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Med > Pediatrics 3 > Flashcards

Pediatrics 3 Flashcards

1
Q

Peak age of Infectious mononucleosis

A

15-19 yr

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2
Q

EBV transmission

A

Infected saliva

Sexual

Incubation: 1-2 mo

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3
Q

Sx of Infectious mononucleosis

A

Infants/young children:
Often asymptomatic or mild

Older children and adolescents:
Malaise, fatigue, fever, sore throat, abd pain (LUQ)
Periorbital edema
Any -itis

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4
Q

Triad of IM

A

Fever

Generalized LAP

Pharyngitis/tonsillitis (exudative)

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5
Q

IM Dx

A

Monospot test:
Sensitivity increases with age
Tests heterophil ab
False positive in: HIV, SLE, Lymphoma, rubella, parvovirus

EBV titres

CBC, diff, blood smear

Throat culture to R/O streptococcal pharyngitis

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6
Q

Mx of IM

A 
Supportive:
Adequate rest
Hydration
Saline gargles
Analgesics

All pts should avoid contact sports for 6-8 wk

If airway obstruction:
Admit
CS

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7
Q

Neurologic complication of IM

A

Guillain-Barré

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8
Q

Etiology of infectious pharyngitis

A

80% viral

20% bacterial:
Mainly GAS
M. Pneumoniae
N. Gonorrhea

Fungal: candida

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9
Q

GAS pharyngitis is uncommon in age:

A

<3 yr
Peak: 5-12 yr

Late winter, early spring

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10
Q

If suspected GAS pharyngitis, next step?

A

Rapid streptococcal Ag test

If negative:
Throat culture

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11
Q

Mx of streptococcal pharyngitis

A 
Penicillin V 
Or
Amoxicillin
Or
Erythromycin

Given within 9 d of Sx

x 10 d

Hydration
Acetaminophen

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12
Q

Indication of tonsillectomy for GAS pharyngitis

A

If proven recurrent strep pharyngitis

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13
Q

Role of antibiotic therapy and prevention of PSGN or rheumatic fever

A

Prevents rheumatic fever but not PSGN

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14
Q

PANDAS is a complication of

A

Pediatric autoimmune neuropsychiatric disorder associated with group A streptococci

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15
Q

When and where does the rash of scarlet fever start

A

24-48 h after pharyngitis

Starts in folds

Within 24 h, sandpaper rash begins to generalize

No pain, No pruritus

Blanchable

Fades after 3-4 d

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16
Q

Tx if scarlet fever

A

Penicillin
Amoxicillin
Erythromycin

x10 d

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17
Q

Peak incidence of rheumatic fever

A

5-15 y

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18
Q

Criteria for diagnosis of rheumatic fever

A

Jones Criteria

2 major
Or
1 major + 2 minor + evidence of preceding strep infection

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19
Q

Tx of RF

A

Acute course:
Penicillin/erythromycin x 10 d
+ prednisone if severe carditis

Secondary prophylaxis:
Daily penicillin or erythromycin

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20
Q

PSGN peak age

A

4-8 yr

M> F

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21
Q

How long after strep pharyngitis does PSGN develop?

A

1-3 wk

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22
Q

Dx of PSGN

A

U/A
ASOT/anti-DNAseB
Low C3

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23
Q

Mx of PSGN

A

If symptomatic:

If HTN/edema:
Loop diuretics, Fluid/Na restriction

+/- dialysis

If evidence of persistent infection:
Penicillin, erythromycin

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24
Q

Peak age of meningitis in children

A

6-12 mo

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25
Q

Meningitis risk factors

A

Unvaccinated

Immunocompromised

Recent or current infections

Neuroanatomical defects/surgery/cochlear implant/dermal sinus, recent trauma

Daycare

Household contact

Recent travel

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26
Q

Inv for meningitis

A 
CBC, diff
Lytes
BUN, Cr
Glucose,
Blood C&amp;S
LP(gram stain, C&amp;S, WBC, diff, RBC, glucose, protein, acid fast if suspect TB, PCR esp if treated with AB)

Urinalysis, S/C

Gram stain/culture of petechial/purpuric lesions

HSV/enterovirus PCR

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27
Q

CSF WBC count in normal newborn/infant

A

Infant: 0-6 (no PMN)

Newborn 0-30 (2-3 PMNs)

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28
Q

CSF WBC count in meningitis

A

Bacterial:
>1000, >50% PMN

Viral:
100-500, <40% PMN

HSV:
10-1000, <50% PMN

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29
Q

CSF Glucose in meningitis

A

Bacterial:
< 1.66

Viral/HSV > 1.66

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30
Q

CSF protein in meningitis

A

Bacterial:
> 1

Viral:
0.5-1

HSV:
> 0.75

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31
Q

CSF RBC in meningitis

A

Bacterial:
0-10

Viral:
0-2

HSV:
10-50

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32
Q

Mx of meningitis

A 
Supportive:
Normal BP
Mx ICP rise
Fluid
Lytes
Acid-base
Glucose
Coagulopathies

Start AB if suspect bacterial meningitis

Isolation

Mx SAIDH (fluid restriction)

Hearing test

Reportable

Prophylactic AB for close contacts (HI, N. Meningitis)

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33
Q

How long should isolation continue for meningitis

A

Until 24 h after culture-sensitive AB therapy

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34
Q

Opistotonos seen in

A

Meningitus

Teranus

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35
Q

Empiric AB for meningitis in newborn

A

Ampicillin + cefotaxime

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36
Q

Empiric AB for meningitis in 1-3 mo infants

A

Vanco + cefotaxime + ampicillin if immunocompromised

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37
Q

Empiric AB for meningitis in infant > 3 mo

A

Ceftriaxone + vanco

If penicillin allergy:
Vanco + rifampin

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38
Q

Mx of viral meningitis

A

Supportive

Acyclovir for HSV

Report to public health

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39
Q

Meningitis with which organism causes higher mortality rates

A

Pneumococcus > N. Meningitis > HiB

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40
Q

Age of mumps

A

5-10 yr

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41
Q

Mumps transmission

A

Respiratory droplets

Direct contact fomites

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42
Q

Mumps communicability

A

7 d before to 5 d after parotitis

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43
Q

Dx of mumps

A

Clinical

But also:
IgM 
PCR (oral secretions, blood, CSF)
Viral culture
CBC
Amylase
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44
Q

Mx of mumps

A 
Analgesics
Antipyretics
Warm/cold pack to parotid
Admit if meningitis/pancreatitis...
Droplet precaution

Px: vaccine

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45
Q

Transmission of pertuss

A

Respiratory deoplermts

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46
Q

Communicability of pertussis

A

Mostly during catarrhal phase

But may remain contagious for weeks

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47
Q

Post-tussive apnea

A

In infents < 6 mo in paroxysmal phase of pertussis

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48
Q

Age of greatest incidence of pertussis

A

<1 yr

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49
Q

Duration of pertussis phases

A

Catarrhal: 1-7 d

Paroxysmal: 4-6 wk

Convalescenct: 1-2 wk (non-contagious)

Cough may last up to 6 mo

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50
Q

Inv for pertussis

A

Gold: culture of NP specimen

PCR to detect Ag

CBC (lymphocytosis)

Serology

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51
Q

Mx of pertussis

A

Admit if: apnea, cyanosis : O2

Supportive care

AB if:
B. Pertussis isolated,
Or
Sx < 21 d

AB: macrolide

Droplet isolation

Reportable

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52
Q

Duration of droplet isolation for pertussis

A

Until 5 d of treatment

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53
Q

Indications for CT for sinusitis

A

Surgery

Complications

Persistent/recurrent disease

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54
Q

Indication of AB therapy for sinusitis

A

All children

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55
Q

UTI in boys and girls

A

< 4-6 wk old, more prevalent in boys

> 1yr, more prevalent in girls

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56
Q

RFs fir URI

A 
Female
Caucasian
Previous UTI
FHx
VUR
Neurogenic bladder
Obstructive uropathy
Posterior urethral valve
Dysfunctional voiding
Repeated bladder cath
Uncircumcised males
Labial adhesion
Sexually active
Constipation
Toilet training
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57
Q

Inv for UTI

A

Sterile urine specimen
U/A, microscopy, C/S

Dx if: suggestive U/A + > 50,000 CFU/ml in U/C

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58
Q

Bagged urine value for UTI Dx

A

Not useful for Ruling in, but iseful for ruling out UTI

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59
Q

Mx of UTI

A

Admit if indicated

Supportive care:
Hydration
Pain control

AB:
Neonates: IV ampicillin and gentamycin

Infants and older children:
If outpt: oral AB
If inpt: IV ampicillin + genta

x7-10 d

Imaging

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60
Q

Indications for admission of child with UTI

A 
<2 mo
Urosepsis
Persistent vomiting
Inability to tolerate oral medications
Moderate to severe dehydration
Immunocompromised
Complex urologic pathology
Inadequate follow-up
Failure to respond to outpatient therapy
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61
Q

Indications for imaging in UTI

A

U/S for all febrile infants (<2yr) with UTI

VCUG:
Not recommended after 1st episode of febrile UTI
Unless:
Signs suggestive of high-grade VUR:
Hydronephrosis on U/S
Obstructive uropathy on U/S
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62
Q

Definition of SGA

A

2 SD < mean wt for GA
Or
< 10th percentile

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63
Q

Definition of LGA

A

2SD > mean wt for GA
Or
> 90th percentile

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64
Q

Ca, BS, Hb in premature infant?

A

Hypocalcemia
Hypoglycemia
Anemia

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65
Q

Ca, BS, Hb in SGA

A

Hypocalcemia

Hypoglycemia

Polycythemia

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66
Q

Ca, BS, Hb in LGA

A

Hypocalcemia

Hypoglycemia

Polycythemia

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67
Q

Routine neonatal care

A

Ophthalmic erythro oint

Vit K IM

Screening tests:
Metabolic disorders
Blood disorders
Endocrine disorders
Other genetic diseases
Congenital hearing loss

If mother Rh - : send cord blood for BG and direct anti-globulin test

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68
Q

Screening tests for neonates:

A 
Amino acid disorders
Organic acid disorders
Fatty acid oxidation defects
Biotinidase deficiency
Galactosemia 
SCD
Hb-pathies
CAH
Hypothyroidism
CF
SCID
Hearing loss
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69
Q

Neonatal care for neonate with HBsAg + mother

A

HBIg

+ Hep B vaccine series

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70
Q

Neonate with APGAR < 7 at 5 min, next step?

A

Assess APGAR q 5 min until above 7

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71
Q

Steps to take immediately after birth

A

Warm and dry

Put in sniffing position and clear airway

Stimulate: rub lower back, flick soles

Assess breathing and heart rate

NO STIMULATION IF MECONIUM PRESENT ( tracheal suction first)

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72
Q

If neonate HR < 60 in delivery room

A

Epinephrine

IV, ET

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73
Q

If evidence of hypovolemia in neonate

A

Fluid bolus

NS, RL, Blood

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74
Q

Definition of depressed newborne

A

I depressed newborn lacks one or more of that following characteristics:

Pulse > 100
Cries when stimulated
Actively moves all extremities
Good strong cry

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75
Q

Inv for depressed newborn

A

Detailed Hx
CBC, ABG, blood type, glucose
Transillumination of chest
CXR

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76
Q

Periodic breathing in newborn. Definition, significance

A

Periods of rapid respiration alternating with pauses lasting 5 to 10 seconds

Normal

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77
Q

Definition of apnea in neonate:

A

absence of air flow for > 20 s
Or
Less if bradycardia or desaturation

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78
Q

Apnea of prematurity

A

< 34 wk

Resolves by 36 wk

CNS immaturity and obstructive apnea

Dx of exclusion

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79
Q

Mx of newborn apnea

A

Full workup

O2,
ventilation support,
maintain normal blood gases

Tactile stimulation

Correct underlying cause

Methyxanthines (caffeine): for apnea of prematurity (stimulates CNS/diaphragm)

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80
Q

Pathophysiology of neonatal alloimmune thrombocytopenia

A

Mother is negative for HPA, fetus is positive

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81
Q

Sx of neonatal alloimmune thrombocytopenia

A

Petechia, purpura, intracranial bleeding

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82
Q

Dx of neonatal alloimmune thrombocytopenia

A

Maternal and paternal platelet typing

Identification of platelet alloantibodies

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83
Q

Tx of neonatal alloimmune thrombocytopenia

A

IVIg to mother starts in 2nd trimester

+/- steroids

+/- fetal plt transfusion

IVIg to neonate

Transfusion with washed maternal plt or donor HPA negative plt if required

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84
Q

Neonatal AI thrombocytopenia

A

Caused by: antiplatelet Ab from maternal ITP or SLE

Sx less severe than neonatal alloimmune thrombocytopenia

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85
Q

Tx of Neonatal AI thrombocytopenia

A

Steroid to mother for 10-14 d prior to delivery
Or
IVIg to mother before delivery

IVIg to neonate if plt < 60,000

Transfusion of infant with maternal/donor plt only in severe cases

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86
Q

Hemorrhagic diseases of the newborn

A

Vitamin k deficiency

Both PT and PTT increase

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87
Q

RFs for vitamin k deficiency in neonate

A

Poor placenta transfer

Insufficient bacterial colonization of colon

Breastfeeding

Mother taking AED

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88
Q

definition of bronchopulmonary dysplasia (chronic lung disease)

A

O2 requirement for > 28 d
Plus
Persistent need for oxygen/ventilatory support at 36 wk corrected GA

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89
Q

Etilogy of BOD

A

Prolonged intubation/ventilation/O2

Infection

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90
Q

CXR in BPD

A

Decreased lung volumes

Areas of atelectasis

Signs of inflammation

Signs of hyperinflation

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91
Q

Tx for BPD

A

Gradual wean from ventilator

Optimize nutrition

Dexa (decrease inflammation, encourage weaning)

Dexa associated with increased risk of adverse neurodevelopmental outcome

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92
Q

Prognosis of BOD

A

pHTN
Poor growth
Right-sided heart failure

May persist into adulthood:
Airway obstruction
Airway hyperreactivity
Emphysema

Adverse neurodevelopmental outcome

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93
Q

DDx of peripheral cyanosis

A

Transient (typical)
Sepsis
Temperature instability

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94
Q

Causes of central cyanosis

A

Deoxygenated Hb

Or

Abn Hb

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95
Q

DDx of abn Hb causing cyanosis

A

Methemoglobinemia:
Reads higher on pulse oximetry than the true level. Alters absorption of red light

Carboxyhemoglobinemia:
CO-Hb, may not be evident clinically and may not register on pulse oximetry

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96
Q

DDx if deoxyhemoglobin

A 
Respiratory
Cardiovascular
Neurogenic
Hematologic
Sepsis
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97
Q

Mx of cyanosis

A

ABG

Elevated CO2: respiratory causes

Hyperoxia test:
If < 150 (cyanotic CHD, possible PPHN)
If > 150: likely respiratory/non cardiac cause

CXR

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98
Q

Diaphragmatic hernia

A

Often associated with other anomalies

Pulmonary hypoplasia
PPHT

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99
Q

Tx of diaphragmatic hernia

A

DO NOT BAG MASK VENTILATE

Large bore orogastric tube to decompress bowel

Stabilization

Mx pulmonary hypoplasia

Hemodynamic support

Surgery when stable

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100
Q

Hypoglycemia definition

A

Glucose <2.6

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101
Q

Mx of hypoglycemia

A

Identify and monitor infants at risk (pre-feed Glucose check)

Begin oral feed as soon as possible

Ensure regular feeds

If significant/symptomatic hypoglycemia: IV glucose

If persistent or if no predisposing cause:
Sent critical blood work during an episode:
ABG, Ammonia, Betahydroxybutorate, Cortisol, FFA, GH, Insulin, Lactate, Urine dipstick for ketones

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102
Q

Hypoglycemia RFs

A 
Prematurity
SGA
RDS
Maternal HTN
GH/Cortisol/EN deficiency
Insulin excess
HPA axis suppression
FFA oxidation defects
Galactosemia
Sepsis
Hypothermia
Polycytemia
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103
Q

RFs for IVH

A 
Prematurity (<32 wk)
BW < 1500
Need for vigorous resuscitation at birth
Pneumothorax
Ventilation in preterm
Hemodynamic instability
RDS
Coagulopathy
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104
Q

IVH screening

A

Routine head U/S of all preterm infants < 32wk or < 1500

MRI for term, extremely LBW infant

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105
Q

Mx of IVH

A

Supportive:
Maintain blood volume
Maintain acid-base status
Avoid BP fluctuation or CBF fluctuation

F/U: serial imaging

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106
Q

At which bil level would jaundice be visible?

A

85-120

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107
Q

Factors increasing jaundice severity and duration

A 
Prematurity
Acidosis
Hypoalbuminemia
Dehydration
Hemolysis
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108
Q

Disorders causing both conjugated and unconjugated hyperbilirubinemia

A

Hyperthyroidism

Sepsis

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109
Q

Physiologic jaundice in term infant

A

Onset: 3-4d

Resolution by 10 d of life

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110
Q

Physiology Jaundice in preterm infants

A

Higher pick

Longer duration

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111
Q

Breast-feeding jaundice

A

Physiologic

Due to dehydration

Common

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112
Q

Breast milk jaundice

A

Physiologic

Onset: 7d of life

Peak: 2-3 wk

Resolution:
By 6 wk

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113
Q

RFs for jaundice

A 
Asian
Native american
GDM
ABO/Rh incompatibility
BF
FHx 
Previous child required phototherapy
Birth trauma
Prematurity
Difficulty establishing breast-feeding
Infection
Genetic factors
Polycythemia
Drugs
TPN
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114
Q

Causes of conjugated hyperbil

A 
Sepsis
Hep B
TORCH
Galactosemia
Tyrosinemia
a-1-antitrypsin deficiency
Hypothyroidism
CF
Drugs
TPN
Idiopathic neonatal hepatitis
Biliary/choledochal problems
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115
Q

Jaundice needing evaluation:

A

First 24 h of life (always pathologic)

Conjugated hyperbil (always pathologic)

Rapid rise of unconjugated hyperbil

Excessive hyperbil for age/wt

Persistent beyond 1-2 wk of age

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116
Q

Inv for unconjugated hyperbil

A

Hemolytic w/u:
CBC, Retic, PBS, Blood group (mother/infant), Coombs

If unwell baby:
Septic workup

Also:
G6PD, TSH

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117
Q

Inv for conjugated hyperbil

A 
AST, ALT
PTT,PT
Alb
Ammonia
TSH
TORCH
Septic W/U
Erythrocyte Galactose-1PUT
Metabolic screen
Abd U/S
HIDA
Sweat chloride
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118
Q

Predicting occurrence of severe hyperBil

A

TSB or TCB in all infants between 24-72 hr of life

Results should be ploted on predictive normogram

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119
Q

Tx of HyperBil

A

Continue BF, ensure adequate feeds and hydration

Pump after feeds

Treat underlying

Phototherapy (not UV)

Exchange transfusion

IVIg

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120
Q

Contraindication to phototherapy

A

Conjugated hyoerBil

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121
Q

Indications of exchange transfusion for hyperbil

A

High bil levels

Mostly for:
Hemolytic disease
G6PD deficiency

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122
Q

Indication for IVIg in hyperBil

A

Severe hyperbil, DAT+

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123
Q

Level of bil able tu cause kernicterus

A

340<

Lower if:
Sepsis, meningitis, hemolysis, hypoxia, acidosis, hypothermia, hypoglycemia, prematurity

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124
Q

Sx of kernicterus

A

15% asymptomatic

Early stage:
Lethargy, hypotonia, poor feeding, emesis

Mid stage:
Hypertonia, high-pitched cry, opistotonos, bulging fontanelle, seizures, pulmonary hemorrhage

Late stage:
Hypotonia, delayed motor skills, extrapyramidal abn (choreoathetoid), gaze palsy, mitral regurgitation, SNHL

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125
Q

Biliary atresia presentation

A

After first week of life

Dark urine, pale stool, jaundice

Persists > 2 weeks

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126
Q

Dx of biliary atresia

A

Conjugated hyperBil

Abd U/S

Operative cholangiogram

HIDA (bypass if time is critical)

Liver Bx

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127
Q

Tx of biliary atresia

A

Surgical drainage

Hepato-porto-enterostomy

Liver transplantation required in most cases

Diet enriched with medium-chain TG

Vitamin ADEK

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128
Q

Site of involvement in NEC

A

Terminal ileum and colon

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129
Q

RFs for NEC

A 
Prematurity
Asphyxia
Shock
Hyperosmolar feeds
Enteral feeding with formula
Sepsis

Protective factor: breast milk, early full enteral feeding

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130
Q

Sx of NEC

A

Onset: 2-3 wk of age

Distended abd

Increased gastric aspirate/vomitus with bile staining

Frank/occult blood in stool

Feeding intolerance

Diminished bowel sounds

Signs of bowel perforation: sepsis, shock, peritonitis, DIC

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131
Q

Inv for NEC

A 
AXR
CBC
ABG
Lactate
Blood culture
Lytes
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132
Q

AXR in NEC

A

Pneumonitis intestinalis (intramural air)

Free air

Fixed loops

Ileus

Thickened bowel wall

Portal venous gas

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133
Q

Tx of NEC

A

NPO (7-10d)

Vigorous IV fluid

Decompression with NGT

Supportive therapy

TPN

AB (ampi, genta+metro if risk of perforation x7-10d)

Serial AXR

If perforation: peritoneal drain/surgery

Surgical resection of necrotic bowel/complications

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134
Q

Presentation of Persistent pHTN of the newborn

A

Within 12 h of life

Severe hypoxemia, cyanosis

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135
Q

RFs for PPHTN

A 
Asphyxia
MAS
RDS
Sepsis
Pneumonia
Structural abn

More common in term/post-term infants

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136
Q

Inv for PPHTN

A

Pre- and post-ductal O2 levels

Hyperoxia test

ECG

Echo

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137
Q

Tx of PPHTN

A

Maintain good oxygenation (SaO2 > 95%)

O2 given early and tapered slowly

Minimize stress and metabolic demands

Maintain nl blood gases

Circulatory support

Mechanical ventilation

NO, surfactant

Extracorporeal membrane oxygenation

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138
Q

Tachypnea and tachycardia in newborn

A

RR> 60

HR> 160

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139
Q

Inv for respiratory distress in newborn

A

CXR
ABG
CBC, BG, B/C
ECG

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140
Q

RF for newborn pneumonia

A

Maternal fever

Prolonged/premature ROM

GBS positive mother

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141
Q

RDS RFs

A 
Maternal DM
PTB
Male
LBW
Acidosis
Sepsis
Hypothermia
Second born twin
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142
Q

Onset of RDS

A

First few hours

Worsens iver next 24-48 h

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143
Q

CXR of RDS

A

Homogenous infiltrates

Airbronchogram

Decreased lung volumes

May resemble pneumonia

Without lungs if severe

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144
Q

Prevention of RDS

A

Prenatal CS if risk of PTB <34 wk

Monitor L/S with AC (> 2: lung maturity)

145
Q

Tx of RDS

A

Resuscitation

O2

Vent

Surfactant

146
Q

TTN gestational age

A

Term, late preterm

147
Q

RFs fir TTN

A

GDM

Maternal asthma

Male

Macrosomia (> 4500)

Elective cesarian

Short labor

Late PTB

148
Q

Onset of Sx in TTN

A

First few hours of life

NO CYANOSIS

Retraction, nasal flaring, grunting

149
Q

CXR in TTN

A

Perihilar infiltrates

Wet silhouette

Fluid in fissures

150
Q

Prevention from TTN

A

Avoid elective Cesarian delivery, esp before 38 week GA

151
Q

Tx of TTN

A

O2 if hypoxic

Vent

If too tachypneic to feed orally:
IV fluid
NGT feeding

152
Q

In TTN when is recovery expected?

A

In 24-72 h

153
Q

Meconium aspiration syndrome GA

A

Term, post-term

154
Q

RFs for MAS

A

Meconium stained AF

Post-term delivery

155
Q

Onset of MAS Sx

A

Within hours of life

156
Q

Barrel chest in neonate

A

Diaphragmatic hernia

MAS

157
Q

CXR in MAS

A

Hyperinflation

Patchy atelectasis

Patchy/coarse infiltrates

Pneumothorax

158
Q

Prevention

A

If depressed at birth:
Intubate and suction below vocal cords

Avoidance of factors associated with in utero meconium passage

159
Q

Tx of MAS

A

Resuscitate

Vent

O2

Surfavtant

Inhaled NO

ECMO if PPHN

160
Q

Early onset sepsis in neonate, Definition, transmission

A

Within 72 h of birth

Vertical

161
Q

Early onset sepsis in neonate, RFs

A

Maternal UTI, GBS+, previous child with GBS infection

Maternal fever/leukocytosis/chorioamnionitis

Prolonged ROM >18 h

PTB

162
Q

Pathogens of Early onset sepsis in neonate,

A

E.Coli, GBS, Listeria

163
Q

Most common infection in early onset neonatal sepsis

A

Pneumonia

164
Q

Late onset neonatal sepsis definition

A

Onset at: 72h-28d

Acquired after birth

165
Q

Most common pathogen in Late onset neonatal sepsis

A

Coagulase negative staph

Others:
GBS, anaerobes, E.Coli, Klebsiella

166
Q

Most specific lab in sepsis?

A

WBC < 5

167
Q

Degree of hypovolemia based on age

A

<2 yr:
Mild: 5% (of preloss body wt)
Mod: 10%
Sev: 15%

> 2yr:
Mild: 3%
Mod: 6%
Sev: 9%

168
Q

Pulse changes in different levels of hypovolemia

A

Mild: Nl, full

Mod: rapid

Sev: rapid, weak

169
Q

BP changes in different levels of hypovolemia

A

Mild: Nl

Mod: Nl-Decreased

Sev: decreased, shock (very late finding)

170
Q

U/O changes in different levels of hypovolemia

A

Mild: decreased

Mod: markedly decreased

Sev: anuria

171
Q

Oral mucosa changes in different levels of hypovolemia

A

Mild: slightly dry

Mod: dry

Sev: parched

172
Q

Anterior fontanelle changes in different levels of hypovolemia

A

Mild: normal

Mod: sunken

Sev: markedly sunken

173
Q

Eyes changes in different levels of hypovolemia

A

Mild: normal

Mod: sunken

Sev: markedly sunken

174
Q

Skin turgor changes in different levels of hypovolemia

A

Mild: nl

Mod: decreased

Sev: tenting

175
Q

Capillary refill changes in different levels of hypovolemia

A

Mild: Nl (<3s)

Mod: Nl-increased

Sev: increased (>3 s)

176
Q

Inv for hypovolemia

A 
If mod-sev:
Urinalysis
Lytes
BUN, Cr
ABG
177
Q

Indications of IV rehydration

A

Severe dehydration

Inability to tolerate ORT:
Vomiting
Altered mental status
Ileus
Monosaccharide malabsorption
Inability to provide ORT
Failure of ORT in providing adequate rehydration
178
Q

Tx of mild dehydration

A

ORT 50 ml/kg over 4 h

+ ORT for ongoing loss

+ age appropriate diet after rehydration

179
Q

Tx of moderate dehydration

A

ORT 100 ml/kg over 4 h

+ ORT for ongoing loss

+ age appropriate diet after rehydration

180
Q

Tx of severe dehydration

A

IV NS or RL, 20-40 ml/ kg bolus over 1 h

Repeat if necessary

Continue with ORT when stable

Replace ongoing loss

Age-appropriate diet after rehydration

181
Q

Calculation of maintenance fluid

A

Per day: 100:50:20

Or

Per hour: 4:2:1

182
Q

Common maintenance fluids for children

A

Should contain dextrose

Newborn:
D10W

First month of life:
D5W/0.45 NS + KCl 20mEq/L(if voiding well)

Children: 
D5W/NS + KCl 20
Or 
D5W/0.45NS + KCl 20
Bolus NS for dehydration
183
Q

Na adjustment rate

A

12 mmol/L/d

184
Q

When to monitor lytes daily in a child being treated for dehydration?

A

If > 50 % of daily fluid intake is via IV

185
Q

Most common cause of ARF in children

A

HUS

186
Q

Inv for HUS

A 
CBC
PBS
BUN, Cr
Lytes
U/A
S/C, verotoxin/shiga toxin assay
187
Q

Mx of HUS

A 
Mainly supportive:
Nutrition
Ventilation
If symptomatic anemia: blood transfusion
Dialysis if indicated
188
Q

Hematuria definition

A

RBC > 5

189
Q

Most common cause of GN in children

A

PSGN

190
Q

GNs with decreased C3

A

PSGN
MPGN

SLE
Bacterial endocarditis
Abscess, Shunt nephritis
Cryoglobulinemia

191
Q

GN with normal C3

A

IgA nephropathy
RPGN
Anti-GBM disease

HSP
PAN
GPA
Goodposture

192
Q

Inv for GN

A

Urine R&M

First morning urine protein/creatinine ratio (nl < 200 mg/mmol)

BUN, Cr
Lytes
ABG
CBC
Alb
C3/C4 
ASOT/anti-hyaluronidase/anti-SK/anti-NAD/anti-DNAse B)
ANA 
Anti-DNA
ANCA
IgA level
Anti-GBM
Renal Bx
193
Q

Indications for renal Bx in GN

A

Acute renal failure

No evidence of strep infection

Normal C3,C4

194
Q

Mx of GN

A

Treat underlying

Supportive:
Dialysis
Proper hydration

HTN:
Water/salt restriction (watch renal function)

Chronic persistent HTN:
ACEI, ARB

Edema:
Salt/fluid restriction
+/- Diuretics

CS if indicated:
IgA nephropathy
Lupus nephritis
…

195
Q

Most common cause of nephrotic syndrome

A

Primary

196
Q

Nephrotic definition

A

Proteinuria > 50 mg/kg/d

197
Q

Inv for nephrotic

A

U/A: 3-4+ proteinuria
Urine microscopy
First morning urine alb/Cr ratio

Alb
Lipid profile
Lytes
BUN, Cr
Coagulation profile
CBC
PBS
C3/C4
ANA
Hep B/C
ASOT
HIV
Renal Bx
198
Q

Indications of renal Bx in nephrotic

A

HTN

Gross hematuria

Decreased renal function

Low C3/C4

No response to CS after 4 wk

Frequent relapse (>2/6mo)

Presentation before first year of life

Presentation after 12 yr

199
Q

PTT in nephrotic

A

Decreased

200
Q

Mx of nephrotic

A

Varicella status should be known

Oral prednisone 2mg/kg/d up to 12 wk

If resistant:
Cytotoxic agents
Immunomodulators
High-dose CS pulse

201
Q

Tx of nephrotic edema

A

Salt/fluid restriction
+/- diuretics

If anasarca:
Furosemide + alb

202
Q

Tx of nephrotic hyperlipidemia

A

Resolves with remission

Limit fat intake

Statin if persistently nephrotic

203
Q

Abn BP

A

If intravascular depletion: fluid

If persistent HTN: ACEI, ARB

204
Q

Diet in nephrotic

A

No added salt

Monitor caloric intake

Ca, Vit D if on CS

205
Q

Vaccines for nephrotic

A

Pneumococcal: at diagnosis

Varicella: after remission

206
Q

Child with nephrotic, on CS, exposed to varicella

A

VZIG + acyclovir

207
Q

Mx of hypercoagulability state in child with nephrotic

A

Mobilization

Avoid intravascular volume depletion and hemoconcentration

Prompt sepsis Tx

Heparin if thrombi

208
Q

Relapse rate in nephrotic

A

2/3

209
Q

Definition of HTN

A

sBP or dBP > 95th percentile on 3 or more occasions

210
Q

Definition of preHTN

A

sBP or dBP > 90th percentile

Or > 120/80 at any age

211
Q

Primary vs secondary HTN

A

Primary: 90% of adolescent (> 10yr) cases (esp if obese, positive FHx, mild)

Secondary: majority of childhood cases

212
Q

RFs for primary HTN

A 
Male
FHx
Obesity
OSA
African American
Prematurity/LBW
213
Q

RFs for secondary HTN

A

Hx of renal
Abd trauma
FHx of AI dis
Umbilical artery cath

214
Q

Signs of secondary hypertentiin

A 
Edema
Abd bruit
Differential 4 limb BP/ diminished femoral pulses
Abd mass
Goiter
Skin changes
Ambiguous genitalia
215
Q

Inv for HTN

A 
Urine dipstick
Urine catecholamines
Lytes
BUN, Cr
Renin, aldosterone levels

Echo

Abd U/S

Renal radionuclide scarring

Other tests based on findings

216
Q

Mx of HTN

A

Tx underlying

LSM:
Wt reduction
Exercise
Salt restriction
Smoking cessation

Thiazides

Mx of EOD

Cosider referral to specialist

217
Q

Mx of hypertensive emergencies

A

Hydralazine
Labetalol
Sodium nitroprusside

218
Q

Pediatric BP calculation

A

sBP: Age x 2 + 90

dBP: 2/3 x sBP

219
Q

Inv for epilepsy

A

CBC,diff
Na, K, Cl, Mg, Ca,
BG

Toxicology

EEG

CT/MRI (if FND, not returned to baseline several hours after seizures)

LP (if first-time, non-febrile)

220
Q

Cardiac disorders often misdiagnosed as seizures

A

Hypertrophic CMP

Long QT syndrome

221
Q

Infantile spasm

A

Brief flex/ext

10-30 sec

In clusters

Developmental delay

Onset: 4-8 mo

EEG: hypsarrhythmia

222
Q

Tx of infantile spasm

A

ACTH

Vigabatrin

BDZ

223
Q

Prognosis of infantile spasm

A

20% idiopathic with good Tx response

80% metabolic/encephalopathic/neurocutaneous/developmental abn reasons with poor response to Tx

224
Q

Lennox-Gastaut triad

A

Multiple seizure types

Diffuse cognitive dysfunction

Slow generalized spikes and slow wave EEG

Other features:
Onset: 3-5 y

Underlying encephalopathy/brain malformation

225
Q

Tx of Lennox-Gastaut

A

Valp

BDZ

Ketogenic diet

226
Q

Juvenile myoclonic epilepsy

A

Onset: 12-16 y

AD

Esp in morning

Frequently presents as GTC

EEG: 3.5-6 Hz, irregular spike and wave, increased with photic stimulation

227
Q

Mx of juvenile myoclonic seizure

A

Lifetime Valp

228
Q

Childhood absence seizure

A

<30 sec

No post-ictal

Onset: 6-7 yr

Strong genetic predisposition

F>M

EEG: 3 Hz spike and wave

229
Q

Mx of absent seizures

A

Valp

Ethosuximide

230
Q

Benign focal epilepsy of childhood with Rolandic/Centrotemporal spikes

A

Focal motor (tongue, mouth, face, upper ext)

Usually in sleep-wake transition state

Conscious but aphasic post-ictally

Onset: 5-10 y

EEG: spikes in centrotemporal area, normal background

231
Q

Prognosis of Rolandic seizure

A

Spontaneous remission in adolescence without sequla

232
Q

Prognosis of absence seizure

A

Spontaneously resolves or becomes generalized

233
Q

Mx of rolandic seizures

A

If infrequent: none

If frequent: carba

234
Q

Mx of seizures

A

Education (precautions: buddy system, shower instead of bath…)

Indication for meds:
> 2 unprovoked, afebrile seizures within 6-12 mo

Start with 1 drug and increase dose

Switch over to another if not controlled

Add a second if not controlled

235
Q

When to D/C AED?

A

If > 2 yr seizure free, taper over 4-6 mo

236
Q

Indication for ketogenic diet in seizure control

A

If no response to polytherapy

Or

Who do not wish to take meds

VALP IS CONTRAINDICATED IN CONJUNCTION WITH KETOGENIC DIET: increased hepatotixicity

237
Q

Age of febrile seizure

A

6mo - 6 yr

238
Q

Features of febrile seizures

A

M> F

Associated illness/fever

FHx

No Hx of afebrile srizure

No evidence of CNS infection/inglammation

239
Q

Typical febrile seizures?

A

Duration < 15 min

GTC

No recurrence in 24 h

No neurological impairment/developmental delay before/after seizures

240
Q

Atypical/complex febrile seizures?

A

Duration > 15 min

Focal onset or focal features

> 1 seizures/24 h

Previous neurological impairment or neurological deficit after seizure

241
Q

W/U for febrile seizure

A

If typical febrile seizures, only determine source of fever

Septic W/U:
Including LP: Strongly consider if child < 12 mo, Consider if 12-18 mo, only if meningeal signs in child > 18 mo

EEG/CT/MRI: only if atypical febrile seizure, or abn neurologic findings

242
Q

Mx of febrile seizures

A

Counsel and reassure

Antipyretics

Fluids

If high risk of recurrence or prolonged seizure: have rectal or sublingual lorazepam at home

Treat underlying cause of fever

243
Q

Prognosis of febrile seizures

A

No brain damage

Very small risk of developing epilepsy

33% chance of recurrence

Px with AED NOT RECOMMENDED

244
Q

Seizures with positive family Hx

A

Juvenile myoclobic epilepsy (AD)

Febrile seizures

Absence

245
Q

Headache red flags

A

First and worst headache of their life

Sudden onset

FND

Constitutional Sx

Worse in morning

Worse with bending over, coughing, straining

Change in LOC

Sudden mood change

Pain wakes pt

Fatigue

Affecting school attendance

246
Q

Inv for headache

A

If red flags: CT, MRI

247
Q

Postural movements showing hypotonia

A

Traction response

Axillary suspension

Ventral suspention

248
Q

Inv for hypotonia

A 
Lytes
ABG
Blood glucose
CK
Serum/urine investigations for metabolic etiologies
MRI/MRA if indicated
EMG, muscle Bx/NCS
Chromosomal analysis, genetic testing, 
Metabolic testing
Neuromuscular testing
249
Q

Cerebral palsy

A

Non progressive

Central motor impairment

Insult to/anomaly of immature CNS

10% intrapartum asphyxia

10% post natal insult

Associated with LBW

No etiology in 1/3

250
Q

Sx of CP

A

Delay in motor milestone

Developmental delay

Learning disability

Visual/hearing impairment

Seizure

Microcephaly

Uncoordinated swallow (aspiration)

251
Q

Inv for CP

A

Metabolic screen

Chromosome studies

Serology

Neuroimaging

EMG, EEG

Ophthalmology assessment

Audiology

252
Q

Mx of CP

A

Multidisciplinary

Orthopedic

Symptomatic

253
Q

Signs of URT disease, above thoracic inlet

A

Inspiratory stridor

Suprasternal retraction

254
Q

Croup location

A

Subglottic laryngitis

255
Q

Croup age

A

<6 yr

Peak 7-36 mo

256
Q

Croup virus

A

Mostly Parainfluenza

257
Q

Inv for croup

A

Clinical Dx

If atypical presentation: CXR: steeple sign

258
Q

Emergency in croup

A

Stridor at rest

259
Q

Tx of croup

A

Dexa, PO 1 dose

Racemic epinephrine: nebulized, 1-3 dose, q 1-3 h

If unresponsive: intubate

260
Q

The most common pathogen of tracheitis

A

S. Aureus

261
Q

Dx of bacterial tracheitis

A

Clinical

Definitive Dx: endoscopy

262
Q

Tx of bacterial traceitis

A

Intubation

IV AB

263
Q

Most common pathogen of epiglottitis

A

H. Influenza

264
Q

Age of bacterial traceitis

A

All ages

265
Q

Age of epiglotitis

A

2-6 y

266
Q

Tripod position

A

Epiglotitis

267
Q

Inv for epiglotitis

A

Clinical

AVOID EXAMINING THROAT

268
Q

Tx of epiglotitis

A

Intubation

AB

269
Q

Sign of airway obstruction below thoracic outlet

A

More expiratory sounds

Wheezing

270
Q

DDx of wheezing

A

Asthma:
Recurrent wheezing
> 6 y
Identifiable trigger

Bronchiolitis:
First episode of wheezing
Usually <1 y

Recurrent aspiration

Pneumonia

Foreign body:
Acute
Unilateral

CF:
Prolonged
Unresponsive to therapy

BPD
CHF
Mediastinal mass
Bronchiolitis obliterans
Tracheobronchial anomalies
271
Q

Most common age for pneumonia

A

< 1y

272
Q

Pneumonia pathogens

A

<5 yr : viral

273
Q

CXR of viral pneumonua

A

Diffuse streaky infiltrates bilaterally

274
Q

CXR of bacterial pneumonia

A

Lobar consolidation

Pleural effusion

275
Q

Mx of pneumonia

A

Hydration

Antipyretics

Humidified O2

276
Q

Peak incidence of bronchiolitis

A

At 6 mo

277
Q

Bronchiolitis and risk if asthms

A

Increases incidence of asthma

278
Q

Most common etiology of bronchiolitis

A

RSV

279
Q

Sx of bronchiolitis

A

Prodrome of URTI
Wheezing, crackles, respiratory distress

Peak: at 3-4 d

280
Q

Inv for bronchiolitis

A

CXR if:
Severe
Poor responsive to treatment
Chronic

NP swab: IF for viral Ag

WBC

281
Q

CXR of bronchiolitis

A

Air trapping

Peribronchial thickening

Atelectasis

Increased linear markings

282
Q

Tx of bronchiolitis

A

Self limiting

Mild-mod:
Supportive:
PO/IV hydration
Antipyretic
Regular/humidified high-flow O2

Sev:
Supportive
+/- intubation/ventilation
+/- ribavirin

283
Q

Indication for ribavirin in bronchiolitis

A

BPD

CHD

Congenital lung disease

ImmDef

284
Q

Px against RSV

A

Monthly palivizumab (RSV-Ig) for high-risk group:

Infants born before 29 wk GA

Infant born before 32 wk with chronic lung disease of maturity

Infant with hemodynamically significant heart disease

Children with pulmonary abn

Neuromuscular disease (impaired ability to clear secretions)

Children < 2 yr who are profoundly ImComp

Recommended for the 1st year of life. Up to 5 monthly doses. (Nov-Apr)

285
Q

Tx with no benefit in bronchiolitis

A

CS
Bronchodilators
Ipratropium bromide

286
Q

Indications for hospitalization of bronchiolitis

A

O2 sat < 92%

Persistent resting tachypnea (>60) and retraction after several salbutamol masks

PMHx if: chronic long disease, hemodynamically significant cardiac disease, neuromuscular problem, immunocompromised

<6mo unless extremely mild

Significant feeding problem

Social problem

287
Q

Common causes of pneumonia in neonates

A

Viral: CMV, HSV

Bacterial: GBS, E.Coli, Listeria

288
Q

Tx of pneumonia in neonates

A

Ampicillin + genta/tobra

+ erythro if suspect chlamydia

289
Q

Common causes of pneumonia in 1-3 mo

A

S. Aureus
H. Influenza
S. Pneumonia
B. Pertussis

Viral: CMV, RSV

290
Q

Pneumonia Tx in 1-3 mo

A

Cefuroxime/ampicillin

+/- erythromycin or clarythro

291
Q

Common causes of pneumonia in 3mo-5yr

A

S. Pneumoniae
S. Aureus
H. Influenza
GAS

Viral: RSV, adeno, inf

292
Q

Tx of pneumonia in 3mo-5y

A 
Amoxi
Or
Ampi
Or
Cefuroxime
293
Q

Common causes of pneumonia in >5y

A

S. Pneumonia
H. Inf
S. Aureus

Viral: influenza, varicella

294
Q

Tx of pneumonia in > 5y

A

Erythromycin
Clarythro
Ampi
Cefuroxime

295
Q

Acute asthma Mx

A

O2 (keep O2sat > 94%)

Fluid if dehydrated

Salbutamol q20 min

Ipratropium bromide if severe q20 min

Steroid x 5d PO (IV if severe)

296
Q

Chronic asthma Mx (LSM)

A

Education

Emotional support

Avoid allergens or irritants

Develop action plan

Exercise program

Monitoring with peak flow meter

PFT for > 6 yr

297
Q

Chronic asthma meds:

A

Reliever therapy: SABA

First line controller therapy: low dose of daily ICS

Second line controller therapy:
<12 yr: mod dose of ICS
>12 yr: add Leukotriene receptor antagonist Or LABA

If no response to 1st and 2nd line Tx:
Injection
Immunotherapy

298
Q

SABA dosage in acute Mx of asthma

A

<20 kg: 5 puff q 20 min x 1 hr

> 20 kg: 10 puff q 20 min x 1 hr

299
Q

Ipratropium bromide dosage in acute Mx of asthma

A

<20 kg: 3 puff

> 20 kg: 6 puff

q 20 min

300
Q

Indications for hospitalization of asthma

A

Ongoing need for supplemental O2

Persistently increased work of breathing

B2-agonist needed > q4h after 4-8 h of conventional therapy

Pt deteriorates while on systemic CS

301
Q

Acute asthma attack discharge

A

If pt asymptomatic for 2-4 h after last dose

302
Q

Adequate control of asthma?

A

Daytime symptoms < 4 d/wk

Night time symptoms < 1 n/wk

Normal physical activity

Mild and infrequent exacerbations

No work/school absenteeism

Need for B-agonist < 4 doses/wk

FEV1 or PEF > 90% of personal best

PEF diurnal variation < 10-15%

303
Q

Antenatal bowel perforation

A

CF

304
Q

Microorganisms causing recurrent chest infection in CF

A

S. Aureus
P.aeroginosa
H. Influenza

305
Q

Inv for CF

A

Sweat chloride test x2 (abn: >60 mEq/L)

3d fecal fat collection

Genetic testing if sweat chloride test was equivocal

Sputum S/C

CXR

306
Q

False negative sweat chloride test

A

Technical problem

Malnutrition

Skin edema

Mineralocorticoids

307
Q

False positive sweet chloride test

A

Malnutrition

Atopic dermatitis

Hypothyroidism

Hypopara

Glycogen storage diseases

Adrenal insufficiency

G6PD

Kleinfelter Sx

Technical issues

Autonomic dysfunction

Familial cholestasis syndrome

308
Q

Mx of CF

A

High calorie diet

Pancreatic enzymes

Fat soluble vitamins supplementation

Chest disease:
Chest physio
Postural drainage
Exercise
Bronchodilators
Aerosolized DNAase
Inhaled hypertonic saline
AB (depending on sputum C&amp;S)
Lung transplantation

Genetic counseling

309
Q

Inv for rheumatologic diseases

A 
CBC, diff
Blood smear
ESR, CRP
Xray
ANA
RF
B/C
Viral/bacterial serology
CK
PTT
SCD screening
Igs
Complement
U/A
Synovial fluid (cell count, gram stain, culture) 
TB test
Imaging
BMA
Slit lamp exam
310
Q

Growing pain age

A

2-12 yr

M=F

Dx of exclusion

311
Q

Characteristics of growing pain

A

Intermittent

Non-articular

Normal PEx

Pain at night

Often bilateral

Calf, shin, thigh

Short-lived

Relieved by heat, massage, mild analgesics

Asymptomatic during day

Well

No functional limitation

Possible FHx

312
Q

Mx of growing pain

A

No lab if typical presentation

Supportive

Reassurance

313
Q

Red flags for limb pain

A

Fever

Pinpoint pain/tenderness

Pain out of proportion to degree of inflammation

Night pain

Wt loss

Erythema

314
Q

Age of transient synovitis of the hip

A

3-10 yr

M> F

Rt> Lt

315
Q

Sx of transient synovitis of hip

A

Afebrile/low fever. Not toxic

Pain in hip, knee (referral)

Painful limp

Full ROM

Pain not disabling

Gradually worsens over few days

Can be sudden

Resolves over 7-10

316
Q

Inv for transient synovitis

A

WBC
ESR, CRP

Joint U/S (to see effusion)

If suspicious for septic arthritis: aspirate joint

If suspicious for osteomyelitis/periarticular pyomyositis: MRI

Dx of exclusion

317
Q

Tx of transient synovitis of hip

A

Symptomatic

Anti-inflammatory meds

Usually resolves within 24-48 h

318
Q

Complication of transient synovitis of hip

A

Legg-calve-perthes

319
Q

Septic arthritis pathogen in neonates

A

GBS, GNB, S. Aureus

320
Q

Septic arthritis pathogen in 1-3mo

A 
Strep
Staph
H. Inf
GBS
GNB
321
Q

Septic arthritis pathogen in child

A

S. Aureus

S. Pneumoniae

GAS

322
Q

Septic arthritis pathogen in adolescents

A

S. Aureus

S. Pneumoniae

GAS

N. Gonorrhea

323
Q

Septic arthritis pathogen in SCD

A

S. Aureus
S. Pneumoniae
GAS
Salmonella

324
Q

Tx of septic arthritis in neonate

A

Cloxa + genta

Or

Cloxa + cefotaxime

325
Q

Tx of septic arthritis in 1-3mo

A

Cloxacillin + cefotaxime/cefuroxime

326
Q

Tx of septic arthritis in child

A

Cefazolin OR cloxa OR clinda

327
Q

Tx of septic arthritis in adolescent

A

Ceftriaxone/cefixime + azithro

328
Q

Tx of septic arthritis in SCD

A

Cefotaxime

329
Q

JIA Dx

A

At least 1 joint

At least 6 wk

Age < 16 yr

Exclusion of other causes

Classification by features in the 1st 6 mo of disease

330
Q

Still’s disease (systemic arthritis)

A

M=F

Fever spikes:
Once/twice daily
>38.5
At least 2 d/wk

Unwell during fever episodes

Rash:
Erythematous salmon-colored

LAP
HSM

Leukocytosis
Thrombocytosis
Anemia

Serositis

Arthritis:
May occur weeks to month later

High ESR, CRP

331
Q

Oligoarticular arthritis

A

1-4 joints

Onset < 5 yr

F>M

Large joints: knee(most common), elbow, wrists

ANA+ (60-80%)

RF-

Asymptomatic anterior uveitis

332
Q

Most common type of JIA

A

Oligo

333
Q

Complications of oligoarticular JIA

A

Knee flexion contracture

Quadriceps atrophy

Leg length discrepancy

Growth disturbance

Uveitis

334
Q

Polyarticular arthritis

A

ANA+ in 50%

Uveitis in 10%

RF negative (usually negative):
Onset: 2-4 yr, 6-12 y
F>M
Symmetrical involvement
Large to small joints of hands and feet, TMJ, cervical spine
RF positive: 
Late childhood/early adolescence
F>M
Severe
Rapidly destructive
Symmetrical
Large and small joints
Reumatoid nodules
Unremitting
Persists into adulthood
335
Q

Enthesitis-related arthritis

A

Late childhood/adolescence

M>F

Enthesitis/arthritis

Wt-bearing joints (esp hip, intertarsals)

Risk of ankylosing spondylitis in adulthood

336
Q

Psoriatic arthritis

A

Onset: 2-4 yr, 9-11 yr

F>M

Dactylitis

Nail pitting

FHx of pso in 1st degree

Asymmetric/symmetric small/large joints involvement

337
Q

Mx of JIA

A

Exercise:
To maintain ROM, muscle strength

OT/PT
Social work
Orthopedics
Ophthalmology
Rheumatology

1st line meds:
NSAIDs
Intra-articular CS

2nd line:
DMARDs (MTX, Sulfasalazine, leflunamide)
CS (acute Mx of severe arthritis, systemic symptoms, topical for eye)
Biologics

338
Q

Reactive arthritis

A

Typically the knee

Following salmonella/shigella/yersinia/campylo/chlamydia

Or

Following Strep

339
Q

Highest incidence of lyme in children at age?

A

5-10 yr

340
Q

SLE

A

F>M

More commonly Age>10

Children have:
More active disease
More likely to have renal disease
More intensive drug therapy
Poorer prognosis
341
Q

Most common vasculitis of childhood

A

HSP

342
Q

Peak incidence of HSP

A

4-10 yr

M>F

343
Q

How long after URT infection does HSP happen?

A

1-3 wk

344
Q

HSP clinical triad

A

Palpable purpura

Abd pain

Arthritis

345
Q

Scrotal swelling

A

HSP

346
Q

HSP arthritis

A

Large joints

347
Q

Renal involvement in HSP

A

Microscopic hematuria

Proteinuria

HTN

RF (<5%)

IgA nephropathy

348
Q

Inv for HSP

A

U/A (blood, ACR)

Urea, Cr

Lytes

Alb

IgA (elevated)

Skin/renal Bx

U/S (intussusception, scrotal pain/swelling)

R/O other AI conditions

349
Q

Mx of HSP

A

Mainly supportive:
Elevation for edema…

Monitor proteinuria, BP q mo x 6 mo

Check for renal disease

Anti-inflammatory meds for joint pain

CS for selected pts

Immunosuppressive therapy if severe renal disease

350
Q

Prognosis of HSP

A

Self-limited

Resolution within 4 wk

Recurrence in 1/3

Long-term prognosis depends on severity of nephritis

351
Q

Most common cause of acquired heart disease in children in developing countries

A

Kawasaki

352
Q

Size of vessels involved by Kawasaki

A

Medium

353
Q

Peak age of kawasaki

A

3mo-5yr

Asian>Black>Caucasians

354
Q

Dx criteria of Kawasaki

A

Fever persisting 5 d or more

And 4 of:

Bilateral, non-exudative conjunctival injection

Oral mucous membrane changes

Changes of peripheral ext

Polymorphous rash

Cervical LAP > 1.5 cm USUALLY UNILATERAL

355
Q

Atypical Kawasaki

A

Fever at least 5 d

Plus 2-3 of symptoms

ESR, CRP

356
Q

Mx of Kawasaki

A

Initial therapy:

IVIg + high dose ASA

Once afebrile > 48h:

Low-dose of ASA until plt normalize. Longer if coronary artery involvement

Baseline echo and F/U echo at 2,6 wk

357
Q

Time of IVIg treatment to prevent coronary artery disease in Kawasaki

A

10 d

358
Q

RFs for coronary artery disease in Kawasaki

A

Male

Age<1 yr, > 9yr

Fever > 10d

Asian or hispanic

Thrombocytopenia

Hyponatremia

Med (25 decks)

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