CLIPP Cases Flashcards
Additional questions to ask a woman with abdominal pain
Menstrual history (date of first period, last period, frequency, duration, regularity, amount of bleeding)
Change in menstrual flow or degree of pain
Pain with intercourse (dyspareunia)
Contraception and sex history
Vaginal discharge
HEADSS (Interview Strategy)
Home, Education, Eating Disorder, Activities, Drugs, Sex, Suicide and Safety
Chadwich’s sign
bluish discoloration of the vaginal walls which may indicate pregnancy
Why are STDs more common in young women?
At this age, there are fewer protective antibodies in the vagina (compared to those in older women).
Another reason is the cervical ectropion which represents the transitional zone between the columnar and the squamous epithelium is not fully matured; cells in this zone are particularly susceptible to STDs, and the cervix is therefore easier to infect.
Why are newborns more affected by unconjugated bilirubin?
they lack GI flora to metabolize bile and that allows the glucuronidase present in meconium to hydrolyze the conjugated bilirubin back to unconjugated. This bilirubin is then absorbed back into the blood stream where it binds to albumin
What are the initial and later signs of bilirubin encephalopathy
Initial: high pitched cry, poor suck reflex, hypotonia, lethargy, seizures
Later: extensor hypertonia, opisthotonus (abnormal posturing that involves rigidity with arched back and head thrown back)
What is Kernicterus?
the pathological term used to describe staining of the basal ganglia and cranial nerve nuclei by bilirubin, usually unconjugated. Results in abnormalities in tone and reflexes, choreoathetosis, tremors, oculomotor paralysis and sensineural hearing loss
What is Physiologic Jaundice of a Newborn?
Total bilirubin level < 15mg/dl, generally noticed on the 3rd day of life. Can be caused by: increased bilirubin production (from red cell hemolysis), relative deficiency of hepatocyte proteins and UDPGT, lack of intestinal flora to metabolize bile, high levels of B-glucuronidase in meconium and minimal oral intake
What is a cephalohematoma?
subperiosteal hemorrhage that is localized to the cranial bone that was traumatized during delivery. Swelling does NOT extend across a suture line
what is a caput succedaneum ?
edematous swelling over the presenting portion of the scalp of an infant and is commonly seen in babies born vaginally in vertex position.
What is ABO mismatch, ABO incompatibility, and ABO set-up?
An ABO mismatch between the mother and the infant is present in 20% of pregnancies.
ABO incompatibility occurs when the mother has blood group O, the baby has blood group A or B, and the direct Coombs test is positive.
If the direct Coombs test is negative, the condition is often referred to as an “ABO set-up” and although not impossible it is an uncommon cause of hemolysis and jaundice.
Maternal tobacco use can cause what defect in neonates?
low birthweight
What is maternal heroin use associated with?
increased risk of fetal growth restriction, placental abruption, fetal death, preterm labor and intrauterine passage of meconium
What complications can result from maternal cocaine/stimulant use?
they can cause vasoconstriction which can lead to placental insufficiency and low birth weight
How do you diagnose rubella, toxo and CMV in a neonate?
rubella and toxo–> IgM or increasing IgG
CMV–> urine or PCR
What are the components of the APGAR score?
Appearance (color) Pulse Grimace (reflex irritability) Activity (muscle tone) Respirations
What APGAR score will justify continued resuscitation with reassessment every 5 minutes?
7
What is asymmetric IUGR and what causes it?
It is a greater decrease in the size of the length and/or weight without affecting head circumference (head sparing). It can be caused by poor delivery of nutrition to the fetus (smoking)
How many calories a day should a term infant eat?
100-120, more if they are premature
when do babies starting eating solid food and sleeping through the night
Start eating rice cereal on a spoon around 4 mo and start sleeping all night between 4-6 mo
Absence of red reflex may indicate what problems?
Cataracts
Glaucoma
Retinoblastoma
Chorioretinitis
Use of ______ may cause a lower antibody response for some immunizations. It should be administered only if absolutely necessary.
acetaminophen
Tell me some stuff about neuroblastoma
The most frequently diagnosed neoplasm in infants; more than half of patients present before age 2.
The tumor may present as a painless mass in the neck, chest, or abdomen.
Children with an abdominal neuroblastoma may be asymptomatic; however, they may also appear chronically ill and may have bone pain from metastases to the bone marrow or skeleton.
Fever, pallor, and weight loss are frequent presenting symptoms.
Neuroblastoma is a likely diagnosis in an infant younger than a year of age who has an asymptomatic RUQ abdominal mass and pallor and no jaundice.
What are the imaging and lab results for neuroblastoma?
Metastases are primarily to regional lymph nodes and to the liver, bone marrow, and skeleton.
Chest radiograph will reveal any lymph node involvement in the chest or additional tumors that may present in the posterior mediastinum.
Histopathology reveals “small round blue cells” or small, uniform cells containing dense, hyperchromatic nuclei and scant cytoplasm, forming small cell rosettes.
Urinary HVA/VMA will be elevated in 90-95% of cases.
A CBC may reveal anemia or other cytopenias that are secondary to bone marrow infiltration.
Beckwith-Wiedemann syndrome
genetic overgrowth syndrome. It associated with Wilm’s tumors, macrocephaly, macroglossia, LGA and hypospadias
What causes Transient tachypnea of the newborn (TTN)?
Result of delayed clearance of fluid from the lungs following birth
Much more common in infants born to diabetic mothers and in infants born by c-section
What’s your DD for neonatal tachypnea?
RDS, Transient tachypnea of the newborn, Pneumothorax, meconium aspiration, hypoglycemia, hypothermia, cardiac abnormalities, neonatal sepsis, congenital diaphragmatic hernia
what are some potential clinical problems for an infant that is SGA?
Temperature instability (hypothermia)
Inadequate glycogen stores (hypoglycemia)
Polycythemia and hyperviscosity
What test definitively diagnose down syndrome?
amniocentesis and CVS
What do infant seizures look like?
subtle and may manifest as jerking or horizontal deviation of the eyes; blinking or fluttering of the eyelids; drooling, sucking, or lip smacking; tonic posturing of a limb; or apnea.
What are the associated conditions with large and small fontanel size?
Large: skeletal disorders, chromosomal abnormalities, hypothyroidism, malnutrition, and increased ICP
Small: microcephaly, craniosynostosis, hyperthyroidism, or could be normal
What enzyme is elevated in 21-OH deficiency?
17-OH progesterone
What are some signs of infant botulism?
sually presents in the first year of life with hypotonia, lethargy, constipation, weak cry and can eventually lead to respiratory failure. These infants will have absent DTRs.
Kernig’s sign
Resistance to extension of the knee
Brudzinski sign
Flexion of the hip and knee in response to flexion of the neck by examiner.
What is a rare bit concerning side effect of TMP sulfa?
SJS
What is the treatment for eczema?
Topical steroids (OTC not enough) Calcineurin inhibitors antihistamines
Which murmurs are holosystolic?
VSDs, mitral insufficiency, and tricuspid insufficiency
What are the signs of CHF in a young infant?
dyspnea with feeding, diaphoresis, poor growth, an active precordium and hepatomegaly
What murmurs are detected later in childhood (3-4yo)?
ASD and bicuspid aortic valve (systolic click)
What should you look for in an ear exam?
Color, mobility, position (normal, retracted, bulging) and translucency (opaque or translucent)
What 2 types of bacteria most commonly cause ear infections?
strep pneumo and H flu
What is the most common seizure in children?
generalized tonic-clonic
Tell me some stuff about roseola.
Presents as a high fever (38.5 to 40.5 C) for 3-5 days in a typically fairly well-appearing child, followed by abrupt resolution of fever and development of a maculopapular rash
During the period of fever, some children have rhinorrhea.
A bulging fontanelle is an unusual physical finding in roseola and may lead to evaluation for meningitis
Precordial catch syndrome
most common cause of chest pain in adolescents and is of unknown etiology. It is a benign condition characterized by sudden, sporadic onset of sharp pain, usually along the left sternal border, which is often exacerbated with deep inspiration. These pains are brief, lasting seconds to a few minutes, and resolve spontaneously. The pain can often be “broken” with a forced deep inspiration. It is often not associated with exercise.
placement of a UVC and UAC may lead to what later in life?
renal artery disease
What is the first sign of microalbuminuria?
periorbital edema
What are the 4 hallmarks of nephrotic syndrome?
edema, proteinuria, hypoalbuminemia, and hyperlipidemia
A diagnosis of PSGN can be supported with which labs?
ASO titer, Positive streptozyme test, elevated anti-DNAase B antibodies and low C3
Why do you see hyperlipidemias in nephrotic syndromes?
In reaction to the decreased albumin, the liver is stimulated to make lipoproteins as well as albumin, which leads to hyperlipidemia and hypercholesterolemia.
people with nephrotic syndrome are at risk for what 2 other complications?
Infection and venous thrombosis
What are the signs of TCA toxicity?
Altered mental status Anticholinergic signs and symptoms Hypotension (a hallmark of TCA toxicity) Dysrhythmias, and Seizures
What is the treatment for TCA toxicity?
sodium bicarb, lidocaine, and maybe volume expansion (for hypotension)
Erythema multiforme
An acute hypersensitivity syndrome
Associated with a symmetrical rash that starts as a dusky red macules and evolves into sharply demarcated wheals and then into target-like lesions.
Individual lesions stay fixed for one to three weeks.
Condition does not come and go.
Most commonly caused by herpes simplex infections, but may be associated with medications.
What are two systemic illnesses commonly have diaper rash as one of the features?
zinc deficiency and Langerhans cell histiocytosis
What are some of the lab results you will see with Kawasaki’s?
WBC: The white blood count is usually elevated, with a predominance of neutrophils.
Hgb/Hct: A normochromic, normocytic anemia is common.
Platelets: Thrombocytosis is a common feature of Kawasaki disease - usually starting in the second week of the illness.
elevated liver enzymes
elevated ESR or CRP
