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
Easy bruisability and petechiae usually following a viral infection, px in early childhood
ITP
All labs normal except for thrombocytopenia
Isolated appearance of axillary hair before the age of six, resulting from premature androgen secretion of the adrenal glands. tx?
pubic hair before the age of 8. tx?
premature adrenarche
benign, no clinical significance
premature pubarche, requires thorough eval, as it may be due to a CNS disorder
Which newborn brachial palsy is accompanied by horner’s symptoms?
Klumpke’s (C7-8, T1)
Give 3 contraindications to breastfeeding?
Active drug abuse,
TB,
HIV
1) CLASSIC TRIAD OF TOXOPLASMOSIS
2) SYPHILIS
3) RUBELLA
4) HSV
1) CHORIORETINITIS, HYDROCEPHALUS, INTRACRANIAL CALCIFICATIONS
2) fever, osteitis, osteochondritis, mucocutaneous lesions, lymphadenopathy, hepatomegaly, rhinitis
3) microcephaly, microphthalmia, meningoencephalitis, sensorineural deafness, PDA, ASD, congenital glaucoma/cataract
4) encephalitis, chorioretinitis, NO MICROCEPHALY/MICROPHTALMIA
Cri-du-chat syndrome is due to what? Px?
5p deletion
microcephaly, hypotonia, short stature, cat-like cry
Long term neurologic sequelae of bacterial meningitis (that can prevent kids from reaching developmental milestones, etc.)
hearing loss
loss of neurons in dentate gyrus
seizures
mental retardation
spasticity or paresis
tx for exacerbation of lung dz 2/2 CF? which organism
penicillin/cephalosporin+aminoglycoside
covers pseudomonas
(ex. ceftazidime+gentamicin)
Gastric residues?
Bloody diarrhea with eosinophils, fam hx of atopy
NEC
milk protein intolerance
Distinguish TTNB from HMD
HMD has fine granularity on CXR
To Screen for dystrophies? To confirm dx?
CK levels
Muscle biopsy
Sturge-Weber (3 characterisstics), (4 more presentations), xray findings, tx (3)
Generalized seizures, mental retardation, portwine (nevus flammeus) along trigeminal [2/2 congenital unilateral cavernous hemangioma]
hemianopia, hemiparesis, hemisensory disturbance, ipsilateral glaucoma
2+ years old, xray shows gyriform intracranial calcifications that resemble a tramline
tx aimed at reducing intraocular pressure and reducing seizures, lazer therapy to remove skin lesions
Treatment for the following: wonder drug (levitiracetam)
1) Absence
2) Trigeminal Neuralgia
3) Myoclonic (helmet), Atonic
4) Febrile Seizures
5) Seizure abortive measure heirarchy (all IV)
6) Wes Syndrome of infantile spasms
levitiracetam
1) ethosuximide
2) carbamazepine
3) valproic acid
4) acetaminophen (tx source)
5) lorazepam, phenytoin, phenobarbital, midazolam+propofol
6) ACTH
Define:
Complex vs. Simple
Generalized vs Partial
Seizures vs Epilepsy
+LOC vs -LOC
Whole body vs Specific symptoms (loss of tone?)
One episode vs life long with “focus” of neuroconductive abnormality pathway
how to distinguish seizures from syncope
SEIZURES WILL HAVE A POST-ICTAL STATE, in which patient slowly regains consciousness
Atonic vs myoclonic vs absence seizures
loss of tone? loss of conciousness?
atonic and myoclonic both DO NOT have LOC (simple)
atonic has LOT while myoclonic is jerky
absence has LOC but no LOT
Patient has infantile spasms, not febrile,
Dx?
Tx?
Hypopigmented spots shown with what test. what’s the name?
interictal EEG showing hypsarrythmia
tx ACTH
ash leaf spots, dx with woods lamp, seen in tuberous sclerosis. tx is supportive
Loud S1, fixed split S2, gets tired in gym class
PDA assoc. with what infection
ASD
Cogenital rubella syndrome
1) Super high fever, 3 days later resolves and now there’s a rash on the trunk and legs
2) Fever, Slapped cheeks
3) 2 weeks post sore throat, fine maculo-pap rash that starts on top and spreads down (tx?)
4) cough, fever, runny nose, rash top down, gray spots on the buccal mucosa (tx?)
5) sore throat, joint pain, fever, pinpoint rash on face that moves down, rose spots on palate
1) Roseola (HHV-6)
2) Erythema Infectiosum (Parvovirus B19)
3) Scarlet Fever (group A strep pyogenes) (PCN)
4) Measles (vitamin A) [koplik spots]
5) rubella (paramyxovirus)
Scabies tx
Impetigo tx
Primethrin
topical muciprocin
1) Most common meningitis bugs overall? Tx?
2) Young and immune suppressed? Tx?
3) Brain surg w/ instruments?
4) 2 Randos and (tx?)
1) Strep pneumo, H flu, Neisseiria meningitidis (encapsulated). Tx. IV Ceftriaxone + vancomycin + steroids
2) GBS, strep pneumo, Listeria, tx add ampicillin
3) Staph tx vanco
4) TB (ripe+steroids) , lyme (IV ceftriaxone)
Retropharyngeal abcess
vs
Peritonsillar abcess
Can’t turn head, can lead to mediastinitis (retropharyngeal space communicates directly with mediastinum). tx I&D, strong abx
“hot potato voice”, deviated uvula tx I&D, strong abx
Croup
Epiglottitis
Bronchiolitis
Pertussis
Parainfluenza, barking cough, steeple sign, racemic epi
H Flu, thumb sign, intubate in OR, ceftriaxone/vanc
RSV, wheezy cough/runny nose, swab, nebs, NO STEROIDS, rare: pavalizumab
Bordatella pertussis, whooping, lymphocytosis, erythromycin for patient and close contacts
2 most common surgeries for Sickle cell patients
study to assess risk?
Chole
Tonsillectomy (hyperplasia happens in sickle)
transcranial doppler
Blackfan Diamond
Fanconi’s Anemia
Lead Poisoning
Triphalangeal thumbs, pale baby, increased RBC ADA
tx. corticosteroid, stem cell transplant, transfusions
Absent thumbs, cafe-au-lait, microcephaly
tx. corticosteroids, stem cell txpt, androgens
Hyper baby, basophilic stippling
Brain tumors in kids. Two most common.
(infratentorial!)
Pilocytic astrocytoma, resect, good prognosis
Medulloblastoma, increased ICP bc it blocks 4th ventricle, vermis, bad prognosis
tx ALL?
What causes mediastinal mass w/resp distress
chemo + intrathecal mtx
non-hodgkins lymphoma. tx surgical excision and radiation
Infant born to an HIV-positive mother. NBS?
Course of Zidovudine
Metabolic derangement from immobilization?
“immobilization hypercalcemia” from sedentary-ness after a fracture, etc.
montior with serum calcium and urine calcium:creatinine ratios (greater than .2 is hypercalciuria)
treatment with mobilization, calcitonin in extreme cases
Tx of hydrocele?
Observation, usually spontaneously resolve after 1 year of life
Encephalofacial angiomatosis
another name for Sturge Weber syndrome
leptomeningeal angiomas
unilateral port-wine nevus
hemiparesis
Distinguish calcifications caused by CMV vs toxoplasmosis. Mnemonic
cmV - periVentricular
toXoplasmosis - scattered throughout the corteX
Infant with hemiparesis looking away from the paralyzed side.
Pathophys?
Acute Infantile hemiplegia
thomboocclusion of the middle cerebral artery
Which “brain bleed” happens with shaken baby syndrome
SubDURAL hematoma (rupture of bridiging veins)
Analgesia for circumcision?
Penile block
Topical Lidocaine
Subcutaneous Ring Block
Parinaud Syndrome
Pineocytoma
Lid retraction, loss of vertical gaze, loss of pupilary light reflex, and convergence-regtraction nystagmus (eyes jerk back into orbit upon attempted upward gaze)
Isoniazid MOA?
Inhibits pyridoxine utilization, therefore consider supplementing Vit B6 in children undergoing tuberculosis treatment.
Recall that B6 def. leads to peripheral neuropathy
What is prune belly syndrome?
Features?
Urinary tract abnormalities, renal malformation, oligohydramnios, pulmonary hypoplasia, club feet, wrinkled abdomen, dilated urinary tract, intra-abdominal testes
1) Dolichocephaly
2) Brachycephaly
1) Long, thin head
2) Broad head
Acute disseminated encephalomyelitis
path?
timing?
features?
imaging?
tx?
- autoimmune demyelinating condition seen in children less than 10 years of age
- follows viral URI
- fever, emesis, weakness, headache
- MRI shows disseminated focal white matter lesions
- corticosteroids
tx for newborn galactosemia?
switch to soy-based or casein-based and avoid galactose
Anaphylactoid purpura
Same thing as Henoch-Schonlein Purpura
Hartnup disease
Path?
Features?
Treatment?
Intestinal malabsorption of tryptophan and other neutral amino acids
Red Scaly rash, emotional lability, episodic cerebellar ataxia, developmental delay
Treat with nicotinamide replenishment
Cure for salycilate poisoning
NaCO3, acetazolamide, hemodialysis if extreme
Which of the following has karytype abnormalities? Gastroschisis or Omphalocele? Which ones?
Omphalocele
the three Trisomies
Antidote for phenothiazine poisoning? Symptoms of this?
Diphenhydramine
Opisthotonus, oculogyric crises, torticollis, tremors, dysphagia
What kind of a patient would have an unresponsive intradermal skin test using Candida Albicans. Explain
DiGeorge.
T-cell deficiency (don’t forget hypocalcemia, heart defects, etc., too).
Therefore, you can’t mount the intradermal response to something like candida
How to test for EHEC?
McConkey Agar
hypothalamic harmatoma
preceded by laughter (gelastic seizures)
GHrH release leading to acromegaly
General example, if you have a negative dipstick, then you’d probably want to do a urine culture.
But obviously if the dipstick was positive, then it’s high index of suspticion enough to consider the infection
Tanner Stages
(review kaplan behavioral video on this?)
Tanner 1 - no pubes?
Tanner 2 - sparse, thin, long pubes
Tanner 3 - pubes begin to curl
Tanner 4 - resembles adult pubes, but incomplete coverage
Tanner 5 - resemlbes adult pubes, but extends on thigh
Impaired ocular mobility, diplopia, pain greatest on upward gaze, infraorbital hypoesthesia,
following blunt force trauma
Orbital Floor Fracture
Kid with SVT, NBS?
Adenosine (NOT CAROTID MASSAGE)
Distinguish the definitions of primary vs secondary enuresis
Nocturnal vs diurnal
Primary - never followed by period of dryness
Secondary - enuresis followed by 6 months of dryness
Nocturnal - only during the nighttime
Diurnal - both night and day
Explain the metabolic derangements you’d find and explain the pathophys:
1) 21-hydroxylase def. & addison’s disease
2) Conn’s Syndrome
3) von-Gierke’s disease
1) hypOnatremic hypERkalemia; low aldosterone (low cortisol/glucocorticoids as well)
2) hypERnatremic hypERchloremic hypOkalemic metabolic alkalosis; high aldosterone
3) hypO everything; VGD patients have glucose-6 phosphatase def. which lends hyperlipidemia. this reduces the aqueous volume which in turn “factitiously” reduces electrolyte concentrations in the reading (the machine thinks there’s normal volume, but there’s actually less) tai
Legg-Calve-Perth’s Disease
SCFE
Transient synovitis of the hip
Femoral head necrosis
Common in blacks, knee pain referred to hip, early teens
Post-infectious condition affecting toddlers
Wiskott aldrich new mnemonic
TEA-TIME
T-cell dysfunction
Hyper IgE, A
Thrombocytopenia
Infection (otitis media)
LOW IgM
Eczema
hypsarrythmia
multifocal high amplitude spikes and slowing on EEG
(characteristic of West’s infantile spasm syndrome)
tx. ACTH
Best treatment to stop carriage of Group A Strep from oropharyngeal secretions
Oral Clindamycin or quinolone
Hurler’s Syndrome
mucopolysaccridosis type I
alpha-L-iduronidase def. leading to deposition of dermatan and heparan sulfate in the skin and excessive excretion in the urine
umbilical hernia, kyphoscoliosis, deafness, cloudy cornea, claw hand
General triad of storage diseases
HSM
Coarse Facies
Progressive developmental delay
What is ebstein anomaly
Downward displacement of the tricuspid valve
WHICH RASH HAS EOSINOPHILS
ERYTHEMA TOXICUM
Paraphimosis. path and tx?
Foreskin is retracted over the glans and does not return to its original position. Emergency.
NBS: manual reduction of the skin back into place
What does ivermectin treat?
cutaneous larva migrans (creeping eruption) caused by dog or cat hookworms
