Pedi 11 Flashcards
Absence seizure CM?
4-10 year
Sudden impairment of consciousness” staring spell”
Preserved muscle tone
Unresponsive verbal/tactile stimulation
Short duration(<20 sec)
Simple motor automatism(chewing/lip smacking/eye blinking/fluttering) is frequently present
easily provoked by hyperventilation
Diagnosis?
EEG:3-Hz spike-wave discharge during an episode
Management?
Ethosuximide
Usualy resolve in adolecence
No long term sequelae
D/t from ADHD?
In ADHD Staring spells responsive to vocal/tactile stimulation Forgetfulness Difficulty in organization Easy distractibility
Cause of vaginal bleeding in neonates?
Hormonal(estrogen withdrawal)--mucoid, self resolved Trauma--Sexual abuse/unintentional fell vaginal foreign bodies-Foul-smelling discharge Vaginal malignancy(pr. Mass)--main rhabdomyosarcoma
Leukocoria in infancy?
Absent Of normal red reflex in the eye
or presence of white reflex
Cause?
Cataract
Eye tumor (retinoblastoma)
Severe retinopathy of prematurity
Retinitis pigmentosa
Cataract?
Congenital infec (CMV, RUBELLA)--microcephaly, bilateral and other congenital inf sign Metabolic--Bilateral
Eye tumor (retinoblastoma)?
Age < 2 Mostly unilateral/bilateral in inherited case Strabismus Nystagmus Diagnose with MRI of brain and orbit
Severe retinopathy of prematurity?
An infant born <30 week
Retinal detachment
Retinitis pigmentosa?
Decrease night vision
Decrease vision acuity and power
Rare to see cataracts in age <1
Metatarsus adductus?
Common in children of primigravida Flexible positioning Medial positioning of the forefoot Normal hindfoot position Overcorrect by forefoot lateralization during active/passive foot movt
What about club foot?
Flexible positioning
Medial/upward positioning of the forefoot and hindfoot
Hyperplatar flexed foot
Highley associated with C.A(Karyotaype is necessary)
Management D/C?
MA:reassurance
CF:Serial manipulation/casting & surgery for refractive cases
Wiskot andrich syndrome pathogenesis?
X-LR
WAS protein gene defect–Defect in cytoskeleton signaling after cell signaling.
Defect in hematopoietic cell
WBC and Platelet will be affected
Impaired WBC migration and immune synapse formation
CM?
Triads
1-Eczema
2-Small and low platelet–bleeding
3-Recurrent infection (viral/bacterial and fungal)
Risk factor for developmental dysplasia of hip?
Breech presentation
Family hx
Tight swaddling(the traditional practice of wrapping a baby up gently in a light, breathable blanket)
Female and white
Clinical feature?
Red flag(Hip dislocation,+ Barlow and Ortolani test, Impaired hip abduction) Supportive(Leg discrepancy, unequal crease in gluteal, inguinal, and thigh area)
Management?
Red flag: refer to orthopedics center Supportive/risk factors depend on 1-< 4month--U/S 2-> 4 month--X-ray Definitive tx is Pavlik harness maneuver(use splint to make hip flexion and abduction and prevent extension and adduction)
EYe complication of Marfan?
Upward and lateral lense
Iridodonesis(rapid dilation and constriction of iris)
MYopia(due to elongated aye)
CVS complication of marfan?
aneurysm
dissection
MVP
Aortic dilation–AR
Bilious vomiting in neonate indicates?
Distal bowel obstruction
Hemodynamically stable–Immediately do X-Ray(r/o perforation)
Meconium ileus?
CF patient Distended S.Bowel Empty rectum Microcolon(due to notusing collon) failure to pass muconium>48 of birth
Management?
First, do an x-ray to r/o perforation
Do hyperosmolar enema(dissolve plug)
Surgery if enema fails
what about Hirshusprung disease?
Narrow rectosigmoid
Dilated anal cannel
Proximal colon enlargement unlike Meconium ileus(micro colon)
Congenital syphilis Bony complication?
Limited joint movement and pain
Frontal bossing and anterior tibia bowing(age >2)
Acute unilateral cervical LDN in children cause?
S.A & S.P:MC/Suppration is common
Anaerobic: Hx of periodontal disease and dental caries
Francella: Hx of animal contact(rabbit)
Acute unilateral cervical LDN in children causes management?
Clindamycin
Chronic unilateral cervical LDN in children cause?
MAC: Violaceous
B.H: Papule at the site of scratch/bite
Bilateral cervical LDP?
Acute: Adenovirus
Chronic: CMV/EBV–Infectious mono
Physiologic jaundice pathophysiology?
High RBC turnover(High HCT and Short BilirubinLS)
Low Hepatic Clearance(Unmatured HGT until 2 weeks)
High EH reabsorption:Low colonic flora-Low UB formation
CM?
2-4 day
Resolve 1-2 week
Hogh UB
Management?
Frequent feeding: Increase GI flora
Phototherapy if a rapid increment
Pneumonia in CF patient management?
MRSA(MC):–Vanvomycine +
Anti-psudomonal(2nd C):-Cefempine/ceftazidime
How to d/t cardiac failure in CAV and KD?
In CAV
No coronary abnormality
The rash is papulovesicular and involves feet, hands, and mouth.But polymorphic(confluent) in KD.
Cxs of CHARGE syndrome?
Coloboma(opening in one eye structure) Heart defect Atresia choanae Retardation of growth Genitourinary malformation Ear abnormality
Aditional finding?
Anosmia
Cleft palate
Hypotonia
Diagnosis?
Clinical
CHD& testing
Choanal atresia CM?
Cyanosis at rest and feeding and improve when cray
Inability to pass NG tube through the nose
cause of cyanotic heart disease with single S2?
Transposition of the great vessel–+/- VSD
Tetralogy of Fallot–+VSD/Pulmonary harsh murmur
Trunks arteriosus–+ systolic ejection murmur
Tricuspid atresia:—+VSD
S.A enterotoxin?
Foods like salad, dairy items, egg, meat and produce Vomiting predominant Sx starts 1-6 Hr Resolve 24-48 hr \+/- diarrhea
If parents disagree on emergency care?
Proceed with treatment if one parent agree
ITP management in children?
Only cutaneous manifestation–Observe regardless of platelet count(unlike adult PLT should be>30,000)
Glucocorticoid, IVIg. Ani-D(RH + & Cb-) if have Bleeding
Spontaneous recovery in 3 month
why a fetus with 21 hydroxylase deficiency will have no aldosterone deficiency sx in the first 1-2 weeks?
Maternal Aldosterone
C/I for rotavirus vaccination?
normaly given 2-6 months in serious Allergy Hx of intussusuption SCID Delay until disease resolusion in moderate and severe current rota illnes
why DMD patients walk by toe?
Achilles tendon contacture
DMD management?
Glucocorticoid
DHN management in neonates?
<7 % wt loss–continu feeding and apint after 10-0-14 day
>7% wt loss–asses oromotor function,asses lactational failure,dailey wight,consider formula suplementation
Normal finding in the neonate?
Uric acid crystals(pink stain and brick dust on diaper)
5% weight loss in the first week
Regain birth weight at 10-14 day
No of wet diaper = age in days and >6 after the first week.
MaCcune Albright syndrome pathophysiology?
GNAS gene(g-protein) mutation--excessive pituitary hormone release LH/FSH--peripheral precocious puberty TSH--Thyrotoxicosis GH---Acromegaly Cushing syndrome--ACTH
other manifestation?
fibrous bone dysplasia–recurrent #
irregular border cafe-aue-lait-maccule
What about NFT1?
Precocious puberty(optic glioma affecting hypothalamus) and #(long bone dysplasia) But the cfe-aue-lait spot will have a regular border and >=6 and have associated axillary freckling and angiofibroma
benign murmur cx?
no cardiac symptom I-II grade mid systolic murmur Decrease on standing and Valsalva Low pitched musical, pure and squeaky on LSB(still murmur), and High pitch in LUSB(pulmonary outflow murmur) No additional feature
management?
reassurance
Indication for voiding cystourethrogram inpatient with UTI?
> =2 UTI
Abnormal renal U/S(hydronephrosis)
Fever >39 with etiology other than E.Coli
Sign of CKD(HTN, Poor growth)
High-grade(III & IV) VUR tx?
Daily antibiotics treatment
when will be repeated urine culture be necessary?
Sx does not resolve within 48 hr
Hypernatremia clinical feature?
Lethargy Irritability AMS Seizure Muscle cramp Muscle weakness Decrease DTR
Pertussis post-exposure prophylaxis?
Regardless of immunization
To all close contact
Partial contact with high-risk people like Px
Age <1 M. azithromycin
Age >1 M, azithromycin, clindamycin, and erythromycin
Hypostenusia?
Common in sickle cell T/D
Difficulty in renal water reabsorption
Polyuria/Nocturia unresponsive to water restriction
Normal kidney concentrating ability(normal Na)
Low urine specific gravity
Ni treatment require
Transfusion decrease symptoms
Sign of malnutrition in DM patients?
Growth retardation
Recurrent hypoglycemia
Decrease insulin requirement
Anemia
what to suspect?
celiac disease
do ATTG level
