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Pediatric Clinical Medicine > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

gastro-colic reflex

A

colon, rectum, and anus are stimulated to evacuate 15-20 min after eating
- good time to have kids sit on toilet if constipated

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2
Q

chronic abdominal pain - time frame

A

pain lasting longer than 6 months

- constipation is one of the most common causes

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3
Q

emesis (aka vomiting)

A

forceful expulsion of stomach contents though glottis, rarely occurs in absence of nausea

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4
Q

retching (aka dry heaving)

A

same mechanism as vomiting, but glottis remains closed

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5
Q

regurgitation

A

return of small amount of food or secretions to the hypo pharynx; effortless

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6
Q

tachycardia causes (GI)

A

dehydration, fever, pain, anxiety

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7
Q

tachypnea causes (GI)

A

pneumonia, acidosis (from slight dehydration or pooping out HCO3)

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8
Q

encopresis

A

fecal incontinence caused by leakage of retained stools

- due to long standing chronic retentive constipation that has been under-treated or untreated

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9
Q

Crohn’s disease - clinical presentation

A

abdominal pain, weight loss, diarrhea, hematochezia, growth failure, delayed puberty
- hint: anal tags and perianal fistulas

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10
Q

Ulcerative colitis - clinical presentation

A

abdominal pain, weight loss, fevers, blood or mucous in diarrhea, nocturnal diarrhea, growth failure, delayed puberty
- hint: anal tags and perianal fistulas

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11
Q

cholestyramine (Questran)

A

possible management for diarrhea associated with viral gastroenteritis (binds stools)
- 1/3 pack mixed with food TID until formed stools

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12
Q

Promethazine (Phenergan)

A

suppository; works for vomiting, w/ potential for respiratory depression and toxicity in younger kids
- contraindicated in kids < 2

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13
Q

most useful individual signs for dehydration in children

A

capillary or sternal refill time
skin turgor (pinch skin fold on lateral abdomen)
respiratory pattern

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14
Q

causes of short stature

A

Normal: constitutional growth delay, familial short stature

Pathological:

  • Nutritional deficiency (diet, anorexia, malabsorption)
  • Endocrine: hypothyroidism, Cushings, GH deficiency, precocious puberty
  • Chromosome defects: Turner (girls), Prader Willi (girls and boys), noonan (girls and boys)
  • Skeletal dysplasia
  • IUGR
  • Metabolic causes: renal disease
  • Chronic diseases: CF
  • Pyschosocial deprivation
  • Drugs: glucocorticoids, stimulants
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15
Q

short stature

A

height > 2SD below mean for age and gender OR > 2 SD below mid-parental height
- can still have normal growth velocity

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16
Q

growth failure

A

abnormally slow growth velocity OR crossing 2 percentile lines on growth chart

  • inadequate growth velocity
  • often first signs of underlying issue (cardiac, GI renal, endocrine)
  • within 1st 3 yrs of life = failure to thrive
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17
Q

causes of failure to thrive

A

diet, psychosocial, diseases that effect metabolism or absorption (cardiac, renal disease, celiac, IBD, et.)

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18
Q

primary hypothyroidism

A

failure at level of thyroid gland (low T4 and inc. TSH)

  • severe primary hypothyroidism: since TSH is similar to FSH, girls get breast enlargement and boys get testicular enlargement
  • leads to poor liner growth and delayed bone age (different than central precocious puberty)
  • growth chart: height falls off before weight; can occur at older age
  • physical clues: younger face, puffiness in lower face, tongue enlargement, thinning of lateral eyebrows
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19
Q

central hypothyroidism

A

failure occurs at level of pituitary (low / normal TSH and low T4)

  • occurs along with GH deficiency and possibly other pituitary hormone deficiencies
  • leads to poor liner growth and delayed bone age (different than central precocious puberty)
  • defect at level of brain: workup for brain tumor
  • growth chart: height falls off before weight; can occur at older age
  • physical clues: younger face, puffiness in lower face, tongue enlargement,
20
Q

growth chart clue to endocrine disorder

A

height falls off before weight

  • primary or central hypothyroidism
  • growth hormone deficiency
  • Cushing’s: height plateaus and weight increases

Note: Turner syndrome (girls) also shows fall off of height growth curve

21
Q

growth hormone deficiency v. hypothyroidism

A

for GH deficieny, height falls off steeply b/t 3-9 months

- more dramatic than hypothyroidism

22
Q

gonadarche

A

activation of HPG (hypothalamic-pituitary-gonadal) axis
- GnRH from hypothalamus - LH/FSH from anterior pituitary - estrogen from ovaries or girls or testosterone from testicles of boys

Girls: breasts, sex organs, linear growth
Boys: testes and penile enlargement, linear growth

23
Q

adrenarche

A 
production of adrenal androgens from adrenal gland
completely separate from GnRH, FHS, LH
 - Pubic and axillary hair
 - Body odor
 - Acne
24
Q

thelarche

A

onset of breast development (subset of gonadarche)

-premature thelarche can occur in abbess of gonadarche and adrenarche (benign incomplete precocious puberty)

25
Q

menarche

A

beginning of menstruation in girls

  • mean: 12 y/o
  • early limit: 10 y/o (9 y/o AA)
26
Q

what stimulates linear growth

A

gonadarche in girls and boys

  • estrogen from ovaries and girls at onset of puberty
  • testosterone conversion to estrogen (via armomatase) in boys during mid to late puberty

Bone age advances with eventual closer of growth plates

27
Q

adrenal gland testing (adrenarche)

A

serum testosterone, DHEA-S, androstenedione, 17-hydroxyprogesterone

28
Q

delayed puberty in females

A

no pubertal signs by 13 years OR lack of progression with no menarche 4 yrs after puberty onset

29
Q

delayed puberty in boys

A

no pubertal signs by 14 years OR lack of progression with incomplete genital growth 5 yrs after puberty onset

30
Q

delayed puberty - 2 causes

A

hypogonadotropic hypogonadism (central hypogonadism): HPG axis dysfunction (low GnRH or LH/FSH

hypergonadotropic hypogonadism (primary hypogonadism): defect in target organs (ovaries / testies) so they do not enter gonadarche
 - usually sex chromosome abnormalities: Turner syndrome (XO) and Klinefelter syndrome (XXY)
31
Q

causes of primary hypogonadism (hypergonadotropic hypogonadism)

A

Usually sex chromosome abnormalities:

  • Turner syndrome (XO)
  • Klinefelter syndrome (XXY), Noonan’s

Additional cases of primary ovarian failure: xx gonadal dysgenesis, galactosemis, radiation/chemo, autoimmune destruction

Additional cases of primary testicular failure: cryptorchidism, radiation

32
Q

causes of central hypogonadism (hypogonadotropic hypogonadism)

A

Congenital: Kallmann Syndrome, Prader-Willi Syndrome, congenital growth delay (reversible / temporary)

Acquired: pituitary or hypothalamic tumors, cranial irradiation, infection

Functional: anorexia/malnutrition, excessive exercise, hyperprolactinemia, hypothyroidism

Reversible: CGD and other causes acquired and functional causes that can be corrected

33
Q

Kallman Syndrome

A

central hypogonadism (gonadotropin deficiency - GnRH neurons have improper migration during embryological development)

  • can occur in girls and boys
  • normal stature with absent or delayed puberty
  • anosmia or hyposmia (sense of smell), micro penis, undescended testes, cleft palate
34
Q

Prader Willi Syndrome

A

central hypogonadism (defect on chromosome 15)

  • can occur in girls and boys (more common boys)
  • short stature (GH deficiency), poor muscle tone and poor feeding as baby
  • cognitive/developmental delay, chronic hunger leading to obesity and type II DM
35
Q

Turner Syndrome

A

primary hypogonadism (absent or abnormal 2nd X chromosome)

  • only seen in females
  • most common cause of short stature in females
  • fall of height growth curve, swollen hands and feet at birth
  • short stature, inc. carrying angle of arms, webbed neck, small or retracted chin, ovarian failure, aortic coarctation
36
Q

Klinefelter’s Syndrome

A

primary hypogonadism (extra x chromosome - XXY)

  • only seen in boys
  • learning disabilities, micropenis, small testes, arrested puberty, gynecomastia (low testosterone does not balance estrogen), infertility
37
Q

gynecomastia - when is it normally seen and when sigg of issue

A

can occur normally in pubertal boys until testosterone “over-rides” estrogen later in puberty

if occurs in pre-pubertal boys = sign of excess exogenous or endogenous estrogen
- abnormal adrenal gland with inc. aromatization

38
Q

evaluation of patient with growth concerns

A

plot height and weight
bone age
screening labs:
- CMP: renal disorders
- CBC: underlying chronic condition
- Chromosomal analysis: Turner’s (girls), Prader-Willi, Noonans (boys)
- Thyroid panel: TSH and T4 central or primary hypothyroidism
- IGF-1 or IGFBP-3: GH deficiency
- IBD: history (stools, pain), ESR (inflammation)
- Celiac: TTG and IgA

39
Q

evaluation of patient with delayed puberty

A

history: cranial radiation, chemotherapy, family hx of genetic disorders, exercise/nutrition/eating disorders, previous concerns about grown, sense of smell

height and growth rate (velocity): will not see if child has delayed puberty since initiated by estrogen

Bone age: delayed puberty typically results in delayed bone age

Labs:

  • gonadotropins (FSH/LH), testosterone, estradiol
  • if FSH and LH elevated: get karyotype to look for sex chromosome defects
  • TSH, T4: r/o hypothyroidism
  • Prolactin: rule out prolactemia
  • CBC, ESR, CMP
40
Q

complete precocious (early) puberty (aka central precocious puberty)

A

early activation of GnRH pulse generator results in early sexual development

  • includes accelerated linear growth w/ advance bone age
  • in girls, will also see signs of adrenarche if > 5 y/o
  • age cut-off: girls < 8 (<7 for hispanic and AA); boys < 9

Causes: cranial radiation, infection, trauma; brain tumor, idiopathic (most)

Manage: cranial MRI
Treatment: GnRN agonist

41
Q

incomplete precocious (early) puberty

A

does not involve GnRH and HPG axis
- not associated with linear growth acceleration or advanced bone age

premature thelarche: breast development w/o other signs of puberty and no inc. growth velocity

  • watch for signs of inc. growth velocity every 4 months
  • get bone age and estradiol levels

premature adrenarche: can result in pubic hair w/ no signs of gonadarche
- causes: benign premature adrenarche, adrenal r testicular tumors, congenital adrenal hyperplasia (CAH)

42
Q

treatment for complete precocious puberty

A

First: must get MRI of brain (r/o CNS tumor) - boys greater risk

GnRH agonist: constant agonist blocks pulsatile signal from hypothalamus to pituitary

  • delay’s bone age (inc. chance to reaching genetic potential)
  • stops puberty (psychosocial reasons)
43
Q

causes of peripheral precocious (early) puberty in females (relatively benign)

A

puberty occurring independent of gonadotropin secretion:

- ovarian cysts, exogenous estrogens (lavender, tea tree)

44
Q

McCune-Albright Syndrome

A

mutation in estrogen receptors on ovary and other “hormone-producing tissues” that sees estrogen all of the time

  • see advanced ben age due to consistent estrogen secretion
  • triad of precocious puberty, cafe-au-alit spots, and fibrous dysplasia of multiple bones
45
Q

thinking functional constipation - what are red flags

A

did not pass meconium w/in 48 hours of birth
fever, vomiting, blood in diarrhea, failure to thrive, tight/empty rectum on PA, anal stenosis, impaction, abd distention

46
Q

thinking functional abdominal pain - what are red flags

A

persistent RUQ and RLQ pain, persistent vomiting, dysphagia, waking at night due to pain, nocturnal diarrhea, unexplained fever, FH of PUD, UC, Celiac, arthritis, peri-rectal disease, GI blood loss, weight loss, deceleration of linear growth, delayed puberty

Pediatric Clinical Medicine (4 decks)

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