CMS peds 8 forma points Flashcards
Had OM. now tympanic membranes are pealy gray and retracted. decr. mobility bilateral = no middle ear inflammatory findings. Dx?
otitis media with effusion
had OM. now tympanic membranes are pealy gray and retracted. decr. mobility bilater. Mx?
otitis media with effusion = no mx inficated.
Apgar score.
0 - absent function
1 - diminished/irregular function
2 normal function
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Bicuspid aortic valve => risk for what????
Bacterial endocarditis (shear forcer => damage => nidus for infection)
Bicuspid aortic valves prone to what?
early aortic stenosis or regurgitation.
Bicuspid aortic valves in peds and syncope? sita zymejau
Syncope may result from one of the condition related to bicuspids, eg advanced HF, BUT NOT DIRECTLY ASSOC. with syncope risk.
Bicuspid aortic valves = abnormal structure => risk for infection. same as with joints and septic arthritis.
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Cyclic neutropenia = rare disease. CP?
Inherited immunodeficiency. Occurs as neutropenia + infection.
pattern: reoccurs every 21 days and lasts for 3-6 d.
Cyclic neutropenia = Dx?
monitoring neutrophil count several times weekly for at least 6 weeks.
Cyclic neutropenia = Tx?
granulocyte-colony stimulating factor
Severe congenital neutropenia CP?
more severe and occurs in the first few months of life.
Same as cyclic: neutropenia, infections.
in cyclic case girl was 2 y.o.
Nr.6 rocky mountain - spausdinti ir skaityti, tupos infekcines ligos
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Global developmental delay defined criteria?
significant delay in 2 or more domains of development.
total are: gross motor, fine motor, cognitive, social, language milestones
Rubella triad?
cataracts, sensorineural deafness, congenital heart disease (PDA)
Parvovirus 19 = hydrops fetalis, High output cardiac failure.
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Listeria?
chorioamnionitis => stilbirth.
Newborns: sepsis, pneumonia, meningitis.
Other: GRANULOMATOSIS INFANTISEPTICA (diffuse, pale, granulomatous cutaneous nodule)
Toxoplasma triad?
chorioretinitis, hydrocephalus, intracranial calcification (ring-enhancing).
CMV?
intrauterine growth restriction, microcephaly, INTRACRANIAL CALCIFICATIONS, hearing loss, seizures, hepatosplenomegaly, jaundice, decr. PLT, petechiae.
intrauterine growth restriction, microcephaly, INTRACRANIAL CALCIFICATIONS, hearing loss, seizures, hepatosplenomegaly, jaundice, decr. PLT, petechiae.????
CMV
chorioretinitis, hydrocephalus, intracranial calcification (ring-enhancing).
toxoplasma
cataracts, sensorineural deafness, congenital heart disease (PDA)???
rubella
tetralogy. murmur = holosystolic best heard on left sternum. Mechanism?
RVOT, not due to VSD.
Nr. 11 Osteomyelitis S. aureus vs Pseudomonas.
S aureus – hematologis (sepsis) or inoculation (iv drugs). Pseudomonas – hematologic spread of existent skin/soft tissue infection or trauma. In case: nail punctured lef through shoe, got tetanus vaccine. Idea is that it was dirty trauma/PUNCTURE WOUND.
PUNCTURE WOUND or DM = Pseudomonas.
Osteomyelitis Dx?
Xray or MRI
Osteomyelitis Tx?
Gold standard: debridement, operative cultures to identify mo, abs
Lupus nephritis vs GN.
Atsakiau teisingai, bet galvojau kad buvo GN (ats buvo decr. serum C3). SLE CP – dark urine, facial rash, diffuse joint pain, decr. early complements C1, C2, C3, CH50, incr. Cr.
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HSV encephalitis = blood in cerebral fluid
Lumbar puncture should be performed in all patients.
Definitive Dx = polymerase chain reaction of cerebral fluid
kawasaki. Cp?
Fever 5 days + bilateral nonexudative conjuctivitis, polymorphous rash, lymphadenopathy, erythema and edema of hands and feet, erythema affecting the mucous membranes with dry, cracked lips.
kawasaki. complications?
Coronary artery aneurysm -> aneurysmal expansion, rupture, MI, congestive HF.
kawasaki. when suspected, what to do????
Immediate evaluation with ECG and cardioecho.
kawasaki. tx?
Aspirin IVIG
This disease is the only when aspirin is allowed to use. It can cause Reye syndrome
Influenza induced myositis. triggered by influenza A or B.
What labs?
Incr. CK, myoglobinuria
Influenza induced myositis. testing?
Testing for influenza virus
Give hemophilus vaccine in normal Ig class levels and low CD4 T cells.
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Vaginal candidasis CP?
pruritus, erythema, white discharge
Vaginal candidasis Tx?
TOPICAL NYSTATIN
Viral rhinosinusitis - less severe than bacterial.
Fever 24-48h.
Bacterial if symptoms > 10 days.
Viral rhinosinusitis Tx?
anagetics, antipyretics, saline nasal spray, oral or intranasal decongestants
NF1 - incr risk for what?2
optic nerve glioma and pheochromocytoma
Topical Mupirocin Tx?
Superficial antibacterial infections, eg S. aureus. No antifungal properties
Topical nystatin Tx?
Mucocutaneous Candida infections
Clotrimazole Tx?
superficial dermatophyte infections, eg tinea corporis.
Congenital hypothyroidism CP?
Lethargy, hypothermia, feeding problems, hoarse cry, myxedematous facies, macroglosia, hypotonia, umbilical hernia, prolonged jaundice caused by impaired feeding and decr. bilirubin conjugation, and dry skin.
Congenital hypothyroidism = can lead to intelectual disability.
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Undercooked poultry?
Campylobacter jejuni
Campylobacter jejuni when subsides? Tx?
1-3 days.
Tx supportive.
Dx = confirm with stool cultures.
HUS mo?
E coli O 157:H7
unpasterized milk, deli meats?
Listeria monocytogenes
Listeria monocytogenes Cp, Tx?
incubation 24h. Fever, watery diarrhea, nausea, vomiting.
Self limited, supportive.
Resolve after 2 days.
Shigella sonnei CP?
Initially watery diarrhea ==> then bloody.
Fever, abdominal distension, cramping.
Dx made with cultures.
Undercooked poultry, eggs, meats; assoc with pets - turtles, reptiles, chickens. Mo?
Salmonela enteritidis
Salmonela enteritidis CP?
Bloody diarrhea, vomiting, nausea, fever.
Fever resolve after 2-3 d.
Diarrhea - after 1 week.
Supportive care
dont give abs
Nr. 29 Gonococal vs chlamydial conjuctivitis. Gonococal = purulent discharge, eyellid swelling, lymphadenopathy. Chalmydial occurs 5-14 post delivery, Cp initially watery dischage that become purulent, conjuctive may be fragile and become bloody.
Gono prevention – erythromycin drops. If diagnosed conjcutivitis = hospitalization, cultures, cextriaxon.
Clamydial Tx = only when confirmed Dx with nucleic acid amplification. Tx = azythromcin.
Allergic conjuctivitis Tx = topical eye drops with an antihistamine or alpha 1 agonist.
Diarrhea acid-base?
Loss on bicarbonates.
Non anion gap hyperchloremic metabolic acidosis
Vit K dificiency Tx?
Vitamin K therapy, FFP - contains all coagulation factors as well as fibrinogen, protein C and S.
Cryoprecipitate contains what?
Factor VIII, XIII, vWF, fibrinogen.
Does not contain coagulation factors that are affected by vit K.
Cryoprecipitate used in what pathology?
DIC
Pyloric stenosis acid-base?
hypochloremic, hypokalemic metabolic alkalosis (loss of gastric hydrochloric acid and potassium)
Pyloric stenosis Dx?
UG
gastroesophageal junction what pathology?
Achalasia
Vascular ring = what GI pathology?
midesophagus obstruction.
vascular ring encircles trachea and midesophagus. Can occur dysphagia, comiting, feeding problems.
Diaper candida (demarcated borders, pustules, satelite papules). Tx?
Topical nystatin
Mother with HIV (CD4 4/mm), newborn (normal CD4). What need to discuss?
Care of the child in case of the mother’s death.
Nr. 35. Erythema toxicum neonatorum – skin erruptions of newborns that begin few days following delivery and lasts for several hours/days. CP = small, yellow papules in healthy kid.
Measured BP in teenager with oscillometric device. BP 138, 140. Next step Dx?
Blood pressure measure by auscultation.
oscillometric devices frequently overestimate!!!
Syphilis chancre painless
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12yo boy + proteinuria. First step?
Repeat urinalysis at bedtime and on awakening (cia toks ats buvo).
Bet texte same - yra proteinuria => kartoti tyrima.
Most common proteinuria in adolescent boy?
Orthostatic proteinuria
Nr. 46 12yo boy + proteinuria. First step = repeat urinalysis at bedtime (butu proteinuria) and on awakening (normal, no proteins). If persistent = further workup. Causes: transient proteinuria secondary to fever, stress, exercise, hydration. In male teens = orthostatic proteinuria.
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Dysplasia of acetabulum. CP in infants?
limb-length discrepancy and inability to abduct the limb.
Dysplasia of acetabulum. manouvers?
Barlow and Ortolani.
Additional testing = UG
Dysplasia of acetabulum. Tx?
Abduction splint (most commonly Pavlik harness).
If untreated = functional disability, pain, early osteoarthritis.
Urinary symptoms (eg dysuria) = test for STI and UTI
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Nr. 50 GERL In infant = extremely common. Good looking kid (good weight, feeding well, not irritable) = conservative Mx. If poor weight, reflux = evaluation of calorie count, UG for pyloric stenosis. In case was healthy kid + frequently spits up after eating.
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