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CLIPP Flashcards

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0
Q

Risk factors at birth for obesity

A

Genetic conditions
High birth weight
Maternal diabetes
Family history of obesity

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1
Q

VITAMIN C (differential diagnosis)

A 
Vascular
Infectious
Trauma
Autoimmune
Metabolic
Iatrogenic
Neoplastic
Congenital
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2
Q

What orthopedic diseases are seen in obese children?

A

Blount Disease
-Medial tibial disordered growh
Slipped Capital Femoral Epiphysis (SCFE)
-Occurs at onset of puberty in obese pts
-Limited ROM of the hip (especially internal rotation)

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3
Q

Most common neurobehavioral problem in childhood

A

ADHD (10% incidence)

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4
Q

Criteria for diabetes diagnosis

A

1) Symptoms of DM & random glucose > 200
2) Fasting glucose > 126
3) 2h serum glucose > 200 during oral glucose tolerance test

Any of those 3 can get Dx of diabetes

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5
Q

Weight criteria for testing for DM2

A

1) BMI > 85th percentile
2) Weight:Height > 85th percentile
3) Weight >120% ideal for height & 2 of:
- FH of DM2
- Native American, Black, Hispanic
- Signs of insulin resistance

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6
Q

Wha is the earliest to screen for diabetes?

A

10 years old or the onset of puberty. Whichever is earlier

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7
Q

How often should qualifying children be screened for diabetes?

A

Every 2 years

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8
Q

When to start screening for HTN?

A

Yearly, beginning at 3y

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9
Q

Staging of HTN in children

A

Normal < 90th percentile
Prehypertension 90-95th percentile
Stage 1 HTN 95-99th + 5mmHg
Stage 2 HTN > 99th + 5mmHg

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10
Q

Secondary causes of HTN

A 
Coarctation of the aorta
Renal artery stenosis
Renal parenchymal disease/scarring
Thyroid disorders
Hyperaldosteronism
OSA
Pheochromocytoma
Cushing syndrome
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11
Q

Guidelines for flu vaccine in children

A

Everyone >6mo of age
Children <9y need 2 doses, one month apart
After that, yearly

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12
Q

When to give HepA vaccine

A

Routine at 12 & 18 months

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13
Q

Overweight & obese BMI classifications

A

BMI 85-95th percentile = overweight

BMI >95th percentile = obese

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14
Q

Mimics of ADHD

A 
Hearing/vision impairment
Sleep problems
Mood disorders
Learning disability
Oppositional defiant disorder
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15
Q

What is a learning disability?

A

A disorder of cognition that manifests as a problem involving academic skills. There is a discord between IQ & academic achievement.

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16
Q

Adverse effects of stimulants (ADHD)

A 
Appetite suppression
Tic disorders
	-1%; stops with d/c of med
Insomnia
	-gets better with time
Stunted growth
	-slight; resolves when med stopped
CV risk in adults & kids with pre-existing heart dz
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17
Q

Which heart defect presents with a late murmur?

A

VSD

This is because there is no L–>R shunt when PVR is high. As it drops (few days-few weeks), the murmur is revealed.

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18
Q

Natural history of VSD’s

A

75% of small defects close spontaneously

25-50% of all defects close spontaneously

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19
Q

VSD murmur

A

Holosystolic murmur +/- small diastolic component

Heard best at tricuspid area (LLSB)

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20
Q

Causes of infantile CHF

A

VSD
Severe aortic stenosis
Coarctation of the aorta
Large PDA

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21
Q

Presentation of infantile CHF

A

Respiratory distress with feedings
Diaphoresis with feedings
FTT
Hepatomegaly

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22
Q

How often do infants breastfeed?

A

20-30 minutes every 1-2h

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23
Q

ASD murmur

When does it present?

A

Fixed widely-split S2
Soft systolic murmur (increased flow over pulmonic valve)

Presents at 3-5y

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24
Aortic stenosis murmur | When does it present?
Systolic ejection murmur Early diastolic murmur (usually also some AR) Presents in infancy
25
PDA murmur | When does it present?
Continuous -Louder in systole Presents in infancy
26
Poor feeding DDx
``` CHF Metabolic disorders Bronchiolitis/pneumonia Sepsis GERD ```
27
Common causes of an unresponsive child
``` Seizure Syncope (breath holding) Meningitis/Encephalitis Toxic ingestions Head trauma Intussusception ```
28
What can precipitate an Absence seizure?
Hyperventilation | Photic stimulation
29
Symptoms of a simple partial seizure
Motor signs in 1 extremity or 1 side of body | May generalize
30
Sandifer's Syndrome
Arching of the back, often unilateral in an infant. Represent's GERD
31
What age of children typically get febrile seizures? | What % of children get them?
6-60 months of age 2-4% of children get them
32
Risk of recurrent febrile seizure
First febrile seizure before 1y ---> 50% risk for 2nd First febrile seizure after 1y --> 30% risk for 2nd
33
Risk of developing epilepsy in children with febrile seizures
Simple --> Slightly increased above 1% general pop risk Complex or early & recurrent --> increases risk
34
Empiric treatment for bacterial meningitis
Ceftriaxone + Vancomycin Treat for 7-14 days
35
Complications of bacterial meningitis
``` Stroke Subdural effusions SIADH Developmental delay Seizures Hearing loss Death ```
36
When does a post-traumatic seizure typically occur? | A febrile seizure?
Post-traumatic --> 1-2h after head injury Febrile seizure --> First day of illness
37
What studies/labs to get for fever without a source & general CNS symptoms?
CBC w/ diff Blood culture Urinalysis/Urine Cx Lumbar puncture
38
Threshold for LP with regard to age
The younger they are, the lower the threshold
39
Hep B immunization schedule
Birth, 1 month, 6 mo
40
Pentacel immunization schedule
Pentacel = DTaP, HiB, IPV 2mo, 4mo, 6mo
41
Pneumococcal immunization schedule
2mo, 4mo, 6mo
42
Rotavirus immunization schedule
2mo & 4mo
43
MMR immunization schedule
12mo & right before starting school
44
Varicella immunization schedule
12mo & 4y
45
TDaP immunization schedule
11y
46
HPV immunization schedule
3 dose series at 11-12y | before sexual activity
47
Measles timeline
Incubation - 2 weeks Prodrome - 2 days Exanthem - 4 days Recovery - 2 weeks
48
Symptoms of measles
``` Fever Cough Coryza Conjunctivitis (b/l) Koplik's spots Exanthem - maculopapular & cephalocaudal ```
49
Causes of rash on palms & soles
Rocky Mountain Spotted Fever Kawasaki Disease Enteroviruses (Coxsackie) Syphilis
50
Erythema infectiosum rash
Appears 7-10d after low grade fever Slapped cheek rash then lacy rash. Clears centrally first. Can have polyarthropathy or aplastic anemia
51
Roseola symptoms
Fever, Fever, Fever, RASH (high fever for 3-4d) Rash remains central. It's macular and reticular looking.
52
Rash of scarlet fever
Sandpaper rash begins in groin, axillae, neck
53
Symptoms: Cholinergic poisoning
DUMBBELLS ``` Diarrhea Urination Miosis Bradycardia Bronchoconstriction Emesis Lacrimation Lethargy Salivation ```
54
Symptoms: Anticholinergic toxicity
``` Fever Dry-mouth & dry skin Mydriasis Delirium/seizures HTN & tachycardia Urinary retention ```
55
Symptoms: TCA overdose
Temperature (fever) Cardiotoxic (hypotension, wide QRS, irregularly irregular) Agitation Also dry, hot skin, mydriasis, can cause apnea
56
Symptoms: SSRI overdose
Hyperthermia Autonomic instability Rigidity Myoclonus
57
Treatment of very hypoglycemic child
D25 bolus (20cc/kg) Octreotide if due to a Tx-refractory sulfonylurea ingestion
58
What are the indications for activated charcoal?
Ingestions NOT due to small molecules or heavy metals
59
Contraindication to activated charcoal
Individual with loss of airway protection. Would have to intubate first.
60
Treatment for TCA cardiotoxicity
1. Cardiac monitoring for at least 6h 2. 1mEq/kg NaCO3 bolus Q5 minutes - Until QRS narrows & hypotension improves - Target serum pH = 7.50-7.55 - Continue maintenance serum alkalinization for 12-24h
61
Treatment of TCA-induced seizures
Benzodiazepines & alkalinization of serum
62
Pathophysiology of HSP
IgA-mediated small vessel vasculitis involving the skin, GI tract, joints, & kidneys
63
Symptoms of HSP
Non-thrombocytopenic petechiae & purpura Hematuria Arthritis (knees & ankles) Colicky abdominal pain
64
Typical age of HSP
4-6 years Boys affected twice as often
65
Treatment for Idiopathic Thrombocytopenic Purpura (ITP)
Oral corticosteroids IVIg Rhogam
66
Symptoms of ITP
Petechiae & bruising Possible severe epistaxis or mucosal bleeding (3%) IC Hemorrhage (0.1%)
67
Bowel obstruction in a child
Intussusception is the most common cause in 6m-6y child | -80% in younger than 2
68
Location of intussusception
``` Idiopathic = ileocecal HSP = ileo-ileal ```
69
S/S of intussusception
``` Triad: -Severe abdominal pain (inconsolable) -Currant jelly stool (FOBT+) -Sausage-shaped mass in right abdomen Also possible: emesis, lethargy, AMS ```
70
Diagnosis of intussusception
Non-HSP = air or contrast enema HSP-related = abdominal US
71
Treatment for HSP
Self-limited lasting 4-6 weeks Monitor for renal involvement
72
Simple vs. Complex febrile seizure
Simple: - Generalized - Less than 15m - No more than 1 in a 24h period
73
Glomerular diseases with low complement
Membranoproliferative Post-Strep SLE
74
Secondary causes of nephrotic syndrome
``` SLE Post-strep GN HBV HIV HSP ```
75
Most common age for minimal change disease
18m-5y Boys > Girls
76
Microscopy seen in minimal change disease
Normal histology Diffuse effacement of epithelial cell foot processes
77
What serum abnormalities are seen with minimal change disease?
Low albumin Hyperlipidemia Hyponatremia (fluid overload +/- pseudohyponatremia)
78
What is seen on exam in minimal change disease?
``` Anasarca -Best seen in scrotum or labial region -Pitting edema -Periorbital edema Fluid wave -Ascites ```
79
What is the limit of normal proteinuria in a child?
Up to 2+ proteinuria | 30-100mg/dL
80
Proteinuria in an asymptomatic adolescent | How to test?
Orthostatic proteinuria Urine should be negative for protein when first morning urine.
81
Treatment of minimal change disease
1. Corticosteroids - 95% steroid responsive - Can also be relapsing or steroid-resistant 2. Sodium restriction - 1500-2000 mg daily 3. Albumin infusion then IV Lasix - Only if dyspneic or scrotal edema is impairing blood flow - Never Alb or Lasix alone - Alb alone --> pulmonary edema - Lasix alone --> shock
82
Immunizations to give in minimal change disease
Pneumococcal Varicella Influenza Only given once in remission
83
Complications of minimal change disease
``` Overwhelming bacterial infections Spontaneous peritonitis Pneumonia Cellulitis Venous thrombosis ```
84
Why are pts with nephrotic syndrome hypercoagulable?
Urinary loss of AT-III Corticosteroid use Hyperlipidemia destabilizes platelets
85
Vitals in sepsis
Tachycardia Tachypnea Hyperthermia
86
What is the first things to assess in an emergency?
``` Airway Breathing Circulation Disability (mental status/neurologic)/Dextrose Exposure (expose entire pt) ```
87
Most sensitive signs of impaired circulation
Tachycardia | Capillary refill
88
DDx of altered mental status in a child
``` Meningitis Encephalitis Sepsis Trauma DKA Renal failure Ingestion Hypoglycemia ```
89
Fluid bolus size for peds
20 cc/kg of NS
90
Indications for intraosseous access
If a peripheral IV cannot be placed within 90 seconds
91
Abx therapy for meningococcemia
Penicillin G
92
Prophylaxis for meningococcal contacts
Ciprofloxacin for adults Rifampin or Ceftriaxone for kids
93
Immunization against meningococcus
Tetravalent Conjugate Vaccine (MCV4) Given IM to 11-18y adolescents - Booster at 16y if 1st dose given before then - College freshmen require booster within 5 years
94
How can tobacco use affect a fetus?
Low birth weight is associated with tobacco use
95
Effects of marijuana use while pregnant
Infants have withdrawal-like syndrome (high pitched cry & tremors)
96
Effects of cocaine use while pregnant
Vasoconstriction --> Placental insufficiency --> Low birth weight Also can cause placental abruption Possible deficits in child's cognitive performance
97
Things that increase risk of HIV vertical transmission
``` Unprotected sex during pregnancy Amniocentesis High viral load Breastfeeding Premature delivery (<37w) ```
98
Decreases HIV vertical transmission risk
Zidovudine C-section prior to labor No breastfeeding
99
What is included in a neonatal screen?
Metabolic screen Hearing screening Congenital heart defects screening (some states; O2 sat)
100
What is mandated in the newborn metabolic screen?
PKU | Hypothyroidism
101
Absolute contraindications to breastfeeding
HIV infection Maternal drug abuse Infants with galactosemia
102
Benefits of breastfeeding
GI development Decreases risk of acute illness (diarrhea, AOM, UTI) Reduced rates of obesity, CA, CAD, allergies, T1DM, IBD Cognitive advantage Decreased maternal risk of breast & ovarian CA, & osteoporosis
103
Recommendations for breastfeeding
Exclusive breastfeeding birth-6mo | Add foods & continue breastfeeding until 12mo
104
Leading causes of death in adolescents
Accidents Homicide Suicide
105
HEEADSSS interview
``` Home Education/Employment Eating disorder Activities/Aspirations Drugs/alcohol/tobacco Sexuality Suicidality/mental health Safety ```
106
APGAR
``` Appearance (skin color) Pulse Grimace Activity Respiratory effort ```
107
What is considered small for gestational age (SGA)?
<10th percentile on intrauterine growth curve
108
Problems seen in SGA infants
Hypoglycemia Hypothermia Hypoxia Polycythemia
109
What is considered appropriate for gestational age (AGA)?
10th-90th percentile 90th = LGA
110
What is considered microcephaly?
<10th percentile of head circumference
111
What is the classic triad of a TORCH infection?
Microcephaly Organomegaly Rash
112
What are the TORCHS organisms?
``` Toxoplasmosis Other Rubella CMV Herpes/HIV Syphilis ```
113
Symptoms of congenital CMV infection
Jaundice Hearing loss Chorioretinitis Intracranial calcifications
114
What studies should be done if congenital CMV is suspected?
Urine CMV culture Newborn hearing test Head CT Ophthalmologic exam
115
What medications are given to all newborns?
Vitamin K injection Erythromycin ointment for eyes -Decreases risk of gonococcal conjunctivitis -Can also use tetracycline or silver nitrate HBV vaccine HBIg if mother is positive for HBSAg
116
How long until a baby should be back at birth weight
2 weeks
117
Average daily weight gain for infant
20-30g for term infant
118
When should weight be 2x birth weight?
4-5mo
119
When should weight be 3x birth weight?
1 year
120
When should length be 2x birth length?
4 years old
121
What are the 4 domains of development?
Gross motor Fine motor Language/Communication Social/Behavior
122
When can children sit in the front seat?
Once they are a teenager (13)
123
How to mix formula powder
2 scoops of powder in 4oz of water
124
Caloric requirements of premature infants
``` Preterm = 130 kcal/day VLBW = 150 kcal/day ```
125
What supplement do breastfeeding infants need?
Vitamin D
126
How often to introduce new solid foods
Starting at 4-6mo: one new food Q5-7 days To identify allergies.
127
Absence of red reflex DDx
Cataracts Retinoblastoma Glaucoma Chorioretinitis
128
When does the moro reflex disappear?
4mo
129
DDx of asymptomatic abdominal mass in an infant
``` Neuroblastoma Wilms' tumor Teratoma Hepatic tumor Hydronephrosis ```
130
When does neuroblastoma present?
Over 50% before age 2
131
Most common sites of neuroblastoma
Adrenal glands or anywhere along the sympathetic chain Abdominal > thoracic > cervical
132
Common presentation of neuroblastoma
``` Fever Anemia/pallor FTT +/- abdominal mass +/- bone pain (mets; Hutchinson syndrome) ```
133
Differentiating Wilms' & Neuroblastoma clinically
BOTH abd mass & can show hypertension ``` Wilms' -Aniridia -Hemihypertrophy Neuroblastoma -Opsoclonus/Myoclonus ```
134
Elevated VMA/HVA in a child
Neuroblastoma
135
Symptoms of Beckwith-Wiedemann syndrome
Hemihypertrophy Macroglossia Organomegaly Wilms' tumor
136
Study of choice in evaluating for neuroblastoma mets
Technetium-99 bone scan
137
Histology: small cell rosettes
Neuroblastoma
138
When should firs dentist visit be?
Within 6mo of first tooth or by 1y
139
When to face car seat forward?
24mo or when they outgrow their car seat
140
When can children stop using booster (forward) car seat?
4 feet 9 inches tall
141
What ages is M-CHAT used for? | PEDS?
M-CHAT = autism spectrum in 16-30mo PEDS = development from birth-8y
142
Most common cause of inward-toe gait
Tibial torsion
143
When to refer in-toe gait
If it doesn't resolve by 4y
144
Anemia DDx
``` Iron deficiency (most common) Chronic GI blood loss Lead poisoning Chronic illness Hemoglobinopathy (thalassemia, SCD, G6PD def) ```
145
Normal Hgb for a child?
6mo-6y: 10.5-14 g/dL
146
Treatment for eczema
1. Lubrication 2. Topical hydrocortisone 3. Antihistamines for itching
147
DDx for school failure
``` Sensory impairment Sleep disorder Mood disorder Learning disability Conduct disorder ```
148
What physical & lab findings are seen in eating disorders?
``` Weight loss Amenorrhea Bradycardia Electrolyte abnormalities Hypoalbuminemia Hypoglycemia Hyponatremia ```
149
When to start screening for HIV?
All sexually active teens (>13)
150
Order of pubertal growth in girls
Breast buds --> pubic hair --> growth spurt --> menarche
151
Order of pubertal growth in boys
Testes grow --> pubic hair --> penile growth --> growth spurt
152
Define: Menorrhagia Metrorrhagia Dysmenorrhea
Menorrhagia - long or heavy periods Metrorrhagia - irregular periods Dysmenorrhea - painful periods
153
What is seen on coagulation testing in vWD?
Low Factor VIII activity Low vWF quantity Low vWF activity
154
Treatment for vWD?
Intranasal or IV Desmopressin
155
Most common causes of chest pain in children
``` Precordial catch syndrome -Sudden sharp pain at LUSB -Pleuritic & clears with deep inspiration Costochondritis -Lasts hours-days ```
156
Risk factors for TTN
LGA Diabetic Mother C-section birth
157
What is considered prolonged PROM?
>18h prior to delivery
158
Most common site of congenital diaphragmatic hernia
``` Left chest Posterolateral side (Bochdalek hernia) ```
159
Problems seen in LGA newborns
Birth injuries | Hypoglycemia (diabetic mother)
160
Problems seen in SGA newborns
Hypothermia Hypoglycemia (inadequate glycogen stores) Polycythemia & hyperviscosity
161
When to intervene on neonatal hypoglycemia
Asymptomatic = <45 mg/dL
162
Normal # of wet diapers for a newborn
6+ per day
163
Which organs are insulin-sensitive?
Heart Liver Muscle Fat
164
Risk factors for NRDS
``` Prematurity Maternal DM Sibling w/ Hx of NRDS Male C-section without labor Perinatal asphyxia ```
165
Differentiating TTN & NRDS
CXR
166
Management of TTN
Supportive | If S/s don't resolve --> Tx for pneumonia
167
When to give IV glucose to newborn with respiratory distress
If RR > 80 or If symptomatic hypoglycemia
168
Criteria for physiologic jaundice
tBili up to 15 mg/dL | No other demonstrable cause for high tBili
169
What causes breastfeeding jaundice?
Not much milk available early on --> low PO intake --> reabsorption of bilirubin from stool
170
G6PD inheritance pattern
X-linked recessive Seen more in Mediterranean, African, Asian families
171
Symptoms of biliary atresia
Jaundice Dark urine/Acholic stools Seen between 3-6 weeks of life (late-onset)
172
What supplements should be given to breastfed infants?
Birth - Vitamin D | 6mo - Iron & Fluoride (if not fluoridated)
173
Bilirubin levels based on PE
Jaundice of face = 5mg/dL | Knees = 10-15mg/dL
174
Cephalohematoma vs Caput succedaneum
Caput succedaneum can cross suture lines (not subperiosteal) Also Caput = serum Cephalohematoma = whole blood
175
What disorders can be missed if metabolic screen is done less than 24h after birth?
Any disorder with accumulation of metabolites (PKU, ect)
176
S/S of congenital hypothyroidism
``` Jaundice Lethargy Macroglossia Umbilical hernia Constipation Abd distention Mental retardation ```
177
What inborn errors of metabolism can present with jaundice?
Galactosemia & Hypothyroidism
178
Definition of FTT in newborn
Not back to birth weight by 3 weeks or continuous weight loss after 10 days of life
179
Causes of congenital hypothyroidism
``` Primary (most common in US; aplasia/hypoplasia) HP axis defect Maternal autoimmune thyroiditis Maternal antithyroid drugs Iodine def ```
180
What conditions are associated with large fontanelles?
``` Congenital hypothyroidism Down syndrome Rickets/OI Malnutrition ^ICP ```
181
What inborn error classes show hyperammonemia?
Urea cycle disorders Organic acidemias FA oxidation disorders
182
CXR findings in TB
Hilar LAD Focal hyperinflation Atalectasis Sometimes primary Ghon focus
183
Normal RR newborn
30-60
185
Normal HR newborn
100-160
186
Normal HR 1-12mo
90-150
186
Normal HR 3-5y
80-110
187
Normal HR 1-3y
80-140
188
Normal HR 6-12y
70-110
189
Stages of Pertussis infection
1. Catarrhal stage (URI) 2. Paroxysmal stage (whooping cough) 3. Convalescent stage (cough subsides)
190
Diphtheria symptoms
Pharyngitis with gray pseudomembranes
191
Barky cough
Croup
192
Stridor vs wheezing
Stridor = pathology above thoracic inlet. Inspiratory. Wheezing = pathology below thoracic inlet. Expiratory.
193
PPD evaluation in children
Positive if: >5mm in high risk >10mm in moderate risk >15mm in low risk
194
DDx for chronic cough in an infant
``` Vocal cord dysfunction Laryngotracheomalacia Vascular ring Laryngeal web Tracheostenosis TEF Foreign body ```
195
What age can you give antihistamines?
>2y
196
How long does middle ear effusion stay after abx?
1mo in 50% 2 mo in 25% 3mo in 12.5%
197
Oral rehydration guidelines
50-100mL/kg over 2-4h then 10mL/kg per diarrhea afterward 2mL/kg per emesis afterward
198
Solute requirements in maintenance fluids
``` Sodium = 3.5 mEq/100mL Potassium = 2.5 mEq/100mL ```
199
Milk allergy presentation
Loose stools | Rash
200
What are the categories of the GCS?
Eye response Verbal response Motor response
201
Typical age & gender of T2DM Dx in youth
12-16y Females
202
Diagnostic criteria of DKA
Random blood glucose > 200 Venous pH < 7.3 or bicarb < 15 Moderate or large ketonemia/ketonuria
203
Which type of dehydration has the highest mortality
Hypertonic volume contraction
204
Studies to do in newly-diagnosed T1DM
Anti-endomysial, anti-TTG, total serum IgA Anti-insulin, anti-GAD, anti-IA2 (confirm T1DM) BUN & Cr Accucheck Serum ketones (to monitor response) Electrolytes (will show high K+. low Na+) Anti-thyroid Ig's UA Venous pH & Bicarb
205
Management of DKA
1. NS Fluid bolus (over 1h) 2. Insulin gtt 3. Manage electolytes
206
Normal uop
2cc/kg/hr for children <15kg | 1cc/kg/hr for larger children or adults
207
Maintenance fluids per hour
4-2-1 rule
208
10-10-10 rule
10 months 10kg Hgb > 10
209
Goal for reducing blood glucose in DKA
80-100mg/hr | End when glucose is 120-200
210
Leading cause of diabetic death in children
Cerebral edema 2/2 DKA
211
Treatment for cerebral edema in DKA
IV mannitol | Slow down fluid administration
212
DDx of limp in a child
``` Trauma Septic arthritis Osteomyelitis Transient synovitis Reactive arthritis Leukemia ```
213
Symptoms of reactive arthritis
Follows GI or GU infection | Arthritis, Urethritis, Conjunctivitis
214
Symptoms of Juvenile Idiopathic Arthritis (JIA)
6w | Can have fever/rash or psoriasis
215
Predictors of septic arthritis
Fever Non-weight bearing ESR/CRP Leukocytosis
216
Types of pediatric brain cancer
Medulloblastoma Astrocytoma Brainstem glioma Ependymoma
217
Types of migraine
Classic (aura) Common (unilateral, no aura) Basilar artery (bilateral vision changes, paresthesias, AMS) Migraine variants (only in peds)
218
HA patterns if caused by increased ICP
Worse after lying down Awakens pt from sleep Relieved by vomiting Worse with valsalva
219
Causes of pediatric ataxia
``` Post-infectious cerebellitis Infectious cerebellitis Medication ^ICP (mass, hydrocephalus) Opsoclonus-Myoclonus syndrome Migraine Metabolic or neurodegenerative disease ```
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Physical signs of allergies
Allergic salute Dennie's lines (infraorbital) Allergic shiners
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Vomiting without diarrhea suggests what
Extra-intestinal pathology
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When does testicular torsion typically occur?
Early adolescence
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Reasons to hospitalize for PID
``` Pregnancy Noncompliance High fever Intractable emesis Can't exclude a surgical emergency ```
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Most specific sign of shaken baby syndrome
retinal hemorrhages (pathognomonic)
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Definition of apnea
Cessation of inspiratory flow for 20s | Or for shorter period of time if also accompanied by bradycardia, cyanosis, or pallor
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ALTE
Apparent Life Threatening Event | Apnea with/without other s/s. Recovers only with stimulation or resuscitation
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DDx for an ALTE
``` Seizures Breath holding ^ICP Arrhythmia Respiratory infx GERD Systemic things (sepsis, metabolic, intoxication, botulism) ```
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Skeletal survey findings suspicious for abuse
Fractures inconsistent with developmental stage Multiple fractures at different stages of healing Leg fracture in non-walking child Posterior rib fractures (shaken baby syndrome) Skull fracture
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Vitamin E deficiency presentation
Neuropathy & hemolytic anemia
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Progression of deficits in growth for a malnourished child
Weight --> Length --> Head circumference
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Definition of FTT in children
Weight <3rd percentile | Crosses 2 or more lines on growth chart
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Causes of organic FTT
``` Chronic diarrhea Formula allergy Heart defect Cystic fibrosis Developmental delay (poor suck) RTA Severe reflux ```
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What is physiologic anemia?
Drop in Hgb after birth due to RBC turnover. Marrow isn't stimulated to respond until Hgb <11 g/dL
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Diagnosis of CF
Newborn screen is just a screen | Sweat chloride test is gold standard
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What test is used to assess exocrine pancreatic function?
Fecal elastase
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Diagnosing functional abdominal pain
No alarm signs Normal PE Negative FOBT
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Causes of hypoalbuminemia
Malnutrition Hepatic disease Protein losses (enteropathy, nephrotic syndrome)
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First line medication for Crohns
Mesalamine (5-ASA)
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Extra-intestinal manifestations of Crohns
Arthritis Uveitis Renal stones Erythema nodosum
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Problems seen in preterm infants
``` BPD ROP Hyperbilirubinemia Periventricular leukomalacia Cerebral palsy ```
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Birth asphyxia & kernicteris cause this type of cerebral palsy
Dyskinetic CP
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MRI findings in CP
Periventricular leukomalacia | Thin corpus callosum
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Physical exam findings in Down syndrome
``` Epicanthal folds Flat facial profile Single palmar crease Gab between 1st & 2nd toes Umbilical hernia ```
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Complications of Down syndrome
``` Hypotonia Mental retardation Endocardial cushion defects Duodenal atresia Leukemia Hypothyroidism ```
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Risk factors for Down syndrome
Maternal age >35y
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Features of Patau syndrome
``` Trisomy 13: Microcephaly Severe mental retardation Polydactyly Cleft lip/palate Cardiac & renal defects ```
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Features of Edwards syndrome
``` Trisomy 18 Prominent occiput Micrognathia Overlapping fingers Rocker bottom feet ```
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Most common familial cause of mental retardation
Fragile X
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Cause of Fragile X
Abnormal number of trinucleotide repeats for FMR1 gene on the X chromosome
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Ways to inherit Down syndrome
Trisomy 21 Unbalanced translocations Mosaicism
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Features of Fragile X
Large testes (post-pubertal) Large ears Long face Large mandible
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Features of Turner syndrome
``` Short stature Webbed neck Edema of hands/feet Shield chest Coarctation of the aorta (20%) Gonadal streaks ```
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Features of Klinefelter syndrome
``` 47XXY Eunuchoid body habitus but tall Low-normal IQ Testicular atrophy & sterility Gynecomastia in adolescence ```
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DDx of neonatal hypotonia
``` Benign neonatal hypotonia Down syndrome Zellweger syndrome Perinatal asphyxia Sepsis Metabolic abnormality Maternal medications ```
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What is Zellweger syndrome
A peroxisome-dysgenesis disorder causing neonatal hypotonia
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Recommended screenings for Down syndrome pts
Hearing & vision ECHO Thyroid studies at birth, 6mo, & annually Cervical Xrays (antlantoaxial instability)
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Physical exam findings of sickle cell disease
Growth impairment Scleral icterus Flow murmur Splenic enlargment
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S/s of acute chest syndrome
``` Fever Cough Chest pain SOB/Hypoxemia Multi-lobar infiltrates, effusions, atalectasis ```
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Prophylaxis for sickle cell disease
Penicillin until 6y HiB & PCV Meningococcal vaccine early Flu vaccine yearly
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Normal Hgb for child with SCD
Hgb = 6-9
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Complications in SCD
``` Sepsis w/ encapsulated org Stroke (10% by 15y) Acute Chest Syndrome Priapism Aplastic crisis (parvovirus) Osteomyelitis (Salmonella or Staph aureus) ```
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Management of Acute Chest Syndrome
``` Pain control IVF 1.5x normal maintenance Incentive spirometry Antibiotics +/- PRBC/Exchange transfusion ```
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Fever in a child with SCD
Blood Cx | IV empiric abx
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Snoring in a child with SCD
Waldeyer's ring lymphoid tissue hypertrophy | Tx: Tonsillectomy, Adenoidectomy

Pediatrics (3 decks)

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