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From Flashcardlet > Pediatrics Case Files > Flashcards

Pediatrics Case Files Flashcards

0
Q

What 2 vaccinations is a true egg allergy a contraindication for them?

A
  1. Influenza
  2. Yellow fever
    * *NOT MMR, it only contains minute amounts of egg products!
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1
Q

Hypersensitivities and contraindications to vaccinations?

A
  • only immediate hypersensitivity rxns to the given vaccine, one of its components, or the preservative agents are contraindications
  • true egg hypersensitivities are contraindications for the influenza and yellow fever vaccinations
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2
Q

Encephalopathy or encephalitis after a diphtheria, tetanus,and pertussis vaccine?

A

-DO NOT give the subsequent vaccines!

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3
Q

Live vaccines and a child living in a home with a pregnant woman?

A

-OK to give the live vaccine

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4
Q

MMR or varicella vaccines in asymptomatic HIV pts?

A

-OK to give

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5
Q

What age is the Hib vaccine no longer reccommended?

A

-age 5+

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6
Q

At what age are undiluted juices allowed? How should they be served?

A
  • avoid until 6 months

- serve in cup, not bottle

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7
Q

When should a child be able to roll over?

A

-4 months

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8
Q

When should a child be able to sit up?

A

-6 mnths

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9
Q

When should a child be able to fix and follow on the human face?

A

-from birth!

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10
Q

Which 2 groups of patients should not receive live vaccines?

A
  1. Pregnant

2. Severely immunocompromised

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11
Q

Plumbism?

A

-lead poisoning

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12
Q

2 methods of chelation for lead poisoning in asymptomatic kids?

A
  1. IM calcium disodium Ethylenediamineteraacetic acid (CaEDTA)
  2. Oral meso-2,3-dimercaptosuccinic acid (DMSA, succimer) –> more common
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13
Q

Normal lead blood levels? Level that warrants hospitalization?

A
  • normal < 10

- hospitalization > 70

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14
Q

What lead level is chelation therapy started at?

A
  • > 45
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15
Q

What lead level is an environmental investigation warranted?

A
  • > 20 or levels that remain elevated despite education of the parents/family
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16
Q

What lead level are long bone radiographs recommended?

A
  • NEVER recommended, no matter what the level is!
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17
Q

After a chelation therapy, what should be done if the levels rise again?

A
  • reassurance, the levels might rise after an initial fall due to redistribution in the body and the lead also deposits in other tissue (such as bone)
  • rechelation tx is only recommended when the level rebounds to 45 or higher
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18
Q

6 Ssx of in utero exposure to mercury?

A
  1. Low birth weight
  2. Microcephaly
  3. Seizures
  4. Developmental delays
  5. Vision impairments
  6. Hearing impairments
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19
Q

7 SSx of mercury poisoning in children and adults?

A
  1. Ataxia
  2. Tremor
  3. Dysarthria
  4. Memory loss
  5. Altered sensorium (vision, hearing, smell, or taste)
  6. Dementia
  7. Death
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20
Q

Ssx of acute arsenic ingestion?

A

-severe GI sx

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21
Q

Ssx of chronic arsenic exposure?

A
  • skin lesions

- can also cause peripheral neuropathy and encephalopathy

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22
Q

What is Orellanine?

A

-toxin found in cortinarius spe ies of mushrooms

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23
Q

4 Ssx of Orellanine ingestion?

A
  1. Nausea
  2. Vomiting
  3. Diarrhea
  4. Renal toxicity (occurs several days later)
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24
Q

5 Behavioral ssx of lead poisoning?

A
  1. Hyper irritability
  2. Altered sleep patterns
  3. Decreased play activity
  4. Loss of developmental milestones (esp speech)
  5. Altered state of consciousness
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25
Q

6 Physical ssx of lead poisoning?

A
  1. Vomiting
  2. Intermittent abdominal pains
  3. Constipation
  4. Ataxia
  5. Coma
  6. Seizures
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26
Q

Tx for hospitalized pts with symptomatic lead poisoning?

A
  1. 2,3-dimercaptopropanol (BAL) + CaEDTA
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27
Q

3 Initial treatments given for an asthma exacerbation?

A
  1. Administration of oxygen
  2. Inhaled Beta-agonists
  3. Systemic dose of prednisone
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28
Q

Triad of asthma exacerbations?

A
  1. Bronchoconstriction
  2. Airway inflammation
  3. Mucus plugging
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29
Q

Pulsus paridoxus: definition? What 3 conditions is it associated with?

A
  • bp that varies more widely with respirations than normal
  • variance > 10 mm Hg between inspiration and expiration
  • suggests:
    1. obstructive airway dz
    2. Precardial tamponade
    2. constrictive pericarditis
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30
Q

Median age of onset of asthma?

A

-4 yrs

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31
Q

What are the 3 strongest risk factors for asthma development in a child?

A
  1. Atopy
  2. Family history
  3. Respiratory infections early in life
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32
Q

Pathophysiology of airway inflammation in asthma?

A
  • result of mast cell activation
  • immediate IgE response to environmental triggers, usually occurs w/in 15-30 min (early phase reaction)
  • includes vasodilation, increased vascular permeability, smooth-muscle constriction, and mucus secretion
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33
Q

Describe the Late Phase Reaction (LPR) in asthma?

A
  • occurs 2-4 hrs after an acute asthma response
  • inflammatory cells infiltrate the parenchyma of the airways –> causes chronic inflammation
  • airway hyperresponsiveness can occur for weeks after an LPR
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34
Q

Anticholinergics and asthma?

A
  • can be helpful in the acute management of asthma exacerbations
  • dont help much with chronic management
  • MOA: inhibit the vagal reflex at smooth muscle
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35
Q

Cromolyn: MOA? Use?

A
  • MOA: anti-inflammatory drugs that reduce the immune response to allergen exposures
  • take 2-4 wks to become effective!
  • on,y successful in 75% of pts!
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36
Q

Nedocromil: MOA? Use?

A
  • MOA: anti-inflammatroy drugs that act by reducing the immune response to allergen exposures
  • take 2-4 weeks to become effective
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37
Q

Name 2 anti-inflammatory drugs that reduce the immune response to allergen exposures?

A
  1. Cromolyn

2. Nedocromil

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38
Q

Leukotriene modifiers: uses?

A

-anti-inflammatory medications that can be used for long term control

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39
Q

Brachydactyly?

A
  • shortening of hand and foot tubular bones –> results in boxlike appearance
  • can be seen in down syndrome
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40
Q

Clinodactyly?

A
  • incurving of one of the digits

- in down syndrome it is usually the pinky finger

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41
Q

What are the three hormones tested in the triple screen and when during pregnancy are they done?

A
  1. Alpha-fetoprotein
  2. hCG
  3. Estriol levels
    - usually done at 15-20 weeks
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42
Q

In newborns with suspected down syndrome, what 2 potentially life-threatening conditions should they be evaluated for?

A
  1. Cardiac abnormalities –> do echo!
    - 50% have cardiac defects
    - most common = endocardial cushion defect, VSD & tetralogy of Fallot
  2. Gastrointestinal abnormalities
    - 12% have duodenal atresia –> do xray and look for “double-bubble” if there are feeding problems
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43
Q

3 types of chromosomal abnormalities that can cause Down syndrome?

A
  1. Trisomy 21 –> most common (95%)
  2. Translocations (2%)
  3. Mosaics (3%)
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44
Q

What 3 screenings are important to do periodically in down syndrome children?

A
  1. Thyroid
  2. Hearing
  3. Vision
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45
Q

Common features of Down syndrome?

A
  • trisomy 21
    1. Hypotonia
    2. Poor Moro reflex
    3. Flat face
    4. Slanted palpebral fissures
    5. Laxity of joints
    6. Excessive skin on the back of the neck
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46
Q

Common features of Edwards syndrome?

A
  • trisomy 18
    1. Weak cry
    2. Single umbilical a.
    3. Micrognathia
    4. Small mouth
    5. High arched palate
    6. Clenched hand with overlapping of index finger over the third finger
    7. Simian crease
    8. Rocker-bottom feet
    9. Small pelvis
    10. Short sternum
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47
Q

Common features of Patau syndrome?

A
  • trisomy 13
    1. Microcephaly
    2. Sloping forehead
    3. Deafness
    4. Scalp cutis aplasia
    5. Microlthalmia
    6. Coloboma
    7. Cardiac defects
    8. Omphalocele
    9. Single umbilical artery
    10. Hypersensitivity to agents containing atropine and pilocarpine
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48
Q

Pauciarticular RA?

A

-RA that involves 1-4 joints

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49
Q

Polyarticular arthritis?

A

-RA that involves 4+ joints

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50
Q

Definition of arthritis?

A
  • swelling or effusion that contains 2 or more of the following:
    1. Limited ROM
    2. Tenderness or pain on motion
    3. Warmth
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51
Q

Timing criteria for dx of juvenile RA?

A
  1. Onset before age 16

2. Sx for > 6 mnths

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52
Q

3 types of JRA?

A
  1. Systemic-onset
  2. Paciarticular
  3. Polyarticular
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53
Q

5 Common ssx of systemic-onset JRA?

A
  1. Daily high spiking fevers
  2. Rash –> wax and wane with fever
  3. Arthralgias –> wax and wane with fever
  4. Lymphadenopathy
  5. Organomegaly
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54
Q

3 Initial lab tests that should be done for systemic JRA? Results that support dx?

A
  1. CBC
  2. ESR
  3. Blood cultures
    Supportive:
  4. Anemia
  5. Leukocytosis
  6. Thrombocytosis
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55
Q

What infectious disease can look like systemic JRA?

A
  • Rubella

- MAKE SURE THEY HAD THEIR VACCINES!!

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56
Q

In what group of kids is slipped capital femoral epiphysis common in?

A

-obese African American boys

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57
Q

What should you think about in a child with a fever of unknown origin?

A

-systemic-onset JRA!

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58
Q

Risk factors for neonatal physiologic jaundice?

A
  1. Male
  2. Cephalohematoma
  3. Asian origin
  4. Breast fed
  5. Maternal DM
  6. Prematurity
  7. Polycythemia
  8. Trisomy 21
  9. Cutaneous bruising
  10. Delayed bowel movements
  11. Upper GI obstruction
  12. HypoTH
  13. Swallowed maternal blood
  14. Sibling w/ physiologic jaundice
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59
Q

Which bilirubin is neurotoxic?

A

Unconjugated

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60
Q

Conjugated bilirubin?

A
  • direct

- chemically attached to a glucuronide

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61
Q

Erythroblastosis fetalis?

A
  • increased RBC destruction due to transplacental maternal antibody passage
  • antibodies are active against infant’s RBC antigens
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62
Q

5 Ssx of hemolysis?

A
  1. Rapid rise of serum bilirubin
  2. Anemia
  3. Pallor
  4. Reticulocytosis
  5. Hepatosplenomegaly
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63
Q

Unconjugated bilirubin?

A
  • indirect

- NOT attached to glucuronide

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64
Q

When is the peak of bilirubin in full-term newborns?

A
  • btwn 2nd and 4th day of life

- 5-6 mg/dL

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65
Q

8 causes of NONphysiologic jaundice in newborns?

A
  1. Septicemia
  2. Biliary atresia
  3. Hepatitis
  4. Galactosemia
  5. Cystic fibrosis
  6. Congenital hemolytic anemia
  7. Drug-induced hemolytic anemia
  8. HypoTH
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66
Q

4 Findings that suggest NONphysiologic jaundice in newborns?

A
  1. Appears w/ in first 24-36 hrs if life
  2. Bilirubin levels rise more than 5mg/dL/24 hrs
  3. Bilirubin is > 12 mg/dL in a full-term infant w/out other physiologic jaundice risk factors
  4. Jaundice that persists after 10-14 days of life
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67
Q

6 Causes of jaundice that presents w/in the first 24hrs of life!

A
  1. Erythroblastosis fetalis
  2. Hemorrhage
  3. Sepsis
  4. Cytomegalic inclusion disease
  5. Rubella
  6. Congenital toxoplasmosis
    * *** any jaundice w/in 24 hrs requires IMMEDIATE attention!!
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68
Q

Tx for breast-milk jaundice?

A

-stop breast feeding and use formula for 12-24 hrs –> then can resume breast-feeding

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69
Q

5 Possible manifestations of neonatal HSV?

A
  • herpes simplex virus
    1. Premature delivery
    2. Localized skin, eye, and mouth involvement (SEM)
    3. CNS disease
    4. Disseminated disease
    5. Combo of any of above
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70
Q

When is an infant’s risk of contracting HSV highest?

A

-in a vaginal delivery when the outbreak of herpes is from a primary infection

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71
Q

When is the risk of death the highest in infants with congenital HSV?

A

-with CNS disease, disseminated disease, esp if pneumonitis or DIC occurs

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72
Q

4 Lab results common in congenital HSV?

A
  1. Moderate peripheral leukocytosis
  2. Elevated serum liver transaminase levels
  3. Hyperbilirubinemia
  4. Thrombocytopenia
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73
Q

Tx for congenital HSV?

A

-parenteral acyclovir

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74
Q

Congenital HSV prognosis?

A
  • kids with isolated skin, eye, and mouth disease generally have the best outcomes
  • using acyclovir long-term can reduce the mortality in children who have localized CNS disease and disseminated dz
  • most kids who survive the CNS dz usually have neurological sequelae
  • most of the kids withs disseminated dz have normal development by 12mnths of age
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75
Q

What should be done in a pregnant woman who gets recurrent HSV genital outbreaks?

A
  • Risk of viral transmission of recurrent HSV is low –> BUT if lesions are present at time of delivery, a c-section should be done
  • surveillance cultures are not recommended –> not very predictive
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76
Q

What to do in a child (older than neonate) has genital herpes?

A
  • worry about sexual abuse!

- could also be from who bathes the child too though!

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77
Q

Prognosis of HSV encephalitis in children?

A

-with appropriate tx and rehab, good outcomes are possible –> majority have permanent neurologic impairment though

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78
Q

Dysentery?

A

-intestinal infection that results in severe bloody diarrhea with mucus

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79
Q

Enteritis?

A
  • inflammation of the small intestine
  • usually causes diarrhea
  • can be the result of an infection, immune response, or other cause
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80
Q

Most common source of non-typhoidal salmonella? Season most common in?

A
  • poultry and raw eggs most common source of human infection –> many animals harbor salmonella
  • iguanas and small turtles can also carry salmonella
  • infections are more common in the warmer months
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81
Q

Spread of salmonella infection?

A
  • need to ingest a lot of organisms

- spread is rarely from person-to-person

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82
Q

Microbio of salmonella?

A

-aerobic gram-negative rods

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83
Q

6 Common ssx of salmonella infection in kids?

A
  1. Sudden onset of nausea
  2. Emesis
  3. Cramping abdominal pain
  4. Watery or bloody diarrhea
  5. Low-grade-fever
  6. Sometimes can have neurologic sx (confusion, headache, drowsiness, and seizures)
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84
Q

Microbio of shigella?

A

-small, gram-negative bacilli

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85
Q

Transmission of shigella? Most common season?

A
  • spread person-to-person most often (fewer organisms requried to cause dz) –> can be in food and water too though
  • most common in the warmer months
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86
Q

6 Common Ssx of shigella infection?

A
  1. Fever
  2. Cramping abdominal pain
  3. Watery diarrhea
  4. Anorexia
  5. Appear ill
  6. Slmetimes neurologic sx (headache, confusion, seizure, hallucination)
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87
Q

Lab findings of salmonella?

A
  1. Stool culture is usually negative
  2. Fecal leukocytes are usually positive = colonic inflammation
  3. Occult blood test usually positive
  4. Mild leukocytosis
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88
Q

Common shigella lab results?

A
  1. Stool culture is usually negative
  2. Fecal leukocytes are usually positive = colonic inflammation
  3. Occult blood = positive
  4. Peripheral white count is usually normal with remarkable left shi!
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89
Q

Tx of salmonella?

A
  • fluid and electrolyte balance!
  • antibiotics are not helpful –> dont shorten course and can increase chances of HUS
  • dont use antimotility tx!
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90
Q

Tx of shigella?

A
  • fluid and electrolyte balance!
  • antibiotics –> decrease duration of diarrhea and decrease the amnt of organism shed (and spreading)
  • dont use antimotility tx!
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91
Q

Most common cause of acute childhood renal failure?

A

-hemolytic-uremic syndrome –> can develop after e. coli (O157:H7)

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92
Q

Typical presentation of HUS?

A
  • Acute onset of:
    1. Pallor
    2. Irritability
    3. Decreased or absent urine output
    4. Stroke
    5. Petechiae
    6. Edema
  • occurs1-2wks after a diarrheal illness
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93
Q

Tx and prognosis of HUS?

A
  • tx: supportive, some children might require dialysis
  • most children recover and renal function goes back to normal
  • continue to follow and screen the child for HTN and chronic renal failure
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94
Q

Tx for intussusception?

A
  • barium enema

- can be diagnostic and therapeutic

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95
Q

Otalgia

A

-ear pain

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96
Q

6 Common ssx of otitis media?

A
  1. Ear pain
  2. Fever
  3. Red TM
  4. Opaque TM
  5. Poorly moving TM
  6. Bulging TM
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97
Q

Serous OM?

A
  • otitis media with effusion

- get a collection of fluid behind the TM, but without ssx of an acute OM

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98
Q

3 Common bacterial causes of OM?

A
  1. Strep pneumo
  2. H. Influenza
  3. Morexella catarrhalis
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99
Q

What is the usual tx for acute OM?

A
  • amoxicillin 80 mg/kg/d for 7-10 days

- if no improvement in 3 days, switch antibiotics!

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100
Q

How long can middle ear fluid persist for after an acute OM episode? Tx?

A
  • for several months!
  • just observe if no hearing loss
  • if hearing loss occurs, a myringotomy with tubes is needed!
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101
Q

3 Important serious complications of OM?

A
  1. Mastoiditis
  2. Temporal bone osteomyelitis
  3. Facial nerve paralysis
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102
Q

2 common bacterial and 2 common fungal causes of otitis externa?

A
  • bacteria:
    1. Pseudomonas
    2. Staph aureus
  • fungal:
    1. Candida
    2. Aspergillus
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103
Q

Mastoiditis tx?

A
  • myringotomy
  • fluid culture
  • parenteral antibiotics
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104
Q

What to do if an OM fails several antibiotics txs?

A

-tympanocentesis and culture the middle ear fluid

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105
Q

Myringotomy?

A

-putting a small hole into the ear drum to relieve pressure

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106
Q

When do children start babbling things like “baba and dada”?

A

-usually by 9 mnths

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107
Q

Conductive hearing loss?

A

-hearing loss caused by disorders of the outer ear (external auditory canal atresia and otitis externa) or middle ear (OM and cholesteatoma)

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108
Q

Eetrocochlear hearing loss?

A
  • central hearing loss

- caused by deficits in the auditory nerve or central auditory nervous system

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109
Q

Sensorineural hearing loss

A

-hearing loss caused by cochlea disorders (damage from infection, noise, ototoxic agents, or genetic defects)

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110
Q

Waardenburg syndrome: 6 ssx? Inheritance?

A

Autosomal dominant!

  1. Partial albinism –> usually a white forelock
  2. Deafness
  3. Lateral displacement of the inner canthi
  4. Heterochromic irises
  5. Medial eyebrow flare
  6. Broad nasal bridge and mandible
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111
Q

Brachio-oto-renal syndrome: 5 ssx?

A
  1. Hearing impairment
  2. Preauricular pits
  3. Brachial fistulas
  4. Renal impairment
  5. External ear abnormalities
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112
Q

Most common infectious cause of congenital sensorineural hearing loss (SNHL)? 3 other infections?

A
  • prenatal CMV
  • can also cause hearing loss later in infancy and childhood
  • other infections:
    1. Toxoplasmosis
    2. Rubella
    3. Syphilis
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113
Q

Two most common postnatal infectious causes of SNHL?

A
  1. Group B strep

2. Strep pneumo

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114
Q

What is the current goal for dx and interventions in hearing loss?

A
  • dx by 3 mnths
  • intervention by 6 mnths
  • *early intervention can enhance communication skills and academic performance
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115
Q

What age can hearing aids be used? What age for cochlear implants?

A
  • 2 mnths for hearing aids

- older than 2 yrs for cochlear implants

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116
Q

What APGAR scores warrant an audiologic evaluation?

A

-< 4 @ 1 minute and < 6 @ 5 minutes

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117
Q

Speech abilities of a 24 month old?

A
  • vocab of 50 words

- able to make 2 word sentences

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118
Q

Speaking abilities of a 36 mnth old?

A
  • vocab of 250 words
  • produce at keast 3 word sentences
  • use pronouns
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119
Q

Two most common drugs that can cause SNHL if taken during prenatal period?

A
  1. Aminoglycosides

2. Loop diuretics

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120
Q

What should a female child be tested for when sexually abuse occurs (7)?

A
  1. Trichomonads
  2. Bacterial vaginosis
  3. Yeast infections
  4. Chlamydia
  5. N. Gonorrhea
  6. HIV test (for at least 6 mnths after the last sexual contact)
  7. Syphillis
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121
Q

How long is forensic information usually present for with sexual abuse?

A

-for 72 hrs

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122
Q

Anal condylomata in a child < 3 yrs old?

A
  • usually acquired at birth via direct conduct w/ genital condylomata of mother in the birth canal
  • but make sure to get a full history to make sure there is no sexual abuse!
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123
Q

Emollient?

A
  • cream or lotion that restores water and lipids to the epidermis
  • the more effective and lubricating ones contain urea or lactic acid
  • creams lubricate better than lotions
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124
Q

Flexural areas?

A
  • areas of repeated flexion and extension
  • often perspire on exertion
  • ex: antecubital fossae, neck, wrists, ankles
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125
Q

In the infantile phase of atopic dermatitis, when do sx usually start?

A

-start to see first signs of inflammation during third month of life

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126
Q

Another name for atopic dermatitis?

A

-eczema

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127
Q

Prognosis of atopic dermatitis in infants?

A

-resolves in 50% by 18 months

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128
Q

Tacrolimus & pimecrolimus: what are they? Use? Possible link?

A
  • what: non-steroidal, immunomodulator topicals for tx of atopic dermatitis
  • use: children > 2 yrs old for short term, or long-term intermittent tx in pts who did not have an adequate response to conventional tx
  • link: possibly linked with lymphoma! –> consult dermatologist!
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129
Q

Iral antihistamines and atopic dermatitis?

A

-can be of use at night to decrease itching, which is often worse at night, and to have some sedating effects

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130
Q

Pityriasis rosea: describe rash? Tx?

A
  • rash: herald patch followed by christmas-tree formation of salmon colored lesions
  • tx: antihistamines, topical antipruritic lotions, low-dose corticosteroids, & photo tx
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131
Q

Eczema herpeticum: what is it? Tx?

A
  • what: infants with atopic dermatitis can develop a rapid onset of diffuse cutaneous herpes, will have high fever and adenopathy 2-3 days after onset of vesicular rash
  • tx: admission to hospital and intravenous acyclovir –> medical emergency in young infant!
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132
Q

Wiskott-Aldrich syndrome: genetics? 3 Ssx?

A
  • X-linked
  • Ssx:
    1. Recurrent infections
    2. Eczema
    3. Thrombocytopenia
  • T-cell dysfunction
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133
Q

How do infants with poor caloric intake usually grow?

A
  • fail to gain weight, but maintain length and head circumference
  • eventually length is affected next, and then head circumference last
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134
Q

Failure to thrive definition?

A
  • FTT
  • physical sign, not a dx!
  • growth below the 3rd or 5th percentile, or growth that crosses more than 2 major growth percentiles in a short time frame
  • usually seen in kids < 5 yrs old
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135
Q

Nonorganic failure to thrive?

A
  • psychosocial
  • poor growth without medical etiology
  • often due to poverty or poor caregiver-child interaction
  • it is usually the cause in nearly all the cases of failure to thrive in the primary care setting
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136
Q

Organic failure to thrive?

A
  • poor growth caused by an underlying medical condition

- ex: inflammatory bowel dz, renal dz, congenital heart conditions

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137
Q

A good way to determine cause of FTT in a younger infant?

A
  • observe a feeding

- it will give clues to maternal-child interaction, bonding issues, physical issues, etc.

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138
Q

4 Tests to do in a child with no signs to the cause of FTT?

A
  1. CBC
  2. Lead level
  3. Urinalysis and culture
  4. Serum electrolyte levels
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139
Q

How many kcal/kg/d do healthy children require in the first year of life? After first year? How much to give in FTT children to ensure catch-up growth?

A
  • first year: 120
  • after: 100
  • catch-up growth: 50-100% more calories needed!
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140
Q

What should be done when evaluating the growth of a premie?

A

-use a premie growth chart!

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141
Q

When do children typically become “picky eaters”? What should be done?

A

-typically btwn ages 18-30 mnths
-counsel parents to provide nutrition, avoid “force-feeding”
, and avoid providing snacks + close follow-up

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142
Q

4 Ssx of renal tubular acidosis? Tx?

A
  1. FTT
  2. Elevated chloride
  3. Low bicarb
  4. Low potassium
    - tx: oral bicarb supplementation
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143
Q

What 3 characteristics are needed to dx ADHD?

A
  1. Inattentiveness
  2. Hyperactivity
  3. Impulsivity
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144
Q

2 First-line tx options for ADHD?

A
  1. Methylphenidate
  2. Dextroamphetamine
    - both are stimulants
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145
Q

What are 3 other types of medications that can be used for ADHD besides stimulants?

A
  1. Atomoxetine = nonstimulant that is a selective norepi reuptake inhibitor
  2. Tricyclic antidepressants
  3. Buproprion
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146
Q

What are 4 common coexisting psychiatric conditions that can occur with ADHD?

A
  1. Oppositional defiant disorder
  2. Conduct disorder
  3. Anxiety disorder
  4. Depressive disorder
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147
Q

What should be done for a child with a new diagnosis of ADHD?

A

-send them for complete psychoeducational testing before developing a management plan

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148
Q

4 First-line tx choices for combination acne?

A
  1. Antibacterial soap
  2. Keratolytic agent = benzoyl peroxide
  3. Comedolytic agent = tretinoin
  4. Topical antibiotics = erythromycin
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149
Q

Open comedones?

A
  • “blackheads”

- composed of compacted melanocytes

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150
Q

Closed comedones?

A
  • “whiteheads”

- contain purulent debris

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151
Q

Cyst?

A
  • dilated intradermal follicle

- usually tender

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152
Q

Inflammatory papule?

A

-red “bump” under the skin that is due to sebum, fatty acuds, and bacteria reacting within a follicle

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153
Q

Pustule?

A

-inflammation and exudate around comedones that occur in the superficial dermis

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154
Q

Why is acne seen mostly during puberty?

A

-pubertal hormones cause an increase in sebum production by the sebaceous glands

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155
Q

What is the bacteria involved in acne?

A

-propionibacterium acnes

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156
Q

2 categories of acne lesions and what falls into each?

A
  1. Inflammatory:
    - papules
    - pustules
    - nodules
    - cysts
  2. Non-inflammatory:
    - open comedones
    - closed comedones
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157
Q

Benzoyl peroxide: what is it? Use?

A
  • what: bactericidal and keratolytic that causes follicular desquamation
  • use: for acne, available OTC, but better to use a higher potency prescription preparation
  • good to use when lesions are widely distributed
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158
Q

Topical tretinoin: what is it? What does it do? Use?

A
  • what: vitamin A derivative
  • function: inhibits formation of microcomedones and increases cell turnover
  • use: for acne, can cause drying of skin, avoid sun exposure & use sunscreen
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159
Q

Isotretinoin: use? Sfx?

A
  • AKA: accutane
  • use: tx for severe, resistant nodulocystic acne
  • sfx:
    1. Highly teratogenic
    2. Cheilitis
    3. Conjunctivitis
    4. Hyperlipidemia
    5. Blood dyscrasias
    6. Elevated liver enzymes
    7. Photosensitivity
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160
Q

Tinea barbae: what is it? Who is it more common in? Tx?

A
  • what: fungal infection that is found in facial hair, can be aquired through animals
  • more common in farmers
  • tx: oral antifungals (topicals dont work!)
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161
Q

What advice should be given to a female on oral contraceptives and oral antibiotics? Why?

A

-use another form of BC too, bc oral antibiotics can decrease the effectiveness of oral contraceptives

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162
Q

Rash with mono?

A
  • not common in adolescents with mono

- but pts with mono who take amoicillin, amoxicillin, or penicillin can get a morbilliform rash = looks like measles

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163
Q

How long after an acute infection with EBV do people continue to shed the virus in their saliva?

A
  • can continue to shed for more than 6 mnths

- can even shed intermittently for life!

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164
Q

Replication of EBV in a pt after an infection?

A

-After an infection occurs EBV replicates in the oropharyngeal epithelium and later in B lymphocytes

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165
Q

5 Possible ssx in a young/small child w/ primary EBV infection?

A
  1. Adymptomatic
  2. Fever only
  3. Otitis media
  4. Abdominal pain
  5. Diarrhea
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166
Q

Monospot test use?

A
  • useful in children > 5 yrs

- early in illness can have false negatives

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167
Q

4 Common results seen in blood tests of Mono pt?

A
  1. Lymphocytic leukocytosis
  2. Atypical lymphocytes
  3. Mild thrombocytopenia
  4. Mildly elevated liver function tests
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168
Q

What is a life threatening complication of Mono?

A

-rupture of a spleen with splenomegaly –> causes blood loss that is life threatening!

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169
Q

Tx of Mono?

A
  • only rest
  • antivirals dont have any affect
  • steroids may be needed if tonsilar hypertrophy is threatening the airway!
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170
Q

Dx of EBV in young children (< 5 yrs)?

A

-specific antibody assays

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171
Q

What does eosinophils in a Hansel stain tell you?

A

-supports the diagnosis of allergic rhinitis –> rarely needed

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172
Q

3 Most common bacterial causes of URIs?

A
  1. Morexella catarrhalis
  2. Strep pneumoniae
  3. Nontypeable H. Flu
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173
Q

Vasomotor rhinitis: what is it? Tx?

A
  • sx are similar to allergic rhinitis, but brought on by weather changes, physical stimuli, or emotion
  • pts lack hx of atopy and lack eosinophils on nasal smear
  • tx: no tx necessary, but topical anti-histamines can be helpful in older children
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174
Q

Nasal steroids and allergic rhinitis: use? Sfx?

A
  • use: effective and well tolerated

- sfx: epistaxis, irritation, or burning

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175
Q

What should be done for a child with nasal polyps who is less than 10 yrs old?

A

-sweat chloride test for CF!

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176
Q

Tender, Soft fleshy mass in a nare?

A
  • most likely a rhabdomyosarcoma
  • most common pediatric soft-tissue sarcoma
  • most are located in the head/neck region
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177
Q

What causes nasal polyps?

A
  • sequelae of chronic inflammation and allergic rhinitis

- but screen any kids < 10 yrs with nasal polyps for CF!

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178
Q

What is the most common cause of ambiguous genitalia? Pathophysiology?

A
  • congenital adrenal hyperplasia (CAH)
  • most commonly due to a deficiency in 21-hydroxylase –> low cortisol and high androgenic intermediate hormone production –> virilization
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179
Q

Hermaphroditism?

A

-discrepancy btwn gonad morphology and external genitalia

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180
Q

Intersex state?

A

-infant with ambiguous genitalia

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181
Q

Microphallus?

A
  • penis size below the 5th percentile for age

- neonate with stretched penis length of less than 2 cm

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182
Q

Virilization?

A
  • Masculinization where infant girls exhibit clitoromegaly, labial fusion, and labial pigmentation
  • infant boys appear normal
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183
Q

Most common form of male pseudohermaphroditism?

A
  • androgen insensitivity

- decreased androgen binding to target tissues

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184
Q

True hermaphroditism?

A
  • most are 46 XX, some 46 XY or mosaic
  • bilateral ovotestes or ovary and testis on opposite sides
  • gender assignment is based on genitalia appearance
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185
Q

Mixed gonadal dysgenesis?

A
  • most 46, XY/45 XO karyotype
  • sertoli and ledig cells, but no germinal elements on one side and streak gonads on the other side
  • hypospadias
  • partial labroscrotal fusion
  • undescended testes most common
  • usually assigned female gender and undergo gonadectomh (streak gonads are at risk for developing malignancy)
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186
Q

What is the most important factor in detmining an infant’s sex assignment?

A

-phallic size

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187
Q

2 lab tests to do with ambiguous genitalia?

A
  1. Karyotype

2. Serum 17 alpha-hydroxyprogesterone level

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188
Q

When is reconstructive surgery usually performed in cases with ambiguous genitalia?

A
  • performed as early as possible, usually before 6mnths of age
  • want to do ASAP bc ambiguous external genitalia can reinforce doubt of sexual identity and can by psychologically harmful
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189
Q

What is avoided in a pt with ambiguous genitalia who has hypospadias?

A
  • circumcisions are avoided so the foreskin can be used for reconstruction
  • goal is to create a phallic urethra
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190
Q

Cause of short/atretic vagina?

A
  • testicular feminization
  • due to decreased androgen binding to target tissues or androgen insensitivity
  • 46 XY
  • phenotypically female
  • maintaine femal gender assignment
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191
Q

What are the 3 ssx of prader-willi syndrome in early life?

A
  1. Hypotonia
  2. Failure to thrive
  3. Hypogonadism
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192
Q

Munchausen syndrome by proxy?

A

-abuse in which the caretaker falsifies symptoms or inflicts injury upon the child to necessitate medical intervention

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193
Q

What tests should be done on a child with lots of bruises that is a suspected abuse vicitim?

A
  1. Platelet count

2. Coagulation studies

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194
Q

4 common places for accidental bruises?

A
  1. Knees
  2. Elbows
  3. Shins
  4. Forehead
    * *bony areas!
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195
Q

4 Areas where bruises are less likely to be accidental?

A
  1. Abdomen
  2. Buttocks
  3. Thighs
  4. Inner arms
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196
Q

2 Classical patterns seen with hot water immersion?

A
  1. Sharply demarcated border

2. “Stocking glove” distribution

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197
Q

What can cigarette burns look similar to?

A

-impetigo

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198
Q

4 Common Ssx of osteogenesis imperfecta?

A
  1. Long bone fractures and vertebral injury with minimal trauma (brittle bones)
  2. Short stature
  3. Deafness
  4. Blue sclera
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199
Q

Urine nitrite test?

A
  • positive test = UTI
  • colony count > 10^5 needed for positive
  • nitrite = end product of enterobacter growth
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200
Q

Urine leukocyte esterase test?

A
  • usually positive in urethritis

- product of the inflammatory response that is associated with pyuria

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201
Q

Condyloma?

A
  • warts caused by HPV
  • small & papular or large & pedunculated
  • usually seen on genitalia, in perianal areas, or on surrounding skin
  • usually asymptomatic, or can be associated with local inflammatory rxn that is marked by tenderness or burning
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202
Q

Balanitis?

A
  • inflammation of glans penis

- can be caused by trauma or infections

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203
Q

Why is annual GC and chlamydia urine screening in sexually active adolescents recommended?

A

-bc more than 60% of pts with urethritis will by asymptomatic

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204
Q

3 Tests to do in a sexually active pt with a GU complaint?

A
  1. Urine dipstick analysis for leukocytes, leukocyte esterase, and nitrites
  2. Routine urine culturing
  3. Urine PCR testing for GC and chlamydia –> but not always accepted in courts, so may have to do urethral swab if the pt is suspected to be an abuse vicitim
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205
Q

Tx for gonorrhea?

A
  • single IM dose of ceftriaxone

- PLUS tx for chlamydia incase there is a coinfection = one dose of azithromycin

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206
Q

Tx for chlamydia?

A

-one dose of azithromycin

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207
Q

Fitz-Hugh-Curtis syndrome?

A
  • Complication of PID
  • Acute presentation = right upper quadrant pain that can refer to the back (from ascending pelvic infection and inflammation of the liver capsule and diaphragm)
  • can occur in both male and female patients, but more prevalent in females
  • can mimic other abdominal emergencies–> consider in any sexually active adolescent as a dx of exclusion
  • caused by either N gonorrhea or chlamydia
  • might see “violin string sign” on ultrasound
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208
Q

Ddx for dysuria (4)?

A
  1. Urethritis
  2. UTI
  3. Irritated GU lesions
  4. Chemical urethritis
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209
Q

Constitutional growth delay?

A
  • The growth is slower than expected in a previously healthy child, but one or more of their parent’s had a pubertal developmental delay and ultimately ended up with a normal adult height
  • bone age = height age
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210
Q

Familial short stature?

A
  • when a short child is born to short parents who had normal timing of their pubertal development
  • bone age = chronologic age
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211
Q

Height age?

A

-age at which a child’s measured height is at the 50th percentile

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212
Q

Growth rate in 1st year of life? 2nd? 3rd?

A

-1st = 23 cm per year
-2nd = 13 cm
3rd = 7.5 cm

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213
Q

Growth rate for boys and girls during puberty?

A
  • girls = 8-9 cm per yr

- boys = 10-11 cm per yr

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214
Q

True or false: the growth rate in a child with constitutional growth delay is normal?

A
  • true!

- they are considered “late bloomers”

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215
Q

How to predict a boy’s final height?

A

-(Father’s height in cm - [mother’s height in cm + 13])/2

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216
Q

How to determine girl’s final height?

A

-(Mother’s height in cm - [father’s height in cm + 13])/2

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217
Q

5 Physical characteristics of a child with Growth hormone deficiency?

A
  1. growth rate is slow
  2. fall’s off growth curve
  3. child appears younger than stated age
  4. frequently chubby
  5. bone ages are delayed
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218
Q

2 Tests for GH screening tests?

A
  1. Serum IGF-1 or somatomedin C

2. IGF-BP3

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219
Q

Clues that growth failure is due to an underlying condition?

A
  1. Poor appetite
  2. Weight loss
  3. Abdominal pain
  4. Diarrhea
  5. Unexplained fevers
  6. Headaches
  7. Vomiting
  8. Weight gain that is out of proportion to height
  9. Dysmorphic features
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220
Q

What test should be done on all females with growth failure?

A

-karyotype to look for Turner’s syndrome!

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221
Q

Narcosis?

A

-deep stupor or unconsciousness caused by a chemical substance such as a drug or anesthesia

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222
Q

Tx for narcotic-related respiratory depression in an infant?

A

-intraveneous, intramuscular, or subcutaneous naloxone

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223
Q

What APGAR scores at 1 minute require immediate resucitation?

A

-less than 3!

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224
Q

Neonate born with scaphoid abdomen, heart sounds heard on right and diminished breath sounds on left: what is probably the cause? Next step for resuscitation? What should be avoided?

A
  • think: diaphragmatic hernia
  • next: endotracheal intubation
  • avoid: bag-and-mask ventilation bc it will, cause an accumulation of bowel gas (which is located in the chest) –> further respiratory compromise
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225
Q

HR cutoffs for a neonate for chest compressions or drug therapy?

A

-less than 60 bpm despite 100% oxygen with PPV –> if still less than 60, use meds (usually epi)

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226
Q

A neonate with respiratory distress when not crying, but fine when crying? Why?

A
  • choanal atresia
  • infants are obligate nose breathers, when they cry they can breathe through their mouth, but when crying they need to have a patent nose
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227
Q

Choanal atresia? Tx?

A
  • congenital disorder
  • back of the nasal passage (choana) is blocked, usually by abnormal bony or soft tissue (membranous) due to failed recanalization of the nasal fossae during fetal development
  • tx: surgical recanalization
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228
Q

Lactovegitarian?

A

-don’t eat animal products, but do consume milk

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229
Q

Omnivore?

A

-diet with both animal and plant products

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230
Q

Ovovegitarian?

A

-dont eat animal products, but do eat eggs

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231
Q

What supplements should infant’s getting fed goat’s milk as their primary nutrition source be given?

A
  1. B12
  2. Folate
  3. Iron
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232
Q

What should be done with Goat’s milk before ingestion? Why?

A
  • Goat’s milk should be boiled first

- why: goats are more susceptible to brucellosis

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233
Q

What 2 things does breast milk contain that help protect infants from infections?

A
  1. High concentrations of IgA –> reduces viruses and bacteria intestinal wall adherence
  2. Macrophages –> inhibit E. Coli growth
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234
Q

3 disadvantages to breast feeding?

A
  1. Possible virus transmission –> ex. HIV
  2. Jaundice exacerbation –> increased unconjugated bilirubinemia levels
  3. Low vitamin K levels
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235
Q

Methylmalonic acidemia: what is it? How does it present in infants (5)? How can it be prevented?

A
  • what: amino acid metabolism disorder, defect in conversion of methylmalonyl-coenzyme A to succinyl-CoA
  • possible presentation:
    1. Failure to thrive
    2. Seizure
    3. Encephalopathy
    4. Stroke
    5. Other neuro ssx
  • prevention: give breast-feeding vegan mothers vit. B12
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236
Q

What vitamin deficiency could cause fontanelle fullness in an infant?

A

-vitamin A

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237
Q

What vitamin deficiency could cause hemolytic anemia in an infant?

A

-vitamin E

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238
Q

Intrinsic factor?

A

-glycoprotein that is secreted into the stomach that binds to vitamin B12 –> together they attach to the receptors in the distal ileum and are absorbed

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239
Q

4 Common causes of macrocytic anemia in children?

A
  1. HypoTH
  2. Trisomy 21
  3. Vit B12 deficiency
  4. Folate deficiency
240
Q

2 Ways that malabsorption of vit B12 in children can occur?

A
  1. Terminal ileum is absent

2. Infections/inflammation compromises the intestines ability to absorb B12

241
Q

What age are ssx of juvenile pernicious anemia usually seen?

A

-ages 1-5 yrs bc that is when the supply of B12 that was passed transplacentally from mother to child is exhausted

242
Q

What parasite is linked with a vitamin deficiency? What deficiency does it cause?

A
  • parasite: fish tape worm = Diphyllobothrium latum –> uses B12 for growth and egg production
  • deficiency: vit B12 –> megaloblastic anemia
243
Q

Brudzinski sign?

A
  • while the pt is supine, neck is passively flexed & results in involuntary knee and hip flexion
  • physical finding that is consistent with meningitis
244
Q

Kernig sign?

A
  • while the pt is supine, legs are flexed at the hip and knee at 90* angle & pain results with leg extension
  • physical finding that is consistent with meningitis
245
Q

Encephalitis?

A
  • brain parenchyma inflammation

- causes brain dysfunction

246
Q

Meningitis?

A

-leptomeningea, inflammations, typically infectious, can also be caused by foreign substances

247
Q

Top 3 causes of bacterial meningitis in infants?

A
  1. E. Coli
  2. Group B strep
  3. Listeria
248
Q

3 Risk factors that make infants more susceptible to meningitis?

A
  1. Low birth weight
  2. Premie
  3. Born to a mom with chorioamnionitis
249
Q

2 Most common causes of bacterial meningitis in older children?

A
  1. Strep pneumo

2. N. Meningitidis

250
Q

What does it mean when a pt infected with N. Meningitidis has a petechial or purpuric rash?

A

-they have septicemia

251
Q

3 Contraindications to lumbar puncture?

A
  1. Skin infection over the planned puncture site
  2. Increased intracranial pressure
  3. A critically ill pt that may not tolerate the procedure
252
Q

8 Possible complications of acute meningitis infection? Most common?

A
  1. Seizures
  2. CN palsies
  3. Cerebral infarction
  4. Cerebral or cerebellar herniation
  5. Venous sinus thrombosis
  6. Subdural effusions
  7. SIADH
  8. Hearing-loss –> MOST COMMON
253
Q

What other infectious process besides bacterial meningitis, can cause neck stiffness?

A

-retropharyngeal abscess

254
Q

Osgood-schlatter disease: what is it? Pathogenesis?

A
  • painful inflammation of the tibial tubercle
  • pathophysiology: repetitive running and jumping motions cause traction and microstress fractures to the developing area –> inflammation, edema, tenderness, and bony changes occur
255
Q

Slipped capital femoral epiphysis: when does it occur? How does it typically present? What is seen on xray? What at risk for?

A
  • typically seen in adolescents during their growth spurt
  • Ssx: limp + groin or thigh pain, pain can be referred to the knee + limited hip flexion, internal rotation, & abduction
  • xray: widening of the femoral epiphysis and osteopenia
  • risk: avascular necrosis of the femoral epiphysis
256
Q

Osgood-schlatter dz: tx?

A
  1. Decreased activity
  2. Ice after exercise
  3. NSAIDs
  4. Knee immobilization –> in severe cases
257
Q

Early onset sepsis syndrome: when? Source?

A
  • neonatal sepsis occurring in the first 6 days of life (majority of the time occurs within the first 24 hours of life)
  • the infection is typically caused by a microorganism from the mothers GU tract
258
Q

Group B strep: where can it be found in healthy adults? Most common site of colonization reservoir?

A
  • infection with GBS is usually limited to the mucous membrane sites in a healthy adult
  • the GI tract is the most common reservoir
259
Q

Late-onset sepsis syndrome: when? Source?

A
  • neonatal sepsis that usually occurs after approximately 7 days of lufe, but before 90 days
  • the source of infection is usually the caregiver’s environment
260
Q

Intrapartum antibiotic prophylaxis?

A

-IV penicillin or ampicillin given during labor to prevent newborn GBS disease

261
Q

4 Most common Ssx of newborn sepsis and meningitis?

A
  1. Temperature instability = high or low
  2. Tachypena
  3. Hypotension
  4. Bradycardia
262
Q

How is overwhelming shock often manifested in newborns?

A
  1. Pallor

2. Poor capillary refill

263
Q

Meningitis v. Pneumonia? Early-onset or late-onset sepsis?

A
  • pneumonia is more commonly seen with early-onset sepsis (w/in first 6 days of life)
  • meningitis is more commonly seen with late-onset sepsis (btwn days 7-90 of life)
264
Q

4 Signs of an infection on a CBC?

A
  1. Markedly elevated or low WBC counts
  2. Increased neutrophil count
  3. Increased immature to total neutrophil ratios (left shift)
  4. Thrombocytopenia w/ platelet count < 100,000
265
Q

What are the 4 tests that should be done to rule out neonatal sepsis?

A
  1. CBC
  2. Blood culture
  3. Urine culture
  4. LP with culture
266
Q

4 Most common causes of early-onset neonatal sepsis?

A
  1. GBS
  2. E. coli
  3. H. Influenzae
  4. Listeria monocytogenes
267
Q

What organism is the most common cause of neonatal sepsis from birth to 3 months?

A

Group B Strep!!!!!!!!

268
Q

5 Clinical hx and findings that are suggestive of early-onset GBS disease?

A
  1. Prolonged rupture of membranes
  2. Apnea
  3. Hypotension in first 24 hrs of life
  4. 1-minute Apgar score of less than 5
  5. Rapid progression of pulmonary dz
269
Q

7 Risk factors for early-onset GBS disease?

A
  1. Rupture of membranes more than 18 hrs before delivery
  2. Chorioamnionitis
  3. Intrapartum temp of > 100.4F (38C)
  4. Previous infant with GBS
  5. Mom < 20 yrs
  6. Low birth weight
  7. Prematurity (<37 wks gestation)
270
Q

What are the preventative guidelines for early-onset GBS infections?

A

-recommend screening women at 35-37 wks gestation for GBS and offering prophylactic antibiotics

271
Q

When does chemical conjunctivitis typically occur in a newborn? Prognosis? Cause?

A
  • usually presents within 6-12 hrs after birth
  • self-limited
  • usually in response to ocular silver nitrate or erythromycin prophylaxis irritation
272
Q

What is the most serious newborn conjunctivitis? When does it typically present? 3 possible Complications?

A
  • gonococcal conjunctivitis
  • usually occurs within 2-5 days after birth
  • if untreated, can cause:
    1. Corneal ulceration
    2. Perforation
    3. Blindness
273
Q

What medication is associated with pyloric stenosis use in children?

A

-oral erythromycin

274
Q

When does chlamydial conjunctivitis typically present in mewborns? Tx? Risks?

A
  • typically presents btwn days 5-14 of life
  • tx: oral erythromycin –> also reduces risk of chlamydial pneumonia
  • risk of oral erythromycin = increased risk of hypertrophic pyloric stenosis
275
Q

Chemical, gonoccoal, and chlamydial neonatal conjunctivitis: when do each usually occur?

A
  1. Chemical = within 6-12 hrs
  2. Gonococcal = days 2-5
  3. Chlamydial = days 5-14
276
Q

Transient tachypena of the newborn is usually caused by what? Tx?

A
  • caused by incomplete evacuation of fetal lung fluid in full germ infants –> more commonly seen with c-sections
  • tx: usually none, but supplemental oxygen if needed
277
Q

What should be done for a healthy newborn of an HIV positive mom who was on proper antiviral tx before delivery?

A

-begin the child on a course of zidovudine

278
Q

Tx of early-onset GBS infection?

A

-penicillin + aminoglycoside

279
Q

Tx of late-onset GBS infection?

A

-beta-lactamase-resistant antibiotic (such as vanco) + a 3rd generation cephalosporin

280
Q

Cerebral palsy: what is it? What is it caused by?

A
  • what: disorder of movement and posture

- cause: insult or anomaly of the immature CNS, dysfunction has a central origin

281
Q

What is the most common childhood movement disorder?

A

-cerebral palsy

282
Q

How common are seizures and mental retardation in kids with cerebral palsy?

A
  • seizures are seen in 1/3 of CP pts

- mental retardation is seen in 60% of all CP pts

283
Q

Which insults/difficulties are thought to be the cause of CP: antenatal or pregnancy/delivery/perinatal?

A

-antenatal insults are more likely to be the cause

284
Q

Can CP be dx at birth?

A
  • no, the CNS is too immature

- it can be dx beyond infancy as a child fails to meet milestones, and/or fails to lose primitive reflexes

285
Q

Hempiplegia?

A

-refers to involvement of single lateral side of body + greater impairment of upper extremities than lower extremities

286
Q

Diplegia?

A

-four-limb involvement + greater impairment of the lower extremities

287
Q

Spastic quadriplegia?

A
  • four-limb involvement with significant impairment of all extremities
  • upper limbs may be less impaired than lower limbs
288
Q

Paraplegia?

A

-term that is reserved for spinal and lower motor neuron disorders

289
Q

Motor quotient of CP?

A
  • determined by dividing the child’s “motor age” by their chronological age
  • the lower the number = the more significant impairment there is
290
Q

What are the 2 most common causes for sudeen development of respiratory sx in a child?

A
  1. Foreign body aspiration

2. Anaphylactic response to an allergen.

291
Q

Stridor v. Wheezing?

A
  • easily confused by inexperienced
    1. Stridor:
  • monophonic = one pitch
  • from partial airway obstruction
  • louder over UPPER chest
    2. Wheezing:
  • polyphonic = multiple pitches
  • best heard at lung BASES
292
Q

Tachypnea: definition? Average resp rate for infant? 8 yr old child? Adult?

A
  • respiratory rate that is faster than normal
  • infant average RR = 30 breaths/min
  • 8-yr old child = 20
  • adult = 16
293
Q

4 Most common causes of croup?

A
  • AKA: laryngotracheobronchitis
  • usually a viral cause
  • top 4:
    1. Parainfluenza
    2. Influenza
    3. Measles
    4. RSV
294
Q

Epiglottitis: cause? 5 most common Ssx?

A
  • cause: H. Influenzae b
  • Ssx:
    1. Drooling
    2. Preference to sit in a tripod or upright position (“sniffing” position)
    3. Muffled vocalizations
    4. Inspiratory stridor
    5. Absence of cough
295
Q

Bacterial tracheitis: most common cause? When is it seen? What is the biggest concern?

A
  • cause = staph aureus
  • can occur as a sequela to viral croup
  • worry = life-threatening airway obstruction –> may require emergency intubation or tracheostomy
296
Q

3 Common noninfectious causes of respiratory distress that mimic a foreign body aspiration?

A
  1. Tracheomalacia = congenital wkness/floppiness of the muscles of the trachea
  2. Airway compression –> ex vascular ring or tumor
  3. Intraluminal obstruction –> ex papilloma or hemangioma
297
Q

Spasmotic croup: what is it? Possible etiologies?

A
  • syndrome of sudden nighttime onset of hoarseness, “barky” cough, and inspiratory stridor in a previously healthy, afebrile child
  • possible etiologies: viral infections, respiratory allergies, gastroesophageal reflux, and psychosocial factors
298
Q

Croup Tx?

A
  • aerosolized epi and oral or aerosolized steroids –> reduce airway edema and relieve croup sx
  • cool mist to relieve spasm –> not supported
  • avoid irritating procedures –> (ex tongue blades or needles, etc) agitation and crying will aggravate resp sx
299
Q

Dx for foreign body aspiration?

A
  • rigid broncoscopy

- can also be therapeutic!

300
Q

Recurrent sinusitis in young children?

A
  • uncommon bc their nasal passages are not fully pneumatized

- probably an underlying dz going on, ex. CF!

301
Q

Triad of CF?

A
  1. Chronic obstructive pulmonary disease
  2. Pancreatic exocrine deficiency
  3. Abnormally high sweat electrolyte concentrations
302
Q

Respiratory infections in CF: what is the typical vicious cycle? Common bacterial causes of pneumonia in these kids?

A
  • cycle: persistent bronchial obstruction from impaired mucus secretion –> predisposes to secondary bacterial infections –> inflammation –> tissue damage –> further obstruction –> chronic infection
  • bugs: at first, bacterial pneumonia is caused by staph aureus, then caused by pseudo aeruginosa
303
Q

Airway hyper-reactivity in CF?

A
  • present in half of the pts

- response to bronchodilators is varried

304
Q

What are the growth defects of CF due to? 4 consequences?

A
  • maldigestion from exocrine pancreatic insufficiency
  • consequences:
    1. Abdominal distention
    2. Rectal prolapse
    3. Subcutaneous fat and muscle tissue deficiency
    4. Steatorrhea
305
Q

Genetics of CF?

A
  • mutation is on the long arm of chromosome 7 = deletion of AA 508
  • genetic testing can be used if CF is suspected, but the sweat test is negative
  • test will pick up pts who carry mutations on both of their 7’s, but may not if they only have it on one
306
Q

CF and newborn screening?

A
  • research shows that earlier diagnosis improves outcomes
  • most states in US do a blood spot screening test on all newborns
  • test detects the pancreatic enzyme immunoreactive trypsinogen (IRT), which is elevated in infants with CF
307
Q

Mean survival for pts with CF?

A

-over 35 yrs

308
Q

Meconium ileus: what is it? What is it caused by? What is it almost pathognomonic for?

A
  • obstruction of the distal ileum by congealed meconium
  • thought to be caused by a deficiency in proteolytic enzymes
  • almost pathognomonic for CF!
309
Q

2 Possible complications of meconium ileus?

A
  1. Volvulus

2. Perforation peritonitis

310
Q

What can cause an infant with CF to present with a bulging fontanelle?

A
  • vitamin A excess, due to their inability to metabolize fat soluble vitamins (ie vitamin A)
  • the excess can cause pseudotumor cerebri = increased intracranial P
311
Q

Dacryostenosis: what is it? Cause?

A
  • congenital nasolacrimal duct obstruction
  • caused by failure of canalization of the nasolacrimal duct
  • have either unilateral or bilateral increased tearing
312
Q

Initial tx of dacryostenosis?

A
  1. Nasolacrimal massage
  2. Eyelid cleansing
  3. Topical antibiotics for purulent discharge
313
Q

Chemosis?

A

-swelling and fluid collection in the membranes lining the eye.ids and conjunctiva

314
Q

Prognosis of dacryostenosis?

A
  • 90-96% of cases resolve spontaneously, usually by 1 yr of age
  • if not resolved, surgery is the tx
315
Q

Triad of infantile glaucoma?

A
  1. Tearing
  2. Photophobia
  3. Blepharospasm
316
Q

Dacryocystitis: tx?

A
  • immediate systemic antibiotics

- may need surgical tx too

317
Q

What to do for conjunctivitis within the first few hours of life?

A
  • send the eye discharge for culture and start antibiotic based on culture status
  • usually due to chemical irritation
318
Q

What can chlamydia cause in newborns? In 1-3mnth old infants?

A
  • newborns = conjunctivitis

- 1-3 mnths = pneumonia

319
Q

How does pneumonia caused by chlamydia trachomatis usually present?

A
  • infants1-3mnths old
  • Ssx:
    1. Cough
    2. Tachypena
    3. Rales
    4. NO FEVER
    5. Eosinophilia on CBc
320
Q

What are topical tertacycline, erythomycine, and silver nitrates used for in newborns?

A
  • prophylaxis for gonococcal eye infections

- does NOT offer prophylaxis against chlamydial eye infections!

321
Q

Enterobius vermicularis?

A
  • pinworms
  • part of the roundworm/nematode family
  • most common nematode infection in North America
322
Q

Tx of pinworm?

A

-a single dose of either mebendazole, albendazole, or pyrantel pamoate

323
Q

Perianal cellulitis: presentation & tx?

A
  • presentation:
    1. Perianal pain
    2. Blood-streaked stool
    3. Perianal puritus
    4. Perianal erythema that is well demarcated
  • tx: oral or topical bactroban (mupirocin)
324
Q

What parasite is known to cause rectal prolapse?

A

-whipworms = trichuris trichuria

325
Q

Ddx for enterobuis vermicularis?

A
  • pinworm
  • cellophane tape test
  • stool ova and parasite studies may not identify pinworm bc the count within the stool is often low
326
Q

What is the most serious complication of Kawaskai syndrome? Dx?

A
  • coronary artery aneurysms & coronary artery disease

- dx via echo

327
Q

Kawasaki dz Tx?

A
  1. High-dose IVIg –> reduces inflammation

2. ASPIRIN –> reduces risk of coronary complications

328
Q

Strawberry tounge?

A
  • erythema of the tongue with prominent papillae

- sx of kawasaki dz

329
Q

Common age & gender for kawasaki dz?

A
  • usually seen in boys < 5 yrs old
330
Q

What part of the well child check changes after a child was on IVIg? For how long?

A

-live-virus vaccines (MMR & varicella) are delayed 11 mnths following high dose IVIg (ex after kawasaki disease)

331
Q

What vaccine should kids on prolonged aspirin tx get? Why?

A
  • should get influenza!

- bc they are at risk for Reye syndrome if they get influenza while on aspirin!

332
Q

6 Risk factors of getting CAD with Kawasaki dz?

A
  1. Male
  2. Fever for > 10 days
  3. < 12 months old
  4. Low serum albumin or Hb
  5. Early cardiac findings
  6. Thrombocytopenia
333
Q

Kussumaul breathing?

A

-deep, rapid respirations associated with acidosis

334
Q

BUN and creatinine levels associated with dehydration?

A

-both are elevated

335
Q

WBC counts with DKA?

A

-usually elevated, esp if an infection exacerbated the DKA

336
Q

What should be added to the IV fluids after a pt being treated for DKA urinates? Why?

A
  • potassium
  • to counteract the total body potassium depletion
  • serum K will be normal or slightly elevated, but the intracelluar K will be low
  • when the hyperglycemia is treated potassium will be driven into the cells and hypokalemia will begin to occur
337
Q

When should glucose be added to the IV fluid when treating a pt with DKA?

A

-when the serum glucose levels drop to approx 250-300

338
Q

4 Reasons why bicarb infusion should be avoided when treating DKA?

A
  1. Can precipitate hypoK
  2. Can shift O2 dissociation curve to the left and make O2 delivery worse
  3. Can overcorrect acidosis
  4. Can cause a worsening cerebral acidosis while the plasma pH is being corrected
339
Q

Headache, personality changes, vomiting, and decreased reflexes in a pt being treated for DKA?

A
  • think: cerebral edema

- this is potentially life threatening!!

340
Q

Apnea?

A
  • cessation of breathing for at least 20 sec
  • can be accompanied by cyanosis or bradycardia
  • recurrent episodes can be seen with immaturity, can be seen in premies –> usually resolved by 37 weeks postgestational age
341
Q

Most common cause of death of infants 1 week - 1 yr old?

A

-SIDS

342
Q

When is SIDS more common? In what ethnicities?

A
  • usually btwn 1& 5 mnths, peak btwn 2 & 4 mnths
  • more common in winter
  • More common in African Americans and Native Americans
343
Q

8 Risk factors of SIDS?

A
  1. Prone sleep position
  2. Sleeping on soft surface
  3. Pre & post-natal exposure to tobacco smoke
  4. Over heating
  5. Late or no prenatal care
  6. Young maternal age
  7. Prematurity &/or low birth weight
  8. Males
344
Q

What is one negative consequence of macrosomia due to uncontrolled maternal gestational diabetes?

A
  • respiratory distress –> bc of increased fetal oxygen demand
  • AKA: surfactant deficiency & hyaline membrane dz
  • can be seen in infants born to GDM moms later than typically seen in babies born to normal moms
345
Q

What blood glucose level of an infant born to a mom with DM be fed at? Given IV glucose?

A
  • fed at a glucose level btwn 25-40

- IV glucose of blood levels < 25

346
Q

4 Complications of gestational DM?

A
  1. Hypoglycemia
  2. Polycythemia
  3. Hypocalcemia
  4. Hyperbilirubinemia
347
Q

Fasting glucose level for gestational DM? Non-fasting?

A
  • fasting > 100

- nonfasting > 130

348
Q

Blood glucose level that is defined as hypoglycemia?

A

-< 40

349
Q

What percentile does a baby need to exceed to be considered macrosomic?

A

-90th

350
Q

Caudal regression syndrome?

A
  • rare congenital malformation
  • found almost only in gestational DM babies
  • hypoplasia of sacrum & lower extremities
351
Q

When are women usually screened for gestational DM?

A

-btwn 24 & 28 wks

352
Q

What can polycytemia lead to in a baby of a gestational DM preg?

A
  1. Elevated bilirubin

2. Renal vein thrombosis

353
Q

What can hypocalcemia lead to in an infant born of a GDM mom?

A
  1. Irritability

2. Decreased myocardial contractility

354
Q

How can renal vein thrombosis present in a newborn?

A

-as an abdominal mass –> hydronephrosis

355
Q

What is a still’s murmur?

A
  • low pitch systolic ejection murmur

- most common innocent murmur in kids

356
Q

What is a carey coombs murmur?

A
  • seen in acute rheumatic fever

- caused by thickening of mitral valve

357
Q

Subdural and epidural hematomas, which are more common in older children and kids < 1 yr? Chronic subdural hematomas?

A
  • subdural = < 1 yr
  • epidural = older children
  • chronic subdural hematomas are more common in older children
358
Q

Epidural hemorrhage?

A
  • bleeding btwn dura and skull

- common w/ skull fractures with middle meningeal artery (or dural sinuses, or middle meningeal v) lacerations

359
Q

Subarachnoid hemorrhage?

A
  • bleeding btwn dura and arachnoid space

- occurs with disruption of bridging veins that connect cerebral cortex and dural sinuses

360
Q

How many subdural hemorrhages are bilateral?

A

-3/4ths!

361
Q

Ssx of chronic subdural hematomas?

A
  1. Chronic emesis
  2. Seizures
  3. Hypertonicity
  4. Irritability
  5. Personality changes
  6. Inattention
  7. Poor weight gain
  8. Fever
  9. Anemia
362
Q

What is the best way to evaluate subacute and chronic hematomas?

A

-MRI bc the signal intensity can help you estimate age of lesion

363
Q

Most epidural hemorrhages are bilateral or unilateral?

A

-unilateral!

364
Q

Mortality is greater in which subdural or epidural hemorrhages?

A
  • epidural!

- but long-term morbidity is low in survivors!

365
Q

Which require urgent surgical evacuation: subdural or epidural hemorrhages?

A

-epidural!

366
Q

What is the typical adult course of ssx of an epidural hemorrhage?

A

-first see altered mental status (initial concussion) –> period of lucidity –> redevelopment of altered mental status + ssx of increased ICP (hematoma effect)

367
Q

What are the common sequelae of a subdural hemorrhage?

A
  1. Headaches
  2. Fatigue
  3. Nausea
  4. Sleep disturbances
368
Q

3 Common associated findings with subdural hemorrhages?

A
  1. Retinal hemorrhages
  2. Seizures
  3. Increased ICP
369
Q

Seizures and retinal hemorrhages with epidural hemorrhages?

A

-NOT as common as with subdural hemorrhages

370
Q

Which cranial hemorrhage type has more long-term morbidity? Why?

A

-subdural, bc brain parenchyma is more often involved

371
Q

Widened pulse pressure: what is it? Physical sign? 5 common causes?

A
  • increase in the difference btwn systolic & diastolic pressures
  • ssx: bounding arterial pulse
  • conditions:
    1. Fever
    2. HyperTH
    3. Anemia
    4. AV fistula
    5. PDA
372
Q

What is the most common heart lesion in kids?

A

-VSD

373
Q

Harshness of murmur and size of VSD?

A

-the harsher the murmur is the smaller the size probably is!

374
Q

5 Ssx of large VSD?

A
  1. Dyspnea
  2. Feeding difficulties
  3. Growth failure
  4. Profuse perspiration
  5. Cardiac failure
375
Q

Prognosis of small VSDs?

A

-most will close spontaneously by 6-12 mnths

376
Q

4 acyanotic congenital heart lesions?

A
  1. VSD
  2. ASD
  3. PDA
  4. AV septal defects
377
Q

What is the most common heart lesions seen in premies?

A

-PDA

378
Q

In normal infants, when does the ductus arteriosus usually close?

A
  • usually w/in 10-15 hrs

- always by day 2!

379
Q

Describe the murmur of a large ASD?

A

-splitting of second heart sound that does not vary with respiration + systolic murmur at left upper and midsternal borders

380
Q

ASD and endocarditis prophylaxis?

A
  • not necessary

- endocarditis is rare

381
Q

3 Common complications of uncorrected AV septal defects?

A
  1. Cardiac failure
  2. Growth failure
  3. Recurrent pulmonary infections in infancy
382
Q

Medical tx for PDA?

A

-indomethacin

383
Q

Who is recommended to get prophylaxis for endocarditis (4)?

A

Patient’s who have/had:

  1. Hx of endocarditis
  2. Prosthetic valve
  3. Heart transplant
  4. Severe or partially repaired cyanotic congenital hearg defect
384
Q

What med should be given to keep ductus arteriosus open?

A

-prostaglandins

385
Q

What is the most common congenital cyanotic heart disease?

A

-transposition of great arteries

386
Q

When are symptoms of TGA first noticed? Why? What is the initial tx?

A
  • usually noticed in the first or second day of life
  • bc during the first few hours the ductus arteriosus and the foramen ovale provide provide a connection btwn the 2 circuits –> symptoms develop when these two structures begin to close
  • tx: prostaglandins to keep the ductus arteriosus patent
387
Q

What is classically seen in a CXR of a pt with TGA?

A

-“egg-on-a-string” appearance to the heart = heart is slightly enlarged and looks like an egg lying on its side w/ a narrow vascular pedicle (bc aorta and pa are lying one in front of the other)

388
Q

What 2 conditions can pulmonary stenosis be seen?

A
  1. Noonan syndrome

2. Glycogen storage disease

389
Q

What is seen on CXR in tetrology of fallot?

A
  1. “Boot-shaped” heart

2. Decreased pulmonary vascularity

390
Q

Hypercyanotic spells: AKA? Cause? Maneuver that can relieve a spell?

A
  • AKA: tetrology spells
  • caused by a sudden increase in R–>L shunting of blood, can be brought on by activity or agitation
  • maneuver = squatting or bringing the knees to the chest
391
Q

Pulmonic murmurs: describe the features of both the benign and pathologic murmurs?

A
  • Benign: left upper sternal border murmur that does not radiate w/ no click or radiation
  • pathologic features: left upper sternal border murmur that radiates, click heard, & ssx of cardiac dz
392
Q

Venous hum murmur?

A
  • low-pitched murmur that is heard at the sternal notch ONLY when a child is upright
  • benign childhood murmur
393
Q

Still vibratory murmur?

A
  • high-pitched “musical” systolic murmur that is heard at the left sternal border in the SUPINE position
  • benign childhood murmur
394
Q

Defects in tetrology of fallot?

A
  1. VSD
  2. Pulmonic stenosis
  3. Overriding aorta
  4. RVH
395
Q

Kippel-feil syndrome: 6 features?

A
  1. congenital fusion of portions of the cervical vertebrae
  2. restricted neck mvmnts
  3. short neck
  4. Low hairline
  5. Sprengel deformity
  6. Structural urinary tract abnormalities
396
Q

Sandifer syndrome: 3 features?

A
  1. GERD
  2. Hiatal hernia
  3. Posturing of the head
397
Q

Sprengel deformity?

A

-congenital elevation of the scapula

398
Q

Torticollis: what is it?

A
  • an obviously twisted neck with the head tilted to one side and the chin tilted toward the opposite side
  • usually caused by injury or contracture of sternocleidomastoid m.
399
Q

Torticollis: presentation?

A
  • presents at or soon after birth
  • usually seen in infants that experienced birth trauma
  • usually have palpable, firm mass within the affected muscle
400
Q

Torticollis: tx? Consequence if persistent?

A
  • tx: gentle sternocleidomastoid m stretching via mvmnt of head toward natural position (as long as the spine is normal, which is checked via radiography)
  • if it persists longer than 5 mnths, an ortho consultation is needed
  • persistent torticollis can lead to facial asymmetry
401
Q

2 Causes of torticollis that presents after infancy?

A
  1. Trauma –> cervical vertebrae injury or musculature
  2. Inflammation –> after URI, cervical lymphadenitis, retropharygneal abscess, cervical vertebral osteomyelitis RA, upper lobe pneumonia
402
Q
  1. Drugs known to cause drug-induced dystonia?
A
  1. Phenothiazine
  2. Metoclopramide
  3. Haloperidol
403
Q

Transient tachypnea of the newborn?

A
  • slow absorption of fetal lung fluid can cause this transient tachypnea
  • more common in babies born via c-section
404
Q

Meconium aspiration syndrome: what can be seen on CXR? What lung condition can it cause?

A
  • CXR: hyperinflattion w/ patchy infiltrates

- meconium can plug small airways –> air trapping –> pneumothorax

405
Q

ECMO: what does it stand for? What is it?

A
  • extracorporeal membrane oxygenation

- system of a modified heart-lung machiene that is used in severe pulmonary failure

406
Q

Transient tachypnea of the newborn: what can be seen on CXR? Prognosis?

A
  • CxR: perihilar streaking and fluid in fissures + aerated lungs
  • prognosis: usually resolves in 24-48hrs –> does not lead to chronic lung dz!
407
Q

RDS: tx?

A
  1. supplemental oxygen, want to maintain oxygen saturation to 90-95%
  2. IV fluids to maintain hydration
  3. Exogenous surfactant
408
Q

2 Possible causes of asymmetrical breath sounds in a neonate?

A
  1. Pneumothorax

2. Congenital diaphramatic hernia

409
Q

Transient tachypnea of newborn: tx?

A

-observe and tx with supplemental oxygen as needed

410
Q

Meconium aspiration tx?

A

-endotracheal intubation with direct suctioning

411
Q

In children of what ages do febrile seizures usually occur?

A

-6mnths - 6 yrs

412
Q

At what age can you begin to assess meningeal signs such as the kernig and brudzinski signs?

A

-in children > 1 yr

413
Q

True or false: febrile seizures can be genetic?

A
  • true!

- febrile seizure risk increases when first-degree relatives have had febrile seizures

414
Q

Simple v complex febrile seizures?

A
  • simple: last less than 15 min, no focal or lateralizing signs or sequelae
  • complex: lasts more than 15 min, may have lateralizing signs
415
Q

What can be used to interrupt a febrile seizure?

A
  1. Lorazepam
  2. Diazepam
    - if seizure lasts for more than 5 min
416
Q

Dx of febrile seizures?

A

-workup not usually needed, just observation

417
Q

What 2 situations call for a workup of febrile seizures? Workup?

A
  1. Not 6mnth-6yrs old
  2. Complex seizure
    - workups?
  3. LP (esp if < 1 yr old)
  4. CT scan
  5. EEG
418
Q

Febrile seizure prognosis?

A
  • Generally good
  • kids < 1 yr at the time of their first seizure have a 50-65% chance of having another febrile seizure
  • older kids only have a 20-30% occurrence chance
419
Q

Biliary atresia?

A

-congenital condition where the liver’s bile ducts become blocked and fibrotic –> results in reduced bile flow into the bowel

420
Q

Kasi procedure?

A

-surgery procedure that uses a bowel loop to form a duct to allow bile to drain from the liver in a pt with biliary atresia

421
Q

What lab results will you see in a pt with rickets?

A
  1. Reduced serum calcium levels (not always)

2. Elevated alkaline phosphatase

422
Q

What is the most common form of nonnutritional rickets?

A
  • primary hypophosphatemia
  • familial, x-linked dominant
  • defective phosphate reabsorption + conversion of 25(OH)2D in the proximal tubule of the kidneys is abnormal
423
Q

Spiral fracture of humerus in a child?

A

-suspicious, but not diagnostic for child abuse

424
Q

Odonophagia?

A

-painful swallowing

425
Q

Stridor?

A
  • abnormal, musical breathing

- result of large airway obstruction

426
Q

Dysphagia?

A

-Difficulty swallowing

427
Q

Trismus?

A
  • inability to open mouth

- secondary to pain, inflammation, or mass effect involving the facial nereve

428
Q

What is the most common age group to see retropharyngeal abscesses in?

A

-toddlers less than 4 yrs old

429
Q

What age group is peritonsillar abscess usually seen in?

A
  • can be seen at any age

- more common in adolescents or young adults

430
Q

Patient who refuses to passively refuses to move neck secondary to pain?

A

-think: retropharyngeal infection!

431
Q

Best imaging for neck abscess?

A
  • lateral cervical xray

- retropharyngeal abscess = widening of retropharyngeal space

432
Q

XRay findings for epiglottitis?

A

-“thumb sign” on a lateral film

433
Q

What is the danger with retropharyngeal abscesses?

A

-potential spread to mediastinum –> can affect cardioresp function or cause mediastinitis

434
Q

Top 3 bacterial causes of neck abscesses?

A
  1. Strep pyogenes
  2. Staph
  3. H. Influenzae
435
Q

Definition of delayed puberty?

A
  • no signs of puberty in girls by age 13 or boys by age 14

- can be caused by: gonadal failure, chromosomal abnormalities, hypopituitarism, chronic disease, or malnutrition

436
Q

Definition of precocious puberty?

A
  • secondary sexual characteristic onset before the age of 8 yrs in girls and 9 yrs in boys
  • different ethnic groups can undergo puberty at different times –> ex black girls < white girls
437
Q

True precocious puberty?

A
  • AKA: True precocious puberty
  • gonadotropin-DEPENDENT
  • hypothalmamic-pituitary-gonadal activation leading to secondary sex characteristics
438
Q

Precocious pseudopuberty?

A
  • gonadotropin-independent
  • NO hypotjalamic-pituitary-gonadal activation
  • hormones usually are either exogenous (birth control pills, estrogen creams) or from adrenal/ovary tumors
439
Q

Premature adrenarche?

A
  • early activation of adrenal androgens
  • usually occurs in girls aged 6-8
  • gradually increasing pubic/axillary hair development and body odor
440
Q

Premature thelarche?

A
  • early breast development
  • typically in girls aged 1-4 yrs
  • WITHOUT pubic/axillary hair development or linear growth acceleration
441
Q

Precocious puberty in boys v girls (stats)?

A
  • more common in girls, but more likely to be idiopathic in girls (>90%)
  • in boys, 25-75% of the time a structural CNS abnormality is present
442
Q

What are the levels of the sex hormones like in a child with precocious puberty?

A
  • usually appropriate for the observed stage of puverty, but inappropriate for the child’s age
  • estradiol in girls
  • testosterone in boys
443
Q

What is the goal in the tx of precocious puberty? Tx?

A
  • goal: prevent early closure of growth plates so full adukt height can be reached
  • tx: GnRH agonist
444
Q

How do boys with adrenal hyperplasia usually present? Dx?

A
  • present: virilization despite prepubertal testicles

- dx: look for overproduction of 17-alpha hydroxyprogesterone and a deficiency in cortisol

445
Q

Vesicourethral reflux?

A
  • VUR
  • retrograde urine flow from the bladder into the ureters and even into the kidneys
  • females > males
  • can lead to recurrent UTIs and diminished renal function
446
Q

Voiding cytourethrogram?

A
  • VCUG
  • radiographic study in which a catheter is placed in the bladder and contrast is pumped into the bladder –> have pt void and take XRays to see if ureters are outlined
447
Q

What is the most common cause of severe urinary tract obstruction in boys?

A

-posterior urethral valves –> ONLY occurs in boys!

448
Q

How do posterior urethral valves present?

A
  • in neonates: distended bladders, poor or dribbling urinary streams, palpable kidneys
  • in older infants: failure to thrive, renal dysfunction, UTI
449
Q

What tests should be done on ANY boys with a UTI?

A
  • VCUG
  • renal ultrasound
  • *look for posterior urethral valves bc there is a strong connection!!
450
Q

Tx of posterior urethral valves?

A
  • immediate tx: bladder catheterization via urethra with a small feeding tube
  • long term tx: endoscopic transurethral valve ablation
451
Q

Tx of VUR in infants and kids?

A
  1. Prophylactic antibiotics

2. Close monitoring for infections w/ UA and cultures avery 3-4 months

452
Q

Grading of VUR? Which is more likely to resolve spontaneously? Which is more likely to cause renal damage?

A
  • graded I-V based on degree of reflux

- higher grade = less likely to resolve spontaneously & more likely to cause renal damage!

453
Q

Beckwith-Wiedemann syndrome?

A
  • *overgrowth syndrome
    1. Macrosomia
    2. Macroglossia
    3. Pancreatic beta cell hyperplasia = excess islet cells = hypoglycemia
    4. Fetal adrenocortical cytomegaly
    5. Omphalocele = intestines that stick out of abdomen
    6. Hemihypertrophy
    7. Linear fissures in lobule of external ear
    8. Increased risk of abdominal tumors –> ex. Wilms and hepatoblastoma
454
Q

What are boys with posterior urethral valve at risk for?

A

-end-stage renal dz, even after proper tx!!

455
Q

Rales?

A
  • wet or “crackly” inspiratory breath sounds due to alveolar fluid or debris
  • usually heard with pneumonia or CHF
456
Q

Pleural Rub?

A

-inspiratory and expiatory “rubbing” or scratching breath sounds heard when inflamed visceral and parietal pleurae come together

457
Q

Staccato cough?

A
  • coughing spells with quiet intervals
  • often heard with:
    1. Croup
    2. Chlamydial pneumonia
458
Q

Progression of bacterial v viral pneumonia?

A
  • viral is more gradual than bacterial

- bacterial progresses rapidly over a few days

459
Q

What 2 causes of pneumonia can cause consolidation on CXR?

A
  1. Pneumococcal

2. Staphhlococcal pneumonia

460
Q

What cause of pneumonia causes air trapping and a flattened diaphragm on CXR?

A
  1. Viral pneumonia w/ bronchospasm
461
Q

What cause of pneumonia causes perihilar lymphadenopathy on CXR?

A
  1. Mycobacterial pneumonia
462
Q

What type of pneumonia is more commonly seen with pleural effusion and abscess formation, bacterial or viral?

A

-bacterial

463
Q

5 Most common causes of pneumonia in the first few days of life?

A
  1. Enterobactefiaceae
  2. Group B strep
  3. Staph aureus
  4. Strep pneumo
  5. Listeria
464
Q

Pneumonia with staccato cough and tachypnea during first few mnths of life? Tx?

A
  • Think: chlamydia

- tx: erythromycin

465
Q

4 Common viral causes of pneumonia?

A
  1. Herpes simplex virus
  2. Enterovirus
  3. Influenza
  4. RSV
466
Q

What is the most prevalent and concerning cause of viral pneumonia in the first few days of life? Tx?

A
  • HSV

- tx: acyclovir

467
Q

5 Viral causes of pneumonia in kids 1-5 yrs old?

A
  1. Adenovirus
  2. Rhinovirus
  3. RSV
  4. Parainfluenzae
  5. Influenza
468
Q

2 Bacterial causes of pneumonia in kids 1-5 yrs?

A
  1. Penumococcus

2. Nontyleable H influenzae

469
Q

What can be 2 causes of pneumonia in a pt intubated in the ICU?

A
  1. Pseudomonas aeruginosa

2. Fungal species –> ex candida

470
Q

Pneumonia in someone who travel to southwestern US?

A

-coccidiodies immitis

471
Q

Pneumonia with retinitis?

A

-CMV

472
Q

Pneumonia in a pt with refractory asthma?

A

-aspergillus

473
Q

Pneumonia in a pt exposed to infected sheep or cattle?

A

-coxiella brunetti

474
Q

Pneumonia in a spelunker?

A

-Histoplasma capsulatum

475
Q

Top cause of pneumonia in: neonates? Toddlers? Adolescents?

A
  • neonates = group B strep
  • toddlers = RSV
  • adolescents = mycoplasma
476
Q

How to dx organophosphate poisoning?

A
  • use high index of suspicion & begin tx!
  • dont delay tx!
  • confirm dx via measuring serum pseudocholinesterase and erythrocyte cholinesterase levels –> both will be decreased!!
477
Q

What is the leading cause of nonpharmaceutical ingestion fatality in kids?

A

-organophosphate poisoning!

478
Q

Nicotinic ssx?

A
  1. Cardiac:
    - HTN
    - tachy
    - arrhythmia
  2. Muscle:
    - fasciculations
    - wknss
    - tremor
  3. Respiratory failure –> due to diaphragm paralysis
479
Q

Muscarinic ssx?

A
  1. GI:
    - emesis
    - urinary & fecal incontinence
  2. Respiratory:
    - bronchorrhea
    - bronchospasm
  3. Cardiac:
    - hypotension
    - brady
  4. Tearing
  5. Drooling
  6. Miosis
480
Q

3 Routes that organophosphate poisoning can occur?

A
  1. Across skin or mucous membranes –> so take off contaminated clothing!
  2. Inhalation
  3. Ingestion
481
Q

Organophoshates: MOA?

A
  • bind irreversibly to the cholinesterase of neurons and erythrocytes & to liver pseudocholinesterase
  • causes failure to terminate the effects of acetylcholine at the receptor sites
482
Q

Ssx of cholinergic excess (8)?

A
  1. Diarreha/Defication
  2. Urination
  3. Miosis
  4. Bradycardia
  5. Bronchorrhea
  6. Emesis/Excitation of muscles
  7. Lacrimation
  8. Salivation
    * *“DUMBBELS”
483
Q

Atropine: Use? MOA?

A
  • Use: organophosphate poisoning

- MOA: antagonizes the muscarinic receptor, so the Ach cant bind!

484
Q

2 Tx for Organophosphate poisoning?

A
  1. Atropine
  2. Pralidoxime
    PLUS: supportive care!
485
Q

Pralidoxime: use? MOA?

A
  • Use: can be used for organophosphate poisoning, esp in a pt with significant muscle wkness, esp if mechanical ventilation is required bc of diaphragmatic muscle failure!
  • MOA: reactivates cholinesterase
486
Q

What ssx will a pt have if they ingest mercury from a thermometer?

A

-probably none bc the amnt is so small!

487
Q

Ssx of ingestion of a large amnt of mercury?

A

-GI complaints

488
Q

3 Ssx of ingestion of fish contaminated with mercury?

A
  1. Ataxia
  2. Dysarthria
  3. Paresthesias
489
Q

3 Ssx of chronic inorganic mercury exposure?

A
  1. Gingivostomatitis
  2. Tremor
  3. Neuropsychiatric disturbances
    * * “Mad as a hatter!”
490
Q

5 Ssx of acute arsenic ingestions?

A
  1. Nausea
  2. Vomiting
  3. Abdominal pain
  4. Diarrhea
  5. Hypovolemic shock due to third spacing and hemorrhage in the gut
491
Q

Paraneoplastic syndrome?

A

-HTN & secretory diarrhea caused by tumor production of catecholamines and vasoactive intestinal peptide

492
Q

Opsoclonus-myoclonus syndrome?

A
  • chaotic eye mvmnts & myoclonic jerks –> “dancing eyes and dancing feet”
  • caused by autoantibodies against neuronal elements
493
Q

What is the most common solid, extracranial tumor in children?

A

-neuroblastoma

494
Q

Where do most neuroblastoma tumors arise from? What do they contain?

A

-most arise in the abdomen from the adrenal gland, intrathoracic, or paraspinal from neuronal ganglia

495
Q

Describe the abdominal mass that is typical of neuroblastoma?

A
  1. Nontender
  2. Irregular
  3. Crosses the midline
496
Q

4 Typical location of mets from neuroblastomas? Ssx they cause?

A
  1. Skin –> bluish skin discoloration
  2. Lungs –> increased work of breathing, dyspnea, pneumonia
  3. Liver
  4. Bone –> bone pain, pancytopenia, petechiae, brusing, pallor, fatigue, if orbital bones are involved get proptosis & bluish periorbital discoloration = “raccoon eyes”
497
Q

3 Common Ssx of Wilms tumor?

A
  1. Hematuria
  2. HTN
  3. Localized abdominal mass that does NOT cross the midline
498
Q

Typical lab results of neuroblastomas?

A
  1. Elevated urinary vanillylmandelic acid
  2. Elevated homovanillic acid levels
    * *both are catecholamine metabolites
  3. Elevated enolase
  4. Elevated ferritin
  5. Elevated lactate dehydrogenase levels
499
Q

Tx of neuroblastoma?

A

-decrease tumor size via chemo and/or radiation, then surgical removal of tumor

500
Q

Prognosis of neuroblastoma?

A
  • Overall cure rates exceed 90%
  • infants typically have a better response than older children
  • poor prognosis: skeletal mets or N-myc oncogene amplification
501
Q

Mysenteric lymphadenitis?

A
  • often viral-mediated swelling of mesenteric lymph node

- can cause nonspecific abdominal pain

502
Q

Wilms tumor v. Neuroblastoma?

A
  • neuroblastoma pts are usually younger and appear sicker than wilms
  • the abdominal tumors of neuroblastoma usually cross the midline, wilms do not
503
Q

Ssx of abdominal migranes?

A

-Recurrent abdominal with emesis

504
Q

3 Ssx of appendicits?

A
  1. RLQ pain
  2. Abdominal gaurding
  3. Rebound tenderness
505
Q

3 Ssx of bacterial enterocolitis?

A
  1. Diarrhea (may be bloody)
  2. Fever
  3. Vomiting
506
Q

Abdominal pain in cholecystitis?

A

-RUQ

507
Q

4 Ssx of Henoch-Schonlein purpura?

A
  1. Purpuric lesions
  2. Joint pain
  3. Blood in urine
  4. Guaiac positive stool
508
Q

2 Ssx of hepatitis?

A
  1. RUQ pain

2. Jaundice

509
Q

3 Ssx of incarcerated hernia?

A
  1. Inguinal mass
  2. Low abdominal or groin pain
  3. Emesis
510
Q

2 Ssx of intussusception?

A
  1. Colicky abdominal pain (paroxysmal)
  2. Red currant jelly stool
  3. Fever
  4. Sausagelike abdominal mass
511
Q

3 Ssx of Intestinal malrotation with volvulus? When does it usually occur?

A
  1. Abdominal distention
  2. Bilious vomiting
  3. Blood per rectum
    * *usually presents in infancy
512
Q

3 Ssx of pancreatitis?

A
  1. Severe epigastric pain
  2. Fever
  3. Persistent vomiting
513
Q

3 Ssx of Pneumonia?

A
  1. Fever
  2. Rales
  3. Cough
514
Q

4 Ssx of streptococcal pharyngitis?

A
  1. Fever
  2. Sore throat
  3. Headache
  4. Abdominal pain
515
Q

Volvulus?

A
  • twisting of mesentery of small intestines

- leads to decreased vascular perfusion, ischemia, and bowel necrosis

516
Q

Most common location for intussusception?

A

-ileocolic portion of the bowel

517
Q

Cause of intestinal malrotation?

A
  • occurs when intestinal rotation is incomplete during fetal development
  • usually volvulus occurs –> necrosis
518
Q

Abdominal XRay will show what with volvulus?

A
  1. “Corkscrew” pattern of the duodenum

2. “Bird’s beak” pattern of the second, or third portions of the duodenum

519
Q

Describe the pain associated with intussusception?

A

-paroxysmal abdominal pain

520
Q

What is the “gold standard” for tx & dx of intussusception?

A

-contrast enema for both dx and tx

521
Q

In which infants is pyloric stenosis more common?

A
  • 4x more common in males

- more common in first-born children

522
Q

4 common ssx of pyloric stenosis?

A
  1. Projectile vomiting
  2. Olive shaped abdominal mass
  3. Hypochloremic metabolic acidosis
  4. Visible peristaltic waves
523
Q

3 Common presentations of immunosuppression?

A
  1. Failure to thrive
  2. Atypical infections
  3. Difficult-to-eradicate infections
524
Q

Chance of vertical transmission of HIV without tx? What is the prophylactic tx to prevent transmission?

A
  • 25% chance of vertical transmission

- zidovudine is given to the mother during the second trimester and to the baby through age 6 wks

525
Q

Dx of HIV in peds?

A
  • > 18 mnths = ELISA first, then westernblot to confirm

- < 18 mnths = HIV DNA PCR testing

526
Q

When does prophylaxis for PCP start in an HIV infected infant? What drug is used?

A
  • start prophylaxis at 6wks old

- tx: trimethoprim-sulfamethoxazole

527
Q

Which two vaccines should not be given to HIV positive kids?

A
  1. MMR

2. Varicella

528
Q

Pathophysiology of immunosuppression caused by DM?

A
  • hyperglycemia produces neutrophil dysfunction

- circulatory insufficiency contributes to ineffective neutrophil chemotaxis during an infection

529
Q

Hemolytic-uremic syndrome: triad of ssx? What causes it? Common prodrome?

A

-Ssx:
1. Nephropathy
2. Thrombocytopenia
3. Microangiopathic hemolytic anemia
-associated with : E. Coli 0157:H7, shigella, or salmonella
Prodrome: bloody diarrhea is common

530
Q

Idiopathic thrombocytopenic purpura: AKA? What is it?

A
  • AKA: immune thrombocytopenic purpura

- condition of increased platelet destruction by circulating antiplatelet antibodies, usually antiglycoprotein IIb/IIIa

531
Q

What is the most common cause if thrombocytopenia in kids aged 2-5yrs?

A

-acute ITP

532
Q

Triggers of ITP?

A
  • can be viral illness

- but often unknown

533
Q

What would be seen on a bone marrow in a pt with ITP?

A
  • increased number of megakaryocytes

- bone marrow is not necessary, but can be helpful to confirm dx

534
Q

Prognosis of ITP in kids?

A
  • within 1 mnth more than half of untreated pts have recovered
  • another 30% are recovered in 6 mnths
  • thrombocytopenia for more than 6 mnths = chronic ITP
535
Q

What is the most serious ITP complication?

A

-intracranial hemorrhage!

536
Q

Tx of ITP?

A
  • tx is controversial
  • to decrease platelet destruction:
    1. IV Ig for 1-2 days
    2. IV anti-D therapy
    3. Systemic steroids for 2-3 wks
    4. Splenectomy in serious cases with no response to tx w
537
Q

Ddx of ITP?

A
  1. Physical exam

2. Peripheral blood smear

538
Q

Management of HSP?

A
  1. Urinalysis

2. Supportive care of hydration and pain management

539
Q

What is seen in the perioheral blood smear of HUS (3)?

A
  1. helmet cells
  2. burr cells
  3. fragmented RBCs
540
Q

Granulocytopenia?

A

-reduction of total circulating leukocytes

541
Q

Lymphoblast?

A
  • large, primitive, undifferentiated precursor cell

- not normally seen in peripheral circulation

542
Q

Pancytopenia?

A

-reduction in circulating erythrocytes, leukocytes, and platelets

543
Q

What is the most common childhood cancer?

A

-leukemia

544
Q

What is the most common leukemia in kids?

A

-acute lymphoblastic leukemia (ALL)

545
Q

What is the peak incidence of ALL? What gender is it more common in?

A
  • 4 years old

- boys

546
Q

Common presenting ssx of ALL?

A
  1. Anorexia
  2. Irritability
  3. Lethargy
  4. Pallor
  5. Bleeding
  6. Petechiae
  7. Leg & joint pain
  8. Fever
  9. Petechia/brusing
  10. Hepatosplenomegaly
    * *ALL is known as the “great imitator” bc ssx are nonspecific!
547
Q

What are kids presenting with ALL typically misdiagnosed with?

A

-JRA

548
Q

What is the leukocyte count usually in kids newly dx with leukemia?

A

-less than 10,000

549
Q

What percentage of blasts in a bone marrow is normal? What percentage is necessary for an ALL dx?

A
  • less than 5% is normal

- minimum of 25% for ALL

550
Q

Prognosis based on: gender? Ethnicity? Age? Leukocyte counts? Mature B-cell or T-cell immunophenotypes? # of blasts in CSF?

A
  • girls have better prognosis
  • African-Americans and Hispanic populations have lower remission and higher relapse rates
  • kids < 1 yr & older than 10 yrs have worse prognosis
  • higher leukocyte counts have worse prognosis
  • pts with mature B-cell or T-cell immunophenotypes have worse outcome than B-precursor ALL
  • more blasts in CSF is worse
551
Q

Tx of ALL?

A

-combined chemotx is principal tx

552
Q

5 yr survival rate for ALL?

A

-> 80 %

553
Q

What 6 diseases/syndromes are associated with a higher risk of leukemias?

A
  1. Kleinfelder syndrome
  2. Bloom syndrome
  3. Fanconi syndrome
  4. Ataxia telangiectasia
  5. Neurofibromatosis
  6. Chromosomal disorder (ex Down syndrome)
554
Q

Vaccines while undergoing chemo for ALL?

A
  • Live virus vaccines are contraindicated in the pt and all the household members during chemo and at least 6 mnths after
  • non live vaccines are not contraindicated, but the immunosuppression with the chemo can inhibit the antibody response to the vaccine
555
Q

What are 4 common ssx of newborn with tracheoesophageal fistula?

A
  1. Excessive oral secretions
  2. Coughing
  3. Choking
  4. Cyanosis –> due to aspiration with first feeds
556
Q

Describe the “H-type” TEF? How does it typically present?

A
  • Esophagus and trachea are fully formed, but the esophagus is connected proximally to the trachea
  • often present later in life with recurrent aspiration pneumonia or feeding difficulty
557
Q

VATER association?

A
  • most common association with TEF
    1. Vertebral abnormality –> ex fused or bifid vertebral bodies
    2. Anal imperforation
    3. TracheoEsophageal fistula
    4. Radial and Renal anomaly
558
Q

Menorrhagia?

A

-excessive and/or prolonged uterine bleeding w/ regular menstrual cycle

559
Q

Metrorrhagia?

A

-irregular uterine bleeding btwn menstrual cycles

560
Q

Menometrorrhagia?

A

-irregular uterine bleeding with excessive and/or prolonged flow

561
Q

What 2 lab tests should be done first when evaluating dysfunctional uterine bleeding?

A
  1. Pregnancy tes

2. Hb –> to determine severity of anemia to help determine severity of bleeding

562
Q

Tx for dysfunctional uterine bleeding?

A
    • according to Hb
  • Hb > 12 = mild bleeding –> tx = iron supplements
  • Hb 9 - 12 = moderately severe bleeding –> tx = iron + monophasic OCPs
  • Hb < 9 = severe blleing –> may need hospitalization and transfusion
563
Q

Glomerulonephritis: what is it? Triad of ssx?

A
  • glomerular inflmmation
  • triad:
    1. Hematuria –> can be microscopic or gross
    2. Proteinuria
    3. HTN
564
Q

What are RBC casts a marker for?

A

-glomerular injury

565
Q

What gender and age group is post strep glomerulonephritis usually seen in?

A
  • boys

- ages 5-15 yrs

566
Q

What infections can lead to post strep glomerulonephritis? Time frame? Prophylaxis?

A
  • group B strep infections: pharyngitis or impetigo
  • usually seen 1-2 wks after pharyngitis or 3-6 wks after impetigo
  • antibiotic tx of both will reduce the risk for rhuematic fever, but wont reduce the risk for PSGN
567
Q

Most important lab tests for Post strep glomerulonephritis?

A
  1. Serum C3 –> usually low

2. Serum C4 –> usually normal

568
Q

What 2 antibody tests can be helpful with GBS infections?

A
  1. ASO antibodies:
    - will be present in 80% of kids with GBS pharygitis
    - only positive in less than 50% of kids with impetigo
  2. Anti-DNase B antibody assays:
    - present in almost all pts after GBS pharyngitis & most after impetigo
569
Q

Post strep glomerulonephritis tx?

A
  1. Fluid balance is important w/ sodium & potassium intake restriction
  2. CCBs for HTN
    * *tx is mainly supportive
570
Q

Prognosis of post strep glomerulonephritis?

A
  • resolves rapidly and completely
  • urinalysis may be abnormal for years though!
  • edema resolves in 5-10 days
  • HTN goes away in 3 wks
  • C3 levels normalize in 2-3mnths
571
Q

Recurrent painless gross hematuria that is frequently associated with a URI?

A

-think: IgA nephropathy

572
Q

What would be seen on a renal bx of a pt with a hx of familial persistent or intermittent hematuria that does not progress to renal failure?

A
  • thin basement membrane

- think: benign familial hematuria

573
Q

C3 and C4 in lupus?

A

-both low!

574
Q

Nephritis and pulmonary hemorrhage?

A

-think: goodpasture syndrome!

575
Q

Abdominal pain that is followed by anorexia and vomiting?

A

-think: appendicitis!

576
Q

Periumbilical pain that migrates to the right lower quadrant?

A

-think: appendicitis!

577
Q

McBurney’s point?

A
  • middle third of the line that connects the anterior superior iliac spine and the umbilicus
  • point of greatest discomfort in acute appendicitis
578
Q

Psoas sign?

A

-irritation if the psoas muscle caused by passive hip extension in pts with appendicitis

579
Q

Obturator sign?

A

-irritation of the obturator muscle caused by passive internal rotation of the thigh in pts with appendicitis

580
Q

What is the peak time of appedicitis?

A

-adolescence

581
Q

What will a CBC show in appedicitis?

A
  • leukocytosis with a predominance of polymorphonuclear cells (“left shift”) = inflammatory process
  • not specific
582
Q

Test of choice for appendicitis?

A
  • CT scan is the test of choice in most places

- ultrasound can be very sensitive, esp in females, where the ddx includes ovarian cysts and pregnancy

583
Q

Right lower quadrant pain, abdominal guarding, and rebound tenderness?

A

-think: appendicitis

584
Q

Diarrhea (often bloody), fever, acute abdominal pain, and vomiting?

A

-think: bacterial enterocolitis

585
Q

Right upper quadrant pain that radiates to the subscapular region on the back?

A

-think: cholecystitis

586
Q

Infrequent hard stools and recurrent abdominal pain?

A

-think: constipation

587
Q

Lower abdominal pain, vaginal bleeding, and an abnormal menstrual history?

A

-think: ectopic pregnancy

588
Q

Fever, vomiting, acute abdominal pain, and hyperactive bowel sounds?

A

-think: gastroenteritis

589
Q

Iritability, petechiae, edema, and acute abdominal pain?

A

-think: hemolytic-uremic syndrome

590
Q

Acute abdominal pain, Purpuric lesions, and joint pains (esp in lower extremities)?

A

-think: henoch-schonlein purpura

591
Q

Weight loss, diarrhea, acute abdominal pain, and malaise?

A

-think: inflammatory bowel dz

592
Q

Sudden onset of right or left lower quadrant pain with ovulation + copious mucoid vaginal discharge?

A

-mittelschmerz

593
Q

Hematuria & colicky abdominal pain?

A

-Think: nephrolitiasis

594
Q

Acute lower abdominal pain in a female with a WBC of < 11,000?

A
  • think: ovarian cyst

- vomiting is rare

595
Q

Acute abdominal pain, Cervical motion tenderness, and WBCs in vaginal secretions?

A

-Think: Pelvic inflammatory dz

596
Q

Acute abdominal pain, anemia, and extremity pain?

A

-think: sickle cell crisis

597
Q

Acute abdominal pain, cough, fever, tachypnea, and diminished breath sounds?

A
  • think: pneumonia

- lower lobe pneumonias can cause abdominal pain!

From Flashcardlet (79 decks)

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