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Pediatrics > Emma Holiday Review III > Flashcards

Emma Holiday Review III Flashcards

1
Q

Pneumonia most common cause

(a) In neonates under 28 days
(b) 1-3 mo
(b) 4 mo- 5 yo
(d) > 5 yo

A

Pneumonia causes

(a) Neonates: GBS, E. coli, lysteria
(b) 1-3 mo: Chlamydia trachomatis, RSV, parainfluenza, strep pneumo
(c) 4 mo-5 yo: viral (RSV) then strep pneumo
(d) > 5 yo: mycoplasma, strep pneumo

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2
Q

Sore throat, fever, fatigue, general adenopathy, splenomedately

A

Epstein-Barr virus- mono

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3
Q

Most common cause of death in Friedrich’s ataxia

A

HOCM –> CHF

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4
Q

Presentation of peritonsillar abscess

(a) Symptoms
(b) Signs

A

Peritonsilar abscess

(a) Symptoms: severe sore throat, muffled voice (hot potato voice), drooling, trismus (lockjaw)
(b) Signs: medical displacement of tonsil and uvular deviation

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5
Q

Classic presentation of Fifths disease

A

Fifths disease = erythema infectiosum

  • Immuncompetent children w/ slapped cheek rash = malar rash (on cheeks) or erythema w/ circumeral pallor
  • lacy reticular rash on cheeks and upper body
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6
Q

2 yo w/ 105 fever, 3 days later gets a pink, mac-pap rash on trunk arms and legs

A

= Roseola

  • HHV6 (human herpes virus 6)
  • 3-5 days of fever (high, can > 104) then abrupt defervescence and development of macular or maculopapular rash on trunk/neck that spreads to face and extremities

-self limited

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7
Q

Kid w/ productive cough, runny nose, fever to 100.8

Based on PE findings
(a) coarse rhonchi
(b) decreased breath sounds crackles in LLL
Next steps?

A

Productive cough, rhinorrhea, fever to 100.8

(a) only coarse rhonchi on exam = acute bronchitis
=> supportive tx

(b) Decreased breath sounds + crackles in LLL = pneumonia
- CXR to confirm, CBC

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8
Q

Clinical presentation of acute rheumatic fever

A

Acute rheumatic fever: 2-4 weeks after initial GAS pharyngitis => fever, multiple painful joints, chorea (involuntary muscle movements), erythema margenatum (characteristic rash)

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9
Q

Name 4 nonsuppurative complications of GAS

A

Nonsuppurative = inflammatory w/o pus productive

Group A strep complications:

  • acute rheumatic fever
  • scarlet fever
  • streptococcal toxic shock syndrome
  • acute glomerulonephritis
  • PANDAS = pediatric autoimmune neuropsychiatric d/o associated w/ group A streptococci
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10
Q

9 mo who had previously been reaching milestones starts to lag
-seizures, hypotonia, cherry red macula

A

Tay-Sachs

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11
Q

14 yo bball player w/ knee pain and swelling of the tibial tubercle

A

Osgood-Schlatter

-overuse injury from jumping

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12
Q

Tx for Kawasaki’s

A

Require tx b/c of the risk of CV complications

Acutely: single dose IVIG + high dose aspirin

  • continue aspirin until lab markers of acute inflammation (platelet count and ESR) return to normal
  • not glucocorticoids b/c doesn’t decrease rates of complications

Later w/ aspirin + warfarin

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13
Q

First line tx for strep pharyngitis

A

Strep pharyngitis first line tx = Penicillins (no resistance, so lets keep it that way by not giving higher stuff)
-Penicillin
-often Amoxicillin b/c tastes better
or can give IM penicillin

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14
Q

2 yo w/ low grade fever, lacy reticular rash on cheeks and upper body that spares the palms/soles

A

5th disease/erythema infectiosum (parovirus B19)

=mild febrile illness w/ erythematous malar rash w/ circumoral pallor (slapped cheek rash)

Dx made clinically in immunocompetent children w/ malar rash of erythema infectiosum

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15
Q

JRA Tx

(a) first line
(b) second line
(c) third line

A

JRA Tx: start w/ NSAIDS –> MTX –> steroids

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16
Q

Hand-Foot-and Mouth disease

(a) Cause
(b) Presentation
(c) Tx

A

Hand-Foot-and Mouth disease

(a) Coxsackie virus A16
(b) Macules –> vesicles –> rupture to form painful superficial ulcers
(c) Self limited, resolves in 7 days

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17
Q

5 yo M initially w/ a cold 1 week ago, now presents w/ limp and effusion in the hip.

-Xray normal
-ESR 35 (high)
Temp 99.8
WBCs- 10k

A

Transient synovitis = self-limited inflammation of the synovium (inner lining of the capsule of the hip joint)

  • Xray often unremarkable
  • elevated acute factors of inflammation
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18
Q

Tx for recurrent peritonsilar abscesses

A

Tonsillectomy

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19
Q

12 yo w/ 2 week history of fever (102) and salmon colored evanescent rash on trunk, thighs, shoulders

-swollen r and l knee

A

JRA = juvenile rheumatoid arthritis

  • intermittent fever, rash, arthritis
  • presents w/ pain, swelling, stiffness
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20
Q

Retropharyngeal abscess

(a) Dx
(b) Etiology
(c) Complications
(d) Tx

A

Retropharyngeal abscess = rare but very serious infection of the retropharyngeal space

(a) CT scan
(b) Often polymicrobial: GAS + staph aureus + resp anaerobes
(c) Life threatening complications: airway obstruction, sepsis
(d) Tx: Hospitalize to ensure airway is maintained, start on empiric therapy (3rd gen cep + amp or clinda), surgically drain
- prevent spread into mediastinum

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21
Q

Sandpaper quality to the skin

A

Sandpaper rash = buzzword for sclaret fever (after group A strep pharyngitis)

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22
Q

Whooping cough

(a) CBC findings
(b) Tx

A

Whooping cough = pertussis

(a) CBC shows lymphocytosis
(b) Azithromycin for 14 days

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23
Q

Tx for Rocky Mountain Spotted fever (muscle pain, fever, abdominal pain –> rash)

A

Doxyycline (at all ages)

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24
Q

JRA

(a) Good prognostic factor
(b) Bad prognostic factor

A

JRA

(a) Good prognostic factor: young age of onset, fewer joints, +ANA
(b) Bad prognostic factor: older at age of onset, polyarticular, +RF

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25
Q

Shin pain that worsens w/ foot dorsiflexion

A

Toddler’s fracture = spiral fracture of the shin bone (tibia)
-pain when foot bent upwards

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26
Q

Tx for peritonsilar abscess

A
  • start empiric abx

- often needs aspiration and I&D (incision and drainage)

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27
Q

Slapped cheek rash

A

Buzzword for 5th disease = erythema infectiosum

-agent = Parovirus B19

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28
Q

Describe the classic presentation of Roseola

A

Roseola (HHV 6): 3-5 days of fever (high, can > 104) w/ abrupt defervescence and development of maculo-papular rash on trunk/neck that spreads to face/extremities

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29
Q

3 mo infant lays in “frog-leg” position, hypotonic, fasiculations of the tongue, absent DTRs

A

SMA-1 = spinal muscular atrophy

-most die before age 2

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30
Q

4 yo w/ inflamed conjunctiva + multiple blisters

-positive Nikolsky’s sign

A

= Staph scalded skin syndrome (SSSS) = toxin from staph aureus => cutaneous erythema, bullae, desquamation

  • Nikolsky’s signs = gentile pressure causes skin to wrinkle due to separation of the upper dermis
  • febrile

Most have concomitant conjunctivitis

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31
Q

9 mo w/ severe coughing spells w/ loud inspiratory whoop w/ vomiting.
-2 weeks ago: runny nose and dry cough

A

Whooping cough = Pertusis

-bordetella pertusis

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32
Q

Work up for meningitis

A

1- start empiric tx w/ Ceftriaxone + Vanco
2- Check CT for signs of increased ICP
3- LP: culture and gram stain, white count, protein and glucose levels

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33
Q

Bronchiolitis

(a) CXR findings
(b) Tx

A

Bronchiolitis

(a) CXR: hyperinflation w/ patchy atelectasis
(b) Tx = albuterol nebs, NO STEROIDS, hospitalize if respiratory distress

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34
Q

9 mo w/ runny nose, wheezy cough, T 101.5, RR of 60

  • chest retractions
  • pulse ox 91%
A

Bronchiolitis

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35
Q

How to differentiate UTI vs. pyelonephritis in neonate

A

Both present w/ vague symptoms: fussy, dehydration

If fever is present it’s pyelo, cystitis (UTI) has NO fever

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36
Q

SCFE

(a) Risk factors
(b) Presentation
(c) Treatment

A

SCFE = slipped capital femoral epiphysis

(a) AA and overweight
(b) PResents w/ pain and altered gait
(c) Tx: operative stabilization

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37
Q

7 yo w/ exudative pharyngitis w/ tender cervical LN and fever to 102

A

Do rapid strep antigen- thinking strep pharyngitis

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38
Q

Why give penicillin for strep throat

A

To prevent complications of post-GAS pharyngitis such as acute rheumatic fever

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39
Q

Tx for otitis media

(a) if no improvement after 2-3 days
(b) when to place tubes

A

Otitis media tx = amoxicillin or azithromycin for 10 days

(a) Switch to augmentin (amox-clav) if no improvement
(b) Place tubes if bilateral effusion > 4 mo or if bilateral hearing loss

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40
Q

Classic presentation of Kawasaki’s

A

5+ days of fever + 4 out of 5 signs of mucocutaneous inflammation:

(i) bilateral nonexudative conjunctivitis
(ii) erythema of the lips and oral mucosa: injected/fissured lips, injected pharynx, strawberry tongue
(iii) rash
(iv) extremity changes: erythema or edema or palm/soles, periungal desquamation
(v) cervical lymphadenopathy: > 1.5 cm diameter
- typically develop after a brief nonspecific prodrome of respiratory or gastrointestinal symptoms

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41
Q

2 yo F w/ 2 week history of daily fevers to 102 + desquamating rash on perineum

  • swollen hands and feet
  • conjunctivitis
  • unilateral swollen cervical lymph node
A

Kawasaki’s

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42
Q

Tx for scabies

A

5% permetrin for the entire family
Permetrin = anti-parasitic used for head lice and scabies
-treat for symptoms and to prevent transmission

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43
Q

12 y/o w/ decreased school performance, behavior change, ataxia, spasticity, hyperpigmentation
-hyperkalemia, hyponatremia, acidosis

A

Adrenoleukodystrophy = X-linked recessive d/o of peroxisomal FA oxidation => accumulation of very long chain fatty acids throughout the body

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44
Q

Mechanism of Kawasaki’s

A

Vasculitis of medium sized muscular arteries

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45
Q

Anatomic risk for UTI

A

Anatomic risk for UTI = vesicoureteral reflux = retrograde flow or urine from bladder in ureter/kidney

-confirmed w/ VCUG = voiding cystourethrogram that visualizes urethra and bladder during voiding

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46
Q

Seizures

(a) 3-4 minute tonic-clonic seizure after fever of 102.4
(b) staring into space, lip smacking
(c) 6 mo old w/ symmetric contractions of neck, trunk, extremities

A

Seizures

(a) Febrile seizure
(b) Absence seizure
(c) Infantile spasms

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47
Q

Measles

(a) Cause
(b) Tx

A

Measles

(a) Paramyxovirus
(b) Tx: supportive care (fluids, antipyretics) + vitamin A

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48
Q

Steeple sign

A

Steeple sign = Xray buzzword for Croup

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49
Q

Koplik spots

A

= white/gray spots on buccal mucosa

-pathognomonic for prodromal phase of Measles

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50
Q

Developmental hip dysplasia

(a) Dx signs
(b) Tx
(c) Risk factors

A

Developmental hip dysplasia

(a) Clunk on Barlow
- can confirm w/ ultrasound of hip if unsure
(b) Tx = Pavilk harness (keeps hips in place), sometimes surgery
(c) Risk factors = 1st born female, breech position

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51
Q

Complications of Rocky Mountains potted fever

A
  • vasculitis (R. rickettsii infects endothelial cells lining blood vessels)
  • gangrene
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52
Q

Classic presentation of German Measles

A

German Measles = Rubella (paramyxovirus)

  • fever, rash (red maculopapular on face), lymphadenopathy
  • milder than measles
53
Q

14 yo lanky M w/ nagging knee pain and decreased ROM of the hip on exam

A

SCFE = slipped capital femoral epiphysis = displacement of femoral epiphysis from femoral neck

-shearing forces to femoral head > stregnth of capital femoral physis

54
Q

Extra bug to think about for meningitis if

(a) young and immunosuppressed
(b) recent brain surgery

A

Extra bugs besides strep pneumo, N. meningities, H. influenza

(a) young and immunosuppressed- Lysteria => tx w/ ampicillin
(b) recent brain surgery- Staph => vanco

55
Q

5 yo M initially w/ painless limp now has pain in his thigh

A

Legg-Calve’s-Perthes Disease = avascular necrosis of the femoral head

56
Q

6 yo kid w/ fever who went camping in central PA

A 
Lyme Disease (bacteria = borrelia burgdorferi) 
-characteristic Target lesion
57
Q

Fine, mac-pap desquamating rash begins on chest and spreads to neck, trunk, and extremities

  • strawberry tongue
  • sore throat 1-2 weeks prior
A

Scarlett fever

-group A strep

58
Q

Describe the 4 phases of the measles

(1) Incubation
(2) Prodrome
(3) Exanthem
(4) Recovery

A

Measles (paramyxovirus)

(1) Incubation- 6-21 days after exposure
(2) Prodrome- fever, malaise, anorexia, runny nose, conjunctivitis, Koplik spots (white/gray spots on buccal mucosa)

(3) Exanthem = break out of red maculopapular rash that classically starts on face
- rash resolves in 5-6 days
(4) Recovery- cough can persist for 1-2 weeks. If fever is present 3-4 days into rash, suggests a measles-associated complication

59
Q

2 yo w/ fever to 104 and drooling w/ intercostal retractions and tripod position

A

= Epiglottitis

-stridor, tripoding, chest retraction, febrile

60
Q

3 ddx for bone pain due to cancer

A
  • Presenting sign of Leukemia
  • Ewing Sarcoma (more likely if under 10 yoa)
  • Osteogenic sarcoma (more likely if over 10 yoa)
61
Q

What is a left shift?

A

Increase in number of immature leukocytes in peripheral blood
-associated w/ neutrophil band cells

62
Q

Most common presentation of adrenoleukodystrophy

A

Often presents in boys (X-linked) w/ emotional instability, hyperactivity, and disruptive school behavior

Adrenoleuodystrophy = d/o of peroxisomal FA oxidation

63
Q

8 yo w/ difficulty balancing while walking

  • no DTRs
  • bilateral Babinski
  • explosive, dysartric speech
A

Friedrich ataxia

  • autosomal recessive
  • trinucleotide repeat
64
Q

Describe the rash of scarlet fever

A

Sandpaper appearance: diffuse erythema that blanches w/ pressure w/ numerous small papular elevations

  • erythematous, blanching, maculopapular
  • delayed-type skin rxn to strep pyogenes exotoxin
65
Q

LP findings consistent w/ meningitis

A

Diagnostic is > 1,000 WBC in CSF (predominately neutrophils)
-positive gram stain

Supportive: high protein and low glucose in CSF

66
Q

3 most common bugs for meningitis in children

A
  • strep pneumo
  • Neisseria meningitides
  • H. Influenza
67
Q

Indication for topical mupirocin

A

Topical muciprocin = abx ointment

-for skin infections: furuncle (infxn of the hair follicle), impetigo, open wounds

68
Q

Meningitis + petechiae indicates what bug

A

Petechaie w/ meningitis indicates Neisseria meningitides

69
Q

Complications of untreated lyme disease

A

Arthritis, heart block, meningitis, Bells (partial face paralysis) , severe headaches w/ neck stiffness

70
Q

1 yo w/ fever (100.5) and barking lough + loud noise on inspiration

A

Croup

  • barking/seal like cough
  • stridor = loud noise on inspiration
71
Q

6 yo w/ clumsiness and frequent falls

  • decreased muscle bulk and “stork like” lower leg
  • multiple small injures on hands and feet
  • pes cavus and claw hand
A

Marie-Charcot-Tooth Disease = peripheral neuropathy

-pes cavus (high arch)

72
Q

Indications for tonsillectomy

A

-recurrent peritonsilar abscesses

Recurrent strep throat:

  • > 5 episodes of strep/yr for 2 years or
  • > 3 episodes of strep/yr for 3 yrs
73
Q

For which childhood viral illness would isolation room be indicated?

A

Measles- extremely contagious
-up to 90% exposed get infected

Also mumps- isolate until parotitis is down

74
Q

Tx for Marie-Charcot-Tooth disease

A

stabilize ankles w/ surgical fusion

-usually normal lifespan and most remain ambulatory

75
Q

Infant w/ increasing head size, prominent occiput, cerebellar ataxia, delayed motor development

A

Dandy-Walker malformation = congenital malformation of absence of cerebellar vermis

76
Q

Tx of

(a) UTI
(b) Pyelo

A

Tx of

(a) UTI- PO trim-sulfa (bactrum) or nitrofurantoin
(b) Pyelo- 14 days of IV ceftriaxone or amp + gent

77
Q

Fever, N/V, headache, back pain

A

Think meningitis

78
Q

Second line tx for strep phayngitis

A

2nd line tx for strep pharyngitis (after penicillins) = 1st gen cephalosporins

79
Q

Why is rubella scary?

A

Congenital rubella syndrome- very dangerous for women to get rubella in first 20 weeks of pregnancy

=> fetal death, congenital abnormalities
-cataracts, deafness, heart and brain problems

80
Q

Tay Sachs

(a) Mode of inheritance
(b) Pathophysiology

A

Tay Sachs

(a) X-linked recessive
(b) Deficiency of hexosaminidase A => accumulation of GM2 in brain

81
Q

Muffled voice, stridor, refuses to turn head left

A

Torticollis/stiff neck, fever, dysphagia = r/o Retropharyngeal abscess = infxn of the retropharyngeal (deep neck) space

82
Q

For which populations may 5th disease be very dangerous

A

Parovirus B19 can cause a transient aplastic crisis by temporarily suspending erythropoeisis

Dangerous in: pregnant women, sickle cell, thalassemia

83
Q

What is seen on CT/MRI in Dandy Walker malformation?

A

Cystic expansion of 4th ventricle

-can see agenesis of cerebellar vermis

84
Q

Complications of meningitis

(a) Neurological
(b) Disseminated illness

A

Meningitis complications

(a) Seizures
(b) Septic arthritic, pericarditis

85
Q

Most common cause of bullous impetigo

A

Impetigo = honey colored crusts plaques

-if bullous, most common = staph

86
Q

Treatment for lyme disease

A

Amoxicillin for kids under 8

Doxycyclin if > 8

87
Q

When is the MMR given?

A

2 doses

1st dose: 12-15 mo
2nd dose: no sooner than 28 days later, usually given btwn 4-6 yo

88
Q

Tx for Infantile spasms

A

ACTH

2nd line- prednisone

89
Q

Specific findings for chlamydia trachomatis pneumonia?

(a) type of cough
(b) White count

A

Chlamydia trachomatis
-often afebrile

(a) staccato cough
(b) eosinophilia

90
Q

Which respiratory illness has a vaccine given to premies and immuncompromised?

A

Palivizumab = RSV antibody to prevent bronchiolitis in premies, CHD, lung and immune disease

91
Q

Prognosis of Adrenoleukodystrophy

A

Death w/in 10 years

-progressive demyelination

92
Q

Thumbprint sign

A

Thumbprint sign = Xray buzzword for Epiglottitis

-showing enlarged epiglottis

93
Q

Tx for croup

A

-mist, nebulized epi, steroids

94
Q

Transient synovitis vs. septic arthritis

(a) US findings
(b) How to differentiate
(c) Symptomatic difference

A

Transient synovitis = self-limited inflammation of synovirum
vs.
Septic arthritis = bacterial infxn of joint

(a) US on both shows effusion
(b) US guided needle aspiration to differentiate toxic synovitis from septic arthritis
(c) Septic arthritis will have more severe symptoms: febrile, irritability, inability to bear white, pronounced muscle guarding

95
Q

Complications of mumps

A
  • Orchiditis (testicular inflammation), sterility
  • meningitis
  • encephalitis (inflammation of brain)
96
Q

Most common bug cause of

(a) Croup
(b) Epiglottitis
(c) Bronchiolitis

A

Most common bug

(a) Croup = parainfluenza virus
(b) Epiglottitis: strep pyo, strep pneumo, staph
- H. Flu B if unimmunized
- **bacterial
(c) Bronchiolitis = RSV

97
Q

Next step for kid w/ meningocele or myelomeningocele

A

Do a head CT looking for hydrocephalus (Arnold Chiari II)

98
Q

Treatment for scarlet fever

A

Really supportive and anti-inflammatory meds

  • aspirin/corticosteroids (but be careful of Reye syndrome risk in children w/ aspirin)
  • no vaccines against Strep pyogenes
  • if throat tests (+) for Strep pyogenes: give Penicillin
99
Q

EEG finding in

(a) absence seizure
(b) infantile spasm

A

EEG finding

(a) absence seizures: 3 Hz spike and wave discharge
(b) infantile spasms: hypsarrhythmia = asynchronous, chaotic, bilateral

100
Q

Tx for 4 yo w/ conjuncitivitis + multiple blisters and + Nikolsky’s sign

A

Staph scalded skin syndrome

Tx = penicillinase-resistant penicillin = IV oxacillin or nafcillin

101
Q

Most common cause of limp in a kid

A

Trauma

102
Q

Tx for epiglottitis

A

Secure airway: if necessary go to OR and intubate

Epiglottitis can be life threatening (airway obstruction) => start empiric tx before cultures come back
Tx = 3rd gen cephalosporin (ceftriaxone/cefotaxime) + anti-staph agent effective against MRSA (clindamycin/vancomycin

103
Q

What is empiric tx for meningitis?

A

Empiric tx for meningitis = 3rd gen cephalosporin (Ceftriaxone) + Vanco

-then when agent confirmed you can make it more specific

104
Q

How long after strep pharyngitis do you see

(a) scarlet fever
(b) acute rheumatic fever

A

Group A Strep pharyngitis

(a) 1-2 weeks later => scarlet fever (sandpaper rash)
(b) 2-4 weeks later => acute rheumatic fever (fever, multiple painful joints, involuntary muscle mov’ts, rash)

105
Q

Best test for Kawasaki’s

A

2D echo and EKG, then repeat echo after 2-3 weeks of tx
-most serious sequellae = cardiac

W/o complications, usually self-limited w/ symptoms lasting about 12 days
-so monitor for cardiac complications

Prognosis based on severity of coronary artery involvement => baseline EKG then repeat after tx

106
Q

UTI gender preference

A

Before age 1: boys more likely than girls to get UTI

-girls more common after age 1

107
Q

2 yo w/ fever (102) tugging on ear. Red and bulging TM

(a) most sensitive dx test

A

Otitis media

(a) Limited mobility of insufflation or visibility of air fluid level- indicating fluid behind TM

108
Q

Hot potato voice

A

Buzzword for peritonsillar abscess

109
Q

What to consider in any infant w/ HC > 95th %

A

Consider hydrocephalus

110
Q

Roseola

(a) Peak age
(b) Cause
(c) Tx

A

Roseola

(a) Peak age: 7-13 mo
(b) HHV-6 (human herpes virus 6) = most frequent causes
- other causes: HHV-7, enteroviruses, adenovirus, parainfluenza
(c) Disease is self limited => just supportive tx
- antipyretics for fever discomfort

111
Q

Most serious complication of Kawasaki’s

A

Pathologic changes in coronary arteries => coronary artery aneurysm or MI

112
Q

16 yo M w/ swollen parotid glands, fever, and headache

A

Mumps (paramyxovirus)

-characteristic parotitis

113
Q

18 mo F w/ asymmetric gluteal fold on exam

A

Asymmetric gluteal folds = developmental hip dysplasia

114
Q

Why is warfarin in the first trimester of pregnancy relatively contraindicated?

A

Increased risk of Dandy-Walker (congenital absence of cerebellar vermis)

115
Q

6 yo kid from costal NC went camping => fevers, myalgias, abdominal pain

A

Rocky Mountain spotted fever (rickettsia rickettsii)

  • tick-borne disease
  • starts w/ nonspecific pains: fever, headache, muscle pain
  • prominent abdominal pain
  • most develop rash btwn 3-5 days of illness
116
Q

8 yo w/ multiple excoriations of arms, itchy at night

-brother also has it

A

Scabies = erythematous papules in characteristic distribution (webbing of fingers, around nipple, in folds) very itchy worse at night
-pruritic eruption + family involvement

117
Q

Transient synovitis

(a) presenting factors
(b) Diagnostic test

A

Transient synovitis

(a) Pain and limited hip movement, hip usually flexed externally rotated and abducted
(b) Diagnostic test = Ultrasound showing fluid inside the joint capsule (effusion)

118
Q

2 y/o w/ gait disturbance

  • loss of intellectual fxn
  • nystagmus + optic atrophy
  • cresyl violet –> metachromatic staining
A

Metachromatic leukodystrophy = auto recessive lysosomal storage disease due to mutation in ARSA (arylsulfatase A) gene => accumulation of cerebroside sulfate

119
Q

12 yo in summer swim league w/ pain behind his ear

  • thick exudates coming out of ear
  • tender posterior auricular nodes
A

Otitis externa = swimmer’s ear

120
Q

What is a maculopapular rash?

A 
Macules = small, flat discolored spots
Papules = small, raised bumps

Maculopapular rash = flat, red areas on the skin covered w/ small confluent bumps

Associated w/ scarlet fever, measles, Rubella, secondary syphilis, 5th disease

121
Q

Ewings vs. Osteogenic sarcoma

(a) Age
(b) Gender
(c) History
(d) Radiologic evidence
(e) Tx

A

Ewings: more likely in under 10 yoa, M > F, more common if hx of retinoblastoma or previous radiation

(d) Onion skinning on xray- layers of periosteal development
(e) Tx: rads and/or surgery

Osteogenic sarcoma: more likely in over 10 yoa, M > F

(d) Sunburst and Codman’s triangle on Xray
(e) Chemo +/- surgery

122
Q

Mononucleosis

(a) Response to amp or amox
(b) Dx
(c) Tx
(d) Precautions

A

Mononucleosis (EBV)

(a) Maculopapular rash develops in response to amp or amox (immune mediated vasculitis)
(b) Dx: Monospot test = heterophile antibody test
or blood smear w/ lymphocytosis and atypical lymps
(c) Tx: rest and symptomatic therapy
(d) Precautions: splenic hemorrhage or rupture => avoid contact sports until splenomegaly resolves

123
Q

Tx for otitis externa

A

Tx: topical cirpofloxacin

124
Q

Cough, runny nose fever –> macular rash behind ears and spreads down
-gray spots on buccal mucosa

A

Measles (paramyxovirus)

gray spots on buccal mucosa = Koplik spots = pathognomonic for Measles
-appear about 48 hrs before exanthem (rash break out)

125
Q

Baby w/ poor feeding. Vesicles in mouth, on palms and soles. Rash on buttocks

A

Hand-Food-Mouth disease (Coxsackie virus A16)

126
Q

Tx for absence seizures

A

Ethosuxamide or valproic acid

127
Q

When is an ultrasound indicated for a UTI?

A

IF pt is febrile

-assess for anatomy, absces, or hydronephrosis

128
Q

Sore throat, joint pain, fever –> pinpoint rash on face that spreads down
-rose spots on palate

A

Rubella (paramyxovirus)

Pediatrics (10 decks)

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