Pediatrics Flashcards
Is gonnorhea on vag cx of a kid evidence for child abuse?
Is chlamydia?
Gonn - yes
Chlamydia - no. Could have gotten it at birth from mom, it can take up to 3 years to present
What type of shunt?
cyanotic congenital heart disease
acyanotic congenital heart disease
cyanotic = R-->L shunt acyanotic = L-->R shunt (VSDs, ASD's, PDA's)
What type of heart defect is associated with: Rubella? Turners? Kawasaki's? SLE? Lithium? maternal DM?
Rubella = PDA Turners = Coarctation of Aorta Kawasaki's = Coronary Artery aneurysms SLE = Congenital heart block Lithium = Ebsteins anomoly maternal DM = Asymmetric septal hypertrophy AND transposition of great vessels
What is the tx for a PDA?
When do you not treat?
Indomethacin (closes the PDA) - can use up to 6-8 months old
Keep open w/ PGE! Don’t close it in case of transposition of great vessels, coarctation of aorta, tetralogy of Fallot, hypoplastic left heart disease, or if indomethacin is contraindicated (intraventricular hemorrhage.)
Where does a coarctation of aorta normally occur>?
Just below the subclavian artery (causes HTN in upper extremities and normal BP below the coarctation
Interestingly, more than 2/3 these pts have a bicuspid aortic valve
What are the risk factors for transposition of great vessels?
WHat additional abnormalities must these kids have to stay alive?
DM and Digeorge Syndrome
Must have an ASD/VSD and a PDA
If kid turns blue after a few years vs few hours?
years = tetralogy of fallot hours = transposition of vessels
What are the risk factor for tetralogy of fallot?
DiGeorge and maternal PKU
Infant is asymptomatic until 4 months when he is diaphoretic with feeding and tachypnic
Dx?
Tx?
Tetrology of Fallot
CXR shows Boot Shaped Heart
Tx with PGE (like transposition of great vessels) but will ultimately need surgery.
Explain tet spells?
kids squat to increase vascular resistance so that they can breath with tet of fallot. (pulmonary stenosis, overriding aorta, RVH, VSD)
What 2 genetic abnormalities can cause down syndrome?
Other issues to worry about in DS?
#1 = meiotic nondisjunction #2 (4%) = robertsonian translocation
Duodenal atresia, Hirschprung’s disease, atrioventricular cushion defects, ALL, hypothyroidism, Alzheimers
What genetic abnormality do PKU kids have? Sx?
decreased phenylalanin hydroxylase or decreased THB cofactor.
After a few normal months, the kids present w. MR, fair skin, blonde, eczema, musty urine. Tx w/ tyrosine and low phenylalanine
Match disease w/ deficiency: Fabry's disease absent galactosylcermidase Gaucher's disease absent sphingomyelinase Tay-Sachs absent Arylsulfatase A Hurler's Absent iduronate sulfatase
Fabry’s disease = galactosidase A (telangiectasias, angiokeratomas)
absent galactosylcermidase = Krabbe’s disease (CNS issues)
Gaucher’s disease = Glucocerebrosidase (crinkled cells, TCP, anemia)
absent sphingomyelinase = Neimann-Pick (cherry spot and HSM)
Tay-Sachs = hexosidase (cherry spot, no HSM)
absent Arylsulfatase A = Metachromatic Leukodystrophy (ataxia)
Hurler’s = a-L-iduronidase (corneal cloud, MR, gargoyl)
Absent iduronate sulfatase = Hunter’s (no corneal cloud, X-linked)
Colicky pain in healthy kid. Flexed knees and vomiting. Current jelly stool w. sausage shaped RUQ mass. Dx? Risk factors? Tx?
Intussusception
Risks = lymphoma, LAD, H.u.S., Meckels Diverticulum
Tx: air contrast barium enema
What Abx can be a risk factor for pyloric stenosis?
What abnormal acid state is seen in PS?
Erythromycin
pt will have hypochloremic hypokalemic metabolic alkalosis (persistent emesis of HCl)
Healthy kid with sudden, intermittent painless rectal bleeding. Dx?
Meckel’s diverticulum, can lead to diverticulitis, volvulus, or intussuss.
FAILURE OF OMPHALOMESENTERIC/VITELLINE DUCT TO DISAPEAR.
Use the 99 scan to check for ectopic gastric tissue
What GI disease is associated with MEN type 2?
Hirschprungs Disease
Dx needs rectal bx (will show absence of myenteric (aurbachs) plexus and submucosal (meissners) plexus
What is the dx of choice for malrotation (kid shows up with bilious vomiting)
An EGD, although an XR will show a birds beak
Newborn with feeding intolerance that has intramural air bubbles in the GI?
Necrotizing Entericolitis (bubbles are made by bacteria)
Tx for: Brutons Agammaglobulinemia CVID IgA def DiGeorge
Brutons Agammaglobulinemia = IVIG (B’s are low, tonsils maybe gone)
CVID = IVIG (Low T’s and plasma’s. B’s normal)
IgA def = tx infections (no IVIG as it can cause anti-IgA Abs)
DiGeorge = BM transplants & IVIG (thymic aplasia()
Tx for:
Ataxia-Telangiectasia
SCID
Wiskott-Aldrich
Ataxia-Telangiectasia = no specific (DNA repair defect) SCID = BM transplant, PCP prophylaxis, IVIG (bubble boy) Wiskott-Aldrich = supportive, die by adults. (infections, purpura, eczema, low IgM, TCP)
Tx of: Chronic Granulomatous Disease Leukocyte Adhesion Deficiency Chediak Higashi Syndrome Job's Syndrome C1 esterase def (hereditary angioma) Terminal Complement Def (c5-c9)
-Chronic Granulomatous Disease = nitroblue test, tx: TMPSMX (cat+ infections)
-Leukocyte Adhesion Deficiency: BM transplant. (umbilical cord)
-Chediak Higashi Syndrome: BM Tx (occulo-albinism, neuropathy, neutropenia.)
Job’s Syndrome: Abx & IVIG (FATED - facies, abscesses, small teeth, hyper-IgE, dermatologic)
C1 esterase def (hereditary angioma): C1 esterase. (edema)
Terminal Complement Def (c5-c9): mening vaccine & Abx (recurrent N.Men infections.)
Kid with painless conjunctivitis and painful unilateral LAD with truncal rash and strawberry tongue w/ desquam of fingertips. Dx? Tx?
Kawasaki Disease
Tx = high dose ASA, IVIG
SCARLET FEVER LOOKS LIKE THIS TOO, BUT HAS NORMAL LIPS AND NO CONJUNCTIVITIS
WHAT will labs look like for Juvenile Idiopathic Arthritis?
Tx?
ANA+
RF-
Tx = NSAIDs and strengthening exercises
High fever (>102) with HSM and a salmon colored macular rash?
Still’s disease (systemic-onset)
RF and ANA negative
Young kid comes in tugging on his ears. What bugs? Tx?
S. pneumo
nontypable H flu
Moraxella catarrhalis
Viruses: influenza A, RSV, paraflu
Tx = amox
Kid gets sick in the Winter. Dx? Bug? Tx? PPx?
Bronchiolitis!
RSV is most common, other = paraflu, influenza
Tx = supportive, maybe nebs. NO CTSDs. Ribavarin for tx in high risk infants w/ heart/lung dz
PPx = poly/monoclonal antibodies in winter for kids
Kid comes in with seal cough. Dx? Bug?
CXR? Tx?
Croup
Paraflu 1
CXR = steeple sign indicating subglottic narrowing
Tx = mild: cool mist, worse: CTSDs, race epi
Kid comes in with a fever, dysphagia, and drooling. Dx? Bug? CXR? Tx?
Epiglottitis
If NOT immunized = H.Flu, if immunized = nontypable H.flu, strep
DO NOT EXAMINE THROAT AS IT MAY COLLAPSE, MAY HAVE TO INTUBATE. Look for cherry red epiglotis on fiberoptic
CXR = swollen epiglottis obliterating the valleculae (thumbprint sign)
Tx: secure airway, IV Cef.
What is the most common cause of viral meningitis in kids?
Enteroviruses
What meningitis medicine do you NOT give to neonates?
Ceftriaxone! It will cause increased biliary sludging and kernicterus. Use cefotaxime or Gent instead
also include Amp and +/- acyclovir for those neonates as well (listeria and herpes)
Kid comes in with sore throat and acute onset of HIGH fiver, muffled potato voice. Dx?
What if his uvula was displaced to the opposite side of the pain?
Retropharyngeal abscess
Displaced uvula = Peritonsilar abscess
Bot hare caused by G.A.S. or Staph
Kid comes in with paroxysmal cough causing him to vomit b/c he can’t breath. Dx? Bug? Tx?
Pertussis. DTap (5) protects against this but by teenage years, the immunity can wane. Infection is mild in adults and kids but can be severe in teens!
Bordella Pertussis. 3 stages, whoop in stage 2, but most contageous in the 1st stage (the catarrhal stage.)
Tx = Erythromycin to pts and contacts for 2 wks
Kid comes in with slapped cheek rash that worsens with sun exposure. Dx? Bug? Complications?
Fifths disease (erythema infectiosum) Parvovirus
Can cause joint pain in kids
If congenital infection, can cause hydrops fetalis and death
Can cause aplastic anemia in Sicklers or H.sperocytosis
Keys to differentiating measles from rubella?
Rubella has a lower fever, the rash progresses quicker, and has posterior auricular lymphadenopathy
Kid comes in with a really high fever (>104) and then gets a rash on trunk after the fever breaks. The rash spreads to the face and lasts
Roseola Infantum
HHV-6 and 7
Kid comes in with oral ulcers, vesicular rash on hands, feet, and butt. Dx? Bug?
hand Foot Mouth
Coxsackie A - self limited disease
Juandiced newporn presents with lethargy, poor feeding, and high pitched cry
Kernicterus, result of really high unconjugated bili
Direct hyperbilirubinemia is always pathologic. Also, jaundice during the first 24h of life is most likely pathological, not physiological.
Also, can’t treat it with phototherapy! Only do this with unconjugated
Pathophys of respiratory distress syndrome?
No surfactant leads to poor lung compliance and alveolar collapse and atalectasis. Occurs in 48-72h of life.
CXR = ground glass w/ air bronchograms
Imaging of:
- Transient tachypnea of newborn (amniotic fluid retention)
- Meconium Aspiration
- Congenital PNX
- Perihilar streaking in interlobular fissures. Tx - O2
- Course, irregular infiltrates w/ hyperexpansion
- Nonspecific patchy infiltrates, neutropenia
What is an intrauterine risk factor for tracheoesophageal fistula?
Polyhydramnios
actually, polyhydramnios is a risk factor for this, gastroschisis, and duodenal atresia
Gastroschisis vs Omphalocele
Gastro = intestine only through the wall (no sac)
Omphalocele = herniation of abdominal viscera through the abdominal wall covered by peritoneum and amniotic membrane. Need c-section to prevent sac rupture
Kid presents with toe walking, scissor gait, and delayed motor development. Dx?
Cerebral palsy
Pyramidal - spastic paresis of any/all limbs - 75% of cases
Extrapyramidal - damage to extrapyramidal tracts. different subtypes that range in severity of muscle movement disorders
Is there a risk of recurrence of febrile seizures?
yes,
Kid who refuses to bear weight on his leg and has a green soft-tissue tumor on his skin?
AML
ALL is the most common kid cancer
Tx w/ CXR to rule out lung metz and BM biopsy showing hypercellular w/ increased lymphoblasts
Kid with ALL starts chemo but gets hyperkalemia, hyperphos, and hyperuricemia. Dx? Tx?
Dx = Tumor Lysis syndrome
Tx = Hydrate, diuretics, allopurinol, alk the urine, reduce phosphate in diet
STAY AWAY FROM CTSDs as they can cause tumor lysis syndrome
What does a neuroblastoma look like on histo?
Where do these originate from?
Small blue tumor cells w/ rosette patterns
Pts will have elvated VMA/HVA
Originate from neural crest cells
Wilms tumor vs Neuroblastoma
Both are palpable stomach masses in kids
Wilms = NO IRIS, hemihypertrophy, Mental retardation, and does NOT cross midline
Neuroblastoma = opsoclonus/myocloonus and MAY cross midline
When can a kid face forward in the carseat?
Age 2 and weighs more than 40 lbs
What tissue do Ewings sarcoma and Osteosarcomas come from?
Ewings = neuroectoderm (sarcoma)
osteosarcoma = mesenchyme (osteoblasts)
