Pediatrics

Question 1

What is the ddx for the constantly crying infant? (8)

Answer 1

"TIM'S CRIES" / IT CRIES
T - Trauma (acc/NAI), bites + Tumous
I - infxn (AOM, herpes stomatitis, UTI, meningitis, OM, etc)
M - mat/pat stress, anx, depression
S - strangulation (hair tourniquet)

C - Cardiac dx
R - Reflux, Rxn to formula/meds, Rectal fissures
I - Immunizations, Intolerance (cow’s milk,etc.), ICP
E - Eyes (occ FB, abrasion, glaucoma, hemorrhage)
S - Surgical (volv, intussusception, inguinal hernia, testicular torsion)

Question 2

What are criteria for simple febrile seizure?

Answer 2

Brief <15 min
Single within 24 hours
Nonfocal

Question 3

What is the recurrence rate of febrile seizures? Any features make higher or lower risk?

Answer 3

33%, 3/4 within first year
50% recur if <1 year
Less like recur if with temp > vs < 40 (13 vs 35%)

Question 4

What are typical features of JIA? Systemic onset JIA?

Answer 4

Insidious onset
- Morning stiffness or gelling phenomenon (ie, stiffness
after long periods of sitting or inactivity)
- Arthralgias during the day (often symm polyarthraliga)
- May complain of pain; disuse of limbs may be more common than pain complaints
- In young kids may have morning limp that improves with time, or not standing in crib anymore after naps
- May have hx of school absences / inability to participate in sports

SYSTEMIC
High fevers/chills - often intermittent spikes up to 39C for 2+ weeks, often 1-2 times per day at same time (very specific pattern)
Polyarticular symm arthritis
Effervescent rash

Question 5

What is life-threatening complication associated with systemic onset JIA? What are features/findings (#)?

Answer 5

MAS = macrophage activating syndrome
Macrocyte and T-cell proliferation with multi-systemic organ failure
- High fever
- Purpura
- Spont mucosal bleeding / DIC
- Altered LOC
- Hepatosplenomegaly
- may see pancytopenia, abn liver function tests

Question 6

What is the definition of colic (there’s a “Rule)?

Answer 6

Colic = excessive crying for >3h/d, for >3d/week for at least 3 weeks (rule of 3s)

Question 7

What are the diagnostic criteria of Kawasaki’s disease?

Answer 7

• Fever >= 5 days AND
• 4+ of the following:
• • bilat nonexudative conjunctival injection (scleral inj’n w/ perilimbic sparing)
• • oropharyngeal MM changes (pharyngeal erythema, red/cracked lips, strawberry tongue)
• • cervical LN (1+ node > 1.5 cm diameter)
• • peripheral extremity changes (acute = diffuse palmar/hand, feet erythema + swelling)
• • polymorphic generalized rash (no specific pathognomonic rash)

– may have other sx: arthritis, keratitis/uveitis, diarrhea/vomiting, gb disease, coryza, cough

– note can also have atypical / incomplete kawasaki’s

Question 8

What are important ddx for Kawasaki disease?

Answer 8

Viral exanthems (not measles -- should be different specific rash)
Streptococcal disease (SF, TSS)
Staphylococcal disease (SSS, TSS)
Bilateral cervical lymphadenitis
Leptospirosis
Rikettsial disease
SJS/TENS
Drug rxn (e.g. mercury hypersensitivty rxn)
Juvenile chronic arthritis

Question 9

What is the MOST important investigative test in KD and when should it be done? What complication are you looking for?

Answer 9

Echocardiography – repeat @4-6 weeks if first normal
Carditis during febrile phase (myocarditis with ST changes, pericardial eff, others), with coronary vessel abn (aneurysm formation) peaking at 2-4 weeks if untreated

Question 10

What is the treatment for KD?

Answer 10

IVIG (2g/kg IV over 10h, best if started within first 10d – 2nd dose if persistent fever)

ASA – 3-5mg/kg PO daily for 6-8 weeks (some argue give higher dose until afebrile 2-3d but may not offer additional benefit)

Question 11

What is Reye’s syndrome?

Answer 11

Acute metabolic encephalopathy associated with hepatic dysfunction.

Question 12

What are clinical and historical features of Reye’s syndrome?

Answer 12

• Recent viral illness or vaccination (esp influenza, varicella)
• Recent salicylate (aspirin) use (80 of carse reports have aspirin within 3 weeks)
• vomiting, esp abrupt onset w/n few days viral illness
• neurologic symptoms: lethargy, irritability, restlessness, delirium, seizures, loss brainstem refelxes, decorticate/decerebrate coma, flaccid paralysis

Question 13

What is the management of Reye’s syndrome?

Answer 13

SUpportive management:
ABCs, hypoglycemia tx, seizure tx, vomiting tx, fluid resuscitaiton, correct hyperammonemia (?sodium phenylacetate, sodium benzoate), prevent/tx raised ICP, tx severe metabolicacidosis, corect coagulopathy