Exam 2 Diagnosis Flashcards by Julia B

What is Wessel’s “Rule of 3s”

Colic

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

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Crying is paryoxysmal, facial grimacing, drawing up of legs

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

Colic

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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)

Temper tantrums

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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

Breath Holding Spells

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Panicky scream, not fully awake

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

Amnesia of episode

1st 1/3 od the night

Night Terrors

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Awaken fully and quickly become oriented, firghtened and seek comfort

Vivid recall of dream

2nd half of the night

Nightmares

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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

Factitious Disorders by Proxy (FDP)

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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

Constitutional Delay

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Heigh and weight are proportional

Normal growth velocity

Normal bone age

Deceleration in growth at 6-18 mo

Familial Short Stature

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Micropenis
Midline defects
Hypoglycemia

GH Deficiency-neonate

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Decreasing growth velocity

Rapid ↑ in growth velocity after starting GH

Low IGF-1

GH deficiency - children

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↓ C-peptide

↓insulin

↑ serum glucose
Auto Ab

Diabetes Mellitus Type 1

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⊖ auto Ab

↑ c-peptide

↑ insulin levels

Diabetes Mellitus Type 2

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Observe uncovered eye: if uncovered eye moves to focus

heterotropia

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

heterophoria

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

Amblyopia

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Onset w/in 1st 24 hours of life

Erythema and watery discharge

Chemical Conjunctivitis

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Onset 2-5 days old

Swelling of lids and conjunctivae

Copious purulent discharge

Neisseria gonorrhoeae

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Onset 4-19 days old

Mils swelling of lids and conjunctivae

Hyperemia (excess blood vessels in eye)

Scant purulent discharge

Chlamydia Trachomatis

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Onset 2-4 wks old

Unilateral

Vesicular lid lesions

Herpes Simplex Virus

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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

Dacryostenosis

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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

Acute Otitis Media

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

Tympanostomy Tube Otorrhea

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Clear or mucoid rhinorrhea, nasal congestion, sneezing

Sore throat, may devel cough and fever

7-9 days may last up to 15

Viral Rhinitis

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Etiology of AOM

S. pneumo

Etiology of viral rhinitis

rhinovirus

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

Sinusitis

Ocular itching, swelling, tearing Always bilateral Nasal itching, sneezing, rhinorrhea, congestion, crease, shiners (darkening around eyes) Photophobia and pain are uncommon

Allergic Rhinitis

Tree pollen allergy timing

early spring

Grass pollen allergy timing

late spring, early summer

Weeds allergy timing

summer, autumn

Ragweed allergy timing

mid-august until frost

Mold allergy timing

all seasons during damp rainy weather

Chronic, mucopurulent, | odorous discharge—especially if unilateral

Nasal Foreign Bodies

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

Mononucleosis

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

Streptococcal Pharyngitis

Bright red, petecchiae rash, sandpaper texture Usually starts in armpits Strwaberry tongue

Scarlet Fever

``` Arthritis Carditis and valvulitis CNS involvement (chorea) Erythema Marginatum Subcutaneous nodules ```

Acure Rheymatic Fever

Gradual onset, nasal irritation, congestion, rhinorrhea, stridor, hoarsenessm "barking" cough ↓ O2 sat as worsens Absence of drooling

Laryngotracheitis | Croup

How long are indiv with croup contacious

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

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

Epiglottitis

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

Uveitis

Red flags for malig

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

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

Systemic JIA | Still's Disease

MC complication of JIA

uveitis

``` 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

Juvenile Dermatomyositis (JDM)

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

Henoch-Schonlein Purpura

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

Kawasaki Disease

Deep “aching” pain occurring over long periods of time Can be precipitated by activity and usually occura late in the day or at night

Growing Pains

If unilat L>R (1/3 are bilat) Asymmetrical creases Galeazzi sign- knee lower on one side

Developmental Dysplasia of the Hip (DDH)

Atraumatic, painless limp May have some mild or intermittent hip/groin, anterior thigh or knee pain ↓ internal rotation and abduction

Avascular Necrosis of Femoral Head | Legg-Calve-Perthes Disease

Hip or knee pain Limp, ↓ ROM, inability to ambulate May hold affected leg in external rotation May have loss of flexion and extension

Slipped Capital Femoral Epiphysis

Pain during and after activity May have tenderness and local swelling over tibial tubercle Can develop bony enlargement of the tibial tuercle

Osgood-Schlatter Disease

Bowleg/ intowing

Genu Varum

Knock knees/ out-toeing

Genu Valgum

1st ID in infants bc of head tilt Ear tilt toward clavicle on affected side Face looks upward toward contralateral side

Torticollis

Polydactyly type 1

soft tissue only

Polydactyly type 2

duplicate finger including bones/joints

Polydactyly type 3

duplication of finger and metacarpal

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

Nursemaid’s Elbow

Apnea (especially <4 months of age) Copious rhinorrhea Cough/wheeze +/- fever, nasal secretions/flaring, wheeze, crackles, retractions, prolonged expiratory phase

Bronchiolitis

Etiology of Bronchiolitis

RSV

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)

Pertussis

Neonates: Fever or hypoxia only Young Infants: Apnea may be 1st sign Children: Fever, chills, tachypnea, cough, malaise, retractions, apprehension

Pneumonia

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

neonate- GBS, E. coli 3-5 yo- RSV 5-18 yo M. pneumoniae

``` Coughing Post-tussive emesis Wheezing Breathlessness Chest Tightness Chest pressure Difficulty breathing ↑work of breathing Respiratory distress ``` Releived w/ albuterol At least 4 x

Asthma

At least 5 min of continous seizure activity or intermittent convulsive activity w/o regaining consciousness Can have non-convulsive SE

Status Epilepticus

2 + unprovoked afebrile seizures Most children will only have one

Epilepsy

etiology of human bites

Eikenella corrodens

etiology of animal bites

Pasteurella specie

Bleeding from circumcision Prolonged bleeding from heel stick Bleeding from intra-muscular injections Swollen tender joints after minor injury Multiple raised palpable bruises

Hemophilia

VIII deficiency

Hemophilia A

IX deficiency

Hemophilia B

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

Leukemia

Peak age for ALL

2-4 yo | B>G

peak age for AML

<2 yo

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

lymphoma

Diverse and elusive HA*mc N/V, visual dield defect, seizure Endocrine dysfn- precocious or delayed puberty, anorexia, polyuria

brain tumor

Best imaging choice for brain tumor

MRI

Neuroblastoma imaging options

Imaging- plain films show calcifications CT staging- extent of primary tumor, lymph node mets MRI- determine spinal cord involvement

Pain over involved area w/ or w/o associated soft tissue mass Systemic sx usually absent

Osteosarcoma

Asymptomatic abd mass Abd pain, HTN, groww hematuria, fever Constipation that does not resolve w/ tx

Wilms Tumor

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

Retinoblastoma

MC cause of hemolytic dz of newborn

ABO Incompatibility

Keratin filled papule usually found o the face, without erythema

Milia

"Similar to neonatal acne- mother is worried pores are clogged Will regress when hormone levels decline

Sebaceous Hyperplasia

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

Neonatal Acne

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

Seborrheic Dermatitis

Color change in neonates sometimes confused with port wine stains

Harlequin Color Change

Marble or lacy pattern usually symmetric on extremities

Mottling | cutis marmorata

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

Erythema Toxicum

Vesicles with cloudy fluid (at birth) —> denuded forming white crusts —> hyperpigmented macules No erythema or clustering

Pustular Melanosis

Creases are not affected, rash in area of contact

Allergic Contact Dermatitis

Satellite lesions, beefy red, affects folds/creases

Candida Diaper Dermatitis

Benign hyperpigmented (usually brown) irregularly shaped macule or patch Found anywhere on body

Café At Lait

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

Slate Grey Patch

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

Infantile Hemangioma

Blanchable capillary malformation usually isolated

Port Wine Stain

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

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

Rare tan-black colored hamartomas can be small, med or large Irregularly shaped and have pliosebaceous glands (hair)

Congenital Melanocytic Nevus

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

Measles (Rubeola)

Swelling of paroitid gland- can not see jawline Fever, malaise, HA, myalgias followed by parotitis 48 hr later (can last up to 10 days)

Mumps

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)

Rubella

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)

Erythema Infectiousum (Fifth Disease)

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

Roseola Infantum | Sixth disease

Acute onset fever, rapid painful eruption of punched out vesicular lesions May have excessive swelling and erythema-indicating bacterial superinfection

Eczema herpeticum

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

Varicella Zoster

Initial tingling painful dermatomal distribution of | erythematous vesicular lesion

Herpes Zoster “shingles”

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

Molluscum Contagiosum

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

Staphylococcal Scalded Skin Syndrome

Rapid onset fever, HA, vomiting, intense myalgias, Pete Niall/ourpuric rash on trunk/extremities Progress quickly to AMS, shock and DIC

Neisseria Meningitis

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)

Lyme Disease

MC cause of fever in infants <28 yo

Group B Strep, E. coli, & Listeria

MC cause of fever in 28day -3 mo old

viral illnesses

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

fever of unk origin