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