Pediatrics Exam #3 Flashcards
1
Q
Normal male genitalia for peds and micropenis
A
Normal - 2.8-4.1cm with average of 3.5cm
Micropenis - under 2.5cm
2
Q
Normal peds foreskin
A
Will not retract
Covers glans by 18-20 weeks
3
Q
Testes in full term infant
A
Should be descended
4
Q
Full term scrotum
A
Should have deep, well developed rugae
5
Q
Earliest sign of male puberty
A
Testicle enlargement folled by pubic hair and THEN penis growth
6
Q
Timing for circumcision
A
Between ages 1 day and 10 days is best -make sure patient voids/no coagulopathy
7
Q
Absolute contraindications to circumcision
A
Hypospadias
Chordee/Curvature of penis
8
Q
Relative CI to circumcision
A
Buried penis
Bleeding disorder
9
Q
Benefits of circumcision
A
Easier genital hygeine
Lower UTI rates during infancy
Decreased penile cancer
Decreased HIV, HSV, HPV
10
Q
Risks of circumscision
A
Procedural risk -amputation, etc.
Bleeding, Infection
Glans amputation
Epidermal inclusion cysts
11
Q
Circumcision technique
A
Make sure to do local nerve block with lidocaine w/o epi
12
Q
Mogen clamp
A
Blind, outdated circumcision techniche
13
Q
2 good techniques for circumcision
A
Plastibell - more complications
Gonco clamps - Less likely to have infection
14
Q
Post circumcision care
A
Use vaseline at least 3-5 days until healed
Okay to have some oozing but not active bleeding
Clean around left over skin - don’t remove
15
Q
When will you be able to retract the foreskin
A
After 3 years of life
16
Q
Phimosis
A
Foreskin adhered to tip of penis
17
Q
Paraphimosis
A
Foreskin cannot be reduced - emergency
Cuts of glans
18
Q
Smegma
A
Epithelial debris under the foreskin - looks like little pearls
Reassure
19
Q
Tx for phimosis
A
Topical steroid - low potency to lyse adhesions for 1-3 months
Surgery if refractive to tx
20
Q
Tx for paraphinosis
A
Emergency - retract skin ASAP, surgery if we can’t reduce
21
Q
Balanoposthitis
A
Edema and inflammation of glans/Foreskin
Infection (bacterial, viral, fungal), trauma, irritation can cause
22
Q
Presentation of balanoposthitis
A
Preputial swelling, tenderness, and erythema
Exudate with foul odor
Lymphadenopathy
23
Q
Tx for balanoposthitis
A
Sitz baths, avoid irritant
Topical bactrim for general
Clotrimazol for fungi, Amoxicillin for strep
24
Q
MC location for hypospadias
A
Ventral shaft of the penis
25
More complicated hypospadias
Opening further away from the glan
26
Presentation of hypospadia
May look like already circumcised
27
Complications and tx for hypospadias
Can interfere with urinary and sexual function
Refer for surgery between 6-12 weeks
28
Epispadia
Dorsal location of urethral meatus - much less common than hypospadia
Surgical correction
29
Cryptorchidism
Undescended testicles
Absent, Undescended, or atopic
May be able to feel and pull down testicles
30
MC cryptorchid testicle
Left testicle
31
When should testicles have descended
Between 4-6 months of life
32
Five Cryptorchidism indications for referral
Bilateral non palpable testes
Unilateral with hypospadias
Ascending testes
Atrophic testes
Not sure if undescended, retractile or atrophic
33
Work up for cryptorchidism
Karytypype if non-palpable
US to look for gonads or uterus
Hormone levels
34
Tx for cryptorchidism
Hormonal not recommended
Orchiopexy - surgery to get testes in scrotum
35
Restractile teste
Can feel in scrotum but sometimes goes up
36
When to refer for cryptorchidism
Around 6 months, get surgery done before 1 year old (cancer risk)
37
Complications of cryptorchidism
Increased risk for testicular cancer
Infertility
Testicular torsion
Sexual dysfunction
38
MCC od disorder of sex development
Congenital adrenal hyperplasia
39
2 things needed for normal sexual development
Right hormones
Tissue responsive to hormones
40
When does genetalia become distinguishable in utero
9 weeks
41
Tx for ambiguous genitalia
Establish dx
Stabilize infant
Address family concerns
42
4 Ongoing medical concerns with ambiguous genitalia
Malignancy in gonads
Altered sex steroid exposure
Decreased bone mineral density
Psychosocial concerns
43
Hydrocele
Extra fluid buildus in the scrotum - d/t patent processes vaginalis
44
Communicating v Non communicating hydrocele
Non-communicating - trapped fluid
45
Presentation of hydrocele
Edematous scrotum
NO PAIN, No erythema
46
Dx for hydrocele
Dx - Positive Scrotal transillumination or Scrotal US
47
Tx for hydrocele
Surgery if not resolved by 1-2 year or symptomatic compromise of skin integrity
48
Inguinal hernia
Protrusion down the inguinal canal into the scrotum
Direct - Outside inguinal canal
Indirect - Inside Inguinal Canal
49
Presentation of inguinal hernia
Painless inguinal swelling
May retract when cold, active, agitated
No spontaneous reduction
50
Incarcerated hernia
Cannot reduce hernia
Usually firm and discrete and tender
51
Strangulated hernia
Affects circulation - necrosis
52
Tx for inguinal hernia
Surgical repair - emergent if strangulated
May exlore both sides
53
Testicular torsion
Doppler US to dx
Urgent detorsion in 4-6 hours
54
Presentation of testicular torsion
Pain relief not achived by testicular elevation
55
Manual detorsion of testicle
Turn laterally - temporary still ned surgery
Will have immediate pain relief
56
Acute epididymitis
Most common in late adolescents
Caused by STI, Exertion, Trauma
57
STD causes of epididymitis
Chlamydia - MCC
Gonorrhea
E. coli
58
Non-STD causes of epididymitis
Mycoplasma, Enteroviruses, Adenoviruses
59
Presentation of epidydimitis
Testicular pain
Red scrotum
Present cremasteric reflex and pain relief with testicular elevation
60
Workup for epididymitis
UA/Culture
Urine PCR is often best
Doppler US
61
Tx for acute epididymitis
Rocephin and Doxy for STD
Levofloxacin for enteric
UTI - non STD - Cefdinir or bactrim
62
Vulvovaginitis presentation
Burning, pruritis, pain, dysuria with negative urine culture
Cheese discharge in candida
Erythema of area - may not have discharge
63
Risk factors for vulvovaginitis
Diaper/Tight pant use
Abx use
Bubble baths
64
Normal vaginal pH
4-4.5
Elevated in bacterial vaginitis
65
Tx for vulvovaginitis
Candidal - Fluconazole
BV - Flagyl or Clinda
Topical can be used
66
Labial adhesion
Fusion of labia minora
Partial or complete
MC in first 5 years of life
My be d/t irritation
67
Uncomplicated labial adhesion
No symptoms
Not complete
May not need to treat
68
Complicated labial adhesion
Accompanying UTI, altered ambulation etc.
69
Tx for labial adhesion
Topical estrogen BID for 2 weeks - if fails surgery
Followed by lubricant for 30 days to ensure healing
70
Manual labial separation
Considered if estrogen not successful after 8 weeks
Will need lubrication for several months
71
Penile adhesion
Fusion of foreskin and corona
72
Tx for penile adhesion
Gentle traction
Topical steroid if not effective
73
Penile skin bridge
Adhesion glans to shaft of penis
May cause pain
Refer to urology to have fixed
74
UTI MC organism
E. coli
75
Age for uncircumcised boys to have more UTIs
Under 3 months
76
Presentation of UTI
Babies with Failure to thrive, Jaundice, Sepsis, Urgency or aneuresis
More classic presentation as age increases
77
Collecting urine sample in peds
Can do directly if potty trained
Suprapubic aspiration
Bladder cath - recommended
Bag specimen not useful in non potty trained pt
78
Urinalysis interpretation for UTI
Leukocyte esterase - Sensitive but not specific
Nitrate - Specific but not sensitive
79
Urine culture for UTI criteria
Clean voided - over 100,000 CFU of 1 pathogen
Catheter sample over 50,000 cfu of 1 pathogen
80
3 UTI admission criteria
Admit if septic, unable to tolerate PO, dehydration,Under 2 months
81
Tx for UTI
3rd gen cephalosporine:
Cefdinir, Cefpodoxime, Rocephin, Cefotaxime
Fever should abate in 48 hours
82
Tx for UTI with pseudomonas
Ciprofloxacin
83
Duration of peds UTI tx
10 days for febrile
3-5 days for afebrile
84
Imaging for peds UTI - 3 indications
Renal US in first febrile UTI for baseline
US if not responding to abx
Hx of kidney disease
85
VCUG imaging - 2
Checks for vesico-ureteral reflux
Children with 2+ febrile UTIs
OR
Children of any age with first febrile UTI and temp 102.2 and non-E coli pathogen, abnormal renal US - must wait until afebrile
86
Vescicoureteral reflux dx
Hydronephrosis on US
87
Grades of VUR
1 - into ureter
2 -into kidneys
3 - dilation
4 -Blunting of calyces
5 - Tortuous and severe
88
Management of grade 1-2 VUR
Watchful waiting with no tx
89
VUR 3-5 tx
Treat when you see dilation of the ureter
Abx
Surgery in 4-5 and noncompliant 3
90
Enuresis
Pee accident twice per week for 3 consecutive months in a child who is at least 5 years old
91
Monosymptomatic enuresis
Only at night - behavioral
92
Polysymptomatic enuresis
Dribbling during the day as well as bed wetting - more concerning
93
Cause of enuresis
Polyuria exceeds bladder capacity
Children holding until last minute
94
Tx for enuresis
Treat daytime before nightime
Treat UTIs or constipation first
Minimize evening fluids
Positive reinforcement
Bed wet alarm for 3 months
95
Pharm for eneuresis
Desmopressin - patients usually relapse after cessation though
96
Definition of child abuse
Failure to act resulting in serious physical harm, emotional harm, etc.
97
Neglect
Failure to meet childs needs, etc. not due to financial limitation
98
Sexual abuse
Sexual touching, penetration however so slight
99
Medical abuse
Substance abuse - exposing child
100
Munchausen by proxy
Making child appear physically ill or impaired
101
Who is required to report child abuse
Anyone who suspects it
Healthcare people
Teachers
Clergy
EMS
Judges
Film/Print processors
102
Failure to resport
Misdemenor in 40 states
Felony if child hurt/killed
103
RIsk factors for child abuse
Young
Single
Low education
Intellectually handicapped
Unstable
Psych illness
Substance abuse
104
Risk factors for child abuse victims
Under 3
African American/Native american
Unplanned or unwanted
ADHD
Disabled
Adopted
105
HX features or abuse
Not feasible for age
Delay in seeking care
Parents don't seem to care
Increasing severity
Unrealistic expectations
106
Child symptoms of abuse
Sad or Angry - nightmares
Relationship troubles
Acting out/Risky behavior
107
Red flags of abuse
Cannot explain injury
Aggression towards child
Refers to child as evil/lyer
Delays/Prevents medical care
Doctor shopping
108
Normal, non-abuse areas of bruising in children
Knees to ankles, wrist, elbow
Over bony prominence
109
Sentinal injuries for child abuse
Trunk, Ear, Neck in any child under 4 months
TEN-4
97% Sensitive and 84% specific for abuse
110
Rib fractures and abuse
71% indicate abuse
111
Burns of abuse
Cigarette burns
Water burns
112
Lab workup for potential abuse
PT/PTT for hemophilia
113
Mongolian spots
Can look like bruises of abuse
Common in darker skinned patients - go away by one ish
114
Abuse radiological findings
Diaphyseal single fresh fracture of long bones
Corner/Bucket handle fracture
Spiral fx
Rib fx
Spinous process fx
Different stages of healing
115
Things that count as sexual abuse
Being shown pornography
Sexual contact
Being shown or showing genitals
116
Things that are diagnostic of sexual abuse
Gonorrhea/Syphillis - post perinatal period
Chlamydia, Trichomonas, HIV not from mother
117
Early childhood sexual abuse response
Within 120 hours
Emergency room and CPS
Rape kit
118
Late childhood sexual abuse response
Over 120 hours
CPS and Abuse Clinic
Check for STDs afterwards
119
Normal vs. Abnormal hymen presentation
Should not be totally torn, may be perforated, etc.
120
STI prophylaxis for abuse
Rocephin
Flagyl
Z-max
HBV Ig
HIV prophylaxis
121
MC perpatrator of muchhausen by proxy
Mother
122
True emesis
Yellow tinge - non-billiary
123
Billiary emesis
Green tinge - can mean a bowel obstruction
124
GERD in infants
Babies that spit up - fed too much
Uncomfortable when eating
Prop up
SHould resolve by 12 months
125
s/s of GERD in infants
Spitting up formula after feeds
Excess belching
Cyanosis and choking
Persistent congestion, cough, or wheezing
Arching back while feeding
126
4 risk factors for pediatric GERD
Asthma
CF
Developmental delays
Tracheoesophageal fistula
127
BRUE
Breif Resolved Unexplained Event
Baby found blue at home
128
Dx and Tx for BRUE confirmed UGI - infants
Look at esophageal pH for reflux
Smaller more frequent feeds
Upright 45 minutes after feeds
THickened feeds
Eliminate milk and eggs for 2-4 weeks
129
2 Meds for UGI BRUE
Famotidine
Prilosec
130
Tx for reflux in older children
Avoid caffein, spicy foods, late eating
Weight loss and no milk
Famotidine or Prilosec
131
NISSEN
Fundiplication for severe life threatening GERD
FTT, Esophagitis, Apneic spells
132
Presentation of gastroenteritis
Stomach pain
Fever
Anorexia
Cramps
133
Common causes of gastroenteritis
Norovirus,Adenovirus, Enterovirus, Rotavirus
Crypto/Giardia
Campylobacter, Clostridium, Salmonella, E. coli
134
Incubation of viral gastroentritis
12 hours
135
8 Concerning features with gastroentritis
Blood or muscous
Weight loss
Prolonged cap refill
Abnormal vitals
Sunken fontanelle
Decreased urine
Out of country
Daycare
136
Tx for gastroentritis
Fluids!!! - PO very little at a time or IV
137
Presentation of appendicitis
MC at 7-12
Periumbilical pain migrating to RLQ
Vomiting and anorexia follow
138
3 signs for appendicitis
Rovsing
Obturator
Iliopsoas
139
8 Factors in an appendicitis risk score (2 ount for 2 points)
2 points:
Pain with cough, percussion, or hopping
RLQ tenderness
1 Point:
Anorexia
N/V
Temp over 38 (100.5)
WBC >10K
Neutrophils >7.5K
140
Imaging for appendicitis
US - 93% sensitive
CT of abdomen - usually follows US
141
Tx for appendicitis
Surgical consult
1 dose cefoxitin or Cefotan prior to incision
142
Presentation of pyloric stenosis
Projectile vomiting preceded with spit up
Non bilious vomiting
Very hungry
MC in boys
Under 12 weeks old often at 2-4 weeks
143
PE for pyloric stenosis
Olive shaped mass in RUQ
Dehydration
FTT
144
Dx for pyloric stenosis
Low potassium and alkalosis
Pyloric US is most common
145
MC time for presentation of pyloric stenosis
2-4 weeks
MC in boys
146
Tx for pyloric stenosis
Pylormyomyotemy
147
Reye's syndrome
Encephalopathy due to virus treated with aspirin as well as kidneys and liver issues
Affects children up to 18 years of age
Leads to mitochondrial dysfunction
93% caucasian
148
Other risk factors for Reye's syndrome
MCAD deficiency
Fatty acid oxidation disorders
Urea cycle disorders
149
Presentation of Reye's syndrome
VOmiting and diarrhea
Lethargy
Tachypnea
Confusion, disorientation
Seizures
Paralysis
150
Dx for Reye's syndrome
Consider in any child with AMS and vomiting
High ammonia level
Look for inborn errors - liver bx
151
Management for Reye's syndrome
Fluids, Diuretics
Vitamin K, Plasma, Platelets
152
Eosinophilic esophagitis
Reflus heartburn and anorexia - unresponsive to reflux drugs
Driven by an internal allergy to food - "asthma of the esophagus"
153
Presentation of eosinophilic esophagitis
Vomiting
Dysphagia - refusal of solid food
Abdominal pain
Heartburn/Chest pain
154
Dx for eosinophilic esophagitis
Allergy hx - asthma, eczema
Eosinophilia may be seen on labs
EGD - abnormalities - linear furrowing
Bx with 15+ eosinophils per HPF is diagnostic
155
Tx for eosinophilic esophagitis
Eliminate foods positive on skin prick test
Puff and swallow IN steroids
Esophageal dilation
156
Steroids for EE (2)
Fluticasone or Budesonide
157
Common onset of peanut allergy
About 12 months
158
Evaluation for peanut allergy
Skin prick or serologic testing
If either positive no need for oral food challenge
Eliminate food
159
Prevention for food allergy emergency
Educate fam and friends
Bendryl or Zertec for mild
Epi pen for severe
160
Indication for early peanut introduction
Severe Eczema or Egg allergy - at 4-6 months
Moderate Eczema - 6 months
161
Gastric ulcers in peds
Pain, bleeding and vomiting
Stool for H pylori
162
Tx for H. pylori gastric ulcers
Amoxicillin, Clarithromycin, Omeprazole
All for 14 days
163
Technical definition of diarrhea
3+ loose stools
164
Acute diarrhea
5-14 days
No fever or blood
Dehydration
Probiotics may help
165
Chronic diarrhea
Over 1 month
Abx use
May be d/t fruit juice, milk protein allergy
166
Viral causes of diarrhea
Rotavirus or Norovirus can also be adenovirus or Coronavirus
3-15 months old
12 hour incubation
4-10 day duration
167
Presentation of viral diarrhea
Vomiting followed by diarrhea
No WBCs in stool
Supportive care and fluids - maybe bicarb
168
Intussussception
Intestine telescopes inside self - emergent
6-12 months MC
MCC of intestinal onstruction in 1st two years
169
Presentation of intussusception
Currant jelly stool
COlicky pain - severe
Vomit
Sausage shaped mass - link
170
Tx for Intussusception
Barium enema usually diagnostic and curative
Some cases need surgery
171
Pseudomembranous Colitis
1-14 days after abx therapy
Fever, abd distension, tenesmus, neutrophils and positive stool culture
Flagyl or PO Vanc
172
Toddler's diarrhea
MCC of diarrhea in kids
No positive stool cultures
Juice makes it worse
173
Milk Protein allergy
Not IgE mediated
Bright red flecks of lood in stool
Take mom off of drinking cows milk, give baby special formula
Disappears by 8-12 months
174
Celiac disease
Often shows up in teens
Failure to thrive
Fatty stools, diarrhea, abd distension
Gluten free diet
tTG 99% sensitive for gluten sensitivity
Endoscopy is diagnostic
175
Peds constipation criteria
1 month in infants toddlers
2 months in older children
176
Definition of constipation
Less than 3 BMs per week
Encoperesis 1+ times per week
Impacted stool
Bulky, painful stool
177
3 Main transitions that can present with constipation in children
Introduction of solid foods/cows milk
Toilet training
School entry
178
Tx for constipation for children
Miralax or Lactulose
Increase fiber
Enema for severe
Bathroom training
179
Encopresis
Fecal incontinence - soft poop around hard poop due to holding poo too long - rectal sphincter is chronically dilated - leaking
180
Dx and Tx for encopresis
Rectal exam and KUB
May take 6+ months to years for rectum to return to normal size
181
Encopresis acute treatment
PEG/Miralax infants and 6+ months
Fleets enema in 2 yrs +
Ducolax suppository
GLycerin suppository for infants
Rectal stimulation
182
CHronic encopresis tx
Timed pottying w/ reward (not as punishment
Laxatives for 6 months to a year
Rescue plan is 3+ days with no BM
Eliminating excess milk
183
Hirschprung's disease
Absence of ganglion cells in mucosal and muscular layers of the colon
Presents at birth!
184
Presentation of Hirschprung's disease
No meconium in first 24-48 hours
Bilious emesis
Abd distension
Reluctant to feed
Ribbon like stools that are foul smelling
185
Dx for hirschprungs disease
Rectum void of stool despite impaction on KUB US
Rectal bipsy is gold standard
186
Tx for hirschprung's disease
Surgical with diverting colostomy or ileostomy
187
Other disorders of the anus/rectum in peds
Anal fissure - constipation, bright red blood
Anal stenosis/imperforate - Ribbon like stools, MC in males
188
Dehydration in peds
Sunken fontanelle - very sick
Decreased turgor of skin
Thready pulse
189
Kg weight loss to fluid loss
2 L fluid lost for 2 kg lost
190
Tx for peds dehyration
Oral rehydration
Pedialyte
191
How much oral rehydration to give at a time
Mild - 50mL/kg
Moderate - 100mL/kg
May also give zophran
192
IV rehydration regimen for peds
NS given
20mL/kg over 1 hour and repeat up to twice
193
Peds hypothermia/Fever
Under 36.5 C
Over 38 C
194
Most accurate way to check temperature
Rectal
195
Difference between oral and rectal temp
0.5-1 degree F lower in oral
196
Difference between oral and rectal temp
1-1.5 F lower than rectal
197
Difference between temporal and rectal temp
0.5-1 degrees less than rectal
198
Tympanic temp in peds
Not reliable under six months
Have to have proper technique
199
Presentation of peds fever
Tachycardia before tachypnea
Glitter in eyes
Hot skin
Sweating
Sleepy
200
MCC of pediatric fever
GI or respiratory viral infection
201
When to treat a peds fever
Depends on child
Will take time for temp to come down
202
Pharm for peds fever
Tylenol safe after 3 months
NSAIDs after 6 months - may use SHORT TERM (like once) under 3 months
203
9 Urgent indications for evaluation of peds patient with a fever
Under 3 months
Over 105.8
Inconsolable
Crying when touched
Difficult arousal
Stiff neck
Petechiae
Difficulty breathing
Seizure
204
5 Indications to see peds patient with fever in 24 hours
3-6 months unless within 48 hours of dtap
Over 104 but under 105.8
UTI
Subsides for 24 hours then returns
Loinger than 72 hours
205
Risk factors for a invasive bacterial infection
Under 28 days
Fever over 104
Not immunized
Previous abx use
Prematurity
206
Workup plan for febrile children
Work up ALL febrile infants
Workup selected depending on age group
207
Required workup for 8-21 day old febrile infant
UA
Blood culture
LP
HSV swab if at risk
208
Tx for 8-21 day febrile infant and what we are coving for
IV abx +/- acyclovir
Ampicillin and Gentamycin to cover E coli, GB Strep, and Listeria
Stop if blood cx comes back positive
209
3 criteria that must be met to d/c febrile peds patient
Culture results are negative within 24-36 hours
Infant improving
No other reasons for hospitalization
210
Required workup for 22-28 day old infants w/ fever
UA, Blood cx, Inflammatory marker(MUST perform LP if IMs elevated or UA abnormal)
211
Diffierence in work up for 29-60 days old
LP not needed if there is a source of infection - blood or urine cultures come back positive
Still start with UA, IMs and Blood cx
212
Minimum time for blood cultures to grow something
24 hours min
213
Workup for fever in 61 to 90 day old infant or 3-36 months
Full septic workup if toxic appearing, signs of focal infection, and abnormal labs
Workup more case-by-case - no LP for recognizable condition
214
WHen to do a full workup in 3-36 months
If they are underimmunized!!
215
Age when febrile seizures are seen
6 months to 5 years - does not occur outside that range
216
Simple febrile seizure
Tonic clonic
Only one
Under 15 minutes
217
Important hx for febrile seizure
What was the temp when the seizure occured and time to onset - lower in either means higher risk of recurrence
218
Workup for febrile seizures
LP if under 6 months
Eval for CNS infection
CBC
219
Fever of unknown origin
Daily temp over 38.3/101 F with no source identified for 8 days
Often a dx is not established
220
Focus for first 24 hours of FUO workup
Focus on infection
221
Focus of FUO workup after 24 hours
Consider cancer and autoimmune causes
222
Interventions of FUO
Only use abx if they are septic appearing
NSAIDs
Rheum/Onc referral may be considered
223
Bacterial sepsis of newborn risk factors and MC 4 patogens
PROM, Maternal infection
Beta hemolytic strep
E coli
Literia
Staph
224
Early onset sepsis
First seven days of life
225
Presentation of early onset newborn sepsis
GBS presenting with pneumonia
Resp distress
Acidosis
Hypotension
226
Presentation of late newborn sepsis
MCC - Staph aureus
Presents like meningitis
Hypotonia, decreased perfusion
227
Workup for bacterial sepsis
CBC w/ diff
Blood culture
UA with culture
Spinal tap (excluded in partial sepsis workup)
228
Tx for early onset newborn sepsis
Ampicillin and Gentamycin (or Cefotaxime)
229
Tx for late onset newborn sepsis
Ampicillin, Gentamycin, Add Vanc
230
Prevention of newborn sepsis
Treat GBS+ mothers with PCN or 2nd gen Ceph or Vanc/Clinda if allergic to both - treat 4 hours before birth
231
VIral meningitis presentation
Acute onset
Marked fever and lethargy
Vomiting, DIarrhea
Maculopapular rash
Bulging fontanelle
232
Virus to consider in WV for meningitis
LaCrosse encephalitis
233
Dx for viral meningitis
Close to normal glucose and protein in CSF
PCR test is super helpful
234
Management for viral meningitis
Control the fever to prevent seizure
Hydration - IVF
Prophylactic ABX until viral PCR returns positive
235
Course of viral meningitis in peds
Usually lasts a week
No need for repeat LP if improvement
CT before repeat LP
236
Indication for acyclovir in viral meningitis
Infants under 1 month - suspect HSV
237
Bacterial meningitis v Viral
Bacterial is worse - risk of hearing loss
238
Presentation of bacterial meningitis
Fever with neck stiffness - B&K signs
Increased protein, decreased glucose on LP
Photo/Phonophobia
Petechial rash
239
Tx for bacterial meningitis
Vancomycin and Cefotaxime (Rocephin if IV)
240
Steroids in bacterial meningitis
Improtant to save hearing in H flu 1 hour before other abx - give in unvaccinated infants
241
Prophylaxis for neisseria meningitis
Anyone with direct droplet contact and same household
Rifampin
242
Abx to decrease endotoxin effect when treating bacterial menigitis
Give clinda - be prepared for shock even if patient is stable
243
MC pathogens for bacterial conjunctivitis
S pneumo, H flu, Mcat
Consider staph
Pseudomonas for contact wearers
244
Presentation of bacterial conjunctivitis
Unilateral
Foreign body sensation
URI associated
245
Tx for bacterial conjunctivitis
Fluoroquinolone eye drops or Polytrim (polymixin-trimethoprim)
Refer if not working
246
Presentation viral conjunctivitis
Preauricular lymphadenopathy
Bilateral more often
247
Keratoconjunctivitis
Keratitis with
Severe and bilateral
Swelling and ptosis
248
Allergic conjunctivitis
More seasonal - MC in spring
Itchy, watery, clear drainage
249
Tx for allergic conjunctivitis
Olopatadine eye drops BID
Systemic tx for steroids if severe
250
Vernal conjunctivitis
Vision threatening allergic conjunctivitis - cobblestoning
251
Atopic conjunctivitis
Associated with eczema - burning pain
TOpical/Oral histamine or steroid in severe cases
252
Risk factors for acute otitis media
Smoke exposure
Bottle feeding
Pacifier use
253
Presentation of AOM
4-7 days after URI
Tugging on Ear
Vomiting
254
Criteria for otitis media dx
Acute onset of fever
Bulging TM
Opaque TM - erythema or distinct otalgia - can't sleep
255
Tx guidlines for AOM
Treat immediately under 6 months
6-24 - May choose to observe if mild but will eventually treat
24+ months - Treat if symptomatic
256
Tx for AOM
PCN - First line
Cephalosporin First line in non-immunized - 3rd gen
257
Drugs for AOM
PCN
Cefdinir
OR - Macrolide, Clinda, Bactrim
258
Indication for systemic rather than topical tx for AOM
Perforation of Systemic symptoms
Tympanostomy tubes are OKAY for topical
259
Complications of AOM
TYmpanosclerosis
Cholesteatoma - greasy artifact from perfed membrane
260
When to refer for perfed TM
If not healed in 3-6 months
Most heal is 2 weeks
261
f/u for AOM
48-72 hours if no improvement
8-12 weeks for under 2 years OR language delayed
Not needed over 2
262
Indications for ear tubes
3+ episodes in 6 moths or 4 in a year
263
Otitis media with effusion
No inflammation - just fluids - clear TM
Do tympanostomy if it lasts over 3 months
264
Presentation of viral rhinitis
Sudden onset
Less than 5 days
Congestion
Fever onset after illness is concerning
265
Tx for viral rhinitis
NSAID
Supportive - Hydration!!
Suction for infants
No cough syrup
266
Herpetic gingivostomatitis presentation
Vesicular lesions - erythematous base
On lips, arounds the mouth, gums
Submandibular lymphadenopathy
267
Management for herpetic gingivostomatitis
Clearing up when no new lesions are appearing
Acyclovir use is controversial
Lasts 7-14 days
268
Thrush
Gingivostomatitis candadiasis
May be painful
Cottony feeling in mouth
269
TX for thrush
Nystatin suspension - cotton swab if they can't swich and spit
If no response in 3-6 days - fluconazole systemic
270
Cocksacki virus presentation
Hand foot and mouth disease
Back of the mouth/ throat lesions (front is more likely HSV)
271
Skin lesions of HFM disease
Not itchy
Maculopapular to ulcerative lesions
272
Presentation of Srep throat over 3
Over 3 - Sore throat, fever, tonsylopharingitis, no cough
Pharyngeal petechiae
Strawberry tongue
273
Strep throat in children under three
Less common
Atypical symptoms
More URI sx
Cervical adenopathy
274
Whom to test for strep throat
Pharyngitis
Fever
HA
Cervical lymphadenopathy
275
Tx for strep throat
PCN or Amoxil
Ceph, Clinda, Z max for resistant
276
Presentation of mono
2-6 week incubation
Fever, sore throat and lymphadenopathy
Very painful sore throat
Palatal petechiae
Hepatosplenomegaly
277
Mono reactive rash
Reaction to PCN or Amoxil
278
Monospot restrictions
Never order under 5 years (order antibodies instead)
279
Labs for Mono
Atypical lymphocytosis with elevated liver enzymes
280
Tx for Mono
Bed rest
Supportive
Fluids
No contact sports 4-5 weeks
No antivirals
281
Presentation of adenovirus
Every mucous membrane
Inflamed pharyngeal walls
Supportive tx
282
Presentation of croup and MCC
Parainfluenza
Barking cough
Inspiratory stridor
Deep brassy cough
Hoarse voice
283
Demographics of croup
3months to 3 years
MC in fall
284
Dx of croup
Steeple sign on XR
285
Tx for pertussiss
Erythromycin or other Macrolide
286
Tx fro croup
Steroids - PO if possible
287
MCC of bacterial pneumonia in children under 6mos
Chlamydia trachomatis
288
MCC of bacterial pneumonia in children over
Strep pneumo
289
Dx for pneumonia
Clinical - CXR for continued dyspnea
290
Pneumonia admission criteria
Admit if - under 3 months, toxic appearing, can't keep abx down
291
Tx for pneumonia
Under 3 months with Amp and Gent
Z-max 1-6 months
Amoxil OR cefdinir 6 mo - 5 years
292
Mycoplasma pneumonia
Kids over 5
Interstitial infiltration rather than consolidation
293
Tx for mycoplasma
Z-max 1st line
294
Rubeola
Measles
295
Presentation of rubeola
Measles
Conjunctivitis
Koplik spot
Photophobia
Rash starting at head
296
Tx for rubeola
Supportive
297
RUbella presentation
Low grade fever, ocular pain, sore throat, myalgia
Postauricular, suboccipital lymphadenopathy
Rash face down
298
Congenital abnormalities of rubella
Growth retardation
Cardiac abnormalities
Deafness
299
Fifths disease
Erythema infectiosum, Parvo B19
Slapped cheek rash - spreads to body
Arthritis
300
Roseola
HHV 6-7
Major casue of febrile seizure
High fever but looks fine, followed by head to toe rash
6 months to 3-4 years
301
5 Rheumatic fever major manifestations
Carditis, Polyarthritis, Chorea, Erythema marginatum, SQ nodules
302
4 Rheumatic fever minor criteria
Arthralgia
Prolonged PR
Fever
Elevated ESR/CRP
303
Tx for RF
PCN G for GAS
NSAID - Naproxen for arthritis
Long acting PCN G until 21 to 28 days for recurrence prevention
304
Kawasaki disease
Multi-system vasculitis - can lead to coronary artery aneurism
305
Criteria for Kawasaki disease - 6 things
MUST have fever for >5 days and 4 out of 5 of:
1.Lip/Oral cavity changes
2.Non-purulent bilateral conjunctivitis
3.Unilateral cervical lymphadenopathy
4.Maculopapular exanthem
5.Redness/Swelling of hands/feet with desquamation
306
Labs for Kawasaki
WBC>15,000
Thrombocytosis >450,000
Elevated LFT with Albumin<3
CRP> 3mg/dL
ESR>40mm/hr
Pyuria>10WBCs - bag speciment ONLY
307
Diagnosing atypical/incomplete kawasaki
Elevated ESR and CRP with 3 other abn lab findings or +Echo
Younger less likely to have an atypical presentation
308
Clinical management of suspected kawasaki not meeting classic or atypical presentation
Monitor serial labs if fever persists
309
Tx for kawasaki disease
Baseline echo
IVIG infusion
High dose aspirin - send home on low dose after d/c
Steroids if both fail
310
Age for circadian rhythm development
4 months
REM/NREM around 3 years
311
MC sleep disorder under 12
Difficulty falling asleep
312
Good sleep hygeine
Dark, Quiet, Cool
Fed in parents arms then put in bed
Put to bed when tired
No devices
313
When should babies be able to sleep through the night
At 12 weeks - after they will learn to not sleep all night
May be ready for solids if waking up genuinely hungry
314
Trained night awakenings
Slow time (1-2 minutes) to go check on baby when they cry after 4 months
Bedding with parent scent
315
How long should bedtime routines be
30 minutes max!!
Need to set boundaries
316
Tx for refusal to go to bed
Put to bed when tired
Don't nap close to bedtime
Set strict routines
317
Parasomnia
Often familial - night terrors and nightmares
318
Presentation of night terrors
1st 3rd of night
Pallor, Sweating, Tachycardia, Children may sit up scream, etc.
May run and fight - forget in morning, unresponsive to confort
319
Tx for night terrors
Reassure
Empty bladder before bed
95% gone by 8
320
Presentation of nightmares
Less vivid - last third of night
Remember the dream
Comfort and reassurance
Low dose trazadone or benedryl in severe cases
321
Tx for peds separation anxiety
Surround with familiar people - help get used to new situation
Firm goodbye
322
Stranger anxiety
Natural phase around 9 months
Reassure that it will get better
Exposure therapy
323
Treatment for childhood aggression
MC in boys -most grow out but MC in learning disabilities
Replace with socially acceptable response
Praise good behavior - consistent discipline
r/o abuse
324
Presentation of temper tantrums
MC 1-4 years
Child seeking autonomy
Challenges adapting
325
Tx for temper tantrums
6 months - need some parental time away
9-12 - Environmental safety - don't have to say NO as much
15-18 months - Give more choices in reason, nap before frustration sets in
Time out
326
Cyanotic breath holding spell
Child breathes in and holds breath and becomes cyanotic - may pass out or look like seizure
327
Pallid breath holding spell
Preceded by minor injury or fear - can be seen with shots
328
Management for breath holding spells
No established tx
Reassure parent
Don't give in
329
Toilet training at 12-18 months
Become aware of need to go
Associate fullness with elimination
Mimic others
Pleasure in autonomy
330
Toilet training 18-24 months
Can briefly control sphincter
Can sit still
Picture a goal
Understand
Want to please parents
331
Toilet training 24-36 months
Able to manage simple clothing
Maintain a routine
Imaginary play
Gender awareness
332
Toilet training 3+ years
Gradual maturing of GI system
Ability to break focus to use the restroom
Peer pressure
Sticker cahrts
333
Sequence of training for toilet
Urination before BM
334
Methods for potty training
2 week immersion
Run aroundnaked
Big-boy underwear
May need a combo approach
335
Tips for potty training
Positive rather than negative reinforcement
Patients
Different for everyone
336
Thumb sucking
Used to self soothing
Can lead to dental malocclusion
May lead to bullying/psych issues
337
Whining and need for attention
Actually indicates increased maturity
Avoid negative situation
Meet basic needs
Let them vent frustrations
338
Children and attention
Need it
Negative attention is better than none at all - will misbehave for it
Ignoring bad behavior may be better
339
Exploration in chilren
Often masturbation, 2months to 4 years
Reassure parents
Not sexual to the child
Suggest not to do in public
Compulsive may indicate deeper issue
340
Head banging and rocking for peds
Self soothing behavior
Compensaotry for excess of stimuli in mentally impaired
Reassure parents - consult if persistant
341
Retentive encopresis
Leakage of BM due to holding stool for so long
May cry thingking about BM
Fecal massses felt
Blood on tissue
342
Tx for acute encopresis
Need a BM every day
Enema for 2-3 days
Miralax
Combo of both
343
Tx for chronic encopresis
Stool softener qd for over 6 months
1-2 BM per day goal
344
Non retentive encopresis
Behavior issue
Give incentives for using the toilet
Refer if won't sit on toilet over 5 or if any issues past 8
345
PDD
Pervasive developmental disorders
Intense interests
Struggle socially
346
3 Categories of symptoms of PDD
Qualitative impairment in social interaction
Impairment in communication
Stereotyped patterns of behavior or interests
347
DSM V ASD criteria
Deficits in all three of:
Social emotional reciprocity
Nonverbal communicative behaviors
Developing, maintaining and understanding relationships
AS WELL AS 2+ of:
Stereotyped movements/speech
Insistance on sameness
Fixated interests
Increased or decreased response to sensory input
348
Levels of ASD severity
1 - Requires support with noticeable impairment without
2 - Requires substantial support - defecits still there
3 - Requires very substantial support - limited social interactions
349
Time to report child abuse
48 hours
350
What to do for pyloric stenosis initially before surgery
Check and correct electrolyte abnormalities
351
Groin pull
Injury to the hip adductors - XR may show an evulsion fracture
352
3 types of knee pain
Acute, Chronic, or Popping
353
MC knee fracture in peds
Tibial spine or osteochondral
354
Ballotment test
Knee straight, pressure applied to top of patella - spongy suggests effusion
355
Patellar apprehension test
Knee bent, pressure applied to the patella on the side -apprehension indicates may dislocate
356
Presentation of tibial spine fracture
Hyperextension if the knee with rotation of femur
Hemarthrosis and joint pain, decreased ROM
Radiographs to dx
357
Osteochondral fracture
Fractures to the intra-articular portions of the femoral condyles, tibial plateau, etc. - frequently with meniscal or ligament injuries
358
Potential complication of osteo chondral fractures
May have fragments of bone/cartilage resulting in clocking or popping
Refer to ortho
359
Patellar sleeve avulsion fracture
Sudden foreceful contraction of the quadriceps -ir. lands on feet after jumping
Hemarthrosis and patellar tenderness, high kneecap
Refer to ortho for MRI
360
Chrinic knee pain in kids
Consider osteonecrosis desicans
361
Osteochondritis dessicans
Osteonecrosis of sub-chondral bone due to overuse
Starts with foacal areas
362
Dx and management for osteochondritis dessicans
XR or MRI
Immobilization for 3-6 months -surgery not needed
363
Tx for popping/meniscal tear in peds
Bracing and PT may need an MRI or ortho referral
364
Tx for ankle sprain
Brace
Support NSAIDs
Controlled ROM
365
Grades of ligament sprains
Grade I - Strain/small tears
Grade II - Incomplete tear
Grade III - Complete tear
366
Transient synovitis
Limp after a fever - kid has healed and feels better - non emergent
Tylenol, rest to tx
367
Kosher criteria
Differentiates septic arthritis from transient synovitis
368
Aspects of the Kosher criteria
Fever over 101.3
ESR>40
WBC>12
No weiht bearing
369
Interpretation of Kosher criteria
1 - 3% chance of septic arthritis
2 - 40% chance
3-4 - Almost definite
370
Dx for septic hip
Recent infection? surgery?
AP pelvis with frog leg views - shows bone marrow destruction
Labs
371
Tx for septic hip
I&D if needed
Abx for Staph aureus
372
Metatarsus adductus
Foot in a C shape curving medially
373
Tx for metatarsus adductus
Passive ROM with massage - special shoes not needed
Cast for extremely severe
374
Risk factors for metatarsus adductus
Breach birth
Twins
Low amniotic fluid
375
Course of metatarsus adductus
Majority resolve by 1st bday
376
Club feet
Sole of the foot faces the other foot - internal rotation at the ankle
MC in boys
Smoking may be a RF
377
3 features of club feet
Plantar flexion
Inversion of heel
Medial deviation of the forefoot
378
Tx for club feet
Ponseti method - serial casting to get more and more aligned
Achilles tendon release if needed for walking a 1
379
Genu varus
Air between knees -bow legged
380
Genu valgum
Knocked kneed - gum sticking together
381
Tibial torsion
Internal or external
Bowing of lower leg
382
MCC of in-toeing in Under 1 and 1-3 years
Under 1 - Metatarsus adductus
1-3 - Tibial torsion
383
Tx for internal tibial torsion
Usually resolves by 5 - refer if it does not or it extremely severe
Not corrected by orthotics
384
Femoral anteversion
Hips are rotated in MCC of intoeing after 3 years old
Sit in a W position
Refer of persists past 11
385
Presentation of developmental dysplasia of the hip
Unequal fat fold in legs
Hip clicks - may be normal
Difficulty diapering
Limp/Swayback
Trendelenburg
386
Barlow
Push hips down (posterior) try to dislocate - adduct
387
Ortelani
Pull hips up and abduct to relocate hip joint
388
Subluxated
Joint is loose but wont dislocate
389
Dx for Developmental Dysplasia of hip
US - Standard for dx for UNDER 6 months
After 6 months - AP, Bilateral hip XR and frog legs XR
390
Tx for DDH
Pavick harness before 6 months
6-18 months - Closed reduction and Spica casting
18months to 6 months closed reduction
391
Osgood schlatter disease
Inflammation of patellar tendon
Growth spurts of puberty
Pain and tenderness at tibial tubercle
Overuse injury - relieved by rest
392
Tx for Osgood schlatter disease
IC, NSAIDs, Stretching
Exercise avoidance NOT recommended
393
Patellofemoral syndrome
Runners knee
MC chronic knee pain in athletes
394
Presentation of patellofemoral syndrome
Abnormal patellar tracking
Knock kneed and flat feet
Worse with activity and prolonged sitting
Inner and front knee pain
395
Dx and tx for patellofemoral syndrome
Ice, NSAIDS, d/c activity
musctle strengthening
Usually clinical - Sunrise view on XR may be used
396
Slipped Capital Femoral Epiphysis
Chubby male adolescents
Ball of the upper end of the femur slips off in a backwards direction
397
Presentation of SCFE
Months of intermittent hip or knee pain - chronic after 3 weeks
Cannot walk = unstable
Can walk with help = Stable
398
Dx for SCFE
AP, PA and Frog leg XR of the hips
399
Management and classification of SCFE
Internal fixation with single cannulated screw
Crutches post op
Mild (1) - under 33% disp
Medium (2) - 33-50% displaced
Severe (3) - Over 50% displaced
400
Complication of SCFE
Avascular necrosis
401
Legg-Calve-Perthes Disease
Bone supply is temporarily disrupted leading to avascular necrosis/breaking
School age children
402
Presentation of LCPD
Pain, stiffness and limited ROM
Takes 1-2 months to show on XR
403
TX for LCPD
Minimize joint impact
PT
Avoid weight bearing
Surgery is controversial
Ice and pain management
404
Scoliosis
S shaped curve - MC
MC in girls
405
Screening for scoliosis
At 8-9 years
Adams forward bend
406
Tx for scoliosis
Observation only for curve under 20 degrees
Over 20 or rapid progression (over 5 degrees), Refer for bracing or surgery
407
Cobbs angle
Used to measure scoliosis curvature
408
Toddler's fracture
Distal half of tibia - spiral
Can't bear weight
Screen for abuse
409
Osteogenesis imperfecta
Many fractures at a young age - with blue sclera
Often a family hx
Hearing loss
Genetic
410
Achondroplasia
Autosomal dom
Hips to pelvis are normal, limbs are short
411
Craniosynostosis
Premature fusion of the sutures - leading to assymetrical head
Plagiocephaly d/t how baby is laid - tummy time
412
Hypophosphatemic rickets
X linked
Impaired growth
Deaf
Calcified tendons
HCTZ and Growth hormone to tx
413
Nursemaids elbow
Subluxation of the radial head - due to a tug or pull injury
Holds arm fully pronated and won't use
414
Reduction of nursemaids elbow
Supinate and and flex elbow to reduce
415
MC malignancy in children
ALL
416
Dx of ALL
Blasts on peripheral smear
Decrease in one cell type on CBC
25+% blasts on bone marrow aspirate - Diagnostic!!
417
Presentation of ALL
Bone pain
White from anemia
Petechiae and easy bruising
Hepatosplenomegaly
Fatigue
Diffuse lymphadenopathy
418
CXR for ALL
May show mediastinal masses from hilar adenopathy
419
Translocation of ALL
Chromosomes 12 and 21
420
Treatment for ALL Phase 1
Remission induction Chemo (vincristine, asparaginase) with intrathecal MTX
421
Treatment of ALL phase II
Intrathecal chemo and radiation - very intense
422
Treatment of ALL phase III
Daily oral chemo, weekly MTX, pulses of IV chemo and oral steroids
423
RF for ALL
Down syndrome
Pre/Post natal XR exposure
424
Prognosis for ALL
90% cure rate
425
AML
2nd most common cancer in children
More aggressive with worse prognosis
Granulocyte precursor disease
426
Presentation of AML
Fatigue
Bleeding
Infection
Nontender, hard lymph nodes
Hepatosplenomegaly
427
Dx for AML
Low neutrophils
30% or more blasts on smear
Auer rods - only in AML NOT ALL
428
TX for AML
Chemo, potential radiation
Bone marrow transplant or cord blood
429
Phase 1 AML tx
Remission induction:
1 month, kill as many leukemic cells as possible
430
Phase 2 AML tx
Consolidation Preventative therapy
Stop spdread to brain and spinal cord
Intrathecal chemo and maybe radiation
431
Phase 3 AML tx
Intensification
1-2 tx lasting two months at a time for 9months total
432
Risk factors for AML
Ionizing radiation therapy
Previous chemo
Neurofibromatosis and Down
35-50% long term survival
433
Hodgkins lymphoma
Middle and HS kids (as opposed to AML/ALL which is younger)
Exposure to infections decreases risk
434
Presentation of hodgkins lymphoma
Painless cervical lymphadenopathy
Mediastinal mass
Fatigue, Anorexia, Weight loss, Night sweats - B symptoms
435
B symptoms for Hodgkins lymphoma
Temp over 38
Weight loss 10%+
Drenching night sweats
436
Dx for hodgkins lymphoma
Normal CBC
Increased EBV titers
Bx of node to diagnose - reed sternberg cells
May also do a bone marrow biopsy to determine extent
437
Indications to biopsy to look for hodgkin lymphoma
Lack of infectious cause
Lymph node over 2 cm
Supraclavicular nodule
Abnormal CXR
Increasing node after 2 weeks abx or failing to decrease in 4-6 weeks
438
Tx for hodgkin lymphoma
Chemo - prognosis tied to B symptoms
439
Non-hodgkin lymphoma
3rd MC cancer in children
Arises from lympoid cells
MC in males and whites
440
Presentation of non-hodgkin lymphoma
Cough, dyspnea, orthopnea, facial edema, abd pain/distension
MC mass in abdomen
2nd Mass in chest
441
MC type of NHL
Burkitt
442
Presentation of Burkitt lymphoma
Boys 5-10 years - B cells and belly
Intra-abdominal tumor MC
Chromosome 8 abnormality
Can have a bowel blockage
443
Lymphoblastic lymphoma
T cells in the thorax
Indistinguishable from ALL except under 25% blasts on biopsy
Type of NHL
444
Large cell lymphoma
Least common type of NHL
Under 15% of cases
Abdominal tumor most common
B and T cells
445
Dx for NHL
Biopsy
LDH can tell us if active tissue breakdown
CT, CXR, US/Echo incase heart impingement from tumor
446
RF for NHL
Radiation exposure
Organ transplant
EBV
HIV
447
Tx and prognosis for NHL
Chemo sometimes radiation
5 year survival - those who live after 5 years and are symptoms free are likely cured
448
Triad of brain and spinal tumors in peds
Morning HA
Vomiting
Papilledema -vision changes
449
Triad of brain and spinal tumors in YOUNG peds
Irritability
FTT
Dev delay
450
Dx for brain tumor in child
CT not as diagnostic - want an MRI if possible
451
Location of peds brain tumors
50% above tenorium, 50% below
452
Astrocytoma
MC brain tumor in kids
453
Tx for astrocytoma
Chemo - relatively high survival rate
454
Brain stem glioma
Middle of the brainstem
Challenging to treat - most no removal
Only school age children
455
Ependymoma
Tumor of ventricle lining of brain
Blocks CSF flow
5 year old peak
Common in neurofibromatosis
456
Medulloblastoma
Most common MALIGNANT tumor
In the cerebellum
Mets to the spinal cord
457
Neuroblastoma
Tumor of nerve tissue
Extermely malignant
Primarily in adrenal gland
MC in boys
458
Presentation of neuroblastoma
Stomach ache
COnstitutional symptoms
Abdominal mass - fills the whole belly
Usually very little
459
Markers and dx for a neuroblastoma
VMA and HVA
CT is definitive dx
Biopsy and bone marrow to eval extent
460
Tx and prognosis for neuroblastoma
Surgical removal, chemo, radiation
Better prognosis under 1
461
Nephroblastoma
Wilms tumor
Bilateral or unilateral
Asymptomatic mass DOES NOT cross the midline
Hematuria
Abd distension
462
Tx for nephroblastoma
Nephrectomy, Chemo, Radiation
Lungs MC site of mets
463
Osteosarcoma v. Ewing sarcoma
Osteo in metaphysis
Ewing - Diaphysis
464
Presentation of osteosarcoma
Bone pain - wake at night
Often in growing children
Taller than peers
Lump on bones
Limp
465
Tx for osteosarcoma and RF's
CHemo, try to save limb
Many will already have mets
Taller males have greater risk
466
Periosteal reaction
In bone cancer
Suburst of Codman's triangle
467
Presentation of ewing sarcoma
2nd most common after osteosarcoma
Swollen and tender to touch
Worse with exercise
In the diaphysis
468
Tx for Ewing sarcoma
Chemo followed by surgery
469
Retinoblastoma
Genetic defect in chromosome 13
One eye is white on picture
470
Presentation of retinoblastoma
Leukoria - whit rather than red reflex
471
Dx for retinoblastima
CT followed by MRI
472
Tx for retinoblastoma
External beam radtiation and removal of eye
