PEDIA AMEDEX Flashcards
Rubella
German measles
Rubeola
Measles
Roseola infantum is also known as
Exanthem subitum / sixth disease and three day fever
Roseola infantum is caused by
HHV 6 / HHV 7 / Enteroviruses such as coxackie virus A and B, echovirus / adenovirus and parainfluenza type 1
Roseola infantum commonly affects
infants mostly 6-18 months
Roseola infantum course
3-5 days of high fever up to 40C or higher then resolves abruptly then rash
Roseola infantum rash
maculopapular rash from the neck and trunk the to the face and extremities, not purpritic
Nagayama spots
Roseola infantum
Whooping cough is caused by
Bordatella pertussis
Guidelines for admission of patient with pertussis (2)
- infants less than 6 months of age
- any child with complications (apnea cyanosis pneumonia encephalopathy)
Indication for antibiotics in a patient with pertussis
- patient is diagnosed in catarrhal or early paroxysmal phase (may reduce severity)
- cough for less than 14 days (may reduce spread; reduces exclusion period)
- the patient is admitted to the hospital
- there are complications
Chemoprophylaxis for pertussis is indicated
- child < 6 months
- < 3 doses of vaccine
blisters of varying stages, macules and papules
chicken pox
school exclusion of chicken pox
after all the blisters have dried out
PDA
- frequently an isolated phenomenon
- pansystolic machinery like murmur at the LSB
- wide pulse pressure
- definitive management: surgical closure
difficulty in internal rotation and abduction in children aged 4-10
Transient synovitis or irritable hip
most sensitive test for TS
Log roll test
Treatment
bed rest for 7-10 days and the use of crutches to avoid weight bearing of the affected joint
Meds: Paracetamol or NSAIDs
Oppositional defiant disorder
Risperidone
Recommendation for premature isolated adrenarche
Followup every 3-6 months
GI abnormality most associated with Down syndrome
Duodenal atresia or stenosis sometimes associated with annular pancreas
Delayed passage of meconium
Hirschsprung disease
Acute bronchiolitis cause
RSV
Clinical presentation of acute bronchiolitis
cough, coryza + wheezy breathing + tachypnea = hyper-inflated chest with subcostal retractions
LCP features
painless limp
trendelenberg gait or abductor lurch
unilateral or successively with contralateral hip joint
LCP is also called
AVN of the proximal femoral epiphysis;
Management of LCP
Ortho referral
Reduce weight from affected joint
Maintain the femur abducted and internally rotated
Assessment of disease progression via xray
Ultrasound indications for UTI
In all children younger than the age of 3 years of age with the first episode of UTI
< 1 year old = ultrasound should be performed first and if normal the next step is VCU
> 1 year of age = ultrasound alone
Deficient in breast milk
Vitamin K - can cause intracranial hemorrhage
Infantile hypertrophic pyloric stenosis metabolic picture
Increased pH, decreased KCl, increased pCO2 and HCO3
immediate non bilous projectile vomiting in a 3-6 week old baby
demands to be re-fed immediately
olive like mass at lateral edge of the rectus abdominis muscle
vaginal bleeding in the first week after birth
maternal estrogen withdrawal
most common cuase of bloody vaginal discharge
may also be purulent
Foreign body
nappy rash
monilial candida vulvovaginitis
most common suppurative complication of AOM
Acute mastoiditis
Common pathogen for acute mastoiditis
Streptococcus pneumoniae - 1st
Hib - 2nd
Treatment of acute mastoiditis
Flucloxacillin + 3 generation cephalosporin
Acute mastoiditis clinical features
postauricular inflammatory signs such as erythema, edema, tenderness and fluctuance
Edema of auricle and or external canal (prior)
Laryngomalaicia (5)
- noisy breathing - audible wheeze when a baby inhales often worse when the baby is agitated, feeding, crying or sleeping on his back
- high pitched sound
- difficulty feeding
- poor weight gain
- choking while feeding
croup / LTB is commonly caused by
distinctive seal barking cough and inspiratory stridor
tracheal tug
cause of LTB
Para influenza virus type 1
Epiglottitis presentation
may lead to sudden obstruction and death
maintains head extended
noisy breathing
sore throat dysphagia high fever drooling inspiratory stridor
4ds: dysphagia, dysphonia, drooling, and distress
Treatment goals for epiglotitis
airway protection and antibiotics
Acute bronchiolitis treatment goal
oxygen and hydration
hot potato voice
epiglotitis
Epiglotitis cause
Hib
Retrophayngeal abscess
similar to epiglotitis but with bacterial upper respiratory tract infection preceding
until when is the index case of measles excluded from school
4 days after rash
exclusion of unvaccinated exposures of measles
14 days after the appearance rash on the index case
Croup treatment is based on severity
mild
- dexa or
- prednisolone or
- budesonide
severe
- adrenaline + dexamethasone or prednisolone
most common cause of painful rectal bleeding
anal fissure
SCFE first symptom
hip stiffness that subsides with rest
SCFE (4)
limp and irritaility of hip movement
knee pain referred from affected hip
on flexion of the hip it rotates externally - hip is often on external rotation on walking
most movements are restricted especially internal rotation
3 important management principles of SCFE
- cease weight bearing and refer urgently
- if acute slip, gentle reduction via traction is better than manipulation
- once reduced pinning is performed
most common intraabdominal tumor of childhood
Wilms tumor or nephroblastoma
classic presentation of neproblastoma on physical examination
smooth firm non tender palpable abdominal mass that usually does not cross the midline
other manifestations; hematuria, fever, hypertension, abdominal pain
most common solid extracrainail tumor in children
neuroblastoma
Neuroblastoma clinical presentation
hard, irregular, non tender, extends beyond the midline
loss of apetite
protrusion of both eyes
lobar pneumonia clinical features
fever + dob + pale ill and grunting, shallow respiration, normal chest auscultation
bronchiolitis most characteristic findings
inspiratory fine crackles
intentional unauthorized or illegal absence from compulsory schooling
Truancy
Truancy
attempt to draw attention or to make an impression on pears
caused by anger at school or problems at home
children sometimes go on to break laws more seriously when they are older
child tries to hide his or her action from parents
common in low socioeconomic status
Encopresis defenition
Voluntary or involuntary passage of formed semiformed or liquid stool into a place other than the toilet for more than 1 time per month for at least 3 months in a child > 4 years
delay to pass meconium
scybalous pebble like hard stool for at least 2 weeks
anal canal devoid of stool on examination with sudden evacuation of stool on digital examination
Hirschsprung disease
Hirschsprung disease pathophysiology
absence of ganglia in the distal colon resuling in functional obstruction
meconium ileus due to obstruction of the ileum by viscid meconium may be the earliest sign of
cystic fibrosis
Hirschsprung disease diagnosis
full thickness rectal biospy
congenital megacolon
Hirschsprung disease
ribbon like stools
Hirschsprung disease
vaccine that has the highest amount of egg protein and contraindicated to patient hypersensitive to eggs
Yellow fever vaccine
dilated bowel loops with air fluid levels and a granular ground glass material
Hirschsprung disease
bilous vomiting + schaphoid abdomen
midgut volvulus
Medications for postherpetic neuralgia
- TCA: amitriptyline and noretriptylline
- Anticonvulsants: gabapentin
- opiods: morphine and tramadol
Egg containing vaccines
mmr
influenza
yellow fever
typhoid
medication that decrease both acute and postherpetic pain
valacyclovir
acquired malabsorption that resolves when the patient is exposed to gluten free diet
celiac sprue
type of anemia associated with celiac disease
microcytic anemia with low serum ferritin levels
curant jelly stools
intussusception
HFMD is casued by
coxscakie virus type A
Incubation period of varciella
11-21 days
right hypochondrium sausage shaped-mass and emptiness in the right lower quadrant
Dance sign of intussuception
currant jelly stools
intussusception
medications for varicella zoster should be given within __ houRs to prevent viral replication
48
when should influenza virus be given
2nd and 3rd trimester
Diagnostic PE finding in patients with NEC
pneumatosis intestinalis
NEC is typically seen in the
NICU in premature infants
Molluscum contagiosum (4)
2-5mm slightly umbilicated flesh colored dome shaped papules
spread by inoculation
self limited
clear spontaneously in 6-9 months
Wassel definition
infantile colic
unexplained paroxysmal bouts of fussing and crying that lasted >3 hours per day for > 3 days a week for > 3 weeks duration
no vomitting, normal stools, no weight loss
leading cause of congenital hearing loss
cmv
shallow oral ulcerations confined to the posterior pharynx
Herpangina
gingivostomatitis that involves the anterior mounth
herpes infection
petechiae on the soft palate in infectious mononucleosis are referred to as
Forchheimer spots
treatment of volvulus in the elderly
decompression by a sigmoidoscope
treatment for hypertropic pyloric stenosis
longitudinal pylorotomy
measles is caused by
paramyxovirus
roseola is caused by
HV6
german measles is also called
rubella
Erythema infectiosum or 5th disease is caused by
Pravovirus B19
Orchitis/ (3)
pain or orchitis is relieved by gently elevating the testis
when diagnosed in prepubertal males, no need for antibiotics
incidence has diminished since the introduction of mmr
mid abdominal pain and diaphoretic but elicits no intensity of pain during abdominal palpation
intestinal ischemia
pain in the right lower quadrant
celcal volvulus
appendicitis
common causes of acute onset facial nerve palsy in children
AOM
Lyme disease
subacute sclerosing panecephalitis is associated with
measles
throglossal duct cyst most common complication
infection
medication for herpes simplex keratitis
idoxuridine
SVT >6 months
ice pack
SVT in neonates
immersion of face in water
SVT toodlers
most common cause of AOM in children >6 weeks
S. pneumoniae (1)
H. influenzae
most common cause of AOM in neonates
RSV
cyanotic when laid on back (mild) however O2 increases when the baby is crying. next step?
rigid NGT
cyanotic when laid on back (mild) however O2 increases when the baby is crying. diagosis and diagnostics?
choanal atresia
rigid NGT
CHARGE syndrome
coloboma, heart difect, atresia choanae, retarded growth and development, ear abnormality
females»_space;
abnormality in upper airway
coanal atresia
once confirmed
o2, oropharngeal airway
intubation if life threatening
ct scan
treatment for primary nocturnal enuresis
desmopressin (minirin) spray
family name
4 years old
bleeding post tonsiellectomy management
(late bleeding) cause
infection of tonsillar fossa
management of post tonsillectomy hemorrhage
resuscitation - 2 large bore cannula
reservation of crossmated rbc
iv antibiotics 1.2 g benzyl penicillin + metronidazole
analgesia without nsaids
hydrogen peroxide gargle (1:6)
diphtheria, tetanus, and acellular pertussis (DTaP) vaccine schedule
Administered at 2, 4, and 6 months of age.
enuresis is cutoff
5 years old
Management of Pertussis Exposure for symptomatic individuals
If symptoms of pertussis develop, treatment with azithromycin (first-line antibiotic) should be started within the first 21 days of symptom onset to reduce the severity and transmission of the disease.
Infected individuals should be isolated for at least 5 days after starting antibiotics to prevent spreading pertussis to others.
very common cause of wheezing in children younger than 12 months
bronchiolitis
common cause of wheezing in children younger than 5 years
asthma
wheezing associated with feeding
reflux
wheezing when supine
laryngomalacia
unilateral wheezing
foreign body aspiration
benign murmur
murmur increases when the child is supine
asymptomatic hematuria in the background of febrile illness other than uti next step
assess after uti
hematuria in the background of uti next step
urine culture
asymptomatic hematuria confirmation
2 positive urine exams out of 3 in 2-3 weeks before any further assessment
Marfan (3)
aneurysms dilatation, aortic regurgitation, aortic root dissection
AR murmur
mid systolic ejection murmur at the 2nd rics
HOCM
Austin flint
> low pitched rumbling mid diastolic mumur over the apex
heard in severe AR
pan systolic murmur at LSE with no radiation
VSD
machinery murmur at 2nd lics
PDA
murmur in marfan
ASD
Daytime bladder control and coordination usually occurs by
4 years of age
Night-time bladder control typically takes longer and is not expected until a child is
5–7 years old.
Typically treatment is not started before age _____, as there is a high rate of spontaneous resolution
6 years
Rotavirus vaccine
first dose cant be given after 12 weeks of age since high incidence of intussuception
intermittent fevers well between fevers
roseola
rash of roseola
maculopapular or erythematous
beginning on the trunk and may spread to involve the neck and extremities
non pruritic
blanches on pressure
Varicella is given at
18 months with MMR as single dose or at 14 years old and up, 2 doses, at 4 week intervals
Bronchiolitis obliterans is caused by
adenovirus
adenovirus manifestations
folicular conjunctivitis, gastroenteritis, intussuception, hemorrhagic cystitis, myocarditis
initial symptoms: cough, chest pain, hemoptysis
symptoms abate then worsens
