Final FINAL-Table 1 Flashcards
What are 2 important diagnostic tests for anemia?
Reticulocyte count, Hgb
What does a high retic count with high bilirubin indicate?
Bone marrow is working!
Most likely d/t destruction or loss of RBCs (hemolytic)
(acute/chronic) anemias are well tolerated in children
Chronic
Anemic disorder characterized by bone marrow aplasia
Diamond Blackfan anemia
Diamond Blackfan anemia responds to ____treatment, and is cured by ____
Steroids
Bone Marrow Transplant (BMT)
3 yo pt with cc of lethargy x3 days. Pt is pale, jaundiced, w/ palpable spleen. CBC shows low Hb, High retic count, and increased LDH. What do you suspect?
Hemolytic anemia
In the case above, which findings were indicative of hemolysis?
Jaundice
Splenomegaly
___ hemolysis can be due to Hereditary spherocytosis, G6PD deficiency, and hemoglobinopaties
Intrinsic
____ hemolysis can be due to AIHA, DIC, or IV hemolysis
Extrinsic
What common virus can produce a low retic count and red cell aplasia?
Parvovirus B19
Your patient presents with anemia + Petechiae. You suspect:
Leukemia or HUS
Which lab would show you the presence of spherocytes?
Peripheral blood smear
When does Fe deficiency anemia first appear?
After the first 4-5 mo of life
What should you check if a pt presents with neutropenia or thrombocytopenia?
Bone marrow fxn
Name the iron studies for Fe Deficient anemia
Serum ferritin (low) Serum iron (low) Total Fe binding capacity (inc) Transferrin saturation (low)
Children who drink cow’s milk are at risk for developing__ deficiency
Iron
Kids who drink goat’s milk are at risk for developing__ deficiency
Folate
Age range for kids with Diamond Black-fan anemia
Birth-1 year
B-12 deficiency is a common finding in this GI disorder
Crohn’s
Smooth beefy red tongue may indicate
B-12 deficiency
Fanconi and Diamond-Blackfan anemias are ____ forms of normocytic anemia
Congenital
Age range for Fanconi anemia
2-10 years
What is TAR and what condition is it found in?
Thrombocytopenia with absent radius. Fanconi anemia
____anemias are characterized by Anemia, Jaundice, Splenomegaly
Hemolytic
Longstanding spherocytosis and sickle cell disease can cause _____
Gallstones
What is the most common inherited enzyme defect?
G6PD deficiency (2nd is Pyruvate Kinase Deficiency)
G6PD manifests as _____ cells on peripheral blood smear
Blister cells
G6PD commonly presents with this finding
Hyperbilirubinemia
B12/folate deficiency presents as _____ RBCs on peripheral blood smear
Macrocytic
This hemoglobinopathy is found in carriers only
Thalassemia trait
Hemophilias, vitamin K deficiency, and DIC are all disorders of _____
Coagulation
Intrinsic clotting pathway is measured by a
PTT
Extrinsic pathway measured with a
PT
A pt who is bleeding into their joints should be worked up for
Hemophilia
More common mechanism of thrombocytopenia
Increased consumption/ breakdown of RBCs
Kasabach-merritt syndrome is associated with sepsis and ____
Thrombocytopenia
DIC, Liver disease, and HSP are all _____ types of bleeding disorder
Acquired
____ is a type of thrombocytopenia associated with severe illness or shock
DIC
Most common bleeding disorder of CHILDhood
ITP (idiopathic thrombocytopenia purpura)
ITP usually shows up after____
A viral infection
Treatment for ITP includes
Steroids IV Ig (in severe cases)
Factor ___- and Von Willebrand work together
VIII
Hemophilia B, aka _____, is x-linked and are assoc w/ factor IX deficiency
Christmas Disease
_____ is the most common INHERITED bleeding disorder among Caucasians (though it can be acquired…)
Von Willebrand disease
VW disease can be treated with _________, which releases vWF from endothelial stores
Desmopressin
FFP contains____
All coag factors
If you have abnormal PT/PTT, you would give
FFP
If you have normal PT/PTT values, you would give
Cryoprecipitate
In ___ syndrome, bilirubin is elevated in times of stress, causing jaundice
Gilbert’s Syndrome
Most common death by disease in children
Cancer
___ has inc. incidence of Trisomy 21, NF type 1, and fanconi’s anemia
ALL
First labs for a CA workup
CBC w/ diff
Peripheral blood smear
ALL occurs most commonly in kids aged _____-______
2-10 (peak at 4)
Most common CA treatment for kids
Chemo
Philadelphia chromosome is associated with ____
CML (Chronic Myelogenous Leukemia)
Pt presents with firm, non-tender lymph node and hx cough. What do you order?
CBC
CXR
Lymph biopsy
What are you looking for on x-ray for a kid with suspected ALL?
Mediastinal widening/ mass
This type of lymphoma peaks in adolescence and again after age 50
Hodgkins Disease
Biopsy for suspected hodgkin’s disease would show this type of cell:
Reed-Sternberg cells
Hodgkin’s is characterized by ______ adenopathy
Painless cervical
Mediastinal lymphadenopathy or mass can present with: __ or ___
Cough, dyspnea
Most common type of solid tumor in kids:
Brain tumor
Classic triad of brain tumors
Papilledema
Morning headache
Vomiting (w/o nausea)
Most common tumor of childhood
Astrocytoma
Young children most often get ______ brain tumors
Infratentorial
Older children more often get ____ brain tumors (which are WORSE)
Supratentorial
Abdominal mass that crosses midline
Neuroblastoma
Painless abdominal mass that does NOT cross the midline
Wilms Tumor (nephroblastoma)
Most common solid neoplasm OUTSIDE the CNS
Neuroblastoma
This type of tumor is common in Beckwith-Widemann syndrome
Wilms tumor
Most common sign of a retinoblastoma
White pupillary reflex
How do you diagnose retinoblastoma
MRI
Most common soft tissue sarcoma in childhood
Rhabdomyosarcoma
3 types of Rhabdomyosarcoma
Orbital, nasal, bladder
____ is a definitive test for osteosarcomas
Tissue biopsy
____ present with a painful, palpable mass and lytic lesions with calcifications on x-ray
Osteosarcoma
___ commonly presents with femur and pelvic pain, fever, and wt loss.
Ewing sarcoma
Most important diagnostic tools in ortho
PE and Radiographic imaging
Hip dysplasia (is/is not) a disease of dislocation
Is NOT
____ is the abnormal relationship between the prox femur & acetabulum
Hip Dysplasia
Hip dysplasia can be diagnosed using these techniques
Barlow’s and Ortolani’s
______ are indicative (not diagnostic) of hip dysplasia, occurring in up to 40% of cases
Asymmetric Skin folds
If diagnosed in the first 4-6 mo of life, hip dysplasia can be treated with __
Pavlik harness
You find a palpable mass in your patient’s neck, and note that their head is twisted to the side. X-ray reveals no cervical deformities. What is your ddx?
Torticollis
Children with this congenital connective tissue disorder can have subluxed ocular lenses, thoracic aortic aneurysms.
Marfan syndrome
This disorder is characterized by in-utero fractures and blue sclera
Osteogenesis imperfecta
_____ show promise for decreasing incidence of fractures in OI
Bisphosphonates
The most common form of short-limbed dwarfism:
Achondroplasia
Patients with achondroplasia have a greater risk for ___
Scoliosis
Your patient has a 20˚ scoliosis curvature. Your next step is:
No tx required
Name 4 types of congenital vertebrae abnormalities
Wedge vertebra
Hemivertibra
Congenital bar
Block vertebra
Most common cause of limping and hip pain for kids in the US:
Transient Synovitis
Most common organism implicated in septic arthritis of the hip
Staph aureus
Treatment course for septic arthritis
ABX then surgery if needed
Your 7 year old male patient presents with an atraumatic painless limp and decreased internal rotation. You suspect:
Legg-Calve-Perthes Dz
Treatment for Perths disease includes
Protecting the joint w/o limiting mobility
3 x-ray views for diagnosing Perths disease
AP, Lateral, Frog-leg
____ is an orthopedic emergency, characterized by pain in hip, medial knee, and anterior thigh.
SCFE
Radial head subluxation is also known as
Nursemaid’s Elbow
Typical posture associated with radial head subluxation
“my arm” posture
SCFE is most common in this age group
Adolescents 10-16
Genu ____ is normal between infancy and 2 years
Varum
Genu ____ is normal between 2-8 years
Valgum
___ is the abnormal growth of the medial aspect of the proximal tibial epiphysis, resulting in a progressive varus deformity
Blout’s
Most common cause of in-toeing in kids under the age of 2
Tibial torsion
The recommended treatment for W-sitters
Bicycle/skating
Patellofemoral Pain Syndrome presents with _______pain, worse with activity, stairs, prolonged sitting
Anterior knee pain
___ can cause microfractures to the tibial tuberosity bone overgrowth
Osgood-Schlatter Disease
_______ is a MSS problem of intrauterine positioning and will resolve spontaneously
Calcaneovalgus
What should you look for on physical exam if the patient also presents with metatarsus varus?
Check for hip dysplasia
Most ___ is caused by congenital hypoplastic tarsal bones (esp the Talus)
Talipes Equinovarus
Torus fractures are also known as
Buckle fracture
Torus fractures affect these bones
Radius/ulnar
___ is an oblique fracture of the distal tibia without a fibula fracture
Toddler’s Fracture
Salter Harris classification describes ______ fractures
Epiphyseal
A type _____ S-H fracture through a portion of the physis and epiphysis into the joint that may result in complication because of intra-articular component and because of disruption of the growing or hypertrophic zone of the physis.
Type III
A type ____ S-H fracture presents as a crush injury to the physis with a poor functional prognosis (aka the WORST)
Type V
This type of S-H fracture has joint involvement
Type III
Types _&__ are a closed reduction and are treated with a cast
Types I & II
Osteosarcomas most commonly occur in ______ bones
Long bones
Most common bone tumor in children (benign)
Osteochondroma
Most common malignant bone tumor in children
Osteosarcoma
____ can present like an osteomyelitis with fever and leukocytosis, but shows lytic lesions on x-ray
Ewing Sarcoma
Anterior thigh and knee pain may be presentations of a ___ problem
Hip
Joint pain can be an early presentation of ___-
Crohns Disease
____ is the inflammation at the insertion of a ligament to a bone
Enthesitis
Pleuritis, pericarditis, or peritonitis are all types of _____
Serositis
Most common chronic Rheumatic Disease of children is ___
JIA/JRA
Young girls with ____ JRA and a positive ANA are at highest risk of uveitis
Pauciarticualr
You order an ANA on your patient. It comes back positive. What should be on your differential?
Lupus
Most common site of pauciarticular arthritis
Knee
___ often presents with a cyclic fever, salmon pink macular rash, and HSM
Systemic Form of JRA
The 3 P’s of systemic JRA
Polyserositis
Pleuritis
Pericarditis
____ in kids usually affects males >10 yrs, and typically presents with a positive HLA-B27, elevated ESR, and CRP
Spondyloarthropathy
1st & 2nd line tx for JRA
1 – NSAIDs
2 – Methotrexate
First lab to order for suspected SLE
ANA
Mainstay treatment for SLE
Steroids
- methylprednisolone/ prednisone
- hydroxychloroquin
- NSAIDs
Leading cause of death from SLE
Renal disease (diffuse proliferative nephritis)
Most common vasculitis in childhood
Henoch Schonelien Purpura
___is a rare inflammatory disease of muscles and skin that presents w/ fatigue, malaise, progressive muscle weakness, w/ low grade fever & rash
Dermatomyositis
Most likely cause of HA in kids
Migraine or tension HA
Secondary gain is common in this type of headache
Chronic Tension Headache
Migraines are usually (unilateral/bilateral)
Unilateral
1st line treatment for migraines in kids
Ibuprofen/APAP
Cluster headaches are best treated with ____
100% oxygen
Define epilepsy:
2 or more unprovoked seizures
___ epilepsy is a benign condition w/ unilateral focal seizures and speech abnormalities
Rolandic epilepsy
Typical age range for febrile seizures
6mo – 6 yrs
___ seizures are associated with GI or upper respiratory infections
Febrile seizures
Most common type of seizure in childhood
Partial/focal (40-60%)
Role of an EEG in diagnosing seizures
Adjunct test (hx is most important)
The majority of febrile seizures are ______
Generalized
Treatment for febrile seizures includes
Phenobarbital, Valproic Acid
Rectal Diazepam
The majority of epileptic seizures are ______
Partial/focal
Type of impairment of consciousness in simple focal seizures
NO impairment
Type of impairment of consciousness in complex focal seizures
Impairment = staring
Type of impaired consciousness in secondary generalized focal seizures
Generalized convusion
____ = no impairment of consciousness
Simple
____= impairment of consciousness (staring)
Complex
____= simple or complex partial seizure that ends in a generalized convulsion
Secondary Generalized
____ can be mistaken for colic, reflux, or startle
Infantile spasms
West Syndrome
Infantile spasms are associated with _____, which presents with ash leaf spots on the skin
Tuberous Sclerosis
Treatment for Status Epilepticus includes:
ABCs then IV benzos
Diazepam or lorazepam
The AAP recommends ____ for obtaining LP
Low threshold
The majority of febrile seizures are (simple/complex)
Simple
Febrile seizures that are focal, prolonged, or multiple are:
Complex
Treatment (if any) for febrile seizures
Rectal diazepam
Sleep disorders, migraine variants, benign breath-holding spells, syncope, movement disorders, and pseudoseizures are all_______
Spells that mimic seizures
An infant pt presents with lethargy and vomiting. Upon PE you find that his fontanelles are bulging. What is the cause?
Increased Intracranial Pressure
Sign visible in the eyes of younger children that indicates ICP
“Setting sun sign”
An obese teenage girl presents to your clinic with a complaint of HA, tinnitus, and loss of vision. You perform an MRI to exclude hydrocephalus and intracranial mass. What do you suspect?
Pseudotumor Cerebri
Most common cause of stroke in children
Cyanotic heart disease
+sickle cell anemia, meningitis, hypercoagulable states
Most common cause of concussion in kids
Falls
Management for children with amnesia or who were unconscious
ER Evaluation
HA, dizziness, forgetfulness, inability to concentrate, slowing of response time, mood swings, and irritability after a concussion is known as:
Post-concussive Syndrome
Meningomyelocele are usually identified using this screening tool
Ultrasound (+ high AFP)
Arnold Chiari types I and II are types of ______
NTDs
Arnold Chiari III defect is also known as
Anencephaly
Migrational disorder associated with severe delay and seizures, with a “smooth brain” on MRI
LIssencephaly
The premature closure of sutures
Craniosynostosis
You notice ash leaf spots on your patient. Which neurocutaneous disorder do you suspect?
Tuberous Sclerosis
____ is an autosomal dominant disorder characterized by café au lait spots, axillary freckling, and learning disabilities
Neurofibromatosis
Characterized by benign tumors in vital organs (brain, eyes, kidneys, heart, skin) and can often cause infantile spasms
Tuberous Sclerosis
This neurocutaneous disease presents with a unilateral port wine stain over the upper face
Sturge-Weber syndrome
Up to 90% of Sturge Weber patients have this vascular anomaly
Leptomeningeal Vascular Anomaly
2 common causes of ataxia in children
Post-infectious
Drug intoxication
A neuromuscular disorder of the Anterior Horn
progressive weakness, wasting of skeletal muscle resp failure
SMA (Spinal Muscular Atrophy)
A neuromuscular disorder of the Peripheral Nerve
ascending symmetrical weakness, post-infectious
Guillian Barre
A neuromuscular disorder of Neuromuscular Transmission
ptosis, loss of facial expression
Myasthenia Gravis
A neuromuscular disorder of Muscle Tissue
X-linked, proximal muscle wasting, pseudohypertrophic calf
Muscular Dystrophy
Pelvic weakness seen in Duchenne Muscular Dystrophy results in a positive _____ sign on physical exam
Gower Sign
Most common type of cerebral palsy
Spastic
5 types of cerebral palsy
Spastic, athetoid, rigidity, tremor, ataxic
Most common nutritional disorder affecting children and adolescents in the developed world?
Obesity
No other source of protein is needed in the 1st 6 mo of life except ___
Breastmilk
Who needs more kcal/kg….a 2 year old or a 10 year old?
2 year old (102 vs 70)
RDA for protein ranges for 2.2g/kg/day for 0-6 mo, to ____g/kg/day for adolescents
1 g
Breast milk provides about ___% calories from fats
50%
During the first year, weight increases ____% and brain size ____
200%, doubles
The last measurement to change in a child with malnutrition is _____
Head circumference
The American Academy of Pediatrics recommends human milk as the sole source of nutrition for______, with continued intake for the first year and as long as desired thereafter
the first 6 mo of life
A new mom comes in and asks if she can breastfeed while on methadone treatment. What do you say?
YES!
SIDS is more common in this type of household:
Smoking
Is breastfeeding recommended in mothers infected with HIV?
No, unless water source for formula is unsafe
How do you assess adequacy of milk intake in an infant?
rate of wt gain is most objective indicator of adequate intake
Breast milk stools typically look ____
Seedy
A well-hydrated infant voids ___-___ times per day
6-8
Standard formulas contain ____cal/oz (same as breast milk)
20
You should use special formulas (soy, lactose free) for infants with:
Malabsorption, gastroschesis,
What kind of TERM infant might need extra calories
Heart disease
What vitamin does breast milk lack?
Vitamin D (supplement 200IU/day)
At what point do full term breast-fed babies need supplemental iron?
4-6 mo of age (1mg/kg/day)
Formula fed infants should get Fe fortified formula for ______
1st year of life
When can you start solid foods in infants?
6 mo
What is the max amount of cow’s milk per day that is recommended?
Not >24 oz/day (over 1 yr old)
At what point should bottle feeding be discontinued?
12-18 mo
Most common form of malnutrition in children living in poverty?
Iron deficiency anemia
Brain growth triples by age ___
6
____ is a leading cause of death in children under 5 years of age
Protein-energy malnutrition
Less than 5% of failure to thrive is due to ____ causes
Organic
This type of adolescent may be especially vulnerable to IDA
Student athletes
Best indicator that baby is getting enough calories
Growth rate in length, weight, and FOC
11yo children who are overweight are more than ___x as likely to remain overweight at age 15 than 7yo children.
2 times
SCFE, Pseudomotor Cerebri, DM Type II, HTN, and low self esteem are all consequences of ____
Childhood obesity
Bacteria that causes cavities
Strep Mutans
CRITICAL CARE Bites/Stings Hyperthermia/hypothermia Burns Shock Respiratory Failure (status asthmaticus, ARDS)
NORMAL ABG VALUES pH 7.35-7.45 CO2 35 – 45 O2 70 –100 O2 sat 93-98 % HCO3 22 – 26
3 important differences in the pediatric patient
- Greater body surface area
- Internal organs are more anterior, protected by less fat
- Airway structural differences
A child’s BP may be maintained with up to _____% acute blood loss
30%
1st step in assessing the seriously ill child:
ABCDE’s
Rapid clinical assessment
What does the term “exposure” refer to?
Hypo/hyperthermia and also
Exposing the patient to assess for injuries
Dehydration d/t gastroenteritis is an example of something that can cause _______ shock in a child
Hypovolemic
Epiglottitis is an (upper/lower) airway disorder leading to resp distress
Upper
_____ presents as the main compensatory mechanism for blood loss
Tachycardia
A goal of resuscitation is to identify and restore abnormalities of __ and __
Oxygenation, Perfusion
Most children with shock have ______causes
Non-cardiac
____ is most common cause of hypovolemic shock in kids
Dehydration
Kid showing up in 1st week of life in shock…you suspect a ___ cause
Sepsis, Cardiac, Or metabolic
Hypoxic injury to the ___may cause seizures, cerebral edema, infarction.
Brain
Hypoxic injury to the ___may cause ATN, ARF
Kidney
____ is the most common cause of unplanned hospitalization in kidd 3-12yr
Asthma
____ is due to severe bronchospasm, excessive mucus secretions, or inflammation/edema of airways, causing airway obstruction that may progress to respiratory failure
Status Asthmaticus
Labs to order for suspected status Asthmaticus
O2sat, ABG, CXR
Therapy for Status Asthmaticus
Humidified O2
B2 agonist (nebulized or bolus)
IV corticosteroids
___ is the most common precipitant of ARDS
Infection
Appropriate labs to order for your peds patient with ARDS
ABGs, daily CXR, CBC (infection surveillance)
Loss of acid occurs with ____/_____
Vomiting/ NG suctioning
Bicarb loss occurs with ____
Diarrhea
Treatment of DKA includes
NS
Insulin, then D5
Na given via NS
*NO bicarb given!
Airway obstruction, pneumonia, ARDS, PE, trauma, and respiratory depression can all lead to_____
Respiratory Acidosis
H+ loss and bicarb gain can lead to____
Metabolic acidosis
Anxiety, pain, altitude, excessive ventilation, PE, asthma, edema, or salicylate overdose can lead to ____
Respiratory Alkalosis
Lactic acidosis, ketoacidosis, and exogenous acid consumption are all types of metabolic acidosis with a ______ anion gap
Increased
Septic, anaphylactic, and spinal shock are all ____ types of shock
Distributive
Type of shock where organ perfusion is maintained
Compensated
Most common cause of shock in children
Hypovolemic shock
This syndrome occurs in response to distributive shock, with fever, tachycardia, tachypnea, and abnormal WBC counts
SIRS (systemic inflammatory response syndrome)
Gram (+ /- ) organisms use endotoxins which cause release of cytokines which can lead to septic shock
Gram Negative
Gram (+ /- ) organisms use pyrotoxic superantigens, which cause massive lymphocyte activation and release of T-cell cytokines, leading to cellular injury, organ failure, and shock
Gram Positive
Which are more painful, 2nd or 3rd degree burns?
2nd degree
Burns > ____cm need grafting
1 cm
___ is a life threatening failure of thermoregulation, characterized by high fever, CNS dysfunction, and incoherence
Heat Stroke
___ in children is defined as core body temp
Hypothermia
Most common cause of burns in children
Scalding
A 5 y/o presents with a deep, white and dry burn on his arm. The skin blanches when you touch it. What degree burn is this and how long should it take to heal?
Partial thickness 2nd Degree
Could take a month or more
What types of findings on PE would make you suspect an inhalation injury?
Facial burns, singed hair, carbonaceous sputum
Labs/vitals to order/monitor for a burn patient
Urine output, CBC, electrolytes, renal function, urinalysis, tetanus prophylaxis
What is the time limit for using activated charcoal for poison tx?
w/in 1 hour
Most common poisoning in kiddos
Acetaminophen
Treatment for carbon monoxide poisoning w/ cerebral edema
100% O2
Your 4 year old patient comes in with a bite on his hand after sticking it into a hole in the woods. You don’t know what bit him, but you should do this for all bites.
Irrigation
- What congenital orthopedic/skeletal problem is characterized by blue sclera?
Osteogenesis imperfect
(also see broken bones pre and post natal – if you see it in US, it is almost pathopneumonic
- What meds are used to treat OI?
bisphosphonate
- Most common form of short-limb dwarfism?
Achondroplasia
- A patient is diagnosed with achondroplasia. What long-term orthopedic problem are they at increased risk for?
Scoliosis
- A mother brings her 6 y/o son in with complaints that he has been limping. He denies any trauma, and says it doesn’t hurt. On PE you note poor internal rotation and abduction. What is your suspicion?
Legg-Calf-Perthes disease
- What exams would you order and what would you expect to find?
XRAY: Necrotic bone (avascular necrosis of hip)
LABS: CBC, ESR
TX: protect joint, limit movement.
- Toxic synovitis is usually an autoimmune response following:
An infection, esp URI
- Clinical features distinguishing L-C-P dz and septic arthritis of the hip include:
- fever in septic arthritis
- + pain in septic arthritis (LCP = PAINLESS)
- What is “nursemaid’s elbow” and how is it treated.
Subluxation of the radial head
TX: Flex the FA, supinate the elbow
- This type of fx is described as “oblique fx of the distal tibia without fibular involvement” and usually manifests in children ages 1-3 without hx of significant trauma, and with only minimal pain/swelling.
Toddler’s Fx
- A common fracture of the forearm, usually about 1/3 way up the radius, is a ____
Buckle fracture (aka Taurus Fx)
- Describe the various Salter-Harris classifications.
Which is worst?
Class V = worst (crushed growth plate, likely to arrest growth)
(III and IV bad too, b/c go into joint space)
- Describe distinguishing factors of a limp caused by SCFE
Slipped Capital Femoral Epiphysis
- Adolescents 10-16
- especially very active or obese males
- Vague syptoms: + limp, +pain knee/med thigh/ hip
- limited internal rotation
- SURGICAL EMERGENCY
- Congenital deformity of the foot, characterized by inward deviation with angulation at the base of the 5th metatarsal.
Metatarsus varus
- ID Causes of #14. Differentiate from club foot
Intrauterine positioning
MV can be passively moved to midline, club foot is a rigid skeletal abnormality.
- An infant born with metatarsus varus is at increased risk of what OTHER ortho finding?
Hip dysplasia (2-10%)
- 14/F presents with lump on knee. She is an active soccer player and says it hurts every now and then, but usually doesn’t bother her. She appears very thin but well –nourished. The lump is visible and makes her nervous. You note a 3-4cm hard, palpable mass on the medial side of the knee. You suspect?
Ostechondroma (most common bone neoplasm)
TX: typically benign, you can leave it there, or surgically remove if problematic
- What is the most common malignant bone tumor in kids? Where are they typically found?
- Osteosarcomas
- Typical in long bones
- What is the first treatment done for osteosarcoma?
- Chemotherapy THEN Excision (excision = curative)
- 6 y/o Female presents with pain in L arm, especially if you touch it. Pain worsens day by day. She also presents with fever. What are your differentials?
- Ewing’s sarcoma vs. Osteomyelitis
- Do Labs + XRay to ID. Fever + lytic lesion in bone = osteomyelitis
- Fever, Inc WBC also osteomyelitis
- An infant is diagnosed with hip dysplasia. You want to apply an orthopedic splint called ____
- Pavlik Harness
- A 4 year old presents in status epilepticus. What is your first-line treatment?
- Diazepam (Valium)
- EEG’s _____ (can/not) be used to diagnose epilepsy
They are NOT used
- What is the most common type (manifestation) of childhood epilepsy?
- partial seizures (usually due to genetics)
- A form of epilepsy characterized by very brief spasms, severe EEG, and poor prognosis is called:
- Infantile spasms
- Describe facts associated with febrile seizures. When would you work them up?
- Typically ages 6m – 6y
- Usually do not progress to epilepsy
- If resolves quickly and returns to normal, no workup need. If difficult to arouse or vomiting after seizure, work up neuro
- Patient presents for 2m check up. Home birth with educated midwife. NB Screen and vaccines done by midwife. Mom’s concern – baby not eating in last week or so, separated sutures and bulging fontanelle. What do you think of?
- Increased ICP – mass? Hydrocephalus?
- What symptoms would you expect to see in a child with increased ICP?
- HA (may be worse in AM, worsens with cough, vagal, or bending over)
- Strabismus, diplopia, wandering eye
- Vomiting WITHOUT nausea
- 13/F overweight, presents with complaint of HA. Mother states she complains a lot, but recently also complains of tinnitus and vision being off. What is your concern?
*most commonly= idiopathic cause
- Most common causes of childhood stroke?
- cyanotic heart disease
- sickle cell disease
- meningitis
- hypercoagulable state
- Sxs: similar to adult: u/l flaccidity, facial droop
- Neurofibromatosis, Tubosclerosis, and Sturge-Webber are all associated with what finding?
Seizures
- 5 y/o presents with concerned grandparents due to him “not like other kids”, has to climb to stand. What do you suspect? What is this finding called?
- Suspect Muscular dystrophe
- Gower sign
- What pathopneumonic finding would further heighten suspicion of MD?
- calves appear full (hypertrophic)
- Match diseases to their pathologies:
a) Muscular dystrophy
b) Guillan-Barre
c) Myesthenia gravis
d) Spinal Muscular Atrophy (SMA)
a) Muscle fiber
b) nerve
c) Neuromuscular junction
d) Anterior horn
- 15y/o mom brings him in in a panic because hisfeet felt numb, by lunch he felt weird standing up. He can talk but he feels like he’s getting weaker in his upper legs. Hx significant for URI this week. You suspect? How do you treat?
- Suspect Guillan-Barre
- Tx: supportive care, ADMIT
- May need ventilator support
- A 12 y/o presents with purpuric rash 1 week following a URI. She also has a blood-shot eye and red colored urine. You suspect?
- Henloch Schenlein pupura (autoimmune against blood vessels)
- Describe tx for meningomyeloceles.
- Surgery
- * be sure to assess for paralysis at birth (active & symmetric movement? Incontinence? )
- Compare and contrast Henoch-Shonlein vs Idiopathic Thrombocytic Purpura
BOTH: Autoimmune, Purpuric rashes, Hx URI (or infection).
HSP = autoimmune a/g blood vessels
ITP = autoimmune a/g platelets
- 18m/f brought in for pallor. Family think something’s wrong because she’s getting pale and they’re dark Hispanic. Nml diet, no PMH. Normal vitals… You only note pallor. No hepatosplenomegaly, lymphadenopathy, no bruising. What do you consider?
- consistent with anemia
- Order: CBC, Iron studies
- What lab would you order in #40 to ID whether this is an acute or chronic anemia and how the body is compensating?
- Order reticulocyte count. High reticulocyte count = enough time AND able to make new cells.
- Low retic = acute onset OR aplastic/hypoplastic (use hx!)
- 3 y/o female in ER presents with jaundice, fatigue x 3 days, Low hgb, high retic. She also has organomegaly. You want to consider what?
- Hemolytic/destructive anemias (organs large from processing broken cells/ bilirubin excess):
- sickle -G6PD
- spherocytosis - thalassemias
43.T/F heart murmurs are commonly associated with anemia.
TRUE
- Diamond Black-fan is a _____ anemia that can be treated by ____ and cured by ___
- Congenital hypo/aplastic anemia
- tx by steroids
- cured by bone marrow transplant
- Diamond black-fan has __ (more/less) association with other anomalies than it’s cousin Fanconi’s anemia
Less: 30% dbf, 50% Fanconi
- How is Fanconi’s managed?
- steroids or IVIG, BM trasfusion
- 20% self-limited auto-immune and often grow out of it.
- Differentiate Fanconis vs DBF:
DBF: onset @ birth-1yr, short stature, autosomal recessive,
Fanconis” onset 2-10 yrs, higher rate congenital problems, autosomal recessive
- 4 y/o male with pallor, fatigue x 2 months. You order a CBC and find low RBC, WBC, AND platelets. What do you think?
- 2+ depressed cell lines think leukemia
- age 4, boy, most common leukemia in kids = ALL
- What lab finding would be consistent with your differential in #48?
- high lymphoblast numbers (overgrow the BM so the BM can’t work)
- Most common cancer in teens?
Lymphomas (3rd most common cancer of all: #1- ALL, #2-brain tumors #3-lymphoma)
- What are the two types of lymphoma? Which is worse?
- Hodgkin vs non-Hodgkin lymphoma
- non-Hodge = worse (also less common)
- What clinical findings would you find in a pt with Hodgekin lymphoma? What would you use to confirm?
- Findings: PAINLESS lymphadenopathy without illness, splenomegaly, nml CBC
- Do CXR to confirm: look for mediastinal widening/mass, enlarged thymus
- What characteristic finding will differentiate between Hodgekin and non-Hodgekin lymphoma?
- Reed Steinberg cells in Hodgekin lymphoma
- hodgekin = cervical lymph most common
- A patient presents with a triad of symptoms including papilledema, HA worse in AM, and vomiting. You recognize this as alarming for ___
Increased ICP
- What is the most common brain tumor in kids?
Astrocytoma
- A brain tumor where allows for the best prognosis?
SUPRAtentorial
- Definitive tx for a brain tumor includes:
Surgical removal (successful in 50-60% of all CA)
- A 3y/o presents with poor feeding, abd distention, and refuses to walk. When you pick him up, he cries loudly. He also appears pale and miserable. On exam you note a large, palpable abdominal mass and HTN. What do you consider?
-Diff dx: HTN=renal?, mass = neuro/nephroblastoma
- Differentiate between neuroblastoma and nephroblastoma. Which is called Willm’s tumor?
- Neuroblastoma can cross midline
- Nephrobllastoma (Willms) does not cross midline
- The most common sign of retinoblastoma is:
- absence of red reflex (white reflex)
- Strabismus
- Tx for retinoblastoma includes:
radiation (mainstay)surgery if ineffective.
− monitor for metastisization (fatal if mets)
- The soft tissue tumor aka most common sarcoma of childhood is called:
-Rhabdomyosarcoma
- Differentiate presentation of rhabdomyosarcoma by age.
- Young – head, neck, GU
- Older kids: extremities, trunk
- A patient presents with jaundice. It is determined that they do not posess the enzyme that metabolizes and conjugates bilirubin. This diagnosis is called ___
Guilbert’s (specifically elevation in unconjugated bilirubin d/t deficiency of conjugating enzyme.
- ID types of congjugating enzyme deficiencies.
- No enzyme AT ALL = Kraigler Najar. (requires tx or fatal; tx = phenobarbiotol)…)
- Diminished activity (Guilberr’s) (usually benign, but keep a close eye out. Often don’t require tx)
- Protein C deficiency, antitrombin 3 deficiency, and protein S deficiency all result in what?
- Hypercoagulation state (clotting problems)
- A pt presents with septic shock. You also note hematuria, bleeding gums, etc. What labs should you order?
What is the most likely diagnosis?
What is the treatment?
- CBC, PTT, PT, fibrinogen, INR
- DIC highly associated with sepsis
Tx: FFP (contains a lot of clotting factors)
- How can you treat severe thrombocytopenia?
- transfusion of platelets
- A 14 y/o presents with heavy periods and occasional nose bleeds. She denies any spontaneous bruising though. What problem might you check for?
- VonWillebrands
- Define whether each problem is due to a problem with production, consumption, or abnormal function:
a) ITP
b) Leukemia
c) Sickle cell (in crisis)
a) Destruction (auto immune)
b) production
c) function
- ID and differentiate between most common childhood leukemias.
ALL (acute lymphoblastic leukemia (most common = 75%
AML (15-20%)
CML (
