MedStudy Flashcards
TSC Brain Changes
Cortical and periventricular calcifications
Sturge Weber Brain Changes
Unilateral serpiginous parenchymal calcifications with hemispheric atrophy
NF1 Brain Changes
Hyperintensity areas in basal ganglia and cerebellum
Vestibular schwannomas symptoms
NF2, 8th cranial nerve
tinnitus, unsteady gait, hearing loss, and/or facial weakness
NF2 can have bilateral cataracts (subcapsular lenticular opacities)
Ascorbic acid deficiency
vit C
fragmented hair with corkscrew appearance
gingival hemorrhage, FTT, irritability, bone pain
ground glass appearance to bones, sharply outlined metaphyseal ends
Langerhans cell histiocytosis derm symptoms
scaly papular seborrheic dermatitis of the scalp and diaper area
Vitamin D deficient rickets XR findings
decreased bone mineralization around epiphyses and bowing of LE
widening of wrist and knees
enlarged costochondral junctions “rachitic rosary”
Caffey Disease
COL1A1
irritability, fever, anorexia, soft tissue swelling associated with subperiosteal cortical thickening of underlying bone
Average onset: 10 weeks - 6 months
Labs: leukocytosis, elevated ESR and Alk phos
Mandible is affected in 95% of cases
Symptoms usually resolve by 24-30 months of age
Choanal Atresia DDX
CHARGE
Treacher Collins - conductive hearing loss, hypoplasia of lower eyelids with lower eyelashes absent/coloboma, cleft lip/palate, mandibular hypoplasia -> respiratory issues 2/2 obstruction
Serotonin Syndrome vs NMS
Myoclonus!!!!
SSRI/MAOI/MDMA aka ecstasy/linezolid
Tachycardia, high temp, HTN, confusion, hallucinations
Ecstasy = bruxism and hyponatremia
Tx - supportive, benzo and cyproheptadine
Do not confuse with NMS - will have hard to control BP and HR with muscle rigidity, Tx with benzo, dantrolene, bromocriptine, amantadine
Ingestion with Bezoar
Salicylates
ASA
OTC cold Med
Anti diarrheal
Oil of wintergreen
Bismuth
Herbal preparations
Acetaminophen Toxicity
Toxicity is mediated by NAPQI (metabolite). It binds to glutathione and if liver levels are depleted, NAPQI causes cellular damage.
NAC is tx -> restores glutathione stores; give within 8 hours of ingestion.
Obtain level at 4 hours to plot on normogram. Activated charcoal can be given at 1-2 hours.
Stages of Acetaminophen Tox
Stage I: malaise, lethargy, N/V
Stage II: 24-72 hours; RUQ pain with lab evidence
Stage III: 72-96 hours; peak lab markers including fulminant hepatic failure and prolongation of prothrombin time; most die at this stage
Stage IV: death or recovery
ASA toxicity
metabolic acidosis and respiratory alkalosis
Causes shift of K into cells -> kidneys conserve K and dump H+ -> urine is acidic
Fluid loss causes hyper NA2+
Toxicity activates the medullary respiratory center -> increased RR and HR, fever, etc.
DDX Cough, Coryza, Conjunctivitis
Measles (rubeola virus): will have classic rash, Koplik spots on buccal mucosa 2-3 days before the rash; splenomegaly and lymphadenopathy are common; college student. Maculopapular rash starts 2-4 days after fever onset and spreads in cephalocaudal direction.
Adenovirus: palatine petechiar, pharygneal/tonsillar enlargement/erythema, periauricular lymphadenopathy; serotypes 3 and 7 most severe. May have sterile hemorrhagic cystitis, PNA, encephalitis, myocarditis, diarrhea. Also can have a Reye like syndrome with bronchoPNA, hepatic failure, seizures, disseminated coagulopathy with serotype 7.
Viruses with Aplastic Crisis
Parvo B19
CMV
EBV
Hepatic viruses
HIV
Bacterial Meningitis for <7 DOL
GBS
E coli
Listeria
Tx amp + cephalosporin (cefotaxmine)
Hypertrophic Pyloric Stenosis
Caused by erythromycin or other macrolides if <6 weeks of age
Can be given to an infant with Chlamydial conjunctivitis or PNA
Gentamycin Toxicity
Oto and nephrotoxic
Congenital Syphilis
Infants with Treponema pallidum can present with bony lesions including osteochondritis at the metaphyses and periostosis. Decreased bands of bony mineralization and focal areas of destruction. It is painful so most refuse to move the affects areas.
Cutaneous lesions of palms and soles, which are contagious if ulcerated
HSM
Jaundice
Coombs neg hemolytic anemia
> 2 years old presentation
Rhinitis -> saddle nose appearance
Mulberry molars
Hutchinson teeth
Frontal bossing
CN 8 deafness
Anterior bowing of the shins
Screen with VDRL or RPR -> confirm with FTA-ABS or MHA-TP
Congenital Toxoplasmosis
Chorioretinitis, microcephaly, diffuse intracranial calcifications, seizures, hearing loss, growth restriction
Ineffective terminal complement cascade infections
C5-9 not working well
Neisseria meningitis and meningococcal infections
Tx: MCV4/Menactra if 9 months or older and they do not have asplenia or HIV
Menveo - give at 2/4/6/and 12 months
Boosters of either given q5 years
Bloody, watery diarrhea + Vulvovaginitis Infection
Shigella
Tx: ceftriaxone
Varicella Embryopathy
VZV infxn before 20 weeks GA
Severe limb malformations including shortening, atrophic, scarring in zig zag pattern
Ocular abnormalities - microphthalmia, cataracts, chorioretinitis, optic atrophy
TCA Toxicity
Prolonged QRS/PR/QT -> heart block. ventricular arrhythmias, PVCs, sinus tachy
Hypotension, shock, respiratory depression, seizures. coma
Can have anticholinergic symptoms
Symptoms can present up to 6 hours later
Tx: immediate activated charcoal if reliable airway, gastric lavage with intubation regardless of airway, and alkalization of serum via sodium bicarb to prevent arrhythmias
Monitor ECG 6-8 hours, but if having cardiac symptoms need to monitor 24 hours after no more abnormal patterns
Ex. amitryptilline, imipramine, doxepin
SSRI Overdose
Serotonin syndrome - myoclonus and rigidity in LEs, tachy, HTN, sweating
Confusion, agitation, loss of urine/stool
Hyperreflexia, clonus, tremor
Combo of SSRI, opioid, CNS stimulants i.e. MDMA/ecstasy and dextromethorphan, triptans
TX: mostly supportive, but can give serotonin antagonist such as cyproheptadine; benzo and IVF resuscitation
Anti-psychotic Overdose
Dystonia and muscle spasticity, eye deviation, trismus, cannot swallow
Chlorpromazine, promethazine
Tx: IV benadryl or IV benzo
Ecstasy (MDMA)
Hyperthermia, sweating, SIADH -> may overcompensate and lead to hyponatremia
Confusion, anxiety, paranoid
Muscle spasticity, seizures -> rhabdo
Hepatotoxicity
Beta blocker toxicity tx
glucagon
Ca channel blocker toxicity tx
IV calcium
Ethylene glycol tox tx
fomepizole
Ex. methanol or ethylene glycol
Cholinesterase inhibiting pesticide tox tx
pralidoxime
Examples: organophosphates and carbamates
Cyanide poisoning
Amyl nitrate
Methemoglobinemia
caused by amyl nitrates, aerosols, benzocaine spray
Tx. Methylene blue
PCP
tachycardia, agitation, HTN
hallucinations
NYSTAGMUS!! - lateral nystagmus can also be with benzo/barbituates
LE edema
Manic mood
Small but reactive pupils
Rhabdo can cause myoglinuria
ADHD med that can cause pinpoint pupils, decreased HR and RR
Clonidine
Malaria PPX
Chloroquine (rising resistance)
Doxycycline - daily tx + 28 days after trip
Atovaquone/Proguanil - daily + 7 days after trip
Mefloquine - weekly + 4 weeks post trip; not in Cambodia, Myanmar, or Thailand
Primaquine and tefenoquine - not in G6PD patients
Salmonella Tx
None unless high risk or severe disease aka hemoglobinopathies, malignancies, and chronic GI disorders only!
Azithromycin
Amox or Bactrim if susceptibility is known
Early onset (1st week of life) + FT infections vs. Late onset in FT
Early onset: Bacteremia/sepsis is most common followed by PNA and meningitis
Late onset: meningitis more common
If premature - more likely to be meningitis
Antibiotics for Meningitis before bacteria known
Vanc, ceftriaxone, metronidazole, and acyclovir (especially if viral vs. bacterial unknown)
Infants with Splenectomy/Asplenia and Vaccination
Menveo (MenACWY-CRM) at 2/4/6/12 months
Remember:
MenACWY-D (Menactra): ≥9 mos, avoid in those with asplenia or HIV
MenACWY-CRM (Menveo): ≥2 mos,
MenACWY-TT (MenQuadfi): ≥2years
Infant born to an HIV+ mother
ZDV (Zidovudine) for 4-6 weeks for ALL infants
PJP ppx with bactrim at 6 weeks of age 3x/week until negative infection is confirmed
Add 3 doses of nevirapine in the 1st week of life if Mom did not take antepartum meds or only received ZDV infusion during delivery (Usually when mom has viral load >1000 or unknown)
The biggest risk of vertical transmission is during delivery
Roth spots
Exudative, edematous, hemorrhagic lesions of the retina
associated with bacterial endocarditis
Suppurative thrombophlebitis
Usually dental infection with Fusobacterium
Can cause a septic embolus in the lungs
MIS-C
elevated troponin, BNP, LFTs, procal/ESR/CRP, triglycerides, ferritin
lymphocytopenia, neutrophilia
thrombocytopenia
Echo: depressed L ventricular function, pericardial effusion
Fever, maculopapular rash, mucus membrane changes, swollen hands and feet, headache, mental status changes
GI symptoms can mimic acute abdomen
Tx: IVIG, TNF inhibitors, IL-1 inhibitors, IL-6 inhibitors
EBV
Specific Ab panel - dx
Spot test - many false +
Morbilliform rash, petechial lesions at the junction of the hard and soft palate
Peripheral smear - foamy like cytoplasm
No strenuous exercise for 1-3 months; at least 4 weeks but not until splenomegaly resolves
Ab are only positive in 80% teens, 40% children, and 20% <4 years
Foreign Body Bacteria - Ring Abscess
B. cereus - esp contact lenses (Acanthamoeba is also associated with contact lenses, but no ring abscess)
Pseudomonas
Proteus
Discitis
narrowing of vertebrae spaces
fever, refusing to bend
ESR and CRP elevated, but WBC normal
Usually children <5 years
Ususally staph aureus
Hib
H flu type B
If infected child <2 years and not treated with ceftriaxone or cefotaxime then should be tx with dose of rifampin prior to discharge
If household contacts are not immunized or partially immunized and <2 years or anyone who is immunocompromised = rifampin
If day care contact, if >2 cases in 60 days and other children who are not immunized or partially, then need rifampin
Dose: 20 mg/kg/day or if <1 month 10 mg/kg/day
Arcanobacterium haemolyticum
aka diptheria (cornebacterium was old name)
fever, sore throat, pruritic/scarlatiniform rash that goes from extensor surfaces of extremities to the trunk, sparing the face, palms, and soles
Gram positive rod
Testing for C diff <1 year
Don’t. Many are colonized with c diff so testing will be a false positive
Parvovirus B19
Young children have slapped cheek fever with lacey rash
Adolescents and adults do not usually have a rash but arthritis without fever
Once the rash appears, they are no longer contagious
Boy who returned from lake vacation with very itchy vesicular rash initially on ankle and progressed to his whole calf
Ancyclostoma braziliense or Necator americanus aka hookworms
rash has serpentine pattern
Tx with albendazole or ivermectin
Conjunctival granuloma with preauricular lymphadenopathy, painless
Bartonella
Tx. azithromycin
Systemic disease: azithro + rifampin + gentamicin
Meningococcal ppx
Neisseria type B
Rifampin 10 mg/kg twice daily for 2 days > 1 month old, but 5 mg/kg BID for 2 days <1 month (oral)
Ciprofloxacin 500mg orally x1
Ceftriaxone 125mg if <15 years and 250mg >15 years IM once
Close contacts are those with contact < 7 days prior to onset, >8 hours prolonged contact, and <3 feet proximately
EBV Peripheral smear
Absolute lymphocytosis with >10% atypical lymphocytes
Child with pertussis and new baby in the family
give azithromycin 10mg/kg/day x 5 days to the newborn
Disorders that affect breastfeeding
HIV, HTLV1, HTLV2
Untreated TB - although can if on anti-TB therapy for 2+ weeks and considered non-infectious
Progressive hoarseness with wheezing, can have association with URI. Soft tissue irregularity at level of vocal cords
HPV
warts on vocal cords
can be wrongly dx as reactive airway disease
do not place trach
Mosquito bites in the summer causing encephalitis
Arbovirus
WNV also suspect if a bunch of birds died in one area
Posterior cervical and suboccipital lymphadenopathy, markedly injected pharynx, rhinitis, and blanching maculopapular rash on the trunk and upper thighs
Fine, discrete, irregular, pinkish-red macules located on the face and trunk
Rubella
Shallow painful ulcers in posterior pharynx, posterior cervical lymphadenopathy, cough, rhinitis
Herpangina (enterovirus aka coxsackie)
Exudative pharyngitis, anterior cervical lymphadenopathy, and diffuse red sandpaper rash
Scarlet fever/group A strep
May be described as a “fine” rash, spares the palms and soles
Strawberry tongue/beefy red tongue
Desquamation of skin 10-14 days after
Cervical lymphadenopathy, painful yellow ulcers of gingiva and anterior pharynx, fever, perioral vesicular erythematous lesions
Gingivostomatitis 2/2 HSV-1
Non-purulent conjunctivitis, exudative pharyngitis, coryza, cervical and preauricular lymphadenopathy
Adenovirus
When is tetanus IG given?
patient has <3 immunizations or vaccination hx is unknown
DTaP for <7 years
Tdap for > 7 years
Tetanus: Dirty wound +patient has <3 immunizations or vaccination hx is unknown
Vaccine and IG
Tetanus: wound is clean and immunizations UTD, last given <10 years ago
No tx
If >10 then give vaccine only
Tetanus: Dirty wound + vaccines UTD with last given <5 years ago
No treatment
If >5 years, vaccine only
Measles post exposure
> 1 year and unvaccinated or 1 vaccine = give MMR within 72 hours, can give to 6-12 mos but would not count towards their series
IG in 6 days for those <1 year, immunocompromised, pregnant women without evidence of immunity
Stages of Lyme Disease
Stage 1: target rash
Stage 2: heart block and Bell’s palsy (CN7)
Stage 3: migratory arthritis, memory issues (several years)
Tx: doxy >8 years and amoxicillin for <8 years
IV ceftriaxone if above does not work
Med interactions with flu and varicella vaccines
salicyclates (aspirin, anti-diarrheal) -> reye syndrome
avoid for 6 weeks
MMR + VZV vs MMRV
increased risk for febrile seizures in MMRV
Chlamydia trachomatis on CXR
hyperinflation with bilateral interstitial infiltrates
Staccato cough
Transmission during delivery and can present at 2-19 weeks (2 weeks - 4-5 months)
Phenytoin exposure in utero
fetal hydantoin syndrome - IUGR, microcephaly, orofacial clefts, digital distal hypoplasia, and DD
Purple lymph node not responsive to abx
Mycobacterium avium complex
excise node
Babesia
Vector is white footed mouse with deer tick (Ixodes)
Infection in asplenia, immunocompromised, Lyme disease
Intracytoplasmic inclusions (intraerythrocyte) on peripheral smear
Pertussis ppx
Azithro preferred due to daily dosing
Papular pruritic gloves and socks syndrome
Parvo B19
Acute sudden onset swelling and erythema of the hands and feet
Papules, petechiae, and purpura
1st tier testing for adoptees
regardless of vaccination records
HIV
Hep C
Hep B
Syphilis
CBC diff
lead level
stool O & P
TST
Toxic Shock Syndrome - GAS vs. Staph
GAS - penicillin G + clinda -> if penicillin allergic than vanc + clinda
Staph vs GAS - vanc
Incubation period for food poisoning
Staph aureus - rapid onset within hours; emesis, diarrhea, and profound weakness
Salmonella and E coli - a few days
Norovirus - 24-48 hours
Febrile well appearing FT infant 8-60 days old - admit or discharge
If LP not done, must admit even if only inflammatory markers were elevated and all other testing was normal
Newborn onset conjunctivitis:
0-2 days
2-5 days
5-12 days
0-2 days - silver nitrate
2-5 days - Gonorrhea
5-12 days - Chlamydia, most common
Mother with TST +, asymptomatic, and neg CXR
no need to separate baby, can still breastfeed
mother needs tx only
Household kids: need to be tested, if they also have latent TB, need 4 months rifampin OR 3 weeks isoniazid + rifapentine
Isoniazid can cause B6 deficiency -> peripheral neuropathy and weakness, cardiac arrhythmias, diaphoresis, bowel/bladder dysfunction
Mother with TST + and positive CXR
separate mom and baby until appropriate tx started, 2 weeks
If baby does not have congenital TB -> tx with 3-4 months isoniazid -> TST neg can discontinue; if + then latent TB
If baby with congenital TB -> both need tx, baby can have breast milk from mom during separation
Initial eval for infants with fever 8-21 days
blood cx
UA
CSF cx and analysis
Hep B Ag+ mother
Give Hep B to baby within 12 HOL
Give HBIG at different site as well
If <2000g at birth, should get Hep B that does not count towards the series
If Hep B status unknown for mom -> give Hep B at birth and wait to give HBIG until result returns for mom
If Ab-, give preterm infants HepB at 1 month of age or when discharged, whichever is first
Benign paroxysmal vertigo of childhood
Occurs in children 1-4 years
Can last 2-3 from onset
Dizziness, ataxia, and vertigo for a few minutes and then self resolves
Increases likelihood of migraine development
Fam hx of migraines
DDX: seizures, but would would not be alert during episodes
Dandy Walker Malformation
missing the cerebellar vermis
asymptomatic, but can have gait disturbances, headache, or develop hydrocephalus
Wound botulism Tx
Pip/tazo
Botulism anti-toxin (also for GI botulism)
Hypsarrythmia
usually in the first year of life, infantile spasms
high voltage, irregular, slow waves on EEG
clusters of muscle spasms >100
Flexed muscles followed by extension
Poor neurocog development
Tx: ACTH, vigabatrin, and PO prednisolone
Eval for TSC
Oxcarbazepine
Causes hyponatremia
Anti-seizure drug and for mood disorders
Idiopathic intracranial HTN
Risk factors: OBESITY, vit A excess, corticosteroids, rapid weight gain, OCPs, tetracyclines, isotretinoin
Tx: acetazolamide 1st; diuretics and migraine meds
Marcus Gunn Syndrome
jaw winking syndrome
trigeminal (mastication) and oculomotor (levator palpebrae) nerves
other eye abnormalities, including strabismus
Mononeuritis multiplex
associated with DM, arthritis, amyloidosis, SLE
Painful
muscle atrophy and weakness develop
Cluster headache tx
100% O2
Abortive: triptans
Ppx: verapamil
Klippel Feil
Noonan like dysmorphology
Fusion of 2 or more cervical vertebrae
Hypoplastic scapulae (Sprengel deformity) where they do not descend completely
Can have NTDs and facial asymmetry
Renal and collecting duct abnormalities
Neurologic issues
VSD, cleft lip/palate, hearing loss, ID
MRI + MRV reason
cerebral venous thrombosis especially with risk factors of dehydration and infection
CN affected with increased ICP
6th
Sturge Weber MRI
serpentine like intracranial calcifications (unilateral, side of port wine stain)
atrophy of the hemisphere also on the same side
4-6 hz spike and wave pattern on EEG
juvenile myoclonic epilepsy
Centrotemporal sharp waves on EEG
childhood epilepsy/benign rolandic epilepsy
Peds vs adult headache
peds have bilateral more often
Anti-sz med and acute angle glaucoma
eye redness, swelling, and pain
topiramate - can also cause nephrolithiasis, fatigue, somnolence, cognitive slowing
Valproate side effects
weight gain, hair loss, hyperNH4, pancreatitis, thrombocytopenia
Phenobarbital side effects
hepatotoxicity, impaired cognition, sedation
Phenytoin side effects
hirsutism, gum hypertrophy, ataxia, skin rash, SJS, nystagmus, drowsiness
Lacosamide side effects
cardiac arrythmias, diplopia, nystagmus, dizziness, headaches
Migraine PPX for children 12-17 years old
Topiramate
Early Signs of Autism
no social smile by 6 months
no babbling, pointing, or gestures by 14 months
not using single words by 16 months
no 2 word phrases by 24 months
lack of make believe play by 18 months
Age that most children gain daytime continence?
30 months
Most are fully toilet trained by 3-4 years and without accidents by 5-7 years
Start the convo for training at 12 months but do not try to toilet train unless 18 months and the child is showing interest
Every Student Succeeds Act (ESSA)
Provides special services to children with disadvantaged backgrounds including poverty, immigration (english as 2nd language)
Requires schools to keep track of performance in math, reading, and science
Carotid artery dissection
usually occurs after trauma, especially MVA with abrupt stop
Horner syndrome - ptosis, miosis, and anhidrosis
MRSA Tx
Bactrim - 1st
Doxycycline if >8 years
Clarithromycin but 10% are resistant
Influenza tx
Neuraminidase inhibitor, antiviral = oseltamivir
Tx in those who are hospitalized, high risk, and children < 5 years regardless of duration of symptoms or vaccination status
Confirmatory dx is not necessary
Infantile Seizure Tx
1st: ACTH (corticotropin)
Vigabatrin if TSC
Prednisolone
Rocky Mountain Spotted Fever
generalized symptoms - myalgias, fever, headache
Rash builds starting with hands and feet, wrists and ankles, etc
Systemic vasculitis -> hypoNa2+, thrombocytopenia, elevated LFTs, leukopenia, anemia
Tx: doxy, teeth discoloration <8 years but unlikely to happen
MRI Brain with Spina Bifida
Hydrocephalus with chiari malformation type II
Remember type I is usually an incidental finding and asymptomatic
Osler Nodes vs. Janeway lesions
Osler nodes - painful, on palms and soles
Janeway lesions - painless, erythematous macular
Perceptual distortions
inflectious mono
Upper motor neuron vs. lower for innervation of the face
Lower motor neuron: impaired wrinkling of forehead, close the eye, or lift corner of mouth; ipsilateral damage causes the same side problems
Upper motor neuron: contralateral innervation of the face; upper part of the face is spared (able to wrinkle forehead) because the ipsilateral lower motor neuron is unaffected
Trigeminal vs. Facial nerves
Trigeminal: 5th, mastication, loss of sensation; ophthalmic, maxillary, mandibular (opening the jaw)
Facial: 7th, facial movements
Acute vs subacute endocarditis
acute: rapid progression, new murmur, bad; staph aureus; Janeway lesions
subacute: a couple weeks long, more likely if already have valve problems; strep viridans, Osler nodes, splinter hemorrhages, Roth spots
Retropharyngeal abscess
Strep pyogenes
Non-exudative conjunctivitis, eye granuloma, and preauricular lymph nodes on same side
B. henselae
Perinaud oculoglandular syndrome (atypical presentation)
Azithro, bactrim, rifampin, cipro
Lead poisoning XR
Lead lines, transverse bands around metaphyseal area in tubular bones
Simple vs complex febrile seizure
Simple: <15 min, generalized, 1 episode in 24 hours; risk for seizures in future 1-2%
Complex: >15 min, >1 episode in 24 hours, focal symptomology, risk for seizures in the future 5-10%
AE DTaP
prolonged crying and irritability
AE MMR-V
thrombocytopenia and arthralgia
general macular rash
V- vesicular rash at injection site
AE Rota
intussusception
Bacterial Vaginosis Dx Criteria
3/4 of the following:
1. >20% clue cells on wet prep (fuzzy appearing 2/2 bacterial fragments sticking)
- pH > 4.5
- Amine/fishy odor with KOH
- Presence of gray-white milky vaginal discharge
Tx: metronidazole 500mg BID x7 days
BV vs. Trich
both have pH > 4.5 and + KOH test
Trich will have erythematous vaginal walls, yellow-green discharge, and punctate hemorrhages on vagina and cervix (strawberry cervix)
BV will have clue cells, gray-white discharge
Klebsiella granulomatis
rod shaped, oval organisms in mononuclear phagocytes aka Donovan bodies (deep purple inclusions, gram neg)
can present with ulcer with raised, rolled margins
more common in India, South Africa, and South America
Lymphogranuloma venerum (LGV)
Caused by chlamydia L1-3
Tx: doxycycline 100mg PO BID x 21 days
Starts with asymptomatic genital ulcer, can look like a small vesicle, which heals within a few days
Then 2-6 weeks later, constitutional symptoms with erythematous, painful lymph nodes that can burst, groove sign from buboes in inguinal area, can cause proctitis if MSM
Hypervitaminosis A
Hyperostosis of bones often sparing the metatarsal areas, usually in mid shaft of long bones
Malaise, drying of mucus membranes, anorexia, hair loss
HSP, AMS, and pseudotumor cerebri symptoms may occur
Body builder may be culprit
Most common CHD in 1st Year/Overall/2nd
VSD in 1st year
Bicuspid is most common overall
2nd most common is pulmonary stenosis
XR pattern in Coarc Aorta
E sign near isthmus from notching of aorta and may also see notching of ribs on that side from collateral vessels off of the aorta
HHV 6
Roseola
Presentation: infant 6-15 months, febrile seizure, bulging fontanelle, postauricular and occipital lymphadenopathy, conjunctivitis, high fever
Rash: after fever has resolved; pink, small, slightly raised (papular) blanching lesions on the trunk and can spread to the face
Hep B Extrahepatic Cutaneous Manifestations
Gianotti Crosti Syndrome: lichen planus, pitted keratolysis, papular acrodermatitis aka multiple symmetrically distributed, small, pink/tan papular lesions that may coalesce into plaques
Face, butt, extensor surfaces, and feet predominately affected
Can also be found in EBV infections
Hep A PPX
Administer Hep A vaccine to unimmunized close contacts only
Benign Rolandic Epilepsy vs. Juvenile Myoclonic Epilepsy
Rolandic - usually occurs in kids 3-13 years, peak 7-9 years; will be awake and aware but cannot control; usually resolve by teen years with spontaneous remission; centrotemporal spikes on EEG; mostly occur when just waking up or during sleep; also called focal aware seizures; can have GTCs
JME - start in childhood, requires lifelong tx with valproic acid (depakote), can start at absence epilepsy and progress to this; usually occur within 1-2 hours of sleep/nap, can appear like the child has become clumsy with jerk like movements of extremities or digits, triggered by mental/emotional stress, can also have generalized tonic-clonic seizures
Toxic Shock Rash and Tx
Diffuse erythrodermal (sunburn like)
Tx if MSSA: clinda + cefazolin or nafcillin
Tx if MRSA: clinda and vanc
Vaccines 2/4/6 Months
2: Hep B, IPV, Hib, Rota, DTaP, PCV
4: same as above expect no Hep B
6: DTaP, IPV, COVID + flu
3rd Hep B can be from 6 months to 18 months
3rd IPV can be 6 months until 18 months
Valsalva/squatting in Heart Murmur
Increases venous return
If quieter - HCM
If louder - aortic stenosis
Vaccines 12 Months
Hib - or at 15 months
PCV - or at 15 months
MMRV - or at 15 months
Hep A - can be 12 - 23 months
Vaccines 4-6 years
DTaP
IPV
MMRV
High risk: PPSV, Hep A series, MCV
After 7 years, give Tdap x1 then Td thereafter
RV1 vs RV5 Rota Vaccine
RV1 - has latex applicator
RV5 - latex free
Vaccines 11-12 years
Tdap
HPV
Meningococcal with 2nd dose at 16 years
MenB - minimum at 10 years, 16-18 years when low risk
Bexsero with 1 month apart for 2 doses
Hep A - Return to School
1 week after illness onset
Measles and Mumps - Return to School
Measles - 4 days after rash
Mumps - 5 days after parotid swelling
Pertussis - Return to School
5 days of antibiotics
Rubella - Return to School
7 days after rash onset
Salmonella Typhi vs Nontyphoidal - Return to School
Salmonella typhi - must have 3 negative stool cultures after diarrhea stops and finished antibiotics, obtain 48 hours apart
Nontyphoidal - once diarrhea stops, cultures not mandated
Scabies and Head Lice - Return to School
Scabies - once Tx started
Lice - do not send home early, may return once Tx started
Shiga toxin and Shigella- Return to School
Shiga: Includes O157:H7
Once diarrhea markedly improves and 2 negative stool cultures, obtained 48 hours apart
Shigella: markedly improved diarrhea, stools must be contained in diaper/controlled by child, no more than 2 stools more than baseline, some may require 1 negative stool culture
VZV - Return to School
Lesions crusted over, usually 6 days after onset of rash
Strep pharyngitis - Return to School
No fever and 12 hours after antibiotics started
