Pediatric Disorders Flashcards

Question

Hyperthyroidism (Grave's Disease)

Answer 1

LP: Peak incidence 10-15 years CP: Same as adult – nervousness, weight loss, heat intolerance, tachycardia, tremor A/D: Enlarged thyroid, TSH, FT4, iodine uptake scan, autoantibodies T: Referral endocrinology, beta blocker for symptom relief, 6-month follow-up

Answer 2

LP: Congenital or acquired (Hashimoto’s disease) CP: Same as adult – weight gain, lethargy, cold intolerance, can be subclinical or nonspecific symptoms, delayed development, short stature A/D: can be subclinical delayed development, short stature. Enlarged thyroid, TSH, FT4. Consider antithyroid peroxidase antibodies, lipid panel, CBC, thyroid scan T: Thyroid replacement therapy

Answer 3

LP: Any age, peak 10-14 years, family history CP: Polyuria, polydipsia, weight loss, and weakness. A/D: Blurred vision, N&V, abdominal pain, Dx: random, fasting glucose, HbA1c, consider fasting C-peptide, autoimmune markers T: Referral endocrinology, basal bolus insulin regimen, diet management, activity management, self-monitoring blood glucose

Answer 4

LP: Male, history of sports/physical activity, hx of dysmorphic disorder CP: History of increased appetite/food consumption, rapid weight gain increased muscular build. Chronic use can result in dermatologic, psychiatric, sexual effects. A/D: May not seek treatment for steroid use specifically, maintain high level of suspicion. Acne, hirsutism & menstrual irregularities(females), scrotal pain, higher pitched voice (males), hostility, aggression, irritability, labile mood Urine toxicology, urinary ratio of testosterone glucuronide to epitestosterone glucuronide. FH, FSH, CBC, CMP, lipid panel, hepatitis panel, HIV, CK T: Manage complications of withdrawal, counseling, psychotherapy, nutrition counseling. Assess for other substance abuse. Consider referrals to mental health, endocrine, cardiac or other professionals depending on effects and comorbidities

Answer 5

LP: Symptoms begin at puberty, family history, obesity CP: Irregular menstruation, hirsutism A/D: Serum 17 hydroxyprogesterone, prolactin, TSH, glucose tolerance, lipid panel, consider total and free testosterone, LT\< FSH, ultrasound, basal body temperature. T: Desiring fertility: weight loss, metformin adjunct Not desiring fertility OCP, metformin adjunct

Answer 6

LP: Sexual abuse a risk factor CP: Development of secondary sex characteristics before 8 (girls) or 9 (boys), tall stature A/D: Bone age assessment, serum testosterone, estrogen, FSH, LH, LNRH stimulation test, pelvic u/s. consider head CT, MRI, pituitary function tests, TSH, u/s adrenals T: Refer endocrinology, Referral for associated brain neoplasms, hypothalamo-pituitary tumors; and neurodisability Treat is replacement of androgens until puberty ends and/or management of precipitating conditions

Answer 7

CP: Non-specific symptoms, fatigue, T: Refer endocrinology, mineralocorticoid and glucocorticoid replacement for life,

Answer 8

LP: pharyngeal, laryngeal or esophageal lesions; foreign bodies; anatomic abnormalities; physiological dysfunction; neurological dysfunction; tumors CP: Progressive dysfunction, reports from patient of pain or food getting stuck after swallowing, child preferring liquids to solids, child refusing feedings A/D: Observe feeding and child’s ability to swallow. Look for choking, vomiting or regurgitation. Palpate child's neck for masses Lateral neck films, barium swallow, fluoroscopy T: Directed at cause

Answer 9

LP: 3–6-week-old Males 4x that of females, firstborn CP: Vomiting, feeding intolerance with multiple formula changes, constipation, dehydration. A/D: Failure to thrive/weight loss, irritability, signs of dehydration, olive shaped mass in upper abdomen Dx u/s upper abdomen, BMP T: Fluid and electrolyte replacement, then surgery

Answer 10

LP: Between 10 and 30, highest incidence in children and adolescents CP: Acute abdominal pain starting in the mid-abdomen, nausea, vomiting A/D: Decreased bowel sounds, tachycardia, positive obturator, Psoas, Rovsing’s signs CT lower abdomen and pelvis, CBC, CRP, HCG if relevant T: Refer surgery

Answer 11

LP: \< 5 mos. CP: Paroxysms of uncontrollable crying in an otherwise healthy and well-fed infant, \>3 hours per day, and \>3 days per week, for at least 3 weeks. Dx of exclusion, review for other causes, absence of nausea, vomiting, distended abdomen, AOM. Dx: UA, urine culture, Xray of any suspected injuries, abdominal x-ray T: Education on feeding, burping, avoidance of excess of stimulation, parental support, this is highly stressful.

Answer 12

LP: Ages 3-12 mos., peak at 9 mos. , males \>females CP: Colicky abdominal pain, flexing of the legs, fever, lethargy, vomiting, may have blood in the stool , a preceding viral illness. A/D: Colicky abdominal pain, vomiting, lethargy, hypovolemic shock, U/S, abd x-ray T: Fluid resuscitation, barium enema

Answer 13

LP: 1st year of life, Trisomy 21 at higher risk CP: Vomiting, abdominal distension, explosive diarrhea and/or enterocolitis. A/D: Failure to thrive, Plain abdominal x-ray, contrast enema, confirmed by rectal biopsy. T: Newborn: Colonic irrigations, surgery depends on severity of disease. If enterocolitis, IV fluids and abx.

Answer 14

LP: All ages most diagnosed \<20 years, peaks at weaning and in in 30’2-40’s, high risk includes autoimmune disease, FH of celiac disease, type 1 diabetes, lack of IgA CP: Diarrhea, bloating, abdominal discomfort, herpetiform rash, A/D: Anemia, autoimmune disease, failure to thrive, NVD, constipation, flatulence, fatigue, paresthesia, delayed growth, delayed puberty, PE: skin (psoriasis, atopic dermatitis), easy bruising, brittle nails. EENT: Oral aphthous ulcers, loss of tooth enamel, neuro: neuropathies, Psych: mood disorders. Testing: CBC with smear, IgG-tTG, IgA-tTG, IgG DGP(celiac panel). Consider small bowel endoscopy, biopsy (controversial) T: Diet counseling, lifelong gluten free diet, assess and treat vitamin deficiencies (iron, vitamin D, vitamin B12, and folate), calcium and Vit D supplements, bone density studies after 1 year of tx.

Answer 15

Key assessment to keep in mind FH, PMH, SH, Hospitalizations Recent antibiotic use Medications including homeopathic, OTC Recent exposure to illness, injury or stress Relationship of vomiting to meals, time of day, activities Presence of associated symptoms: diarrhea, fever, ear pain, UTI, visual changes, head trauma, headaches, high pitched cry, seizures, anorexia Cyclic vomiting Syndrome (CVS): acute attacks of vomiting, noticeable pattern day to day. Not the same as recurrent.

Answer 16

Obstruction: adhesions, strangulated hernia, neoplasms Inflammation: cholecystitis, acute pancreatitis, acute APPY, diverticulitis, ulcerative colitis, Crohn disease Perforations: gastric ulcer, Mallory Weiss tear Gyn: ectopic pregnancy, PID, endometriosis DKA, Opiate withdrawal Infectious: gastroenteritis, hepatitis, infectious colitis Sickle cell crisis, testicular torsion

Answer 17

urgent concern is dehydration Viral, bacterial, parasitic infections Medications Inflammatory bowel disease IBS

Answer 18

Colonic: Inflammatory bowel disease , Infective gastroenteritis (bacterial/viral/parasitic), ischemic colitis Small bowel: Celiac disease, Crohn disease, bacterial overgrowth, lymphoma Small bowel bacterial overgrowth Pancreatic: pancreatitis, Cystic fibrosis Functional: IBS Metabolic: Hyperthyroidism, diabetes, hypoparathyroidism, Addison disease Medication effects Fecal impaction

Answer 19

Hirschsprung disease Anorectal anomaly Anal fissure Sexual abuse Myotonic dystrophy Cow milk intolerance Celiac disease Crohn disease

Answer 20

PE: Look for volume depletion, fever, pallor, lethargy, extremity perfusion, neurologic signs, confusion, tachycardia, hypotension, hyperventilation, A/: Red flags: Recurrent vomiting, rather than cyclic. Neurological or Developmental abnormalities. Evidence of encephalopathy . CBC, CMP, Amylase, serum ketones, urine culture, and urinalysis. Consider ABG, consider toxicology screen, consider hepatitis panel. Abdominal Xray, u/s, CT, consider MRI/CT of head T: Focused on cause, rehydration and electrolyte balance. Admission for toxic appearing child

Answer 21

LP: All ages, infants prone to rotavirus in not vaccinated A/D: Assess for hydration, skin integrity T: Focused on causes, in all patients, rehydration and electrolyte balance, skin integrity

Answer 22

PE: Abdominal and neuro exam, rectal exam (bruising raises suspicion of abuse) A/D: No primary tests, diagnostics aimed at likely causes, abd/pelvic u/s, abdominal Xray, colon transit study, psychological evaluation T: Focused on causes, in all patients, rehydration and electrolyte balance, skin integrity

Answer 23

LP: Low Birth Weight, infants weaning, toddlers learning toilet skills, school age. Withholding peaks at 2-3 years and fecal incontinence is frequent RFV, low fiber diet, poor nutrition, psychiatric history, obesity. Functional constipation in school age A/D: Rectum and anus for fissures, causes of painful defecation, abdominal exam, full neuro exam, dietary history. No initial diagnostic tests, consider abd U/S, x-ray, pelvic U/S, transit studies in certain cases, suspected impaction Explore child’s perception of safety in public toilets. T: Focused on likely cause, eliminating cow milk, increasing fiber and hydration, counseling, Stool softeners. Goal is to reduce pain and increase frequency of stool. Trial of dairy-free diet, increase physical activity in older children Osmotic laxatives and stool softeners

Answer 24

LP: 4-18 years, maternal nicotine use in pregnancy, lbw, family history, epilepsy., males but likely underdiagnosed in females CP: Easily distracted, fidgets, excessive motor and verbal activity, schoolwork or play activities disrupted. Hyperactivity more prevalent in younger children, inattention in adolescents Rule out mood disorders, anemia, lead, visual, cognitive or language disability abuse, seizure disorder, thyroid disorders, stress, medications, substance abuse. Narratives from teachers, caregivers, tutors, counselors etc. Developmental hx, family hx, social hx, patterns of behavior. T: Collaboration with mental health professionals essential. Behavioral therapy first line for younger children, but should be used for all children, parental education and support. Stimulants for school age children and older are first line.

Answer 25

LP: Females, adolescence/puberty, males most likely underdiagnosed CP: Most often diagnosed through parent interview or weight checks at routine visits. Assess weight at routine visits. If wt is significantly low, set up weekly visits for wt check. BMI \<5th %ile is red flag A/D: Detailed dietary hx, r/o comorbid psych disorders, (OCD is common), disruption in individual growth curve, menses, CBC, CMP, TSH, FT4, magnesium, Phosphate, CK, if amenorrhea, HCG, estrogen, LH, FSH, consider testosterone levels in males, prolactin, consider bone density scan, fat soluble vitamin levels. ECG for arrhythmias, T: Team approach across spectrum of care (outpatient to hospitalization) Mental health counseling, diet supplementation, monitor fluid intake, individualized for each patient, may need enteral nutrition.

Answer 26

LP: Females, peak at 25-30 years, males most likely underdiagnosed, likely obesity CP: History of binge eating, frequent vomiting, frequent diets, GI symptoms, marked fluctuations in weight, A/D: If frequent vomiting, assess loss of tooth enamel, swollen parotids, consider all above in anorexia nervosa + HCG T: Team approach across spectrum of care, CBT, family therapy, psychoanalysis, SSRI, SNRI, Individualized nutrition counseling. Consider self-help groups and telemedicine approaches

Answer 27

LP: Males\>females, ages 3-17, prenatal exposure to toxins, maternal mental health disorders, coercive parenting style CP: Ages 3-7: defiance, angry outbursts, physical aggression, destruction of property Ages 8-11: physical fights, cruelty to animals, fire-setting, stealing, ages 2-17 all above + assault, robbery, vandalism, truancy. A/D: Psychiatric evaluation. Collect information from multiple sources, Assess for comorbid mental disorders, hx of sexual abuse, substance use, epilepsy, learning disabilities, assess family risk factors, neurodevelopmental history, prenatal history T: Multisystem – family therapy, cognitive therapy, behavioral therapy. Refer

Answer 28

LP: Males\>females, onset \<18 yrs. Hx of maternal nicotine, hx of family OCD disorders CP: Involuntary repetitive movements and or sounds, usually brief, sudden, increase in stress or anxiety. A/D: Classify type based on duration and motor, phonic, or mixed. Assess for comorbid mental disorders, primary tics will have normal neuro exam, assess for secondary causes such as infections, TBI, substances, toxins, neurologic disorders (full neuro exam), no specific tests, consider head MRI, CSF eval, EEG. Rule out seizures, chorea, dyskinesia, Consider urine tox, TSH, FT4 T: Mild tics do not required treatment. Treat when tics interfere with daily activities and QOL. CBT, HRT (Habit reversal training), medications include dopamine antagonists (antipsychotics) alpha 2 agonists, benzodiazepines. ECG prior to medications for baseline

Answer 29

LP: Rare, mean age 5-6 years, usually resolves by age 18, greatest severity at 10 years, males\>females CP: Motor and phonic tics that wax and wane, premonitory A/D: Assess for comorbid mental disorders, esp ADHD and OCD, Other diagnostics as above T: Mild symptoms do not required treatment. Treat when tics interfere with daily activities and QOL. CBT, HRT (Habit reversal training), Approved meds are haloperidol, pimozide, and aripiprazole. ECG baseline prior to medications

Answer 30

LP: Post group A strep disorder, family history of tic disorder, OCD, or acute rheumatic fever, onset before puberty, maternal autoimmune disease CP: Abrupt onset of OCD, tics, food refusal, anorexia. Begins up to 3 days before GAS infection symptoms, can appear up to 30 days after. A/D: Family hx, autoimmune disorders, (ANA), full assessment for strep infection, GI assessment, full neuro assessment, assess for mycoplasma, influence, Lyme,, r/o endocrine, neurologic, CBC, CMP, ESR/CRP, throat culture, titers for streptococcal infections, UA. T: Treat for strep (regardless of cultures and titers) Refer for psychiatric assessment and treatment

Answer 31

LP: 3-36 months, likely preceded by parainfluenza, peaks in late Autumn, winter months CP: Insidious onset barky cough, stridor, intercostal retractions, worse at night, URI symptoms preceding croup A/D: Assess severity and potential respiratory compromise, r/o GERD, pneumonia, epiglottitis (vaccination status), wheezing, drooling, toxic appearance (consider alternative dx) Clinical diagnosis. If unresponsive to treatment, consider CBC, CT of neck , CXR T: If mild- moderate, nebulized racemic epi and one time injection dexamethasone, retractions should resolve within 2 hours, surveillance. Otherwise admit for more intensive care

Answer 32

LP: Vaccines incomplete, occurs at any age, infants \<12 mos. are at high risk CP: Abrupt onset, high fever, severe sore throat, dysphagic, drooling. Do nothing that can upset the child, no pharyngeal assessment, transfer to ED is suspected. T: Life-threatening, emergency admission

Answer 33

LP: Infants peaks at 6-8 months, starts as early as 2 weeks, Assoc with Down’s syndrome or CHD CP: Recurrent inspiratory stridor, recurrent croup, feeding difficulties, coughing/choking during feedings A/D: Recurrent croup is a red flag for structural anomalies. Always consider Xray in cases of recurrent croup, diagnosed with flexible laryngoscopy T: If mild, watch and wait, if there is nutritional or respiratory compromise, Endoscopic supraglottoplasty

Answer 34

LP: Traumatic (Hx of intubation ) appears after insult. Congenital appears in very young neonates CP: Recurrent inspiratory and expiratory stridor, otherwise similar presentation to laryngomalacia, stridor supine AND prone A/D: Lateral neck x-ray, CXR, flexible laryngoscopy may miss dx, rigid laryngoscopy T: Endoscopic dilation for most cases. Refer

Answer 35

LP: 1-2 years of age most common, \> 1-year right bronchus. If item is small to air trapping CP: Choking, coughing, hoarseness, decrease lung sounds, asymmetry is key finding A/D: CXR, inspiratory and forced expiratory, indicates asymmetry. Inhaled vegetable matter will not show up on x-ray, commonly diagnosed as recurrent croup, croup, asthma, bronchitis, pneumonia, URI. Need a good history of onset and any triggering events. T: Removal with bronchoscopy

Answer 36

LP: RSV usually, inflammation in distal airways, air trapping, First 2 years of life, winter disease, leading cause of hospital admission in infants \<1 yr. CP: Mild URI, coughing, fever, tachypnea, resp distress, transient apnea, diffuse, exp wheezing A/D: Differentiate from asthma by clinical signs Higher incidence of asthma in later life. Link with atopy T: Supportive care, hydration, monitoring, if resp distress in severe cases, hospitalization, trial of Beta 2 agonists. No ribavirin usually, no steroids unless in ICU. Prevention with high-risk infants w Palivizumab (D-MARD)

Answer 37

LP: Usually viral, in children \<5, \>5 Mycoplasma, chlamydia, pneumococcus, strep. Chlamydia 1-3 mos., staccato cough Inflammation of lower airways CP: Viral: insidious onset, low grade fever, nontoxic looking, wheezing, crackles Bacterial: acute onset, high fever, toxic looking, decreased LS A/D: CXR (looks worse than child) In viral – interstitial consolidation, Bacterial – lower lobe infiltrate, WBC to 10,000, bands, Focal infiltration likely strep Treat empirically T: Viral : symptomatic care, Bacterial : 3rd gen cephalosporin if pneumococcus, macrolide, may need to be hospitalized

Answer 38

LP: Caucasian, exocrine, impaired Cl- and therefore Na+ and H2O, water loss, dry think resp secretions CP: Fat malabsorption, wt. loss, FTT, steatorrhea, loss of Vit ADEK, respiratory distress, repeat infections, wheezing, pneumonia, A/D: Multiple other sx, genetic origin, nasal polyps may be presenting sx, rectal prolapse, acute pancreatitis, sx of hypoxemia. Resp organisms staph aureus, later pseudomonas, T: Pancreatic enzymes, vitamin supplementation, airway prophylaxis, followed by specialists

Answer 39

LP: Highest incidence 4-6 mos., single most important trigger is prone sleeping CP: No other findings of death. T: Prevention is key, parent education on back to sleep, bare crib, no co-sleeping.

Answer 40

LP: Ages 3 years and older. Preterm, LBW infants, FH of atopic conditions, hx severe RSV, exposure to air pollution, irritants, obesity, CP: Recurrent wheezing, dry cough (at night/early morning), shortness of breath A/D: Assess for severity, frequency of symptoms, triggers for symptoms, other atopic symptoms, FH, SH and environment, limited physical activity, skin/EENT, Resp/Cardiac assessments. Dx: Spirometry, peak-flow \>5 years, younger, use GINA guidelines, trial of treatment/response T: Based on severity rating, mild intermittent . Goal is no daytime /nighttime symptoms, no need for rescue med, no exacerbations, full activities. Peak expiratory flow (PEF) \>80% predicted Environmental controls, self-management, education.

Answer 41

LP: Any age, the older the child, the more likely the origin is musculoskeletal. A/D: Reports of pain, stiffness. CP: Red flags: weakness, self-limited activities, constitutional symptoms, bowel or bladder incontinence, or pain that awakens patient's from sleep . Full musculoskeletal exam, neuro exam, Consider CBC, ESR/CRP, ANA, RF. AP and lat back x-ray, add lumbar and oblique for lumbar pain, MRI T: Consider a referral to pediatric orthopedist, muscle strains to PT. Refer any children/adolescents with red flag symptoms

Answer 42

LP: Between ages 10-18 CP: Usually painless, dx’d on screening, uneven shoulder height, unequal scapula, unequal muscle mass, forward bend test. A/D: Growth spurts, functional limitations, Red flags: back pain, alterations in sensation or motor control. Gait, neuro and skin assessment, LLE length discrepancy. Diagnosis of exclusion. Standing AP and lat x ray, MRI T: 90% will not need treatment, based on initial deformity, rate of curve progression, overall assessment of growth potential. Exercise, surveillance, bracing, surgery

Answer 43

LP: Males, ages 4-8 years, low socioeconomics, coagulation disorders CP: Short stature, painless limp, limited hip ROM, A/D: Asymmetric limb length, Bilateral hip x rays, muscle wasting, knee and/or hip pain, positive Trendelenburg T: Manage acute pain, casting, surgical intervention, refer

Answer 44

LP: Adolescence, during growth spurt, active in sports, CP: Tibial tubercule pain and local tenderness, tibial tubercle pain on leg extension A/D: Clinical dx, x rays knee U/S, MRI T: Rest, ice, NSAIDS, PT, if unresponsive, bracing

Answer 45

LP: FH, males \>females, CP: Can be dx’d prenatally, A/D: Not definitive test, T: Refer orthopedics

Answer 46

LP: 6 months to 7 years CP: Hx of forceful traction on extended, pronated arm. Generalized pain in arm on movement, tenderness of radial head. A/D: Evaluate clavicle, shoulder, entire arm to r/o injuries, significant tenderness, swelling, bruising, or deformity suggests serious cause such (supracondylar fracture), if suspected fox, AP & lat elbow x-ray T: Pain management, Internal reduction

Answer 47

* toddler's fracture - nondisplaced fracture of tibia in infants and children aged 9 months to 3 years * septic arthritis - most common cause of severe monoarticular pain * osteomyelitis * previously undiagnosed [developmental dysplasia of the hip](https://www.dynamed.com/condition/developmental-dysplasia-of-the-hip) * [transient synovitis of the hip](https://www.dynamed.com/condition/transient-synovitis-of-the-hip) * congenital limb length discrepancy * [cerebral palsy](https://www.dynamed.com/condition/cerebral-palsy-cp) * spinal abnormalities

Answer 48

* trauma/fracture * transient synovitis of the hip * septic arthritis * osteomyelitis * juvenile idiopathic arthritis * Legg-Calve-Perthes disease * developmental dysplasia of the hip

Answer 49

* trauma/fractures * overuse syndromes * septic arthritis * slipped capital femoral epiphysis (SCFE) * juvenile idiopathic arthritis * reactive arthritis * tumors