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Peds > CLIPP 5/4/17 > Flashcards

CLIPP 5/4/17 Flashcards

1
Q

Opsoclonus-myoclonus syndrome

A

paraneoplastic syndrome that occurs most often with neuroblastoma in a young child who presents with ataxia and jerking or erratic movements as well as jerky conjugate movements of the eyes.

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2
Q

Post-infectious cerebellitis
pres
path

A

typically presents in a younger child with ataxia, nystagmus, vomiting and sometimes dysarthria

believed to be an autoimmune response leading to demyelination of the cerebellum occurring several weeks after a viral infection such as varicella or coxsackie virus

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3
Q

. Headaches of new onset that do not go away and are worse in the mornings and associated with vomiting and personality changes would be most concerning for

A

brain tumor etiology

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4
Q

headache that should be responsive to nsaids

A

Tension-type headache

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5
Q

4yo child presents withCC fatigue, evidence of anemia (fatigue, tachycardia, pallor) and thrombocytopenia (unexplained bruising)

you should suspect…

A

ALL
Failure of two or more hematologic cell lines should always raise suspicion for malignant invasion of the marrow. Furthermore, the child’s chief complaint, fatigue, is the most common presenting symptom of acute leukemia. Finally, the incidence of ALL peaks at age 4 years.

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6
Q 
HSP
etiology
peak age and range, gender
signs and symptoms
important to labs at follow-up
A

exact etiology of HSP is unknown, but it is believed to involve an IgA-immune-mediated vasculitis in response to infection or other triggers

peak at ages 4 to 6 years (range of 2 to 17 years)
M:F 2:1

characterized by a rash consisting of petechiae and palpable purpura. Other findings include a colicky diffuse or periumbilical abdominal pain, arthritis or arthralgia, and renal disease

UA, BP, BUN Cr: Given the incidence of renal disease, it is important to check the urine for signs of hematuria or proteinuria; sudden changes in blood pressure can potentially suggest a change in renal function. With abnormal findings, serum BUN and creatinine must be checked

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7
Q

platelet count in HSP

A

normal, hallmark rash is a NON-THROMBOCYTOPENIC PURPURA

Idiopathic thrombocytopenic purpura (ITP) is part of the differential for palpable purpura and petechiae. ITP is characterized by low platelet counts (usually < 20,000) with normal WBCs and hemoglobin. Should you find low platelets, you may want to reconsider the differential and think about ITP or possibly leukemia.

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8
Q

CBC in ITP

A

low platelet counts (usually < 20,000) with normal WBCs and hemoglobin

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9
Q

PT/PTT in HSP

A

normal
not a coag disorder, an IgA-immune-mediated vasculitis

but coag disorder on the ddx for palpable purpura and petechaie so get PT/PTT if dx uncertain

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10
Q

Peds leukemia
path
signs and symptoms
labs to get if suspected

A

bone marrow infiltration and cytopenia,
abnormalities in the different cell lines (WBC, RBCs and platelets)

petechia and purpura, bone pain, fever, fatigue, malaise, hepatosplenomegaly, and lymphadenopathy

When leukemia is suspected, it is important to measure WBCs, Hgb and platelets

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11
Q

intracranial hemorrhage is a potential but rare complication of which ddx for petechiae and palpable purpura

A

intracranial hemorrhage is a potential but rare complication of idiopathic thrombocytopenic purpura (ITP). The incidence of ICH in patients with ITP is 0.1 to 0.5% of cases

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12
Q

labs to get when working up palpable purpura and petechiae, according to ddx

A

HSP - BP, UA, BUN Cr if the first two abnormal, because of frequent renal involvement

ITP - CBC - low platelet counts (usually < 20,000) with normal WBCs and hemoglobin

Coag disorder - PT/INR

Leukemia - CBC - bone marrow infiltration and cytopenia

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13
Q

tf

hsp is characterized as a small vessel vasculitis

A

HSP is classified as a small vessel vasculitis. The exact mechanism of HSP is unknown; however, it is thought to be an IgA-mediated immune response affecting small vessels (skin, GI tract, joints, kidneys). Approximately 50% of cases follow viral or bacterial URIs. Biopsy of affected organs shows leukocytoclastic vasculitis with IgA deposition

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14
Q

biopsy of affected organs in HSP shows

A

leukocytoclastic vasculitis with IgA deposition

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15
Q

Approximately 50% of cases of HSP follow what kind of preceding illnesses

A

viral or bacterial URIs

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16
Q

UA in HSP

follow-up labs

A

UA in HSP will often reveal mild hematuria and/or proteinuria. If either are present, BUN and Cr should be ordered to further evaluate the extent of renal involvement.

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17
Q 
HSP
tx
time to resolution
recurrence rate
give IVIG?
A

treatment of HSP is symptomatic and supportive (e.g., NSAIDs for joint pain). HSP usually resolves within four to six weeks and has a 30% recurrence rate. IVIG is not indicated in patients with HSP; it is, however, a treatment option for ITP

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18
Q

what % HSP pts have elevated serum IgA

A

50%

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19
Q

tf

HSP pts have GI bleeding

A

T
Since IgA immune complexes in HSP also attack the GI vessels, around 67% of patients have GI bleeding, either occult blood or grossly bloody stool

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20
Q

tf

HSP pts have abdominal pain

A

T
Abdominal pain occurs in 50 to 75% of HSP patients, as a result of the immune attack on the GI vessels, as described above

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21
Q

tf

HSP pts have arthralgias

A

T

Arthralgias, mainly of the knees and ankles, are seen in about 75% of children with HSP

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22
Q

___ are often the delineating finding between HSP and ITP

A

Decreased platelets (ITP)

hallmark rash in HSP is a NON-THROMBOCYTOPENIC PURPURA

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23
Q

rash description in HSP

A

erythematous, slightly raised, non-blanching, maculopapular rash over the legs, buttocks, and posterior portion of the elbows

aka petechiae and palpable purpura

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24
Q

tf
observation is appropriate in this patient: 8yo, joint pain, erythematous, slightly raised, non-blanching, maculopapular rash over the legs, buttocks, and posterior portion of the elbows, normal CBC, Skin biopsy shows leukocytoclastic vasculitis with IgA deposition

A

T
treatment of HSP is symptomatic and supportive (e.g., NSAIDs for joint pain). HSP usually resolves within four to six weeks and has a 30% recurrence rate

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25
Q

fitz-hugh-curtis syndrome
define
symptoms

A

rare complication of pelvic inflammatory disease (PID) involving liver capsule inflammation leading to the creation of adhesions. abdominal pain would be felt in the right upper quadrant and may be referred to the right shoulder if the peritoneum becomes irritated

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26
Q

___ is the most sensitive and specific lab test to diagnose pancreatitis.

A

Lipase

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27
Q

fever and vomiting in the setting of a uti makes you think

A

pyelonephritis

28
Q

tf

pelvic inflammatory disease requires inpatient treatment

A

depends
may be managed with abx outpatient if low risk… but if eg pregnant manage inpatient, or homeless and higher risk of not completing abx course, manage inpatient

29
Q

is ovarian torsion more common pre or post menopausal

A

Ovarian torsion is more common in the post-menopausal population, though it can present in any age group

30
Q

things that would make you lean ovarian torsion instead of appendicitis on history and physical

A

pain is intermittent
palpable ovarian mass (inc risk of torsion)
postmenopausal (more common than premenopausal)

31
Q

temporality of pelvic inflammatory disease pain

A

often post-coital and also first occurs during or immediately following menstruation

32
Q

cervical motion tenderness think

A

pelvic inflammatory disease

33
Q

tf

pelvic ultrasound to dx PID

A

F for initial dx
can initiate treatment based on H&P without further diagnostic workup

but can consider pelvic ultrasound if ovarian torsions were suspected, or if her symptoms were refractory to treatment, suggesting a tubo-ovarian abscess that could be detected by ultrasound

34
Q

Cervical discharge in PID should be tested for

A

should be tested for gonorrhea and chlamydia and sent for culture

35
Q

tf

infant bloody stools and poor weight gain put milk protein allergy on the ddx

A

T
but
most common symptoms include diarrhea, vomiting, abdominal pain, and allergic reactions ranging from urticaria to anaphylaxis

gastroenteritis or intussusception, or other intestinal anomaly on ddx for bloody stool too

36
Q

milk protein allergy more common in breast milk or formula?

A

more common with formula

less common with breast milk, but still occurs

37
Q

what signs and symptoms suggest CHF as cause of failure to thrive

A

tiring with feeds, sweating, or tachypnea, tachycardia, or hepatomegaly

38
Q

most common cause of failure to thrive

A

inadequate caloric intake

39
Q

most common symptoms of milk protein allergy

A

most common symptoms include diarrhea, vomiting, abdominal pain, and allergic reactions ranging from urticaria to anaphylaxis

40
Q

Stool culture with Wright stain for WBC’s could be useful in a patient with diarrhea if you suspect

A

an infectious cause of the diarrhea

41
Q

TF

9wk old baby with steatorrhea and poor weight gain but normal newborn screen at birth should have CF on the ddx

A

T

newborn screens not completely standardized across states, CF may have been missed

42
Q

inheritance of CF

A

autosomal recessive

43
Q

tf

most peope with CF have a positive family history

A

f

autosomal recessive inheritance

44
Q

tf

gene therapy is a current treatment option for CF

A

f
not yet
Current treatment includes a multidisciplinary approach - pancreatic enzyme and vitamin replacement, mucus clearing, possibly transplant, and more

45
Q

kernicterus due to hyperbilirubinemia is associated with what type of cerebral palsy

A

kernicetrus is associated with dyskinetic CP (basal ganglia pathology on imaging)

46
Q

dyskinetic cerebral palsy is associated with what newborn issues, what neural structures, what symoptoms

A

perinatal asphyxia involving the thalamus and cerebellum

kernicterus from unconjugated hyperbilirubinemia affecting the basal ganglia

motor abnormalities throughout the body

47
Q

spastic diplegia
assoc w what newborn issue,
what neural structures, what
symptoms

A

spastic diplegia is classically associated with premature birth and specific MRI findings of periventricular white matter abnormalities. Patients present with motor involvement that is more prominent in the legs than the arms

48
Q

spastic quadriplegia
symptoms’
neural abnormalities

A

spasticity, clonus, and exaggerated tendon jerks throughout their bodies

Imaging would show global brain abnormalities

49
Q

spastic hemiplegia

typical presentation

A

after a stroke damaging a unilateral upper motor neuron tract
spasticity of the contralateral arm and leg

50
Q

ataxic cerebral palsy

what neural abnormality

A

cerebellar abnormalities

51
Q

18 month old not walking. physical exam reveals spasticity, exaggerated deep tendon reflexes, and clonus in both of his lower extremities. An MRI of the brain is ordered, and the radiologist reports findings of periventricular leukomalacia. What is the most likely diagnosis?

A

spastic diplegia

52
Q

Neimann-Pick disease is a _________ disease that can present in children between the ages of _ months and _ years. It causes _____ delays as well as regression of _______. Other signs and symptoms include __________, __________, and __________

A

Neimann-Pick disease is a neurodegenerative disease that can present in children between the ages of 6 months and 2 years. It causes global delays as well as regression of milestones. Other signs and symptoms include hepatosplenomegaly, interstitial lung disease, and a macular cherry red spot

53
Q

Spastic diplegia is a form of __________, a non-progressive static __________ characterized by delays in __________. It may be associated with ________________ abnormalities that are thought to be due to _____. These changes can be visualized on ___. In spastic diplegia, the motor abnormalities are often greater in the ___ than in the ___

A

Spastic diplegia is a form of cerebral palsy, a non-progressive static encephalopathy characterized by delays in motor development. It may be associated with periventricular white matter abnormalities that are thought to be due to ischemia. These changes can be visualized on MRI. In spastic diplegia, the motor abnormalities are often greater in the legs than in the arms

54
Q

Athetoid cerebral palsy involves motor deficits of ________. It is often caused by perinatal _____ and _____, both of which damage the ________, ________, and/or ______

A

Athetoid cerebral palsy involves motor deficits of the entire body. It is often caused by perinatal asphyxia and kernicterus, both of which damage the basal ganglia, cerebellum, and/or thalamus

55
Q

A ___ age child should be able to scribble, use a cup, and/or stack 2 blocks. His word count should be three to six words at this stage of development

A

A 15-month-old child should be able to scribble, use a cup, and/or stack 2 blocks. His word count should be three to six words at this stage of development

56
Q

a premie born via emergency c-section now 18 mos old can pull to stand but not walking yet, increased tone and hyperreflexia of lower extremiteis on exam

most likely dx

A

cerebral palsy

Children with cerebral palsy often present with defects in motor development and are often found to have abnormal neuromuscular exams, including increased tone and reflexes. Other areas of development are less consistently impacted. The cerebral palsy most likely was the result of an hypoxic injury during the perinatal period

57
Q

3-year-old male presents to clinic with an annular, well-circumscribed, scaly plaque with a raised erythematous border and central hypopigmentation on the left thigh. The mother reports that the lesion is highly pruritic and that the patient has been exposed to other children with a similar rash at day care. Upon further examination, a similar lesion with boggy borders is also found on the posterior aspect of his scalp

treat

A

Although topical antifungal therapy (TOPICAL CLOTRIMITAZOLE) would be appropriate for the lesion on the leg (tinea corporis), involvement of the scalp (tinea capitis) necessitates systemic antifungals. Topical antifungals are not usually successful in treating tinea capitis, because the infected hair follicles are deep within the scalp. SYSTEMIC GRISEOFULVIN is the first choice for the treatment of tinea capitis.

SELENIUM SULFIDE SHAMPOO may decrease the likelihood of transmission of the infection to others by decreasing the number of spores shed, but does not treat the primary infection

58
Q

Cellulitis in children is usually caused by _____ or _____ . Treatment with a ___________ (such as _____ ) or a __________ with a __________ (such as __________) would be approppriate of there is no concern for ____. _____ or __________ would be appropriate treatment for cellulitis caused by ____.

A

Cellulitis in children is usually caused by S. pyogenes or S. aureus. Treatment with a first-generation cephalosporin (such as cefalexin) or a semi-sythenthetic penicillin with a beta-lactamase inhibitor (amoxicillin-clavulonate) would be approppriate of there is no concern for MRSA. Clindamycin or trimethoprin/sulfamethoxazole would be appropriate treatment for cellulitis caused by MRSA.

59
Q

Changing detergents would be an appropriate intervention for what skin pathology
where does it usually appear in children
is it more or less pruritic than atopic dermatitis

A

Changing detergents would be an appropriate for irritant dermatitis

diaper area, face, and extensor surfaces on children

typically less pruritic than atopic dermatitis

60
Q

Treatment with topical clotrimazole would be appropriate for ________

A

Treatment with topical clotrimazole would be appropriate for tinea corporis

61
Q

dry, itchy skin in addition to erythema, scaling, vesicles, or lichenification in skin flexures

dx
tx

A

Atopic dermatitis

Treatment consists of emollients and topical corticosteroids

62
Q

Treatment with permethrin cream would be appropriate for ____ infection

A

Treatment with permethrin cream would be appropriate for scabies infection

63
Q

when do scabiesoften itch more

A

at night

64
Q

where are the common lesion locations for scabies

A

wrists, ankles, palms, soles, interdigital spaces, axilla, waist, and groin are among the most common locations for lesions

65
Q

10-year-old boy, history of hypopigmented non-pruritic “dots,” mostly located on his face and neck. worse during the summer when plays outside. On exam, they are slightly scaly, hypopigmented lesions approximately 0.5 cm in diameter. What is the most likely etiology of his rash

A

pityriasis alba

Decreased number of active melanocytes and decreased number and size of melanosomes

66
Q

Pityriasis alba
age
appearance
etiology

A

common in children 3 to 16 years of age

presents as hypopigmented macules. most often on the face, neck, trunk, and extremities. irregular borders, can vary in size, and may have a slight scale. may become more noticeable after sun exposure because of tanning of the surrounding skin.

etiology is unknown, but ultrastructural examination of epidermal cells reveal decreased number of active melanocytes as well as decreased number and size of melanosomes

Peds (12 decks)

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