Clerkships-PEDIATRICS Flashcards
1) mongolian spot. comprised of? 2) pale pink vascular macules in nuchal area or face 3) firm yellow-white pustules/papules on an erythematous base, perhaps seen on DOL 2; what would you find on bx? 4) cherry hemangioma
1) arrested melanocytes 2) nevus simplex 3) erythema toxicum; eosinophils 4) raised, palpable
2 ddx for papules on the face in neonate 2 distinguishing features
baby acne (not present on day 1 of life) milia
Etiology of neonatal acne!
Maternal hormones! (not p. acnes)
What is this rash called? How is it characterized? Tx and why?
Nevus sebaceous, an area of alopecia with orange colored nodular skin,
tx by removing before adolescence bc of malignant transformation risk
What is the cradle cap? tx and definition (looks like impetigo but it’s not)
Seborrheic dermatitis, “thick yellow/white oily scale on an erythematous base.”
tx, clean with shampoo
What two things are mandatory on neonatal screens?
Timing of the px of each?
PKU, Galactosemia (can cross placenta!)
PKU longer time to show up, galactosemia present right away.
Days of jaundice, levels; dx? NBS?
1, 14, .5
2-3, 10, .5 (normal stool and feeds)
7, 12, .5 (dry mucous membranes)
14, 12, .4 (otherwise healthy, regained birth weight)
1) Hemolytic, DAT- if +
2) physiologic jaundice of newborn, should resolve by day 5
3) breast FEEDING jaundice (def?)
4) breast MILK jaundice (def?)
Other kinds of jaundice:
1) Dark urine, pale stools
2) Rando INHERITED causes of indirect
3) Rando INHERITED causes of direct
4) Random non-inherited cuases of DIRECT
1) Cholestatic/biliary atresia
2) Gilbert’s (less enzyme), Criggler Najjar type 1 (abscent enzyme UDP-glucuronyl-tranferase)
3) Rotor’s, Dubin Johnson
4) sepsis, hypothyroidism, galactosemia, CF, choledochal cyst
What is given to sickle patients to prevent encapsulated infxn?
Penicillin
Postpericardiotomy syndrome
pericardial effusion 2/2 autoimmune response occurring 1-6 weeks postoperatively following surgery for congenital heart disease.
Foreign body in the vagina
common in pre-pubertal girls. The foreign body should be removed before CPS is contacted, if warranted.
Wheezing that improves with neck extension and unaffected by bronchodilators. Etiology?
Tracheal compression by a vascular right (ex. double aortic arch, right sided aorta, pulmonary sling, etc.)
Night terrors vs nightmares
Night terrors: non-REM, crying, screaming, tachycardia, no recollection
Nightmares: REM, no crying, no screaming, no tachy, recollection upon wakening
dx and nbs for baby with bowel loops in thorax
pulmonary hypoplasia
deliver baby in a place with ECMO, 3-4 days later correct surgically
Baby is cyanotic but becomes pink when crying.
Other asociated things to look for?
Choanal atresia,
CHARGE: coloboma, cognitive, heart defects, retarded growth, ear anomalies, eye anomalies
Gastroschisis vs Omphalocele vs Umbilical Hernia
Gastroschisis - lateral, no sac, not assoc. w/ any other anomalies, high AFP
Omphalocele - midline, sac, assoc. w/Beckwith Weidemann syndrome = ear pits, big baby, big tongue, low glucose
UH - HYPOTHYROIDISM, resolves by 2-3 years, if not, surgery
Management of itussusseption vs meconium ileus
Barium enema vs gastrograffin enema
(dx and tx)
CF genetics
AR!!!!!
cryptorchidism tx
if testes don’t descend within 1 year (reduces cancer risk; detection, not prevetion)
Midline suprapubic mass with anuria early in life. dx, tx,
(distended bladder is the mass here)
posterior urethral valves
NBS is catheterization for relief
surgery for correction
congenital adrenal hyperplasia (21-hydroxylase def.)
px, path, labs, dx, tx
- ambiguous genitalia at birth
- 21 hydroxylase deficiency (AR)
- hyponatremia, hyperkalemia
- 17 hydroxy-progesterone
- hydrocortisone (replace cortisol), fludrocortisone (replaces aldosterone)
more medical name for osgood schlaughtters
traction apophysitis
IgA def vs Wiskott-Aldrich syndrome vs X-linked bruton’s agammaglobulinemia vs hyper IgM
Transfusion rxn/anaphylaxis?
Recurrent URI?
Giardia?
Serum levels?
IgA: yes, yes, yes, obv
WAS: (thrombocytopenia, otitis media, eczema)
Bruton’s: NO, yes, NO, no levels
hyper IgM: NO, yes, yes, high M, low G&A
intussusseption dxx,tx?
U/S targetoid mass
tx: air-contrast enema (dx and tx)
Most common symptoms of polycythemia of the newborn
Respiratory distress, cyanosis/tachypnea (decreased pulm perfusion 2/2 increased viscosity of blood), poor feeding, hypoglycemia, hypocalcemia, neurologic (seizures, jitteriness, irritability, lethargy)
tx: hydration and exchange transfusion
Fever >101.2 in neonate, <28 days old
sepsis until proven otherwise,
order everything
tx. amp/gent
GBS, listeria, E coli
Gonorrhea vs Chlamidia conjunctivitis neonate
Gonorrhea: DOL 3-5, purulent dcg, tx. ceftriaxone, topical erythromycin
Chlamidia: mucopurulent, DOL 7-14, tx oral erythromycin, chlamydial pneumonia concern
Most common cause of unilateral lymphadenopathy
Staph aureus
Lead posoning screenings?
Do screenings frequently. Try to do it before 5 years of age. If there’s more suspicion, do a SERUM lead and go from there.
How to potty train if child isn’t interested?
Stop potty training attempts for several months and allow the child to become interested.
If interested, then use positive reward techniques and regular scheduling.
The most common predisposing factor for acute bacterial sinusitis
Viral URI
Fluctuant, cervical lymphadenitis/lymphadenopathy 2 most causative agents and tx?
Staph/strep
DICLOXACILLIN
Cephalexin and clindamycin work as well
Congenital syphillis presentation and tx
HSM
Jaundice
Cutaneous Lesions
Anemia
Rhinorrhea
(metaphyseal dystrophy, periostitis)
TREAT: penicillin G
Most common causes of viral meningitis?
Echovirus, coxackievirus
Child falls on a pencil or a stick in his mouth. What can result? What is the mechanism? Time till onset?
vs.
postictal condition that usually rapidly improves with restoration of function within 24 hours
Stroke 2/2
Internal carotid artery dissection/thrombosis
onset can be up to 24 hours later
postictal (Todd’s) paralysis
Kid with ADD symptoms but also poor eye contact, poor language development
UNDETECTED HEARING DISORDER! DON’T MISS IT!
could be absence seizures
Most common cause of diarrhea in children? Some others?
Rotavirus (watery)
Norwalk (second most common)
MSK manifestation of Down’s
Atlanto-axial instability
Omphalocele, microcephaly, clenched hand, rocker bottom feet, hammertoe
Severe mental retardation, holoprosencephaly, microcephaly, cleft lip/palate
Edward’s Syndrome 18
Patau’s Syndrome 13
Breast milk vs formula
Breast milk
WHEY is dominant, more LONG-chain fatty acids, less iron but better absorbed, more lactose
14 yo boy, always been below 5th percentile for height, both parents are super tall and were late bloomers. dx? bone age vs actual age? prognosis for kid?
Same story, but both parents are super short. ???
Comment on bone age in obese ppl. Why?
Constitutional growth delay, bone age less than actual age (bones “have more room to grow), kid can attain height
Familial Short Stature, bone age=real age (bones “don’t have any more room to grow”), kid is doomed
Bone age>actual age, fat=estrogen
Most common leukemia in children? Dx?
ALL (acute lymphoblastic leukemia); +25% lymphoblasts in bone marrow
Spondylolisthesis
Developmental disorder in which a vertebrae makes a forward slip (L5 over S1 usually).
Palpable “step off” at lumbosacral area.
Cauda equina type symptoms