Falcon Review Pediatrics 3 Flashcards
1
Q
A patient presents with a history of sweating while feeding, what pathology does this suggest
A
Suggestive of cardiac disease
2
Q
What physical exam findings are suggestive of cardiac disease pediatrics
A
Poor growth or failure to thrive Abnormal heart rate blood pressure Crackles suggest of left-sided failure Hepatomegaly suggestive of right-sided failure Cyanosis or clubbing Murmur
3
Q
What is the best diagnostic test for pediatric cardiovascular disorders
A
Echocardiography
Other studies are helpful such as chest x-ray EKG MRI and cardiac catheterization
4
Q
Generally speaking define innocent murmurs
A
Usually soft
Never just diastolic
Never associated with a thrill or a click
Do not require additional work up
5
Q
Name the four major types of innocent murmurs
A
Stills
Pulmonary flow murmur
Pulmonary ejection murmur
Venus hum
6
Q
Describe a stills murmur
A
3 to 6 years old
Soft vibratory or musical systolic ejection murmur heard at left lower to mid sternal border
7
Q
Describe a pulmonary flow murmur
A
0 - 6 months of age
High-pitched blowing systolic murmur at upper left sternal border due to turbulent flow at the origin of the right and left pulmonary arteries
Transmits to back and axilla
8
Q
Define pulmonary ejection murmur
A
Similar to pulmonary flow murmur
8 to 14 years of age
Blowing early systolic murmur at upper left sternal border due to increased flow over the pulmonary valve
9
Q
Define a Venus hum
A
Not a true murmur
3 to 6 years of age
Continuous (starts in systole and spills into diastole) murmur
Heard in supraclavicular or infraclavicular areas, disappears with compression of jugular vein Institute and supine position
10
Q
What other concerns should you have for a patient with a congenital heart disease
A
30% of patients will have other anatomic abnormalities
11
Q
What are the common causes of cyanosis
A
Cardiac
Pulmonary
Hematologic
Neurologic
12
Q
What is the best test isolates the cause of cyanosis
A
Hyperoxia test
13
Q
What are the expected results for cardiac disease causing cyanosis on the hyperoxia test
A
Before oxygenation less than 40 PaO2
after oxygenation less than 50 PaO2.
With complete mixing before you have 50 PaO2 after oxygenation you’ll have less than 150 PaO2
14
Q
What valves open with systole
A
Aortic and pulmonic
15
Q
What valves close with systole
A
Tricuspid and mitral
16
Q
What is the most common congenital heart malformation
A
VSD
Ventricular septal defect
17
Q
Will a large or small ventricular septal defect have a soft murmur
A
large
18
Q
What are the symptoms of a large ventricular septal defect
A
Congestive heart failure Active precordium Hepatomegaly Crackles BVH or LVH
19
Q
What is Eisenmenger’s physiology
A
Initially there is a left to right shunt
Then right ventricular hypertrophy and increased pulmonary vascular resistance
Then a right to left shunt develops
Blood is bypassing lungs and leads to cyanosis
20
Q
What murmur is highly suggestive of a the ventricular septal defect
A
Holosystolic murmur (Harsh or soft) at lower left sternal border
21
Q
What is the prognosis of a ventricular septal defect
A
30 to 50% of cases will close spontaneously by two years
Surgical closure for failure to close and large defects
22
Q
What is the normal cardiac to rib cage ratio
A
Less than 0.5
23
Q
When does pulmonary vascular resistance reached its nadir in pediatrics
A
Eight weeks
You will begin to get an increase in left to right shunting
24
Q
What is the most common type of ASD
A
Ostium secundum type
25
Most patients with ASD or asymptomatic until when
Third decade of life
26
What murmur is suggestive of an atrial septal defect
Systolic ejection murmur and left mid and upper sternal border,
Wide fixed split S2 due to an increased blood in the right atrium and ventricle being pushed through the pulmonic valve
27
Discuss normal physiology of a split S2
With inspiration the pulmonic valve closes a little later
28
What many seen on X-ray with an atrial septal defect
An enlarged right atrium in ventricle
29
What is the biggest risk factor for endocardial cushion defect
Trisomy 21
30
What murmur is associated with endocardial cushion defect
Holosystolic murmur heard at apex (AV valve insufficiency)
31
What is a PDA
Patent ductus arteriosus
Failure of closure of ductus resulting in blood flow from aorta to pulmonary artery
Common in prematurity
32
What symptoms are associated with a large PDA
Pulmonary overload
Wide pulse pressure
Bounding arterial pulses
33
In infants what may be used to help close the PDA
Indomethacin
| prostaglandin inhibitor
34
What cardiac malformation is highly associated with Turner's syndrome
Coarctation of the aorta
35
What murmur is associated with coarctation of aorta
Short systolic murmur at the left upper sternal border with radiation to left back
36
What chest x-ray findings are associated with coarctation of the aorta
Marked cardiac enlargement
Increased pulmonary vascular markings
Rib notching (from enlarged collaterals)
37
What congenital malformations are associated with cyanotic heart disease
The five T's
```
Truncus arteriosus
Transposition of the great arteries
Tricuspid atresia
Tetrology of Fallot
Total anomalous pulmonary venous return
```
Pulmonary atresia
Large VSD
The last two or associated with cyanotic heart disease after Eisenmenger's physiology
38
What's the most common cause of congenital cyanotic heart disease
Tetralogy of Fallot
39
What are the findings associated with tetralogy of Fallot
Ventricular septal defect
Pulmonary stenosis
Hypertrophy of right ventricle
Overriding aorta
40
What determines the cyanotic yet spells associated with Tetralogy of Fallot
Ventricular pressure determines the direction of bloodflow
Acyanotic tetralogy is associated with sufficient pulmonary bloodflow shunting across the VSD is balanced
Paroxysmal cyanosis tet spells occur when systemic resistance drops or pulmonary resistance increases
41
What will reverse the paroxysmal cyanosis associated with pathology of Fallot
Increasing the left side pressures will reverse the right to left shunt such as bringing the knees to the chest or squatting
42
What are the murmurs associated with tetralogy of Fallot
VSD over the lower left sternal border
| Pulmonic Stenosis
43
What chest x-ray finding do you expect to have with tetralogy of fallot
Boot shaped heart
44
What is the transposition of great vessels
Aorta arises from right ventricle, pulmonary artery arises from left ventricle resulting in a parallel circulation
Must be some communication atrial, septal or ductal levels to be compatible with wife
45
What is the most common cause of extreme cyanosis within the first 24 hours of life
Transposition of the great vessels
46
Will the cyanosis correct with oxygenation for a transposition of the great vessels
No
47
What is the treatment for transposition of the great vessels
Prostaglandin to maintain ductus open is life-saving used PGE
Surgical correction is definitive
48
What do you expect to find with pulmonary atresia on EKG
Tall spiked P waves suggestive of right atrial enlargement, right ventricular hypertrophy
49
What is the treatment for pulmonary atresia
Maintain ductus open until surgery
50
What murmur is associated with pulmonary stenosis
Harsh systolic ejection murmur with ejection click at left upper sternal border
51
What findings suggestive of tricuspid atresia
Cyanosis at birth
Systolic murmur along left sternal border
Single S2
Left axis deviation in the infant
52
What findings on X-ray are suggestive of a total anomalous pulmonary venous return
The snowman or figure 8 with cardiomegaly
53
What murmur is associated with total anomalous pulmonary venous return
Systolic murmur at left upper sternal border
| S2 fixed and widely split
54
Increase flow over the pulmonic valve will cause what heart sound
Split S2
55
What is truncus arteriosus
Single vessel arises from the ventricles supplying systemic/pulmonary/coronary circulation
56
What the complications of a hypoplastic left heart
Inadequate systemic circulation and pulmonary venous hypertension
Small aorta
57
What is the most common cause of myocarditis
Viral etiology is most common enterovirus (coxsackie) virus and adenovirus
58
What are the causes of a dilated cardiomyopathy in infants
Often idiopathic
| Maybe associated with neuromuscular disease, drug toxicity, and chemotherapy (including doxorubicin)
59
What is the diagnostic study for cardiomyopathies
Echocardiogram
60
What causes acute rheumatic fever
GABHS
| 1 to 3 weeks after preceding streptococcal infection is commonly in 5 to 15-year-olds
61
What is required to diagnose acute rheumatic fever
The Jones criteria
| - Must have two major criteria or one major and two minor criteria plus evidence of preceding strep infection
62
What are the Major Jones criteria
```
Carditis
Arthritis
Erythema marginatum
Chorea
Subcutaneous nodules
```
63
What are the minor Jones criteria
```
Fever
arthralgia
elevated acute phase reactants
Prolonged ER
Previous rheumatic fever
```
64
What is the treatment for acute rheumatic fever
Treat streptococcal infection and monthly penicillin prophylaxis
Salicylates to decrease myocardial inflammation
Steroids for carditis
65
What is a complication of acute rheumatic fever
Valvular heart disease
66
What are the most common organisms that cause endocarditis
Staff aureus
| Streptococcus Viridans
67
What are the signs and symptoms of endocarditis
Acute or insidious onset
Persistent fever, chills, arthralgias, new murmur, petechiae
Oslers nodes (painful)
Janeway lesions (painless) splinter hemorrhages
68
How is endocarditis diagnosed
Echocardiogram
69
What preventative measures must be taking with endocarditis
Prophylactic antibiotics prior to dental visits
70
How is hypertension diagnosed in pediatrics
What pressure above 95% for age 3 review measurements
71
What is the most common cause for pediatric hypertension
Most commonly secondary
| Renal is 75 to 80%
72
What are the risk factors for pediatric arrhythmias
```
Congenital, acquired or functional heart disease
Electrolyte abnormalities
Drug toxicity
Poisoning
Collagen vascular disease
```
73
What are some causes of sinus bradycardia pediatrics
Increased vagal tone
hypothyroidism
increased intracranial pressure
anorexia nervosa
Most commonly a normal finding in healthy athletic children
74
What is the difference between a Mobitz type I and a Mobitz type II heart Block
Type one will have a prolongation of PR then a drop a QRS
| Type II will just drop the QRS
75
What maternal diseases associated with a third degree heart block in infancy
Maternal lupus
76
What are the causes of sinus tachycardia
```
Hypovolemia
Shock
Anemia
Fever
Sepsis
Pulmonary embolism
Medications
```
77
What do you expect to see on an EKG for supraventricular tachycardia
A runn of three or more premature supraventricular beats a greater than 230 beats permitted
Abnormal or absent P waves
Key association with WPW syndrome
78
What is WPW syndrome
Anomalous conduction pathway to ventricles bypassing the AV node which leads to premature and prolonged depolarization of ventricles
Predisposes to SVT
On the EKG: shortened PR, Delta wave, wide QRS
79
What is the treatment for long QT syndrome
Beta blocker
80
What is apnea of prematurity
Premature infants less than 36 weeks of gestation holding their breath for periods of less than 15 seconds
81
What is the treatment of apnea prematurity
Theophylline/caffeine as central stimulant
82
What is the obstructive sleep apnea
Prolonged partial airway obstruction intermittent cessation of breathing disrupting sleep and breathing
83
What are the pediatric risk factors for obstructive sleep apnea
Adenotonsillar hypertrophy
trisomy 21
Anatomical abnormalities
84
What is used to diagnose obstructive sleep apnea
Polysomnography
85
What are the complications of obstructive sleep apnea
Cor pulmonale
Poor growth
Poor school performance
86
What is cyanotic breath holding
Breath holding spells between the ages of one and three years old usually associated with temper tantrums or angry outbursts
It's self-limited and very benign
87
What is Pallad Breath holding
Associated with fright
Patient becomes pale and hold breath
loses consciousness
88
What is the most commonly aspirated food
Peanuts
| Popcorn, grapes, hot dogs are also common
89
What are the signs and symptoms of a foreign body aspiration
Cough, Strider, shortness of breath, cyanosis
| Localized wheezing or new onset wheezing
90
How will a chest x-ray demonstrate foreign body aspiration
With an expiratory expiratory film. The effected side is the same appearance for both inspiration and expiration
Ball valve mechanism
91
What is the treatment for foreign body aspiration
Bronchoscopy
92
What is the pneumothorax
Intrapleural accumulation of air, maybe spontaneous or traumatic
93
What are the causes of the pneumothorax
CF, congenital lobar emphysema, asthma, pertussis,
| Due to excessive cough
94
What is croup
Laryngotracheobronchitis
95
What are the most common causes of croup
Parainfluenza is the most common
Adenovirus, RSV, influenza
Most common three months to five years of age
96
What is the expected x-ray finding for croup
Staple sign
| Suggestive of subglottic swelling
97
What is the treatment for croup
Humidified air in mild cases such as the steam from a shower
| For ill children you can use corticosteroids
98
What is spasmodic croup
episodic and recurrent stridor associated with croup without the associated viral symptoms
99
What is the most common cause of bacterial tracheitis
Staph aureus
100
What are the signs and symptoms of bacterial tracheitis
Strider, respiratory distress, toxic appearance, "Brassy" cough, purulent airway secretions
101
What is epiglottitis
Acute inflammation of the epiglottis
Most commonly H influenza type B, can be strep pneumo-, nontypeable H. influenzae
Most common 2 to 7 years of age
102
What are the signs and symptoms of epiglottitis
Sudden onset of high fever, dysphasia, drooling, muffled voice, respiratory distress, tripod position, neck hyperextension
103
What is the main concerns with epiglottitis
The number one priority is securing the airway
TONGUE BLADE EXAM SHOULD NOT BE DONE OR ANY AGITATION PROCEDURE
104
What is bronchiolitis
Lower respiratory tract infection caused by inflammatory obstruction of the small airways
Usually less than two years of age
RSV is most common
105
What are the signs and symptoms of bronchiolitis
URI, rhinorrhea, fever, may progress to respiratory distress and poor feeding
Tachypnea, wheezing, crackles, retraction, cyanosis
106
What is pneumonia
Inflammation of pulmonary tissue associated with consolidation of alveolar spaces
Most commonly viral
107
What are the signs and symptoms of pneumonia
Fever
Tachypnea
Cough
108
What are the likely causes of pneumonia in neonates
```
Gram-negative rods
E. coli
Lysterria
Enterococcus
Klebsiella
```
109
What are the most likely causes of pneumonia in preschool age children
Strep pneumonia
Staph aureus
Viral is the most common
110
What is the most likely causes of pneumonia and school-age and up
Mycoplasma/chlamydia
Strep pneumonia
Staph aureus
Viral most common
111
What will viral pneumonia show on a chest x-ray
Streaky infiltrates, peribronchial coughing
| No consolidation
112
What will a bacterial pneumonia show on a chest x-ray
Lobar consolidation
113
What is the treatment for mycoplasma pneumonia
Macrolides or quinolones
| Most commonly azithromycin
114
Who is most likely to get chlamydia trachomatis pneumonia
Six weeks to six month olds
115
What type of cough is associated with chlamydia trachomatis pneumonia
Staccato cough
116
What is the treatment for chlamydia trachomatis pneumonia
Erythromycin
117
What is the treatment needed for aspiration pneumonia
Anaerobic coverage such as clindamycin in addition to usual bacterial coverage
118
What is asthma
Reversible obstructive airway disease affecting small and large airways
119
What are the components of asthma such as clinical findings
Bronchospasm
Mucus production
Airway inflammation
120
What are the triggers to asthma
```
Infection
Exercise
Cold
Allergens
Smoke
```
121
What can be used for serious acute exacerbations of asthma
Magnesium sulfate
| Terbutaline confusion
122
What is mild intermittent asthma
Daytime symptoms less than two times per week
| Nocturnal symptoms less than two times per month
123
What is mild persistent asthma
Daytime symptoms greater than two times per week but less than one times per day
Nocturnal symptoms greater than two times per month
124
What is moderate persistent asthma
Daily symptoms
| Nocturnal symptoms greater than one time per week
125
What is the severe persistent asthma
Continuous symptoms
| Frequent nocturnal symptoms
126
What is the treatment for mild intermittent asthma
No daily medication
| Short acting bronchodilator as needed
127
What is the treatment for mild persistent asthma
One daily medication- low dose inhaled corticosteroid
| Short acting bronchodilator as needed
128
What is the treatment for moderate persistent asthma
One daily medication-medium acting inhaled corticosteroid and a long acting bronchodilator
Short acting bronchodilator as needed
129
What is the mutation associated with cystic fibrosis
Deletion
| Most common mutations Delta 508
130
What is the major problem associated with cystic fibrosis
Abnormality of the chloride transport
Thick mucus and impaired pancreatic secretions
Average age is 30 years
131
What are the signs and symptoms of cystic fibrosis
```
Meconium illeus, rectal prolapse, failure to pass meconium in first 24 hours
Recurrent respiratory infections
Stearrhea
Vitamin deficiency A,D,E and K
Nasal polyps
Diabetes mellitus
Delayed sexual development
```
132
What is the gold standard to diagnose cystic fibrosis
Sweat chloride test
133
What is the treatment for cystic fibrosis
1. clear secretions
- VEST, Chest PT, inhalation therapy, DNAse
2. nutrition therapy
- Pancreatic enzyme replacement, Vitamins
3.treat infection aggressively
134
What is a duodenal atresia
Obstruction resulting from failure to re-canalize the duodenal lumen
135
What are the risk factors for duodenal atresia
Trisomy 21
136
What are the signs and symptoms of duodenal atresia
Bilious vomiting, often on the first day of life
| Usually no abdominal distention
137
What's will an x-ray show for a duodenal atresia
Double bubble
First bubble is air in the stomach
Second bubble is air in proximal duodenum
No air in the rest of the intestines
138
What is Hirschsprung's disease
Absence of ganglion cells of bowel wall
139
What are signs and symptoms of Hirschsprung disease
Failure to pass meconium in 24 hours
| Obstruction leads to bowel dilation
140
What is the treatment for Hirschsprung disease
Surgical resection
141
What is meconium ileus
Abnormally thick meconium can cause in utero or neonatal blockage
Volvulus and bowel infarction can occur
142
What is the risk factors for meconium ileus
Cystic fibrosis
| 90% of patients with meconium ileum have cystic fibrosis
143
What is appendicitis
Blockage of appendiceal lumen
| Most commonly caused by lymphoid hyperplasia, feoclith
144
What are the causes of gastroesophageal reflux
Inappropriate LES relaxation, hiatal hernia, delayed gastric emptying
Common in all
145
When is gastroesophageal reflux considered pathological
Infants not gaining weight
Pain and discomfort
Aspiration
146
What are the signs and symptoms of gastroesophageal reflux
Vomiting, chronic cough, wheezing, apnea, failure to thrive, substernal chest pain
147
What is the treatment for gastroesophageal reflux
Head elevation
Thickening of seeds (rice, bananas)
Medical managements: H2-blockers, proton pump inhibitors, prokinetic's
Surgical correction: Nissen fundoplication
148
What are the risk factors for pyloric stenosis
Firstborn males
149
What are the signs and symptoms of pyloric stenosis
Nonbileus projectile vomiting usually beginning of 3 to 4 weeks of age
Happy vomiter
150
What happens with excessive vomiting
Hypokalemic, hypochloremic, metabolic alkalosis
With vomiting you lose hydrogen which leads to alkalosis. Also vomiting chloride which leads to hypochloremia.
Because you are alkolotic, your kidneys begin excreting potassium instead of hydrogen to maintain the hydrogen which leads to hypokalemia
151
What will ultrasound demonstrates for pyloric stenosis
Thickened elongated pylorus
152
What is the treatment for pyloric stenosis
REHYDRATION AND ELECTROLYTE CORRECTION FIRST
Then surgical correction
153
What is colic
Rules of three
1. Usually seen three weeks to three months of age
2. Crying for greater than three hours per day
3. More than three times per week for no other reason
154
What are the signs and symptoms of small bowel instruction
Bilious vomiting
155
What are the two classifications of diarrhea
Infectious
| Malabsorptive
156
One of the two mechanisms of diarrhea
Osmotic
- stool volume depends on diet and decreases with fasting
Secretary
- Stool volume is increased and does not increase with diet
157
What is the most common cause of infectious diarrhea
Viral is most common: rotavirus
Bacterial
Parasitic
158
What are the features of rotavirus
Watery diarrhea for 7 to 10 days
| Maybe associated with vomiting
159
What is associated with enteropathogenic E. coli
Nurseries and daycare
160
What are the features of enterotoxigenic E. coli
hemorrhagic colitis
| Associated with hemolytic uremic syndrome
161
What are the features of Yersinia associated diarrhea
Transmitted by pest, contaminated food
Maybe associated with arthritis and rash
Often confused with IBD
Pseudo-appendicitis
162
What is the onset of time for staph aureus toxin mediated associated diarrhea
Within 12 hours of ingestion
| Other food toxins will take closer to 24 hours before symptoms manifest
163
What is the treatment for diarrhea
Ensure adequate hydration
164
What is the most common cause of constipation
Functional (voluntary withholding)
Other causes include: meconium ileus (CF) Hirschsprung disease, botulism, hypothyroidism
165
What is encopresis
Fecal incontinence after age 4 years
166
What are the signs and symptoms of encopresis
Leakage of loose stool around obstruction
167
What is hematemesis
Blood stained vomitus
Usually indicates bleeding proximal to the ligament of Treitz
(Dividing line between duoden and jejunum)
168
What is allergic proctocolitis
Streaks of blood in stool
Typically not ill appearing with history of milk use or exposure
Hematochezia in infancy one day to three months of age is typical
169
What is the treatment for allergic proctocolitis
Partially hydrolyzed formula
| Hypoallergenic formula
170
What is Meckel's diverticulum
Known as the happy bleeder
Most common congenital G.I. anomaly
Vestigial remnant of the omphalomesenteric
Disease of 2's
2% infants, two years, 2 cm, 2 feet from ileocecal valve
171
What are the signs and symptoms of Meckel's diverticulum
Painless rectal bleeding
172
What will hard stools induce
Anal fissures
173
What is an intussusception
Portion of G.I. tract telescopes into portion Distal to it; most are ileocolic
6-24 months
Associated with lympoid hyperplasia (peyer's patches), Meckel diverticulum
174
What are the signs and symptoms of intussusception
Acute onset of cramping intermittent pain, lethargic, currant jelly stool, soft sausage shaped mass on rectal exam
175
What is both diagnostic and therapeutic for intussusception
Barium enema
Surgical intervention needed if failed reduction with enema twice
176
What are the signs and symptoms of Crohn's
```
Weight loss
Fever
Abdominal pain
Growth failure
Diarrhea
Perianal disease or mouth ulcers
```
177
What does a colonoscopy and biopsy demonstrate for Crohn's disease
Skip lesions
Transmural inflammation
Noncaseating granuloma's
178
What is the treatment for Crohn's disease
Steroids
| Immunosuppression
179
What are the signs and symptoms of ulcerative colitis
Involves only the colon
Bloody diarrhea with mucus
Abdominal pain symptoms
must be present for at least 3 to 4 weeks to make a diagnosis of exclusion
180
What is the complication of ulcerative colitis
colon cancer
181
How is a obesity determined in pediatrics
BMI greater than 95% for age/sex
| BMI greater than 30 in adolescence
182
What are signs and symptoms of obesity in pediatrics
Striate
Pseudogynecomastia
Early puberty
183
What are the causes of obesity in pediatrics
Endocrine (cushion, hypothyroidism, Prader-Willi)
Genetic (turner)
Most commonly lifestyle
184
What is celiac disease
Gluten sensitive enteropathy
Develop when gluten containing foods (wheat, rye, barley) introduced 6 to 12 months, depending on preference leading to failure to thrive
185
What is the pathophysiology of celiac disease
Intraepithelial lymphocytes in villi causing villous blunting
Associated with dermatitis herpetiformis
186
What is the dermatitis herpetiformis
Erythematous vesicles distributed symmetrically over elbows and knees
187
What are the rest factors for celiac disease
Down syndrome
Type I diabetes mellitus
Autoimmune disease
188
What testing is available for celiac disease
Tissue transglutiminase
Anti-enodmysial antibody
Must obtain an IgA level at the same time to prevent a false negative
189
What's will biopsy demonstrate for celiac disease
Villus blunting and second biopsy following gluten-free diet with normalization of architecture
190
What is failure to thrive
Failure to gain weight or deceleration of weight growth
Less than 10 percentile
Crosses two or more percentile marks for growth curve
191
What are the causes for failure to thrive
Nonorganic (deprivation, neglect, abuse) is the most common cause
```
Malnutrition
Mal absorption
Allergies
Immune deficiency states
Chronic disease
```
192
What is the first thing to notice with caloric deprivation failure to thrive
Weight
193
What is affected more for failure to thrive due to hyporthyroidism and growth hormone deficiency
Height
194
What is constitutional growth delay
The child will follow the growth curves and will ultimately reach adulthood with a delayed growth spurt
195
What is familial short stature
Adult height will be below the growth curve
Normal curve throughout, just below the normal percentages
196
How do you tell the difference between a constitutional growth delay and familial short stature
By using a bone age
- If bone age is less than chronological age then the diagnosis constitutional growth delay
- If bone age equals chronological age, then diagnosis is from familial short stature
197
What is the symptoms of vitamin A deficiency
Ocular lesions (xerosis)
Night blindness
Dry skin
198
What are the symptoms of a thiamine (B1) sufficiency
Beriberi neuritis
Heart failure
Encephalopathy
199
What are the symptoms of the niacin deficiency
Pellagra
Diarrhea
Dermatitis,
Dementia
200
The symptoms of a pyridoxine (B6) deficiency
Seizures
Neuritis
Dermatitis
Anemia
201
What are the symptoms of a vitamin C deficiency
Scurvy
Pseudoparalysis
Mucous membrane hemorrhages
202
What are the symptoms of vitamin D deficiency
Rickets
Craniotabes
Rachitic rosary
Bowlegs tetany
203
What are the symptoms of vitamin E deficiency
Creatinuria
Muscle weakness
Anemia
204
What are the symptoms of vitamin K deficiency
Hyporprothrombinemia
| Bleeding
205
What are the symptoms are riboflavin (B2) deficiency
```
Seborrheic dermatitis
Anemia
chelitis/bursitis/stomatitis
Photophobia
Sore throat
edmatous oropharyngeal mucosa
```
206
What is the problem with adolescent pregnancy
Higher rates of illness and death from both mother and infant
207
What is pelvic inflammatory disease
Ascending spread of organisms from lower genital tract to cervix, endometrium and fallopian tubes
208
What is the most common calls of pelvic inflammatory disease
Chlamydia and gonorrhea
209
What are the signs and symptoms of pelvic inflammatory disease
Abdominal pain, cervical motion tenderness, adnexal tenderness;
May have fever, leukocytosis
210
What is the treatment for pelvic inflammatory disease
Gonorrhea: IM ceftriaxone
Chlamydia: 14 days of doxycycline
211
What is the reason we treat for pelvic inflammatory disease
```
To prevent complications such as
Tubo-ovarian abscess
Increase risk for ectopic pregnancy in the future
Decreased fertility
Fitzhugh Curtis syndrome
```
212
What is Fitzhugh Curtis syndrome
Perihepatitis
| PID plus right upper quadrant pain in transaminase elevation
213
What are the signs and symptoms of gonorrhea
Purulent vaginal discharge, dysuria, abdominal pain, arthritis (large joints)
214
What is the treatment for gonorrhea
Cefiximine for anything less than PID
Ceftriaxone for PID
Treat concurrently for chlamydia
Emperic testing for comorbid STDs
215
What complication is associated with gonorrhea
Fitzhugh Curtis-perihepatitis
216
What is chlamydia
Intracellular obligate parasites
| Most common STD
217
What is gonorrhea
Gram-negative intracellular diplococci
218
What are the signs and symptoms of chlamydia
They are often asymptomatic; use a routine screen
| Urethritis, cervicitis, PID
219
What is the treatment for chlamydia
Azithromycin or seven days doxycycline for urethritis/cervicitis
14 days doxycycline for PID
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Legally how are adolescents affected by reproductive health
There considers emancipated minors
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Herpes simplex virus type I most often affects what region
Make calls genital disease but usually oral and CNS infections
222
Herpes simplex virus type II soft effects what region
More common causes genital infection
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Where the signs and symptoms of herpes
Fever, regional adenopathy, dysuria, painful vesicles and ulcers
224
How's herpes diagnosed
Most often clinical but may use a tzanck smear
225
What is the treatment for herpes
Acyclovir for outbreaks-early in the course (within a day)
| If genital disease, evaluate for other STDs
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What is Trichomonas vaginalis
Mobile flagellated protozoan
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What are the signs and symptoms of trichomonas vaginalis
Malodorous, frothy, yellow-green discharge and vaginal itching
228
How is trichomonas vainalis diagnosed, what technique
What prep to look for leukocytes and Mobile trichomonads
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What is the treatment for trichomonas vaginalis
Metronidazole
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What causes bacterial vaginosis
Gardnerella vaginalis,
| Mycoplasma hominis
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What are the signs and symptoms of bacterial vaginosis
Send, white, foul-smelling discharge that smells "fishy" when mixed with KOH
Vaginal pH > 4.5
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What will a wet prep demonstrate for bacterial vaginosis
Clue cells
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What is the treatment for bacterial vaginosis
Metronidazole
234
What are the signs and symptoms of vaginal candidiasis
Thick, white, vaginal discharge with vaginal itching and burning
235
What will a wet prep demonstrate for vaginal candidiasis
KOH prep to look for yeast and pseudohyphae
236
What are the causes for amenorrhea in pediatrics
Primary: chromosomal (turner syndrome) or congenital (imperforate hymen)
Secondary: malnutrition (anorexia), endocrine disorders/hypothalamic
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What are the steps to diagnose amenorrhea
Evaluate for pregnancy and presents/absence of virilization
Progesterone challenge test: withdrawal bleeding will occur with normal endometrium tract presents
Check FSH, LH (elevated level suggest primary gonadal failure), TSH and prolactin
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What are the causes of dysmenorrhea
Primary: absence of pelvic condition and related to prostaglandin production
Secondary: structural abnormality, endometriosis
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What is the treatment for dysmenorrhea
Consider NSAIDs, OCP
240
What is polycystic ovarian syndrome
Excessive levels of LH resulting and increased ovarian androgen production
Associated with peripheral insulin resistance
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One of the signs and symptoms of polycystic ovarian syndrome
Multicystic ovaries, hirsutism, menstrual irregularities
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What is the treatment for polycystic ovarian syndrome
Consider OCP's
