Deck 1 Flashcards
what are some consequenses of gestational diabetes on the newborn
macrosomia (–> shoulder/hip dislocation), hypoglycemia from overactive beta cells during pregnancy, heart defects, polycythemia, organomegaly, hypertrophic cardiomyopathy
what is myositis ossificans
this is when there is trauma to a muscle and it filled with new lamellar bone instead of repaird (heterotropic ossification)
myositis ossificans presentation
pain on movement, no pain at night, following an injury, swelling/induration
adolescent privacy allowances
adolescents have a right to protect certain aspects of their care such as sexual, drug use, and mental health topics so records should be transferred very carefully
how does labial adhesion present
itching and normal development
treatment of labial adhesions
estrogen cream due to low estrogen in a child
what is spondylosis
this is just a general term for degenerative disc changes that cause pain in the spine due to nerve compression
how does spondylosis present in a child
typically they will be in sports and forward extension of the spine makes the pain worse
should you do a CT scan in a child
NO!!
what should you do if you suspect GBS in a child
spirometry then intubate based on function
fetal alcohol presentation
thin vermillion border, small palpebral fissures, smooth philtrum
eosinophilic esophagitis presentation in a toddler
food aversions especially solid foods! eczema, weight loss
how do you dx EoE in a child
endoscopy and biopsy
signs of opiod overdose in a child
sleepy, low bp, low HR, prolonged QT, acute change in mental status
history findings of an opiod OD in a child
child with grandparents, recent surgery etc.
signs of alcohol ingestion in a child
drowsiness, bradycardia, hypotension (no miosis)
signs of clonidine injestion by a child
obtundation, miosis, bradycardia, NO QT prolongation
immediate eval of a possible ingestion of a toxic drug
spot glucose to make sure the obtundation is not due to hypo/hyperglycemia
what is a pulmonary finding (as in function test) of opioid toxicity
decreased tidal volume, residual volume does not change
what is a morbilliform rash
this is a macular rash that has big macules that merge into each other to form one big macule, typically from a drug reaction
signs of acute mono infection
fatigue, cervical lymphadenopathy, tonsillar exudates, fever, splenomegaly
dx of mono
monospot- tests for heterophile Ab
CBC results from a pt. with acute mono
abnormal lymphocytes (downy cells which are T cells!) and lymphocytosis
describe what type of virus EBV is
EBV is a DNA virus, it is a herpesvirus
treatment of mono
rest and rehydration. No trtment. Pts with splenomegaly should avoid contact sports for 3 months
what is a complication of mono
tonsillar hypertrophy trt with steroids
differ between EBV (mono) and ALL CBC findings
all same symptoms except mono will have only 1 cell line of atypical cells, whereas ALL will have many atypical cells in the smear
how do you verify a mono dx in a young child
antibody tests because the monospot is not as reliable in a child
when do babies start to coo or smile back
about 6-8 weeks old
neonate HR range
100-205
infant HR range
100-180
toddler HR range
98-140
preschooler HR range
80-120
school aged child (6-11) HR range
75-118
adolescent-adult HR range
60-100
what are the most common bugs that cause otitis media
strep pneumo, H flu, moraxella
what typically precedes otitis media
a viral URI
treatment of OM
amoxicillin unless they have been prescribed it in the past 30 days then they can use a betalactam
what does the TM look like in OM
bulging and erythematous
what is a complication of OM
mastoiditis
what do you see in the urine of PSGN
RBC casts, proteinuria (+2),
how long after GAS infection does PSGN show up
~2 weeks later
presentation of PSGN
gross hematuria, periorbital edema, hypertension
treatment of psgn
furosemide for the HTN
lab findings of psgn
low C3/normal C4 levels due to immune complex formation, ASO titer, etc,
dangerous complication of psgn
hypertensive encephalopathy
what are the complement levels like in lupus
low C3 AND low C4
in rhabdo, what is in the urine
myoglobin, gives false positive for blood on dipstick but does not actually have RBCs
what is the presentation of epiglottitis
inspiratory stridor, drooling, dysphagia, hoarseness, refusal to eat
what causes epiglottitis
mostly h flu type B but other H flu strains can cause it too
how do you treat H flu
ceftriaxone and vanc
dx of scoliosis
xray
signs of slipped capital femoral epiphysis
patient holds their leg externally rotated (foot angles out), trendelenburg gait, progressive pain, limping
how do you dx slipped capital femoral epiphysis
bilateral hip xray
rubella presentation in an unvaxxed adolescent
fever, cephalocaudal expansion of maculopapular rash that spares hands, arthralgias, arthritis, lymphadenopathy
signs of intussusception in infant
bloody mucusy stools, sudden intermittent abdominal pain, air in abdomen,
what is dysentary
this is when you have bloody diarrhea and lymphocytes in the stool
affects of antiepileptic use during pregnancy
cleft lip, hypoplasia of the distal phalanges, cardiac abnormalities, neural tube defects (valproate mostly), excessive hair growth
adenovirus signs
URI, conjunctivitis, pharyngitis ,
kawasaki disease
C: conjunctivitis R: rash A: adenopathy S: strawberry tongue H: hand and foot swelling BURN: high fever
measles presentation
4 Cs: cough, coryza, conjunctivitis, koplik spots and fever then maculopapular rash craniocaudal
RMSF presentation
fever, headache, rash hands up, myalgia
erythema infectiosum (parvo aka 5th disease)
low grade fever followed by facial slapped cheek rash then lacy on body,
roseola presntation
high fever for 4 days followed by rash (erythematous macules)
how do you treat kawasaki
aspirin and IVIG
signs of inhalent use in an adolescent
irritability, nystagmus, normal vitals, perioral rash, hallucinations etc.
signs of cannabis use in an adolescent
tachycardia, increased blood pressure, increased respiratory rate, conjunctival injection, dry mouth, and increased appetite
signs of cocaine/amphetamine use
increased physical activity, rapid and/or irregular heart rate, increased blood pressure, and decreased appetite
long term AE of inhalents
cerebellar atrophy (gait ataxia), restrictive lung disease, dysrhythmias
signs of bath salt use
euphoria, dilated pupils, loss of inhibition, involuntary muscle movement, tachycardia, and hypertension
signs of IgA vasculitis (HSP)
Purpura, arthralgia, bloody stool, abdominal pain, low grade fever
signs of hemolytic uremic syndrome
Irritability, pallor, bloody diarrhea, anemia, thrombocytopenia, decreased urine output, hypertension
what is ITP
this is when you have antibodies against platelets, can be primary or secondary to a viral illness
signs of ITP
petichiae, purpura, bleeding etc.
lab findings of appendicitis
leukocytosis, typically present after first 48 hours of illness
describe the location of pain I nappendicitis
starts periumbilically and then moves to mcburneys point (RLQ)
describe the ortolani and barlow maneuver
ortolani abducts the hips and barlow adducts the hips
describe the hairloss in alopecia acreta
this is patchy hair loss in small circular areas that can be anywhere around teh body (scalp, eyebrows, eyelashes, etc)
describe what the hair shaft looks like in alopecia
it is thick at the bottom and thin at teh top called exclamation point hair
what is the treatment for alopecia
topical corticosteroids
what is a common finding on the hands of kids with alopecia
nail pitting
how do you manage IgA vasculitis
symptomatic management with NSAIDs and acetominophen
workup of intussusception
if you can see target sign on US, you do not need to do CT just go straight to surgery
what is a typical sign that kids have iron def. anemia
PICA
how do you treat IDA?
supplemental iron
what labs are seen with Diamond blackfan anemia
normal platelet count
physical signs of diamond blackfan anemia
triphalangeal thumbs, multiple craniofacial defects
what is the moro reflex
moro is when you startle baby by quickly “dropping” them, they should abduct and extend their arms
what does moro reflex test for
brachial plexus injury
signs of spondylolithiasis
pain with extension of lumbar spine (bending forward), no pain with flexion of lumbar spine, “drop off” observed during palpation
what is spondylolithiasis and who gets it
its when the whole vertebral disk is pushed forward anteriorly seen in overuse injuries like divers, gymnasts, etc or elderly individuals
what screening should duchenne MD patients get
echo for cardiac abnormalities due to replacement of the muscle
what are signs of an imperforate hymen
this is when you have cyclical pain with bowel movements and can have primary amenorrhea. on exam you will see a bulging red mass from the vagina
mean age of menarche
13yo
what should you evaluate if a child is undergoing precocious puberty?
bone age evaluation
where is pulmonic regurg heard and what type
left sternal border third intercostal space, decresendo diastolic murmur that increases with inspiration
lab findings in a newborn of a diabetic mother
hypocalcemia, hypomagnesia, hypoglycemia
signs of hypocalcemia in a newborn
jitteriness
what is the first step in management of a newborn with pyloric stenosis
first correct their fluids and then surgery
how do you treat an acute splenic sequestration
packed red cell infusion
signs of acute splecic sequestration
splenomegaly, abdominal pain, signs of anemia, thrombocytopenia
signs of anemia
tachy, fatigue, pallor (eyes and nailbeds)
when do you lose moro reflex
by 6mo
signs of sleep apnea in a child
enuresis >5yo, large tonsils, daytime irritability,
what are signs of empyema
pneumonia with pleural effusions, pneumonia that gets worse even after treatment
what antibiotics should be given for empyema
vanc and ceftriaxone
signs of mccune albright
cafe au lait spots, precocious puberty
what is the management of a biliary cyst
surgical resection to prevent malignancy
dx of suspected mastoiditis
MRI brain
treatment of nonbullous impetigo
topical mupicorin (rna synthetase inhibitor)
neurological sequelae of isotretinoin
pseudotumor cerebri (elevated ICP, papilledema, headaches etc)’
hypoxic-ischemic injury presenting with HTN and bradycardia
highly elevated ICP, this is the cushings triad where the brain is swelling due to cell death, this occludes small blood vessels which causes the cushing reflex which the body responds with increased blood pressure and decreased HR due to baroreceptor overactivity
during DKA what are total body potassium stores like
they are usually low due to ineffective reabsorption in the the kidney bc of the excess diuresis
signs of NEC on X ray
air in the bowel and portal veins
pathogenesis of anemia of prematurity
babies are oxygenated earlier in life so they have decreased EPO production but their RBCs also have a shorter life span so they have anemia with inadequate reticulocyte response. they should have a reticulocytosis
benign murmur characteristics
grade <2, vibratory, decreases or disappears with standing, etc
management of benign murmurs
reassurance
what is the mutation of marfans
fibrillin 1
two treatments of pinworm
albendazole or pyrantel pamoate
signs of RMSF
macular/petechial rash on wrists and ankles, general malaise, abdominal pain, fever, headache
lab findings RMSF
elevated liver enzymes, low sodium, low platelets,
treatment of ITP
Observation
what is strabismus
this is when one eye is malaligned, can be deviated inward and have asymmetrical red reflexes
how do you ID strabismus
dilated fundoscopic exam
management of hydrocele
reassurance and observation
what other organ should be surveiled if a baby has trachesophageal fistula
renal ultrasound and echo
if a child presents with massive spontaneous intraperitoneal hemorrhage what is the etiology
splenic rupture
what can precede splenic rupture
recent viral illnes
if a baby has light stools is there bilirubin being excreted
NO!
what does UDP-glucoronidase do
this conjugates bilirubin so it is making DIRECT bili
if the patient has a direct bilirubinemia what is the problem
this is an excretion problem
what bili would be high if they have crigler najar
indirect
how do you dx biliary atresia
liver biopsy
how do you workup primary amenhorrhea
you first get an FSH
signs of congenital rubella
bilateral sensorineuronal hearing loss, PDA, cataracts
signs of urinary tract obstruction in a newborn
Xray with diminished lung volume, minimal wet diapers, distended abdomen
most common cause of urinary tract obstruction in boys
posterior urethral valves
signs of congenital hypothyroidism
apathy, weakness, hypotonia, large tongue, sluggish, abdominal bloating, umbilical hernia
main causes of meningitis in newborns
GBS, listeria, E coli
meningitis pathogens children
streptococcus pneumoniae or neisseria meningitidis (rarely H flue type b)
neonatal trtment meningitis
gent, amp, cef
child trtment meningitis
vanc and ceftriaxone
manifestation of salmonella in gi
bloody diarrhea +/- neurologic symptoms
treatment of bloody diarrhea
typically just rehydration
what bug causes HUS
EHEC
what should make you suspect abuse
abrupt onset of mood changes, bedwetting, and/or academic difficulties.
what is transient synovitis
transient inflammation of the hip joint, commonly following a viral illness
management of transient synovitis
conservative manatement with NSAIDS
what is the squirt sign
expulsion of stool or gas following rectal exam
what does the squirt sign mean
patient has Hirschsprungs
signs of congenital toxo
hydrocephalus, intracranial calcifications, chorioretinitis, petechiae (blueberry muffin rash), lymphadenopathy
signs of congenital CMV
small for gestational age, petechiae (blueberry muffin rash), sensorineuronal hearing loss, chorioretinitis, seizures
signs of croup
inspiratory stridor, barking cough, worse at night, hoarseness
signs of croup on xray
steeple sign
what causes croup
parainfluenza
haptoglobin levels in RBC hemolysis
decreased haptoglobin bc the hemoglobin in the RBC binds to it
what is the treatment for infantile hemangioma
beta blockers
signs of ALL
pancytopenia, diffuse nontender lymphadenopathy, splenomegaly, weight loss
signs of fanconi anemia
short stature, hypo/hyper- pigmented macules, thumb hypoplasia, genitourinary malformations
pathophys of fanconi anemia
dna repair defect
what are the signs of hyperbilirubinemia in a neonate
lethargy, change in tone, jaundice
when should transfusion therapy be started for hyperbilirubinemia
> 25 or if it is unresponsive to light therapy and still rising
signs of acute rheumatic fever
arthritis, carditis, subcutaneous nodules, erythema marginatum, syndeha chorea, fever, elevated ESR, prolonged PR
what is erythema marginatum
annular pink rash with sharp, raised edges and central clearing
what is the most commo risk factor for orbital cellulitis
bacterial sinusitis
when does galactosemia present in newborns
first few days of birth
galactosemia enzyme deficiency
galactose-1-phosphate-uridylyltransferase
description of seborrheic dermatitis
scalp/face/retroauricular greasy scales, interriginous regions with glistening confluent erythema
long term complication of vesicoureteral reflux in children
fibrosis of the interstitial space
describe methemeglobinemia
this is when the Fe2+ gets oxidized to Fe3+ and does not bind oxygen.
what will the PaO2 on arterial blood gas be in methemeglobinemia
it will be normal bc this measures dissolved O2 which does not change
what organism causes impetigo
staph aureus
if a baby has persisent jaundice and they have elevated direct bili what is the haps
they have biliary atresia dx by ultrasound RUQ
what do you give to infants with NARDS
give them surfactant
what drug do you give for congenital prolonged QT
propanolol
most common cause of occult small bowel bleed in a child
meckels diverticulum
dx process of GI bleed in a child
stool test for occult blood –> upper and lower endoscopy with biopsy –> meckels scan
if a child has prolonged LOC following a syncope episode what is the likely cause
likely a psychogenic pseudosyncope episode which is part of conversion disorder
what is constitutional growth delay
this is when the child has short stature and delayed bone age but has linear growth curves, they will eventually catch up
what causes the pathology in reyes syndrome
hyperammonemia
in divorced parent families with joint custody, what is needed to get consent
only one parents consent for treatment
what is first line treatment in suspected NEC
blood cultures then antibiotics
what is infant dyschezia
this is a benign functional stooling disorder in whcih the infants do not have coordinated intraabdominal pressure with relaxation of the pelvic floor, totally normal
describe signs of infant dyschezia
episodes of straining for 10 minutes with normal stool consistency and frequency
what is congenital melanocytic nevus
this is a benign proliferation of melanocyte cells, solitary hyperpigmented patch with dark course hair
signs of congenital hypothyroidism
aysmptomatic at birth, lethargy, poor feeding, protuding tongue, constipation, prolonged jaundice, dry skin
course of infantile Hypertrophic cardiomyopathy of diabetic mothers
spontaneous regression by 1yr
what is the lesion called when an infant spontaneously gets a vascular bright red plaque that proliferates suddenly
this is a strawberry or superficial hemangioma
management of baby with GERD
reassurance and positioning therapy
signs of viral myocarditis
viraI prodrome, respiratory distress, murmur, hepatomegaly (from RHF)
cardinal features of neonates with down syndrome
low birth weight, upslanting palprebral fissures, epicanthic folds, single palmar crease
what is erythema toxicum neonatorum
this is a benign neonatal rash with pustules and erythematous bases on the trunk and proximal extremities
management of benighn neonatal rashes
observation
2 month gross motor
lifts head/chest when prone
2 month fine motor
eyes track past midline
2 month social/communication
alerts to sound, social smile
2 month cognitive
recognizes parent
4 month gross motor
rolls front to back
4 month fine motor
grasps rattle
4 month social
laughs, soothed by parents voice
4 month cognitive
orients head to direction of voice
6 month gross motor
can sit with little or no support
6 month fine motor
reaches with one hand, transfers objects
6 month communication/social
babbles, stranger anxiety
6 month cognitive
feeds self
9mo gross motor
pulls to stand
9mo fine motor
bangs together two objects, immature pincer grasp
9mo communication/social
waves bye bye, says mama/dada, separation anxiety
9mo cognitive
plays gesture games
12mo gross motor
stands/walks alone
12mo fine motor
finger pincer grasp
12 mo communcation/social
one word other than mama/dada
12 mo cognitive
uses spoon/cup, points to desired object
18 mo gross motor
runs well
18mo fine motor
builds tower 3 blocks
18mo communication/social
points to 1-3 body parts
18mo cognitive
“helps” in house
2yr gross motor
throws ball overhand, kicks ball
2yr fine motor
copies a line with crayon
2yr communication/social
2 word sentences, >50 words
2yr cognitive
removes article of clothing
3yr gross motor
pedels tricycle
3yr fine motor
copies circle
3yr communcation/social
speaks in three word sentences, 75% langueage is intelligible
3yr cognitive
brushes teeth with help
4 yr gross motor
hops on two feet
4yr fine motor
copies square
4yr communication/social
100% of language intelligible, plays in a group
4 yr cognitive
knows 4 colors
5 yr gross motor
skips
5 yr fine motor
copies triangle
5 yr communication/socila
defines simple words, uses 5word sentences
5 yr social
dresses self
