Pediatrics 2 Flashcards
kid with drooling fever odynophagia dysphagia muffled voice and trismus what can cause that(3)
infection of larynx
Pharynx
or
deep neck space
clue for retropharyngeal abcess in the setting of drooling fever odynophagia dysphagia muffled voice and trismus(2)
inability to extend the neck
widened prevertebral space in lateral xray
complication of retropharyngeal abcess(4)
airway compromise
bactriemia
carotid artery rupture
jugular venous thrombosis
cause of retropharyngeal abcess
direct spread infection from paharyngitis
tonsilitis
otitis media
or sinusitis
bugs involved in retropharyngeal abcess
polymicrobial
stable patient with retropharyngeal abcess
polymicrobial
clue for early congenital syphilis(5)
hepatosplenomegaly cutaneous lesion jaundice anemia rhinorrhea
xray in congental syphilis(2)
metaphyseal dystrophy
periostitis
late manifestation of congenital syphilis (7)
2 years frontal bossing high arched palate hutchinson teeth intersticial keratitis saddle nose perioral fissures
screening test for syphilis(3)
VDRL
RPR
Enzyme immunoassay
confirmatory test for syphilis(3)
FTA-ABS
TPPA=traponema particle agglutination assay
in the vignette the clue for syphilis congenital
ulcerative on his feet
3 phases of pertussis
catarrhal
paroxysmal
convalescent
immunisation in pertusis(2)
5 doses of Tdap from 2 months and 6 years
TDAP booster age 11-18 and during pregnancy
CBC in pertussis
lymphocyte predominant leukocytosis
does immunization protects for life
no immunity doen not provide lifelong immunity
confirmatory dx of pertussis(2)
bacterial culture
PCR
rx of pertussis
macrolides
complication of pertussis(5)
pneumonia weight loss subonjonctival hemorage pneumothorax respiratory failure and deat
clue in catarrhal phase
mild cough
rhinitis
duration of catarrhal phase
1-2 weeks
clue for paroxysmal phase(4)
20-30 mn coughing paroxysms
inspiratory whoop
staccato cough
posttussive emesis
duration of paroxysmal phase
2 - 6 weeks
clue for convalescent phase(2)
cough and
post tussive emesis resolve
duration of convalecent phase
weeks to months
osteomyelitis in sickle cell disease(2)
salmonella # 1
staph aureus
important clue to dx pertussis
inadequate vaccination
predisposing factor for sinusitis
viral upper respiratory infection
clue for sinusitis(4)
erythema and swelling of the nasal turbinates
purulent drainage
congestion
cough
quid of preseptal cellulitis
mild infection of the eyelid anterior to the orbital septum
quid of orbital cellulitis
seriuos infection post to the orbital septum
clue to distinguish preseptal from orbital cellulitis
ophtalmoplegia in orbital cellulitis(diplopia)
eye problem in orbiatl cellulitis(4)
decreased visual acuity
diplopia
ophtalmoplegia
proptosis
dangerous complication of orbital cellulitis(4)
blindness
intracranial infection
orbital abscess
cavernous sinus thrombosis
characteristic of non inflammatory joint fuid(3)
clear
200-2000 wbc
25% PMN
example of non inflammatory joint disease
OA
characteristics of inflammatory joint fluid(3)
translucent and opaque
2000-100000 wbc
often> 50% PMN
example of inflammatory joint disease(2)
crystal
RA
characteristics of septic joint(3)
opaque
50 000-150 000 WBC
often 80%-90 %
first bug in septic joint
staph aureus
rx of septic joint(2)
IV antibiotics
emergency surgical drainage
complication of septic joint
permanent joint destruction
most frequent complication of mumps
orchitis
febrile illness with development of rash 1 day after taking amox which infection should be suspected and dx(2)
epstein barr virus
post antibio rash
triad in Mononucleosis infection(3)
exsudative tonsillitis or pharyngitis
posterior or diffuse cervical lymhadenopathy
fever
presentation of post antibiotoc rash(2)
polymorphous
maculopapular
break time in sport during mononucleosis
> ou egal a 3 semaines
common oropharyngeal lesions in kid(5)
aphtous stomatitis herpangina herpes gingivostomatitis group A streptococal pharyngitis infectious mono
quid of aphtous lesions or canker sores(2)
reccurent ant oral mucosa ulcers
no fever
localisation of ulcers in canker sores(4)
lips
cheeks
mouth floor
ventrum of the tongue
clue for herpangina(2)
vesicles and ulcer on post oropharynx
fever
clue for gingivostomatitis
vesicles and ulcer on ant oropharynx
fever
clue for group A strep pharyngitis(3)
tonsillar exsudates
fever
anterior cervical lymphadenopathy
cause of unilateral cervical adenitis in children(5)
staph aureus and staph pyogenes anaerobic bacteria non tuberculos bacteria Mycobacterium TB bartonella henselae
clue for adenitis induced by staph and strep(2)
associated cellulitis
or
suppuration
rx of adenitis induced by staph or strep
clindamycin
incision and drainage
risk factor for anaerobic bacteria induced adenitis(2)
dental caries
periodontal disease
rx of anaerobe adenitis(2)
clindamycin
augmentin
clue for non TB mycobacteria adenitis
rarely tender
rx of non tb mycobacteria adenitis(2)
excision
macrolide +/- rifampin
clue for adenitis caused by bartonella hensellae
exposure to kittens or cats
rx for adenitis caused by bartonella hensellae
no needed
contraindication to rotavirus vaccination(4)
history of antissuception
anaphylaxis to vaccine ingredients
history of uncorrected congenital malformation in the GI like Meckel
severe combined immunodeficiency
age for administration of rotavirus
2-6 months
management of cat bite
augmentin pendant 5 jours
most common cause of osteomyelitis in kid
staph aureus
most common cause of acute tender lymph node in kids
staph aureus
clue for rhinosinusitis(3)
persistent symptom> ou egal a 10 jours without improvement
or
severe symptoms including fever> ou egal 39,purulent discharge or face pain> ou egal a 3 days
or
worsening symptoms > ou egal a 5 jours after initially improving viral upper respiratory infection
bugs causing rhinosinusitis(2)
step pneumoniae
nontypeable haemophilus influenzae
rx of choice of bact rhinosinusitis
augmentin
step in management of septic joint with effusion(4)
Labs de routine
xray
arthrocentesis
(in some vignette arthrocentesis is more important than Xray)
osteomyelitis in kid less than 3 years(3)
staph
group B streptococcus
gram negative bacilli
osteomyelitis in kid more than 3 years(3)
staph aureus
group A streptococci
strep pneumo
rx of osteomyelitis in kid less than 3(2)
nafcillin or vancomycin
plus
gentamycin or cefotaxime
rx of osteomyelitis in kid more than 3(4)
nafcilin or clindamycin or cefazolin or vancomycin
quid of howel jolly bodies(2)
single round blue inclusions on wright stain
nuclear remnants
quid of aplastic anemia
everything is low
acquired cause of aplastic anemia(6)
drugs toxic chemicals idopathic viral infection immune disorder thymoma
drugs causing aplastic anemia
NSAIDS
sulfonamides
toxic chemicals causing aplastic anemia(2)
benzene
glue
congenital cause of aplastic anemia
fanconie anemia
inheritance of fanconi(2)
autosomal recessive
or xlinked
risk in fanconi
cancer by the age of 16
Dx of fanconi
chromosomal breaks
clue for fanconi(4)
congenital marrow failure
poor growth
morphologic abnormalities
macrocytic anemia
disease with cafe au laits spots(2)
fanconi
neurofibromatosis
eyes and ears problem in fanconi(3)
strabismus
lot set ears
middle ear abnormalities
middle ear abnormality in fanconi(4)
hemorrgae
incomplete development
chronic infections
deafness
definitive rx in fanconi for the anemia
hematopoietic stem cell transplantation
most common complication of sickle cell disease
painless hematuria
why patient will sickle cell disease pee a lot at night
isisthenuria=inability to concentrate urine
kid with foot refent foo woung you decide to vaccinate for tetanos mother who is the guardian accepts but the father not what to do
administer the vaccine
in case of separated couple how do you proceed for the consent
the consent of one parent or the guardian is sufficient to perform
clue for wiskott aldrich syndrome(3)
low platelet
plus eczema
plus reccurent bacterial infection
cause of thrombocytopenia in wiskott
decreased platelet production
platelet in wiskott aldrich
small
inheritance of aldrich wiskott
x linked
clue for acute lymphoblastic leukemia(5)
bone pain lymphadenopathy hepatosplenomegaly pallor from anemia petechia from throbocytopenia
dx of acute lymphoblastic leukemia
bone marrow biopsy with >25 % lymphoblasts
most common cancer in childhood
ALL
peak of ALL
2 - 5 ans
rx of ALL
chemotherapy
clue in the USMLE for ALL(2)
infant
high WBC
nosebleed and congestion in a patient with CT shows visible mass at the back of the left nostril and erosion of the adjacent bone dx
angiofibroma
male adolescent with epistaxis and bone erosion on the back of the nose
angiofibroma until proven otherwise
when to rx angiofibroma(3)
if juvenile angiofibroma is enlarging
obstructing the airway
cause chronic nosebleeds
surgery in angiofibroma
risk of recurrence
xray in osteosarcoma of humerus(2)
sunburst periostal reaction
codman triangle
the most common bone tumor in kid and young adults
ostosarcoma
bone of predilection of osteosarcoma
long bone
quid of codman triangle
periostal elevation
rx of osteosarcoma(2)
tumor excision
chemotherapy
when to suspect herediatary spherocytosis(4)
coombs negative
hemolytic anemia
splenomegaly in the setting of reticulocytosis hyperbilirubinemia spherocytosis and family history of anemia
confirmatory dx of hereditary spherocytosis
eosin 5 maleimide and acidified glycerol lysis tests
stroke in kid next step
peripheral smear and reticulocyte count
stroke in kid cause
SCD
physiopatho of stroke in SCD(3)
unknown but we think
red blood cell adherence to endothelium
activation of von willbrand’s factor’s
hyperviscosity
patient with history of easy bruising develops knee swelling after trauma first step
platelet count and coagulation studies
3 clue for bleeding disorders
prolonged bleeding after dental or minor procedures
bruising at pressure points
hemarthrosis
cause of bleeding disorder(4)
hemophilia A
hemophilia B
von willebrand disease
platelet function disorder
disease with platelet dysfunction(2)
bernard souilier
glanzman thromboasthenia
patient knee pain and swollen without trauma xray show central lytic lesion onion skinning appearrance dx
ewings sarcoma
type of tumor in erwing sarcoma
malignant
xray in erwing sarcoma(3)
onion skin, lamelated appearance
with a moth eaten or mottled appearance and extension in soft tissue
dx differenciel in erwing sarcoma
osteomyelitis
lieu for metastasis in erwing cell sarcoma(2)
lung
lymph nodes
patient with reccurrent sinopulmonary infection and diarrrhea since childhood develops anaphylactic transfusion reaction after blood transfusion cause of that
IgA deficiency
confirmatory dx of IGA deficiency(2)
low IGA level
normal IGM and IGG
prevention of infection and death in SCD(2)
give PNC prophylaxis
plus
pneumococcal vaccination
admistration of PNC in SCD
twice a day
until they reach five yo
factors of coagulation missing in cystic fibrosis(3)
vit K dependent
2, 7,9 ,10
protein C et S
why you have problem of bleeding in cystic fibrosis(2)
pancreatic insufficiency
problem in liposoluble vit absorbtion
toddler with unilateral firm mass and hematuria
tumeur de wilms(nephroblastoma)
peak for wilms tumor
2-5 ans
associated syndrome with wilms tumor(3)
wagr
beckwith wiedman syndrome
denys drash syndrome
quid of WAGR syndrome(4)
wilms tumor
aniridia
genitourinary anomalies
retardation mental
most common primary renl neoplasm in kid
wilms
dx of wilms(2)
1- contrast enhanced CT
2- chest xray for metastasis
rx of wilms(3)
tumor excision or nephrectomy
chemo
+/- radiation therapy
prognosis for rx wilms
5 year survival rate with rx :90%
role of hydroxyurea
increase fetal Hb
side effect of hydroxyurea(3)
leukopenia
anemia
thrombocytopenia
bref marrow suppression
marrrow suppression with hydroxyurea
temporary
polycythemia in newborn quid
central nervous hematocrit level greater than 65%
cause of polycythemia in newborns
delayed clamping of the umbilical cord
risk foor neonate in polycythemia(3)
respiratory distress
poor feeding
neurologic manif
clue for ALL(4)
more then 25 % de lymphoblast
lymphoblast lacks of peroxydase positive granules
but contain periodic acid schiff positive material
immunostaining for terminal deoxynucleotidyltransferase
immunostaining in ALL
TDT expression dans 95% des cas
cells expressing TDT(2)
pre T lymphoblastes
Pre B lymphoblastes
SCD patient with hip pain first dx
osteonecrosis(avascular nerosis)
mosr common affected bone in osteonecrosis in (2)
humerus
fever
patient with SCD presenting with dyspnea fatigue Hg: hb 4,5 wbc: 10000 platelets:300 000 reticulocytes=0,1% dx
aplastic crisis
low HB in SCD causes (3)
aplastic crisis
hemolysis
splenic sequestration
differentiate aplastic crisis from aplastic anemia
aplastic anemia =pancytopenia in a patient without SCD
characteristics of iron deficiency anemia(8)
Hmt< 30% RDW increased total RBC decreased low serum iron ferritin increased TIBC responds to iron supplementation normal electrhoresis no target cells
characteristics of alpha thalassemia anemia(8)
Hmt.> 30% RDW normal total RBC normal normal to increased serum iron ferritin TIBC normal no responds to iron supplementation normal electrophoresis target cells
characteristics of beta thalassemia anemia(8)
Hmt.> 30% RDW normal total RBC normal to increased normal to increased serum iron ferritin TIBC normal no responds to iron supplementation electrophoresis=elevated hb A2 target cells
shistocytes in the settting of bloody diarhea administration of antibiotics,low Hb low platelet and high creat
microangiopathic hemolytic anemia
bugs involved in hus(5)
E coli 0157h7 shigella campylobacter salmonella yersinia
peripheral smear in HUS
schistocytes
continuous flow murmur in left sternla border in young child (son)
Patent ductus arteriosus
knee chest position of in fallot how it will improve cyanosis (2)
increased systemic vascular resistance
increases pulmonary blood flow
viral prodrome(rhinorrhea,fever) and heart failure
viral myocarditis
chest xray in viral myocarditis(2)
cardiomegaly
pulmonary edema
ECK in viral myocarditis
sinus tachycardia
echo in viral myocarditis(2)
decreased ejection fraction
diffuse hypokinesis
Biopsin in viral myocarditisdium with myocite necrosis(2)
gold standard
inflammatory infiltrate of the myocardium with myocite necrosis
prognosis of viral myocarditis in newborns
mortality 75%
prognosis of viral myocarditis in older infants and children
mortality in 25%
out come in viral myocarditis
full recovery within2-3 months 66%
dilated cardiomyopathy /chronic heart failure 33%
what dysfunction you have in viral myocarditis
systolic and diastolic
management of viral myocarditis(3)
ICU
to reduce the risk of acute decompensatio
fatal arythmia
antibiotics used in rheumatic fever prophylaxis
IM PNC G given q 4 semaines
duration of prophylaxis of rheumatic fever without carditis
5 years or until the patient reaches 21 yo
duration of prophylaxis of rheumatic fever with carditis but no residual heart or valvular disease clinical or by echo
10 years or until the patient reaches 21 yo
duration of prophylaxis of rheumatic fever with carditis and persistent heart or valvular disease
10 years or until 40 yo
why you give PNC in patient rheumatic fever(2)
to prevent recurrent group A streptococcus pharyngitis
limit progression of rheumatic heart disease
patient one day old comes for cyanosis ,pulse oxymetry 80% with no improvement with 100% inspired o2.continuous machine like murmur is heard on auscultation oral mucosa is blue dx
cyanotic heart disease
central cyanosis plus 70-90% oxygen saturation dx
cyanotic heart disease
what to do in front of cyanotic heart disease
prevent closure of ductus arteriosus by giving prostaglandine E 1
PDA dependent congenital heart disease(5)
coarction of the aorta D transposition of the great arteries hypoplastic left heart syndrome total pulmonary venous connection tricuspid atresia
cause of supraventricular tachycardia in adolescent
WPW
mechanism involved in WPW
accessory atrioventricular pathway
EKG of WPW(3)
shortened PR interval
delta waves
widening qrs complex
clue for tricuspid atresia
left axis deviation
decrease pulmonary markings on chest xray
why tricuspid atresia you have decrease pulmonary markings on chest xray
due to hypoplasia of the right ventricle and pulmonary outflow tract
neonatal with EKG shwsleft axis deviation
it’s never normal
quid of tricuspid atresia
cyanotic heart disease
post pericardiotomy syndrome
pericardial effusion occurring within days or months after cardiac surgery
cardiomegalie with hypotension tachycardia muffled heart sound after surgery
pericardial effusion
most common heart malformation
VSD
clue for VSD
holosystolic murmur in left sternal border
plus
apical diastolic rumble
when will you have cyanosis in VSD
eisenmenger syndrome
quid of eisenmenger syndrome(2)
right to left shunt
unrepaired large VSD causes permanent pulmonary Hypertension and right to left shunt
cause of diastolic rumble in VSD at the apex
increased flow across the mitral valve
patietn 5y0 with asymptomaticgrade 2 left sternal border systolic ejection murmur best heard when the child is lying down and decreases with standing dx
benign chilhood murmurs
what to do in benign childhood murmur
observation
characteristics of inocent murmur(6)
asymptomatic no structural heart disease associated grade 2/6 early or mid systolic decreases with standing and valsalva have a normal associated s2
characteristics of pathologic murmur(6)
syptomatic structural heart disease associated grade 3/6 or higher hars and holosystolic or diastolic increases with standing and valsalva loud s2 fixed s2 splitted
adolescent losing consciousness after crying or anytime she gets frustrated .EP normal dx and rx
breath holding spell
reassure the patients
type of breath holding spell(3)
pallid =patient pale
cyanotic=
mixed=cyanose plus seizure/pallid plus seizure
stridor improving with neck extension chez 1 patient de moins d’un an with cardiac abnormalities no improvement with epinephrine corticosteroids or bronchodilators
vascular ring
where can you have vascular rings(2)
trachea=stridor wheezing
esophagus=dysphagia
age pour vascular ring
mois d’un an
risk in long Qt syndrome(3)
syncope
ventricular arythmia
sudden cardiac death
medication used in prevention of death in long Qt syndrome(2)
betablocker
pacemaker
what a patient with long qt syndrome should avoid(2)
electrolyte derangement
medications that block K+ channels
ventricular arythmia in long Qt syndrome
torsade de pointes
congenital cause of long Qt syndrome(2)
Jervell and lange nielsen syndrome=autosomal recessive
romano ward syndrome=autosomal dominant
jervel and lange nielsen syndrome(3)
family history of sudden death
congenital neurosensorineural deafness
qt interval=600ms
what happen in jervell and lange nielsen syndrome
molecular defect in potassium channels
rx of JLN syndrome(3)
refrain from vogorous exercice
maintaining normal ca++,K+and Mg++
avoid medication that can lengthen the qt interval
metabolic derangements causing long Qt syndrome(3)
hypocalcemia
hypoK+
hypoMg++
antibiotics induced long qt syndrome(2)
macrolide
fluoquinolone
psychotics meds induced long qt syndrome(3)
antipsychotics
TCA
SSRI
opioids meds induced long qt syndrome(2)
methadone
oxycodone
antiemetics meds induced long qt syndrome(2)
ondansetron
granisetron
antiarythmics meds induced long qt syndrome(5)
quinidine procainamide flecainide amiodarone sotalol
Qt interval
debut qrs a fin onde T
scaly rash in eyebrows nasolabial fold and scalp dx
seborrheic dermatidis
rx of seborheic dermatidis(3)
moisturisers
antifungals
topical steroids
quid cradle cap
seborrheic dermatidis
platelet in henock shonlein purpura
normal
problem in henock shonlein purpura
IGA mediated vasculitis
clue for Henock shonlein purpura(4)
palpable purpura on lower extremities
abdominal pain
arthralgia
renal involvement
atopic dermatitis in infant(2)
pruritis
skin lesions
skin lesions in atopic dermatitis localisation(4)
face
scalp
extensor surfaces
diaper region is spared
rx of atopic dermatitis in kid
improve the skin barrier function through the use of mild cleanserss and thick bland emollients in addition to mild topical antiinflammatory ointments
Tinea corporis=date
erythematous scaly pruritic rash with central clearing
rx of tinea corporis
topical antifungals
dx of tinea corporis(2)
skin scraping
koh examination
rash in neonates(4)
erythema toxicum neonatorium
neonatal herpes simplex virus
neonatal varicella
staphyloccocal scalded skin syndrome
quid of erythema toxicum neonatorium(2)
asymptomatic erythematous blanching macules ,papules and pustules throughout the bodies
resolves spontaneously within 2 weeks after birth
Rx of erythema toxicum neonatorium
none
quid of neonatal herpes simplex virus(3)
vesicular clusters on skin eyes and mucous membranes
central nervous system involvement
fulminanat multiorgan failure
rx of neonatal herpes simplex virus
acyclovir
neonatal varicella(3)
fever
vesicular clusters on skin
fulminant disseminated disease
rx of neonatal varicella
acyclovir
quid of staphyloccocal scalded syndrome(4)
fever
irritability and diffuse erythema
followed by blistering and exfoliation
positive nickolsky sign
rx of staphyloccocal scalded syndrome(3)
oxacillin
or nafcillin
or vancomycin
recommendtion during sunburn even if if the patient is suing factor 50 sunscreen and develops sunburn(prevention)
apply sun protection factor(15-30) or higher 50 sunscreen 15- 30 mn before sun exposure
avoid tannig beds
rx of mild to moderate sunburn(4)
cool compresses
aloe vera
calamine lotion
NSAIDS
severe sunburn rx(4)
hospitalization
IV fluids
analgesia
wound care
complications of sunburn(2)
cancer
photoaging
cancer in sunburn(4)
melanoma
basal cell carcinoma
squamous cell carcinoma
after camping patietn presents with itching,burning and oozing skin lesions in both legs dx
allergic contact dermatitis
type of hypersenstivity in allergic contact dermatitis
cell mediated hypersensitivity
bugs in impetigo(2)
staph aureus
strep
2 types of impetigo
vesicular pustulous
bullous
cause of bullous impetigo
staphylococcus
characteristics of impetigo(3)
erythmatous papules
rapidly evolves in vesicles and pustules
and at last honey colored crusted exsudates
primary herpes simplex virus associated with dermatitis atopic
eczema herpeticum
clue for eczema herpeticum(2)
numerous vesicles over area of atopic dermatitis
fever
rx of eczema herpeticum(2)
can be life threatning
acyclovir
physiopatho of staphylococal scalded skin syndrome
toxins produced targeting desmoglein 1
role of desmoglein 1
keratinocyte adhesion in the superficial dermis
rash in staphylococal scalde skin syndromeSSSS(5)
1- erythema starting on the face 2-generalizes in 24-48 h 3-superficial flaccid blisters develops 4 nickolsky sign posive 5-fever
age de SSSS(3)
children below 10
adults with kidney disease
immune compromise patient
capillary hemangioma(strawberry)(2)
tumors composed of capillaries separated by connective tissues
appear first week and regress by 5-8 yo
clue for measles(rubeola)(4)
cough
coryza
conjunctivitis
koplik spots
rash in measles
maculor papular rash spreading in a cranial caudal pattern sparing palms and soles
prevention of measles
vaccination
rx of measles(2)
isolation in private room with negative air pressure and a minimum of 6-12 air changes per hour with door closed
wear of facemask N95 by staff and parents
transmission of measles
respiratory droplets
dx of measles(2)
PCR
serology
what should be given to any kid with measles
vit A
complications of measles(4)
otitis media
pneumonia
neurologic
gastroenteritis
neurologic complications in measles(3)
encephalitis within days
acute disseminated encephalomyelitis(within weeks)
subacute sclerosing panencephalitis(within years)
after trauma 5 yo kid develops headcahe vomiting and left pupil dilation dx possible
epidural hematoma
ct of epidural hematoma
biconvex mass on ct
indication of emergent craniotomy in epidural hematoma(5)
GCS< 8 sign of increased ICP pupillary abnormalities hemiparesis cerebellar signs
6 yo boy with poor feeding and bulging anterior fontanelle best next step in the management ot this baby
CT of the brain
clue for hydrocephalus
rapidly increasing in size of head circumference greater than the 97 th percentile(growth chart)
symptoms in hydrocephalus(4)
poor feeding
irritability
decreased activity
vomiting
physical exam in hydrocephalus(4)
tense and bulging fontanelle
prominent scalp veins
widely spaced cranial sutures
rapidly increasing head circumference
when using ultrasound in the setting of hydrocephalus
kid less than 6 months
drug of choice for absence seizure in kid(2)
ethosuximide(++++++)
or
acid valproic
patient with ear pain on antibio develops vomiting and awakened headaches inthe morning.Physical exam shows left tender mastoid next step in the patient
CT of brain
red flag for intracranial pathology
morning vomiting
nocturnal headaches
risk in otitis media or mastoiditis
brain abcess formation
dx of brain abcess formation
ring enhancing and hypointense center lesion on CT or MRI
ceiteria dx for febrile seizure(5)
age 6 months -6 years T.> ou egal a 38 no history of previous afebrile seizures no CNS infection no acute metabolic cause of seizure
quid of simple febrile seizure(3)
non focal (tonic clonic or atonic)
one episode last< 15 mn
or multiple episode< 30 mn
quid of complex febrile seizure(3)
focal
one episode > ou egal a 15 mn
or multiple episode > ou egal a 30 mn
risk factor of febrile seizure
infection virale
immunization
family history
immunization involved in febrile seizure(2)
DTAP
MMR
management of febrile seizure(2)
reassurance
abortive rx if seizure lasts more ou egal a 5 mn
prognosis of febrile seizure(3)
normal intelligence and development
environ 30% risk of recuurrence
less than 5% risk of epilepsy
quid of petit mal
absence seizure
confirmatory test for petit mal
EEG studies
clue for generalised seizures(3)
can have loss of consciousness
bilateral motor findings
can be convulsive or non convulsive(bsence)
physiopatho of generalised seizures
both hemisphere is involved
seizure activity in partial seizures
appears limited to part of oen hemisphere in brain
quid of simple partial seizures(4)
no loss of consciousness
feeling of deja vu(familiarity)
can have aura
patient remeber event well
partial seizure with generalisation(2)
1- loss of consciousness
2-tonic clonic activity
complex partial seizures(6)
loss of consciousness can have aura motor automatism bilateral motor findings staring spells postictal confusion
motor automatism in complex partial seizures(4)
chewing
swallowing
sucking
picking movements
clue for partial seizure with secondary generalisation(2)
blood tinged sputum suggesting bite tongue
urinary incontinence
fever with tonic clonic seizure in a patient with digeorge during exam babay cries and develops cyanosis
brain abcess
risk factor for brain abcess
otitis media /mastoiditis frontal and ethmoidal sinusitis dental infection cyanotic heart diasease bacteriemia from ather sites of infection
pathogenesis of brain abcess in otitis media and mastoiditis(2)
direct spread
temporal lobe and cerebellum abcess
pathogenesis of brain abcess in frontal and ethmoidal sinusitis(2)
direct spread
frontal lobe
pathogenesis of brain abcess dental infection(2)
direct spread
frontal lobe
pathogenesis of brain abcess in bacteriemia from other sites of infection and cyanotic heart disease(2)
hematogenous spread
mulptiple abcess along the distribution of middle cerebral artery(gray white matter junction)
most common cause of headaches acute and reccurent in the pediatric population
migraine headache
firs-line regimen in rx migraine(2)
acetaminophen
NSAID
EEg in complex partial seizures(2)
normal
or
show brief discharges
day dreaming episodes in 4 to 8 yo child , brief staring spells and decline in school performance and post ictal phase rx and dx(3)
ethosusuximide
valproate
dx absence seizures
skin changes in aptient taking anabolic steroid(2)
acne
accelarated male pattern baldness
why gynecomastia in patient taking anabolic steroid
testosterone is converted to estrogen and will drive breast enlargement
psychiatric problem in anabolic steroid(2)
aggresssion
major mood disorder
metabolic problem in anabolic steroid
low HDL
cardiac problem in anabolic steroid
cardiac dysfunction in high dose of anabolic steroid use
why erythrocytosis in anabolic steroid use
androgen stimulating erythropoiesis
endocrine problem in patient taking anabolic steroid(3)
decreased testicular size
low sperm count
virilization
quid of anabolic steroids(3)
testosterone
stanalozolol
nadrolone
clue for neurofibromatosis type 1(7))
cafe au lait spots axillary freckles lish nodules ot the iris bony lesion neurofibroma macrocephaly short stature
complication or assoiciated problem in neurofibromatosis(4)
tumor in CNS
tumor in peripheral nervous system
skin
viscera
learning problem in neurofibromatosis
learning disability
dx differetiel in delayed passage of meconium(2)
hirshprung
meconium ileus
level of obstruction in hirsprung
rectosigmoid
level of obstruction in meconium ileus
ileum
consistency of meconium in hirsprung
normal
consistency of meconium in meconium ileus
inspissated
earliest manif of cystic fibrosis
ileus meconial
associated condition in cystic fibrosis
rhinosinusitis
clue for duodenal atresia(2)
bilious vomiting
double bubble sign
congenital problem associated with down
duodenal atresia
blood in stool of 2 yo boy
meckel
rule of 2’s in Meckel(4)
2% prevalence
2/1 male to female ratio
2% asymptomatic at age 2
located 2 feet of ileoceacal valve
dx of Meckel
technetium 99 m pertechnetate scan
clinic of Meckel(4)
painless hematochezia
intussuception
intestinal obstruction
volvulus
most common congenital small intestine anomaly
meckel’s diverticulum
cause of Meckel(2)
incomplete obliteration of vitelline duct(omphalomesenteric duct)
why bleeding in meckel
ectopic gastric tissue secretes HCL
risk factor for NEC(4)
prematurite
very low birth weight
reduced mesenteric perfusion by hypotension and congenital heart disease
enteral feeding
pathogenesis of NEC(2)
gut immaturity
expose to bacteria from enteral feeds
measure to decrease NEC
breast feeding premature infant
clue for NEC in abdominal xray(4)
visible air in bowel wall=pneumatosis intestinalis
portal venous air
normally you have inside the bowell
train track appearance or double line
complication of NEC(5)
necrosis and pneumoperitoneum septic shock intestinal strictures short bowel syndrome death
patient with ulcerative colitis develops diarrhea irritability and poor concentration rash resembles to sunburn on distal arms and legs dx
niacin deficiency
4 D in Niacin deficiency
Diarrhea
Dermatitis
Dementia
Death
clue for intussuception (3)
periodic abdominal pain associated with drawing the legs up the abdomen
vomiting
intestinal obstruction
currant jelly stools
most common cause of intestinal obstruction in kid
intussuception
why currant jelly stools in intussuception(2)
ichemia of bowel wall
occult bleeding
risk factor for intussuception
viral infection plays role in inflaming intestinal lymphatic tissue(payers patches) which can serve as a lead point for intussucetion
ultrasound in intussuception
target sign
rx of intussuception
reduction with air or water soluble enema
role of lead point in intussuception
75% des cas no lead point identified
25 % des cas cause of intussuception(2)
meckel
polyps and hematoma in case henock shonlein purpura
esophageal coin in asymptomatic patient
observe for 24 hours after ingestion
symptomatic esophageal coin or time of ingestion is unknown
prompt removal with flexible endoscopy
most common foreign body ngested by children
coin
when to suspect foreign body aspiration(3)
difficulty swallowing
feeding refusal
vomiting
rx of NEC(3)
supportive care
IV antibiotics
surgery
supportive care in NEC(2)
bowel rest
parenteral hydration /nutrition
importanceof abdominal xray in the setting of intestinal occlusion
to rule out pneumoperitoneum
next step after ruling out pneumoperitoneum in teh setting of intestinal occlusion
contrast enema to determine the level of obstruction
contrast enema in meconium ileus
microcolon
role hyperosmolar enema
can break up the inssipated meconium and remove the obstruction
physiopatho in cystic fibrosis(2)
delta F508 mutation responsible chlorde transport and tenacious secretions in multiple organs
when to perform sweat chloride testing(2)
age > 2 weeks
or
weight > 2 Kg
timing in breatfeeding failure jaundice
first week of life
timing in breast milk jaundice(2)
starts at 3-5 days
peaks at 2 weeks
physiopatho of breastfeeding failure jaundice(3)
lactation failure results in
decreased bilirubib elimination
increased enterohepatic circulation
physiopatho of breast milk jaundice
high levels of B-glucuronidase in breast milk deconjugate intestinal bilirubin and increase enterohepatic circulation
clinical features in breastfeeding failure(2)
suboptimal breastfeeding
signs of dehydration
clinical features in breastfeeding failure(2)
adequate breastfeeding
normal examination
normal number of wet diaper in the first week of life
should equal the infants age in days
sign of dehydration in infant during first week of life(3)
slightly decreased urine output
brick red urate crystals in diaper
lost of weight
rx of breastfeeding failure(2)
breakfast 15 mn per side every 2-3 hours
supplementation with cow’s milk if the mother’s milk supply is inadequate
squirt sign in hirshprung
positive
squirt sign in meconium ileus
negative
baby with failure to pass meconium within 48 hours in the setting of down syndrome
hirsprung
presentation of hirshprung(3)
poor feeding
abdominal distension
absent air in the rectum
associated disease with hirsprung
down
associated disease with meconium ileus
cystic fibrosis
differential dx in vomiting and regurgitation in infants(4)
physiologic GER
Milk protein allergy
GERD
pyloric stenosis
clue physiologic gastroesophageal reflux(2)
happy spitter
asymptomatic
clue milk protein allergy(3)
regurgitation
eczema
bloody stools
GERD in baby(3)
failure to thrive
significant irritability
sandifer syndrome
pyloric stenosis in baby(3)
projectile non bilious vomiting
olive shaped abdominal mass
dehydration and weight loss
management of physiologic GER(2)
reassurance
positionning therapy
management of milk protein allergy
elimination of dairy and soy protein from diet
management of GERD(4)
thickened feeds
antacid therapy
esophageal PH probe monitoring
upper endoscopy
management of pyloric stenosis(2)
abdominal US
pylomyotomy
why post prandial regurgitation is frequent in infant(4)
shorter esophagus
decreased angle between the stomach and the esophagus
incomplete closure of the lower esophageal sphincter
greater time spent in the suoine position
management of physiologic GER(2)
frequent small volume feeds
hold the infant upright 20-30 mn after feeds
Mild dehydration in kid(2)
3 a 5 % volume loss
minimal or no clinical symptoms
moderate dehydration (7)
6 -9 % volume loss decreased skin turgor dry mucus membranes tachycardia irritability a delayed capilary refill(2-3 seconds) decreased urine output
severe dehydration (10)
10-15 % volume loss cool clammy skin delated capillary refill> 3 seconds cracked lips dry mucous membrane sunken eyes sunken fontanelle tachycardia lethargy minimal or no urine output
rx of moderate to severe dehydration
IV bolus of isotonic fluid
indication for renal and bladder US(4)
infants and children age < 24 months with a first febrile UTI
recurrent febrile uti in children of any age
children who do not respond to appropriate antibio rx
UTI in a child of any age with a family history of renal or urologic disease HTA and poor growth
children < 24 months with first febrile UTI(2)
rx for 7-14 jours antibio
renal and bladder US for structurakl abnormality that could predispose to UTI
first cause of vulvovaginitis in prepubertal children
vaginal foreign bodies
most common vaginal foreign body in kid
toilet paper
removing of toilet paper in vaginal(2)
calcium alginate swab
or
irrigation with warmed fluid
quid of monosymptomatic enuresis
urinary incontinence occuring at least twice a week after age of 5 without any medical condition
first line rx of enuresis
enuresis alarm
second line regimen in enuresis
medication
first line medication used in enuresis
desmopressin
second line medication used in enuresis
TCA
most efficient long term rx of enuresis
enuresis alrm
inconvenient with desmopressin
high risk of relapse
normal age for bedwetting
before 5
mastery of the nightime continence in kid
can take months to years
gender in nightime continence
boys generally achieves this milestone later than girls
most common urologic problem in children
vesicoureteral reflux
quid of vesicoureteral reflux
retrograde flow of urine from the bladder up into the ureter and renal pelvis
long term complication of vesicoureteral reflux
renal scarring
best test to Dx vesiculo ureteral reflux
voiding cystourethrogram
first UTI next step
renal ultrasound
reccurent UTI next step
voiding cystouretrogram
acute pyelonephritis next step(2)
bood and urine culture
hospitalizatin and empiric therapy with IV antibiotics
patient with fever and rhinorrhea ,an incidental urine shows 2 + protein
transient proteiunuria
what to do in transient proteinuria
repeat urine dipstick testing on 2 separate occasions to rule out persistant proteinuria
most common cause of isolated proteinuria
transient proteinuria
transient proteinuria cause(5)
fever exercice seizure stress volume depletion
causes of secondary enuresis(5)
psychological stress urinary tract diabetes mellitus diabetes insipidus obstructive sleep apnea
associated symptom of secondary enuresis with psychological stress(2)
behavior regression
mood lability
secondary enuresis in urinary tract infection(4)
dysuria
hesitancy
urgency
abdominal pain
diabetes mellitus (6)
polyuria polydipsia polyphagia weight loss lethargy candidiasis
diabete insipidus in secondary enuresis(2)
polyuria
polydipsia
assoicated symptom in obstructive sleep apnea(4)
snoring
dry mouth
fatigue hyperactivity
irritability
syndrome nephrotic in kid eleven YO with postive HBsag HBe ag dx
membranous glomerulonephritis
what marker will be positive in membranous glomerulonephritis induced by infectious viral hepatitis B
HBe ag
Potter sequence
urinary tract anomaly—>anuria and oligoanuria in utero——> oligohydramnios
three consequences of oligohydramnios in potter (3)
pulmonary hypoplasia
flat facies
limb deformities
prenal US showing bladder distension ,bilateral hydronephrosis and bilateral hydroureters Dx?
posterior uretral valves
why respiratory distress in oligoamnios
pulmonary hypoplasia
most common cause of secondary HTA in children
fibromuscular dysplasia
clue fibormuscular dysplasia(2)
hum or bruit in the costovertebral angle due to well developped collaterals
HTA
angiography in fibromuscular dysplasia
strings and beds pattern of renal artery
most common artery involved in fibromuscular dysplasia
right one
patient with severe pneumonia with absolute level of CD3 normal and low CD19 dx(2)
x linked agammaglobulinemia
or
bruton’s agammaglobulinemia
rx in bruton’s
regular infusion of IV immunoglobulin
quid of CD 3
lymphocytes T
quid of CD 19
Lymphocytes B
lymho low in bruton’s
lympho B
indication of endotracheal intubation and mechanical ventilation in asthma(6)
asthma unresponsive to medications who have Fatigue altered mental status Co2 retention worsening hypoxemia poor air movement on examination
first line rx of anaphylaxis
IV epinephrine
age for brutons
6-18 mois
physical exam in brutons
absent tonsils and other palpable lymphoid tissue
chest xray in infant les than 3
tonsils will be seen
tonsil on xray(2)
sail sign
triangular shape
role of thymus
production of lymphocyte and maturation
what to do in a patient with history of anaphylaxis
patient should carry self injectable epinephrine
next step in hymenoptera sting triggers
refferal to an allergist for venom immunotherapy
patient with neck swelling and irritability ,he keeps his head rotated slightly to the right side dx
acquired torticollis
next step in acquired torticollis
xray of the neck
most common cause of acquired torticollis(5)
upper respiratory infections minor trauma cervical lymphadenitis retropharyngeal abcess atlantoaxial subluxation
why neck xray in acquired torticollis(3)
to rule out cervical spine fracture
dislocation
which requires extreme caution
prematured infant with respiratory distress dx
hyaline membrane disease
risk factor for hyaline membrane disease(5)
prematurity maternal diabetes c section without labor perinatal asphyxia sexe male
how maternal diabetes increases the risk of respiratory distress syndrome or hyaline membrane disease(2)
delays maturation of surfactant
hyperinsulinism antagonizes the action of cortisol and the lung maturation process
how do you differentiate artralgia in jones criteria
if you choose arthritis in major criteria you can’t choose arthralgia anymore
clue for lyme disease
trip in northeastern and upper midwestern united states
time to have early localised Lyme
days to 1 month after the bite
clue for early localised Lyme disease(2)
erythema migrans
myalgias and arthralgias
time to have early disseminated lyme
weeks to months
carditis in early disseminated lyme(2)
AV block
cardiomyopathy
neurologic problem in early disseminated lyme(3)
unilateral or bilateral cranial nerve defects
meningitis
encephalitis
cranial nerve most commonly involved in Lyme disease
7
muscular problem in early disseminated lyme
migratory arthralgias
skin problem in early disseminated lyme
multiple erythema migrans
eye problem in early disseminated lyme
conjunctivitis
most common finding in early disseminated Lyme
migratory arthralgia dans 60% des cas non traites
time for late or chronic manif of Lyme disease
months to years after the bite
problem in late or chronic manif of Lyme disease(3)
muscular =arthritis dans 60% des cas non traites
encephalomyelitis
peripheral neuropathy
adolescent male athlete with knee pain
osgood schlatter disease
quid of osgood schlatter disease
traction apophysitis of the tibial tubercle
xray finding in osgood schlatter(3)
soft tissue swelling
lifting of tubercle from the shaft
irregularity and fragmentation of the tubercle
rx osgood schlatter(3)
activity restriction
strectching exercice
NSAIDS
synovial fluid in lyme disease
average leucocyte count 25000
patient rx for sore throat fever difficulty swallowing ,symptom subsides rapidly with PNC.ten days later the patient presents with fever ,skin rash fleeting joint pain in lower extremities dx
serum sickness like reaction
quid of serum sickness like reaction
hypersensitivity reaction occurring one to 2 weeks after administration of certain drugs
drugs involved in serum sickness like reaction (4)
PNC
amox
TS
cefaclor
physiopatho of serum sickness like reaction
immune complex mediated hypersensitivity reaction to non human proteins
age for kawasaki
less than 5 years
conjunctivitis in kawasaki
spares limbus
oral mucosae changes in kawasaki(3)
erythema
fissure lips
strawberry tongue
extremity changes in kawasaki(3)
erythema
edema
desquamation of the hands and feet
quid of kawasaki
vasculitis
lab in kawasaky(4)
elevated CRP and ESR
leucocytosis with neutrophilia (viral= lymphocytosis)
reactve thrombocytosis
sterile pyuria in uninalysis
rx of kawasaki(2)
aspirin
plus IV immunoglobulin
complications of kawasaki(2)
coronary artery aneurisms
myocardial infarction and ischemia
consequense of coronary artery aneurism
thrombotic occlusion —> myocardial ischemia and death
echocardiography in kawasaki(2)
at the time of Dx
repeat 6-8 weeks later
baby born at 33 semaines de gestation how will you deal with immunization
immunization should be given according to chronologic age
what is the rule to administer hep B vaccine
weight should be > ou egal a 2 kg
region with high level of hepatitis b infection(2)
asia
and
africa
cancer preventable by vaccination
hep B
congenital manif of german measles(4)
sensorineural hearing loss
cardiac anomalies
cataracts
glaucoma
cardiac problem in rubella(german measles)
PDA
children with german measles(4)
low grade fever
conjunctivitis coryza and cervical lymphadenopathy
cephalocaudal spread of blanching erythematous maculopapular rash
german measles in adults (5)
low grade fever
conjunctivitis coryza and cervical lymphadenopathy
cephalocaudal spread of blanching erythematous maculopapular rash
arthritis
prevention of german measles in baby
vaccination (live atenuated vaccine )
rubella in first trimester
teratogenic
screening test in infant 0-5 ans recommneded by the USPSTF(united preventive services task force)(3)
strabismus
amblyopia
refractive errors( bref vision screening)
the most common reservoir for rabies in the US(2)
racoon
bats
clue for encephalitis rabies(2)
hydrophobie
aerophobie
post exposure prophylaxis of rabies(2)
rabies immune globulin
plus
rabies vaccine
quid of encephalitic rabies(5)
hydrophobie
aerophobie
pharyngeal spasm
agitation spastic paralysis
quid of paralytic rabies
ascending flaccid paralysis
complication of rabies(3)
coma
respiratory failure
death within weeks
transmission of rabies
exposure to saliva
clue for acute otitis media(2)
middle ear effusion
plus
acute eardrum inflammation
quid of acute eardrum inflammation(2)
bulging eardrum
fever
clue for otitis media with effusion(2)
middle ear effusion
without
acute inflammation
clue for bullous myringitis
serous liquid filled blisters on the tympannic membrane
clue for cerumen impaction(2)
liquid or wax in auditory cana
no visualisation of eardrum
clue for hemotympanum
purple or red eardrum plus ou moins bulging
clue for otitis externa(3)
pain with tragal traction
erythematous and swollen external auditory canal
+/- otorhea
dx in otalgia(6)
acute otitis media otitis media with effusion bullous myringitis cerumen impaction hemotympanum otitis externa
cardinal clue for otitis media(2)
bulging of the tympannic membrane
which reflects middle ear effusion
peak for otits media(2)
6-18 mois in daycare
around 5 when school initiation
next step in any children with trouble in school to understand or behavioral disorder in childhood dx
undetected hearing impairement
first cause of hearing impairment
conductive hearing loss due to repeated ear infection
when to suspect hearing inpairment(3)
poor language development
social skills
inattentiveness
patient with sore throat dysphagia odynophagia pharyngeal and tonsillar erythema dx(2)
viral pharyngitis
strep pharyngitis
when to think about strep pharyngitis(5)
presence of exsudates edema palatal petechiea tender anterior cervical lymphadenopathy absence of viral symptoms
when to think of viral pharyngitis
presence of viral symptoms
quid of viral symptoms(4)
cough
rhinorrhea
conjonctivitis
oral ulcers
what to do if you suspect strep paharyngitis
rapid antigen test
what to do if you suspect strep paharyngitis with neagtive rapid antigen test
obtain throat culture
left sided ear discherge resistant to antibiotics EP reveals granulation and some skin debris
cholesteatoma
new onset of hearing loss or chronic ear drainage despite antibiotic therapy dx
cholesteatoma
otoscopy in cholesteatoma(3)
granulation tissue
skin debris
retraction pockets of the tympannic membrane
cause of cholesteatoma(2)
congenital
ssecondary to chronic middle ear disease
criteria to dx attention deficit hyperactivity disorder
symptoms present before age of 12
in at least 2 settings(schoole home and other)
what is so improtant to make the dx of attention deficit hyperactivity disorder
teachers evaluation
clue for night terrors(5)
fear crying screaming decreased level of consciuosness amnesia of the event
when does night terror occurs
during non REM sleep
triggers for night terrors(4)
acute stress
sleep deprivation
illness
medication affecting central nervous system
peak of incidence of night terrors
2 a 12 ans
patient 11 yo with continuous thought of stabbing his mother dx
Obssessive compulsive disorder
rx of obssessive compulsive disorder (2)
CBT
plus
high dose of selective serotonin inhibitor
rx of obssesive compulsive disorder with no response to CBT and serotonin reuptake inhibitor(2)
clomipramine
or
increase dose of antipsychotic rx
severe refractory obsessive compulsive disorder
deep brain stimulation
which of the following behaviors should be concerning in a young children 2-5 years(extensive sexual knowledge)(5)
simulating forplay simulating intercourse preoccupation of masturbation touching other genitals excessive talk about swxuality
what sexual extensive knowledge can teach us in kid
possibility of sexual abuse
quid of constitutionnal growth delay(3)
delayed growth spurt
delayed puberty
delayed bone age
14 yo boy with feeling of a mass under his right nipple.Physical exam is normal dx
gynecomastia
physiologic cause of gynecomastia(3)
preburte
can be unilateral or bilateral
you have firnm subareolar nodules sometimes tender with the touch
rx of pubertal gynecomastia (2)
nothing
resolve within few months to years
percentage of adolescent with gynecosmatia in prepuberte
2/3
pathological causes of gynecomastia(2)
increased estrogen production or peripheral conversion
androgen deficiency
pathology with increased estrogen production or peripheral conversion causing gynecomastia(9)
testicular adrenal or HCG secreting tumors cirrhosis malnutrition thyrotoxicosis congenital excessive aromatase activity androgen use medications herbal products illicit drugs
medication induced gynecomastia by increasing estrogen production or peripheral conversion(2)
spironolactone
cimetidine
illicit drugs induced gynecomastia by increasing estrogen production or peripheral conversion(4)
alcohol
amphetamines
heroin
marijuana
herbal products induced gynecomastia by increasing estrogen production or peripheral conversion(2)
tea tree oil
lavender oil
androgen deficiency causing gynecomastia(3)
primary or secondary male hypogonadism
hyperprolactinemia
renal failure
cause of primary or secondary male hypogonadism(2)
klinefelter syndrome
testicular damage
4 yo boy comes with nausea vomiting and abdominal pain.parents found pills scattered on the kitchen floor next to an open unlabeled bottle.boys develops hematemesis abdominal xtay reveals several small opacities in teh stomach and duodenum dx
iron poisonning
acid base problem in iron poisonning
metabolic acidosis with anion gap
complication of iron poisonning within 2 days
hepatic necrosis
complication of iron poisonning within 2-8 weeks
pyloric stenosis
rx of iron poisonning(3)
whole bowel irrigation
deferoxamine
supportive care for circulation airway and breathing
risk for factor for lead poisonning(5)
home built before 1978 under renovation with peeling paint Pica sibling with lead poisonning low socio economic status immigrant or international adoptee
screening for lead poisonning
capillary blood specimens
confirmatory test for lead poisonning when lead level > ou egal a 5 microgram/dl
vcenous lead
venous lead 2-44 Micro/dl (mild)next step(2)
nothing
repeat in < 1 month
venous lead 45-69Micro/dl(moderate) next step
use meso 2,3 dimercaptosuccinic acid(DMSA)
venous lead > ou egal a 70 Micro/dl(moderate) next step(2)
use meso 2,3 dimercaptosuccinic acid(DMSA)
plus
calcium dodium edetate(EDTA)
action of iron pills
disruption of basic cell process
action of deferoxamine(2)
binds ferric iron
allowing urinary excretion
cause of hypervolemic hypernatremia
renal losses
extrarenal looses
renal losses in hypervolemic hypernatremia(2)
diuretic use
glycosuria
extrarenal losses cause of hypovolemic hypernatremia(2)
GI upset
excessive sweating
rx of hypovolemic hypernatremia
nacl 0,9 %
cause of hypervolemic hypernatremia(2)
exogenous sodium intake mineralocorticoid excess(hyperaldosteronism)
patient with vomiting caused by pyloric stenosis metabolic disturbance(5)
Hco3increased cl decreased K+ decreased Paco2 increased PH increased
metabolic problem in pyloric stenosis induced vomiting
hypochloremic hypokaliemic metabolic alkalosis
complication of supracondylar fracture in kid
compartment syndrome
clue for compartment syndrome
severe pain
pallor
paresthesia
late finding in compartment syndrome(2)
pulselessnes
paralysis
