydreams a lot”
EEG, worry about absence seizures
When to start return to play protocol for concussions
After 24 hours asymptomatic (without use of meds)
How long do most concussions take to resolve
7-10 days
