Pediatrics Flashcards
What three qualities characterize constitutional bone delay?
Delayed growth spurt
Delayed puberty
Delayed bone age
MCC of short stature and pubertal delay in adolescents?
Constitutional growth delay.
When does constitutional growth delay occur?
Children born with normal weight and height at birth experience a slowed height velocity between 6 months to 3 years.
In constitutional growth delay, when should normal growth resolve?
At 3 years of age the child regains normal growth velocity and follows the growth curve at the 5th to 10th percentile. However, puberty and adolescent growth spurt are delayed, though they will occur. They will reach a normal adult height.
3yo boy presents with fever, cough, SOB. He recently recovered from Giardia and has an Hx of lobar pneumonia and ear infxns that were recurrent since age 6months. He has a mild fever. PE reveals small tonsils and crackles in the right lower lobe. He has normal growth. Cause of reccurrent infxns?
X-linked agammaglobinemia (Bruton agammaglobinemia). This results from failure of B cell development. Small or absent lymph tissue with recurrent sinopulmonary and GI infxns occur after maternal antibody protection wanes. T cells are normal. Rx: Ig replacement and antibiotics.
X-linked agammaglobinemia (Bruton agammaglobinemia) presents as?
B cell failure causing small/absent lymphatics with recurrent sinopulmonary infxns and GI infxns after maternal antibodies wear off (after 6 months).
Pts. with recurrent severe viral, fungal, and bacterial infxns who are also failure to thrive. Dx?
Adenosine deaminase deficiency. This causes SCID (severe combined immunodeficiency).
Patients with complement deficiencies are at increased risk of what diseases?
Disseminated bacterial infxns, especially those caused by encapsulate species (e.g. S. pneumoniae, N. meningitidis). Giardia is not problematic in complement deficiency.
Chronic granulomatous disease is due to?
Impaired oxidative burst that leads to recurrent skin/pulmonary infxns with catalase+ organisms (S. aureus, Serratia marcescens)
DiGeorge syndrome (thymic hypoplasia) results in?
Hypocalcemia
Cardiac defects
Failure to thrive
Recurrent infxns (loss of T cell maturation)
Common variable imunodeficiency presents with?
Normal B cells, but reduced IgG, IgM, and IgA.
Selective IgA deficiency results in what Sx?
Usually asymptomatic, but some have recurrent respiratory, GI, urogenital infxns due to low serum IgA. IgM is normal.
Patients with selective IgG subclass deficiencies have?
Recurrent infxns with low or normal total IgG and normal IgM.
Young child presents with severe and recurrent sinopulmonary infxns as well as tympanostomy tube Hx and poor growth. His IgG and IgA are markedly decreased, but his elevated IgM is normal. Dx?
Hyper IgM syndrome. Presents with recurrent sinopulmonary infxns and poor growth. The lack of normal CD40 ligands prevents B cells switching to produce IgG and IgA, thus, encapsulated bacteria cause infxns often Opportunistic infxns (PCP) also can occur. Rx: IV Ig and ABx.
Does a child with a grade III murmur that increases with standing, but decreases with laying supine warrant an echo?
Yes. The decreased preload when standing results in low venous return and preload leading to worsened obstrxn due to lower LV size. Harsh, holosystolic, or diastolic murmurs are concerning.
Does a child with a grade II murmur that decreases with standing, but increases with laying supine warrant an echo?
No. This is more likely to be an innocent murmur. Grade 1 or 2 murmurs which decrease with standing and valsalva and are louder when supine are typically benign.
Newborn presents with a 5-cm skin patch of dark skin with overlying hair on the upper back. Likely Dx?
Congenital melanocytic nevus. Solitary, hyperpigmented lesions with increased density of overlying dark, coarse hair. 5% increase in melanoma risk.
Asian newborn presents with dark, blue-gray patches on the skin, especially the lower back. Dx?
Mongolian patch aka congenital dermal melanocytosis. These are poorly circumscribed and often fade with time.
Blanchable red patch in newborn on one side of the face that overlies the eye. Dx?
Nevus flammeus aka port-wine stain. These tend not to regress.
Blanching pink patches that fade with time. Tend to be located on the eyelids, glabella, and nape of neck in kids. Dx?
Nevus simplex.
1 month old presents with frequent regurgitation of mild and painless bloody stools. He appears to have eczema on physical exam. Dx?
Milk-protein induced enterocolitis. A non-IgE mediated immunologic response to proteins in formula or milk causes inflammation in the colon leading to the Sx. Prognosis is excellent and most kids tolerate milk/soy products by 1 year old.
Children with sickle cell trait are at increased risk for?
Renal issues, especially painless hematuria resulting from sickling in the renal medulla. Isosthenuria (trouble concentrating urine) is also common and can present as nocturia and polyuria.
Sickle cell trait Hgb electrophoresis pattern?
50-60% Hgb A and 35-45% Hgb S.
Sickle cell disease Hgb electrophoresis pattern?
85-95% Hgb S and 5-15% Hgb F.
Hgb electrophoresis pattern in person without sickle cell (normal person)?
~99% Hgb A and <1% Hgb F.
Rx for pinworms (Enterobious vermicularis)?
Albendazole OR
pyrantel pamoate. These are given for the patient and all household contacts.
A febrile child presents with painful eyelid swelling and erythema. Eye movements are intact and no proptosis or conjunctival injeciton are noted. Vision is normal. Dx?
Preseptal cellulitis. The painful eyelid swelling with erythema is typical preseptal cellulitis. The infection is isolated to the anterior orbital septum and does not affect vision or the eye globe as in orbital cellulitis (proptosis/visual changes).
Young boy presents with redness and painful eyelid swelling. He also complains of seeing double. He is febrile and the right eye is abducted laterally. Dx?
Orbital cellulitis.
Child presents with swelling of the face and trouble breathing. His hands and legs are also swolen. No rash is present. He is afebrile with normal vitals otherwise. Mom states this has occurred before after getting a tooth extracted when he was 2. He has had bronchitis for a week. What is the pathology behind the disease?
He has a C1 inhibitor deficiency that has led to angioedema. Hereditary angioedema is rapid onset edema of the face, extremities, genitals, trachea, and abdominal organs without urticaria. Deficiency in C1 inhibitor eads to elevated C2b and bradykinin. ACE inhibitors can lead to this also. Episodes usually follow infxn or surgery/trauma.
A child presents after emigrating to the US. He has aheart murmur and has Hx of febrile illness 1 year ago with sore throat and joint swelling. Loud 1st heart tone with mid-diastolic rumble at the apex is present. What is the Rx, if any?
Long-term Penicillin. People with RH have an increased risk of recurrent spisodes and progression of the RH with repeat GAS infxn. Continuous antibiotic prophylaxis is recommended to limit progression.
What Xray finding in a child under 3 is common and normal within the chest?
Thymus. The thymus is quite large in children of this age.
What Xray finding in a child under 3 is common and normal within the chest?
Thymus. The thymus is quite large in children of this age.
What comorbidities are common in a child with absence Sz?
ADHD and anxiety.
What is the Rx in a child with absence Sz?
Ethosuximide.
Children living in a home before what year are at risk for lead poisoning?
- Usually houses under renovation or with peeling paint are the problem. Sometimes, children playing with toys from older generations may get it also.
What is the most appropriate next step in suspected lead poisoning?
Measure venous lead level, then if the levels are elevated, remove the child to a new environment.
When should aplastic anemia be suspected?
In any patient with pancytopenia following drug intake, toxin exposure, or viral infxns. Profound hypocellularity in the marrow biopsy with a decrease in all cell lines (including reticulocytes) and fatty infiltration of the marrow.
What physical quality leads to increased risk for rickets?
Darker skin pigmentations.
Child presents with a larger left arm and leg than the right and an enlarged, protuberant toungue. He is 99% on the growth chart and has an umbilical hernia. Dx?
Beckwith-Wiedemann syndrome. Inherited alteration to chromosome 11p15 that predisposes to macrosomia, macroglosia, hemihyperplasia, hernia, and hypoglycemia. Must be monitored for Wilms tumor or hepatoblastoma (do US).
Proper management of a child with head trauma who briefly lost consciousness, but is vomiting. No Sz/AMS.
Head CT without contrast. MRIs take too damn long.
MCC of meningitis in kids 3 months-10yrs?
S. pneumoniae
N. meningitidis
MCC of meningitis in kids ≥11yrs?
N. meningitidis
What classic characteristic would differentiate meningitis due to H. flu from N. meningitidis?
Petechial rash in N. meningitidis. H. flu does not have a rash.
A child with constipation and an anal fissure presents. He is normal physically despite the fissure. Appropriate Rx?
Laxatives. Constipation is common in toddlers due to transition to solid foods, milk, toilet training, and entrance to school.
Child presents with uncontrollable writhing movements of the arms/hands and Hx of a sore throat that resolved a month ago. Vaccinations are up to date and PE reveals pericardial friction rub with Sub Q nodules on the hands. ESR is elevated and ECG shows diffuse PR depressions and ST elevations. DX?
Acute Rheumatic Fever due to S. pyogenes. Typical symptoms can be recalled from the acronym JONES. Joint pain Heart Nodules Erythema marginatum Syndenham's chorea
13yo girl with Down Syndrome presents with positive babinski sign and trouble moving her legs. She is ataxic and dizzy. She has urinary incontinence. Dx?
Atlantoaxial instability.
Baby presents with stridor. He is not sick and has no signs of illness. Eating normally. The stridor is inspiratory and expiratory. It is worse with crying. Breathing treatments are not useful. The stridor improves with extension of the neck, but not when prone. Dx?
Vascular rings from the aorta are encompassing the trachea. Inspiratory stridor that is most prominent in infants. It is improved by extending the neck. Think: the extensions from the aorta do not block the airway when the neck is extended too.
Infant presents with stridor that is inspiratory and expiratory. No recent illness and eating normally, the stridor improves when the child is prone, but worsened when supine. Dx?
Laryngomalacia. This condition is due to collapse of the supraglottic structures during inspiration. Think, laryngomalacia improves when the child is “laying flat” on their belly.
What is the MCC of pneumonia in a child under 20 with cystic fibrosis? After 20?
<20yo: S. aureus
>20yo: Pseudomonas *Though both are possible in either age group, younger CF patients are at higher risk of S. aureus than adults. Both should be considered as a potential infective organism in either age group.
What is the proper testing for a neuroblastoma?
Serum/urine catacholamines and homovanillyic acid as well as vanillyic acid are elevated. Arising from neural crest cells, the neuroblastoma arises from sympathetic chains and the adrenal medulla. Calcifications and hemorrhgage are classic on xray.
17yo female presents with difficulty breathing. Swollen lymph nodes and a red, sore throat and fatigue are her symptoms. Monospot is positive. PE reveals swollen tonsils and difficulty swallowing. Rx?
Steroids must be administered in rare cases to avoid airway obstrxn in mono.
Introduction of Cow’s milk in an infant prior to 1 year and prematurity can lead to risk of what deficiency?
Iron. Thus, iron must be included with vitamin D in all preterm, exclusively breastfed children until they reach 1 year old to avoid deficiency.
When are the varicella vaccines typically administered?
1 and 4 years old.
Proper management of preseptal cellulitis vs orbital cellulitis?
Preseptal requires ABx orally only, while orbital cellulitis requires IV ABx +/- surgery.
Child presents with flat head on one side (plagiocephaly) and a preference to turn the head toward the right. A neck mass is palpable on the anterior neck. Where is the lesion?
Congenital muscular torticollis is a postural deformity that presents between ages 1-6 months due to increased tone in the SCM. RFs include crowding in the uterus (twins, breech, oligohydramnios).
A teenager has small bald spots on her head and her mother notes that she pulls her hair out when she is anxious. Dx?
Trichotillomania.
English-decent child presents with jaundice and fatigue. Labs reveal high reticulocytes, low Hgb and low hct with elevated unconjugated bilirubinemia. MCHC is elevated. LFTs are normal. PE reveals jaundice and splenomegaly. Coombs test is negative. Best test for diagnosis?
Acidified glycerol lysis test. Testing for spherocytosis is confirmed with this test and eosin-5-maleimide binding test (flow cytometry). Family history is commonly present and the typical affected population is those of European descent. MCHC is usually elevated due to cellular dehydration and membrane loss.
What is proper management of a subluxed radial head in the pediatric population?
Hyperpronation of the forearm can reduce the subluxation or forearm supination with elbow flexion. If the child resumes full use of the arm after reduction, no films are needed to confirm.
Hyaline casts and/or bland sediment are seen in?
Prerenal AKI
RBC casts are seen in?
Glomerular AKI
WBC casts are seen in?
Nephritis or inflammatory renal disease.
Fatty casts are seen in?
Nephrotic syndrome.
“Muddy brown” casts or granular casts or tubular cells are seen in?
Acute tubular necrosis (later stage of prerenal AKI).
Postrenal urine sediment?
None/benign or may see some RBCs or WBCs.
Child presents with abd. pain, nausea, vomiting, and diarrhea. Mother notes that an empty bottle was found at the house from grandma’s old supplies. The child begins vomiting blood. What’d she take?
Iron poisoning. Within 30 minutes to 6 hours of ingestion, elemental iron corrodes the GI mucosa causing GI symptoms. Hypotensive shock and anion-gap metabolic acidosis occur in severe cases due to poor perfusion and lactic acid buildup. Gastric scarring and pyloric stenosis can develop after weeks if acute toxicity is survived.
Chelation therapy for iron OD?
Deferoxamine
