PEDIATRICS Flashcards
Bilous vomiting in neonate, commonly associated with Down’s syndrome
Duodenal Atresia
Nonbilous vomiting in neonate, presents with olive-shaped mass, high risk in patients with Turner’s syndrome and Trisomy 18
Pyloric Stenosis
Rule of 2’s: Meckel’s Diverticulum
2% of normal population
2 feet from ileocecal valve
2 inches long
2x more common in males
often symptomatic by age 2
2 complications: bleeding, perforation
2 types of tissue: pancreas and gastric
2 presentation: GI bleed and diverticulitis
Most common cause of lower GI bleeding in children
Meckel’s diverticulum
Antibiotic that can cause Pyloric stenosis
Erythromycin
Mutation that causes failure of ganglion cells to migrate to wall of colon in Hirschsprung disease
Tyrosine Kinase receptor (RET gene)
Causative agent of Slapped cheek appearance in Erythema infectiosum/ fifth disease
Parvovirus b19
Live attenuated vaccines (6)
BCG
Measles
Mumps
Rubella
Varicella
Rotavirus
(BCG + MMRV + Rota)
Immunity induced through administration of antibody-containing preparation
Achieved by administration of PREFORMED ANTIBODIES
Passive immunity
Administration of a vaccine or toxoid to stimulate the immune system to produce a prolonged humoral and/or cellular immune response
Active immunity
4 m/o
No BCG vaccine yet
+ exposure to TB patient
What will you do?
Do PPD testing prior to giving BCG
Most common cardiac manifestation of maternal rubella syndrome
Patent ductus arteriosus
Machinery like murmur
PDA
Pharmacologic closure of PDA
Prostaglandin Synthase Inhibitor
Indomethacin
Most common cyanotic congenital anomaly
Tetralogy of fallot (TOF)
Four cardinal features of TOF
P-ulmonary infundibular stenosis
R-VH
O-verriding of aorta
V-SD
Cyanosis
Dyspnea on exertion
Paroxysmal hypercyanotic attacks (Tet spells)
Dx?
Tetralogy of fallot
Blue baby
TOF
Boot shaped heart
Couer en sabot
Caused by?
Right ventricular hypertrophy
Management of Tet spells
-Squatting or knee chest position
-Administer oxygen
-Beta adrenergic blockade - Propanolol
Palliative surgery done in Tetralogy of fallot
Blalock-Taussig shunt
Most common aorticopulmonary anastomosis
Mucocutaneous lymph node syndrome
Infantile polyarthritis nodosa
Kawasaki disease
Vasculitis with a predilection for the coronary arteries
Kawasaki disease
- High fever for 5 days which is unresponsive to antibiotics
- Bilateral nonexudative conjunctival injection with limbal sparring
-Strawberry tongue and red cracked lips
Edema and erythema of hands and feet
Kawasaki disease
Cardiac involvement in kawasaki disease
Myocarditis
Coronary aortic aneurysm
Tx of kawasaki disease
2g/kg IVIG and high dose Aspirin within 10 days of disease onset
Earliest sign of puberty in girl
Thelarche (breast bud)
Measurement of physical growth (wt and height) and body composition (mid up arm, waist and hip circumference)
Anthropometry
Assesses prevalence of Vit A def l, Iron def anemia and other nutrient deficiencies
Biochemical
Food fortification act
Vit A
Iodine
Iron (Fe)
STGs directly related to health
2 - zero hunger
3 - good health and wellbeing
6 - clean water and sanitation
Vulnerable group
Under five clinics
Pregnant and lactating
Elderly
Exclusively breastfed children prone to IDA
Breastmilk deficient in iron
DOH program suggest composition of Filipino meal
Pinggang pinoy
Leading cause of death in the philippines
Cardiovascular disease
When does Ductus arteriosus close?
- Physiologic - 14-15hrs after birth
- Anatomic - after 2-3 weeks after birth
Primary closure of patient with gastrochisis
Intragastric pressure <20cm H2O and CVP does not increase by 4mmHg or more as the abdominal viscera are replaced into the abdominal cavity
Triad of
Respiratory distress
Cyanosis
Apparent dextrocardia
Congenital diaphragmatic hernia
Primary prognostic variable of congenital diaphragmatic hernia
Degree of associated pulmonary hypoplasia
Bowel segments typically involved in intestinal atresia
Duodenum
Jejunum
Terminal Ileum
Anus
Etiology: intrauterine mesenteric ischemia
Presentation: bilious emesis
Jejunal-ileal atresia
Nonbilious projectile vomiting
Defect occurs in 1/3000 births and is most common in 1st born males
Olive may be palpable in epigastrum on PE
Pyloric stenosis
Noninvasive diagnostic test of pyloric stenosis
Ultrasound
Leading cause of death in childhood
Trauma
MC type of choledochal cyst
Type 1 - involves CBD only
Tx- hepaticojejunostomy
Problems of children with Tracheoesophageal Fistula repair may be encountered
Have reactive airway disease or other lung disease suggestive of chronic aspiration
Esophageal stenosis may require dilatation and bougienage
Preferred maintenance fluid of children older than 6mon of age
5%dextrose in 0.45% saline
Preferred maintenance fluid of children younger than 6mon of age
5% dextrose in 0.2% saline
Most prevalent in infants.
Subacute in onset
Lower temperature
Lower WBC count
Croup
More prevalent in toddlers and preschoolers
High fever
Toxic appearance
Brief course before onset of respiratory distress
Epiglottitis
Cyst like structure in neck of infant. Midline. Moves with swallowing
Thyroglossal duct cyst
- derived from foramen cecum and can have abberant thyroid tissue with malignant transformation potential
Tx: excision of thyroglossal duct cyst with hyoid bone
Tumor of childhood MC malignancy in child with VMA and N-myc
Neuroblastoma
Most common solid malignancy of childhood
Hypertension is present in 25%
Tumor markers: catecholamines / metenephrines
Tumors occur anywhere along the sympathetic chain/nerve distribution
Neuroblastoma
MC organism encountered in cervical lymphadenitis
Group A Streptococcus and Staphylococcus aureus
Intermittent crampy abdominal pain with severe bouts of colic
Mucous and bloody stool
Clinical bowel obstruction w bilious vomiting and poor PO tolerance
Dilated small bowel and air fluid levels on KUB
Involution of distal ileum into R colon is the most frequent site w TARGET SIGN
Intussusception
MC type of TEF
Blind ending proximal esophageal pouch w fistula from lower esophagus to the trachea (85%)
Inability to pass NGT
Cough with feeds
Tx: R anterolateral thoracotomy
Normal urine output of newborn babies
1-2 cc/kg/hr
Fundamental steps required in Ladd procedure for malrotation
Detorsion of volvulus,
Division of Ladd’s bands overlying duodenum
Mobilization and straightening of duodenum
Appendectomy
MC brachial cleft anomaly
2nd brachial cleft sinus
MC location of diaphragmatic hernia
80% Left PosteroLateral chest through foramen of Bochdalek
Associated anomalies should be excluded in eval of neonate with esophageal atresia
Those of VATER or VACTERRL syndrome (Vertebral, Anorectal, Cardiac, Tracheoesophageal, Radial, Renal, Limb)
Geneteic abnormality with Duodenal atresia
Trisomy 21 (Down’s syndrome)
Polyhydramnios
—-DOUBLE BUBBLE
Etiology: mucosal web 2ndary to failure of bowel recanalization
Tx for Duodenal atresia
Duodenoduodenostomy
MC cause of colonic obstruction in infants
Hirschprung’s disease
Male
Presentation: failure to pass meconium
Gold standard dx of Hirschsprung in newborn
Absent Meissner and Auerbach plexus on rectal biopsy
Aganglianosis
Hypertrophic nerves
Increased cholinesterase staining
MC cause of infantile GI perforation
Midgut volvulus w intestinal ischemia, vasopressor medications and indomethacin
Most common malignant childhood malignancy
Leukemia
MC hepatic malignancy in a child <4yo
Hepatoblastoma
MC hepatic malignancy in a child >4yo
Hepatocellular carcinoma
MC soft tissue tumor of childhood
Rhabdomyosarcoma
Tx: sx excision
Embryonic remanant that causes Meckel’s diverticulum
OMPHALOMESENTERIC DUCT
Tx for imperforate anus
Below levators- anoplasty
Above - temp colostomy, vagina/bladder repair PRN, delayed coloanal repair
MC cause of rectal bleeding in children >1yo
Juvenile polyps
MC location of gonadal germ cell tumot in childhood
Ovary
MC location of extragonadal germ cell tumor in childhood
Sacrococcygeal region
Pt with bilious emesis
Malrotation of midgut
Large painless abdominal mass (MC presentation)
Mets in the lungs
Wilm’s tumor (nephroblastoma)
MC leading to liver transplantation in pedia population
Biliary atresia
MC intraabdominal tumor diagnosed during childhood
Wilm’s tumor
MC indication for cholecystectomy in pedia age group
Cholelithiasis 2ndary to sickle cell disease
MC indication of splenectomy
Hereditary spherocytosis
Tx of choice in biliary atresia
Hepatoportoenterostomy
(Kasai procedure)
4mon old
Barking cough
Inspiratory stridor for 2 months
Bright red lesion on back that has been gradually enlarging
Asymmetric narrowing of subglottic region
Subglottic hemangioma
Large port wine stain in forehead and maxilla
Sturge- Weber syndrome
- capillary malformation involving V1 and V2
- vascular malformation involving brain — seizures and cognitive impairment
8yo boy
Draining ear filled w friable tissue
Punched-out lytic lesion of temporal bone
Lipid laden histiocytes
Dx?
Histiocytosis X
Posterior compression of esophagus demonstrated on barium esophagogram most likely caused by
Aberrant subclavian artery
Coagulative necrosis
Protect deeper tissues
Acid burn
Liquefactive necrosis
More extensive burns
Alkaline burn
Tx for caustic injury to the entire esophagus with full thickness mescoris
Esopahgectomy with colon interposition replacement
Medical therapy may be beneficial for patients with corrosive burns of esophagus
Antibiotic hasten epithelialization
Corticosteroids decrease stricture formation
3yo constant purulent nasal drainage
Recurrent pneumonia
Dextrocardia on chest xray
Kartagene’s syndrome