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Pediatrics > Exam 2 Diagnosis > Flashcards

Exam 2 Diagnosis Flashcards

1
Q

What is Wessel’s “Rule of 3s”

A

Colic

crying for more than 3 hr/day for more than
3 day/week for more than 3 weeks

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2
Q

Crying is paryoxysmal, facial grimacing, drawing up of legs

Otherwise feeling well, appropriate weight gain, mno signs of infection, witals WNL

A

Colic

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3
Q

Out of control behavior including screaming, stomping, hitting, head banging, falling down and other violent displays of frustration

Seen when child is frutrated, angry or unable to cope

1/wk lasting 2-3 min (duration ↓ w/ age)

A

Temper tantrums

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4
Q

Involuntary bperiod when child stops breathing

Usually when frustrated, angry, in pain

stop breathing and turn blue, may arch back and stretch out legs in response to hypoxia

Will return to nrml but may be sleepy afterwards

A

Breath Holding Spells

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5
Q

Panicky scream, not fully awake

Disoriented, aroused, difficult to calm then fall right back asleep

Amnesia of episode

1st 1/3 od the night

A

Night Terrors

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6
Q

Awaken fully and quickly become oriented, firghtened and seek comfort

Vivid recall of dream

2nd half of the night

A

Nightmares

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7
Q

Multiple hospitalizations for seizures
Negative repeated evaluations
Child looks well between episodes with negative work up
Mother very attentive, always by child’s side
Seizure tonight

A

Factitious Disorders by Proxy (FDP)

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8
Q

Delayed bone age usually ~2-2.5 yrs behind →corrects

Normal growth velocity for bone age

Absence of other medical conditions

Growth chart deceleration pattern when most children going through growth spurt

A

Constitutional Delay

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9
Q

Heigh and weight are proportional

Normal growth velocity

Normal bone age

Deceleration in growth at 6-18 mo

A

Familial Short Stature

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10
Q

Micropenis
Midline defects
Hypoglycemia

A

GH Deficiency-neonate

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11
Q

Decreasing growth velocity

Rapid ↑ in growth velocity after starting GH

Low IGF-1

A

GH deficiency - children

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12
Q

↓ C-peptide

↓insulin

↑ serum glucose
Auto Ab

A

Diabetes Mellitus Type 1

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13
Q

⊖ auto Ab

↑ c-peptide

↑ insulin levels

A

Diabetes Mellitus Type 2

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14
Q

Observe uncovered eye: if uncovered eye moves to focus

A

heterotropia

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15
Q

Observe covered eye as you remove cover: if covered eye moves when uncovered

A

heterophoria

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16
Q

Loss of visual acuity due to cortical suppression of the vision of an eye

A

Amblyopia

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17
Q

Onset w/in 1st 24 hours of life

Erythema and watery discharge

A

Chemical Conjunctivitis

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18
Q

Onset 2-5 days old

Swelling of lids and conjunctivae

Copious purulent discharge

A

Neisseria gonorrhoeae

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19
Q

Onset 4-19 days old

Mils swelling of lids and conjunctivae

Hyperemia (excess blood vessels in eye)

Scant purulent discharge

A

Chlamydia Trachomatis

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20
Q

Onset 2-4 wks old

Unilateral

Vesicular lid lesions

A

Herpes Simplex Virus

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21
Q

Chronic or intermittent tearing, debris on eyelashes

Palpation of lacrimal sac may cause reflux of tears and/or mucoid discharge into eye through the puncta

A

Dacryostenosis

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22
Q

Moderate to severe bulging of TM (most specific finding)

White/pale TM

Impaired TM mobility w/ pneumatic otoscopy or tympanogram

Intense erythema

Severe sx: toxic appearing, otalgia >48 hr, temp >39C, uncertain access to f/u

A

Acute Otitis Media

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23
Q

AOM following an acute URI, or introduction of contaminated water from ear canal into middle ear

A

Tympanostomy Tube Otorrhea

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24
Q

Clear or mucoid rhinorrhea, nasal congestion, sneezing

Sore throat, may devel cough and fever

7-9 days may last up to 15

A

Viral Rhinitis

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25
Q

Etiology of AOM

A

S. pneumo

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26
Q

Etiology of viral rhinitis

A

rhinovirus

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27
Q

Sx > 10 d w/o improving or sx worsen w/ new onset of fever or cough or temp > 39°C for more than 3 days

A

Sinusitis

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28
Q

Ocular itching, swelling, tearing
Always bilateral

Nasal itching, sneezing, rhinorrhea, congestion, crease, shiners (darkening around eyes)

Photophobia and pain are uncommon

A

Allergic Rhinitis

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29
Q

Tree pollen allergy timing

A

early spring

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30
Q

Grass pollen allergy timing

A

late spring, early summer

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31
Q

Weeds allergy timing

A

summer, autumn

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32
Q

Ragweed allergy timing

A

mid-august until frost

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33
Q

Mold allergy timing

A

all seasons during damp rainy weather

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34
Q

Chronic, mucopurulent,

odorous discharge—especially if unilateral

A

Nasal Foreign Bodies

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35
Q

Tonsillar exudates, cervical lymphadenopathy (posterior chain), fever, +/- spleen enlargement

A

Mononucleosis

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36
Q

Abrupt onset of sore throat

Tender cervical lymphadenopathy, fever, erythematous posterior pharynx +/- exudate, +/- petechiae

N/V, HA

Centor 4 pt scale: fever, absence of cough, anterior cervical adenopathy,
tonsilar exudates

A

Streptococcal Pharyngitis

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37
Q

Bright red, petecchiae rash, sandpaper texture

Usually starts in armpits

Strwaberry tongue

A

Scarlet Fever

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38
Q 
Arthritis
Carditis and valvulitis 
CNS involvement (chorea)
Erythema Marginatum
Subcutaneous nodules
A

Acure Rheymatic Fever

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39
Q

Gradual onset, nasal irritation, congestion, rhinorrhea, stridor, hoarsenessm “barking” cough

↓ O2 sat as worsens

Absence of drooling

A

Laryngotracheitis

Croup

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40
Q

How long are indiv with croup contacious

A

up to 1 week before to 1-3 weeks after illness

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41
Q

Sudden onset high fever, dysphagia, drooling and muffled voice, unable to clear secretions

Inspiratory retractions, stridor, cyanosis

Tripod or “sniffing dog” position

“Cherry red” and swollen epiglotis

A

Epiglottitis

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42
Q

What is the number one treatable cause of blindness in children?

A

Uveitis

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43
Q

Red flags for malig

A

Non-articular bone pain
Back pain on presentationYoung kids don’t get back pain
Bone tenderness
Severe constitutional symptoms
Night sweats
Ecchymoses/bruising Leukemia more than inflam
Features atypical of rheumatologic disease

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44
Q

Daily or diurnal temperature spike over 39 ̊ C

Returns quickly to below baseline

Child feels well between temperature spikes

Erythematous macules on trunk and proximal extremities that occurs at peak of gever, is migratory and quickly fades

A

Systemic JIA

Still’s Disease

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45
Q

MC complication of JIA

A

uveitis

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46
Q 
Heliotrope Rash (dark purple red rash
around eyes)

Gottron’s Papules (hyperkeratotic knuckles and elbows)

Periungual erythema

Proximal muscle weakness- hip and shoulder girdles, abd and neck muscles

A

Juvenile Dermatomyositis (JDM)

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47
Q

Palpable Purpura most prominent on legs and butt

Petechiae to ecchymosis may start as macules or urticaria

Subcutaneous edema of hands and feet, face, scrotum

Arthralgias/Arthritis- knees, knkles, acute, very painful, swelling w/o erythema, lasting days-1 wk

A

Henoch-Schonlein Purpura

48
Q

Fever lasting at least 5 days

Red eyes: non-exudative
bilateral conjunctivitis

Body rash

Swollen, red, cracked lips and tongue (i.e. Strawberry tongue and lip fissures)

Swollen, red feet and hands

Lymphadenopathy- single, enlarged, cervical node measuring approximately 1.5 cm

Coronary Artery Aneurysms

A

Kawasaki Disease

49
Q

Deep “aching” pain occurring over long periods of time

Can be precipitated by activity and usually occura late in the day or at night

A

Growing Pains

50
Q

If unilat L>R (1/3 are bilat)

Asymmetrical creases

Galeazzi sign- knee lower on one side

A

Developmental Dysplasia of the Hip (DDH)

51
Q

Atraumatic, painless limp

May have some mild or intermittent hip/groin, anterior thigh or knee pain

↓ internal rotation and abduction

A

Avascular Necrosis of Femoral Head

Legg-Calve-Perthes Disease

52
Q

Hip or knee pain

Limp, ↓ ROM, inability to ambulate

May hold affected leg in external rotation

May have loss of flexion and extension

A

Slipped Capital Femoral Epiphysis

53
Q

Pain during and after activity

May have tenderness and local swelling over
tibial tubercle

Can develop bony enlargement
of the tibial tuercle

A

Osgood-Schlatter Disease

54
Q

Bowleg/ intowing

A

Genu Varum

55
Q

Knock knees/ out-toeing

A

Genu Valgum

56
Q

1st ID in infants bc of head tilt

Ear tilt toward clavicle on affected side

Face looks upward toward contralateral side

A

Torticollis

57
Q

Polydactyly type 1

A

soft tissue only

58
Q

Polydactyly type 2

A

duplicate finger including bones/joints

59
Q

Polydactyly type 3

A

duplication of finger and metacarpal

60
Q

Not using arm

Holds arm close to body with elbow fully extended or slight flexed and forearm pronated

Little distress unless attempting to use the arm

Pain w/ active supination

No swelling, bony tenderness, deformity

A

Nursemaid’s Elbow

61
Q

Apnea (especially <4 months of age)
Copious rhinorrhea
Cough/wheeze

+/- fever, nasal secretions/flaring, wheeze, crackles, retractions, prolonged expiratory phase

A

Bronchiolitis

62
Q

Etiology of Bronchiolitis

A

RSV

63
Q

Catarrhal: cough and rhinorrhea (1-2 wks)

Paroxysmal: paroxysms, inspiratory whoop, post-tussive emesis (2-8 wks)

Convalescent: gradual waning of sx (wks to mo)

A

Pertussis

64
Q

Neonates: Fever or hypoxia only

Young Infants: Apnea may be 1st sign

Children: Fever, chills, tachypnea, cough, malaise, retractions, apprehension

A

Pneumonia

65
Q

Etiology of Pneumonia in:
neonate
3-5 yo
5-18 yo

A

neonate- GBS, E. coli

3-5 yo- RSV

5-18 yo M. pneumoniae

66
Q 
Coughing 
Post-tussive emesis
Wheezing
Breathlessness
Chest Tightness
Chest pressure
Difficulty breathing
↑work of breathing
Respiratory distress

Releived w/ albuterol

At least 4 x

A

Asthma

67
Q

At least 5 min of continous seizure activity or intermittent convulsive activity w/o regaining consciousness

Can have non-convulsive SE

A

Status Epilepticus

68
Q

2 + unprovoked afebrile seizures

Most children will only have one

A

Epilepsy

69
Q

etiology of human bites

A

Eikenella corrodens

70
Q

etiology of animal bites

A

Pasteurella specie

71
Q

Bleeding from circumcision

Prolonged bleeding from heel stick

Bleeding from intra-muscular injections

Swollen tender joints after minor injury

Multiple raised palpable bruises

A

Hemophilia

72
Q

VIII deficiency

A

Hemophilia A

73
Q

IX deficiency

A

Hemophilia B

74
Q

Weight loss, fever, free infections, easy SOB, night sweats, easy bleeding and bruins, fatigue, loss of appetite, bone pain or tenderness

Anemia- pallor, fatigue, ↓ appetite, CHF

Neutropenia- fever gingival hypperplasia, sepsis

Thrombocytopenia- petechiae, ecchymoses, mucosal and other bleeding

A

Leukemia

75
Q

Peak age for ALL

A

2-4 yo

B>G

76
Q

peak age for AML

A

<2 yo

77
Q

Fever, weight loss, night sweats, rash, pruitis, lymphadenopathy, masses, malignant effusion

HD- intermittent and slowly evolving sx

NHL: more and rapidly evolving sx

↑ risk immunodeficiency

A

lymphoma

78
Q

Diverse and elusive
HA*mc
N/V, visual dield defect, seizure

Endocrine dysfn- precocious or delayed puberty, anorexia, polyuria

A

brain tumor

79
Q

Best imaging choice for brain tumor

A

MRI

80
Q

Neuroblastoma imaging options

A

Imaging- plain films show calcifications

CT staging- extent of primary tumor, lymph node mets

MRI- determine spinal cord involvement

81
Q

Pain over involved area w/ or w/o associated soft tissue mass

Systemic sx usually absent

A

Osteosarcoma

82
Q

Asymptomatic abd mass

Abd pain, HTN, groww hematuria, fever

Constipation that does not resolve w/ tx

A

Wilms Tumor

83
Q

Leukocoria (no red reflex), strabismus, proptosis, neurologic sx
Mets to optic nerve, CNS, pituitary

A

Retinoblastoma

84
Q

MC cause of hemolytic dz of newborn

A

ABO Incompatibility

85
Q

Keratin filled papule usually found o the face, without erythema

A

Milia

86
Q

“Similar to neonatal acne- mother is worried pores are clogged

Will regress when hormone levels decline

A

Sebaceous Hyperplasia

87
Q

Presents areound 2 wks, no scarring, resolves with decline in maternal hormones in 3-4 mo

A

Neonatal Acne

88
Q

Yellow/pink greasy appearing scale on scalp (cradle cap) and erythematous scaling on neck and older children will be itchy, erythematous scaly rash on face

A

Seborrheic Dermatitis

89
Q

Color change in neonates sometimes confused with port wine stains

A

Harlequin Color Change

90
Q

Marble or lacy pattern usually symmetric on extremities

A

Mottling

cutis marmorata

91
Q

2-5 days of life rash appears, bump surrounded by flat patch erythema

A

Erythema Toxicum

92
Q

Vesicles with cloudy fluid (at birth) —> denuded forming white crusts —> hyperpigmented macules

No erythema or clustering

A

Pustular Melanosis

93
Q

Creases are not affected, rash in area of contact

A

Allergic Contact Dermatitis

94
Q

Satellite lesions, beefy red, affects folds/creases

A

Candida Diaper Dermatitis

95
Q

Benign hyperpigmented
(usually brown) irregularly shaped macule or patch

Found anywhere on body

A

Café At Lait

96
Q

Benign hyperpigmented
(usually blue/black) patches,
usually on sacrum but can be
over back and extremities (usually not on face)

A

Slate Grey Patch

97
Q

Present at birth and grow rapidly over 6-12 mo of life then begins to spontaneously involuted

A

Infantile Hemangioma

98
Q

Blanchable capillary malformation usually isolated

A

Port Wine Stain

99
Q

If upper and lower eyelid affected withn port wine stain (segments 1 and 2 of trigeminal nerve) what is your concern

A

more likely to be associated with Sturgeon-Weber Syndrome, neuro syndromes or glaucoma

100
Q

Rare tan-black colored hamartomas can be small, med or large

Irregularly shaped and have pliosebaceous glands (hair)

A

Congenital Melanocytic Nevus

101
Q

Erythematous maculopapular (initially blanching, then darkens
and coalesces) rash beginning on forehead  spreading down.
Rash starts 2-4 days after fever onset. Usually not pruritic.
Generalized lymphadenopathy; possible splenomegaly

Fever lasts 2-4 days into rash, then self-resolves

A

Measles (Rubeola)

102
Q

Swelling of paroitid gland- can not see jawline

Fever, malaise, HA, myalgias followed by parotitis 48 hr later (can last up to 10 days)

A

Mumps

103
Q

Faint maculopapular rash , low grad fever ad lymphadenopathy (post auricular or suboccipital) for 1-5 days

Rash appears from head and spreads down and resolves within 2 days

May get arthraligias and arthritis (more common in adults)

A

Rubella

104
Q

Slapped cheeks appear first and fade over 1-4 days

Body rash after facial lesions, erythematous macules and papule s become confluent giving lacy or reticular appearance, best seen on extensor arms, trunk and neck (fades 5-9 days)

A

Erythema Infectiousum (Fifth Disease)

105
Q

3-5 days of high fever (>40°C); Fever subsides, then< – Followed by rash (blanching pink, maculopapular) starting
on the neck/trunk  spreading to the face & extremities

A

Roseola Infantum

Sixth disease

106
Q

Acute onset fever, rapid painful eruption of punched out vesicular lesions

May have excessive swelling and erythema-indicating bacterial superinfection

A

Eczema herpeticum

107
Q

Water drop on rose petal

Malaise, low grade fever precede rash by 1 day, pruritic crops of macules that turn into vesicles on erythematous base that crust over within hours to days

New crops appear for 3-4 days, start on trunk then face and extremities

Marked pruritus, worse in older children

A

Varicella Zoster

108
Q

Initial tingling painful dermatomal distribution of

erythematous vesicular lesion

A

Herpes Zoster “shingles”

109
Q

Flesh colored umbilicated, fluid filled pustules can last up to 6 mo

A

Molluscum Contagiosum

110
Q

Fever, skin with generalized erythema, I’ll allearing, initial flaccid Bullard usually in skin folds (neck, nares, conjunctiva, periodally, GU area) —> Bullard rupture and create erosion

Usually spares actual mucous membranes

A

Staphylococcal Scalded Skin Syndrome

111
Q

Rapid onset fever, HA, vomiting, intense myalgias, Pete Niall/ourpuric rash on trunk/extremities

Progress quickly to AMS, shock and DIC

A

Neisseria Meningitis

112
Q

Erythema migrants- target rash from site of tick bite occurs 7-14 days after bite

Early disseminat3- multiple erythema migrants, neuro sx (HA, bilat Bell’s palsy, meningitis, encephalitis), cardiac sx (carditis), fever, malaise, myalgia, arthritis (late sign)

A

Lyme Disease

113
Q

MC cause of fever in infants <28 yo

A

Group B Strep, E. coli, & Listeria

114
Q

MC cause of fever in 28day -3 mo old

A

viral illnesses

115
Q

Fever >14 days w/o ID etiology despite H&P

A

fever of unk origin

Pediatrics (7 decks)

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