Pediatrics Flashcards
Adolescent, obese patient with thigh and knee pain, limp, limited internal rotation and abduction of the
hip, hip flexion produces obligatory external hip rotation, knee examination is normal.
1. Diagnosis and Rx
2. Differential diagnosis
- Slipped capital femoral epiphysis→Separation through growth plate of femoral epiphysis from metaphysis, 10-14 yrs. Rx►posterior and medial displacement of the femoral head from the femoral metaphysis
- Legg-Calvé-Perthes disease→AVN of capital femoral epiphysis, 3-8 yrs. Rx► asymmetric hips, small affected femoral head with sclerotic bone and widened joint space
Treatment for Lyme disease in patients younger than 8 years old
Amoxicillin
Complications of Slipped capital femoral epiphysis
- Avascular necrosis (AVN)
- Chondrolysis (degeneration of cartilage)→Premature osteoarthritis
Risk factor for Slipped capital femoral epiphysis
- Obese with delayed skeletal maturation
- Thin with a recent growth spurt
- Black race
- Hypothyroidism➡❌ossification of growth plate. Thyroid hormone promotes ossification of growth plate.
Pathophisiology of Intussusception
- No identifiable lead point (75%)→Preceding viral infection (ex, gastroenteritis)→inflaming intestinal lymphatic tissue (ex, Peyer patches)►lead point for intussusception
- Identified triggers (25%)→Meckel’s diverticulum, polyps, hematomas (ex, Henoch-Schölein purpura)
Best initial test and most accurate test for intussusception. Which is the finding?
- Best initial➡Ultrasound→”Target sign”, “Doughnut sign”
- Most accurate➡Air (preferred), saline, or barium enema (also therapeutic)
Treatment of intussception. How does it work?
Enema reduction→Air or water soluble contrast is instilled through the rectum►pressure reduces obstruction
*Air enema preferred→faster, cleaner, safer than contrast
Physiologic responses to transplacental maternal estrogen exposure in a newborn? Next step when identified
- Mammary gland enlargement (girls and boys)
- non-purulent vaginal discharge (leukorrhea)
- Mild uterine withdrawal bleeding
- Swollen labia
- Work-up is unnecessary→routine care and reassurance
Common clinical presentation of renal tubular acidosis in children
- Normal anion gap metabolic acidosis
- Failure to thrive→poor cellular growth and division in acidic conditions
Most appropriate next step when stablished gonadotropin-dependent (central) precocious puberty and why?
MRI of the brain with contrast→Hypothalamic or pituitary tumors (more cases in boys but must be ruled out in girls)
What suggest a left axis deviation on neonatal electrocardiogram? Which other findings do you expect?
- Tricuspid valve atresia→lack communication between right chambers►hypoplastic right ventricle►↓right ventricular forces on ECG
- Decreased pulmonary markings on chest x-ray (hypoplasia of the right ventricle and pulmonary outflow tract)
- Small or absent R waves on ECG
Secondary causes of enuresis
- Psychological stress
- Urinary tract infection
- Diabetes mellitus
- Diabetes insipidus
- Obstructive sleep apnea
Treatment of common variable immunodeficiency
Intravenous immunoglobulin infusion→avoid infection, prevent some complications of chronic infection
*Also for X-linked agammaglobulinemia
How can you differentiate severe combined immunodeficiency and common variable immunodeficiency?
- SCID→tipically begin early in infancy
- CVID→present at chilhood (around puberty), or more commonly in adulthood (20-40)
Treatment of the radial head subluxation (Nursemaid’s elbow)
Hyperpronation and/or supination with hyperflexion while continuously applying force over the radial head
How can you distinguish functional constipation vs Hirschprung disease by physical examination?
- Functional constipation→stool in ampulla
- Hirschprung disease→NO stool in ampulla
Most appropriate next step in management when suspect hirschprung disease
Anorectal manometry→No sphincter relaxation
Most appropriate next step in management when you identify a patient with epiglottitis
Intubate→Do not waste time with anything else, the airway may close off any minute
Clinical presentation of epiglottitis
In a patient with uncertain history of vaccination:
- Muffled (“Hot potato”) voice
- Fever
- Drooling in the tripod position
- Refusal to lie flat
- Extremely hot cherry-red epiglottis
- Inspiratory stridor
- Toxic appearance
Etiology of epiglottitis. Empiric antibiotic treament.
- H. influenzae type B (now less common), S. pyogenes, S. pneumoniae, S. aureus (including MRSA), Mycoplasma
- Ceftriaxone + Vancomycin
Most common causal agent of croup
- Parainfluenza virus type 1 and 2
2. Respiratory syncytial virus
Rare but potentially serious complication of infectious mononucleosis and treatment
- Acute airway obstruction
- Intravenous corticosteroids
Most common cause of acute unilateral cervical lymphadenitis in children
- Staphylococcus aureus
2. Group A streptococcus
Gold standard to diagnose vesicoureteral reflux in children
Voiding cystourethrogram
Cause of vesicoureteral reflux
- Defective valve in the ureter (Primary VUR)
- High bladder pressure (Seconday VUR)
Long-term complication of renal scar formation (due VUR for example)
Secondary Hypertension and Chronic renal insufficiency
Common sympyoms of craniopharyngioma
- Compression of optic chiasm→bitemporal hemianopsia►run into the corners of walls or furniture
- Pituitary stalk compression→multiple endocrinopathies►Ex: GH deficiency; diabetes insipidus (polydipsia/polyuria, high-normal serum sodium, dilute urine)
- Compression of nearby structures or obstructive hydrocephalus►headache
How do you see a craniopharyngioma on MRI or CT scan?
Calcifications
*Key finding to differentiate it from pituitary adenoma, that can cause bitemporal hemianopsia as well
How do you differentiate craniopharyngioma from rathke cleft cysts?
- Rathke cleft cysts→sellar region and no calcifications
- Craniopharyngioma→suprasellar region and calcification
- If Rathke cleft cysts are large may yield similar symptoms as craniopharyngiomas
Key to distinguish benign vs pathologic chilhood murmurs
- Benign→Reduce intensity with maneuvers that decrease the venous blood return to the heart (standing, valsalva)
- Pathologic→Increase intesity with standing and valsalva
How is the murmur of hypertrophic cardiomyopathy with valsalva maneuver or standing?
Drecrease venous return and preload→Increase the obstruction→Increase murmur intensity
Most likely diagnosis in a fetus with ultrasound findings of periventricular calcifications, intrahepatic calcifications and fetal growth restriction with a negative treponemal antibody absorption test in the mother
Congenital Cytomegalovirus infection
All immunoglobulins levels on Hyper-IgM syndrome and why does it happen?
- Increase IgM, Low Others (IgA, IgG)
- CD40L deficiency X-linked recessive→Defective Ig class switching
*Normal B-cell count
What do you suspect when see a child with severe and recurrent sinopulmonary infections with viruses and encapsulated bacteria, and poor growth?
Primary humoral deficiency
Treatment of Hyper-IgM syndrome
Antibiotic profilaxis and interval administration of intravenous immunoglobulin
What is congenital dermal melanocytosis? Why is Important to document in the child?
- Flat, blue-gray, no tender patches fund in infants over lower back and buttocks, fade in first decade→Melanocytes within skin dermis
- May be mistaken for bruises→coagulopathy or child abuse►Tender, varied in color and fade quickly
Most common cause (agent) of very acute unilateral cervical adenitis in children. Clinical features. Treatment
- Staphylococcus aureus, Streptococcus pyogenes
- Erythematous, enlarged, markedly tender submandibular nodes
- Clindamycin
Most common causes of red eyes or conjunctivitis of the newborn based upon day of beginning from the delivery
- Day 1→chemical irritation
- Days 2 - 7→Neisseria gonorrhoeae (Ophtalmia neonatorum)
- > 7 Days→Chlamydia trachomatis (Ophtalmia neonatorum)
- > 3 weeks→Herpes simplex
Contraindications for breastfeeding
HIV, TB, Herpes of the nipple
What is failure to thrive?
Persistent weight less than the fifth percentile for
age or “falling off the growth curve”
Most common causes of polyhydramnios
Not swallowing
- Werdnig-Hoffman syndrome (unable to swallow)
- Intestinal atresias (Ex, Tracheoesophageal fistula, Gastroschisis, Omphalocele, Duodenal atresia)
Most common causes of oligohydramnios
Cannot urinate
- Prune belly
- Renal agenesis (associated with Potter syndrome, incompatible with life)
Screening tests for omphalocele
Alpha fetoprotein (AFP) levels and ultrasound
What is the Wilms tumor and its most important clinical feature? Most valuable clinical clue to suspect it.
- Nephroblastoma→Most common abdominal mass in children
- Aniridia
What is the WAGR syndrome and its cause?
- Wilms tumor + aniridia + genitourinary malformations + mental retardation
- Deletion in chromosome 11
Three leading causes of meconium
- Physiologic maturational event
- Acute hypoxic event
- Chronic intrauterine hypoxia
Best initial diagnostic test for necrotizing enterocolitis and what expect to find?
Abdominal x-ray→pneumatosis intestinalis, pneumoperitoneum if perforation, hepatobiliary gas, portal venous gas
Common age of presentation of coarctation of the aorta and why?
Around day 3 - ductus arteriosus begins to close
*Severe aortic narrowing makes systemic blood flow dependent on the ductus arteriosus
Until which age you may find babinski reflex in children?
Up to age of 2, but can disappear at 12 months
Cause and pathogenesis of infant botulism
Ingestion of Clostridium botulinum spores (environmental dust/soil, honey)→spores colonize GI tract→produce toxin→✖presynaptic acetylcholine release in neuromuscular junction
Typical clinical manifestations of cranial nerves compromised in infant botulism
Oculobulbar weakness or palsies►absent gag reflex, ptosis, ophthalmoplegia, impaired pupil constriction
Why tet spell helps to relieve dyspnea in children with tetralogy of fallot?
Squatting during exercise (playing)→↑preload, ↑systemic vascular resistance→↓right-left shunting→↑pulmonary blood flow►↑oxygen saturation
Most common cyanotic lesions in children
- Tetralogy of fallot→after neonatal period (most overall)
- Transposition of great vessels→during neonatal period
What do the transposition of great vessels need to maintain the blood oxygenated?
Patent ductus arteriosus OR atrial septal defect OR ventricular septal defect
Chest x-ray finding of transposition of great vessels
“Egg on a string”→Narrowing of superior mediastinum and globular shape of the heart
Chest x-ray finding of Total anomalous pulmonary venous return (TAPVR) without obstruction
Snowman or figure of 8 sign
Most common congenital heart disease
Ventricular septal defect
Auscultatory finding of ASD and VSD
- VSD→Holosystolic murmur over lower left sternal border
- ASD→fixed wide splitting S2
Chest x-ray finding of tetralogy of fallot
Boot-shaped heart
Jug handle appearance on chest x-ray
Primary pulmonary artery hypertension
Best initial treatment for Long QT syndrome
Beta blockers→↓activation of stellate ganglion, ↓cardiac excitation during exertion→may shorten QT interval
In which congenital heart diseases are needed the PDA for survival?
- Transposition of great vessels
- Hypoplastic left heart syndrome
- Tetralogy of fallot (severe RVOT obstruction)
- Critical coarctation of the aorta in infancy
- Tricuspid valve atresia
Most accurate test for pyloric stenosis and which signs you expect to find?
Upper GI series
- String sign→severe narrowing of loop of bowel►thin stripe of contrast within the lumen looks like a string
- Shoulder sign→filling defect in the antrum due to prolapse of muscle inward
- Mushroom sign→hypertrophic pylorus against the duodenum
- Railroad track sign→excess mucosa in the pyloric lumen►2 columns of barium
Best initial test for pyloric stenosis
Abdominal ultrasound→thickened pyloric sphincter
Electrolytic and acid-base disturbance from vomiting in pyloric stenosis
Loss of H+, loss K from aldosterone release in response to hypovolemia→Hypochloremic, hypokalemic metabolic alkalosis
Which findings can help to identify homocystinuria? From Which disease yo may differentiate?
- Both Marfanoid habitus→differentiate from Marfan Sx
- Fair eyes and hair, developmental delay, thrombosis (stroke, MI, venous thromboembolic disease), downward lens dislocation
Treatment of homocystinuria
- Vitamin B6, Folate, Vitamin B12→↓homocysteine
- Antiplatelets or anticoagulation
What is the Breastfeeding jaundice?
Unconjugated hyperbilirubinemia in first week of life due insufficient intake of breast milk
Which is the clinical presentation of Breastfeeding jaundice?
- Suboptimal breastfeeding (normal is >10-20 min/breast every 2-3 hours)
- Signs of dehydration➡⬇urinary output➡⬇diapers/day (equal of age in 1st wk); excessive ⬇weight; delayed stooling
*Total Bilirubin may be >10mg/dL
Pathophysiology of breastfeeding jaundice
- ⬇Bilirubin elimination
- ⬆Enterohepatic circulation
What is the Breast milk jaundice?
Physiologic jaundice persists beyond 1st wk of life; starts 3-5 days and peaks 2 wks due to ⬆glucuronidase in breast milk
Cause of Breast milk jaundice
⬆️Glucuronidase in breast milk➡️deconjugate intestinal bilirubin, ⬆️enterohepatic circulation
Total Bilirubin threshold for phototherapy and exchange transfusion in fullterm healthy newborn with jaundice
- Phototherapy in >20mg/dL
- Exchange Transfusion in>25mg/dL or bilirubin-induced neurologic dysfunction
Most common cancer in children. Peak age of incidence.
Acute lymphoblastic leukemia
Peak age 2-5 years
Clinical presentation of Acute lymphoblastic leukemia
- Nonspecific symptoms (fever, fatigue, weight loss)
- Bone pain
- Lymphadenopathy
- Hepatosplenomegaly
- Pallor (anemia)
- Petechia (thrombocytopenia)
Laboratory findings and diagnosis of ALL
- Bone marrow failure➡Pancytopenia (severe neutropenia)
- BM biopsy➡>25% lymphoblasts
Treatment of slipped capital femoral epiphysis
- Non-weight-bearing status and bedrest if bilateral
- Surgical screw fixation➡stabilize the physis, prevent further slippage
Auscultatory finding of patent ductus arteriosus
Continuous flow murmur
*If small PDA➡mildly accentuated peripheral pulses
Classic clinical presentation and finding on diagnostic test of duodenal atresia
- Bilious vomiting within 12 hours of birth
- Chest x-ray➡double bubble sign
Diagnosis in a patient with currant jelly stool, bilious vomiting, colicky abdominal pain, right quadrant sausage-shaped mass, neurologic signs
Intussusception
Classic presentation of Meckel’s diverticulum
Painless rectal bleeding (bright red blood)
*May have palpable mild mass left quadrant
Most accurate test for Meckel’s diverticulum
Technetium-99m (99mTc) pertechnetate scan (Nuclear scintigraphy)→detects gastric mucosa
*Also known as Meckel scan
Most accurate test for Osteogenesis Imperfecta
Skin biopsy➡analyze for collagen synthesis culturing dermal fibroblasts
How do you differentiate clinically croup and epiglottitis? Best next step when identifying each one.
- Croup➡Hypoxia on presentation, mild symptoms▶steroids; severe symptoms▶racemic epinephrine
- Epiglottitis➡Hypoxia, imminent respiratory failure➡Intubate
Best long-term treatment for severe combined immunodeficiency
Stem cell transplant
Important fact to diagnose severe combined immunodeficiency disease
Absence T cells (CD3+), dysfunctional B cells (Low CD19+)
Important findings in the hemogram and peripheral blood smear in Hemoglobin H disease (Alpha-thalassemia)
- ⬇MCV RBC’s (microcytic, hypochromic)▶Target cells
- Chronic hemolysis➡⬆RBC’s and reticulocytosis (replenish hemolyzed RBC’s)
Most common cause of short stature and pubertal delay in adolescents
Constitutional growth delay➡⬇height growth velocity at 6 mo to 3 yr➡at 3 years regain normal growth velocity➡delayed puberty and adolescent growth spurt, but occur➡normal growth spurt and adult height
*Bone age radiographs➡delayed bone age compared to chronological age
How do you suspect the childhood phenotype of myotonic dystrophy?
- Cognitive manifestations➡Intellectual impairment
- Behavioral manifestations➡ADHD, mood disorder
- Sleep disturbances➡excessive daytime sleepiness
- Hallmark: Muscle weakness, myotonia (grip myotonia)
*By Age 10
How do you identify a transient tachypnea of the newborn?
Newborn (premature, cesarean, maternal diabetes) with tachypnea, ⬆work of breathing, clear breath sounds, chest x-ray➡hyperinflation, fluid in fissures
Pathophysiology of transient tachypnea of the newborn
Delayed resorption and clearance of alveolar fluid
Common clinical presentation of Celiac disease in children
- Growth delay (often initial sign)
- Nonspecific gastrointestinal symptoms (bloating, abdominal discomfort; classic diarrhea might not be present)
- Malabsorption➡microcytic anemia
Head CT scan findings of congenital toxoplasmosis
Diffuse intracerebral calcifications and ventriculomegaly
Clinical presentation of Reye syndrome
- Acute liver failure: Nausea, vomiting, hepatomegaly
- ⬆⬆Ammonia neurotoxic➡cerebral edema▶Encephalopathy: mental status changes (lethargy, sleepy)
Findings on liver biopsy in a patient with Reye syndrome
Microvesicular fatty infiltration or steatosis
Causes of chronic stridor in infants and toddlers and key finding of each one
- Laryngomalacia➡inspiratory stridor worsens feeding, crying, supine, improves prone
- Vascular ring➡Biphasic stridor improves with neck extension (can also compress esophagus)
- Airway hemangioma➡worsening biphasic stridor, concurrent skin hemangiomas (“beard distribution”)
What do you suspect in a patient with recurrent stones since childhood, family history of nephrolithiasis, hexagonal crystals on urinalysis?
Cystinuria➡impaired transport of cystine and dibasic amino acids (ornithine, lysine, arginine) by renal tubular and intestinal epithelial cells➡⬇cystine reabsorption➡⬆urinary excretion
*Cystine is poorly soluble in water➡cystine stones (radiolucent)
Which test may aid in the diagnosis of cystinuria?
Urinary cyanide-nitroprusside test (qualitative)➡suggest ⬆cystine levels
*Used as a qualitative screening test as well
Management for neonatal varicella-zoster infection prevention
- Isolate infant from varicella contact
- VZ immunoglobulin (VZIG) if maternal infection developed 5 days before or 2 days after delivery
Causes of monoarticular joint effusion in an adolescent when you did rule out trauma, septic arthritis and inherited blood disorders
Late Lyme disease, Juvenile arthritis, Serum sickness
*All accompanied by preceding/ongoing rash (ask for it)
Best first step in a patient less than 6 months with fever and seizure
Lumbar puncture for CSF study
*Do not require neuroimaging before LP➡⬇risk of herniation (if non-focal signs and open fontanelle)
Cause of edema at birth in a patient with Turner syndrome
Lymphatic network dysgenesis➡⬆protein-rich interstitial fluid in hands, feet and neck (nonpitting)▶Congenital lymphedema
*Severe obstruction of lymphatic vessels➡Cystic hygroma
Most common gastrointestinal complication of Henoch-Schönlein purpura
Intestinal edema and bleeding➡lead point to the intestines to telescope into the adjacent bowel (ileoileal)▶Intussusception
*Others GI complications: bowel perforation, GI hemorrhage
Screening for critical congenital heart disease in a newborn. How do you interpret it?
- Pre- (right arm) and post-ductal (either leg) pulse oximetry
- Positive: <90% in either extremity, <95% in both upper and lower extremity, or >3% difference between upper and lower extremities➡Echocardiogram
*1/3 of newborns with critical CHD are asymptomatic for the first few days (patent ductus arteriosus)
Indications of echocardiogram in a newborn
Postive screening for CHD and cyanosis
*No acrocyanosis, might be benign in first days of life due peripheral vasoconstriction
Treatment of bloody diarrhea in a patient with stool
culture confirming shiga toxin-producing E. coli O157:H7 (STEC)
Supportive only (ex, rehydration)
*Antibiotics and antimotile agents ⬆risk of HUS, specially in children <5 years
Most common cause of chronic renal insufficiency/failure in children
Posterior urethral valves➡distal urinary tract obstruction
- May cause secondary urinary reflux
- Only in boys
What age the speech of children is completely intelligible? Most common cause when It is not after that age?
- 4 years
- Hearing impairment➡Isolated speech delay▶Articulation disorder
Best first step to evaluate a child with speech or language disorder
Hearing test
*Regardless of history of frequent ear infections or abnormalities on otoscopy
Most common cause of hearing impairment in young children
Conductive hearing loss from recurrent acute otitis media
Renal manifestations of Henoch-Schölein purpura
- 1/3 of cases➡at symptoms onset or months later
- Hematuria followed by mild (non-nephrotic range) proteinuria
*Nephrotic syndrome, HTN, ⬆creatinine is more common un adults with HSP
How do you confirm the diagnosis of laryngomalacia?
Flexible fiberoptic laryngoscopy➡omega-shaped epiglottis and collapse of supraglotic structures during inspiration
Which cephalosporine must be avoided in neonates and why?
Ceftriaxone➡impairment of biliary metabolism
What etiology may you consider in a child with seizures and acute infectious bloody diarrhea?
Shigella sonnei
Potential complications of shigella infection
- Seizure (severe)➡Febrile seizure or enterotoxins
- Rectal prolapse (severe rectal inflammation)
- Bacteremia (⬆fatality)
- Hemolytic uremic syndrome (antibiotics do not increase the risk, in contrast to E. coli O157:H7)
Most specific physical findings of acute otitis media
- Middle air inflammation
- Bulging tympanic membrane
- Middle ear effusion
- ⬇tympanic membrane mobility on tympanic insufflation
- Visible air-fluid levels
Clinical presentation in an infant with shoulder dystocia
Klumpke palsy▶excessive traction of the C8 and T1 nerves during delivery➡”claw hand”, Horner syndrome (miosis, ptosis)
When do you suspect chronic granulomatous disease?
Recurrent, severe cutaneous and pulmonary infections with catalase-positive bacterial and fungal organism (Staphylococcus aureus, Serratia, Burkholderia, Aspergillus, Nocardia)
Prophylaxis in chronic granulomatous disease
- TMP-SMX and Itraconazole
- Severe phenotypes: interferon-gamma injections
Most common complications of sickle cell trait
- Sickling in the renal medulla▶Hematuria (microscopic or gross)
- Hyposthenuria➡nocturia and polyuria
- ⬆Risk of UTI (during pregnancy)
Empiric treatment for urinary tract infection in infants
Third-generation cephalosporin (Ex, cefixime)
Most common cause of delayed meconium passage
- Normal rectal tone + negative squirt sign: meconium ileus▶blockage of the terminal ileum by inspissated meconium (cystic fibrosis)
- Increased rectal tone + positive squirt sign: Hirschsprung disease▶failure of neural crest cell migration
Most common cause of anemia in preterm infants
Anemia of prematurity: ⬇erythropoietin, shortened RBC life span, blood loss (exsanguination in NICU)
Empirical treatment for whooping cough
Macrolide (eg, Azithromycin) by 10 days in the meantime the confirmatory test comes out
Most common complication of nonbullous impetigo
Poststreptococcal glomerulonephritis
Treatment for nonbullous impetigo
- Localized: Topical antibiotic (Mupirocin)
- Extended: Oral cephalexin or Dicloxacillin (impractical to use topically)
*No use amoxicillin (no good coverage for staph)
Findings in head CT scan of congenital CMV infection
Periventricular calcifications and microcephaly
Most likely diagnosis (etiology) in a 15-month-old patient with chronic viral meningitis, history of sinopulmonary infections and prolonged diarrhea
X-linked agammaglobulinemia
Most common associated malformation or abnormality with myelomeningocele
Chiari II malformation➡inferior displacement of medulla and cerebellum through foramen magnum, and obstructive hydrocephalus
Most likely etiology in a 5-year-old patient with gray vesicles/ulcers on oropharynx
Coxsackie A virus
*Herpangina
Surveillance tests for an infant patient with fetal macrosomia, macroglossia, hemihyperplasia, omphalocele or umbilical hernia, rapid growth until late childhood
Most likely Beckwith-Wiedemann syndrome➡overgrowth disorder with predisposition to neoplasm
- Abdominal ultrasound and alpha-fetoprotein every 3 mo until age 4, and renal ultrasound every 3 mo from age 4-8
- ⬆Risk hepatoblastoma, wilms tumor
Pathologic findings of bronchopulmonary dysplasia
- Reduced number and septation of alveoli
* Increased distance between alveoli and pulmonary capillaries
Contraindications of Rotavirus vaccine
- Allergy to vaccine ingredients (previous anaphylaxis)
- Severe combined immunodeficiency
- History of Intussusception
Most common complications in an infant with small gestational age
- Hypoxia▶Polycythemia
- Hypoglycemia
- Hypothermia
- Hypocalcemia
*Small gestational age➡birth weight<10th percentile for gestational age
What do you suspect on an infant with macrocytic anemia, reticulocytopenia, normal leukocytes and platelets; and craniofacial abnormalities, triphalangeal thumbs?
Diamond-Blackfan Anemia➡congenital erythroid aplasia▶⬆apoptosis of RBC
When do you suspect a pathologic lead point in a patient with intussusception?
25% of patients with intussusception may have a pathologic lead point:
- Recurrent episodes
- Atypical location (eg, small bowel into small bowel)
- Atypical age
- Persistent rectal bleeding despite reduction
Indication of tympanocentesis and culture during tympanostomy tube placement in acute otitis media
- Multiple episodes of AOM (≥3 in 6 months)
- Persistent (>3 months) middle ear effusions with hearing loss
What is fetal hydantoin syndrome?
Teratogenic effect of phenytoin: orofacial clefts, microcephaly, nail/digit hypoplasia, cardiac defects, dysmorphic facial features
Most common cause of congenital hypothyroidism worldwide
Thyroid dysgenesis
Clinical presentation of neonatal abstinence (withdrawal) syndrome
- Maternal opioid exposure (methadone, buprenorphine, heroin)
- Fetal growth restriction
- After 48 (heroin) to 72 (methadone) hours of delivery
- CNS: Short sleep-wake cycles, irritability, hypertonicity, tremors, jitteriness
- ANS: Sweating, sneezing, nasal stuffiness, yawning
- GI: Poor feeding, vomiting, diarrhea
Treatment for Neonatal abstinence (withdrawal) syndrome
- Mild withdrawal: low-stimulation environment, swaddling, small, frequent feeds
- Severe withdrawal: Opioid replacement (methadone, morphine)
Most common cause of nonhereditary sensorineural hearing loss in children
Congenital CVM infection
Best next step in infants, toddler and preschool children with balanitis or balanoposthitis
- KOH microscopy to rule out Candida if thick and white discharge
- Sexually transmitted disease if urethral discharge
- Screen for Diabetes mellitus if Candida➕ with no associated risk factors (diaper dermatitis, recent antibiotic use)
Annual screening tests for a child with Neurofibromatosis type 2
- Annual audiometry
- Annual brain MRI beginning at 10 years➡⬆rate of intracranial tumors▶schwannoma, ependymoma, meningioma
Most important risk factor for orbital cellulitis
- Sinusitis (ethmoid, maxillary)
- Dental maxillary infection (caries, abscess)
- Skin infection
Most common sequela of congenital cytomegalovirus
Sensorineural hearing loss
Indication of pharmacologic treatment for infantile hemangioma
Beta-blocker therapy (eg, oral propranolol)
- Large, facial, segmental, &/or rapidly growing (ulcerations, scarring)
- Periorbital (visual impairment)
- Hepatic (high-output heart failure)
- Subglottic (airway obstruction)
Most common cause of acute bacterial rhinosinusitis in children
- Nontypeable Haemophilus influenzae (40-50%)
- Streptococcus pneumoniae (20-50%)
- Moraxella catarrhalis (25%)
Treatment of hypertrophic cardiomyopathy in infants of diabetic mother
Intravenous fluids and beta-blockers to increase LV blood volume
Most common complication of diamniotic, monochorionic twins
Twin-twin transfusion syndrome➡heart failure/neonatal mortality in both twins
Most common complication of monochorionic monoamniotic gestations
Cord entanglement
Most likely predisposing factor of recurrent UTI in a 5-year-old girl with chronic renal insufficiency and renal scintigraphy with dimercaptosuccinic acid showing bilateral focal parenchymal scarring and blunted calyces
- Vesicoureteral reflux
- Posterior urethral valves is wrong because even though they are the most common cause of chronic renal insufficiency in children, they only affect boys
Treatment for neonatal chlamydial conjunctivitis
Oral erythromycin
*Topical erythromycin alone has high failure rates
Most likely cause of acute otitis media after 2 weeks of antibiotic treatment and infection persistence and concurrent purulent conjunctivitis (otitis-conjunctivitis syndrome)
Non-typeable Haemophilus influenzae
