Pediatrics Flashcards
What effects on the fetus is associated with maternal use of heroin/opiates during pregnancy? what should these children be monitored for?
increase risk of: fetal growth restriction placental abruption fetal death preterm labor intrauterine passage of meconium infants should be monitored for NEONATAL ABSTINENCE SYNDROME (uncoordinated sucking reflex = poor feeding, irritability, high pitched cry)
what is the cause: 3 day old infant large bump on head scleral icterus, abdominal jaundice swelling over parietal bone - does not cross suture lines
Cephalohematoma
what is the best tx for osgood-schlatter disease?
ibuprofen
What is the caloric requirement for most 1. healthy babies 2. preterm babies 3. VLBW (very low birth weight) infants = <1500g in the first 1 to 2 months of life?
- 100 cal/kg/day 2. 115 to 130 cal/kg/day 3. 150 cal/kg/day
when does a child double their birth length?
4 years of age
what is the Ballard Assessment tool?
uses signs of neurologic and physical maturity to estimate gestational age
For a 18 month old child what are the milestones for: 1. gross motor 2. fine motor 3. language 4. social/adaptive
- walks alone, may climb stairs/runs, can help undress 2. drinks from cup/spoon, make tower of 2 cubes 3. 6 words in vocabulary 4. points to show what he wants, shakes head no
What is the disease: 5 year old with newly discovered cardiac murmur. elfin facies, mild retardation what kind of cardiac defect?
Williams-Beuren syndrome - also HTN, short status Bicuspid Aortic Valve –aortic regurg –aortic stenosis develops 40s-50s
For a 6 month old child what are the milestones for: 1. gross motor 2. fine motor 3. language 4. social/adaptive
- rolls over, sits unsupported, no head lag when pulled to sit from supine 2. reaches for objects, looks for dropped items 3. turns to voice, babbles 4. feeds self, demonstrates stranger recognition (prelude to stranger anxiety)
What is the most likely inborn error of metabolism in a 2 day old infant with severe metabolic acidosis?
Glutathione synthetase deficiency –severe metabolic acidosis + jaundice + hemolytic anemia
what is the infective agent: 7 year old w low grade fever, headache, pruritic rash. Rash began on cheeks, spread to trunk and extremities. Physical exam shows maculopapular rash w lacy, reticulated appearance
Erythema infectiosum - parvovirus B19
cal/mL for 20 cal formula?
0.67 cal/mL
Neonate IV fluids +/- feeds
Increase 20-30 mL/kg/day until 150-160 mL/kg/day Day 1: 60-80 mL/kg/day Day 2: 80-100 mL/kg/day Day 3: …etc… 60+(20day)= max limit
What is dz and defect? Tall 10 year old, arachnodactyly, ligamentous laxity, pectus excavatum
Marfan syndrome - fibrillin
what is the etiology: infant born w part of small bowel protruding from abdomen to the right of the umbilicus.
Gastroschisis —involution of the second umbilical vein
how old is the child: Child says “mama” and “dada” w meaning, follows one-step commands, shows objects to parents to share interest. plays interactive games (peekaboo, waves bye bye). points to desired object
12 months
What electrolyte abnormalities is most often seen in infants of diabetic mothers?
hypoglycemia hypocalcemia hypomagnesemia
what is the dx? 1 month old with head circumference > 100th percentile. mother had no prenatal care. Macrocephaly w no other dysmorphic features. Transillumination of the head is positive.
hydranencephaly
cal/mL for 24 cal formula?
0.80 cal/mL
What will a coin appear like in an AP CXR if in the 1. esophagus 2. trachea
- Round – The coin will face you 2. Linear – You are looking at the coins edge. A Sagital CXR needed to see the front/back of the coin.
Identify the pathogen: 12 day old infant w bilateral eye discharge. conjunctival injection, lid swelling, scant mucopurulent discharge. no rashes
chlamydia trachomatis
What are the two most prevalent causes of acute otitis media?
Streptococcus pneumoniae Haemophilus influenzae, nontypeable
Fluid management for neonate
Based on weight until day 7 Feeding q 3 hours
What is the definition of Small of Gestational age?
Less than 10% for Birth Weight At Term = <2500g At 37 wk = <2000g At 34 wk = <1500g At 31 wk = <1000g At 24 wk = <500g
What are the components of the HEADS adolescent screen?
H-home E-education/employment/eating disorder A-activities/alcohol D-drugs/depression S-safety/sex/suicide
What are the components of an APGAR score?
Appearance (skin color) Pulse (heart rate) Grimace (reflex irritability) Activity (muscle tone) Respiration
What congenital heart defect results in a biscuspid aortic valve and patent ductus arteriosus? neonate has recurrent epistaxis
Coarctation of the aorta a/w –bicuspid aortic valve –persistent ductus arteriosus –ventricular septal defect
What is the current guideline for intrapartum antimicrobial prophylaxis against Group B Strep?
If the mother is in labor with ruptured membranes and one of the following is present: G – Gone – Unknown Status B – Before – Prev infant infected w/ invasive GBS S – Soon – During pregnancy: + bacteriuria, + vag-rec culture During Labor: Premature delivery, ROM >18hrs, +GBS PCR, Maternal Fever
cal/mL for D10 formula?
0.34 cal/mL
Neonate “feeds only” amount per day
Increase 30 mL/kg/day until 150-160 mL/kg/day Day 1: 30 mL/kg/day Day 2: 60 mL/kg/day Day 3: …etc… 30day=max limit
What effect on the fetus can occur from a mother on anticonvulsants?
Cardiac defects Microcephaly, dysmorphic craniofacial features hypoplastic nails, distal phalanges IUGR Mental retardation rare: methemoglobinuria
what is the cranial nerve affected: 1 month old presents w poor feeding, suckling difficulty. she had this problem since birth. pt has a cranial dysfunction
CN IX – glossopharyngeal
What supplement is recommended for exclusively breastfed infants younger than 6 months?
Vitamin D
What are 3 risk factors an infant is susceptible to who is small for gestational age?
Hypoglycemia Hypothermia Polycythemia
What 3 medications are routinely given to newborns?
- Intramuscular Vit K 2. Hepatitis vaccine (HBIG if mother is + for HbsAg) 3. Erythromycin, tetracycline, silver nitrate - for gonococcal conjunctivitis
How old is the child: uses more than 50 words, follows two-step commands, engages in parallel play, stacks 5-6 blocks, turn pages in book, throw ball overhand, refer to themselves as “me” or “I”
2 years old -uses two word phrases
A 7cm mass is palpated on the right side that does not cross the midline in a 5 month old. The child was born large for gestational age with macrocephaly, macroglossia, hypospadias. what is the etiology?
Wilms Tumor - associated with Beckwith-Wiedemann syndrome = a genetic overgrowth syndrome a/w omphalocoele, hemihypertrophy, hypoglycemia, large for gestational age, other dysmorphic features.
A 2 year old with 102.6F fever has a seizure. what should you tell the parents?
Simple Febrile Seizure = reassure parents
cal/mL for 22 cal formula?
0.73 cal/mL
Pounds to grams conversion
1 lb. = 453.59 g
What congenital heart condition results in a cleft anterior mitral valve leaflet?
ostium primum atrial septal defect –clefts in anterior leaflet of the mitral valve –a/w anomalies of the AV valves –possible defects on the ventricular septum
A child born to a diabetic mother has an absent Moro reflex on the left. left SCM appears to be in spasm. what is the cause?
clavicle fracture = absent moro reflex on affected side + spasm of SCM
What type of congenital heart defect: neonate is born and initial physical exam is unremarkable. holosytolic murmur is heard on day 5 of life
Perimembranous VSD –upper ventricular septum close to aortic/mitral valve –left to right shunt occurs several days after birth when pulmonary vascular resistance decreases
What does it mean to have a term pregnancy?
born at >37 weeks gestation
What are 3 side effects of stimulant medication in a child with ADHD?
- decreased appetite 2. insomnia 3. decreased growth velocity
How old is the child: says “mama”, ball”, “yes”, “no”, “hi” turn pages in a book greet people, show empathy listen to story, drink from a cup
15 months
What are the contraindications for a child against receiving a DTaP vaccination?
- serious allergic reaction/anaphylaxis after a previous dose 2. encephalopathy within 7 days after dose
3 yo M w/ 3 day hx of fever, fussiness, stiff neck, decreased oral intake. Hx shows Upper resp infection one week ago. throat gram stain gram-positive organisms. Confirm w/ lateral neck radiography… Dx?
Retropharyngeal Abscess –hx of upper respiratory, throat/ear infection –may present w torticollis –S. pyogenes, S. aureus
2-day old male w/ numerous small papular, and pustular lesions w/ surrounding erythema on the anterior chest and abdomen. Multiple eosinophils w/o microbial organisms on Bx… Dx?
erythema toxicum neonatorum
Age? 10-25 words, names one picture on demand. engages in pretend play (feeding doll), laughs in response to others, walk up steps, run, stack 2-3 blocks, use spoon/cup
18 months
what are 5 alarming symptoms following vaccination?
FUCSA 1. fever > 104F 2. unresponsiveness of infant 3. crying > 3 hours within 48 hrs 4. seizure within 3 days 5. allergic reaction
what is the dx: 6 year old male w painful oral lesions. had similar episode one year ago. multiple round, clearly defined, small buccal ulcerations w a grayish base that are tender to palpation. lips are normal without lesions. oropharynx is clear w/o erythema, exudate or tonsilar enlargement
aphthous stomatitis (canker sores)
What are the 3 circumstances that “Failure To Thrive” describes?
- Weight falls below the 3rd percentile 2. Weight for height/length falls below the 3rd percentile 3. Rate of weight gain slows compared to previous growth (growth chart crosses two or more major percentiles)
What are the screening guidelines for diabetes? when do you start screening? frequency?
Overweight (>85% weight + height or >120% weight for ideal height) +2 Risk factors: 1. fam Hx 2. race = NA, AA, Hispanic, Asian 3. signs of insulin resistance 4. maternal Hx of diabetes/gestational diabetes
what are 5 alarming symptoms following vaccination?
- fever > 104F 2. persistent crying > 3 hours within 48 hrs 3. seizure within 3 days 4. unresponsiveness of infant 5. signs of severe allergic reaction
dx: 4 year old w fever, respiratory distress. toxic appearing, drooling, sitting upright, holding neck in hyperextension. pt rapidly develops stridor and cyanosis
Epiglottitis –lateral neck x-ray = thumb sign
What is the most likely inborn error of metabolism in a 2 year old that develops severe cutaneous photosensitivity?
Hartnup disease - decreased availability (transport) of tryptophan for niacin synthesis
What effect on the fetus/pregnancy can Cocaine and other stimulants cause?
Vasoconstriction = placental insufficiency and low birth weight
when does an infant 1. double 2. triple their birth weight?
- 5 months 2. 12 months
What immunologic abnormalities are found in ataxia-telangiectasia?
undetectable IgA levels elevated IgM normal IgG
what is the pathogen: 5 year old w axillary lymphadenopathy. small wound on palmar surface of the third digit adjacent to the distal interphalangeal joint. Cultures are obtained resulting in growth on Warthin-Starry stain.
Bartonella henselae
how does depression in adults differ than depression in adolescents?
Adult depression often includes early morning waking with difficulty sleeping at night
5 year old female with blood in underwear -multiple pathological fractures -tanner stage 2 breast development -multiple hyperpigmented irregularly shaped cutaneous macules
McCune-Albright syndrome –GNAS gene GnRH independent, peripheral precocious puberty from ovarian hyperfunction and cyst formation, episodic estrogen secretion –unpredictable vaginal bleeding –breast development w/o growth of pubic hair –bone lesions - polyostotic fibrous dysplasia
6 year old with sore throat, painful swallowing -no cough -febrile -bilateral tonsillar hyperemia, edema -lymph node enlargement in the anterior cervical chain -diffuse, pimply sandpaper-type rash on trunk and extremities
Scarlatina = rash that appears w group A streptococcal infection 1. fever 2. tonsillar exudates 3. cervical adenopathy 4. absence of cough
What congenital heart condition results in a persistent left superior vena cava
Total anomalous pulmonary venous connection –cyanotic –four pulmonary veins fails to make normal connection in left atrium and drain into systemic venous circulation
what is the most appropriate step after suspecting intussusception?
air contrast enema
What congenital heart defect causes a redundant tricuspid valve leaflet
Ebsteins anomaly –hypoplastic right ventricle –enlarged right atrium –most patients also have an ASD
when should tympanostomy tube placement be considered?
Otitis media w effusion (OEM) for 4 months + hearing loss/documented language/developmental delay
What effect on the fetus can tobacco use cause?
Low birth weight
what is the cause: lethargic newborn lump on scalp that is slowly growing firm, fluctuant mass overlying the occiput which crosses over to the left parietal skull
subgaleal hemorrhage
What are the four criteria in the diagnosis of diabetes?
- HbA1c > 6.5 2. fasting glucose >126mg/dL 3. 2 hour fasting glucose > 200 mg/dL 4. random plasma glucose > 200 mg/dL
Neonate caloric intake goal
100-110 cal/kg/day
Pathological Jaundice HPI
Onset: <24 Hrs Bilirubin Involved: Direct/Conjugated, >2 or >20% Total Rise: >5/day or >0.2/Hr Resolve: 14 days+
Pathological Jaundice HPI
Onset: <24 Hrs Bilirubin Involved: Direct/Conjugated, >2 or >20% Total Rise: >5/day or >0.2/Hr Resolve: 14 days +
Physiological Jaundice HPI
Onset: <7 days Bilirubin Involved: Indirect/Unconjugated, <10% Total Rise:<5/day or <0.2/Hr Resolve: w/n 10 days
Caffeine Citrate is used for…
Obstructive/Mixed/Central Apnea in Preterm Neonates <35wks
Methylxanthine is used in the NICU for…
Apnea control, precursor for caffeine
Central Apnea is …
lack of inspiratory effort
Mixed Apnea is …
Upper airway obstruction w/ inspiration that follows/precedes Central Apnea
Sx of Neonatal Abstinence Syndrome
High Pitched Cry Irritable Poor Feeding Poor Coordinated Suckle
Obstructive Apnea is …
Inspiratory effort present but ineffective d/t upper airway obstruction
A newborn male child has a flat facial profile, upslanted palpebral fissures, epicanthal folds, a small mouth with a protruding tongue, small genitalia, and simian creases on his hands. What of the following chromosomal disorders is most likely in this child?
Tri 21
Sign/Sx of congenital hypothyroidism
Cretinism – severely stunted physical and mental growth
Sign/Sx of congenital hypothyroidism
Cretinism
Deficiency that causes: Night blindness, xerophthalmia, Bitot spots, follicular hyperkeratosis; immune defects
Vitamin A
Deficiency that causes: reduced bone mineralization
Vitamin D
Deficiency that causes: Hemolysis in preterm infants; areflexia, ataxia, ophthalmoplegia
Vitamin E
Deficiency that causes: Prolonged prothrombin time; hemorrhage
Vitamin K
Deficiency common w/ Malabsorption; breastfed infants
Vitamin D
Deficiency common with protein-calorie malnutrition; malabsorption
Vitamin A
Sx: Pitting Edema, Hypo-albumin, normal weight, muscle atrophy, abdomen is distended, bowel sounds hypoactive. moon facies
Kwashiorkor – Protein malnutrition African child
Sx: Muscle and adipose wasting, hair and skin is dry and thin, bradycardia, hypothermia
Marasmus – Complete Malnutrition Concentration camp
Drugs/Intoxications that cause hypoglycemia
SAD Q-TIP PA Val Salicylates Alcohol Diabetic Medication Quinine TMP-SMX Insulin Propanolol Pentamidine Ackee Fruit Valproic Acid
Hypoglycemia without ketonuria suggests…
hyperinsulinism or a defect in fatty acid oxidation.
Scalp swelling that extends across the midline, and contains serosanguinous, subcutaneous, extraperiosteal. Involves bleeding below the scalp and above the periosteum
Caput Succendaneum
Bleeding between the skull and the periosteum, does not cross suture lines.
Cephlahematoma
A narrow pulse pressure is seen with…
pericardial tamponade, aortic stenosis, and heart failure
A wide pulse pressure may be seen with…
PDA, truncus arteriosus, AV malformations, aortic insufficiency, anemia, vasodilation with fever or sepsis.
LLSB or between LLSB and apex Vibratory, musical Systolic ejection murmur decreases in upright position
Still/Vibratory/Flow/Innocent Murmur
Balloon septostomy is…
the widening of a foramen ovale, patent foramen ovale, or atrial septal defect via cardiac catheterization to allow flow of oxygenated blood in the presence of CHD, to prepare for, or sustain until corrective heart surgery.
Down Syndrome heart defects
VSD AVSD Cushion defects
Cyanotic CHD
Right to Left Shunt 1. Truncus Arteriosus 2. Transposition of the Great Vessels 3. Tricuspid Atresia 4. TOF 5. TAPVR 6. Hypoplastic Left Heart
Acyanotic CHD
Left to Right Shunt – “Holy” Child ASD VSD PDA CoA
Mid-systolic click indicates…
Mitral valve prolapse
Turner Syn heart defects
Bicuspid Aorta Coarctation of the Aorta
Trisomy 18 Heart Defects
ASD VSD PDA Bicuspid Aortic/Pulmonary Valve CoA
Trisomy 13 Heart Defects
ASD VSD PDA Bicuspid Aortic/Pulmonary Valve CoA
Hyperpigmentation w/ Vitiigo and Hypoglycemia, Hyopnatremia, Hyperkalemia
Addison Disease, get ACTH stimulation test
Pt presents w/ Floppy Baby Small Head Bulbous nose Cleft Palate Forked Uvela TOF Interrupted Aortic Arch Truncus Arteriosus Long, tapered fingers … Dx?
Velocardialfascial syndrome
Fluid Maintenance Therapy Guideline
4-2-1 4 ml/kg/hr for the first 10 kg 2 ml/kg/hr for the next 10 kg 1 ml/kg/hr for remaining kg Over 20 kg: Wt in kg + 40 = Maintenance ml/kg/hr
Painful Buccal/Lip/Gum Ulcers along w/ GU Ulcers that scar and Uveitis…Dx? Other findings?
Bechet Dz Red papule following skin prick, skin lesions, vasculitis
IV Flow Rate Calculation
Vol (Drops per min)/time in min
Drop rates for: Blood Regular Microdrop
Blood = 10/ml Regular = 15/ml Microdrop = 60/ml
Fxn abdominal pain or HA that has no constitutional Sx…Dx?
New life stress
Swollen knees/ankles Abdominal pain Purpuric rash on feet/legs/buttocks Renal pathology
Henoch-Scholein Purpura
Infant presents w/ severe cough, resp failure, apnea. What vaccine was missed by the older sibling.
Tdap
First line tx for acute OM
High Dose Amoxicillin
Fever Achy joints HTN Edema Cough Dyspnea Hemoptysis Diffuse alveolar hemorrhage Renal Sx
Goodpasture Syn
Cardiac finding in Marfan
Mitral prolapse
Long Thin Face Hyperflexible Pectus Excavatum High arch palate Dental Overcrowding Scoliosis Dx?
Fragile-X
Follow up management on UTI
Renal ultrasound >> all Males >> all Females <5 yo >> Females >5 yo w/ more that two UTI
Small Eyes Flattened nasal bridge Thin lip Mid-fascial hypoplasia Cardiac septal defect Dx?
Fetal Alcohol Syn
Asx infant w/ possible drain cleaner ingestion. PE unremarkable, next step….
Admit for possible esophageal endoscopy
Diffuse rales and wheezing Hyper inflated Lungs Flat diaphragm Patchy atelectasis Hypoxia Cough Reduced appetite
RSV Bronchiolitis
Newborn Reflexes
BDRMSTG Moro Dance Root Suck Tonic Neck Babinski Grasp
CF pt w/ pancreatic dysfxn presents w/ hemolytic anemia. Why?
Deficient in Vit ADEK d/t decreased lipase. Extensive Vit E deficiency may lead to hemolytic anemia.
Children w/ high milk and low meat intake are at of …
iron deficiency anemia
Fever, weight loss, painless nodes… next step?
CXR
Easy bruising, hypermobile, hyperelastic skin, slow wound healing… Dx?
EDS
Full testicle with twisted mass, non-tender, positive cremaster
Vericocele
DKA pt present w/ acidosis, hyponatremia, hypokalemia. IV NS bolus given next step?
IV NS w/ potassium The hyponatremia is dilutional
Physical Nadir of a newborn
Infant 6-12 weeks has a drop in Hgb to 9-11. Normal occurrence, no intervention needed.
Infant has increased renin levels, other vitals/labs normal. Most likely causes (3)
Renal Thrombosis CoA Congenital Renal Abnormality (Stenosis, Parenchymal Disease, Wilms Tumor)
Aniridia presents w/…
absence of pupil
Infant presents w/: Dysuria Hematuria u/l painless abdominal mass HTN Fever Constipation Aniridia
Nephroblastoma: Wilms Tumor
A 2-year-old girl is brought to the emergency room after her mother discovers a mass in the girl’s abdomen while bathing. The girl occasionally cries when urinating, but is otherwise asymptomatic, without any abdominal pain. On exam, she is found to be hypertensive. There is a palpable, non-tender mass on the right side, which does not cross the midline. A chest radiograph is ordered to assess for lung involvement.
Wilms Tumor
Toddler w/: Chest pain Dyspnea Short PR Wide QRS Normal Sinus Rhythm
WPW
6 mo w/ nl birth, no PMH presents w/ neuro delay, exaggerated startle response, and no organomegaly…Dx?
Tay-sachs
15 mo old w/ nl birth, no PMH presents w/ gargoyle facies, clouded corneas, heart dz, skeletal deformity, hepatomegaly, development delay… Dx?
Hurler syn
3 mo w/ nl birth, no PMH presents w/ hepatomegaly, FTT, Resp Tract infxn, irritable. Progresses to hypotonia, develop delay, spastic, rigid, and introversion… Dx?
Neimann-Pick Dz
3 yo w/ nl birth, no PMH presents w/ course facies, short for age, hepatosplenomegaly, Skeletal abnormality, vision loss, hearing loss, retardation… Dx?
Hunter Syn
Tx for Digoxin toxicity
Digoxin Immune Fab
Testicular cancer suspected. Initial work up includes…
U/S AFP Beta-hCG
6 mo girl w/ nl birth, no PMH presents w/ rapid decline in motor skills, hypotonia, hand-wringing, introversion, FTT…Dx?
Rett Syn, X-Linked Dominant
1 wk old w/ nl birth, no PMH presents w/ a 2 cm raised well circumscribed non-fluid lesion over the lumbar spine. Next step?
U/S to r/o spina bifida
9 mo old w/ nl birth, no PMH presents diarrhea, abdominal pain, distention, flatulence, delay tooth eruption, aphthous stomatitis, growth delay, tympanic abdomen… Dx?
Celiac Sprue
2 yo prev healthy child presents with black maxillary teeth and nl mandible teeth… Dx?
Bottle Feeding Caries
Ig _ crosses the placenta and transfers some imunity
IgG
Cyanotic one day old presents w/ grade 1 gallop, hepatomegaly, diminished pulses, RVH…Dx?
TAPVR
Asx toddler turns blue and faints following a tantrum…Dx?
Breath-holding
Two week old presents with a painless mastoid mass and head tilted/flexed to the same side.
Congenital Torticollis
16 yo w/ Fever, HA, Sore Throat, Abdominal Pain…Dx?
Strep Pharyngitis
Tongue coated in white w/ prominent red papilla
Strawberry Tongue
Low back pain that decreases throughout the day, fatigue, pain in achilles/plantar fascia…next step?
X-ray of the spine
Causes for fractures in infants other than abuse…
Rickets (Secondary Hyperparathyroid) Osteo imperfecta
Neonate presents w/: Irregular port wine stain on face that follows CNV Hamartoma of eye/skin/CNS Seizures Mental retardation Amblyopia …Dx?
Sturge-Weber Syn
Infant presents w/: Posterior Fossa Abnormality Hemangioma Arterial Abnormality Cardiac Defect Eye Abnormality … Dx?
PHACE Syn
Child presents w/ 6+ cafe au lait spots >5mm ADHD Axillary Freckles FamHx of seizures …Dx?
NF1
Reasons not to breastfeed…
Varicella 5 days prior/2 days after birth Illicit drug use Active, untreated TB Chemo HIV Active HSV Infant w/ galactosemia Radiation
Tx for labial fusion…
Estrogen Cream
Newborn presents w/ Large hands and feet Hypoplastic concave nails Diminished pulse in legs Redundant neck folds … Dx?
Turner Syndrome
Fever, rash, splenomegaly, sore throat that follows an ampicillin tx…
Mononucleosis
Newborn presents w/ Microcephaly Retardation Thrombocytopenia Blindness Hearing loss Jaundice Anemia Scattered calcification throughout cortex … Dx?
Toxoplasmosis
Prev healthy 3 yo presents w/ hoarseness, PE unremarkable…Dx?
Vertical HPV in resp tree
Flu like Sx with tender adenopathy along w/ vesicles on GU and cervix… Dx?
HSV
Short child w/ recurrent skin infections, abscess formation, osteomyelitis and PNA w/ a likely immunodeficiency… Dx?
Chronic Granulomatous Dz
Pseudo albinism Ocular albinism Frequent infections …Dx?
Chediak-Higashi Syndrome
Every 21 days (-ish) pt presents w/: Oral ulcers Fever Stomatitis Pharyngitis … Dx?
Cyclic Neutropenia
Neonate presents w/ Poor Tone Prolonged Jaundice Enlarged fontanelle Excessive sleep Hoarse cry FTT Coarse facies Constipation … Dx?
Hypothyroid
Infant presents w/ Vomiting Musty smell Eczema Seizures Self-mutilation … Dx?
PKU
Infant presents w/ Jaundice Irritable Hepatomegaly Smells of boiled cabbage … Dx?
Tyrosinemia
Infant presents w/ Projectile vomit Lethargic Smells of sweaty feet… Dx?
Isovaleric Acidemia
Greasy, scaly plaque that causes hair loss…
Seborrheic Dermatitis
Uniformly broken hairs, black dots on scalp, circle lesion…
Tinea Captitis
Permethrin is used to tx …
Lice and scabies
Pneumococcal pneumonia classically presents as…
Sudden onset of high fever Respiratory distress Lobar consolidation Elevated white blood count with left shift
GBS presents as …
Sudden onset of respiratory symptoms Hypothermia Respiratory failure Diffuse bilateral granular infiltrates Neutropenia with marked left shift
Causes of PNA in neonate…
GBS E. Coli Listeria
Patient between 5 to 20 years of age with a several day or week history of cough and low grade fever who has evidence of pneumonia likely has …
Mycoplasma Tx w/ macrolide
Age? Uses dada or mama specific to each parent Uses simple gestures (waving bye) and copy gestures Respond to simple requests and pull up to stand.
12 months
Age? Puts on clothing Washes and dries hands Combines two different words Name a picture, and can throw a ball overhand
24 months
Age? Dress with supervision Copy a cross Draw a man of three parts Knows first and last name Use plurals.
48 months
Nenonate presents w/
Fever
Decreased Feeding
Sunken Fontenelle
Normal - High Urine output
Hypernatremia
Dilute Urine
… Dx?
DI
Electrolyte disturbances in hyperthermia
Elevated
- Creatine Kinase
- Hyperphosphatemia
- Hyperuricemia
- Cardiac Troponin I
- Hyperkalemia
Depressed
- Hypoalbuminemia
- Hypocalcemia
Infant has high white count and recurrent infections w/o pus. Sig PMHx include delayed cord seperation at birth…Dx? Transmission?
LAD
Autosomal Recessive
4 wk M presents w/ vomiting, dehydration, hyponatremia, hyperkalemia.
Dx?
CAH, most likely 21-hydroxylase-deficency
Excessive circulating thyroid stimulating Ig
Dx?
Graves Dz
Mom has fever, sore throat, headache, tender posterior auricular and suboccipital lymphadenopathy, and a diffuse rose-pink colored maculopapular rash…
neonate most likelt to present w/…
Rubella Congenital Defects:
- Hearing Loss
- Cataracts/Glaucoma
- PDA/Aortic Stenosis
- Blueberry Rash
A child who develops intermittent excess gas and diarrhea suggests …
an infectious agent or food intolerance
Teenager w/ fever, joint pain, weight loss, pallor, and joint edema. Evaluate for …
ANA, SLE
Topical benzocaine has recently been identified as a cause of …
methemoglobinemia
Tx for OE
Topical steroids and oral Abx
Howell Jolly bodies indicate …
Asplenia/Hyposplenia
Tx w/ phenytoin can cause … anemia, … will be seen on blood smear
Folate Deficent
Hypersegmented PMN
Micro Anemia + Basophilic Stippling
…Dx?
Lead Intoxication
The only reasons not to give a vaccines…
- Anaphylactic allergy
- Live vaccines in severely immunocompromised
- Encephalopathy within seven day
- MMR or varicella in the pregnant patient
Emperic Tx for PID
Ceftriaxone
Doxycycline
Metronidazole
First meningococcal vaccine given at ___ yo.
2nd at ___ yo>
11
16
Premature infant being started on enteral feeds presents w/ temperature instability, abdominal distension, increased feeding residuals, apnea, and bradycardia.Imaging shows dilated loops, abnormal gas pattern, and bowel wall edema
…Dx?
Necrotizing Enterocolitis
3 to 4 mo w/ “doll’s face” presents with seizures, hypoglycemia, hepatomegaly, lactic acidosis, massive hyperlipidemia, and hyperuricemia.
Von Gierke disease
2 mo presents w/ hypotonia, macroglossia, hepatomegaly, and profound cardiomegaly
Death w/n first year d/t cardiorespiratory failure
Pompe disease
Newborn presents w/ bulging, thin membrane over the introitus… Dx?
… Next step?
Imperforate hymen
U/S
Yellow fever is a mosquitoborne virus infection endemic in parts of northern South America and in central Africa. The classic description is of Child w/ recent travel presents w/ sudden onset of fever, headache, myalgia, lumbosacral pain, nausea, and vomiting, flushing of the face, conjunctivitis, and red tongue. Sx improve for a few days, but then a recurrence of the fever, gastrointestinal symptoms, jaundice, renal failure, seizures, and coma ensue.
… Dx?
… Tx?
Yellow Fever
Supportive
A soft, short, medium pitched systolic ejection click at the apex of the heart that does not change with Valsalva maneuver suggests a …
bicuspid aortic valve
Pt w/ sickle cell and history of fever, cough, and increased work of breathing suggests …
pneumonia or chest syndrome
Appy is suspected, next step?
U/S
Sickle cell pt has osteomylitis, most common bug?
Salmonella
An afebrile child with a recent upper respiratory infection who has groin and thigh pain, and mild limp is suspicious for having …
toxic (transient) synovitis
HTN is more prevelant in babies that spend time in …
rhe NICU
