Pediatrics Flashcards
Type I HSR
IgE mediated
anaphylaxis
type II HSR
cytotoxic, antibody mediated
HA
type III HSR
serum sickness
type IV HSR
delayed T cell mediated rxn
conjunctivitis timeline of newborn
immediate - chemical
2-7 days - gonoccal
7-14 days chlamydia
tx of gonoccocal conjuctovitis
ceftriaxone
tx of chlamydia conjuctivitis
oral erythromycin
Necrotizing fascitis
symptoms that are out of proportion compared to the PE
PKU
AR
deficiency in phenylalinine hydroxylase
mental retardation
CF
AR thick mucous nasal polyps pseudomonas recurrent URIs pancreatic insufficiency
MC skull fractures
linear - depression can cause further cortical damage
caput succedaneum
crosses the midline
swelling of the soft tissues of the scalp
cephalohematoma
subperiosteal hemorrhage
does NOT CROSS the suture lines
causes of polyhydramnios
werdig hoffman syndrome - cant swallow
intestinal atresias (dbl bubble)
diaphragmatic hernia
bowel sounds in the chest
air fluid lvels are seen on CXR
concave abd
barrel shaped chest
associated with polyhydramnios
ophalocele
link to edwards trisomy 18
intestines with sac covering
increased AFP on screening
due to the failure of the GI sac to retreat at 10-12 wks gestation
umbilical hernia
associated with congenital hypothyroidism
weakness of rectus abdominus
allows protrusion of vessels and bowel
most spontaneously resolve
gastroschisis
intestines outside abdomen without sac
usually lateral to midline
tx- sx intervention - aggressive reintroduction of bowels –> infarction of bowel
causes of elevated AFP
neural tube defects
abdominal wall defects
MCC - incorrect dating
nephroblastoma
wilms tumor
large palpable abdominal mass
aniridia - absence of iris
hemihypertrophy of 1 kidney due to increased vascular demand
tx chemo
WAGR syndrome
chromsome 1 deletion
wilms tumor
aniridia
genitourinary malformations
retardation
neuroblastoma
MC of cancer in infancy
extracranial solid malignancy
blue spots in eyes
cross midline
CT calcification
dx of neuroblastoma
increased VMA
increased Metanephrines
(similar to pheochromocytoma)
hydrocele
painless swollen fluid filled sac
transluminates
remnant of tunica vaginalis
self resolving typically
varicocele
bag of worms
swelling of pampiniform plexus
heaviness in scrotum
cryptochordism
absence of 1 testicle usually found in inguinal canal
must be removed to prevent cancer risk (after 1yr)
hypospadies
urethra found on ventral surface of penis (bottom)
associated with inguinal hernias and cryptochordism
Circumcision = C/I
epispadies
opening of urethra dorsal (top)
associated with urinary incontinence and bladder exstrophy
TOF
chromosome 22 deletion pulmonary stenosis rvh overriding aorta vsd
tet spells
TOF - kids squat to increase preload - increases svr - decreases R>L shunting - increases pulmonary blood flow - which increases blood O2 saturation.
types of holosystolic murmurs
mitral regurgitation
vsd
tricuspid regurgitatioin
pda
transposition of great vessels
maternal DM kids
MC cyanotic lesion during neonatal period
aorta and pulmonary artery switched
requires PDA to stay alive - prostaglandin E1 to keep it open
CXR of transposition of great vessels and auscultation
egg on a string
s2 heard
causes of otitis media
viral - adenovirus
bacterial - strep pneumonia, h influenza , m catarrhalis
child received 5% dextrose in water for a prolonged period of time and has seizure, whats the cause
hyperosmotic hyponatremia
point tenderness of a joint
increased uptake by bone scan
increased ESR
dx = ?
osteomyeletis
lens shaped cranial hemorrhage
epidural hematoma
BUN to creatine ratio greater then 15:1
acute renal failure
pt with abdominal cramps relieved by BMs and arthritis
Ulcerative Colitis - manifests with GI and arthritic symptoms
reducing substance in urine
jaundice
poor weight gain
neonatal period
dx = ?
galactosemia
anemia
target cells
MCV <70
asian
dx = ?
thalessemia
decreased synthesis of globulin chains
DKA TX
IVF first then insulin
antibodies to proteus vulgaris = what test
weil felix test which is for ricketssia
borrelia = what type of organism
spirochete
atelectasis hyperinflation recurrent resp problems infancy hyperexpanded chest clubbing
dx = ?
cystic fibrosis
digital clubbing differential
cystic fibrosis
malignancy
R>L Shunt
brown urine after a cold 1-2 days after
IgA nephropathy
features of cor pulmonale
peripheral edema raised jvp loud S2 right sided heave pulsatile liver hepatomegaly
absence of cremasteric reflex
unilateral testicular pain
testicular torsion
young boy recurrent bacterial infections from encapsulated organisms (otitis media, sinusitis, pneumonias)
small lymphoid tissue
brutons
XLA
felt syndrome
rheumatoid arthritis
splenomegaly
neutropenia
anemia of chronic disease
diarrhea causes what metabolic disorder
metabolic acidosis - losing bicarb
gait ataxia
bilateral papilledemea
abducens palsy in a kid
dx = ?
medullobastoma
majority occur in the cerebellar vermis - truncal ataxia
block 4th ventricle - > hydrocephalus
oropharyngeal candidiasis tx
nystatin
invasive fungal tx
intestinal candidiasis tx
topical mupirocin treats
impetigo
MCC of hypothyrodisim in infants
thyroid dysgenesis - appear normal at birth but gradually develop apthy, weakness hypotonia and large tongue
mechanisms behind hashimotos
lymphocytic thyroiditis
large dense consolidation and fixed effusion on cxr - what bug
description = abscess caused by old pna now staph causing abscess plus new pna
tricuspid atresia
left ventricular hypoplasia LAD mitral valve atresia absent pulses with a single s2 increased RV impulse gray cyanosis
truncus arteriousus
1st few days of life severe dyspnea early and frequent infections single S2 heard systolic ejection murmur bounding peripheral pulses
CXR of truncus arteriosus
cardiomegaly with increased pulmonary markings
VSD
dyspnea with resp distress
loud pulmonic S2
high pitched holosystolic murmur over the L sternal border
apical diastolic rumble - increased flow across mitral valve
CXR of VSD
increased vascular markings
complications of VSD
pulmonary HTN
CHF
ASD
Fixed wide splitting of S2
systolic ejection murmur at Left upper sternal border
complications of ASD
dysrhythmias
perodoxical emboli from DVT
PDA
machine like murmur
wide pulse pressure
bounding bulses
complications of PDA
recurrent resp infections and infective endocardatitis (MC complication)
EKG presentation of a PDA
LVH secondary to increased systemic resistance
presentation of coarctation of the aorta
severe CHF and resp distress within first few months of life
LE and UE pulses vary
presentation of prolonged QT syndrome
hearing loss
syncope
normal vital signs
normal PE
Tx of prolonged QT syndrome
metoprolol
Rheumatic heart disease
complication of rheumatic fever
mitral stenosis - MC
major criteria for rheumatic fever
migratory polyarthritis carditis erythema marginatum subcutaneous nodule chorea
minor criteria for rheumatic fever
fever antecedent strep infection arthralgias elevated ESR prolonged PR Interval heat block on EKG
criteria needed to dx rheumatic fever
2 major
or
1 major and 2 minor
when is hyperbilirubinemia pathologic
day 1 of life
increase of 5mg/day
above 19.5 in term child
direct bili above 2mg at ANY time
complications of hyperbilirubinemia
kernicterus - hypotonia seizures hearing loss choreoarthritis
choanal atresia
blue when feeding
pink when crying
resp distress caused by the: buccopharyngeal membrane - between the nostrils and pharyngeal space
esophageal atresia
esophagus ends in blind pouch
recurrent ASPIRATION PNA early on
vomiting with 1st feed
choking/coughing
cyanosis
dx of esophageal atresia
coiling of the NG tube
gastric air bubble
esophageal air bubble
pyloric stenosis
1-6 month old BOY typically
NONbilious PROJECTILE vomit
hypochloremic hypokalemic metabolic ALKALOSIS
dx of pyloric stenosis
olive sign - palpable mass epigastric
abd US - string sign (barium leaking thru)
tx of pyloric stenosis
1) IVF and electrolytes
2) NGT decompress the bowel
3) Sx
best initial step for choanal atresia
pass the NGT tube
then secure airway
CHARGE accroynm
coloboma of eye, CNS heart defects atresia of choanae retardation genital and lower urinary tract issues ear anomalies
duodenal atresia
down syndrome
double bubble on CXR
no resp distress
BILIOUS VOMITING
best first step for duodenal atresia
IVF
hirschsprung disease basics
congenital lack of innervation of distal bowl by the auerbach plexus
constant contracture of muscle tone
hirschsprung disease presentation
DOES NOT pass meconium within 48 hrs
large bowel obstruction
tight rectal sphincter
+ squirt sign
if older child - hx of constipation and poor weight gain
dx of hirschsprung dz
X-Ray - distended bowel loops with lack of air in the rectum
biopsy with lack of ganglion cells
VACTERL
Vertebral anomalies Anal atresia Cardiovascular abnormalies TEF Esophageal atresia Renal anomalies Limb anomalies
volvulus
bowel obstruction leading to loop of bowel twisted on itself
vomiting + colicky abd pain
complications sepsis/necrosis
dx of volvulus
Upper GI series - multiple air fluid levels
intussusception definition and causes
telescoping of bowel into another
causes: polyps, hard stool, lymphoma, virus, rotavirus vaccine, HENOCH SCHLOEN PURPURA
odd complication of henoch schloen purpura
intussusception
presentation of intussusception
colicky abd pain INTERMITTENT
bilious vomiting
RQ sausage shaped mass
currant jelly stools
dx of intussusception
US - dough sign or target sign (concentric alternating mucosa and submucosa bands)
Barium Enema or air Enema are both dx and tx
tx steps for intussusception
1) IVF
2) NGT decompress bowel
3) Barium or air Enema
4) Sx if needed
meckel diverticulum
only true diverticulum
vitelline duct persists in small intestine tract
presentation of meckel diverticulum
painless rectal bleeding 2y/o M typically (rule of 2’s)
- bleeding is from gastric acid secretion from ectopic tissue
dx of meckel diverticulum
techenium 99 scan
Rotavirus diarrhea
MC winter months Fever, emesis, NO BLOOD < 7 days viral prodrome
adenovirus diarrhea
year round fever emesis NO BLOOD <7 days viral prodrome
norwalk virus diarrhea
epidemic
EXPLOSIVE diarrhea
cramping pain
short lived = 1-2 days
timeline of Fever and Rash in measles and rubella
Measles = fever + rash
Rubella = fever —> –> Rash
Necrotizing enterocolitis
premie infants who have blood in stool
low birth weight
vomiting and abd distension
bacteria invade intestinal wall
dx of NEC
ABD x-ray - pneumatosis intestinalis or AIR in the bowel
air in the portal vein on CT
tx of NEC
1) Feedings stopped - REST BOWELS
2) IV fluids
3) NGT for bowel decompression
4) sx if needed
antidote to methhemoglobin
methylene blue - acts as an electron acceptor for NADPH and is reduced to a substance that then in turn –>
reduces methemoglobin back to hemoglobin
new born with large posterior fontanelle large tongue hypotonia nml agpar scores nml pregnancy and delivery
cause = ?
thyroid dysfunction
tx of afib in a newborn
ice pack to chest
then adenosine
fresh newborn hours old with cyanosis of arms and legs feeding well no distress cap refill time delayed low body temp bradycardia
dx = ? tx = ?
neonatal hypothermia
place under warming lights
scaly puritic rash on flexor surfaces in a kid
occurs during episodes of resp distress and wheezing
dx = ? tx = ?
atopic dermatitis (eczema)
tx:
emolients (petrolatum or aquaphor)
topical steroids
triamcinolone
betamethasone valerate
what type of shunting do you see in a PDA
left –> right shunt allows blood from systemic circulation to the pulmonary circulation
pulmonary blood flow is excessive
prominent apical impulse
at what age do you start worrying about puberty in female and male
15 years old
serous otitis media
middle ear effusion without the evidence of acute infection
dull (blueish grey) TM that is hypo mobile
MOA of post strep glomerulonephritis
type III HSR
antigen antibody immune commplexes
Timeline if IgA nephropathy h
1-2 days after URI
Volvulus dx
corkscrew appearance on KUB
C diff presentation
s/p abx use and occasionally can be bloody (rare)
fever
abd pain
BUN: Cr greater than 20:1
prerenal injury
- decreased renal perfusion
direct hyperbilirubinemia
> 20% of total bili
decreased excretion of bilirubin
indirect hyperbilirubinemia
decreased conjugation of bilirubin
hepatic enzyme deficiency
increased production of bilirubin
pale stools are caused by
obstructive jaundice
increased direct bilirubin
4 month old with increased BP right > left pronounced S2 precordial heave hepatomegaly RVH RAD wheezing occasionally heard
dx = ?
bronchopulmonary dysplasia
leads to pulmonary HTN
- hepatomegaly
- edema RVH
dx of PSGN
elevated ASO abs
decreased C3 concentration in plasma
pedal edema
Sequela of PSGN
nothing full recovery without any complications
VSD on PE
4/6 holosytolic murmur with thrill heard along the left sternal boarder
P2 is accentuated
2/6 mid diastolic murmur is heard at the apex
tx of chemical ingestion
stabilize airway
fiberoptic endoscopy (see damage)
17 alpha hydroxylase def
increased aldosterone and cortisol
decreased K+
decreased sex hormones
HTN
nml girls
boys - pseudohermaphrodism
21 hydroxylase def
decreased cortisol and aldosterone
increased K+
increased sex hormones
girls - virilized
boys - nml
legg calve perthes dz
avascular necrosis of the femoral head
painless limp
2-8 y/o
nml weight
dx and tx of legg calve perthes
dx - x-ray joint effusion and widening
tx - NSAIDS and rest
slipped capital femoral epiphysis
and risk
adolecents 10-15
OBESE
painful limp
externally rotated
tx of slipped capital femoral
internal fixation with pinning
2 sources of milk that are low on Vit D
goats milk and breast milk
lead poisoning
vomiting, abd pain
fatigue
loss of appetitie
decreased sleep
path behind Osgood Schlatter
repeated knee extensions leading to microalvusions of the tibial tubercle
ewing sarcoma
onion skinning - lytic lesions causing laminar peristeal elevation
midshaft
systemic symptoms
local pain and swelling
osteosarcoma
sunburst pattern - sclerotic destruction
metaphysis of long bones
increased alk phos
local pain and swelling
osteoid osteoma
round central lucency with a sclerotic margin
adolescent boy
proximal femur site - worst at night
unrelated to activity
NSAIDS will spontaneously resolve
tx for neonatal sepsis order
IVF
cultures
ampicillin and gentamicin
causes of early neonatal sepsis
e coli
listeria
causes of late neonatal sepsis
e coli
GBS
presentation of toxoplasmosis
chorioretinitis
hydrocephalus
multiple ring enhancing lesions
dx and tx of toxoplasmosis
dx - (initial) increased IgM to toxo , PCR (most accurate)
tx - pyrimethamine and sulfadiazine
syphilis presentation of a neonate
desquamation of the palms and soles
frontal bossing
sniffles
rubella presentation
fever –> –> rash
sensoneuronal deafness
PDA
cataracts
hepatomegaly
blueberry muffin rash
hyperbilirubunemia
thrombocytopenia
CMV presentation
periventricular calcifications with microcephaly
chorioretinitis
petechiae
varicella presentation
vesicles on an erythematous base
START on face
possible fever and malaise
rubeola (measles) presentation
4’Cs - cough, conjuctivities, coryza (stuffy/running nose), C(k)oplik spots (buccal surface)
cephalocaudal spread
5th dz or erythema infectiosum presentation
parvob19
fever and URI –> –> slapped cheek rash
complication of 5th disease
aplastic anemia
Herpes 6 roseola presentation
HIGH fever –> goes away –> diffuse lacy rash
mumps presentation
fever that precedes parotid gland swelling
complications of mumps
orchitis
aseptic meningitis
scarlet fever presentation 3-6 days
fever pharyngitis SANDPAPER rash strawberry tongue cervical lympadenopathy
kawasakis disease presentation
FEVER >5 days mucositis conjuctivitis rash edema of hands and feet cervical lympadenopathy
complication of kawasakis dz and tx
complication - coronary artery aneursym
tx - IV Ig and aspirin
malignant otitis externa
exquisite otalgia and otorrhea
retropharyngeal abscess
decreased ROM of neck and jaw
muffled voice
younger kid 4years old
fever dysphagia
lateral neck soft tissue x-ray - widened prevertebral space
croup presentation
parainfleunza virus
barking cough inspiratory stridor difficulty breathing while lying flat signs of hypoxia hoarse voice
tx of croup
mild .- steroids
mod-severe = racemic epinephrine
epiglottis
due to H influenza type B (unvaccinated kid)
fever
QUICK ONSET
muffled voice/ drooling
TRIPOD position/refusal to lie flat - hyperextended neck
whooping cough - bordetella pertussis
catarrhal stage - severe congestion and rhinorrhea (14 days)
paroxysmal stage - severe coughing episodes with vomiting, gasp for air, inspiratory wheeze (14-30 days)
convalescent stage - decrease freq of coughing (14 days)
tx of pertussusis for pt and close contacts
macrolide for close contacts
erythromycin or azithrymycin during catarrhal stage or with kids IV Ig
pharyngitis presentation
cervical adenopathy
petechiae
fever >104
Diptheria
membranous inflammation of the pharynx
gray highly vascular pseudomembranous plaques on a pharyngeal wall
DO NOT SCRAPE
tx of diptheria
antitoxin
riboflavin vit b2 def
anuglar cheilosis stomatitis glossitis normocytic anemia seborrhic dermatitis
vit b6 pyridoxine def
peripheral neuropathy
vit D toxicity
increased Ca2+
polyuria
polydipsia
von gierkes dz
glucose 6 phosphatase deficiency
liver hepatomegaly
ketotic hypoglycemia
ketones
increased TGLs and Uric Acid
Doll Face adn thin extremeties
tay sachs
hexosaminidase A def increased gangliosides cherry red macula mental retardation seizures
lysosome onion whorled membrane
gaucher dz
beta glucoererbrosidase def
hepatosplenomegaly
aseptic necrosis of femur head
fabry dz
alpha galactosidase A def
x-linked
peripheral neuropathy
nieman pick dz
cherry red macula
neurodegeneration
hepatosplenomegaly
increased sphingomyelin
metachromatic leukodystrophy
arysulfatase A def
dymelination with ataxia and dementia
patient with subcutaneous emphysema secondary to severe coughing paraxysms what is the first test done
CXR in order to rule out pneumothorax
what can cause methemoglobuniemia
exposure to oxidizing substances
dapsone
nitrites (meats)
local/topical anesthetic
presentations of methemoglobunemia
cyanosis
pulse Ox 85%
dark chocolate blood
saturation gap between pulse ox and PaO2 >5% on ABG
decrease O2 delivery to peripheral tissues - supp O2 does not help
blue green discoloration of blood and mucocutaneous surfaces
cause = ?
sulfhemoglobinemia - exposure to sulfur meds such as:
sumatriptan
sulfasalazine
antidotes for lead poisoning
dimercaprol
EDTA
tx of ethylene glycol or methanol ingestion
fomepizole - inhibits alcohol dehydrogenase - preventing the metabolism of these alcohols to their toxic metabolites
antidote for beta blockers
glucagon - activates adenylate cyclase -> increased Ca2+ –> improves cardiac contractility
antidote for acetominephen toxicity
N-acetylcysteine
cause of Howell Jolly bodies
asplenic pts
nuclear remnants within the RBCs that are typically removed via the spleen
chylothorax
milky white fluid
increased TGLs
galactose 1 phosphate uridyl transferase def
failure to thrive bilateral cataracts jaundice hypoglycemia vomiting hepatomegaly mental retardation
increased risk for neonatal sepsis via E coli
galactokinase def
cataracts only
complication of hereditary spherocytosis
cholelithiasis
initial test for asthma
spirometry
if not available methemacholine test
other symptoms associated with juvenile idiopathic arthritis
anterior uveitis so perform a slit lamp examination
dx of JIA - elevated ESR,ANA ab, pain in AM
testicular torsion PE
absence of cremasteric reflex
epididymitis will have a nml cremasteric reflex
precocious puberty ages
Males <9
Females <8
croup edema location
subglottic edema which improves with the vasoconstriction effects of cold air
lethargy
complexion darkening
height weight nml
decreased BP
dx test ?
plasma cortison - since this is a decreased of ACTH
young boy with GBS infection HIB infection leukocytosis
and low lymphoctes
dx = ?
agammaglobulinemia - infec form encapsulated bugs that normal ppl are immune too
tx - abx and IV Ig
fat kid bowing legs
dx = ?
tibia vara
neurofibromatosis type 1
cafe au lait spots
seizures
skin tags (lisch nodules)
clustered freckles
nerve sheath tumors
optic gliomas
prophylactic tx of TB
Isoniazid
sudden onset of constipation, bilious vomiting, squirt sign neg and blood in stool in 1 month
shows its below the level of duodenum this dx = volvulus until proven otherwise
neuroblastoma presentation
young kid racoon eyes (blue underneath eyes)
HTN
fatigue
posterior mass
weight loss
mets to the bone
sinusitis presentation
long term fever, ha, yellow green nasal discharge
posterior pharyngeal wall is erythematous and covered with gray mucus
aspirin ABG findings
mixed metabolic acidosis and respiratory alkalosis
hyperglycemia causes osmotic shifts of water from intracellular to the extracellular space leading to
dilutional hyponatremia
low BMI and no periods put you at risk for what?
osteoperosis
biliary cyst
extrahepatic mass –> dilation of the bile duct
scerlal icterus
palpable abd mass
abd pain
dark urine
conjugated bili =
unconjugated bili =
conj = direct
unconj = indirect
breast feeding jaundice
1st week of life SUB OPTIMAL FEEDING decreased bili elimination increased enteroheptic circulation signs of dehydration
tx = increase feedings
Heavy irregular mentsrual bleeding in a young teenager cause = ?
immature hypothalamic pituitary axis - causing anovulation
tx = high dose OCPs - stabilize endometrium
complication of repeated otits media
conductive hearing loss
tx of strabismus
cover up the good eye to strengthen the bad eye
presentation of neonatal herpes
temporal lobe hemorrhage/ edeme
mucucutaneous vesicles
keratoconjuctivitis
seizures
fever, lethargy
guillane barre syndorme
follows URI
ascending paralysis - concerned about resp compromise so perform spirometry to check
chronic sickle cell hemolysis can lead to what def
folate deficiency
papillry necrosis
pathological murmur
diaphoretic fatigue with feeding or exercise poor growth , dizzy poor weight gain
harsh holosystolic, diastolic
increased intensity on standing and valsalva manuever
strong family hx
acute causes of hemiplegia in kids
seizures - todd paralysis
intracranial hemorrhage - vomit, brady
hemiplegic migraine - family Hx
Measles Virus precautions
airborne transmission
vitamin A for hospitalized patients
causes of impetigo
staph auerus
strep pyogenes
causes of vit K def
malnutrition CF IBD Biliary atresia celiac dz frequent abx use
homocystinuria
marfanoid habitus
intellectual disability
megaloblastic anemia
thrombosis
lens dislocation
joint hyperlaxity
skin hyperelasticity
scoliolisis
generalized seizure presentation
LOC
post ictal state
tongue laceration
+/- preceding aura
vasovagal syncope
preceding lightheadnes
pallor
diaphoretic
IMMEDIATE return to baseline mental status
cardiogenic syncope
sudden LOC without prodrome
IMMEDIATE return to base line mental status
dissemenitaed gonoccal infection
fever
rash - vesiculopustular (no facial involvement)
polyarthritis
rocky mountain spotted fever
febrile prodrome –> –> erythematous macular rash that STARTS on the wrists and ankles and spreads centrally
selective IgA def
recurrent sinupulmonary and GI infections
associated with celiac and atopy
anaphylaxis during transfusion
milk or soy induced colitis
FmHx of eczema, allergies, asthma
2-8wks old regurgitation or vomiting
can have painless blood stools
tx = resolves in one year - hydrolyzed formula
Chronic Granulomatis disease
x-linked
recurrent pulmonary and cutaneous infections
susceptibility to CATALASE + organisms (staph, serratia, brukholeria)
dx = nitroblue tetrolium, dihydrodium test
defect in intraccellular killing due to impaired resp burst
beckwith wiedeman syndrome
deregulation of imprinted gene expresssion on chr 15
fetal macrosmia
hemihypertrophy
rapid growth until late childhood
umbilicated hernia
complications of Vesicoureteral reflux
pyelonephritis –> parenchymal scarring, HTN and renal insufficiency
pediatric causes of stroke
sickle cell dz prethrombotic disorders congenital cardiac dz bacterial meningitis vasculitis head/neck trauma
Werdnig hoffamn syndrome
degeneration of anterior horn cells and cranial nerve motor nuclei
other cause of floppy baby syndrome and associated with polyhydramnios (due to inability to swallow)
myotonic congential myopathy
muscle weakness and atrophy (distal muscles of UE and LE)
testicular atrophy
baldness
hand grip myotonia
dysphagia
atopic dermatitis
itchy red scaly crusted lesions
extensor and flexor surfaces
(lichenified plaques)
risks with low humidity
tx - emollients and topical steroids
complications of atopic dermatitis
eczema herpeticum
cellulitis
abscesses
septic arthritis presetnation
acute onset of fever and joint pain
fatigue and refusal to bear weight
erythema, warmth, swelling and pain with ROM
increased WBCs, ESR, c-react
synovial fluid = wbcs >50,000
retinal hemorrhage seen on a baby =
shaking baby syndrome - acceleration deceleration injury
bronchiolitis presentations in a small children
low grade fever
rhinorrhea/congestion
cough/ wheezing + respiratory symptoms
RSV cause
tx = supplemental O2
vit A toxicity can lead to
Increased cranial pressure
uric acid stones
headaches
what type of PNA bug do HIV patients get
pneumocystis jerovecii
patients of diabetic mothers that have prolonged QT and then seizures due to
hypocalcemia due to suppressed PTH
tuberosclerosis presentation
ash leaf spots (hypopigmentation) pariventricular masses sare sub ependymal nodules seizures forehead plaques mental impairment renal angiomyolipoma (benign)
young girl with peristent diarrhea multiple episodes of oral thrush failure to thrive
viral infections and heart murmur
dx = ?
SCID
T lymphocyte def
SCID basics
Fungal infection
Viral Infection
Bacterial Infection
T lymphocyte deficiency
failure to thrive
chronic diarrhea
culprit for salmonella diarrhea
uncooked bbq chicken
how to prevent rotavirus outbreak
strict hand washing protocol
palpable suprapubic mass
distended bladder
CVID
susceptible to encapsulated organisms due to impairment of the humoral system
so gets infected with strep pnumo and Hib while nml ppl are protected with the vaccines
serum glucose –> decrease plasma osmolarity –> fluid goes back into cells –>
cerebreal edema
shunt reversal of VSD leads to
pulmonary artery HTN leading to polycythemia
tx for septecemia in neoneate
cefotaxime
fundoplication can tx
stage 4 GERD
shigellosis presentation
bloody stool young child tonic clonic seizure high fever dehydration
adam strokes attack presentation
attack occurs without warning leading to sudden LOC and generalized tonic clonic seizure activity
what causes a J wave on an EKG
hypothermia <90degrees F
hypercalcemia
brain injury
v fib
chemical ingestion presentation in a kid
drooling
ulcers involving the lips annd the tongue
vomiting
newborn male not urinated since birth and abdomen is distended with a midline mass
dx = ?
posterior urethral valves
midline mass = bladder from not urinating
hodgkin lymphoma presentation
painless lymphadenopathy - usually cervical, axillary or inguinal - rubbery
mediastinal mass on CXR
teenagers
hematocrit 50-60% in a neonate = ?
normal in a neonate
test for addisons
measurement of morning serum fasting cortisol concentration
HIV presentation in infancy
failure to thrive
lymphadenopathy
opportunistic infections
severe thrush
selective loss of CD4 cells
thalessemia minor presentation
microcytic anemia
normal red cell distribution width
increased reticulocyte count
hereditary spherocytosis
jaundice, splenomegaly
increased reticulocyte count
increased Mean corpuscular Hgb concentration
increased osmotic fragility on acidifed glycerol lysis test
nml MCV, nml RDW
tx of erythema migrans
< 8/o = amoxicillin
> 8 y/o = doxycycline
> stage 1 = ceftriaxione
hypertrophic cardiomyopathy physio behind increasing murmurs and decreasing murmurs
manuevers that increased preload or afterload (squatting, leg raise, hand grip) will increased LV cavity size and decreased Lv outflow obstruction –> decreasing murmur intensity
things that decreased preload will increase murmur intensity (standing up)
causes and tx of otitis externa
pseudomonas and staph auereus
ototopical abx - fluoroquinolone +/- glucocorticoid
aplastic crisis in a sickle cell patient
decreased reticulocytes - due to a transient arrest of erythopoesis secondary to infection (parvo b19)
splenic sequestration crisis
increased reticulocytes
splenic vaso-occlusion –> rapidly enlarging spleen
occurs in children prior to autosplenectomy (sicklers)
aplastic anemia lab values
thrombocytopenia
leukopenia
anemia
viral meningitis causes and basics
majority caused by enteroviruses - coxsackie b
spread by fecal oral transmission
pathogenesis of refeeding syndrome
starvation -> decreasd insulin increased glucagon increased cortisol -> decreased ketone bodies in muscles + increased ketones in brain -> increased glycogenlysis incresde lipolysis increased protein catabolsm -> depleted fat and protein
start refeeding -> increased insulin -> increased glycogen synthesis, increased protein synthesis, -> decreased thiamine, decreased K+ , decreased PO4, decreased Mg -> seizures, CHF
causes of QT prolongation
decreased Ca, K , Mg
macrolides, fluoroquinolones
antipsychotics, TCAs, SSRIs
opiods (methadone, oxycodone)
antimetics (zofran)
quinidine, procainamide, flecanamide, amiodarone, sotalol
complications of prolonged QT syndrome
torsades de pointes
Wiskott aldrich syndrome
x-linked
imparied cytoskeleton changes in leukocytes, platelets
eczema
microthrombocytopenia
recurrent infections
ataxia telengectiasias
T- cell def associated with a defect in DNA repair
progressive cerebellar degeneration
congenital clubfoot
rigid positioning
medial/upward deviation of forefoot and hindfoot
hyper plantar flexion of the foot
MC complication of a patient with sickle cell trait
painless hematuria
FB aspiration
MC -infants and toddlers
acute onset of inspiratory stridor +/- wheezing without infectious symptoms
perform an endoscopy or bronchoscopy
laryngolamalacia presentation
inspiratory stridor most prominent in infants
stridor is worse when supine
stidor improves when prone
vascular ring presentation
infants
biphasic stridor that improves with neck extension
primary nocturnal enuresis age and tx
> 5 y/o
tx - alarms, routine adjustment, and then desmopressin therapy if needed
levonorgestrel pill > OCPs for what use
emergency contraception (plan B)
risk factor for henoch schonlein purpura
intussussception risk
erythema toxicum neonatorum def and tx
asymptomatic scattered erythematous macules, papules, pustules throughout the body
tx - reassurance
neonatal HSV presentation and tx
vesicular clusters on skin, eyes, mucous membranes
CNS infections
fulminant, disseminated multi organ disease
tx = acyclovir
tx of neonatal varicella
acyclovir
staph scalded syndorme
fever, irritability
diffuse erythema followed by blistering and exfoliation
+ nikolsky’s sign
tx = naficillin, oxacillin or vanco
friedrich ataxia
neurodegenerative disease - presents with progressive ataxia and loss of positional and vibratory senses
genetic test - excessive # of tri nucleotide repeats
cerebral palsy risk factors
prematurity (that leads to hypoxia induced damage)
low birth weight
cerebral palsy clinical features
delayed motor milestones abnormal tone hyperreflexia comorbid seizures intellectual disability
craniopharyngioma
calcified intracranial tumors that occur in the suprasellar region
craniopharygioma presentation
bitemporal hemaniopsia
pituitary hormonal deficiencies (DI, GH def)
pityriasis rosea clinical features
+/- viral prodrome
annular pink herald patch on trunk
oval lesions in x-mas tree pattern
pruritus
tx = reassurance and antihistamines for pruritus
acrocynasosis
typically normal during newborn period
MC pathogen associated with kids with CF
staph aureus - while pseudomonas is more associated with adults with CF
cystic hygromas
congenital malformation of the lymphatic system - located in the posterior triangle of the neck
fluctulant mass that transuluminates with light
associated with turners syndrome
clavicle fx presentation in a newborn
crepitus
swelling
decreased ROM of UE (ipsy)
congenital muscular torticollis
posterior neck deformity
SCM mass
ispy head tilt
contra chin deviation
presentation of viral conjunctivitis
unilateral/ bilateral
1-2 wks
watery/mucoid
viral prodrome
presentation of bacterial conjunctivitis
uni/bilateral
1-2wks
unremitting ocular discharge
purulent
allergic conjunctivitis
ocular pruritus*
always bilateral
<30min or annually (certain time of year)
asian babies have what def
decreased UGT activity –> increased total Bili and increased unconjugated bili
sturge weber syndrome
mutations in GNaq gene
port wine stain leptomenengial capillary venous malformations seizures +/- hemiparesis intellectual disability visual field defeceits glaucoma
ALL
MC childhood cancer, 2-5 y/o, M>F bone pain lymphadenopathy hepatosplenomegaly pallor petechiae
Common Variable immunodefeciency
recurrent resp infections (sinusitis, pna, otitis)
reccurent gi infections (salmonella, campylobacter
autoimmune diseases (RA, thyroid dz) chronic lung disease (bronchiectesis) GI disorders (chronic diarrhea,)
dx of CVID
decreased IgG
decreased IgA/IgM
no response to vaccinations
tx of CVID
Ig replacement therapy
antifungal and antiviral prophylaxis is important for what patients
CGD
SCID
transplant patients
rett syndrome
girls - loss of speech and purposeful hand use
gait disturbance
stereotypical hand movements
seizures
landon klefer syndrome
regression of language skills due to severe epileptic attacks
3-6 years old
presentation of reactive arthritis
injected conjuctivae with mucopurulent discharge
pain swelling and rash over a joint
otitis media with effusion physical exam
observable air fluid levels (which may be vertically oriented)
serous middle ear fluid
translucent membrane with diminished mobility
otitis media without effusion
bulging erythematous
purulent discharge
limited mobility
tinea capitis
MC in black children
transmission via direct contact or from fomites
scaly erythematous patch with hair loss on scalp
tx of tinea capitis
oral grisefulvin or terbinafine
langerhans cell histiocytosis
lytic bone lesions (skull, femur, jaw) skin lesions (purpleish papules, eczematous rash) lymphadenopathy hepatosplenomegaly pulmonary cysts/ nodules
central DI
elevated glutamyl transpeptidase
alcoholics
wilson disease
copper accumulation - > leak from damaged hepatocytes -> deposits in tissues (basal ganglia, cornea)
acute liver failure, chronic hepatitis, cirrhosis
neuro - parkinsonisms, gait disturbances, dysarthria
psych - depression, personality changes, pyschosis
tx of wilsons disease
chelators
- D penicillamine
zinc (messes with copper absorption)
preseptal orbital cellulitis
PAIN to palpation
eyelid swelling
No pain with EOM
postseptal orbital cellulitis
PAIN with palpation
eyelid swelling
PAINFUL and difficulty with EOMs
minimal change disease
MCC of nephrotic syndrome in children <10 y/o
T cell mediated injury to podocytes caused by increase molecular permeability to albumin
minimal change disease presentation
edema
fatigue
NO hematurial
proteinuria >3g
tx of minimal change disease
corticosteroids
leukocyte adhesion deficiency
recurrent skin and mucosal bacterial infections
No PUS - lack of neutrophils at the inflammation site
delayed umbical cord separation
marked peripheral leukocytosis with neutrophilia
steps for precious puberty workup in a female
bone age - if >2yrs –> Baseline LH –> if elevated = central precocioys puberty –> MRI
lab values for iron def anemia
low -MCV
low - Fe
low -ferritin
low - transferrin
high - TIBC
lab values for thalessemia
low low - MCV
low - TIBC
high - ferritin
high - transferrin
lab values for anemia of chronic disease
mcv - normal
low - Fe
low - TIBC
presentation of juvenille idopathic arthtritis
subacute/chronic - pain that is worse in the am but able to bear weight
long standing fever
arthritisi > 1 joint
pick macular rash
increased WBCs, thrombocytosis, high ESR
antidote to protect from cardiac damage in hyperkalemia
calcium gluconate
hypertrophy of peyers patches is a risk for
intussception
MC type of CNS tumor in kids
astrocytoma
complications of otitis media
facial nerve palsy
mastoiditis
dx test of choice for DMD
genetic testing
presentation of HSP
IgA mediated leukocytoclastic vasculitis
palpable purpura
arthitis/ arthalgias
abd pain/ intussecpetion
renal disease - IgA nephropathy
reactive attachment disorder
pattern of emotional and social withdrawal
lack of positive response to. attempts to comfort
disinhibited social engagment disorder
overfamiliarity and an unhesistant approach to unfamiliar adults
outcome of early neglect
MCC of proteinuria in kids
transient proteinuria - make sure to obtain at least 2 dipsticks to r/o whether its a more serious cause of proteinuria
PKU presentation highlights
fair complexion
musty odor
mcCune albright syndrome
cafe au lait spots
precocoious puberty
fibrous dysplaisa of the bone
tx of bullous impetigo
tx of non bullous impetigo
tx of bullous = cephalexin, dicloxicillin, clindamycin
tx of non bullous = mupirocin
mastoiditis
complication of AOM
strep pneumo
fever otalgia
inflammationof mastoid
deviation of ear
needs CT or MRI
dactylitis
earliest manifestion of a vasoocclusive crisis in sicke cell patient
symmetrical swelling of the hands and feet
caused by: mcrovascular occlusion
compliactions of bacterial meningitis
intellectual/behavioral disablity
hearing loss
cerebral palsy
epilespy
complications of. prematurity
resp distress syndrome/ PNA
bronchopulmonary dysplasia
intraventricular hemorrhage
NEC
retinopathy of prematurity
what accumulates in a 21 hydroxylase def
17 hydroxy progesterone
avascular necrosis - risks
steroid use alcohol abuse SLE - antiphospholipid syndrome sickle cell dz infections decompression sickenss
presentation of avascular necrosis
groin pain on weight bearing
pain on hib abduction and internal rotation
no erythema, swelling or point tenderness
NML - WBCs, ESR, CRP
meconium ileus
ileum obstruction
meconium inspissated
negative squirt sign
associated with CF
congenital lymphedema
occurs due to dysgenesis of the lymphatic system and presents at birth with non pitting carpal and pedal edema
eventually leads to the webbed neck - seen in turners syndrome
immune thrombocytopenia
platelet autoantibodies
preceding viral infection
petechia, ecchymosis mucosal bleeding
tx- observe
serous OM vs AOM
lack of inflammatory signs = serous
absence seizures on EEG
3hz spike and wave pattern
juvenille myoclonic epilepsy
generalized seziures during adolescence
myoclonic jerks that are more prominent in the first hour after awakening
alport syndrome
recurrent episodes of hematuria
sensorineural deafness and family hx of renal failure
first line tx for ADHD non stimulant
atomoxetine
neonatal sepsis
temp instability poor feeding jaundice CNS signs abnormal WBCs left shift
choleostoma
peripheral granulation and severe skin debris visualized in the ear
spondylolisthesis
forward slip of vertebrae MC - L5 over the S1 preadolescent children back pain neurological deficit
viral myocarditis
cosackie B virus
Adenovirus
prodrome HF resp distress murmur hepatosplenomegaly
dx of viral myocarditis
CXR - cardiomegaly, pulmonary edema
ECG - sinus tachy
Echo - decreased Ejection Fraction
suspicious burns
buttocks and back of legs
sparing of the flexor surfaces
sharp lines of demarcation
uniform burn depth
delayed medical treatment seeking
growing pains
primarily occurs at night and resolves by morning
affects the LE bilaterally
Normal PE and activity level
tx = reassurance and NSAIDs
hemophilia knee joint microscopic exam
hemosiderin deposition and fibrosis
transient tachypnea of the newborn
resp distress and fluid in the intralobular fissures from a neonate that has been delivered via C-section
path behind coarctation of the aorta
thickening of the tunica media of aortic arch near the ductus arteriosus
hyposthenuria
inability of the kidney to concentrate urine and can occur in pats with sickle cell trait
polyuria
decrease urine specific gravity
nml serum Na
central Diabetes insipidus
polyuria
increased Na in serum
primary pyschogenic polydipsia
decreased Na due to dilutional
brain abscesses
HA
vomiting
fever
focal neuro deficits (stroke like)
riing enhancing lesions on CT
Congenital heart defect increases risk for NEC due to
decreased mesenteric perfusion
pneumatosis
extravasation of bowel gas into the damaged bowel
breath holding spell
cyanosis
LOC
nml pe
risks for hip dysplasia
breech position
Fhx
excessive tight swaddleing
graves dz
transplacental TSH receptor antibody
tachy
weight loss
jittery
poor feeding
atlantoaxial instability
pts with down syndrome who present with upper motor neuron findings
excessive laxity in the posterior transverse ligament causing increased mobility between C1 and C2
fanconis anemia
dna repair defect
Bone marrow failure
short stature
hypo/hyper pigmented macules GU malformations
lab avlues in fanconis anemia
low WBCs
low RBCSs
low platelets
benzene exposure leads to
chromosomal breakage
aplastic anemia
scabies
spread by direct perosn to person contact
extremely pruritic
small erythematous papules
rash located on interdigital web spaces, felxor wrists, extensor elbows, axillae, ubilicus, genitals
tx of scabies
topical 5% permethrin or oral ivermectin
midgut volvulus
neonates with bilious vomiting and abdominal distension
dx - upper GI study
HUS
shigella toxin (serotype O157H7) vascular damage and microthrombi formation
HUS clinical features
hemolytic anemia (schistocytes increased bili)
thrombocytopenia
acute kidney injury (Increased BUN and creatine)
tx of perinatal hep B
HBV and HB Ig
symptoms of. bacterial sinusitis
nasal congestion
drainage and cough
that are all persistent
most common predisposing factor = viral URI
comorbidites that go along with tourrette synrome
OCD and ADHD
parinaud syndrome
pineal gland tumor
limited upward gaze
upper eyelid retraction
pupils non reactive to light
pupils reactive to accommodation
subdural hemorrhage neonates
convulsions period of apnea resp depression altered muscle tone fontanelles may be tense and bulging
eczema herpicum
complication of atopic dermatitis
painful vesicles - punched out erosions
hemorrhagic crusting along with fever
lymphadenopathy
membranous nephropathy
edema proteinuria hypoalbuminemia in adolescents and adults
active hep B infections - important risk factor
pneumococcal vaccine
conjugate capsular polysacharride
antibodies to dsDNA
SLE
hydroxyurea ADR
myelosuppresion
Serum sickness like rxn
caused by beta lactams and sulfa drugs
Ic formation
acute hep B infection
1-2 weeks after exposure
myotonic muscular dystrophy
grip myotonia delayed muscle relaxation facial weaness foot drop dsyphagia
tx of tourrettes
antidopaminergic medication
pinworm
school aged children
nocturnal perianal pruritus
spread by itching to other areas
helminth infection
celiac disease
autoimmune disorders increase the risk
abd pain, bloating, diarrhea
failure to thrive/short stature
dermatitis herpitiformis
Iron deficiency
vitamin d deficiency
increased skin pigmentation delayed fontanelle closure enlarged skull frontal bossing enlarged costochondrial joints long bone joints
genu varum
language disorder
common and characterized by persistent difficulties in the acquisition and use of language due to defects in comprehension and/or production
limited vocab sentence structure and functional use of language
iron toxicity
radioopaque pills
abd pain
vomiting
hematemesis
metabolic acidosis
aspirin poisoning
tinnitus resp alkalosis and metabolic acidosis fever hyperapnea pills not RADIOOPAQUE
anemia of prematurity
usually asymptomatic
tachy
poor weight gain
apnea
normocytic, normochromic
low reticulocyte count
low hgb and low hct
premature adrenarche
early activation of adrenal androgens
obese children
precocious puberty development of pubic and axillary hair, acnes and body odor in a child with normal bone age
eosinophilic esophagitis
chronic immune mediated inflammation
dysphagia chest pain/ epigastric pain reflux, vomiting food impaction associated atopy
sickle cell provides decrease morbidity when it comes to what disease
malaria
MCC of lymphadenitis in kids
staph aureus followed by group A strep
lab values of turners sydndrome
increased FSH and LH
due to negative feedback of estrogen
renal tubular acidosis
poor hydrogen secretion into urine urine pH > 5.5 serum K low high Cl low HCO3
nml anion gap + failure to thrive
lactic aidosis metabolic panel
high anion gap metabolic aidosis
DKA
polyuria/ nocturia, polydipsia, polyphagia
vomiting, abd pain, weight loss
fatigue, dehydration
kaussmaul respirations
gucose > 200
bicarb < 15
pH < 7.3
anion gap >14
urine ketones
increased FFAs
falsely normal K - due to decreased insulin –> K. shift to ECF
reye syndrome biopsy
microvesicular fatty steatosis
complication of friedreich ataxia
cardiac dsyfunction - hypertrophic cardiomyopathy
seborrheic dermatitis
peaks in infancy and adulthood
erythematous plaques and/or yellow greasy scales
located on scalp face eye area, posterior ears umbilicus/ diaper area
tx of seborrheic dermatitis
emollient
then topical antifungals or low potency glucocorticoids
infant botulism
ingestion of botulinum spores from environmental spores
ringworm
tinea corporus
tx - topical clotrimazole
jejunum atresia
risk factors = vasoconstrictive meds, cocaine use in mom
dx - triple bubble sign and gasless colon
risks seen in a small for gestational age infant under 10%
hypoxia polcythemia hypoglycemia hypothermia hypocalcemia
MCC of conductive hearing loss
repeated OTITIs media infections
congenital torticollis can lead to
positional plagiocephaly
MCC of childhood bloody diarrhea
entamoeba histolyticum
dx of ALL via
bone marrow biopsy
central DI labs
increased Na
recommendation for diabetic athletes
lower there dose of insulin 10 to 15% on practice days
ADR of ceftriaxone
hyperbilirubenmia
tx for neonatal meningitis i kids < 30 days
ampicillin
steroids
cefotaxime
testing for HIV in baby <18months
DNA PCR
testing for HIV in baby > 18months
ELISA
CD4 count diseases
<200
<100
<50
<200 = PCP - tx - TMP-SMX +/- dapsone <100 = toxoplasmosis - tx - TMP-SMX +/- atovaquone <50 = mycobacterium avium - tx - azithromycin
tx for kid with latent TB
INH + vitamin b6
TB test for kid <5 and > 5
< 5 = PPD
> 5 = quantiferon
Peritonsilar abscess
approx 10 years old
displaced uvula to one side
sore throat, muffled hot potatoe voice
drooling
tx of angioedema
FFP
tx of scabies
topical permethrin
urine pH >5.5 \+ metabolic acidosis = dx?
renal tubular acidosis
physio of transient tachypneic of the newborn
delayed resorption and clearance of aleolar fluid
diamond blackfan anemia
weird tripharyngeal thumbs
craniofacial abnormalities
increased risk of malignancy
macrocytic anemia
reticulocytopenia
normal platelets, white
tx corticosteroids
erythematous plaques and yellow, greasy scales located on scalp, nasolabial folds
seborrheic dermatitis
tx - emollients
difference between angioedema and anaphylaxis
anaphylaxis has hypotension angioedema does not and you treat with securing airway vs anaphlyaxis you give IM epi
if c1 eserase def tx with FFP
tx of allergic rhinitis
avoid allergen + intranasal steroids
presence of gamma tetramers (hemoglobin barts ) should make you suspicious for
alpha thalassemia - associated with hydrops fetalis
elevated reticuloctye count
low MCV
target cells seen on peripheral smear
heavy regular bleeding in menses in an adolescent with normal cogulation profile =
Von WIllebrand disease
hemophilia A patient develops increased bleeding frequency or has become refractory to treatment =
inhibitor development - body recognizes factor 8 being infused as foreign and rejects it
fever, irritability
generalized erythema, blisters
epidermal shedding (nikolsky sign)
staph scalded skin syndrome
tx - nafcillin, vancomycin
neruoblastoma can be associated with what disorders
neurofibromatosis
hirchsprung disease
nurse maids elbow
radial head subluxation
tx - reduction
supracondylar humerus fracture
MC pedaitric elbow fx
5-8 yrs old
increased risk of volkmann contracture - due to compartment syndrome
beware of brachial artery entrapment - check radial pulse
compication of scolioiss
restrictive lung disease
what live attenuated vaccine can HIV patients take
MMRV
male in fant with a distended palpable bladder and low urine output
posterior urethral valves - MC congenital urethral obstruction
dx step of croup
give raecmic epi and they get better
croup that does not improve
slightly more toxicity
raecemic epi doesnt help
bacterial tracheitis - caused by staph aureus
do a tracheal culture
tx - iv abx
unilateral anterior chain lymphadenopathy
mass
drooling
peritonsillar abscess
VSD can lead to what
RVH
CXR of ASD
increased vascular markings and cardiomegaly
complications of ASD
dysrhythmias
paradoxical emboli and DVTs
pear shaped heart
pericardial effusion
jug handle appearance
primary pulmonary artery HTN
adverse rxn of working with plastics
hydrogen cyanide poisoning - ha, confusion, sudden LOC, metabolic acidosis
diluting formula leads to
hyponatremia –> seizures
nevus flammeus =
nevus simplex
salmon patch
flat vascular lesions that occuri n the beck/base of scalp
appear more prominnent during cyring or exerise
pustular melanois
benign self limited newborn dz
more common in blacks
1-2mm pustules that result in hyperpigmented lesions encircles by scale
sebacceous nevi
small sharply demarcated lesions that occur more commonly on the head and neck of infants
yellow -orange in. color
slightly elevated
hairless
cold panniculitis
destruction of fate cells caused by expposure to cold weather or cold object
self resolving
tx for aspirin overdose
sodium bicarbonate
teratogeneic effects of ACE-I
oligohydramniosis
renal dysgenesis
tx of inflammed lesions in seborrheic dermatitis
topical corticosteroids
neonatal SLE exposure can lead to
heart block –> heart failure
testing for digeorge syndrome
intradermal skin test using candida albicans
NO RESPONSE in patients with T cell defect
fecal occult blood test + in a newborn
meckels diverticulum
dx - meckels scan = technium 99
or if a teenager = ct scan
baby swallows moms blood what test
apt test
Ulcerative colitis basics
bloody diarrhea
surgery is curative
continous damge in the colon
crohns basics
skip lesions
watery diarrhea
medications - tx
weight loss
kid with fever and bloody BM what is the next step
stool culture
milk protein allergy tx
hydroylzed formula
metabolic acidosis effects on bilirubin
reduces its binding similiar to. sulfa drugs
phenobarbital has what effect on bili pathway
kickstarts gluconuryl transferease
neonatal sepsis has what effect for bili
interrupts the BBB incresing risk for kernicterus
hyperalbuminemia has what effect on bili
will aid in reducing excess bili by binding to it
what drugs are C/I in breast feeding
amphetamines lithium cyclosproin drugs bromocrptine
what symptoms follow in a newborn delivered by maternal diabetes mom that has finally got insulin and glucose under control
hypocalcemia –> tetany
hypomagensia
smaller for dates infants have a higher incidence of
major congenital anomalies and at increased risk for future growth retardation
in premature infants apnea is thought to be secondary to
an incompletely developed respiratory center
early tx of galactosemia =
soy formula feeding
polycythemia in a newborn can lead to what complication
seizures
goats milk is deficient in
vit d
folate
newborns with cleft lip and cleft palate are at greater risk for
recurrent otitis media and hearing loss
speech issues
2 week old newborn with: enlarged fontanelles jaundice lethargic feeding difficulties edema of extremities and gentials bradycardia
dx =
congenital hypothyroidism
cxr of transient tachypnea of the newborn
increased pulmonary vascular markings
most common type of PNA in kids , 5 y/o
viral
1 day old infant fronto occipital head circumference that is 2cm larger than it was initially several hours ago and the scalp is no squishy and the infant is now tachy
subgaleal hemorrhage
subaponeurotic hemorrhage
intraventricularhemorrhage (germinal matrix hemorrhage)
small premature infants
can lead to hydrocephalus –> tx = vp shunt
caput succedaneum
soft tissue swelling - presenting in the delivery portion of the head
can CROSS suture line edema may be. pitting
resolves in the first few days
tx of SVT in infant
carotid massage
complicaitons = hydrops fetalis
pulsus parodoxus in a kid cna be seen in what autoimmune disease
JIA
muffled heart sounds
increase pulsus parodoxus
spindle shaped swelling of finger joins
tricupsid atresia
RVH
LAD
LVH
unilateral nasal obstruction with foul smelling discharge in young kid
FB
complication of staph and other types of pna - signs
- acute worsening over minutes
markedly increased work of breathing
increased O2 requirements
hypotension
tension pneumothroax - tx - needle aspiration
tx and management of bacterial tracheitis
maintain airway
lens shaped hemorrhage
epidural
crescent shaped hemorrhage
subdural
punctate hemorrhages seen on a head CT
concussion
car safety
car seat - rear facing 0-2yrs old
booster seat until 4’9’’
hypertrophied tonsils and adenoids lead to what metbaolic condition
respiratory acidosis with metabolic compensation - due to chronic upper airway obstruction
cause of. mono
ebv
dx of lactose intolerance can be made via
hydrogen breath test
first teeth to form in a newborn are
mandibular central incisors
prolonged bottly use in an infant can lead to
tooth decay
other lab values that can occur during nephrotic syndrome
incerased cholesterol and TGLs
complication of spina bifida
recurrent UTIs
hypotnia o LE
muscle atrphy of LE
FB and expiratory wheeze
intrathroacic airways - bronchioles since they collapse when breathing out
FB and inspritory wheeze
extrathroacic airways since the air has to push to get around object
+ coin sign on lateral x-ray FB is located
in the trachea
Athsma taper tx
1) SABA + rescue inhaler (RI)
2) above + inhaled corticosteroid (ICS)
3) above + leukotriene antagonist
4) above + increased dose of. ICS
5) above + LABA
6) above + oral steroid
tx of RSV
supportive care
O2
IVF
complete lack of acid beta galactosidase actvity
niemman pick
B cell def diseases
XLA
CVID
IgA DEF
hyper IgM
T cell def
dieorge syndrome
HIV
Combined b cell and t. cell def diseases
Wiskott aldreich
ataxia telengectasias
SCID (mega aids)
phagocytosis diseases
LAD
CGD
chediak higashi
XLA - LAB VALUES
CBC -. NORMAL
NO IgG
No B. cells
no RTK gene
CVID lab values
mild form of XLA
teenager
normal CBC
decreased 2/3 of Igs’s
diegorge syndorme
22q11.2 - 3rd pharyn pouch
wide spaced eyes, low set ears, small face
absent thymic shadow
fungi + PCP infection
digeorge lab values
CBC = decreased absolute lymphocytes
decreased Ca
wiskott aldrich lab values
CBC = decreased WBCs, decreased platelets
increased IgM
increased IgG
SCID lab values
CBC = decreased WBCs
decreased IgG, IgM, IgA
CGD lab values
CBC = increased WBCs
increased IgM, IgG
recurrent staph abscesses
LAD lab values
CBC = increased WBCs
Increased temp
no pus
delayed cord separation
tx of c1-esterase def
FFP
rubeola =
measles
test for scoliosis
adams test
signs of botulism
constipation poor feeding absent gag reflex ptosis hypotonia descending paralysis
when is chelation therapy needed
> 45 lead levels
tx of diabetes insipidus
desmopressin
excessive milk intake can lead to
iron def anemia
microcytosis
increased red cell distribution width
langerhan histiosytosis
lytic bone lesions
skin lesions
lyphadenopathy
pulmonary cyst/nodules
tx - vinblastine + prednisone
neuroblastoma can also present with
spinal cord compression from epidural invasion
serous otitis media basics
non bulging
biliary atresia
direct bili increased
7-14 days after birth
US- no ducts
HIDA scan 7 days after phenobarbital is given
dysmorphic RBC casts in urine =
glomerular damage = nephritic syndromes
ectopic ureter presenttion
young girl who is never dry
tx of ringworm
topical clotrimazole
migraine HA presentation in predtriacs
mcc of acute and recurrent hAs
unilateral or bilateral
photophobia
n/v
biphasic stridor that improves with neck extension
vascular ring
rickets labs
low Po4 and normal Ca
osteogenesis imperfect
normal PO4
normal Ca
medulloblastoma
2nd mcc tumor of brain
cerebellar vermis - ataxia
ha
n/v
simple seizures in newborns
require no workup
- less than 15min
only 1 in 24hr
gnerlaized
risk factor for RDs
maternal diabetes
non classical congenital adrenal hyperplasia
premature secondary se characteristics
accerlaerated growth and bone age
low/normal LH levels
periventricular calcifications in newborn
CMV
intracerebeal calcifcations
chorioretinitis
toxoplasmosis
fredriech ataxia
mri cervical spinal cord atrophy loss of position sense and decreased vibratory sense progressive weakness in LEs wide based gait kyphoscoliosis
complications - hypertrophic cardiomyopathy
tx of acute bacterial rhinosinusitis
amoxicillin +/- clavulanuate
premature adrenarche
caused by early activation of adrenal androgens
more common in obese children
nml bone age
primary cause of toxo
undercooked food
cxr of transient tachypnea
lung hyperexpanded
wet
increased pulmonary vascular markings
viral myocarditis
can be caused by coxsackie b and adenovirus
viral prodrome heart failure resp distress murmur hepatosplenomegly
dx workup of precocious puberty
advance bone age –> LH test
if low –> gnrh stimulation test
if high –> MRI - central precocious puberty
shigellosis
bloody diarrhea
seizures
fever
dehydration
s3 gallop
hypotension
recent URI
myocarditis
ADR of TMPSMX
neutropenia
+ ppd
- cxr
dx =
latent TB - tx - INH + B6
