pedi! Flashcards
conjunctivitis with clear discharge and pruritus?
Allergic Conjunctivitis (IgE mediated)
what is radial head subluxation?
axial traction (pulling up on a kid's arm) causes radial head to slip out of the annular ligament clinically- kid will keep arm pronated, to the side, and will cry if supination is tried
what is diagnostic and therapeutic for radial head subluxation?
diagnostic- an audible click when forearm is HYPERpronated or forearm is supinated and elbow is flexed.
these same moves are also therapeutic/the treatment
whats the definition of primary amenorrhea? age + 2ndary sex?
no menses and no 2ndary sex >13
no menses but approp 2ndary sex >15
whats the first step in work up of primary amennorrhea?
a pelvic ultrasound to rule out anatomical abnormalities
what are levels of E, FSH, and LH in Turner’s?
low E b/c streak ovaries
high FSH and LH bc feedback
what are the (3) characteristics of McCune Albright Syndrome?
(1) precocious puberty
(2) unilateral cafe au lait macules
(3) long bone fractures bc of ployostotic fibrous dysplasia
whats the pathophys of McCune Albright?
- mutation in GNAS gene that causes overproduction of pituitary hormone
what does iron poisoning look like
iron tablets are radioopaque and can be visualized on xray. they are corosive to gastric mucosa, and cause GI problems like abdominal pain, hematemesis
it can also cause hypotension and metabolic acidosis
if you see target sign on US of a baby whats the next step?
most likely intusseption
- give air or water soluble contrast enema
Vesicouretral reflux leads to?
recurrent UTIs
renal scarring
medulloblastomas occur mainly in _____
pilocytic astromas occur mainly in _____
cerebellar vermis
cerebellar hemispheres
SCD pts should prophylactically take what med till age 5,why?
- Penicillin
- to prevent S.Pneumo infection due to functional asplenia (vax prevents most H influ and N Meningitidis but many strains of S Pneumo are not protected against)
HSV vs Impetigo location?
- Impetigo can be all over face, but HSV is usuallt restricted to orolabial area.
- both can affect the finger
consequences of Mumps
Aseptic Meningitis, orchitis, and parotitis
how to differentiate a focal (complex partial) and absence seizure
focal - lasts couple minute
absence- last 10-20 sec
focal- cannot be caused by hyperventilation
absence- can be brought on by hyperventilation
what is an SGA baby?
less than 10th percentile of average birth weight.
what are risk factors of SGA babies?
- hypothermia, hypocalcemia, hypoglycemia
- hypoxia, perinatal asphyxia, meconium aspiration, polycythemia
how to tell apart JIA from ARF?
JIA: the arthralgia isnt migratory and has to last >6wk
ARF: arthralgia is migratory (fits JONES) and is preceded 2-4 wks by GAS infection
congenital melanocytic nevus vs congenital dermal melanocytosis vs nevus flameus
CMN- raised hyperpigmented macule with hair on it
CDM- mongolian spots, bluish grey non raised macules
nevus flameus- port wine stain
close contacts of pertussis patients?
need prophylaxis with macrolides EVEN if immunized!
if under 1 only give azithromycin not erythromycin bc it can cause pyloric stenosis
treatment for acute croup
corticosteroids and nebulized epinephrine
how do you diagnose pyloric stenosis?
abdominal US
what is Wiskott Aldrich Syndrome?
eczema
thrombocytopenia
recurrent infections
Xlinked recessive defect in WAS gene which causes abnormal cytoskeleton in WBC and platelets
baby who is cyanotic at birth with a single S2 most likely has?
Transposition of Great Vessels
respiratory distress and fluid in interlobar spaces?
Transient Tachypnea of the Newborn
rotavirus contraindication?
personal history of intusseception
newborn with conjugated hyperbilirubinemia dn hepatosplenomegaly most likely has
biliary atresia
painless hematochezia in toddler?
most likely Meckel’s
what is refeeding syndrome
aggressive feeding of a malnourished pt, carbs cause a spike in insulin which causes cellular uptake of Phosphorous, potassium, and magnesium. Low levels of these ions cause cardiopulm failure.
whats hyper IgM syndrome?
Xlinked deficiency in CD40 which causes impaired class switching, so more IgM and less of all the others. increase risk for infection with encapsulated bacteria and PJP
In AIS when should you do the gonadectomy?
do it after puberty if the gonads are stable, bc the benefits of gonad-dependent growth outweigh the risk of gonadal malignancy
retinal hemorrhage in newborn=
child abuse
scaphoid abdomen=
congenital diaphragmatic hernia
1st step of management of congenital diaphragmatic hernia?
- 1st= endotracheal tube
- then you can place an NG or OG tube to prevent abdominal distension
imaginary friends in a 6 yo? is it good or bad?
its totally normal, and can actually help social relationships by being a form of rehearsal
what is gold standard to diagnose DMD?
- genetic studies which show a deletion of dystrophin gene on Xp21, which is Xlinked recessive
whats the causing of non-pitting edema in a baby with turner syndrome
lymphatic dygenesis, causes accumulation of lymph with high levels of protein (therefore nonpitting)
marfanoid habitus (and hyperelasticity) + pale skin + cerebrovascular events
homocysteinuria
how to evaluate ICP in a child?
CT !
how does an osteoid osteoma present
a benign tumor of the proximal femur, usually well demarcated on xray.
progressively increasing pain, thats worse and night and relieved by NSAIDS
what is Todd Paralysis?
its paralysis of ipsilateral Upper and Lower extremities in the post ictal state (aka following a seizure). it resolved within 36 hours max of a seizure. MRI and CT are negative.
whats the most common type of nephrotic syndrome in peds?
MCD
- normal LM, foot process effacement on EM. usually no biopsy req
devpt: age 2 mos
language: coos
social: smiles + recog parents
motor: lift head when prone + hands unfisted 1/2 the time
devpt : 4 mos
language: laugh
motor: sits up w support, rolls
devpt: 6 mos
language: babble and respond to name
motor: hand to hand transfer, rake
social: stranger anx
devpt 9 mos
language: dada and mama
motor: cruise, pull to stand
social: waves bye
devpt: 12 mo
language: dada mama + 1 wd
motor: stands well, and walks with support
social: separation anx, simple 1 wd commands
aplastic anemia vs aplastic crisis
aplastic anemia- problem with the bone marrow so PANcytopenic
aplastic crisis- prob with JUST RBC production. usually secondary to infection like parvo and common in SCD.
tinea versicolor?
hypopigmented plaques that are more apparent after sun exposure. doesn’t have to be itchy
apart from anaphylaxis (duh!) what are contraindications to the pertussis vax?
- encephalopathy within a week
- severe progressive neuro defecits ex: UNCONTROLLED seizure (febrile seizure doesnt count)
whats the difference between metatarsus adductus and congenital club foot?
MA- is common, and usually self resolves. the foot is flexible not rigid, and in neutral position the forefoot deviates medially.
Congenital club foot- needs further workup like karyotype and serial manipulations and casting. the foot is rigid, and both hindfoot and forefoot is deviated.
whats the treatment for impetigo?
- local and nonbullous- MUPIROCIN ( a topical antibiotic)
- widespread or bullous- oral ab like cephelexin or clindamycin, or dicloxacillin
whats selective mutism
child’s refusal to speak in social setting for greater than 1 mo. child speaks normally in other settings. this is not to be considered normal and must be worked up
a maculopapular rash on head and trunk after mmr?
infection with measles live but attenuated from vax. much weaker infection but can still be transmitted so do not go near immunocompromised. – reassurance, no need for serology or any treatment, will self resolve.
if girl has primary amenorrhea, and US shows normal uterus what is the next step in workup? how do the results of this next step affect the differential?
- FSH levels
if FSH is HIGH its most likely a peripheral cause like Turner’s or an issue with the ovaries
if FSH is LOW it is most likely a central cause like a prob with the pituitary
is FSH is NORMAL consider an imperforate hymen
most common sequelae of acute bacterial meningitis
- hearing loss
Minimal change disease work-up
- renal biopsy not required
2. 85% of cases are responsive to prednisone/ steroids
what does mild vs moderate vs severe dehydration look like?
mild- asymptomatic on PE, decreased intake or increased output.
moderate: PE shows dry mucous membranes, decreased turgor
severe- tachy, low urine output, clammy/cold, sunken eyes/fontanelle
whats the follow up for dehydration?
mild- oral rehydration
mod/severe- bolus of normal saline
Hep B + nephropathy?
Membranous nephropathy
treatment for strabismus (nasal or temporal deviation of one eye)
if under 4 mo, no treatment
if over 4mo, use eye patch to cover NORMAL eye
what do you do about vaccines if a baby is preterm?
give vaccines by chronological age (normally) not by gestational age if infant is healthy. the exception is hep B, the first shot should be given when the infant in min 2 kg
trauma to posterior oral pharynx followed by hemiplegia is most likely due to what
ICA dissection
how do you work up signs of early puberty?
- bone scan- to see if its truly precocious puberty or just precious adrenarche and precocious thelarche
- then check LH levels to diff btw central and peripheral
follow up for cat bite in vaccinated child
amoxicillin clavunate
when is the autism screen
18 mo
2 yo
when does the vision screen start
4 yo
when does depression screen start
12 yo
rotavirus is administered at what age
2-8 mo
when is the meningococcal vax
11/12 years and at 16
management of newborn with mom who has HBsAg+
- passive immunization with Immunoglobulin against HepB
- Hep B vax (active imm)
within 12 hours of birth
edwards syndrome trisomy 18
microceph, micrognathia, absent palmar creases, rockerbottom ft, and VSD
how to tell apart thalassemia from iron def?
thal has low retic count and high RDW
iron def has high retic count and normal RDW
kid with bilateral sensorineural deafness who suddenly drops and has FH of sudden death and
Jervell and Lange Neilson syndrome
whats the treatment for Jervell and Lange Neilson syndrome?
beta blocker and pacemaker
HSP symptoms
- non blanching palpable purpura on buttocks and thighs
- GI symptoms
- arthralgia
- renal disease- hematuria
(note there is NO platelet abnormality!!!!)
Tourette’s syndrome is comorbid with what diseases?
OCD (can develop 3-6 yrs after first tic) and ADHD
how is Duchenne’s different from Becker’s muscular dystrophy
sign/symptoms such as Gower’s usually seen earlier in DMD (less than 5yo), BMD has a later onset 5-15.
DMD is more severe because there is NO dystrophin, where as BMD has decreased levels of dystrophin
thrombocytopenia+ anemia + evidence of hemolysis following GI distress is most likely
HUS
what is anemia of prematurity
low levels of EPO in premies and frequent blood draws in NICU can cause this–
normocytic normochromic RBC, with normal retic count, and low Hbg levels
what are the 3 broad causes of meningitis and whats in the CSF??
- bacterial
- viral
- TB
- neutrophil predom, low glucose
- lymphocyte predom, normal gluc
- lymphocyte predom, low glucose
whats a superficial infantile hemangioma?
aka strawberry hemangioma
a capillary tumor, should regress, but if it is very disfiguring or harming baby you can given propanalol
whats the management guideline for UTIs in children
if <2 yr need 1-2 wk of antibiotics, and renal ultrasound to work up
if renal scarring seen, if culprit is bug other than EColi, or if under 1 mo, get a voiding cystogram
how to diagnose ADHD?
need evidence of symptoms for >6mo in TWO settings, therefore usually need teacher to complete evaluations.
how can you differentiate between nonclassic CAH and idiopathic precocious puberty?
nonclassic CAH is a peripheral defect, so it either has low LH levels and/or doesn’t respond to GnRH stimulation
idiopathic precocious puberty is a central defect, and DOES respond with increase in LH to GnRH stim
intraventricular hemorrhage
common in underweight neonates and preemies. Can cause decreased absortion from the arachnoid villi causing communicating hydrocephalus. Presents as hypotonia, and acutely increasing HC. Use serial US to diagnose.
nightly pain in bilateral LE in children 2-12?
Growing pains- etiology unknown. Reassure parents, teach stretching, OTC motrin
doll face + lactic acidosis/ hypoglycemia + hepatomegaly?
G6PD
clean catch urine sample vs urine cath for UA? when would you prefer the cath?
for kiddos in diapers! bc clean catch will not be TRULY clean
systemic onset juvenile idiopathic arthritis
- pink maculopapular rash
- oligoarthritis
- worse in morning
- elevated inflammatory markers, wbc, platelets
- anemia
when should a child babble and respond to her name by?
6 mo
how can you tell if a rhinosinusitis is viral or bacterial?
- bacterial if it lasts >10 days, if it gets worse after initially getting better, or if its VERY SEVERE for >3 days.
- if any of these things are true, treat with amoxicillin+ clavunate.
CMV vs toxo pregnancy exposure?
CMV- no hydrocephalus, intra VENTRICULAR calcifications
Toxo- diffuse intracerebral calcifications, hydrocephalus
most common risk factor for orbital cellulitis ( redness, proptosis, decreased EOM)
sinusitis
AUB is what
menses in <21 days or >45 days
during adolescence b/c of anovulatory cycles due to immature HPO axis.
can cause painless, heavy bleeding
Neimann Pick vs Tay Sachs
NP- sphingomyelinase deficiency, + hepatosplenomegaly
TS- B hexaminidase def
hydroxyurea side-effects?
MYELOSUPPRESSION
what can make an HCM murmur louder?
- decreasing preload by Valsalva, NO, or suddenly standing.
what constitutes the different severity of TBI and whats the f/u?
mild- glagow=15; no loss of consciousness/vomitting, normal exam —> send home w/ f/u instructions
moderate- glasgow=15 but evidence of loss of consciousness/vomitting, abnormalities in exam —-> do a non-contrast CT, or watch in ED for 4-6 hrs
severe- glasgow<13, prolonged loss of consciousness>5 min —-> admit to inpatient with neuro exam every 2 hr
cow’s milk: when to introduce and how much?
after 1 yo
limit to LESS than 24 oz of milk which is about 3 glasses.
- too much cow’s milk can cause iron deficiency!
FT asymptomatic baby with a diffuse blanching rash
Erythema Toxicum Neonatum – spontaneously resolved w/in 2 wks of birth
what are Howell Jolly bodies?
on Wright stain, its a single blue dot in the RBC which is a nuclear remnant. It indicated a splenectomy of functional hyposplenemia
neonatal vaginal bleeding and discharge?
maternal hormone withdrawal. In utero, baby is getting estrogen and builds endometrial lining, within 2 wks of birth, the lack of estrogen can cause bleeding. This is self-limited, reassurance.
scaly erythematous bald spot on AA child’s scalp?
- Tinea Capitus a dermatophyte infection
confirm with KOH prep of hair stub
treat with griseofulvin or terbinafine
give selenium or ketoconazole shampoo to close contacts.
whats pressure induced alopecia?
after prolonged surgery, pressure on scalp can cause transient hair loss.
what is polycythemia of the infant? what causes it? complications?
Hematocrit >65%
most common cause- late clamping of umbilical cord
- in utero hypoxia due to maternal htt, db, or IUGR
- increased viscosity can cause poor organ perfusion, ex tachypnea
recurrent fractures + joint hypermobilit?
OI (type I collagen) NOT ED (type IV collagen), b/c there are no fractures in ED
what are the indications for emergent surgical synovial fluid drainage?
- synovial aspiration shows leukocyte >100,000 with neutrophil >90%
what does a FAS baby/kiddo look like?
- small palpebral fissures
- absent philtrum
- thin vermillion border.
what is cyclic vomitting syndrome?
regular, recurrent episodes of self limited vomitting without symptoms between vomits.
often has FH of migraine.
treatment for chlamydial conjunctivitis?
- ORAL erythromycin/azithromycin (not topical!!!!)
pink stains or brick dust in diaper?
uric acid crystals. can be normal in neonates, only concern for dehydration if there are other findings on PE.
choleastoma?
- can be congenital or acquired due to recurrent middle ear infections
- suspicion if new hearing loss or chronic ear discharge
- skin and debris, retraction pocket in TM.
purulent conjunctivitis DOL 2-5 caused by?
watery conjunctivitis DOL 5-12?
which one does topical erythromycin prevent?
NG
Chlamydia
erythromycin prophylaxis only prevents NG
isolated, painless gross hematuria with no other UA abnormalities?
-renal papillary necrosis
SSSS vs TEN?
TEN involves oral mucosa typically.
3 mo - 10 yrs most common cause of meningitis
> 11?
- S. Pneumo.
2. N. Meningitis (greater than 11, this is the primary cause)
<3 mo most common cause of meningitis
- GBS
- EColi
- Listeria
- HSV
subhorreic dermatitis?
- cradle cap + eyebrows, behind ears, nasolabial folds etc.
caused by malassezia
tx- nonscented shampoo, emollients
measles vs rubella
- measles: high grade, cervical adenopathy, SLOW cephalocaudal spread aka seen on head for several days before spreading to trunk
- rubella: low grade fever, posterior auricular/suboccipital lymph, arthralgia, RAPID cephalocaudal spread moves to trunk in one day
recurrent UTI + constipation?
- severe chronic constipation can cause distension of rectum and block urine flow causing urinary stasis. this urinary stasis increases risk of infection.
transient synovitis vs septic arthritis
- to tell the difference see if the kiddo has (1) fever (2) elevated WBC (3) can bear weight or not
if these are all normal, transient synovitis is more likely and joint aspiration is not needed, just wait and watch with ibuprofen
newborn cyanosis worse with feeding, better with crying?
choanal atresia
scabies treatment?
- 5% topical premethrin
- or oral Ivermectin
how to prevent congenital rubella?
passed mom–> baby in 1st trimester
therefore only prevented by pre-conception vax of mom
most common cause of rabies in US
bat
Alport Syndrome?
- proteinuria, hematuria
- alt thin/thick cap loops, splitting of GBM
- sensorineural deafness
DiGeorge Syndrome clinical features?
CATCH: conotruncal abnormalities Abnormal facies Thymic aplasia/hypoplasia Cleft Palate HYPOCALCEMIA
IVH risk factors?
prematurity, low birth weight
what are lab findings in JIA?
anemia, HYPERferritinemia
hypergammaglobinemia
elevated ESR, and CRP
thrombocytosis
1st line NONSTIMULANT treatment for ADHD?
Atomoxetine ( NE reuptake inhibitor)
Reyes syndrome liver biopsy will show?
MICROvesicular fatty changes
fever/fatigue + exudative pharyngitis+ cervical lymphadenopathy WITH RASH AFTER AMOXICILLIN OR AMPICILLIN ????
EBV, mono
slipped capital femoral epiphysis
when the femoral head is not in line with the femoral neck. seen in adolescent, obese kiddos.
presents as: hip and knee pain. cannot abduct hip, can not IR hip, cannot ER hip when knee flexed.
treatment of SCFE?
- surgical pinning of the femoral head to prevent compications of avascular necrosis and chondrolysis
use of dapsone, nitrites, and topical analgesics like lidocaine/benzocaine can cause cyanosis why?
- methemoglobinemia
whats a way to differentiate btw Freidrich’s and GBS?
- Freidrich also has loss of position and vibration.
Freidrich is accompanied by scoliosis and changes in spinal cord
eye problems in a kiddo with NF1?
optic pathway glioma (15% likely in <6 yo)
who needs iron supp?
premies exclusively breast fed
FT babies, have Fe stores for 4-6 mo regardless of nutrition
infant with bloody stools + eczema + throw up after feeds is most likely due to????
whats the treatment?
milk protein allergy
- t(x) ask mom to stop having milk/soy and she can continue to BF, switch baby to hydrolyzed formula
Langerhans Cell Histiocytosis?
- lytic bone lesions (usually in skull but can also be in long bone)
- skin lesions/ rash
- DI (increased urinary freq)
- pulmonary cysts and nodules
- lymphadenopathy
pyloric stenosis treatment?
normalize electrolytes and IV fluids before going into surgery as this can decrease risk of postoperative apnea and improve outcome
isolated early pubic hair devpt in normal bone age child?
- premature adrenarche, normal Test and Est levels
double bubble=? risk factors?
triple bubble=? risk factors?
- duodenal atresia, Down’s Syndrome
- jejunal atresia, - vasoconstrictive meds/cocaine
acute lymphadenitis cause?
- S. Aureus or S.Pyogenes
most common cause of hypothyroidism in newborn?
thyroid dysgenesis
criteria to diagnose Tourette’s
(1) multiple motor + atleast one vocal tic
(2) lasts greater than one year
(3) symptoms start under 18
treatment for tourette?
habit reversal therapy
alpha2agonists like clonidine
antipsychotics like haloperidol and risperidone
swallowed battery management?
- if in esophagus, then immediate endoscopic removal
- if distal to esophagus 90% will pass uneventfully
conditions seen in sickle cell carrier
hematuria
hypoesthenuria
Reye Syndrome
- encephalopathy in setting of no fever and normal CSF with increased opening pressure
- elevated liver enzymes
how to treat suspected osteomyelitis in SCD pts?
- do vanc/oxacillin AND ceftriaxone
cerebral palsy
nonprogressive motor function with uncoordinated or limited movements. can present as
“equinovarus deformity” both feet pointing down and inward. hypertonia and hyperreflexia most common
main risk factor for cerebral palsy
- multifactorial
- prematurity
kallman syndrome
- anosmia + delayed puberty but normal internal genitalia
- low FSH and LH
- normal karyotype
streptococcal perianal dermatitis
well demarckated, bright red, itchy, painful (esp with stools) rash around anus.
esp in school age child
anaphylaxis definition
- involvement of >2 systems
- hypotension following allergen
pre-septal vs pre-orbital cellulitis
cellulitis often caused by an abrasion
- preseptal does not involve muscles or fat so no proptosis or EOM changes.
HSP common complication
ileoilial intusseception
when is measles vax given?
1 yr and 4 yr
if planning to travel internationally GIVE if between 6-11 mo
name the Lyme rash
Erythema migrans
nephroblastoma (Wilms) vs neuroblastoma
wilms- doesn’t cross midline, 3-5 yo
neuroblastoma- cross midline <1 yo
the growth curve of constitutional growth delay
born at a normal ht and wt, btw 6 mo-3 yrs kid falls to lower percentile abruptly. Kid continues to track at that percentile
signs of neonatal meningitis
fever or hypothermia decreased feeds mild jaundice CNS signs of lethargy or irritability abnormal wbc count
glacactosemia is a defect in _____ which causes what ?
galactose 1P uridyl transferase
- hypoglycemia, failure to thrive, jaundice, bilateral cataracts
how are galactokinase def, galactosemia (G1P uridyl transferase), and galactose 4 epimerase deficiency different?
galactosemia- bilat cataracts, hypoglycemia, jaundice, FTT
galactokinase only has the bilateral cataracts
epimerase def- has symptoms of galactosemia + nerve deafness and hypotonia
how to tell apart AML and ALL on smear?
- AML has Auer rods, also has peroxidase + material
- ALL - has peroxidase neg, but PAS pos.
what are signs of XLA?
- recurrent sinopulmonary infections
- GI infections
- small lymph tissue, like tonsils
- symptoms after 6 mo old
herpangina vs HSV gingivostomatitis
herpangina- caused by Cocsackie, posterior oropharynx gray lesions. seasonal
HSV- anterior oropharynx, HSV,
emergency oral contraception?
levongestrel
ulipristal
- delay ovulation
laryngomalacia
inspiratory stridor thats worse when supine.
clinical diagnosis with laryngoscopy to confirm
scrotum is transilluminated,whats the next step?
- its a hydrocele, not a hernia so just leave it alone, should self resolve in 1 yr.
what are the Parinaud symptoms, what tumor is it associated with?
- eye lid retraction
- limited upward gaze
- light near dissociation (pupils that respond to accomodation not to light)
assn with Pineal tumor
signs of central precocious puberty, how to evaluate?
- adv bone age + high LH
- evaluate by brain MRI
Edwards Syndrome features
trisomy 18
- rocker bottom ft, closed fist overlapping digits, microcephaly, micrognathia, prominent occiput, IUGR
bed wetting is normal before age??
5 yo
how to decrease risk of SIDS
- no smoking
- firm mattress
- no pacifiers or other things in bed
- no side or supine sleep
- no sleep with caretaker
what is Legg Calve Perthes syndrome?
idiopathic avascular necrosis in boys 5-7
what are signs of slipped capital femoral epiphysis
an obese boy btw 10-13 who has his hip externally rotated. youll notice the femur shaft and head don’t perfectly line up on XRAY.
Fanconi Anemia
- macrocytic anemia
- due to chromosomal breaks
- pancytopenia with low platelets so increased bleeding
- cafe au lait
what are the specific and nonspecific signs of congenital syphillis
specific : snuffles, long bone lucency, rash on palms and or soles that desquamates/ or bullous
nonspecific: jaundice, blue berry muffin rash
most common cause of otitis externa?
- Pseudomonas A.
Staph aureus can also be common
in a baby with flaccid paralysis how can you tell apart, Wednig Hoffman, infant botulism, and Guillain Barre
werdnig hoffman- mainly LE hypotonia, no eye involvement
infant bot- dont need history of honey spore ingestion**, eye involvement, descending
GB- ascending
increased urination in patient with sickle cell trait
hyposthenuria = inability of kidneys to concentrate urine, in setting of normal serum sodium
cephalohematoma vs caput seccundum
cephalo- does not cross suture lines
findings of Tricuspid Atresia?
- L axis deviation
- hypoplastic RV (b/c blood never gets in there)
- decreased Pulmonary A markings on CXray
- murmur, in order for kiddo to survive
- large peaked P waves, bc the RA is working so hard
Common Variable Immune deficiency
a defect in B cell maturation , which causes recurrent sinusitis, GI , etc, that presents shortly before puberty or in 20’s
widened pre-vertebral space + can’t extend neck
= RPA
why would CF kiddo have increased bleeding?
vit K def, so can’t be cofactor for V, VII, IX, X activation
ITP vs HUS
ITP is isolated thrombocytopenia
HUS- thrombocytopenia, anemia, and renal symptoms
RDS risk factors
#1. prematurity also maternal db, Csection without labor, male sex, perinatal asphysxia
treatment of lyme disease for kiddo under 8 yo
oral amoxicillin
or oral cefuroxime
what kind of alkalosis does pyloric stenosis cause
hypochloremic, hypokalemic metabolic alkalosis
most common adolescent/adult onset muscular dystrophy?
myotonic muscular dystrophy type 1, autosomal dom
how to work up increased lead in blood levels
get a venous lead level to confirm
start chelation therapy if >45
low bicarb, high chlorine, alkalotic urine, acidemia w/FTT
RTA
how to tell apart pituitary adenoma and craniopharyngioma
craniopharyngioma is calcified
horner’s syndrome in child with paravertebral mass is ?
neuroblastoma
hemihyperplegia, macrosomia, reducible umbilical hernia, protruding tongue are concerning for
Beckwidth Wiedemann Syndrome
appropriate management of Beckwidth Wiedemann syndrome?
abdominal US and serum afp every 3 mo from birth to 4 yo
abdominal US every 3 mo from 4-8
renal US 8+
bc of high risk of wilms tumor and hepatoblastoma
describe dermatitis herpetiforms, assn?
vesicular extensor surface rash
celiac
most common cause of bacterial sinusitis
viral URI
congenital adrenal hyperplasia
defect in 21 aOHlase, causes decreased 11BOhlase and therefore low aldosterone– salt wasting, dehydration
- increased 17 hydroxyprog, hypervirilization
how to work up parapneumonic pleural effusion
sm effusion with no resp distress - oral ab’s
medium/lg effusion or resp distress or hypoxia- IV ab, US, drainage
foreign body aspiration, whats next?
bronchoscopy
what is reactive attachment disorder
- can be related to history of abuse or trauma
- child does not seek comfort, is not comforted, can have flat social affect
most common bacterial infection of CF
before 20 yo- S.Aureus
after 20 yo- P. Auereginosa
how to tell apart croup and HIB epiglottitis?
how does the initial management differ
both have the inspiratory stridor
but HIB also has drooling, and tripod positioning (sitting up and leaning forward)
- croup: corticosteroids or epi neb
- HIB- ET tube, or tracheostomy
how can you tell vascular rings apart from laryngomalacia?
- vasc rings are better with neck extension
- laryngomalacia is better in prone position
hints that baby has developmental dysplasia of the hip
- clunk on Ortalani and Barlow maneuvers
- leg length discrepancy
- asymmetric skin folds
working up developmental dysplasia of the hip
- <4 mo do ultrasound
>4 mo do XRAY
how to know if its an exudate
(1) fluid protein: serum protein >0.5
(2) fluid LDH: serum LDH >0.6
(3) fluid LDH is upper 2/3 of normal
lymphopenia (low Tcells)+ hypogammaglobulinemia (low differentiation from IgG to other Ig’s) is indicative of
SCID
tinea corporis 1st line tx
topical clotrimazole, terbinafine
what are breath holding spells
(1) cyanotic, cries really hard holds breath, passes out
(2) pallid, gets hurt, hold breath, pass out
sunburst pattern
osteosarcoma
single lucent spot on bone xray
osteoid osteoma
splenic sequestration, platelet ct ? retic?
- platelets decreased
- retic increased
signs of an intentional burn
- clear demarcation
- same depth of all burn
- spares flexors areas
immune thrombocytopenia treatment
if only cutaneous symptoms- watch&wait, should resolve w/in 6 mo
if mucosal bleeding- give corticosteroids and IVIG
Angelmann vs PWD
Angelman is deletion of maternal gene 15q11q13
PWD is a deletion of paternal gene 15q11q13
Down’s Syndrome with UMN findings
atlanto-axial instability
SCID tx
urgent stem cell transplant
how to work up bilious emesis
- get IV fluids, NG tube decompression
- get xray
- if xray shows gasless– get upper GI series
- if dilated loops of gas noticed, get contrast enema
- free air– emergency surgery
most common cause of lymphadenitis in kiddos
staph aureus
gas
what is Adam Stokes
arrhythmia induced syncope or seizure
J -wave (osborn wave)
immediately following QRS, caused by hypothermia (can also be caused by hypercalcema, or subarachnoid hemorrhage)
GDM + prematurity puts baby at risk for seizure and prolonged QTc why?
because more likely to have hypocalcemia which can cause these things
if mom is HIV+ how do you manage the newborn?
AZT within 12 hours of delivery for 6 wks
why would a DM1 patient have hyponatremia?
hyperglycemia can cause pseudohyponatremia by shifting H2O out and diluting the Na
what is a AE of TMP SMX
- neutropenia
new systolic murmur + fever should make you think?
endocarditis!
when is precocious puberty
<8 yo girls
<9 you boys
how to tell apart viral meningitis from TB, cryptococcal, and treponema pallidum
in viral, the protein and glucose are elevated
in TB, crypto, and Tpallidum, the protein is very very high and glucose very very low
whats a “flow” murmur
grade 1-II mid systolic murmur
trisomy 18
microcephaly, micrognathia, prominent occiput
rocker bottom feet
fingers crossing eachother in fist
what antibiotic for UTI in child
cefexime, 3rd gen cefalosporin
cherry red spots are seen in what 2 deficiencies
Neimann Pick (sphingomyelin) and Tay Sachs (B hexosaminidase)
