Pediatrics Flashcards
4 y/o child presented with:
pruritic vesicular eruption on face, neck, trunk, extremities, and scalp. Ulcers in mouth. Febrile and flu-like 3 days prior. Lesions began as papules and then scabbed over.
Chicken pox/varicella
6 y/o patient presents with:
sudden onset high fever, body aches prior to rash that was initially macular around tongue and mouth then spread to body and became papular. Second fever within a week with umbilicated pustules. Pitted scars.
Smallpox
.Preschooler with a 2 day history of fever, sore throat, malaise. Vesicular lesions on erythematous bases on hands and feet. Ulcerations on throat.
Hand, foot, and mouth disease
5 y/o with fever, weepy eyes, HA, cough, rhinitis, pharyngitis, red papular rash on face. Three days rash has become confluent on face, generalized, involves palms and soles. Immunization status UNKNOWN.
Measles
.Unimmunized 2//yo with low grade fever, does not appear ill, erythematous maculopapular rash began on face and spread to include toes. Mildly pruritic.
German measles (rubella)
.14 month old with red papular morbilliform eruption, mostly on trunk. Rash appeared post-fever with no source. Cranky but WNL.
Roseola (exanthem subitum)
.12 month old otherwise healthy and UTD on vaccines, had mild febrile illness accompanied by diarrhea 1 wk ago. Rash is papular, erythematous, involving extensor surfaces of arms and legs as well as cheeks.
Gianotti Crosti (papular acrodermatitis)
6 y/o boy with HA, pharyngitis, fever for 48 hrs, fine papular sandpaper-like rash begun in groin and armpits and then generalized. Desquamation of fingers.
Scarlet fever
.9 y/o girl with “slapped” red cheeks a week prior to disseminated red, reticulated, lacy rash involving palms and soles. Afebrile, rash became brighter when bathing.
Fifth’s disease (parvo)
4 y/o with low grade fever, malaise, vomiting. Generalized, reticulated, lacy rash that was purpuric and appeared on hands and feet.
Parvovirus Gloves and Socks syndrome
7 y/o boy, ill-appearing, severe HA, fever, palpable purpuric rash on arms and legs. Nausea and pain in arms and legs.
Meningococcemia
Teenager, fever, exudative pharyngitis, fatigue. Morbilliform disseminated eruptions. May develop post amoxicillin?
Infectious mononucleosis
.14 month old with unilateral morbilliform eruption in left axilla that spread to upper arms and trunk. Resolved spontaneously within weeks.
Unilateral lateral thoracic exanthem
.This three year old developed honey crusted lesions around the nose and mouth following a recent cold. Mom had noticed a small “pimple” under the nose at first.
Impetigo
Afebrile two week old was otherwise well-appearing and feeding well, developed flaccid pus filled bullae on his suprapubic area. A mild irritant diaper rash produced the lesions.
Bullous Impetigo
.One year old with an erythematous, minimally scaly rash in the diaper area which spared the creases.
Irritant diaper dermatitis
Child presents with erythematous scaly diaper rash, most prominent in the creases. He also had a generalized scaly erythematous rash and yellowish scales in his scalp.
Seborrheic diaper dermatitis
Rash began after several episodes of diarrhea during a course of antibiotics. It is erythematous and involves the creases of the diaper area and also has satellite lesions.
Candidal diaper dermatitis
Teenaged wrestler noticed itchy annular lesion with a crusty border and flesh-colored center a week ago.
Tinea corporis
Otherwise healthy adolescent noticed that these hypopigmented scaly patches on his shoulders, neck, back, and chest became more pronounced in the summer months.
Tinea versicolor
pruritic papulovesicular rash developed two days after patient was helping with some yardwork.
Contact dermatitis
Rash began when infant was about one month old. Erythematous papular and symmetric on the cheeks, forehead, scalp, and trunk, sparing diaper area. Mom noticed rash flared with introduction of new food.
Eczema/Atopic
16 year old developed pruritic erythematous edematous papules and confluent plaques after a recent cold. She had all of her immunizations. She was taking ibuprofen for comfort for menstrual cramps and trying an herbal tea for comfort.
Urticaria
Initial scaly patch of erythema prior to papulosquamous eruption involving primarily the trunk. Red scaly papules and annular plaques, “christmas tree” distribution.
Pityriasis rosea
Papulovesicular lesions, some with burrows noted, found on entire family. Intensely itchy. Noticed lesions months ago.
.Scabies
Annular, erythematous lesions that appeared after camping. May see flu-like symtoms.
Lyme disease
Tick bourne, red partially blanching papular eruption on hands and feet, including palms and soles. Progressed to trunk over three days. Other symptoms included headache, high fever, arthralgias, myalgias. Progressed to petechial rash within days.
Rocky Mountain Spotted Fever
Palpable purpuric rash on buttocks and legs, associated with arthralgias, and abdominal pain. May see microscopic hematuria on urinalysis.
Henoch Schonlein Purpura
4 year old with fever for 6 days along with sandpaper-like papular red rash and desquamation in the diaper area. Associated peeling of lips, strawberry tongue, puffy hands and feet, and nonexudative conjunctivitis, and tender anterior cervical LAD.
Kawasaki’s Disease
Fever and sore throat one day prior to eruption of red papulovesicular rash involving face, lips, mouth, upper trunk, and distal extremities. Lesions on hands and feet resembled a target configuration. Eyes spared.
Steven’s Johnson syndrome
Healthy immunized toddler developed generalized annular target-like plaques after starting antibiotics for infected insect bites. No involvement of mucus membranes.
Erythema multiforme (minor
10 year old with pain localized to left side of chest and back two days before eruption of erythematous vesicular rash. Grapelike clustered appears of lesions following dermatome.
Herpes zoster
Factors influencing chances of developing congenital heart disease
Maternal teratogenic meds
Maternal infection or disease
First degree relative with CHD
Genetic abnormality
Teratogen: Alcohol
Associated heart defect:
VSD, PDA, ASD
Teratogen: amphetamine
Associated heart defect:
VSD, PDA, ASD, Transposition
Teratogen: Trimethadione
Associated heart defect:
Transposition, tetralogy of Fallot, hypoplastic left heart syndrome
Teratogen: Hydantoin
Associated heart defect:
Pulmonary or aortic stenosis, coarctation, PDA
Teratogen: Lithium
Associated heart defect:
Ebstein’s anomaly, tricuspid atresia, ASD
Teratogen: Thalidomide
Associated heart defect:
Tetrology of Fallot, VSD, ASD, truncus arteriosus
Teratogen: Retinoic acid
Associated heart defect:
VSD
Maternal disease: Rubella
Associated heart defect:
Pulmonary arterial stenosis, PDA, VSD, ASD
Maternal disease: Diabetes
Associated heart defect:
Transposition, VSD, coarctation, hypertrophic cardiomyopathy
Maternal disease: lupus
Associated heart defect:
Heart block
Maternal disease: PKU
Associated heart defect:
Tetralogy of Fallot, VSD, ASD
How much higher is a patient’s chance of having a congenital heart disease if a first degree relative has one?
Twice as high
Genetic abnormality: Trisomy 21
Associated heart defect:
Endocardial cushion defect (AV canal)
Genetic abnormality: Alagille syndrome
Associated heart defect:
Pulmonary stenosis
Genetic abnormality: DiGeorge syndrome
Associated heart defect:
Interrupted aortic arch, Truncus arteriosus, VSD, PDA, Tetralogy of Fallot
Genetic abnormality: Turner syndrome
Associated heart defect:
Bicuspid aortic valve, coarctation of the aorta
Genetic abnormality: William’s syndrome
Associated heart defect:
Supravalvar aortic stenosis, supravalvar pulmonary stenosis
Genetic abnormality: Noonan’s syndrome
Associated heart defect:
Pulmonary valve stenosis, hypertrophic cardiomyopathy
Signs of cardiac defects to watch for in infants:
Significant birth or maternal history, feeding difficulty, tiring prematurely during feeding, cyanosis, diaphoresis, poor weight gain
Signs of cardiac defects to watch for in children/adolescents:
Palpitations, fainting, poor exercise tolerance, chest pain
Family history features suggestive of cardiac defects:
Congenital heart defects, deafness, sudden cardiac death
Social history features suggestive of cardiac defects:
Drugs of abuse, herbs or performance enhancing drugs
Normal heart, awake, newborn:
100 - 180 bpm
Normal HR, awake, 1wk-3mos
100 - 220 bpm
Normal HR, awake, 3mos-2yrs
80-150 bpm
Norma HR, awake, 2-10yrs
70-110 bpm
Normal HR, awake, >10 yrs
55 - 90 bpm
Cyanotic or acyanotic?
Qp/Qs
Cyanotic
Cyanotic or acyanotic?
Qp/Qs >1:1
Acyanotic
Cyanotic or acynotic?
VSD, ASD, AVSD, PDA, aortic stenosis, coarctation
Acyanotic
Name that heart defect:
Blowing, holosystolic at LLSB or apex
Small VSD
Name that heart defect:
Harsh systolic ejection murmur at LUSB, may have diastolic rumble at apex. Also tachycardia, tachypnea, and hepatomegaly
Large VSD
Name that heart defect:
Increased precordial activity, widely split and fixed S2, crescendo/descrescendo systoli murmur at LUSB
ASD
Name that heart defect:
Machine like murmur heard best at apex, trasmission throughout. Bounding pulses, widened pulse pressure. Tachycardia, tachypnea, hepatomegaly
PDA
Name that heart defect:
Harsh systolic ejection murmur at RUSB radiating to carotids with early systolic ejection click (apex), thrrill at suprasternal notch
Aortic stenosis
Name that heart defect:
Poor femoral pulses, upper-lower BP discrepancy
Coarctation
Cyanotic or acyanotic?
Tetralogy of Fallot, Total anomalous pulmonary venous return, transposition, triscupid atresia, truncus arteriosus, hypoplastic left heart syndrome
Cyanotic
Name that heart defect:
Cyanosis, clubbing, harsh systolic ejection murmur at LUSB
Tetralogy of Fallot
the PROVe of TOF:
Pulmonic stenosis, Right ventricular hypertrophy, Overriding aorta, VSD
Name that heart defect:
Cyanosis, respiratory distress, poor perfusion
Total anomalous pulmonary venous return
Name that heart defect:
Cyanosis, feeding difficulties, heart failure, respiratory distress, may hear murmur, maintained by ASD/VSD/PDA.
Mustard or Jantene procedure for tx.
Transposition of the great arteries
Name that heart defect:
Cyanosis, harsh holosystolic ejection murmur
Tricuspid atresia
Name that heart defect:
Cyanosis, gradual respiratory and feeding difficulties, widened pulse pressure, ejection click, to-and-fro murmur
Truncus arteriosus
Name that heart defect:
Cyanosis, lethargy, shock, PDA murmur, poor pulses, hepatomegaly
Hypoplastic left heart syndrome
Fractures should be described in terms of the following (5):
Anatomic position, direction, type, degree of angulation, degree of displacement
A non-displaced spiral fracture of the distal tibia that results from a fall with a twist:
Toddler’s fracture
A fracture of a long bone due to a bending and incomplete line of breakage (only one side of cortex breaks). Often of the radius and ulna when falling on ouotstretched arm with wrist dorsiflexed.
Greenstick fracture.
Fractures involving growth plate are classified using:
Salter-Harris classification
A fracture that is limited to growth plate (6%):
Type I Salter-Harris fracture
A fracture that involves variable amount of growth plate with extension into metaphysis (75%)
Type II Salter-Harris
A fracture that involves the growth plate with extension into epiphysis (8%):
Type III Salter-Harris
A fracture that involves the growth plate with extension into metaphysis and epiphysis (10%):
Type IV Salter-Harris
A fracture that is a crush injury to the growth plate (1%)
Type V Salter-Harris
Radial head slips under annular ligament, often due to sudden traction applied to extended arm. MC in children ages 1 - 4.
Nursemaid’s elbow
Treatment for nursemaid’s elbow?
Supinate, extend, apply pressure over radial head
Groin pain with decreased range of motion of hip (decreased IR, affected hip will ER when flexed), gait abnormality, Usually unilateral, MC in african-american children.
Slipped capital femoral epiphysis
Unilateral avascular necrosis of femoral head due to impairment of blood supply during development. Prolonged limp or waddling gait, pain in groin/thigh/knee, thigh muscle atrophy
Legg-Calve Perthes disease
MC disorder affecting hip in children, females. Diagnosis based on Barlow and Ortalani tests.
Developmental dislocation of the hip
Complications of DDH:
Osteonecrosis, failed reduction-redislocation
Rotational deformity of the subtalar joint with os calcis internally rotated beneath the talus. Creates a block to dorsiflexion.
Clubfoot (Talipes Equinovarus)
Physiologic bowlegs: normal variant of LE configuration between ages 1 - 3. Up to 20* bowing.
Genu varum
Physiologic knock-knees: normal variant of the LE configuration btw ages 2 - 4.
Genu valgum
Routine screening with Adams test (forward bending) should be part of all exams in children ages:
6 - puberty or longer
Tx for idiopathic scoliotic curves
repeat x-ray every 6 mos
Tx for idiopathic scoliotic curves >10*
Referred to orthopedics
Tx for idiopathic scoliotic curves 20* or greater with progression:
spinal bracing
Tx for idiopathic scoliotic curves >40*:
Operative intervention
MCC URI in children:
Rhinovirus
What to look for if URI has secondary bacterial infection:
Earache, sinus pain not relieved by nasal washes, dyspnea, fever >3d, fever that comes back after 24 hours remission, nasal discharge >2wks, cough >3wks
MC disease diagnosed in children
Acute otitis media
MCCs of Acute OM
Strep pneumoniae > H. influenzae > M. catarrhalis > viruses
Otoscopic findings for OM:
Red/pink/cloudy, bulging/retracted/normal, may have reduced mobility
Tx for OM:
High dose amoxicillin > amox-clavulanate > cephalosporins
Diagnostic features of sinusitis:
Persistent sx (congestion or cough >10d), severe sx (temp >38.5 C with purulent rhinorrhea >3d), worsening sx (after 3-4 d improved sx)
Diagnostic features unique to GAS pharyngitis:
Dysphagia, fever, headache, abd pain, N/V, soft palate petechiae, anterior cervical LAD, scarlet fever rash
Diagnostic features unique to viral pharyngitis:
Cough, runny nose, hoarse voice, diarrhea, stomatitis, conjunctivitis
Tx for GAS pharyngitis:
Oral Penicillin VK > amoxicillin > cefdinir > azithromycin
Complication following GAS infection, 3 - 4 wks after infection
Acute rheumatic fever
Complication following GAS infection, occurs 10 days later, hematuria/edema/oliguria/HTN/low c3
PSGN
Viral infection of glottic and subglottic regions, occurs between ages of 3 - 36 mos in late fall/early winter, narrowed subglottic space due to swelling and edema of respiratory epithelium. Barking cough, stridor, usually at night.
Croup (Laryngotracheobronchitis)
Viral lower respiratory tract infection, RSV accounts for 65% of cases, virus proliferates in epithelium and causes distal airway obstruction.
Bronchiolitis
Abrupt onset of fever, headache, myalgia, sore throat, non-productive cough may persist, GI sx. Detect with rapid test and culture.
Influenza
Onset for viral pneumonia is ____ vs bacterial which is ____
Viral: slow
Bacterial: abrupt
MCC vertically transmitted bacterial pneumonia in infants 2 - 3 mos
Chlamydia trachomatis
MCC bacterial pneumonia in children
Streptococcus pneumoniae
MCC bacterial pneumonia in children >5yrs
Mycoplama pneumoniae
Local lymphadenitis in fall or winter with red papule at cat scratch site
Bartonella henselae
Child >12 mos with headache, neck pain, nausea, vomiting, fever, irritability, nuchal rigidity.
Bacterial meningitis
MCC bacterial meningitis in neonates and tx
HBS, gram neg bacilli, listeria
Ampicillin and gentamicin or ampicillin and cefotaxime
MCC bacterial meningitis in infants 1 - 24 mos
S. pneumoniae, N. meningitidis, Hib
Third gen cephalosporin; add Vancomycin till sensitivities are known
MCC bacterial meningitis children >24 mos
S. pneumoniae, N. meningitidis, Hib
Inflammatory response in joint space that occurs as a result of infection elsewhere in the body.
Reactive arthritis
Bacterial infection in joint space, children
Septic arthritis
If the cough is nonproductive, think:
Reactive airway disease, bronchitis, irritants
If the cough is productive of purulent sputum, think:
CF, bronchiectasis
If the cough is productive of clear/white sputum, think:
Asthma
If the cough is productive of blood, think:
TB, CF, bronchiectasis, hemosiderosis
Hep B vaccine: route of administration, dosing schedule
Intramuscular; 0, 1, 6 mos
Rotavirus vaccine: valence, route, schedule
Pentavalent; oral; doses at 2, 4 , 6 mos
DTaP vaccine: route, schedule
Intramuscular; primary series at 2, 4, 6, and 15 mos; booster at 4-6 years. TDaP booster every 11 - 12 years.
Hib vaccine: route, schedule,
Intramuscular; primary series a 2, 4, 6 mos; booster at 12 - 15 mos
pneumococcus PCV13: valence, schedule
Heptavalent conjugate; doses at 2, 4, 6 and 12 mos
Pneumococcus PPV23: valence, schedule
23 valent polysaccharide; given to high risk >2 yrs, 5 years after initial dose
Polio vaccine: route, schedule
Inactivated injection subq; Primary doses at 2 mos and at least 6 weeks later, third dose at 6 - 18 mos, fourth dose at 4 - 6 years.
Inactivated influenza vaccine: valence, route, schedule
Quadrivalent; inactivated vaccine at 6mos - 3yrs; 2 doses req. for first year children
Live attenuated influenza vaccine: valence, route, reason
Quadrivalent; intranasal spray; children >24 mos; more efficacious and add’l benefit prevention OM
MMR vaccine: route, schedule
Subq live vaccine; first dose by 15mos, second dose recommended at school entry
Varicella vaccine: route; schedule
Subq live vaccine; first dose at 12 mos, second at 4 yrs; children >13 yrs two doses 4 wks apart
Hep A vaccine: recommended for, schedule
Recommended for children >12mos; 2 vaccines 6 mos apart
HPV vaccine: valence; schedule
Bivalent, quadrivalent, 9-valent for females; quad and 9-valent for males; initial dose then at 2 then at 6 mos.
Meningococcal conjugate vaccine: serogroups, route, schedule, complications
Serogroups A/C/Y/W-135; intramuscular; Ages 11 - 55 w booster after 5 yrs, ages 2 - 10 for high risk prophylaxis; Associated with Guillain-Barre syndrome
Meningococcal B vaccine: recommendations
Short term protection, recommended in ages 16 - 23; 2 - 3 doses.