Conditions of Pediatrics Flashcards
What are the symptoms of acute lymphocytic leukemia (ALL)?
1) Abrupt onset systemic symptoms: pallor, fever, HA, vomiting, lethargy, irritability, weakness
2) LAO: non-tender, firm, rubbery
3) Moderate hepatomegaly and splenomegaly
4) Bone pain
5) Easy bruising
6) Bleeding: petechiae, mucosal bleeding, spontaneous bleeds
How is (ALL) diagnosed?
1) High WBC count with >20% lymphoblasts present
2) Thrombocytopenia
3) Anemia
What might be in the history of someone with AML?
History of radiation or chemotherapy
How is AML diagnosed?
Bone marrow biopsy
Where does the tumor of Ewing sarcoma usually develop?
Bones: especially the legs, pelvis, ribs, arms or spine or any soft tissue without bone involvement
Where do neuroblastomas typically develop?
Anywhere in the sympathetic nervous system. Most common in adrenal gland and abdomen
What kidney tumor affect children?
Wilm’s tumor. most common, childhood abdominal malignancy
What are the findings in Wilm’s tumor?
1) Painless palpable abdominal mass
2) Hematuria
3) Systemic symptoms: Fever, anorexia, N/V, HTN
How is Wilm’s tumor usually diagnosed?
1) Renal ultrasound followed by abdominal CT
2) Biopsy
What physical exam finding would indicate a retinoblastoma in a child < 2 years old?
Leukocoria “white pupil”, abnormal red reflex
What causes fifth disease or erythema infectious?
Parvovirus B-19
What is the incubation period for erythema infectiosum?
4-14 days
What is a classic finding in erythema infectiosum?
3 stage Rash:
1) Erythematous, maculopapular rash on the face that looks like a slapped cheek
2) Rash spreads distally and symmetrically to trunk and extremities, favors extensor surfaces
3) Resolving rash of variable duration, fades into a lacy pattern especially on proximal extremities
What are some of the other symptoms of erythema infectiosum?
Mild fever
Fatigue
Pharyngitis
Headache
N/V, abdominal pain
Arthralgias (rare)
What is the common presentation of roseola infantum?
Sudden high fever that last 3-5 days. May be accompanied by nasal discharged and loose stools. Followed by appearance of rash that spreads from the trunk to the extremities
What virus is implicated in roseola infantum?
Usually Human Herpesvirus 6 (HHV-6) or 7 (HHV-7)
What is the prodrome for rubella?
Low grade fever
Conjunctivitis, eye pain
Sore throat
Myalgia
What is the exanthem of rubella?
Rose-pink maculopapular rash starts on face, then spread centrifugally to trunk and extremities
How long does the rash last in rubella?
About 4 days
What is a concern with rubella in pregnant women?
It is teratogenic: sensorineural hearing loss, ocular abnormalities, congenital heart disease
What is the incubation period for rubeola/measles?
8-12 days
What is the prodrome rubeola?
High fever
Malaise
Conjunctivitis with photophophia
Cough
Coryza
White spots on buccal mucosa
What are the pathognomonic white granular papules on the buccal mucosa in a patient with Rubeola called?
Koplik’s spots
Describe the exanthem of rubeola.
Maculopapular rash that spreads from face and trunk to extremities fading on face first
What is the mnemonic for rubeola?
Four Cs
Cough
Coryza: common cold
Conjunctivitis
Cutaneous (Koplik) spots
What nutrient can be used to treat rubeola?
Vitamin A
What organism causes scarlet fever?
Group A beta-hemolytic strep pyogenes
Which clinical findings are strongly indicative of scarlet fever?
Strawberry tongue and sandpaper rash
What are some long term sequelae of untreated scarlet fever?
1) Rheumatic heart disease
2) Post-streptococcal glomerulonephritis
3) Pneumonia
4) Arthritis
What are the common pathogens causing encephalitis?
Enteroviruses
Herpes simplex virus
EBV
Arborviruses: La Crosse
What are the common signs and symptoms of encephalitis?
Fever
Seizures
Focal Neurologic Signs
Decreased consciousness
A child presents with ulcers on the tongue and oral mucosa with non-ulcerating lesions on the palms of his hands, soles and interdigital skin. What is your working diagnosis? What would be on the ddx?
Likely: Hand, foot, and mouth disease
DDX: Herpangina, Herpes simplex, syphilis, aphthous stomatitis, Stevens- Johnson syndrome
What causes hand, foot, and mouth disease?
Coxsackie virus
A child presents with small oral ulcers that have been forming over 2 days. They evolved from initial gray ppaulovesicles and are found on the anterior pillars, soft palate and possible the uvula. There is a fever, sore throat, headache, myalgia and anorexia. What is your workings diagnosis? What is on your ddx?
Working diagnosis: Herpangina- no ulcers on anterior mouth
DDX:
1) Herpes simplex stomatitis (ulcers in anterior mouth)
2) Hand- foot- mouth disease (ulcers on tongue)
3) Viral pharyngitis ( no ulcers)
4) Aphthous stomatitis
What is the hallmark of impetigo?
Honey- colored crust
What causes impetigo?
Staph aureus or Group A Beta- hemolytic strep
What are the symptoms of impetigo?
Pustules, vesicles, bullae exuding honey -golden fluid that crusts over, itches and ulcerates
What topical antimicrobial might you use for impetigo?
Mupirocin
What are the common pathogens causing meningitis?
Streptococcus Pneumoniae
Neisseria meningitidis
Haemophilus influenzae type B
What are the common signs and symptoms of meningitis?
Fever
N/V
Headache
Nuchal rigidity
Petechiae and purpura
A child is brought to your office with an enlargement of the parotid glands, fever, tender salivary glands and you notice her ears are displaced laterally and superior. What is your diagnosis?
Mumps
What is the incubation period for mumps?
14-21 days
At what ages is it common to have otitis media (OM)?
6-24 months of age
What are the various types of OM?
Acute otitis media
Acute otitis media with effusion
Otitis media without effusion
Chronic otitis media
What is the etiology of OM with effusion?
Incomplete resolution of acute OM
Eustachian tube dysfunction
Allergic rhinitis
Cleft palate
What type of OM do these symptoms describe: May have no ear pain and may be bilateral usually afebrile with conductive hearing loss and a fluid line in the TM; TM looks opaque, bulging with air bubbles and decrease mobility?
OM with effusion
What are the symptoms for acute OM?
Persistent earache, usually unilateral, fever, hearing loss, inflammation and bulging of the TM with obscured landmarks and diffuse cone of light. May perforate.
What herbs are indicated for otitis media?
Allium sativa (topically)
Verbascum thapsus (topically)
What antibiotic is often prescribed for otitis media?
Amoxicillin
What are the signs and symptoms of lice infection (pediculosis)?
1) Severe pruritus
2) Blue macules
3) Nits present and visible near root of the hair
4) Excoriation from scratching
How is pediculosis diagnosed?
Visualization of nits on hair on clothing. Woods lamp: yellow-green florescence
What disease are lice a vector for?
Typhus, trench fever and relapsing fever
A child present with fever, rhinitis, sneezing and a cough that started 2 weeks after URI symptoms. The cough is paroxysmal with bouts if 10-30 coughs with inspiratory whoops and occasional vomiting. The child appears exhausted. What is your working diagnosis? What is in the ddx?
Diagnosis: Whooping cough/ Pertussis
DDx:
Asthma
Croup
Bronchiolitis Viral URI
Pneumonia
TB
What are the common signs and symptoms of Group A strep pharyngitis?
Sore throat
Absence of cough or other signs of URI
Pharyngeal and/or tonsillar exudates
Middle grade fever
Palatal petechiae
Anterior cervical LAO
Which antibiotics are indicated for strep pharyngitis?
Penicillin
Amoxicillin
Macrolides or Clindamycin
What infection often precedes rheumatic fever?
Group A strep pharyngitis
What are the symptoms of rheumatic fever?
Polyarthritis
Fever
Carditis: Mitral insufficiency, cardiomegaly pericardial rub
New onset murmur
Chorea
Erythema marginatum
Subcutaneous nodules on extensor surfaces of large joints
What is a mnemonic for the major manifestations of rheumatic fever?
CHANCE
Chorea
Arthritis
Nodules
Carditis
Erythema marginatum
What is in the DDx for rheumatic fever?
Juvenile RA
Viral myocarditis
SLE
Bacterial endocarditis
Infectious arthritis
What is the incubation period for varicella?
10-21 days
What is the prodrome of varicella?
HA
Low grade fever and fatigue 1-2 days before rash appears
What happens with the exanthem of varicella?
Simultaneous presence of different stages of rash: Macular, papular, vesicle, pustule, crust
Severe pruritis
Rash appears in crops
How long do the lesions of varicella last?
Between 2-3 weeks
Who is most likely affected with bronchiolitis?
Children under 2 years old
What is the etiology of bronchiolitis?
Viral: RSV, parainfluenza, adenovirus
What are some of the common signs and symptoms of bronchiolitis?
1) Rhinorrhea and pharyngitis appear first
2) Followed by fever, dry cough, wheezing and tachypnea
3) Use of accessory muscles of respiration, nasal flaring, cyanosis
How is bronchiolitis diagnosed?
Clinical picture, pulse oximetry, CXR
What age group is most affect with croup?
< 3 years of age
What are the symptoms of laryngotracheobronchitis (viral croup)?
Children has a prodromal URI of gradual onset. They have a low grade fever and an hoarse, barking cough with inspiratory stridor
What are the symptoms of spasmodic croup?
Went to bed ok, woke at night with barking cough, inspiratory stridor and hoarseness. Not febrile
What is seen on x-ray with croup?
Steeple sign: subglottic narrowing
What is the DDx for croup?
Epiglottitis
Bacterial tracheitis
Diphtheria
Pertussis
Bronchiolitis
Asthma
Foreign body Aspiration
What is a genetic disease that involves the chloride channel?
Cystic Fibrosis
What are some of the findings for cystic fibrosis?
Recurrent respiratory infection with cough and difficulty breathing
Salty sweat
Pancreatic insufficiency: steatorrhea
Recurrent sinusitis
Failure to thrive
What is the main concern with croup-like symptoms?
Epiglottis
What are the symptoms of epiglottitis?
Rapid onset high fever (croup usually afebrile)
Respiratory stridor dyspnea
Dysphagia and drooling
Very ill appearance
Sits forward trying to breath: tripod position
What do you not do with epiglottitis?
Have the patient open their mouth
What is seen on x-ray with epoglottitis?
The thumbprint sign
What population is infant respiratory distress symptom most commonly seen in?
Preterm infants
What is the major deficiency in infant respiratory distress syndrome?
Surfactant
What are some early signs and symptoms of cerebral palsy?
1) Poor feeding and irritability in the neonatal period
2) Delay in disappearance of developmental reflexes
3) Poor head control
4) Delay in motor milestones
What is the major consequence of congenital hypothyroidism?
Physical and mental disability
A newborn has constipation with mild diarrhea, followed bu abdominal distention, vomiting, anorexia and failure to thrive. What should be your working diagnosis? What’s in the DDX?
Working Diagnosis: Hirschsprung’s disease (congenital megacolon; nerves missing from large intestine)
DDX:
Colonic atresia: Large bowl obstruction
Meconium ileus
Hypothyroidism
Functional constipation
What is the definition of colic?
1) Infant crying greater than or equal to 3 hours per day
2) Occurs on greater than or equal to 3 days per week
3) Infant less than 3 months of age
4) Infant is otherwise healthy and well fed
What is the most common cause of encopresis?
Constipation
What should be ruled out in a child with suspected functional constipation?
Hirschsprung disease
Diary intolerance
Anorectal abnormalities
Celiac disease
Hypothyroidism
What is one of the main causes of functional diarrhea in children?
Excessive intake of fruit juices or soft drinks
What are the common signs and symptoms for intussusception?
1) Severe abdominal colic
2) Vomiting
3) RUQ mass
4) Current Jelly stools
5) Infant draws up leg
How is intussusception diagnosed?
Ultrasound, constrast enema
A new born is brought into your office with projectile vomiting. She is 14 days old and has constipation, is ravenously hungry, displays failure to thrive, dehydration, and weight loss. What is your working diagnosis? What’s on the DDX?
Working Diagnosis: Pyloric stenosis
DDx:
GERD
Hirschsprung’s
Gastroenteritis
Intussusception
Esophageal or duodenal atresia
What is seen on abdominal ultrasound with pyloric stenosis?
Hypertrophies pylorus: donut sign, muscle will thickness > 4mm
What are the common signs and symptoms of femoral anteversion?
1) When standing, patella face medially
2) When walking, toes and patella face anteriorly
3) Windmill pattern when running
What would you find on physical exam of child with congenital hip dislocation?
Ortolani’s click, Barlow maneuver, Galeazzi sign: one leg shorter than the other and/or asymmetric thigh, gluteal or labial creases
What is different in a patient with internal tibial torsion?
When walking, toe points inward and patella faces anteriorly
A child has swelling, pain and tenderness involving more than 1 joint leading to impaired growth and development. She has limited movement in the affected parts with ankylosis and flexion contractures. What us your preliminary diagnosis?
Juvenile idiopathic (rheumatic) arthritis
What are the different types of juvenile idiopathic (rheumatoid) arthritis?
Systemic: Symmetric arthritis, cyclic fever, rash
Oligoarticular: < 5 asymmetric large joints, involved, fever is rare
Polyarticular: >5 Symmetric arthritis for large and small joints
How is juvenile rheumatoid arthritis diagnosed?
No confirmatory lab test
CBC: Leukocytosis, thrombocytosis, anemia
Elevated ESR and CPR
ANA may be positive, RF usually not found
What is unilateral aseptic necrosis of femoral capital epiphysis?
Legg- Calve’ Perthes Disease, femur head looses blood supply
What are the findings for Legg-Calve’ Perthes disease?
Painless limp
Abnormal gait
Gradual Onset
Reduced ROM in hip
Atrophy in thigh, buttocks, calves
How is Legg- Calve’ Perthes disease diagnosed?
Plain film of hips
What is in the DDx for Legg- Calve’-Perthes disease?
Congenital hip dislocation
Osgood- schlatter disease
Slipped capital femoral epiphysis
Septic arthritis
Osteopmyeliti s
What age group is most affected by Osgood- Schlatter disease?
Boys; between 12 and 15
Overuse condition or injury of the knee; that causes a painful bump or swelling on the shinbone below the knee
What are the findings for Osgood-Schlatter disease?
Pain and inflammation over tibial tubercle, no systemic signs usually due to trauma
How is Osgood-Schlatter disease diagnosed?
Knee radiography
What is osteogenesis imperfecta?
Genetic disorder which there is mutation in gene coding of type 1 collagen resulting in brittle bones and increased fractures
What vitamin deficiency causes rickets?
Vitamin D
Where is the deformity found in a patient with Scheuermann disease?
Juvenile Kyphosis; hyper-kyphosis
Deformity in the thoracic or thoracolumbar spine; resulting in increased kyphosis
A child is brought to the office with an inability to move his affected arm. While shopping, his parent suddenly pulled up on the child’s arm. There was exquisite pain initially and now it is painless. What is the diagnosis?
Nursemaid’s Elbow
What is going on anatomically in nursemaid’s elbow?
Subluxation of the radial head
Name some of the diagnostic criteria for autism?
1) Impaired nonverbal communication behaviors
2) Failure to develop age normal per relations
3) Lack of spontaneous seeking for social interactions
4) Lack of social/emotional reciprocity
5) Delay or lack of development of spoken language
6) Impaired initiation and sustaining of conversations
7) Stereotyped, repetitive or idiosyncratic language
8) Lack of age-normal make- believe play
9) Preoccupation with one or more patters of behavior
10) Inflexible adherence to specific nonfunctional rituals or routines
11) Onset <3 years old
What would be in the DDx for autism?
1) Hearing impairment
2) Developmental Disorder
3) Fragile X-Syndrome
4) Down’s Syndrome
5) Schizophrenia
6) Fetal alcohol syndrome or other substance exposed in utero ie: crack cocaine
7) Hypothyroidism
What is an undescended testicle called?
Cryptorchidism
What are the clinical findings of cryptorchidism?
Palpable testicle in the inquinal canal
Lack of testicle int he scrotum
Poorly develops scrotum
A child has a urethra that opens on the underside of the penis. What is this called?
Hypospadia
What epispadias?
Urethral canal that is not dorsally fused
What is contraindicated in an infant who has hypo or episdadias?
Circumcision
Where is the best place to auscultate artrial septal defect?
2nd and 3rd left intercostal space
How is atrial septal defect usually diagnosed?
Doppler echocardiogram
What are the clinical findings of atrial septal defect?
1) Murmur with right ventricular heave and wide S2 split
2) Asymptomatic in most cases
3) Increases the incidence of URIs in some
4) Slight exercise intolerance
Which sex is most affected by coarctation of the aorta?
Males 2:1
Narrowing of the aorta almost always at the level of ductus arterious and left subclavian artery
Commonly associated with bicuspid aortic valve (50%); Turner Syndrome (35%)
What are the clinical findings of coarctation of the aorta?
Asymptomatic, if mild
Reduced femoral pulses
Blood pressure difference in upper and lower extremities
CHF
HTN
Wha do you hear upon auscultation of coarctation of the aorta?
Midsystolic murmur, head anteriorly and posteriorly
What is the best way to diagnose coarctation of the aorta?
Chest x-ray (cardiomegaly) or echocardiography
A child is brought to the office with bounding peripheral pulses and a widened pulse pressure. On auscultation of the heart you hear a continuous murmur in the 2nd and 3rd left intercostal space. It sounds like machinery. The chid is asymptomatic except occasional fatigue. What is the diagnosis?
Patent Ductus arteriosus
What’s in the DDx for coarctation of the aorta?
1) Aortic stenosis
2) Cardiomyopathy
3) Patent ductus arterious
4) Congenital adrenal hyperplasia
How is patent ductus arteriosus diagnosed?
Echocardiography
What are the 4 lesion of the Tetrology of Fallot?
Ventricular septal defect
Right ventricular outflow obstruction: pulmonic stenosis
Overriding Aorta
Right Ventricular Hypertrophy
What are the findings for the Tetrology of Fallot?
1) Cyanosis
2) Exertional Dyspnea
3) Failure to Thrive
4) Digital Clubbing
5) Systolic ejection murmur
6) Tendency to squat
7) Thrill along left upper sternal border
How is the Tetrology of Fallot Diagnosed?
Chest x-rau or echocardiography
What is the most common congenital heart defect?
Ventricular septal defect
What are some of the medical causes of failure to thrive?
1) Chronic diarrhea
2) Renal Failure
3) Congenital Heart Disease
4) Tuberculosis
5) Hyperthyroidism
6) Inborn error of metabolism
7) Congenital malformation
8) Malnutrition
What are some of the nutritional causes of failure to thrive?
Incorrect breast feeding technique
Insufficient calorie intake
GI disease: IBD, celiac sprue
Which sex is most affected by ADHD?
Boys are 3-5 times more likely to get a diagnosis
When does ADHD or ADD have to begin in order to be diagnosed as such?
Onset of problem before age 7
In order to make a diagnosis of ADD/ADHD there has to be impairment from symptoms in how many realms of their life?
In at least 2 realms
How long do the symptoms have to last? (ADHD)
Six or more months
What are the three subtypes of Attention Deficit/Hyperactivity Disorder (ADHD)?
Predominately Hyperactive- Impulsive
Predominately Inattentive
Combined
Is ADHD limited to children?
No
What needs to be ruled out in order to diagnose ADHD ?
Normal developmentally appropriate behavior, oppositional defiant disorder, conduct disorder, food allergy, abuse, hearing disorder, substance abuse, sleep disorder, malnutrition, mild autism
What is the diagnosis for repetitive and persistent pattern of behavior in which the basic rights of others are violated?
Conduct Disorders
Name some of the criteria for the diagnosis of conduct disorder
Aggression to people and animals. Destruction of property. Deceitfulness or theft. Serious violation of rules
What is the name for a pattern of negativity, hostile and defiant behavior, lasting at least six months?
Oppositional Defiant Disorder
What needs to be ruled out, in order to diagnose oppositional defiant disorder?
Psychotic or mood disorder. Criteria are not met for conduct disorder or antisocial personality disorder
What are the defining features or pervasive developmental disorder?
Significant challenges in social and language development, sometimes called subthreshold autism
What is reactive attachment disorder thought to result from?
Failure to form normal attachments to primary caregivers in early childhood
According to the Merck Manual, child abuse is generally caused by the breakdown of what?
Impulse control in the caregiver
What are the four basic categories of child abuse?
Neglect
Physical Abuse
Sexual Abuse
Emotional Abuse
Name some of the signs of child abuse
Parental reluctance to give history of an injury
Inconsistent History
History of injury that is incompatible with developmental capability of the child
Delay in reporting injury
History of multiple injuries
In terms of examining a patient, what should you do in the case of acute sexual abuse?
Refer to a specially trained team at the emergency room for an exam
What are the signs and symptoms of dacrocystitis?
- Inflammation of lacrimal duct
1) Sudden onset of pain, erythema and edema in lacrimal sac region
2) Purulent discharge
3) Conjunctival injection and preseptal cellulitis; may be present also
4) Serious sequelae includes orbital cellulitis and blindness
What are some of the symptom of Fanconi syndrome?
- Disease of the proximal renal tubules; glucose, amino acids, uric acid, phosphate and bicarbonate are passed in the urine; instead of reabsorbed
1) Polyuria, polydipsia, and dehydration
2) Rickets in children or osteomalacia in adults
3) Growth Failure
4) Hypokalemia, hypophosphatemia and acidosis
How does type 1 diabetes mellitus present in children?
Polyuria and polydipsia
Unexplained weight loss
Fatigue and malaise
Ketoacidosis: abdominal pain, vomiting, drowsiness
Which heavy metal poisoning are children highly susceptible to?
Lead poisoning
What are some of the symptoms of acute lead poisoning?
1) GI: forceful vomiting, abdominal pain, constipation
2) CNS: Ataxia, altered consciousness, seizures, coma, HA
3) Reduced playfulness and increased irritability
What are some of the common signs and symptoms of chronic lead poisoning?
Abdominal pain
Anemia
elevated Liver enzymes
Learning disabilities and poor intellectual development
HTN
Grey lines on the gums
How is lead poisoning diagnosed?
aka Plumbism
1) Anemia: Hypochromic, microcytic
2) Whole Blood levels of lead > 10 mcg/dL
What lab test is elevated in lead poisoning?
Elevated free erythrocyte protoporphyrin levels
- Lead lines of gingivae and epiphyses of long bones on x-ray
What are some of the common causes of sudden unexpected infant deaths (SUID)?
Fatal child abuse
Inborn errors of metabolism
Suffocation, asphyxia and/or entrapment in bedding
If no cause is found, sudden infant death syndrome can be diagnosed
What are some of the characteristic autopsy findings in sudden infant death syndrome (SIDS)?
1) Previously healthy appearing infant with frothy, blood-tinged fluid at the nares
2) Intra-thoracic petechiae
3) Pulmonary congestion and edema
4) Upper respiratory tract inflammation
