Pediatrics Flashcards
What diseases cause a rash of the palms of the hands and soles of the feet?
Enterovirus (cocksackie A - hand, foot, mouth disease)
Syphilis
Rocky Mountain Spotted Fever
Kawasaki disease
Toxic shock syndrome (also diffuse rash)
2 month anticipatory guidance and screening
Parental well-being Infant behavior Infant-family synchrony Nutritional adequacy Safety Universal screening: metabolic and hemoglobinopathy, hearing Selective screening: blood pressure, vision
12 month anticipatory guidance and screening
Family support Establishing routines Feeding and appetite changes Establishing a dental home Safety Universal screening: anemia, lead (high prevalence/Medicaid) Selective: oral health, blood pressure, vision, hearing, TB
24 month anticipatory guidance and screening
Assessment of language development Temperament and behavior Toilet training Television viewing Safety Universal screening: autism, lead (high prevalence/Medicaid) Selective: oral health, blood pressure, vision, hearing anemia, TB, dyslipidemia
5 year anticipatory guidance and screening
School readiness Mental health Nutrition and physical activity Oral health Safety Universal screening: vision, hearing Selective screening: anemia, lead, TB
10 year anticipatory guidance and screening
School Development and mental health Nutrition and physical activity Oral health Safety Universal screening: vision, hearing Selective screening: anemia, TB, dyslipidemia
15 year anticipatory guidance and screening
Physical growth and development Social and academic competence Emotional well-being Risk reduction Violence and injury prevention Universal screening: vision Selective: hearing, anemia, TB, dyslipidemia, STIs, pregnancy, alcohol or drug use
2 month immunizations
Hepatitis B Rotavirus DTap Hib PCV IPV
4 month immunizations
Rotavirus DTap Hib PCV IPV
6 month immunizations
Hep B Rotavirus DTap Hib PCV IPV Influenza
12 month immunizations
Hib PCV IPV Influenza MMR Varicella Hep A
4-6 year immunizations
DTap IPV Influenza MMR Varicella
11-12 year immunizations
Influenza Tdap HPV Meningococcal
16 year immunizations
Influenza Meningococcal
CXR findings of TTN vs. RDS
TTN: wet lungs (fluid in fissure), no bronchograms RDS: ground-glass appearance, bronchograms
Treatment of pyelonephritis
IV ampicillin/gentamicin > IV ceftriaxone > IV pipperacilin/tazobactam > IV ciprofloxacin (only if child > 1) Oral cephalexin Renal ultrasound If abnormal ultrasound or recurrent UTI –> VCUC
Criteria of Kawasaki disease
Fever > 5 days Changes in oral mucosa Extremity changes (redness/swelling) Unilateral cervical lymphadenopathy Rash Conjunctivitis
SCFE
Knee pain Medially rotated foot Limited ROM of hip External rotation of hip upon raising leg Dx: lateral and AP xray Tx: internal fixation
Transient synovitis
Recent URI Low-grade fever Tx: rest and ibuprofen; resolves in 3-10 days
Reactive arthritis
A few weeks after recent bacterial gastroenteritis or genitourinary infection; antibodies attack joint a/w urethritis, conjunctivitis
Septic arthritis
Fever Non weight-bearing Elevated ESR Elevated WBC
Henoch-Schonlein Purpura
Non-thrombocytopenic pupura Hematuria Arthritis, esp. of knees and ankles Colicky abdominal pain Recent URI Tx: acetaminophen for pain; self-resolves Complications: chronic kidney disease, intestinal bleeding
Idiopathic thrombocytopenic purpura
Often follows URI Asymptomatic petechiae Thrombocytopenia
Intussusception
Invagination of bowel Lead point may be peyers patch (viral infection), Meckel’s diverticulum, tumor Paroxysms of severe abdominal pain Currant jelly stool Sausage-shaped mass in right abdomen Dx: target sign on ultrasound Tx: air or barium enema
Scarlet fever
Group A strep infection Fever Fine, sandpaper rash that starts in the groin, axillae, and neck but spreads rapidly Pastia’s sign (linear petechiae in body folds) Tx: abx within 9 days to prevent rheumatic fever (tx will not prevent PSGN)
Pyloric stenosis
Projectile, non-bilious vomiting after feeds Palpable olive-shaped epigastric mass Hypochloremic, hypokalemic metabolic alkalosis Dx: pyloric ultrasound Tx: IVF for rehydration, pyloromyotomy
Bordetella pertussis
Triphasic: catarrhal, paroxysmal (whooping cough), convalescent
Laryngotracheobronchitis (croup)
Caused by parainfluenza virus More common in the winter URI symptoms Barking cough Inspiratory stridor
Roseola
Caused by HHV-6 Maculopapular rash that starts on the trunk and spreads outward Rash preceded by fever
Parvovirus B19
Erythema infectiosum Slapped-cheek rash, lacy appearance Pain and swelling of joints May precipitate aplastic anemia
Measles
Prodrome fever Cough, coryza, conjunctivitis Rash spreads downward Koplik spots on buccal mucosa
DKA
Nausea, vomiting, altered mental status, polyuria, abdominal pain, hyperglycemia, hyponatremia, elevated BUN and creatinine (dehydration pre-renal azotemia), normal potassium Dx: random blood glucose > 200, pH
What is associated with a port-wine stain in the distribution of CNV1?
Sturge-Weber syndrome Check for vascular abnormalities in the brain
What is associated with port-whine stains of the face?
von Hippel-Lindau Check for vascular lesions of the retina and brain
Caput succedaneum vs. cephalohematoma
Caput is edema above the periosteum and thus crosses sutures Cephalohematoma is fluctuance below the periosteum and thus doesn’t cross sutures
Infant growth guidelines
Weight should triple and length should increase by 50% by 12 months
Contraindications to rotavirus vaccine
Anaphylaxis to vaccine ingredients
History of intussusception
History of uncorrected congenital malformation of GI tract (e.g. Meckel’s diverticulum)
SCID
Juvenile arthritis
Autoimmune, symmetric arthritis for at least 6 weeks
Labs: elevated ESR and CRP, hyperferritinemia, hypergammaglobulinemia, thrombocytosis, anemia
Presentation and management of Tetrology of Fallot
Clinical features: RVOT obstruction, RV hypertrophy, overriding aorta, VSD
S&S: hypercyanotic, hypoxic “tet” spell, crescendo-decrescendo systolic ejection murmur with agitation or exertion (e.g. feeding, crying, hyperventilation)
Pathophysiology: agitation or exertion → infundibular spasm → increased RVOT obstruction → R to L shunt
Management: knee-chest positioning (kinks femoral arteries → increased systemic vascular resistance → L to R shunt), inhaled oxygen, IV fluids
Holosystolic murmur with late diastolic rumble in children
VSD
Continuous machine like murmur in newborns
PDA
Wide fixed and split S2
ASD
