Pediatrics Flashcards
2 day female, feeding were fine. Now bright green emesis. Distended abdomen but can be compressed. No stool in rectal vault. Xray dilated loops of bowel with a ground glass appearance in RLQ and scant air distally in colon. Next step?
obstruction
Could be meconium ileus
Test: Upper GI series and contrast enema
Possible tuberculosis in 3 y.o
TST (skin test) even if had vaccine
Interferon gamma release assay not done till 5 y.0
Live vaccines
MMR, Rota, Varricella, intranasal flu
Inactivated vaccines
Hep A, Hep B, Polio, diptheria, streptococcus, pneumococcal, Hib
Vaccines in first year
Hep B, Rota, Dtap, Hib, Streptococcal pneumonia, Polio, influenza
Vaccines given at 12 months
MMR, varicella, Hep A
Bone pain, sunburst pattern, humerus
Associated with
Osteosarcoma
Retinoblastoma
onion skinning w/ lytic appearance, shaft lower extremity
Ewing sarcoma
Click in baby’s hip when examining
Reexamine at 2 weeks
Ultrasound at 4 weeks if persists
Ciprofloxacin drops
Pseudomonas coverage for ear
Otitis externa
Pyloric stenosis
IV fluid first
Then pyloromyotomy
Tetanus question
If they have had 3 lifetime doses of tetanus then no immunoglobulin needed
If recieved less than 10 years ago then no booster either
If >10 years and clean wound or dirty wound 5 years since booster –> Only need tetanus booster
Eczema, thrombocytopenia, frequent infections in young child
- due to what
- tx
Wiskott-Aldrich syndrome (WAS)
Impaired cytoskeleton changes in leukocytes, platelets
Tx: Stem cell transplant
Low platelets and hematochezia
Anemia
Schistocytes
Renal failure
Hemolytic uremic syndrome
Isolated thrombocytopenia
Large immature platelets
Idiopathic thrombocytopenic purpura
X linked agammaglobulinemia
Males only
Lacks B cells
Recurrent sinopulmonary infections
Hyper Igm Syndrome
Recurrent infections
High IgM
Low IgA IgG
“Spells”
Conscious but unresponsive and unaware of environment
Maintain motor function
Eyes open
Doesnt interact
Repetitive hand movements
Confusion following
No recollection of event
Complex partial seizure
Alteration in mentation= complex
No tonic-clonic activity (only automatism)= partial
Complex seizure
Alteration in mentation
Complex generalized seizure
Tonic clonic
(Full body convulsions)
Alternation in mentation
Prevent drowing
Life jacket
Supervision
Cyanotic baby
Persistent hypoxemia that does not improve w/ oxygenation
No murmur
Not improving w/ oxygenation –> none of the inspired oxygen is getting to systemic arterial circulation –> transposition of great vessels
Baby only alive due to patent ductus arteriosus
Must keep patent
Tx Prostaglandins prolongs the duct
[Endomethacin (indomethacin) ends the ductus]
Diagnose coarctation of aorta
Echo
Water for infant
120 or lower to decrease chance of burns
Urethra on ventral side of shaft
hypospadias
Delay circumcision so there is foreskin for reconstruction
Kid gets transfusion and has anaphylactic rxn
Recurrent gastrointenstional infections
Selective IgA deficiency
ABO mismatch
Hemolysis
2 y.o abdominal pain
Fecal occult blood
Cylindrical mass
Relief w/ pulling feet to chest
Intussusception
Abdominal US
Technetium 99 scan
Meckel’s diverticulum
Presents as asymptomatic GI bleed
Asthma like but no response to therapy
Negative CXR
Infxn w/ RSV
Knee to chest position does what
Increased systemic vascular resistance
Blue baby when eats, resolves
Tetralogy of fallot
2/6 systolic crescendo-decrescendo murmur on left sternal border
ventricular septal defect
Transposition of great vessel vs tetralogy of fallot
Transposition diagnosed at birth or baby dies
Nodule of tibial tuberosity in teenager
Xray irregularities and haziness over metaphyseal border of tibia
Tx
Osgood-Schlatter disease
Decrease activity and NSAIDS follow by PT
Retinal hemorrhages next step
CT scan of head for subdural hematoma
Leg pain Lytic lesion with clear ring on bone Worse at night NSAIDS help some No fever or WL
Osteoid osteoma
Alcohol consumption Pain in abdomen Resolved by morning No discharge No costovertebral angle tenderness
Dx
Ureteropelvic junction (UPJ) obstruction
U/S
Narrowing is distended in setting of large diuresis
2/6 holosystolic murmur
Adult
Child
Mitral regurg and ventricular septal defect
Ventricular septal defect more common
Children do not have MR
Most common congenital heart disease after age 1
Atrial septal defect
Fixed split S2
Atrial septal defect
Infant multiple UTI what test
Voiding cystourethrogram
Increased conjugated bilirubin and Jaundice
Dx
US of RUQ
Blockage somewhere
Sickle cell on peripheral smear
Howell-Jolly bodies if no spleen
Bite cells
G6PD deficiency
African
Pain crises w/ jaundice
Reduced hemoglobin
Reticulocyte count of 15%
How to prevent death
Sickle cell disease
Vaccination w/ conjugate capsular polysaccharide
Strep. pneu
H. flu
5 day old infant with eye infection. Gram negative diplococci
Tx
Intramuscular ceftiraxone
Tx chlamydia (unilatearl purulent conjunctivitis)
Oral erythrmycin
PO macrolide
Prophylaxis for gonoccal conjunctivitis
Topical silver nitrate
Newborn no urine in 24 hrs
Suprapubic mass
Dx
Posterior urethral valves
Suprapubic mass= distended bladder
Straight catheterizeation
2 y.o SOB and barking cough. Improved by going outside. Low grade fever. Wheezing
Tx
Croup
Parainfluenza
Racemic epinephrine
10 day old infant. Becoming progressively jaundice. Clay stools
Bilirubin 7 with 6 being unconjugated
Breast milk jaundice
AFTER baby went home –> Breast feeding or breast milk jaundice
Swollen tonsils with white on them, sore throat
At risk for
Streph
Risk for glomerulonephritis
Way to prevent painful legs in sickle cell patient
Hydroxyurea
Reduces amount o f sickle hemoglobin in circulation
Contraindications for vaccine
Encephalopathy
Relative
- fever > 105
- Insoluble cry 3 hrs
Bleeding in diaper 20 months old No pain or distress Eating and drinking normal Sort non distended abdomen
Dx
Meckel’s diverticulum
Technetium 99 scan
Seizing child
< 1 y.o
Hyparrhythmia on EEG
Tx
West syndrome
TX: ACTH (cosyntropin)
Adams forward bend test
Scoliosis
Female 4 y.o who keeps wetting diapers. Feels urge and trained on potty but keeps happening
Low implantation of ureter
Toilet training age
2-4
Disease of newborn
Intraventricular hemorrhage
Bronchopulmonary dysplasia
Retinopathy of prematurity
Necrotizing enterocolitis
Air in the stomach and duodenum without any distal air
Annular pancreas or duodenal atresia
Multiple air fluid levels
Vascular insult
intestinal atresia
Distended proximal colon with normal gas pattern distally
Hirschsprung’s disease
Increased soft tissue swelling w/ throat issue
Retropharyngeal abscess
Thumb print
Epiglottitis
Steeple sign
Croup
Bacterial tracheitis
Projectile vomiting of bilious contents is indicative of
multiple air fluid levels
Pathlogic emesis in a newborn
Multiple air fluid levels -> Intestinal atresia –> cocaine
Recurrent abscesses
Absent macrophages oxidative burst seen in chronic granulomatous disease
Typical pathogens staph, aspergillus, serratia
Percentages of body
Head 18% (9% front and back)
Arm- each arm is 9%
Thorax- front and back thorax are 18%
Legs- total is 27%, 13.5 for each leg
Genitals- 1%
Dx esophageal atesia
NG tube and x ray to confirm placement
NEwborn, difficulty feeding. Coughs and spits up his feedings both times it is attempted. Gurgling bubbles form mouth. Infant becomes cyanotic but improves w/ suction
Esophageal atresia
Pre-eclampsia in mother and infant not passing meconium
Check Mg level
Jittery infant with glucose of 20
Diabetic mother
IV administeration of D10 bolus
Infant is hypoglycemic
Baby with two blue dots on butt, there at birth
Congenital Dermal melanocytosis
Mongolian spot
Latin culture
Spontaneously resolve
7 y.o w/ strep and given pencillin develops hives
what to do
Discontinue penicillin
State cephalexin & cetrizine
Lower risk BRUE
> 60 days
45 weeks post conception if over 32 weeks
First occurrence
No CPR by trained provdier
No concerning findings on hx/PE
Higher risk BRUE
Premies Under 2 months < 60 days <45 weeks post conceptional Multiple episodes
Infant given aspirin check what level
ammonia
Hepatic encephalopathy
6 y.o w/ headache and rash. Has been outside on farm. Rash with ring of erythema surrounding a ring of clearing, surrounding a hyperpigmented lesion at the center
Lyme disease
Tx: Amoxicillin
16 y.o egg allergy wanting flu shot
Inactivated influenza vaccine and observe for 30 min
Legg- Calve Perthes disease
Ischemia and osteonecrosis of the femoral head in a child around 6 y.o
Antalgic gait (limp)
Machine like murmur
Patent ductus arteriosus
3 y.o
Infxn 6 weeks ago
Flank mass
Hematuria
Wilms tumor
4 y.o
Febrile seizure
Hypopigmentation that enhaces under wood’s lamp
Small calcified appearing tumors in brain
Develop later in life?
Tuberous sclerosis
Febrile seizure fails to remit
Ash-leaf lesions
Sebacous adenoma
Failure to pass meconium
Distended abdomen w/ palpable stool
Stool in small bowel w/ some in colon. No stool in rectal vault
Proximal colon dilated and distal colon appears normal
Hirschsprung disease
Contrast enema
Next step after Rectal suction biopsy to confirm
Cleft lip Low set ears Wide spaced eyes Hypocalcemia Reduced PTH Candida in blood
Deletion on chromosome 22
DiGeorge sydnrome
Deficiency of parathyroid gland
9 mn w/ recurrent abscess
Leukocyte adhesion deficiency
Nitro blue test positive
Indicates oxidative burst produced by leukocytes present
So not Chronic granulomatous disease
Chediak higashi syndrome
Neuropenia on lab work
Albinism
Infant w/ downs syndrome most likely heart defect
Ventricular septal defect
Holosystolic murmur at the left sternal border
Take to ER for epistatsis
After 30 min
Growth delay in kid check
Left wrist and hand radiograph
HA, emesis, vision changes, nystagmus and ataxia
Intracranial pathology
Check brainstem
MRI
Hearld patch–> generalized rash
What test
RPR
pityriasis rosea
Fracture
Blue sclera
Tx
Osteogenesis imperfecta
Skin biopsy
Check serum calcium and phosphorus for
Rickets
Large newborn with grunts and limp arm
Phrenic nerve disruption
3 infections of neisseria meningitidis
C6, C7, or C8 deficiency
Chronic skin infections, abscess formation, osteomyelitis, and pneumonia
Chronic granulomatous disease
Albino like skin
Ocular albinism
Frequent infections
Chediak Higashi syndrome
Fever, aphthous ulcer, stomatitis, and/ or pharyngitis
Repeated episodes
Cyclic neutropenia
Mother gets nonspecific flu like symptoms
Brown amniotic fluid and preterm
Baby comes out with pustular rash
Listeria monocytogenes
GBS & Ecoli in newborn
Normal appearing baby with nonspecific findings of temperature instability, lethargy and poor feeding
GBS –> progresses rapidly to tachypnea, grunting, retractions, trachycardia and poor perfusion
Tx enlarging red mass on baby butt, present at birth
Observe
Hemangioma tends to enlarge over first year then slowly decrease in size
late systolic murmur at apex and midsystolic click
Tx
Mitral valve prolapse
Tx beta blocker
Fever 102 (spiking) Swollen red eyes Rash Palms and soles swollen and red Lymphadenopathy
Kawasaki disease
Fever > 5 days Bilateral non-suppurative conjunctivitis Dry fissured lips Injected lips Strawberry tongue
Risk: Coronary artery aneurysms
Myocardial infarction
Scarlet fever
Group A strep
Abrupt onset fever, sore throat, HA, abdominal pain and malaise
Bright red mucous membranes with petechiae on soft palate
Strawberry tognue
CHARGE syndrome
Coloboma Heart defects (septal defects and aorta/aortic arch defects) Choanal atresia Retardation of growth and development Genital anomalies Ear anomalies
Upper limb defect
Cardiac defect
Holt-Oram syndrome
Atrial septal defect
Neonatal jaundice w/ days of phototherapy
Anemia (pallor)
Enlarged spleen w/o hepatomegaly
Hereditary spherocytosis
Hearing localizes to right. bone conduction greater
conductive hearing loss on right
10 y.o fell to floor and acute onset headache
Lethargic
Right central facial weakness
Cannot move right side of body
Eyes deviated to left
Occlusion of middle cerebral artery
Post morning stiffness in child/ after nap. +ANA
At risk for
Juvenile idiopathic arthritis
Anterior uveitis
Chalazion
lump in eye lid
painless
red
Dacryocystitis
infxn of lacrimal gland
Hordeolum
style
infection on eye lid
hairfollicle
Hyphema
pool of blood in eye
two month old Seizure Doll like appearance Hepatomegaly Low glucose level Lactic acidosis Hyperuricemia Elevated triglycerides
Von Gierke disease
Macroglossia
Hypotonia
Hepatomegaly
Enlarged heart
Pompe disease
Macroglossia Omphalocele Large umbilical hernia Hypoglycemia Hepatomegaly Enlarged kidneys
Beckwith-Wiedeman
Cataracts
Galactosuria
Galactokinase deficiency
no mental retardation
Galactosuria and mental retardation
classic galactosemia
Hypoglycemia
Ataxia
Coma
Hypothermia
injest what
Ethanol
Infants who are small at birth are at risk for
Hypoglycemia
Baby is noisy breather
Inspiratory stridor
(no cyanosis)
Laryngomalacia
Self limiting
Yellow green nail on infant
Meconium in utero
Give Broad spectrum antibiotics
Patient with asthma fails beta agonist and steriods
Test to do
Flexable laryngoscope
Inducible laryngeal obstruction (vocal cord dysfunction)
Child w/ sickle cell and has ischemic stroke what to do
Admit and begin emergency partial exchange transfusion
Cardiac tumor on ultrasound
also see
tuberous sclerosis
Hypopigmented skin lesions
Axillary freckling
Neurofibromatosis 1
Brushfield spots on iris
Down syndrome
Coloboma
CHARGE syndrome and Trisomy 13
Unilateral port-wine lesions
Sturge- Weber syndrome
Risk factors of renal vein thrombosis in infant
Birth asphyxia (apgar scores less than 7)
Diabetic mother
Polycythemia
Floppy baby
Continue oxygenation
Mother given narcotic due to pain –> respiratory depression
Strep decision points
1 point [ ]Fever > 100.4 F [ ] No cough [ ] Tonsillar exudate [ ] No mention of cervical lymphadenopathy [ ] Age 3-14
15-44 +0
45+ -1
Score 0= no testing
Score 1= consider rapid strep test
Score 2 or 3= rapid strep
Score 4= tx empirically
Bilateral hydronephrosis on prenatal ultrasonography
Suggests obstuction
(In males posterior urethral valves)
Get renal and bladder ultrasound
Hematemesis in baby with no signs of distress
What exam
Send emesis to lab for Apt-Downey test
Blood from another source
Child delivered with prolonged labor, had non-tender demarcated swelling that doesnt cross suture lines over parietal region
Cephalohematoma
Observe for extension of lesion or jaundice
Neurologic deterioration with exaggerated resposne to noise and no hepatosplenomegaly
Tay-Sachs
Cherry red spot
Normal birth 2-4 y.o Coarse facies Short Hepatosplenomegaly Hearing loss Retinal degeneration Mental retardation
Hunter syndrome
1 y.o course facies corneal clouding Hepatomegaly Heart disease Skeletal deformities Developmental delays
Hurler syndrome
3 months Hepatosplenomegaly Cherry red spot FTT Resp tract infections
Age 6 hypotonia
Spasticity
Rigidity
Niemann-pick
High fever that goes away and rash develops
Roseolainfantum
Roseola (HHV 6)
Day 2 infant 96.9 F HR 180 Oxygen sat 65% Cyanosis Hepatosplenomegaly
Shock in infant
Day 2 infant
Enhanced right ventricular impulse, normal first heart sound and loud isngle heart sound
Left sided cardiac abnormality
Day 2 closure of ductus in patients with hypoplastic left heart –> cyanosis
Rapid course of altered mental status, fever, shock, and progression of purpura
Meningococcemia
Hypotension
Cardiac depression
Fever or bloody diarrea week before
Now elevated BUN and CR
Proteinuria
Hematuria
Anemia
Low platelets
Hemolytic uremic syndrome (HUS)
Single slightly raised orange peel like hairless lesion on scalp of new born
A. Aplasic cutis congenital B. Congenital melanocytic nevi C. Erythema toxicum D. Herpes simplex virus infection E. Mongolian spot F. Neonatal acne G. Nevus sebaceus H. Nevus simplex I. Port wine stain J. Pustular melanosis K. Seborrheic keratosis
Nevus sebaceus
Removal recommended
New born healthy
Multiple erythematous blotchy macrules on face, back, chest and upper extremities. Have like pustules in center
A. Aplasic cutis congenital B. Congenital melanocytic nevi C. Erythema toxicum D. Herpes simplex virus infection E. Mongolian spot F. Neonatal acne G. Nevus sebaceus H. Nevus simplex I. Port wine stain J. Pustular melanosis K. Seborrheic keratosis
Erythema toxicum
Resolves in 14 days
Contains eosinophils
Rash on skin under neck, upper back, lower back and rash appeared in three stages
numberous 2-4 non erythemaous lesions with intact pustules
Ruptured pustules
Rim of thin skin found at endge of denuded pustules
Freckle like lesions of same size noted proximal to previous two lesions
A. Aplasic cutis congenital B. Congenital melanocytic nevi C. Erythema toxicum D. Herpes simplex virus infection E. Mongolian spot F. Neonatal acne G. Nevus sebaceus H. Nevus simplex I. Port wine stain J. Pustular melanosis K. Seborrheic keratosis
Pustular melanosis
Ill-defined red macule over the glabella, nuchal area and symmetrically over eye lids
A. Aplasic cutis congenital B. Congenital melanocytic nevi C. Erythema toxicum D. Herpes simplex virus infection E. Mongolian spot F. Neonatal acne G. Nevus sebaceus H. Nevus simplex I. Port wine stain J. Pustular melanosis K. Seborrheic keratosis
Nevus simplex (salmon patch)
Fade over first months of life
Pustules isolated to cheeks and forehead
A. Aplasic cutis congenital B. Congenital melanocytic nevi C. Erythema toxicum D. Herpes simplex virus infection E. Mongolian spot F. Neonatal acne G. Nevus sebaceus H. Nevus simplex I. Port wine stain J. Pustular melanosis K. Seborrheic keratosis
Neonatal acne
Single lesion on scalp with well-demarcated area of missing skin
A. Aplasic cutis congenital B. Congenital melanocytic nevi C. Erythema toxicum D. Herpes simplex virus infection E. Mongolian spot F. Neonatal acne G. Nevus sebaceus H. Nevus simplex I. Port wine stain J. Pustular melanosis K. Seborrheic keratosis
Aplasic cutis congenital
Sporadic
Autosomal dominant
Teratogen exposure (HSV or varicella)
Trisomy 13
Well circumscribed light brown to black macules (may have hair)
A. Aplasic cutis congenital B. Congenital melanocytic nevi C. Erythema toxicum D. Herpes simplex virus infection E. Mongolian spot F. Neonatal acne G. Nevus sebaceus H. Nevus simplex I. Port wine stain J. Pustular melanosis K. Seborrheic keratosis
Congenital melanocytic nevi
Suspected myelomeningocele
What test
Ultrasound of lower spine
Seen w/ DiGeorge
Cardiac anomalies (tetralogy of fallot, truncus arteriosus, interrupted aortic arch)
Abnormal facies
Thymic hypoplasia
Cleft palate
Hypocalcemia
Chromosome 22
Cleft lip
Mandibular hypoplasia
Downslanted palpebral fissures
Low set notched ears
DiGeorge
Microcephaly Wide fontanels Microphthalmia High arched palate Malformed ears heart defect pulmonary hypoplasia omphalocele
Edwards syndrome (trisomy 18)
Newborn w/ fever, irritability and poor feeding
Voids 15 x per day
Dehydration
Hypernatremia
Urine gravity <1.005
No leukocytes
No Leukocyte esterase
Diabetes inspidius
Nephrogenic DI
test
- water deprivation test
- MRI brain
- trial of desmopressin
Microcephaly
Corneal clouding
Jaundice
Petechiae
Murmur (continuous harsh)
Congenital rubella
Murmur= patent ductus arteriosus
Small for gestational age Hepatosplenomegaly Anemia Thrombocytopenia --> petechiae and purpura Microcephaly Deafness cerebral atrophy
Congenital cytomegalovirus
Imaging- calcification in a periventricular pattern
Vaginally born
Week old
Sepsis
Penumonia
Congenital herpes
Hepatosplenomegaly
Lymphadenopathy
Thrombocytopenia
Mucocutaneous rash
Runny nose
FTT
Chorioretinitis
Congenital syphilis
Hutchinson teeth
Microcephaly
Anemia
Thrombocytopenia
Jaundice
Mental retardation
Hearing loss
Blindness
Neurologic sequelae
Congenital toxoplasmosis
Intracranial calcifications
Recurrent oral and genital ulcers
- disease
- look for
- test
- complications (3)
Behcet disease
Look for anterior and posterior uveitis
Positive pathergy skin test
Complication= vasculitis (pulmonary artery aneurysms are fatal) and arthritis
Distal small bowel wall thickening on CT
Crohns disease
Harsh holosystolic ejection murmur at left lower sternal border
Ventricular septal defect
Baby has to stop feeding to catch breath
Ventricular septal defect
Harsh systolic murmur at right sternal border at second intercostal space.
Crescendo-decrescendo systolic murmur
Aortic stenosis
Tenderness of tibial tuberosity bilateral in healthy adolescent
Osgood schlatter disease
Ice
NSAIDs
Stretching
Cognitive impairment Small eyes Mid-face hypoplasia Thin upper lip Short nose Flattened nasal bridge
Also see?
Fetal alcohol syndrome
Smooth philtrum
Girl 6 months Hypotonia Gross motor developmental delays Loss of eye contact Hand wringing
Rett syndrome
Newborn who develops cyanosis but which worsens w/ oxygen administration
Tx
Congenital cyanotic heart disease
Ductal dependent lesion
Tx: Patency of patent ductus arteriosus
- Prostaglandin E1 infusion
Chest pain and hemoptysis
Severe day cough, SOB, and last several weeks fever and achy joints
Bilateral lower extremity edema
CXR: diffuse alveolar hemorrhage
Test?
Good pasture syndrome
Urine analysis
Neonatal jaundice w/ excessive phototherapy
Onset of jaundice to sulfa drug
No hepatosplenomegaly
G6PD deficiency
Fave benas
Sulfa meds
Carotenemia
Eat alot of carrots and veggies
Jaundice palms and soles and nasolabial folds
Spares sclera
Poor feeding Vomiting FTT Jaundice Hepatomegaly Cataracts Hypotonia
Hereditary galactosemia
Frequent staphylococcal skin infections
Recurrent staph sinusitis/ mastoiditis
COarse facial features
Prominent forehead
Deeply set/ widely placed eyes
Wide fleshy tip nose
Test?
Job syndrome
Hyper IgE syndrome
Test: Serum IgE level