Pedi 13 Flashcards
Pathogenesis of refeeding syndrome?
High insulin–Increase cellular uptake of K/Mg/P and thiamin–Low serum k/Mg/P and thiamine
High insulin also increases Na and Water retention
Manifestation?
Arrhythmia and CHF CNS(Seizure, Treamour..) Wernicke encephalopathy MSK(rhabdomyolysis and weakness) GI(diarrhea and elevated TA)
RTA type?
1–distal
2-proximal
4-aldosterone related
D/T based on urine PH and electrolyte(PH is >5.5 in 1 and <5.5 in 2 and 4), serum K high in 4, and low-normal in 1 and 2
CM of RTA?
Growth failure
Low bicarbonate
High serum chlorine(help to D/T from MA from Gi causea)
Non Anion GAP metabolic acidosis
T1RTA Cxs?
Poor H secretion in the distal nephron High urine PH Low-Normal serum K Medication disorder AID(SS and RA) Family Hx of nephrolithiasis
T2RTA?
Defect in proximal Bicarb absorbition
Low urine PH
Low-Normal serum K
Fanconi syndrome(Glucoseuria,Posphaturia and aminoaciduria)
T4RTA?
Aldostrone resistant/defect in k/Na antiporte in DCT
Urine Ph <5.5
High serum K
CAH and Obstructive uropathy
DPT component?
Diphtheria Toxoid
Tetanus Toxoid
Conjugated/acellular pertussis
Schedule?
6 dose
2,4,6 month
15-18 month
4-6 year
C/I?
in Px dose
EncephalopathyIAMS, Prolonged seizure, comma…)
Anaphylaxis
Unstable neurologic sign(uncontrolled seizure and infantile spasm)
Reactive attachment disorder (RAD) CM?
Occur in children with Hx of neglect/abuse/prolonged institutionalization and inconsistent care
Seldom need comfort
Do not respond to confrontation
Lack of social responsiveness
Lack of positive emotion
Unexpected irritability and sadness to non-treatning situation
What about PTSD?
No emotional stunning
No lake of response to the caregiver
Risk factor for methemoglobinemia?
Nitrates
Dapsone
Topical/Local anesthetic
CM?
Cyanosis
Dark checolate blood
Pulsosimetry–85%
LAB?
Normal Po2
>5% d/c in saturation by pulse oximetry and ABG
pathophysiology?
Oxidizing agents—Change Fe2+ to Fe 3+–Low O2 affinity and Deacrese 02 release from periphery–Hypoxia/Blood colour and cyanosis did not respond to 100 02 but ABG read normal o2
management?
Methylene blue(reduce MetHb to Hb) Vit C if MB not available or C/I(G6PDD)
Viral meningitis Cxs?
Viral predoom Meningeal sign CSF(WBC(10-500),G(40-70,I.e N) and P(40-150) Focal NS less likely MCC is Enterovirus
Enterovirus
part of picorena (NE,IS,SS,RNA) Poliovirus Echovirus, Coxsackievirus can cause aseptic (viral) meningitis
management?
Supportive
Important Hx in monoarteritis?
Hx of rash(LD, SS, SJA–all three have a rash)
SS and SJA will have a rash
Cxs of streaptococal perianal dermatitis?
School-age Sharpley demarcated perianal erythematous lesion Pruritis and perianal pain Fissure--Blood on stooling Constipation due to pain Personal or contact pharyngitis
Management?
Oral antibiotic
what about PW(EV)?
No significant perianal pain
Night pruritis
No sharp demarcated lesion
MA(RKHS) d/t with AIS?
AIS
Male with female external genitalia
Absent axillary/pubic hair development
CF complication in females?
Delay puberty due to malnutrition
Infertility due to cervical mucus thickening
Hereditary angioedema pathophysiology?
Low C1 inhibitor protein –excessive C1 esterase activation–High bradykinin/Kalerkine activation–Low C4 level
CM?
Edema(Face, genitalia, and extremity) Laryngeal edema Nu urticaria or pruritis Abd pain, Vomiting, and diarrhea Episode Occur in stress, dental procedure, or trauma
Management?
C1 concentrate
AntiBradykinin (icatibant) and ant Kallerkine(ecallantide)
Avascular necrosis etiology?
steroid Alcohol SLE Hemoglinopphaty(SSD) APS Infection(osteomyelitis,HIV) Renal transplant Decompression sickness
Pathophysiology of laryngomalacia?
Delayed maturation and NMD
Redundant supraglottic tissue
Recurrent inflammation(reflex)
Management?
Normally resolve by 18 month
Reassurance +/- GERD therapy
Surgery in severe case
Diagnosis?
Laryngoscopy
Omega shaped epiglottis
The collapse of the larynx during inspiration
Newborn boy with potter sequence(flat face, deformed foot, and pul. Hypoplasia)
Posterior urethral valve
transient tachypnea of the newborn?
Due to retained intrauterine fluid in neonate’s lung
transient RD and cyanosis
cause of Trendelenburg sign?
contralateral Gluteus medius and minimus lesion Cause NM disorder Trauma and impediment of SGN Inflammatory myopathy
Lesch-Nyhan-syndrome genetics?
X-L-R
Deficiency of HGPRT enzyme
Accumulation of Hypoxanthine and Uric acid
CM?
Delay in milestone and hypotonia in infancy
Early childhood
–Intellectual D
–Extrapyramidal Sx(e.g dystonia and choria)
–Pyramidal Sx (e.g hyperreflexia and spasticity)
–Self-mutilation
Gouty arthritis in late, untreated disease
What to do inpatient with suspect of lead poisoning?
Capillary blood lead level
If >5ng/dl do venous sampling B/C CBLL have a high FP rate
If venous sampling >45 ng/dl–chelation
X-Ray–For GI symptomatic patient(constipation,abd pain, and diarrhea)–we see an opaque lesion
Cong.Hypothyroidism sx?
neonate normal during early infancy Hypotonia Protruding tongue Umbilical hernia weakness/sluggish movt Jaundice Hypothermia Refractory Macrocytic anemia Respiratory difficulty and noisy breath
Management?
All neonates should be screened with T4 and TSH
dysgenesis(Aplasia, ectopia, and hypoplasia) MCC
Levothyroxine 10 mcg/kg and titrate based on need
What to do in a child if parents refuse life-saving therapy like chemotherapy?
Seek court order
Hospital EC/RMG and social worker can assist in parent convincing
HD sign help to d/t from MI?
High rectal tone
Squirt sign
Colonic dilation
When will the germinal matrix be involute?
At 32 week
I.e the reason why prematurity is the main risk for IVH
Aproch in wommen with primery amenoria?
Pelvic u/s
1–If uterus present–Do FSH(if high karyotype and if low cranial MRI)
2–If uterus absent—Do karyotype(XX–MA and if XY AIS)
But when we consider observation?
age 13-15 with development of other SSC(Breast)
Why do turner patients will have adrenarche?
B/C TS doesn’t affect the Adrenal gland i.e patient will have normal axillary/pubic hair development.
Lyme disease prophylaxis Indication?
Deer thick identified Thich attached for more than 36 hr Px started before 72 hr of removal Local LD PV is high>20% No Doxycycline C/I
what to do??
Detach Bug by forceps w/o twist
Doxycycline one dose
Infantile butulinism CM?
Constipation, poor feeding, and hypotonia
Oculobulbar pulsy (absent gag reflex and ptosis)
Symmetric descending paralysis
Aut.Dsfn(dec,salivation and fluctuant Hr/RR
