Natsumi Pediatric Flashcards
Children younger than 5, averaging 18 months old.
Myoclonic jerk extremities, chaotic eye movements in all directions, hypertension, palpitations, diarrhea.
PE: palpable abdominal mass, diastolic hypertension, increased urine VMA and HVA
What do you suspect? Investigation? Tx?
Neuroblastoma - adrenal medulla cancer
Test:
Tumor biopsy
CT or MRI of chest, abdomen, pelvis
bone scan to look for lytic lesions
Tx: usual cancer tx
Prognosis: 40% survival rate, but children 1 yo have a 90% cure rate
This condition has point mutation that inactives RB Leukocoria, strabismus are associated with?
Encephalitis
Inestivestigtion
MRI is best
This childhood condition Slapped cheek appearance and exanthema. lasts 2-4 days with headache fever, sore throat, pruritus, arthralgia. Erythematous maculopapular rash extends to the trunk and proximal extemitites.
Erythema infectiosum
ELISA increased IgM , PCR, clinci l
Self limiting -can use NSAID
Parovirus B19 is associated with which dz
Erythema infectiosum
Coxsackievirus
Hand-foot-mouth disease
- fecal oral route or skin lesion contact or oral contact t
Mcular lesion on buccoal mucosa, tongue that may be painful. Lesion vesicular that erode and become surround by erythematous halol
hands, feet, butt, genital
- Fever of 38-39 C within the first 24-48 hours
Hand-foot-mouth disease
clinical dx, self limiting
Coxsackievirus
Hand-foot-mouth disease
Fecal-oral route or skin lesion contact or oral contact t
- Macular lesion on the buccal mucosa, the tongue that may be painful. They can erode and become surrounded by an erythematous halo.
- Skin lesions are erythematous, tender macules or vesicles on hands, feet, butt, genital
- Fever of 38-39 C within the first 24-48 hours
Hand-foot-mouth disease (Coxsackievirus)
clinical dx, self-limiting
coxsackievirus A16 and enterovirus 71
Herpangina
- Most are asymptomatic
- Fever 101-104 F
- Multiple vesicles or ulcers on soft palate and pharyn surrounded by erythema
- Gray papulovesicular with erythematous base
- Sore throat upon swallowing
- Incubation period: 4-14 days
What do you suspect? Investigation? Tx?
Herpangina - due to enterovirus infection (fecal-oral, respiratory route, fomites)
Diagnosed clinically
Self-limiting
Fever, nuchal rigidity/stiff neck, headache, seizures, altered level of consciousness, n/s
Lab differences: (bacterial vs. viral)
Increased CSF protein
Increased total CSF leukocytes
Normal CSF glucose
Grain stain negative
or
Increased CSF protein
Increased total CSF leukocytes
Decreased CSF glucose
Grain stain positive, positive culture
Meningitis - pia mater inflammation
ER!!! MONITOR VITALS & AIRWAY
- Most are asymptomatic
- Fever 101-104 F
- Multiple vesicles or ulcers on soft palate and pharyn surrounded by erythema
- Gray papulovesicular with erythematous base
- Sore throat upon swallowing
- Incubation period: 4-14 days
What do you suspect? Investigation? Tx?
Herpangina - due to enterovirus infection (fecal-oral, respiratory route, fomites)
Diagnosed clinically
Self-limiting
Paramyxovirus
Mumps
Paramyxovirus
Mumps, Rubeola
- Incubation 12-25 days transmitted via droplets
- Fever, HA, BL parotitis with increased serum amylase, ears are displaced laterally and superiorly, myalgia, malaise
What do you suspect? Investigation? Tx? Complications?
Mumps
Test: ELISA immunoglobulin titer
Tx: MMR vaccine
Complications: pancreatitis, orchitis, epididymitis, infertility, encephalitis, myocarditis, arthritis
Bordetella pertussi bacterial infection
Pertussis
Tx: Azithro
3 stages
Catarrhea stage (1-2 weeks): mild cough, coryza, cyanosis Paroxysmal stage (2-4 weeks): paroxysmal bouts of 10-30 coughs, interrupted by 'whoops" to get air. Vomiting with coughing spells Convalescent stage (1-2 weeks): decreased frequency and severity yhst van last up to 6 months
Pertussis
High fever that lasts 3-5 days which
after an abrupt loss of fever → pink, non-pruritis macules and maculopapular that starts at neck and trunk → face and extremities (lasts 2 days)
Roseola Infantum
Complications
Febrile seiuares
enxephalitis
HSV 6
Roseola Infantum
RNA togavirus (
Rubella (3 day measle)
Forcheimer’s spot
red sports that develop on posterior soft/hard palate that develop at the onset of rash
Rash that is ITCHY, starts at hairline → rapidly spreads to neck trunk and tst of the body
Rubella
ELISA
Rash that is ITCHY, starts at hairline → rapidly spreads to neck trunk and tst of the body
Rubella
ELISA
- Morbilliform rash starts at hairline → spreads to neck/face/trunk, desquamates
- Enanthem: koplik spots (grey/white papules on buccal mucosa)
- Prodrome: Cough, coryza, conjunctivitis
What do you suspect? Investigation? Tx? Complications?
Rubeola
desquamates = no palm or sole involvement
Test: Clinical
Complication: otitis media, pneumonia, encephalitis, SJS, glomerular nephritis, myocarditits/pericarditis
Vitamin A, immunoglobulin, MMR vaccine
- Caused by toxin-producing group A beta-hemolytic streptococci (GABS)
- Children aged 5-15 years
- Acute onset of fever, sore throat
- 24-48 hours after pharyngitis, erythematous rash develops on the face and neck before spreading to
other parts of the body - Sandpaper quality, non-pruritic, non-painful
- Spares the mouth, but tongue has white exudate that is studded with prominent red papillae
- Rash fades after 6 days and peeling begins that can last up to 10 days
- White exudate on tongue disappears leaving it to be beefy red which is termed, ‘strawberry tongue’
What do you suspect? Investigation? Tx? Complications?
Scarlet Fever
Investigation: rapid strep test, throat culture
Tx: Penicillin, amoxicillin
- Group A streptococci infection (GABHS)
- Commonly occurs in school
- Children aged 5-10 years, uncommon children <3 years old
Clinical Features • Mclssac Criteria • No cough • Age 3-14 years old - Tender anterior cervical lymphadenopathy • Erythematous tonsils - Fever >38°C
Assign 1 point for each feature
• 0-1: no culture, no antibiotics - 2-3: Culture, treat if positive - 4: Antibiotic Investigations • Culture, Rapid Strep antigen test • If Rapid strep test is negative (50-90% sensitivity), throat swab for culture as it is the gold standard (90-95% sensitivity)
Streo Pharyngitis
Investigations • Culture, Rapid Strep antigen test • If Rapid strep test is negative (50-90% sensitivity), throat swab for culture as it is the gold standard (90-95% sensitivity) Treatment
• If Mclsaac score is >1, treat with Penicillin or Amoxicillin, but must be treated with 9-10 days to
prevent rheumatic fever
• Acetaminophen for discomfort
complications
• If untreated, it can lead to complications such as otitis media, sinusitis, pneumonia, mastoiditis,
peritonsillar abscess, scarlet fever, rheumatic fever
• If infection is invasive, prescribe clindamycin antibiotic
This condition is investigated using psudohyphae and gram-positive yeast seen on gram stain or with KOH stain
Limited in infants, antibiotics/steroid use/ immunocompromised group
Thrush
Tx: Nystatin or fluconazole
• Varicella-zoster virus
• Affects those who are <10 years of age, usually occurs in the spring months
• Incubation of 2-3 weeks; patient is highly infectious 1 week before rash begins and until vesicles have
crusted over
• Transmitted through respiratory secretions and vesicular fluid
• Maternal infection in the first trimester can cause a small chance (0.4 - 2.0%) that the baby could be
born with birth defects known as “congenital varicella syndrome”. Also 10-20% of pregnant women may
develop pneumonia, with the chance of death as high as 40% if infected in the first trimester.
Clinical Features
• 1-3 days of fever and respiratory symptoms
• Pruritic rash progresses from macules, to vesicles to pustules that burst and lesions crust over
• Involves trunk, face, scalp, conjunctivae, oral mucosa, extremities including palms and soles
• If scratched, vesicles can bleed• Maternal infection in the first trimester can cause a small chance (0.4 - 2.0%) that the baby could be
born with birth defects known as “congenital varicella syndrome”. Also 10-20% of pregnant women may
develop pneumonia, with the chance of death as high as 40% if infected in the first trimester.
Clinical Features
• 1-3 days of fever and respiratory symptoms
• Pruritic rash progresses from macules, to vesicles to pustules that burst and lesions crust over
• Involves trunk, face, scalp, conjunctivae, oral mucosa, extremities including palms and soles
• If scratched, vesicles can bleed
Investigations
• Tzanck smear test (Sensitivity of 60%)
• Confirmation with culture of vesicular fluidComplications
• Secondary bacterial infection with Group A streptococci
• Impetigo, abscesses, cellulitis, necrotizing fasciitis, sepsis
• Cerebellar ataxia, pneumonia
• Life-threatening in immunocompromised patients
• Neonates who were born from mothers who developed varicella 5 days before, or 2 days after
delivery are considered high risk
• Must begin Varicella zoster immune globulin (VariZIG) treatment ideally with 4 days (10 days
the latest)
• Virus becomes latent in sensory ganglia and reappears later as herpes zoster (shingles)
- Increased incidence in immunocompromised individuals
Varicella
Treatment
• Acyclovir antiviral medication
• Proper hygiene, do not scratch to prevent spread of infection to others
• Do not prescribe aspirin (ASA) in children due to risk of Reye’s syndrome
• Avoid contact with others until lesions have crusted over and no new lesions appear
6 months to 4 years
Prainfluenza (type 1,2,3)
Adenovirus
Clinical Features
• Begins with nonspecific respiratory symptoms such as rhinorrhea, sore throat and cough
• Low grade fever
• Within 1-2 days,
• Hoarse voice, barking cough
• Inspiratory stridor
© Symptoms worse at night as it is difficult to breathe while sleeping that can send the
child to the ER
• Symptoms resolve within 3-7 days but can last up to 2 weeks
Croup
Tests: Clinical diagnosis
- AP X-ray → Steeple sign with subglotting narrowing
Tx:
- Humidified O2
- Dexamethasone, prednisone
- Epinephrine
- Intubation, hospitalization if not better in 4 hours
Steeple sign on X-ray
Croup
- Autosomal recessive, chromosome 7
- Primarily affects Caucasions (>98%)
- Usually diagnosed at 5 months of age with a median survival age of 30 years
Clinical Features • Nasal polyps • Heat exhaustion from the loss of sodium in the sweat from the skin • Recurring respiratory infections • Pseudomonas aeruginosa, Staph. aureus - Cor Pulmonale commonly occurs • Wheezing or chronic cough • Malabsorption - Chronic pancreatitis - rales, rhonchi, clubbing of fingers, anemia, hypoproteinemia, hyponatermia
- Type 1 diabetes mellitus from chronic pancreatitis
- Meconium ileus
- Gallstones (>50%)
- Distal intestinal obstruction syndrome, rectal prolapse
- Clubbing of fingers
Cy stic fibrosis
Test:
- Sweat chloride test (> 60 mmol/L in children, >80 mmol/L in adults)
- Clinical
Treatment • Bronchodilators (e.g Albuterol/Salbutamol) • Antibiotics depending sputum (e.g ciprofloxacin, cephalosporin) • Corticosteroids • High calorie diet • Fat soluble vitamin supplements • Pancreatic enzyme replacement • Refer to Pulmonologist
In this condition, vocal cords are not involved, HiB vaccine is usually administered to avoid this dz.
Clinical Features
• Occurs at any age, particularly between the ages of 1 to 4 years old
• Rapid onset
• Cyanotic, inspiratory stridor, slow breathing, drooling
• Sore throat
• Dysphagia (difficulty swallowing)
• Restlessness
Epiglottitis
Investigations
• Physical exam can lead to complete obstruction, therefore they are contraindicated
Investigations
• Physical exam can lead to complete obstruction, therefore they are contraindicated
SUDDEN INFANT DEATH SYNDROMEEpidemiology
• Leading cause of death of infants in the 12 months
• Approximately 60-70% of SIDS deaths occur in males
• More common in children who are placed in prone position
• Most deaths occur between midnight and 8 AM
Risk Factors
• Smoking in the household
• Bed-sharing may lead to compromise of an infant’s airway, especially before the age of 3-4 months
• Breastfeeding reduced the risk of SIDS by approximately 50% at all ages throughout infancy
• Pacifier (dummy) use may reduce the risk of SIDS
• Covering the infant’s head with bedding or bed clothing is a risk factor for SIDS
• Overbundling of infants during sleep should be avoided
Prevention
• Place infant on back, NOT in prone position when sleeping
• Avoid overheating and overdressing
• Observe for presence of toys, pillows, or other objects that may cause asphyxiation
• Firm mattress, no loose bedding
• Avoid smoking
Risk Factors
• Smoking in the household
• Bed-sharing may lead to compromise of an infant’s airway, especially before the age of 3-4 months
• Breastfeeding reduced the risk of SIDS by approximately 50% at all ages throughout infancy
• Pacifier (dummy) use may reduce the risk of SIDS
• Covering the infant’s head with bedding or bed clothing is a risk factor for SIDS
• Overbundling of infants during sleep should be avoided
Prevention
• Place infant on back, NOT in prone position when sleeping
• Avoid overheating and overdressing
• Observe for presence of toys, pillows, or other objects that may cause asphyxiation
• Firm mattress, no loose bedding
• Avoid smoking
Suddwn infant death syndrom
Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections in infants and
young children and manifests as bronchiolitis
• See Bronchiolitis in Respirology
Baby bronchitis dearth
Risk Factors • Childcare attendance • Overcrowding and lower socioeconomic status • Exposure to environmental pollutants • Minimal breastfeeding • Multiple birth sets (triplets or more)
Clinical Features • Low grade fever • Cough • Wheezing • Cyanosis • Tachypnea • Rales or crackles • Sepsis or toxic-like appearance
Respiratory Syncytial Virus
Investigations
• Viral culture for RSV (Molecular probe is the most sensitive) by swabbing nasopharynx
• X-ray shows hyperinflated lung fields with a diffuse increase in interstitial markings• On autopsy, histological findings of mononuclear cell and neutrophil infiltration of the peribronchiolar
areas
CONGENITAL HEART DISORDERS
ATRIAL SEPTAL DEFECT (ASD)
• Patent foramen ovale (opening between right and left atriums)
Epidemiology
• 6-8 % of congenital heart lesions
• 80-100% spontaneously close if the ASD is <8 mm
• Most common adult AD, congestive heart failure and pulmonary hypertension can develop in adults
while asymptomatic in childhoodPhysical Exam
• Blood flow across the AS does not create a murmur at the site of the shunt because there is no
pressure gradient between the atria. But, an AD with a moderate to large left-to-right shunt results in a
increased right ventricular stroke volume leading to a crescendo-decrescendo systolic ejection murmur
heard at the 2nd intercostal space at the upper left sternal border
• Patients with large left-to-right shunts often have a rumbling mid-diastolic murmur at the lower left
sternal border because of increased flow across the tricuspid valve; and fixed splitting of S2
Atrial septal defect
Investigations
• ECG
• Chest X-ray show cardiomegaly because of dilatation of the right atrium and right ventricular
chamber.
• Doppler echocardiography may be helpful in demonstrating flow across the atrial septum
Tx: surgery to close ASD through catheterization
•
• Associated with Turner’s syndrome
Physical Exam
• Increased upper extremity blood pressure
• Increased cerebral blood flow
• Decreased blood pressure in the lower extremity
• Leg claudication (pain in calf when walking) with weak or absent pulses in lower extremities
• Decreased renal blood flow leading to an activation of renin-angiotensin-aldosterone system causing
hypertension
Coarctation of the aorta - Narrowing of aorta almost always at the level of the ductus arteriosus and left subclavian artery
Test: Chest X-ray, MRI
Treatment
• Surgery to remove coarctation
•
• In PDA, it produces a left-to-right shunt causing blood from systemic circulation to pulmonary
circulation, leading to pulmonary hypertension
• Produces a pink upper body and cyanotic lower body (because ductus ateriorosus occurs after
the left subclavian artery)
Physical Exam
• Tachycardia
• Heavy “machinery” murmur heard during systole and diastole
• Wide pulse pressure
• The peripheral pulses are bounding because of high left ventricular stroke volume to compensate for
the PDA, and with low diastolic pressure in systemic circulation
Investigations
• ECG
• Chest X-ray may show normal to mildly enlarged heart
• Doppler echocardiography to identify the abnormality
Patent Ductus Arteriosus (PDA) - In PDA, ductus arteriosus remains open (vessel connection between descending aorta and left
pulmonary artery)
Tx: Surgery to close PDA
- Right-to-left shunt causing cyanosis, shortness of breath and fatigue,
- severe= seizure
Physical Exam:
• Systolic murmur heard along the left sternal border
• Systolic thrill along the left sternal border
• Harsh systolic ejection murmur is heard over the pulmonic area and left sternal border
• Loud S2 heard due to pulmonary stenosis
Tetraology of Fallot
• Combination of conditions:
- Ventral septal defect
- Right ventricular outflow tract obstruction
- Overriding aortic root
- Right ventricular hypertrophy
Treatment: Surgical repair preferably before the 2nd year of life
Investigations
• Doppler echocardiography
• Chest X-ray shows a classic boot-shaped heart
• ECG
Tx: Surgical repair before 2 yo
- Most common congenital heart disease in children
- Opening in ventricle septum allowing blood to flow between ventricles
- Left-to-right shunting
Clinical Features
• Shortness of breath, exercise intolerance
• Lethargy, delayed growth and development
• Recurrent upper respiratory tract infections
• Congestive heart failure
Physical exam
• Holosystolic murmur at lower left sternal border with thrill
• Mid-diastolic rumble at apex
Ventricular Septal Defect (VSD)
Investigations
• Doppler echocardiography can be used to determine the size and location of VSDs
• Chest X-ray
small VSD - most close spontaneously
Most common congenital heart disease children
VSD
Name of the following condition:
Risk Factors
- Associated with malformations of the anorectal, vertebral or genitourinary structures
Clinical Features
- Persistent straining, ribbon stools
- Fecal impaction, distention
Anal Stenosis - congenital narrowing of the anal canal
Tx: surgical dilation
What is Encopresis
Seen more in M or F
Definition • Fecal incontinence in a child >4 years old, occurring at least once per month for 3 months • M:F = 6:1 in school-aged children Risk Factors • Chronic constipation • Difficulty with bowel training • Hypothyroidism
Evaluation
• Clinical diagnosis
• Physical exam may show anal fissure from painful stooling
• Emotional history could present a social and emotional stress between child and parent
• Child develops constipation through withholding bowel movement leading to fecal impaction and
seepage of soft or liquid stool
• Lack of toilet training or motivation to learn
• May show oppositional behavior
Child develops constipation through withholding bowel movement leading to fecal impaction and seepage of soft or liquid stools. Social and emotional stress.
HIRSCHSPRUNG DISEASE
• Absence of ganglion cells in Meissner’s submucosal plexus and Auerbach’ myenteric plexus in distal
colon, causing localized constant contraction without relaxation, resulting in obstruction
Clinical Features
• No meconium within the first 48 hours
• Palpable stool on abdominal exam with empty rectum on digital rectal exam
• Bowel movement only with rectal stimulation
• Alternating signs of diarrhea and constipation
• Abdominal distention, vomiting, failure to thrive
Hirschsprung Disease
Investigations
• Diagnose with rectal biopsy (lack ganglion cells)
• Barium enema shows dilated proximal segment and narrow distal segment
Treatment
• Surgical resection of affected segment (colostomy)
• Increase fiber and fluid intake if it is a short segment
Complications
• Enterocolitis of dilated bowel, leading to perforation which is the most common cause of death
• 90% idiopathic
• Children with cystic fibrosis are significantly at risk
• Telescoping of the intestine into itself into distal segment leading to mechanical obstruction and
bowel perforation
• Usual site is the ileocecal junction; jejunum in children
Clinical Features
• Sudden onset of recurrent, paroxysmal and severe periumbilical pain with pain-free intervals
• Palpable sausage-shaped mass in the right lower quadrant (Dance sign)
•
“Red currant jelly” stools (10-15% of patients)
• Shock and dehydration
• Later vomiting and rectal bleeding
Intussusception
Tests: U/S, contrast enema (barium or air)
SEND TO ER!!!
Air enema can reduce intussusception in 75% of cases
MECONIUM ILEUS
• Meconium is the first stool of a newborn which is very thick and sticky
• Meconium ileus is a bowel obstruction that occurs from impaction of even thicker and tenacious
meconium than normal meconium
• Distal intestinal obstruction results from the impaction of thick, tenacious meconium in the distal
small bowel
• 90% of patients who have meconium ileus have cystic fibrosis
• Rare condition that affects 1 in 25,000 newborns
Clinical Features
• Abdominal distention
• Bilious (green) vomit and no passage of meconium
Meconium ileus
Test: abdominal x-ray
SEND TO ER!! IV hydration
- Positive Ortolani’s test
- Short leg (s)
- Usually asymptomatic
What do you suspect? Investigation? Tx?
Congenital hip location
Test:
- US & X-ray is not sensitive enough until >4 months old
- Positive Ortolani’s test
Tx: PT, surgery
Inward twisting of tibia
Tibial torsion test (+)
How’s the progonisis
Internal tibial torsion
Prognosis is good, resolves with time usually between ages 5-8
Surgery if severe
Inward twisting of femur
• Inward twisting of the femur causing knees and feet to turn inward and have a
“pigeon-toed”
appearance
• Appears between the ages of 2-4, prominent at age 5-6
Epidemiology
• Congenital or acquired
• M:F = 1:2
• Ligamentous laxity
Clinical Features
• Child appears to have toes turned in toward midline
• Unsteady balance
• Legs appear to bow to give the patient more stability when standing
Femoral Anteversion
Clinical Dx, CT to measure degree or torsion
Prognosis is good, resolves with time usually between ages 5-8
can give braces, PT
urgery if severe
What is the primary method imaging for the diagnosis and follow-up eval for Juvenile rheumatoid arthritis?
X-ray
What is the primary method imaging for the diagnosis and follow-up eval for Juvenile rheumatoid arthritis?
X-ray
Tx for Juvenile Rheumatoid Arthritis?
- Exercise
- PT, OT, eye doc, rheumatologist
- DMARDs, NSAID, corticosteroid
Clinical Features
• Hip pain and a limp, progressing to knee pain
• Pain resulting from necrosis of the involved bone
• Limited internal rotation and abduction of hip
• Atrophy of quadriceps muscles, hip many develop adduction flexion contraction
- Limited internal rotation and abduction of hip
- BL 20% of the time
- Mostly in boys 3 to 10 years of age
- Family history
- Avascular necrosis of the proximal femoral epiphysis, causing abnormal growth and remodeling of regeneated bone
Legg-Calve-Perthes Disease - Avascular necrosis of femoral head ossification center
X-ray, MRI or bone scan if x-ray is inconclusive
Complications
• Eventually, collapse of the femoral head may occur, increase in the width of the neck, and
demineralization of the femoral head
• Early onset of arthritis and decreased range of motionTreatment
• Consultation with an orthopedist
• Eliminate hip irritability
• Restore and maintain good range of motion in the hip
• Prevent femoral epiphyseal collapse
• Attain a spherical femoral head when the hip heals
• Bracing
• Surgery on femoral head or hip (osteotomy)
Mechanism
• Repetitive quadriceps contraction through the patellar tendon at its insertion that has a skeletally
immature tibial tubercle, eventually leading to fragmentation of the tibial tubercle
Epidemiology
• Very common cause of knee pain in athletic children (jumping sports) aged 10-15 years,
Clinical Features
• Knee pain, occurs during activities such as jumping, squatting, running
• Pain on resisted leg extension
• Pain is relieved with rest
Osgood-Schlatter Disease
Investigations
• Knee X-ray shows fragmentation of tibial tubercle (with or without ossicles in patellar tendon)
Treatment
• Benign, self-limited condition
• Analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief and reduction of local
inflammation
• Restrict movement such as jumping, squatting, running etc.
• Stretching of the quadriceps to decrease tension on the tubercle and also stretching of the hamstrings
• Surgery is rarely indicated
Clinical Features
• Anxious child who is protective of the affected arm, supported with the other hand
• Tenderness at the head of the radius
• Patient resists all ranges of motion
Investigations
• Assume there is a fracture and send to ER for X-ray
• E doctors will manipulate radial head back into annular ligament through axial compression at the
wrist while supinating the forearm and flexing the elbow
- Snap will be heard to confirm radial head is back into anatomical position with the annular
ligament
Subluxation of Radial Head/ Nursemaid’s elbow
What is cryptorchidism? Tx and complications
Tx: orchiopexy
Complications
Failure to thrive definition
Investigation
Tx
Counseling, supplemental nutrition, observe feeding habits, diet
Hypospadias/Epispadias - ventral or dorsal? Tx
surgery!
Tx more ADD
Methylphenidate
Tourette’s syndrome tx?
Clonidine
onset at 5-18 yp
Polyuria, polydipsia, bouts of dehydration
Muscle weakness, constipation, sudden death
bone deformities
imapred growth
acidosis
No rsrobtion of glucose, phosphate, amino afid, URI acid, bicarconaonate
Fanconi syndrome
Tx:
- Replace substance lost in urine
- Hydration to correct polyuria
- Metabolic acidosis due to the loss of Picard via sodium bicarbonate
- Phosphate and vitamin D sup,entation are also necessary
Hemangioma
surgical excision
• Lead poisoning
• Lead comes from lead paint, pipes, window blinds, toys that get ingested causing permanent CNS
toxicity, chronic liver failure, gout, seizures, leading to death
Clinical Features
• Weakness, irritability
• Weight loss
• Vomiting, abdominal colic
• Personality changes
• Wrist and foot drop
Investigations
• Basophilic stippling of RBCs
• Hypochromic microcytic anemia (sideroblastic)
• Lead lines on gingivae and epiphyses of long bones on x-ray
• Increased serum lead (serum lead is more sensitive than hair analysis of lead)
Plumbism - lead poisoning
EDTA chelation
