Pediatrics Flashcards
What signs and symptoms would you expect in a patient with Cystic Fibrosis?
Nasal piolyps
Heat exhaustion from loss of sodium in the sweat
Recurrent respiratory infections (Pseudomonas, Staph aureus)
Cor pulmonale
What is a neuroblastoma? Where is it located?
Malignant tumor of postganglionic sympathetic neurons.
Commonly in adrenal medulla and accordingly secretes catecholamines.
Neuroblastomas are most commonly seen in children of __ old.
Less than 5 years old
Median age of onset is 18 months.
A child presents with chaotic eye movements in all directions, myoclonic jerking of extremities, and history of diarrhea. He also has paraneoplastic signs and symptoms of hypertension, palpitations.
What is the condition?
Neuroblastoma has chaotic eye movements, myoclonic jerking, diarrhea, and paraneoplastic signs and symptoms from excessive catecholamines.
What labs and imaging to order if you suspect a child has a neuroblastoma?
CT or MRI of chest, abdomen, pelvis because you need to find the neuroblastoma.
Bone scan to find lytic lesions
How do you treat a child with neuroblastoma?
Cut it, poison it, burn it.
Surgery, chemotherapy, radiation.
Patients with neuroblastoma have a ___% survival rate but children under ___ yo have a ___% cure rate
40% survival rate
Children under 1 yo have a 90% cure rate
_____ or _____’s tumor accounts for 5% of childhood cancer
Nephroblastoma or Wilm’s tumor
_______ is the most common viral exanthema in children under 2 years old.
Roseola infantum is the most common viral exanthema in children under 2 years old.
______ is the primary renal tumor in children.
Nephroblastoma or Wilm’s tumor
Forchheimer spots are characteristic of _____.
Rubella (German measles)
Nephroblastomas typically occur in children between ____ and ____ years old
Nephroblastomas
A child presents with a palpable abdominal mass and history of nausea and vomiting. You take his blood pressure and he has hypertensive blood pressure. What is the condition and why does he have high blood pressure?
Nephroblastoma accounts for the palpable abdominal mass, nausea and vomiting and the blood pressure is elevated because of renin secretion.
______ is the most common site for metastasis of nephroblastoma.
The lungs are the most common site for metastasis of nephroblastoma.
What labs and imaging to order if you suspect a child has a neuroblastoma?
Renal ultrasound - because it is a tumor of kidneys
Biopsy of tumor
CT scan, MRI
What is the leading cause of death in infants around 12 months?
SIDS
Why order a CT for a child with suspected nephroblastoma? What questions does a CT scan answer?
You want to know the ORIGIN of the tumor, whether there is LYMPH NODE involvement, whether ONE OR BOTH kidneys are involved, whether there is invasion in the MAJOR VESSELS (inferior vena cava) or METASTASIS to LIVER
CT scan will answer these questions.
Is a CT scan or an MRI more sensitive to see if a nephroblastoma has invaded the IVC?
MRI is more sensitive to see nephroblastoma invasion of IVC
How do you treat a child with a nephroblastoma?
Nephrectomy - partial or full
Chemotherapy
Radiation
The 5-year survival rate for nephroblastoma is ____%.
5 year survival rate for nephroblastoma is 80%.
________ is the most common primary ocular malignancy in childhood.
Retinoblastoma is the most common primary ocular malignancy in childhood.
A child presents with vision loss. On examination, you find white pupillary reflex or cat’s eye reflex and strabismus (eyes not properly aligned). What is the diagnosis?
Unilateral or bilateral vision loss with leukocoria (white pupillary or cat’s eye reflex) and strabismus suggests retinoblastoma.
1/3rd of cases are bilateral. Strabismus is because of vision loss.
What labs and imaging to order if you suspect a child has a retinoblastoma?
Ultrasound or CT
How do you treat a child with a retinoblastoma?
Chemotherapy
Radiation
A child presents with a slapped cheek appearance on his face. This fades over 2 to 4 days. What is the condition?
Erythema infectiosum.
What is the virus that causes Erythema infectiosum? What is another common name for it?
Parvovirus B19 causes Erythyma infectiosum aka Fifth’s disease
An 18 month child presents with 1-5 mm pink macules and maculopapules that are not itchy. These appeared after a abrupt loss of high fever (>39.5 C) that had persisted for 3 to 5 days. What condition is this? How long will the rash last? What is a complication of fever?
Pink, non pruritic macules and maculopapules that appear after an abrupt loss of fever is characteristic of Roseola infantum, It is typically seen in under 2 year olds. The rash lasts for about 2 days. Fever may be accompanied by febrile convulsion.
_______ is the organism that causes Roseola infantum. Hence, its other name is ______ disease.
HHV-6 or Human Herpes Virus 6 causes Roseola infantum, aka Sixth disease.
HHV-6 is a _____ virus with a ____-_____ day incubation period.
HHV-6 is a DNA virus with a 5 to 15 day incubation period.
What drugs can you use to treat the child with Roseola infantum?
No drugs exist. Treatment is supportive.
What are two complications or Roseola infantum?
Febrile seizure
Encephalitis
What is another name for German measles?
Rubella
What is another name for measles?
Rubeola
_______ is the organism that causes Rubella.
RNA togavirus (3 day measles).
The incubation period for ____________, the organism that causes Rubella, is ____-____ days.
The incubation period for RNA togavirus is 14-21 days.
___________, the organism that causes rubella, is transmitted by __________.
RNA togavirus is transmitted by droplets.
______ vaccine covers Rubella.
MMR
________ spots are red spots that develop on the ___________ ___________ of a child at the onset of the Rubella rash.
Forchheimer spots are red spots that develop in the posterior hard/soft palate of a child at the onset of the Rubella rash.
A child presents with a rash that starts at the neck and trunk and spreads to the face and extremities. The rash is not itchy. What condition is this?
Roseola infantum is characterized by non-itchy rash that starts at neck and trunk and spreads to face and extremities.
A child presents with an itchy pink rash that starts on the hairline and rapidly spreads to the neck, then trunk, then to rest of the body. What condition is this? What two signs would you want to check?
Rubella is characterized by an itchy pink, discrete, maculopapular rash that starts on hairline, spreads to neck, trunk and rest of body.
An addition to noting the rash is pruritic, you would check for Forchheimer spots on the posterior hard/soft palate, and for painful post-auricular lymphadenopathy.
What is a risk of a pregnant woman being infected with Rubella?
Infection during first trimester of pregnancy may produce congenital abnormalities.
What symptom is seen in adults with Rubella?
Polyarthritis is seen in adults with Rubella.
What labs should you order for a child with Rubella? What must be kept in mind?
ELISA serology for Rubella IgM. IgM may not be detected for 4 to 5 days after onset of rash.
How do you treat a Rubella patient?
Treat the symptoms
________ is the microorganism that causes RUBEOLA
Paramyxovirus causes Rubeola aka Measles
The 3 _____’s of _______, ________, and _________ are characteristic symptoms in a child with Rubeola.
The 3 Cs of Cough, Coryza and Conjunctivitis are characteristic symptoms in a child with Rubeola or measles.
________ spots on the _________ are seen in Rubella but _______ spots on the ________ are seen in Rubeola.
Forchheimer spots on the posterior hard/soft palate are seen in Rubella but KOPLIK spots are grey-white papules seen on the buccal mucosa in Rubeola.
You advise parents to prevent SIDS by placing the infant ________ and not in the _________ when sleeping.
Additionally, they should avoid __________ and __________ the infant. Most of all, protect the infant from exposure to __________.
Finally, to reduce risk of SIDS by 50% at all ages throughout infancy, they should ____________, and risk may also be reduced by using a ____________.
You advise parents to prevent SIDS by placing the infant ON HIS BACK and NOT IN THE PRONE POSITION when sleeping.
Additionally, they should avoid OVERDRESSING and OVERHEATING the infant. Most of all, protect the infant from exposure to CIGARETTE SMOKE.
Finally, to reduce risk of SIDS by 50% at all ages throughout infancy, they should BREASTFEED the child, and risk may also be reduced by using a PACIFIER.
Should an infant younger than 3-4 months share a bed? Should her head be covered with bedding or bed clothing?
NO because risk of SIDS
Most deaths from SIDS occur between ____ and ____.
Most deaths from SIDS occur between 12 am and 8 am.
An Atrial-Septal defect (ASD) is a patent __________. ASD comprises ____ to ____% of congenital heart lesions.
ASD is a patent foramen ovale, or opening between left and right atriums. ASD comprises 6 to 8% of congenital heart lesions.
____ - ____% of ASD spontaneously close if the ASD measures _____.
80 - 100% of ASD spontaneously close if the ASD measures less than 8 mm.
Surgery through ____________ is used to close ASD.
Surgery through catheterization is used to close ASD.
ASD should be ruled out in an adult patient with _____________ and ___________.
ASD should be ruled out in an adult patient with CHF and Pulmonary Hypertension.
A _________________ murmur heard at the ____ intercostal space at the ________________ is associated with an atrial-septal defect.
A CDSE crescendo-decrescendo systolic ejection murmur heard at the 2nd intercostal space at the upper left sternal border is associated with an atrial septal defect.
Blood flow across the AS does not create a murmur at the site of the shunt because there is no pressure gradient between the atria. But an ASD with a moderate to large left to right shunt results in an increased right ventricular stroke volume leading to the CDSE murmur.
Patients with a large left to right shunt often have a _______________ murmur at the _____________ because of increased flow across the ________ valve, and fixed splitting of S2.
Patients with a large left to right shunt often have a Rumbling mid-diastolic murmur at the lower left sternal border because of increased flow across the tricuspid valve, and fixed splitting of S2.
What 3 diagnostic evaluations should you order for an ASD?
ECG
CXR to visualize cardiomegaly due to dilatation of right atrium and right ventricle
Doppler echocardiogram to visualize flow across atrial septum.
___________ is a benign childhood condition characterized by a slapped cheek appearance that lasts for ___-___ days and ____________.
Erythema infectiosum is a benign childhood condition characterized by a classic slapped cheek appearance that lasts for 2 to 4 days and exanthema or widespread rash.
_____________ is the pathogen that causes Erythema infectiosum.
Human Parvovirus B19, an erythrovirus
The five prodromal symptoms of Erythema infectiosum are ________, _________, ________, ________ and _______ and they appear ____ week after exposure and last ___-____ days.
Headache, Fever, Sore throat, Arthralgia and Pruritus appear 1 week after exposure and last 2-3 days.
In Erythema infectiosum, the slapped cheek appearance lasts ___-___ days. Then, ___-___ after it disappears, there is an erythematous _________ rash that extends to the _________ and __________.
In Erythema infectiosum, the slapped cheek appearance lasts 2-4 days. Then, 1-4 days after it disappears, there is an erythematous MACULOPAPULAR rash that extends to the TRUNK and EXTREMITIES.
Can Erythema infectiosum be diagnosed by clinical presentation alone? What labs and imaging should you order for a child with Erythema infectiosum?
Yes, it can be diagnosed by clinical presentation alone.
You should confirm with ELISA to see increased IgM
Western Blot Hybridization
PCR Assay
_______________ is the condition characteristically associated with a palpable sausage shaped mass in the ______ _______ quadrant. This is known as the ___________ sign.
Intussusception is the condition characteristically associated with a palpable sausage shaped mass in the RIGHT LOWER quadrant. This is known as the DANCE sign.
Erythema infectiosum is treated by __________.
Self limited condition. Symptomatic relief with NSAIDs.
__________ is the virus that causes Mumps.
Paramyxovirus is the virus that causes Mumps.
The incubation period for ___________, the virus that causes mumps is ____ - _____ days.
The incubation period for Paramyxovirus, the virus that causes mumps is 12-25 days.
___________, the virus that causes mumps is transmitted by __________.
Paramyxovirus, the virus that causes mumps is transmitted by droplets.
A patient presents with bilateral __________ with increased serum ___________. His ears are displaced __________ and _________. His other symptoms are _________, ________, ________ and _______. What is the condition?
A patient presents with bilateral parotitis with increased serum amylase. His ears are displaced laterally and superiorly. His other symptoms are fever, hadache, myalgia and malaise. The condition is Mumps.
_____________ is the most common congenital heart disease in children.
VSD or Ventricular Septal Defect is the most common congenital heart defect in children.
