Pediatrics Kaplan USMLE Flashcards
Time in APGAR that gives an idea what was going on during labor
1 min
Time in APGAR that gives an idea of response to therapy (resuscitation)
5 mins
Cervical level affected in Erb Duchenne and the movement affected
C5-C6
Abduct shoulder, externally rotate and supinate forearm
Brachial palsy that affects the C7-C8 +- T1 and may give rise to Horner syndrome
Klumpke
Injury to what nerve is the entire side of face with forehead affected due to forceps delivery or in utero pressure
Facial nerve injury
Injury during delivery that is characterized by diffuse edematous swelling of soft tissue of scalp and CROSSES suture line
Caput succedaneum
Injury during delivery that is characterized by subperiosteal hemorrhage and does NOT CROSS the midline
Cephalhematoma
PE finding in NB characterized by lacy reticular vascular pattern over most of body when baby is cooled
Curis marmorata
PE finding in NB characterized by firm white papules with inclusion cyst on palatenmidline; epstein pearls
Milia
PE finding in NB characterized by palenpink vascular macules found in nuchal area, glabella, eyelids and usually disappears
Salmon patch (nevus simplex)
PE finding in NB characterized by blue to slate gray macules seen on presacral, back, posterior thighs; arrested melanocytes
Mongolian spots
Ddx of mongolian spot
Child abuse
PE finding in NB characterized by firm yellow whitebpapules/pustules with erythematous base; peaks on second day of life and contains eosinophils and is benign
Erythema toxicum neonatorum
Superficial hemangioma mostly appear at what age and involutes at what age
1st 2 months
5-9 y/o
PE finding in NB characterized by erythematous papules on face and associated with high maternal androgen
Neonatal acne
PE finding in NB characterized by cleft at six o’clock position; kst with other eye abnormalies; CHARGE association
Coloboma iris
PE finding in NB characterized by hypolasia of iris; defect may go through to retina; association with Wilms tumor
Aniridia
Enzyme deficiency of Classic Galactosemia
Gal-1-P uridylyltransferase
Classic manifestations of classic galactosemia
Jaundice (often direct), hypoglycemia, cataracts, MR
Infection associated with Classic Galactosemia
E.coli
Most common presentation of PKU
MR
Likely associations of PKU
Fair hair, fair skin, blue eyes
T/F PKU normal at birth
T
Type of IUGR whose etiologies are genetic syndromes, chromosomal abnormalities, congenital infections, teratogens, toxins
Symmetric
Type of IUGR whose etiologies are uteroplacental insufficiency secondary to maternal diseases and/or placental dysfunction
Asymmetric
Weight of LBW
<2,500gms
Weight of LGA
> 4,500gms
Major fetal growth hormone
Insulin
Maternal hyperglycemia is associated with
Fetal hyperinsulinemia
Major metabolic effect is at birth with placental separation
Hypoglycemia
Metabolic abnormalities with infants of diabetic mothers
Hypoglycemia, hypocalcemia, hypomagnesemia
Common findings in infants of diabetic mothers
Birth trauma, tachypnea, cardiomegaly, polycythemia, renal vein thrombosis, increased congenital anomalies (cardiac, small left colon syndrome, caudal regression syndrome)
Specific cardiomegaly finding in infants of diabetic mothers
Asymmetric septal hypertrophy
Cardiac anomalies in infant of diabetic mother
VSD, ASD, transposition
Pulmonary finding for RDS
Decreased FRC and atelectasis
Primary initial pulmonary hallmark in RDS
Hypoxemia
Radiologic findings of RDS
Ground glass appearance, atelectasis and air bronchograms
Most accurate dx test in RDS done on amniotic fluid prior to birth
L/S ratio
Best initial treatment in RDS
Oxygen
Most effective treatment in RDS
Intubation and exogenous surfactant administration
Disease of the NB characterised by slow absorption of fetal lung tissue leading to decreased pulmonary compliance and tidal volume with increased dead space
TTN
Condition common in term infant delivered by CS or rapid stage of labor
TTN
Radiologic finding of TTN
Air trapping, fluid in fissures, perihilar streaking
Radiologic findings of meconium aspiration
Patchy infiltrates, increased AP diameter, flattening of diaphragm
Prevention of Meconium aspiration
Endotracheal intubation and airway suction of depressed infants with thick meconium
Treatment of Meconium aspiration
Positive pressure ventilation
NB born with respiratory distress and scaphoid abdomen
Diaphragmatic hernia
Best test to diagnose diaphragmatic hernia
Postnatal xray
Greatest risk factor to develop Necrotizing Enterocolitis
Prematurity
NEC symptoms usually related to _______
Introduction of foods
Pathognomonic radiologic finding of NEC
Pneumatosis intestinalis
Condition wherein there is deposition of unconjugated bilirubin in the basal ganglia and brainstem ganglia
Kernicterus
Features of kernicterus
Hypotonia Seizures Opisthotonus Delayed motor skills Choreathetosis Sensorineural hearing loss
Physiologic jaundice Appears \_\_to\_\_\_ DOL (term) Disappears by \_\_\_\_DOL (term) to \_\_\_\_DOL Peaks at \_\_\_\_to \_\_\_\_\_DOL Peak bilirubin
2nd to 3rd 5th to 7th 2nd to 3rd 13 5
Breast feeding jaundice appears how days of life?
First
Breast milk jaundice appears in what week of life?
2nd week
Main problem in breast milk jaundice
Glucoronidase
Syndrome that occurs with direct hyperbilirubenemia manifested by dark and grayish-brown discoloration of the skin (photo-induced change in porphyrins which is present in cholestatic jaundice)
Bronze baby syndrome
Treatment in hyperbilirubenemia wherein bilirubin continues to rise despite intensive phototherapy and/or kernicterus
Double volume exchange transfusion
Familial nonhemolytic hyperbilirubinemia is also known as
Crigler-Najjar syndrome
Type I familial nonhemolytic hyperbilirubinemia
Absence of glucoronyl transferase
Type II familial nonhemolytic hyperbilirubinemia
Small amount of inducible glucoronyl transferase
Most common organisms causing neonatal sepsis
Group B streptococcus, e.coli and listeria monocytogenes
Treatment in neonatal sepsis when there is no evidence of meningitis
Ampicillin and aminoglycoside until 48-72hour cultures are negatively
Treatment in neonatal sepsis when there is evidence of meningitis
Ampicillin and third generation cephalosporin (not ceftriaxone)
TORCH infection
Toxoplasmosis Other (syphilis, varicella, HIV and parvovirus B19) Rubella Cytomegalovirus Herpes
TORCH infection that came from ingestion of water or food with oocytes that have been excreted by infected cats
Toxoplasmosis
Common findings in Toxoplasmosis
Chorioretinitis, hydrocephalus, intracranial calcifications
Common outcome in patients with Toxoplasmosis
Visual impairments
Treatment in infants for Toxoplasmosis
Pyrimethamine, sulfadiazide, leucovorin
Congenital cataract is a classic finding when this TORCH infection occurs in first 8weeks of gestation
Congenital rubella
Findings for congenital rubella
Blueberry muffin spots (extramedullary hematopoiesis)
Cardiac such as PDA and pulmonary artery stenosis
Cataracts
Congenital hearing loss
TORCH infection causing periventicular calcifications, IUGR and microcephaly
CMV
Outcomes of CMV
Sensorineural hearing loss
MR
Best treatment for Herpes simplex
IV acyclovir
When does skin problems manifested in herpes simplex during the NB period?
5-14 days
When does CNS problems manifested in herpes simplex during the NB period?
3-4 weeks
When does disseminated problems manifested in herpes simplex during the NB period?
5-7 days
Best dx modality in Herpes Simplex infection
PCR
Prevention of outcomes in Herpes simplex in the delivery
Elective CS when active disease or visible lesions are identified; however not 100% effective
Early findings of congenital syphilis (birth-2 y/o)
Snuffles, maculopapular rash (palms of soles, desquamates), jaundice, periostitis, osteochondritia, chorioretinitis, congenital nephrosis
Late findings of congenital syphilis (>2 y/o)
Hutchinson teeth, clutton joints, saber shins, saddle nose, osteochondritis, rhagades (thickening and fissures of corners of mouth)
Neonatal varicella is observed when delivery occurs ______week before/after maternal infection
<1 week
Outcomes of congenital varicella
Limb malformations and deformations, cutaneous scars, microcephaly, chorioretinitis, cataracts, cortical atrophy
Most likely presentation of toxoplasmosis
Hydrocephalus with generalized calcifications and chorioretinitis
Most likely presentations of congenital rubella
Cataracts. Deafness and heart defects
Most likely presentation of Congenital CMV
Microcephaly with periventricular calcifications
Most likely presentation of syphilis
Snuffles (mucopurulent rhinits)
Maternal major illicit drug use that increases risk of SIDS and stillborns
Opiates
Maternal major illicit drug use that has high degree of polysubstance abuse
Cocaine
Maternal major illicit drug use that causes CNS ischemia and hemorrhagic lesions
Cocaine
Most common pattern of human malformation
Trisomy 21
Speckling of iris is also known as _____which is also seen in Trisomy 21
Brushfield spots
Findings of Down Syndrome
Upward slanting palpebral fissures Speckling of iris (Brushfield spots) Inner epicanthal folds Hypotonia Hearing loss Cardiac anomalies Gastrointestinal anomalies Atlanti-axial instability Hypothyroidism ALL MR
Most common cardiac anomaly in Trisomy 21
Endocardial cushion defect > VSD > PDA, ASD also MVP
Most common GI anomalies in Trisomy 21
Duodenal atresia, Hirschprung disease
Early onset of this disease is seen in Trisomy 21
Alzheimer disease
2nd most common pattern of malformation
Trisomy 18
Findings of Trisomy 18 or Edward Syndrome
MR
Low set, malformed ears, microcephaly, micrognathia, prominent occiput
Clenched hand - index over third, fifth over fourth
Rocker-bottom feet, hammer toe
Omphalocele
Trisomy 13 is also known as ______
Patau syndrome
Defect of midface, eye and forevrain development leading to single defect in 1st 3 weeks development of prechondral mesoderm
Trisomy 13 (Patau Syndrome)
Findings in Patau Syndrome
Holiprosencephaly and other CNS defects Severe MR Microcephaly; microphthalmia Severe cleft lip, palate or both Postaxial polydactyly
Single umbilical artery
WAGR syndrome is also known as __________
Aniridia-Wilms Tumor Association
WAGR is defined as deletion kn what gene
11p13
T/F: highest risk of aniridia compared to wilms
False
Highest in wilms compared to independent aniridia or GU defect
Most common findings of Klinefelter syndrome (XXY)
MR (average IQ 85-90)
Behavioral problems
Long limbs (decreased upper:lower segment ratio); arm span>height
Hypogonadism and hypogenitalism
Turner syndrome is also known as _______
XO
Findings of Turner syndrome (XO)
Congenital lymphedema, residual puffiness over dorsum of fingers and toes
Broad chest, wide spaced nipples
Low posterior hairline; webbed posterior neck
Cubitus valfus and other joint problema
Horseshoe kidney and other renal defects
Cardiac: bicuspid aortic valve and coarctation
Number 1 cardiac anomaly in Turner syndrome
Bicuspid aortic valve
Treatment for Turner syndrome
Estrogen
GH: may increase height by 3-4cm
Molecular diagnosis of Fragile X syndrome
Variable number of repeat CGG
Most common cause of inherited MR
Fragile X syndrome
Findings of Fragile X syndrome
Mild to profound MR; learning problems
Large ears, dysmorphoc facial features, large jaw, long face
Macroorchidism
Genetic cause of Beckwith-Wiedemann syndrome
IGF-2 disrupted at 11p15.5 (imprinted segment)
Findings of Beckwith-Wiedmann syndrome
Macrosomia Macroglossia Pancreatic beta cell hyperplasia leading to hypoglycemia Omphalocele Hemihypertrophy
Hemihypertrophy in Beckwith-Wiedemann syndrome is attributed to what condition
Wilms tumor
Management of Beckwith-Wiedemann Syndrome
UTZ and serum AFP every 6 months through 6 years of age to look for Wilms and hepatoblastoma
Chromosome responsible for Prader-Willi syndrome
Paternal chromosome
Genetic defect seen in Prader-Willi syndrome
Deletion at 15q11-q13-imprinted segment
Findings of Prader Willi
Obesity
Mild to severe MR
Binge eating
Small hands and feet, puffy; small genitalia
Hypothalamic-pituitary dysfunction hypogonatropic-hypogonadism
Angelmann syndrome is also known as
Happy puppet syndrome
Genetic defect of Angelmann syndrome
Deletion of 15q11q13 but MATERNALLY DERIVED (imprinted segment)
Findings of Angelmann Syndrome
Severe MR
Paroxysms of inappropriate laughter
Absent speech or <6 words; most can communicate with sign language
Ataxia and jerky arm movements resembling a puppet’s movement
Facial feature defect characterized as mandibular hypoplasia in utero
Robin sequence (Pierre Robin)
Findings of Pierre Robin
Micrognathia
Retroglossia
Cleft soft palate and other abnormalities
Jaw growth over first years of life
Autosomal dominant Osteochondrodysplasia with mutations in gene for FGFR3
Achondroplasia/Hypochondroplasia
Findings of Achondroplasia
Short stature
Proximal femur shortening
Megalocephaly, small foramen magnum, small cranial base, prominent forehead
Lumbar lordosis
Natural history of Achondroplasia
Normal intelligenxe
Tendency of late childhood obesity
Small eustachian tube
CTD Autosomal dominant with wide variability; mutations in fibrillin gene (FBN1)
Marfan syndrome
Findings of Marfan Syndrome
Tall stature with long, slim limbs and little fat
Arachnodactyly
Joint laxitt with kyphoscolios
Lens subluxafion (upward)
Ascending aortic dilatation with or without dissecting aneurysm
Most common cardiac problem in Marfan Syndrome
Ascending aortic dilatation with or without dissecting aneurysm
Lens subluxation in Marfan is directed upward as a defect in what ligament?
Suspensory ligament
Chief cause of death of Marfan syndrome
Vascular complications
Most common type of Ehler Danlos syndrome
Type 1
CTD characterized by droopy ears, hyperextensible skin, fragile, easy bruisability, poor wound healing, joint hyperlaxity, blue sclera, ectopia lentis
Ehlers-Danlos syndrome
Most common cardic problem in Ehler Danlos syndrome
Aortic root dilatation
Most common teratogwn to which fetus can be exposed
Alcohol
Findings of Fetal Alcohol Syndrome
Pre- (symmetric IUGR) and postnatal growth deficiency (short stature)
MR, microcephaly
Hyperactivity in childhood
Behavioral abnormalities
Mid-face dysmorphism (abnormal frontal lobe development)
Joint annormalities
Cardiac anomalies
Most common cardiac anomaly in fetal alcohol syndrome
VSD>ASD
Condition with similar features (FAS) with prenatal exposure to carbamazepine, valproate, primidone, and phenobarbital
Fetal hydantoin syndrome
Unique findings in fetal hydantoin syndrome
Hirsutism
Cupid’s bow lips
Fetal valproate syndrome is characterized by:
Midfave hypoplasia
Cardiac decects
Meningomyelocele
Findings of retinoic acid embryopathy
Bilateral microtia/anotia; facial nerve paralysis ipsilateral to ear
Conotruncal malformations
CNs malformations
Decreased intelligence
How many days is isotretinoin stopped so that no problems will be observed natally?
Before 15th postmenstrual day
Etiology of Potter Sequence
Renal agenesis/dysnesis
Findings in Potter Sequence
Pulmonary hypoplasia
Potter facies
What is potter facies?
Hypertelorism, epicanthal folds, low set flattened ears, micrognathia, compressed flat nose
Cause of mortality in potter sequence?
Respiratory insufficiency (hypoplasia)
Most common Coloboma?
Retinal
Infant doubles BW by ____mos, triple by ______year
6 months
1 year
At what age does myelination is completed?
7 y/o
Boys’ highest growth stopsnat what age?
18 years old
Girls’ average height peak at what age?
11.5 years
Girls’ height stops at what age?
16 y/o
How many percentage does a NB loses in the first week of life?
10%
Best tool to determine patterns of growth
Growth chart
How to get the bone age?
Xray of left hand and wrist (non-dominant)
If BA < CA
Constitutional delay
Chronic illness, nutritional deficiencies, endocrine disorders
If BA=CA
Normal growth velocity
Abnormal growth velocity
Familial short stature
Genetic syndromes associated with short stature
If BA>CA
Normal growth velocity
Abnormal growth velocity
Familial tall stature, obesity
Genetic syndromes, endocrine disorders, CNS lesions
T/F: height percentile at 2 years correlates with final adult height percentile
True
Single best growth curve indicator for acute malnutrition
Weight/height <5th percentile
Accepted as best clinical indicator for measure of under and overweight
BMI
Skeletal maturity is linked more to _________than ___________
Sexual maturity
Chronilogic age
How many months does a normal NB has sufficient stores of iron to meet requirements?
4-6 months
What particular protein does human milk have?
Whey dominant
What particular protein does cow milk have?
Casein dominant
When to introduce iron-fortified cereal?
4-6 months
Staple product of given in the first year of life will develop infant botulism
Honey
When to introduce table foods?
9-12 months
What do you call when the child is short prior to onset of delayed adolescent growth spurt; parents are of normal height; normal final adult height is reached; growth spurt and puberty are delayed; bone age delayed compared to chronological age?
Constitutional growth delay
What is familial short stature?
Patient is parallel to growth curve; strong family history of short stature; chronological age equals bone age
What is pathologic short stature?
Patient may start out in normal range but then starts crossing growth percentiles
Most common reason in all age group for non-organic failure to thrive
Psychosocial deprivation
What is diagnostic of obesity?
BMI > 95% for age and sex
It is defined as performance significantly below average
Developmental delay
How is MR characterized?
IQ 70-75 plus related limitation in at least 2 adaptive skills
Tool used for screening the apparently normal child between ages 0-6 years old
Denver II Developmental Assessment
What are the areas Denver II developmental assessment screen?
Gross motor, fine motor, language, personal-social
For infants born <38 weeks AOG, correct age for prematurity up to what age
2 y/o
How many delays are needed to tell if there is failure in the development?
2 delays
Parachute reflex appears at what age?
6-8 months
Disappearance age of parachute reflex?
Never
Asymmetric tonic neck appears at what age?
Birth to 1 month
Trunk incurvation disappears at what age?
6-9 months
Root reflex originates from what part of the CNS?
Brainstem
Trigeminal system
Placing reflex originated from what part of the CNS?
Cerebral cortex
Trunk incurvation originates from what part of the CNS?
Spinal cord
When does the baby coos?
4 months
When does the baby babbles?
6 months
When does the baby recognises the parent?
2 months
When does the baby uses the words mama and dada indiscriminately?
9 months
When does the baby sits alone?
6 months
When does the baby develop the raking grasp?
6 months
When does the baby starts to site without support?
7 months
When does the baby develop immature pincer grasp?
9 months
When does the baby develop mature pincer grasp?
12 months
When does the baby develop object permanence?
12 months
When does the baby develop 1-2 words other than mama and dada?
12 months
When does the baby cooperates with dressing?
12 months
When does the baby scribbles and builds towers of 2 blocks in imitation?
15 months
When does the baby develop 4-6 words?
15 months
When does the baby follows 1 step command with gestures?
15 months
When does the baby uses cup and spoon?
15 months
When does the baby scribbles spontaneously?
18 months
When does the baby build tower of 3 blocks?
18 months
When does the baby know 15-25 words and knows 5 body parts?
18 months
When does the baby starts parallel play?
24 months
When does the baby build tower of 7 blocks?
24 months
When does the baby develops 50words, 2 word sentences?
24 months
When does the baby follows 2 step command?
24 months
When does the child uses pronouns inappropriately?
24 months
When does the child pedals a tricycle?
3 y/o
When does the child copies a circle?
3 y/o
When does the child develops >250 words?
3 y/o
When does the child develop 3 word sentences?
3 y/o
When does the child starts group play?
3 y/o
When does the child hops and skips?
4 y/o
When does the child plays cooperatively?
4 y/o
When does the child tell tall tales?
4 y/o
When does the child copies a triangle?
5 y/o
When does the child copies a square?
4 y/o
Square has 4 sides
When does the child answers all “wh” questions?
5 y/o
What is the first problem you should consider if there is language delay?
Conductive hearing loss
ASD must occur at the age
3 y/o
Formula of developmental quotient
Developmental age/chronological age x 100
Repeated or chronic ingestion of non-nutritive substances?
Pica
Main predisposing factor of pica
MR and lack of parenting nurturing
Pica increased risk for:
Lead poisoning, Fe deficiency, parasitic infections
It is defined as voluntary or involuntary repeated discharge of urine after a developmental age when bladder control should be present
Enuresis
Typically, enuresis is seen at what age
5 y/o
Most common type of enuresis characterised by no significant dry period and usually nocturnal
Primary
Type of enuresis when there is hyposecretion of ADH and/or receptor dysfunction
Primary
DOC for failed behavioral therapy in nocturnal enuresis
Imipramine
Type of enuresis which occurs after a period of dryness >=6 months
Secondary enuresis
Children with both diurnal and nocturnal enuresis are most likely to have
Abnormalities of the urinary tract
It is defined as passage of feces into inappropriate places after a chronological age of 4 years or equivalent developmental level
Encopresis
Most common type of encopresis
Retentive encopresis
Rectal exam of retentive encopresis
Hard stool
Primary encopresis is seen especially in ______associated with globalndevelopmentalndelays and enuresis
Boys
Secondary encopresis has been documented to have high levels of _________stressors and ________disorder
Psychosocial
Conduct
It is defined as episodic nocturnal behaviors that often involve cognitive disorientation and autonomic and skeletal muscle disturbance
Parasomnias
Nightmares against sleepwalking and sleep terrors have
Daytime sleepiness
Low arousal threshold
No familial history
Does not require treatment
Live attenuated bacterial vaccines are
BCG, oral typhoid
Live attenuated viral vaccines are
MMR, varicella, yellow fever, nasal influenza, smallpox, oral rotavirus
Whole inactivated virus vaccines are
Polio, rabies, hep A
Fractional inactivate protein based are
Subunit: hep B, parenteral influenza, acellular pertussis
Inactivated fractional polysaccharide based vaccine that are toxoid are:
Diphteria, tetanus
Inactivated fractional polysaccharide based vaccine that are pure are:
Pneumococcal, Hib, meningococcal
Inactivated fractional polysaccharide based vaccine that are conjugate are:
Hib, pneumococcal, meningococcal
Live vaccine is delayed for how many months if gamma globulin is given
3-11 months
Where is MMR derived from?
Chick embryo fibroblast tissue cultures
How many doses of DTaP is recommended before school entry?
5
Tdap (childhood tetanus) is given at what age?
11-12 y/o
Td (adult tetanus) is given every?
10 years
How many IPV should be given?
4 doses
HiB conjugate vaccine does not cover what specific organism
Nontypeable Haemophilus
HiB conjugate vaccine is not given after what age in normal children?
5 years
What pneumococcal vaccine confers additional protection to the PCV13 in some high risk children such as functional/anatomic asplenia age >2 years?
23-valent pneumococcal polysaccharide
Varicella vaccine is given at what age for healthy person who have not had varicella illness?
12 months or older
Second dose of varicella is given at what age?
4-6 years
First dose of MMR is given at what age?
12-15 months
Second dose of MMR is given at what age?
4-6 y/o
Hep A vaccine is recommended at what age?
12-23 months of age
How many doses and interval of hepatitis A vaccine?
2 doses, 6 months apart
MCV 4 or meningococcal conjugate vaccine is given at what age and booster at what age?
11-12 y/o
16 y/o
What is the older pure polysaccharide meningococcal vaccine?
MPSV4
Route of administration of live influenza vaccine?
Intranasal
Age of the patients that can be given with live influenza vaccine?
2-49 y/o who are not pregnant and healthy
No dose of rotavirus shall be given after what age?
8 months
It is defined as abusive actions or acts of commission and lack of action, or acts of omission that result in morbidity or death
Child maltreatment
It is defined as intentional injuries to a child by a caregiver that results in bruises, burns, fx, lacerations, punctures or organ damage; also may be accompanied by short- or long-term emotional consequenxea
Physical abuse
It is defined as intentionally giving poisons or toxins or any other deceptive action to stimulate a disorder
Factitious disorder
Most common cause of underweight infants
Nutritional neglect
Syndrome suggested by bruises, scars, internal organ damage, and fractures in various stages of healing
Battered child syndrome
Fracture developed from wrenching or pulling an extremity
Corner chip or bucket handle fracture of metaphysis
Inflicted fracture of bone shaft is more likely what type of fracture
Spiral fracture
Most common burn in infant
Immersion burn
Skeletal survey is recommended if you suspect abuse child of what age?
<2 y/o
Most common reported sexual abuse
Daughters by fathers or stepfathers
Most common overall sexual abuse
Brother-sister incest
Inflammation of subglottic area
Croup
Inflammation of epiglottis and supraglottis
Epiglottitis
Laryngoscopic finding of epiglottitis
Cherry-red, swollen epiglottis
Most accurate test for Croup
PCR for virus
Not needed clinically
Most accurate test for epiglottits
C and S from tracheal aspirate
Best initial test for epiglottitis
Laryngoscopy
Definitive treatment for croup
Dexamethasone
Definitive treatment for Epiglottitis
Tracheostomy (if needed) + broad spectrum antibiotics
Most common laryngeal airway anomaly and most frequent cause of stridor in infants and children
Laryngomalacia
Laryngomalacia starts in ____weeks of life then symptoms increase up to ____months
First 2 weeks of life
6 months
2nd most common cause of stridor
Congenital subglottic stenosis
Common presentation of congenital subglottic stenosis
Recurrent/persistent croup
3rd most common cause of stridor
Vocal cord paralysis
Vocal cord paralysis is associated with what conditions:
Meningomyelocele, Chiari malformation, hydrocephalus
Bilateral vocal cord paralysis is manifested as
Airway obstruction, high pitched inspiratory stridor
Unilateral vocal cord paralysis is manifested as
Aspiration, cough, choking, weak cry and breathing
Dx test in vocal cord paralysis
Flexible laryngoscopy
Most common site of foreign body aspiration in children <1 y/o
Larynx
Radiologic finding of foreign body obstruction
Airtrapping (ball-valve mechanism)
Definitive diagnostic in foreign body aspiration
Bronchoscopy
Most common organism in brochiolitis
RSV
Bronchiolitis lasts how many days?
Average of 12 days (worse in first 2-3 days)
DOC in bronchiolitis for high risk patients
Palivizumab
Major pathogen in pneumonia younger than 5 y/o
RSV
Most common organism producing local infiltrate in children of all ages
S. Pneumoniae
Most common nonviral cause of pneumonia older than 5 y/o
M. Pneumoniae and C. Pneumoniae
Pneumonia manifested by staccato cough and peripheral eosinophilia
Chlamydia trochomatis pneumonia
Organisms caused by bronchopneumonia
Chlamydia and mycoplasma
Radiologic finding of viral pneumonia
Hyperinflation with bilateral interstitial infiltrates and peri bronchial cuffingi
Radiologic finding of pneumoccal pneumonia
Confluent lobar consolidation
Radiologic finding of Chlamydia pneumonia
Interstitial pneumonia or lobar
Radiologic finding of Mycoplasma pneumonia
Unilateral or bilateral lower lobe interstitial pneumonia
Titer to be obtained for mycoplasma pneumoniae
IgM
If S. aureus is suspected in pneumonia, what drug should be added?
Vancomycin or clindamycin
Major cause of severe chronic lung disease and most common cause of exocrine pancreatic deficiency in children
Cystic fibrosis
Most common life-limiting recessive trait among white
Cystic fibrosis
Gene mutation occurs at what chromosome in patients with CF
Long arm chromosome 7
Usual location of CF
Intestinal tract
Radiologic finding of CF in the abdomen
Dilated loops, air fluid levels, “ground-glass” (bubbly appearance) material in lower central abdomen
Clinical presentation of CF in the rectum and usually presented with steatorrhea, malnutrition and cough
Rectal prolapse
Chief determinant of mortality and morbidity of Cystic Fibrosis
Rate of progression of lung disease
Common findings in CF
Meconium ileus Frequent, bulky, greasy stools and failure to thrive ADEK deficiency Acute pancreatitis Rectal prolapse
Organism associated with rapid deterioration and death in CF
Burkholderia cepacia
Male reproductive manifestation of CF
Azoospermia
Female reproductive manifestation of CF
Seconda amenorrhea, cervicitis, decreased fertility
Sweat gland manifestation of CF
Salty taste of skin
Diagnostic criteria of CF
Any of the following:
Typical clinical feature
Hx of a sibling with CF
Positive NBS
Plus any of the following
2 increased sweat chlorides on separate days
Identification of 2 CF mutations (homozygous)
Increased nasal potential difference
Best test to dx CF
Sweat test >60 mEq/L
If sweat test is equivocal:
Increased potential difference across nasal epithelium
Pancreatic function
Pulmonary function test finding of CF by age of 5 years
Obstructive pulmonary disease then restrictive
Early respiratory tract presentation of CF during the 1st year
Cough, purulent mucus, extensive bronchiolitis
Respiratory organism responsible in CF
Non-typeable H.influenza and S.aureus then pseudomonas then burkholderia cepacia
Organism initially seen in sputum of CF
S. Aureus then pseudomonas (virtually diagnostic)
Aerosolized antibiotic in CF
Tobramycin
SIDS is frequently observed at what age?
2-4 months of age
Ddx of eosinophilia
Neoplasms Asthma/Allergy Addison disease Collagen vascular disorder Parasites
Best test for allergic rhinitis
Skin test
Most effective method for allergic rhinitis
Environmental control plus removal of allergen
Most effective medication for AR but not first-line
Intranasal corticosteroid
Major indication of immunotherapy
Duration and severity of symptoms are disabling in spite of routine treatment (for at least 2 consecutive seasons)
Treatment of choice for insect venom allergy
Immunotherapy
Immunotherapy for AR should not used due to lack of proof for the following:
Atopic dermatitis Food allergy Latex allergy Urticaria Children <3 y/o
Most notorious insect responsible in insect venom allergy as characterized by aggressive, ground-dwelling, linger near food
Hymenoptera (yellow jacket)
Indication for venom immune therapy
Severe reaction with +skin tests (highly effective in decreasing risk)
What foods are most infant and young children outgrow in the half in first 3 years?
Milk and egg allergy
Most common cause of anaphylaxis seen in emergency rooms
Food allergic reactions
Most common skin manifestation of food allergy
Acute urticaria/angioedema
Condition that presents with bloody stool/diarrhea (most cow milk or soy protein allergies)
Food protein-induced enterocolitis
Best test for food allergy
Food elimination and challenge tear
Duration of acute mediated IgE urticaria
<6 weeks
Causes of non-IgE mediated urticaria but stimulates mast cells
Radiocontrast
Viral agents (especially EBV, hep B)
Opiates, NSAIDS
Autosomal dominant that has deficiency of C1 esterase inhibitor manifested as recurrent episodes of non-pitting edema
Hereditary angioedema
Treatment for chronic refractory angioedema/urticaria
IVIg or plasmapharesis
Most common food presenting with Anaphylaxis
Peanut
Reactions from ingested allergens are delayed for how many minutes/hours?
Minutes to 2 hours
If allergen is injected, reaction is immediate with what system often manifested?
GI symptoms
What drug classification is used if patient has respiratory symptoms from anaphylaxis?
Short acting beta 2 agonist
Atopic dermatitis starts at what age?
Half at age 1 year
Acute presentation of atopic dermatitis?
Erythematous papules
Intensely pruritic
Serous exudate, excoriation
Subacute presentation of atopic dermatitis?
Erythematous, excoriated, scaling papules
Chronic presentation of atopic dermatitis
Lichenification
What is the distribution pattern of atopic dermatitis in infancy?
Face, scalp, extensor surfaces of extremities
What is the distribution pattern of atopic dermatitis in older and long-standing disease?
Flexural aspects
Higher potency classes of topical corticosteroid are not used on what body parts?
Face and intertriginous areas
Drug classification of Tacrolimus that is used safely on the face for atopic dermatitis
Calcineurin inhibitor
Treatment for atopic dermatitis in descending order
Antihistamine
Glucocorticoid
Cyclosporine
Interferon
Most common complication of atopic dermatitis from recurrent viral skin infections?
Kaposi varicelliform eruption (eczema herpetiform)
Organisms increased incidence as a cause of complication of atopic dermatitis from secondary bacterial infection
T.rubrum and M.furfur
What type of hypersensitivity reaction is contact dermatitis categorized?
Type IV
Most asthma starts at what age and resolves at what period?
<6 y/o
Late childhood
Gold standard in diagnosing asthma
Spirometry during forced expiration
What is the result of FEV1 in exercise challenge for asthma?
15%
Daytime symptoms/Nighttime symptoms of Intermittent Asthma
<2x/week
<2x/month
Daytime symptoms/Nighttime symptoms of Mild persistent Asthma
> 2x/week
>2x/month
Daytime symptoms/Nighttime symptoms of Moderate persistent Asthma
Daily
>1x/week
Daytime symptoms/Nighttime symptoms of Severe persistent Asthma
Continual
Frequent
DOC for rescue and preventing exercise-induced asthma
Short-acting beta 2 agonist
Much less potent than beta agonist and mostly added tx of acute severe asthma
Ipatropium bromide
Recommended drug for asthma in the hospital
Methylprednisolone
DOC for persistent asthma
ICS
Long-term controller medication only used mild-moderate asthma and required to be administered frequently
Cromoglycates
Only approved ICS by the FDA for <1 year duration
Nebulized budesonide
Six approved inhaled steroids
1st generation: beclomethasone, flunisolide, triamcinolone 2nd generation (better therapeutic index): budesonide, fluticasone, mometasone
LABA such as Salmeterol and formoterol should be used with this drug
ICS
What are the 2 classes of leukotriene modifying agents?
Inhibitor of synthesis (zileuton) and receptor antagonist (montelukast and zafirlukast)
Controller of asthma that has a narrow therapeutic index hence needs to be routinely monitored
Theophylline
Patient can be discharged in the ER for asthma exacerbation if:
Sustained normal PE findings and SaO2 >92% after 4 Hours in room air and PEF >70% of personal best
What are the adjunctive treatment to prevent intubation and ventilation from asthma?
IV beta agonist
IV theophylline
Heliox: decreased airway resistance and clinical response in 20 minutes
IV MgSO4: smooth muscle relaxant
Normal values of the following may exclude a particular diagnosis
Absolute lymphocyte count
Absolute neutrophil count
Platelet count
T-cell defect
Congenital or acquired neutropenia and both forms of leukocyte adhesion deficiency
Wiskott-Aldrich syndrome
Complement deficiency results in susceptibility to what organism?
Neisseria
Phagocyte deficiency often leads to multiple infections with what organism?
Catalase positive organisms such as staph
Best test to check neutrophil respiratory burst
Rhadamine dye
X-linked disorder of the B-cell characterized by the absence of circulating B-cell, significant decrease in all immunoglobulin, and lymphoid hypoplasia
Bruton agammaglobunemia
B-cell defect characterized by hypogammaglobunemia with phenotypically normal B cells, normal or increase lymphoid tissue, significant autoantibody production and significant increase in lymphomas
Common variable immune deficiency
Most common B-cell defect
Selective IgA deficiency
B-cell defect wherein one or more of the 4 subclasses are decreased despite a normal or even increased total IgG
IgG subclass deficiency
CATCH-22
Cardiac Abnormal facies Thymic hypoplasia Cleft palate Hypocalcemia
T-cell defect wherein there is dysmorphogenesis of the 3rd and 4th pharyngeal pouches
DiGeorge syndrome
Characteristic features of DiGeorge syndrome
Thymic hypoplasia
Parathyroid hypoplasia
Anomalies of the great vessels (e.g. Right aortic arch)
Other CHD (conotruncal lesions, ASD, VSD)
Dysmorphic features: mandibular hypoplasia
Treatment of DiGeorge syndrome
Transplantation of thymic tissue of MHC-compatible sibling or half-matched parenteral bone marrow
IgA, CD3 and absolute lymphocyte count in DiGeorge syndrome are _________while IgE is _______
Decreased
Increased
X-linked Combined antibody and cellular defect condition characetrized by absence of all adaptive immune function and perhaps natural killer function
Severe combined immunodeficiency
Most common genetic type of SCID
X-linked
Considered to be a true pediatric emergency wherein bone marrow transplant is a necessity or else death by 1 year of age
SCID
Autosomal recessive Severe Combined Immunodeficiency has deficiency in what particular substance?
Adenine deaminase
X-linked combined immunodeficiency oftentimes seen in prolonged bleeding from circumcision
Wiskott-Aldrich syndrome
T-cells in Wiskott-Aldrich syndrome is moderately (increased/decreased)
Decreased
Combined immunodeficiency disorder characterized by A-T mutation on chromosome 11, moderate decreased in response to B and T cell mitogens, features such as mask-like facies, progressive ataxia, oculotelangiectasias with higher incidence of malignancies
Ataxia-Telangiectasia
Phagocytic defect X-linked and autosomal recessive disease with neutrophils and monocytes can ingest but not kill catalase-positive microorganisms
Chronic granulomatous disease
Most common cause of ectopia lentis
Trauma
Location of ectopia lentis in Marfan syndrome?
Superior and temporal; bilateral
Location of ectopia lentis in homocystinuria?
Inferior and nasal
What reflex test is considered as the most rapid and easily performed to check for strabismus?
Hirschberg corneal light reflex
Chemical conjunctivitis is most common in first ____hours of life
24 hours
Incubation period of Neisseria gonorrhea in developing ophthalmia neonatorum?
2-5 days
Incubation period of Chlamydia trachomatis in developing ophthalmia neonatorum?
5-14days
Treatment of Neisseria gonorrhea in developing ophthalmia neonatorum?
Ceftriaxone
Treatment of Chlamydia in developing ophthalmia neonatorum?
Erythromycin PO
Topical erythromycin does not prevent chlamydia conjunctivitis
Epidemic keratoconjunctivitis is caused by what organism?
Adenovirus type 8
Keratitis is commonly caused by what organisms?
H.simplex and adenovirus
Most common primary malignant intraocular tumor
Retinoblastoma
Average age diagnosis of retinoblastoma
Bilateral
Unilateral
15 months
25 months
Initial sign of retinoblastoma
Leucokoria
2nd most common sign in retinoblastoma
Strabismus
Inflammation of pida and periorbital tissue without signs of true orbital involvement; insidious onset; low-grade fever; no toxicity
Perioribital cellulitis
Infection of orbital tossue including subperiosteal and retrobulbar abscesses
Orbital cellulitis
Most common organism in otitis externa
Pseudomonas aeruginosa
2nd most common cause of otitis externa
S.aureus
Otitis externa that invades the temporal bone and skull base with facial paralysis, vertigo, other cranial nerve abnormalities
Malignant otitis externa
Most common organism in bacterial OM
S.pneumoniae
Nontypeable H.influenzae (25-30%) Moraxella catarrhalis (10-15%)
Factor that is most sensitice and specific to determine presence of middle ear effusion with the use of pneumatic otoscopy
Mobility
First line DOC in patients with OM
High dose Amoxicillin
If allergic to penicillin, what is the alternative drug for OM?
Azithromycin
2nd-line drug for OM if continued pain after 2-3 days
Amoxicillin-clavulanic acid
If unsatisfactory to good second-line drug in treating OM, what is the next step?
Myringotomy or tympanoscentesis
Complications of Otitis Media with effusion
Acute mastoiditis acquired cholestoma (progressively expands and intracranially)
Most common area of epistaxis
Anterior septum or Kiesselbach plexus
Most common cause of epitaxis
Nose picking
Most common cause of nasal polyp
Cystic fibrosis
Samter triad
Polyp
Aspirin sensitivity
Asthma
Sinus that is only pneumatized
Ethmoid
Sphenoid sinus presents at what age?
5 years
Frontal sinus begins to develop at what age?
7-8 years
Etiologic agents of sinusitis
S. Pneumoniae, nontypeable H.influenzae, M.catarrhalis
Etiologic agent for chronic sinusitis
S. Aureus
Basis of diagnosing sinusitis
Persistent URI symptoms without improvement for at least 10 days
Severe respiratory symptoms with purulent discharge and temperature at least 38.9C for at least 3 consecutive days
Findings of Scarlet fever
Same as pharyngitis plus circumoral pallor, red finely papular erythematous rash diffusely that feels like sandpaper
Disease by coxsackie that causes small 1-2nm vesicles and ulcers on posterior pharynx
Herpangina
Time period wherein if treated will prevent RF
Within 9 days of illness
Parameters for tonsillectomy in patients with strep pharyngitis
> 7 documented infections within the past year
5/year for 2 years
3/year for 3 years
Indication for tonsillectomy and adenoidectomy
> 7 infection
Parameters for tonsillectomy in patients with strep pharyngitis
> 7 documented infections within the past year
5/year for 2 years
3/year for 3 years
Indication for tonsillectomy and adenoidectomy
> 7 infection
Parameters for tonsillectomy in patients with strep pharyngitis
> 7 documented infections within the past year
5/year for 2 years
3/year for 3 years
Indication for tonsillectomy and adenoidectomy
> 7 infection
Innocent murmur is also known as
Functional, normal, insignificant, flow murmur
CHDs causing right to left shunting
TOF
Ebstein anomaly
Tricuspid atresia
CHDs causing left to right shunting
PDA
VSD
ASD, ECD
CHDs causing mixing of blood
Truncus
TAPVR
Hypoplastic left heart
Transposition of great arteries
Most common congenital heart lesion
VSD
CHD that has transformation of any untreated left to right shunt into a bidirectional or right to left shunt, causing cyanosis, resulting from high pulmonary blood flow causing medial hypertrophy or pulmonary vessels and increased pulmonary vascular resistance
Eisenmenger syndrin
What CHD is PVR>SVR
Eisenmenger syndrome
Cardiac auscultatory finding of VSD
Harsh holosystolic murmur over lower left sternal border with or without thrill
Widely split S2
Small muscular VSD is more likely to close at what age?
First 1 to 2 years
Indications of surgery for VSD in first year
Failure to thrive or unable to be corrected hemodynamically
Infants at 6-12 months with large defects and pulmonary artery hypertension
More than 24 months of age with Qp:Qs >2:1 (shunt fraction)
Most common type of atrial septal defect
Ostium secundum defect
Cardiac auscultatory finding of ASD
Wide fixed splitting of S2, systolic ejection murmur along left mid to upper sternal border (from increased pulmonary flow)
ECG finding of ASD
Right axis deviation and RVH
If ASD and VSD occur which are contiguous and the AV valves are abnormal
ECD
Manifestations of ECD
Mild, intermittent cyanosis Early heart failure Infections Hepatomegaly Failure to thrive
Cardiac auscultatory/examination finding of ECD
Precordial bulge and lift
Widely split S2 (like an isolated ASD)
Pulmonary systolic ejection murmur, low pitched diastolic rumble at left sternal border and apex
Maternal infection is associated with the development PDA
Rubella
Cardiac auscultatory findings of large PDA
Wide pulse pressure, bounding arterial pulses, characteristic sounds of machinery, decreased Bp (primarily diastolic)
Common CHD defect of Noonan syndrome
Pulmonary stenosis as a result of valve dysplasia
Common CHD defect of Alagle syndrome (arteriohepatic dysplasia)
Pulmonic stenosis (either valve or branched artery)
Cardiac auscultatory finding of pulmonic stenosis
Pulmonary ejection click after S1
In left upper sternal border and normal S2 (mild mild); relatively short, low to medium pitched SEM over pulmonic area radiating to both lungs
Treatment in moderate to severe pulmonary stenosis
Balloon valvuloplasty
Most common type of aortic stenosis
Bicuspid aortic valve
Least common form of Aortic stenosis which occurs sporadically, familial or with William syndrome
Supravalvular stenosis
Williams syndrome (deletion of elastin gene 7q11.23)
MR, eflin facies, heart disease, idiopathic hypercalcemia
Cardiac auscultatory finding of aortic stenosis
SEM upper-right second intercostal space; the louder (harsher) and longer the murmur, the greater the degree of obstruction; radiates to neck and left midsternal border; positive thrill in suprasternal notch
CHD that causes narrowing just below origin of left subclavian artery at origin of ductus arteriosus
Juxtaductal coarctation
CHD that causes narrowing at any point from transverse arch to iliac bifurcation
Coarctation of the aorta
Adult type of coarctation of the aorta
Discrete juxtaductal coarctation
What artery is affected in coarctation of aorta if pressure is greater in right arm than left arm?
Left subclavian artery
In coarctation of the aorta, short systolic murmur heard along left sternal border at 3rd to 4th intercostal space radiates to what structure?
Left scapula and back
Ddx for an asymptomatic child with hypertension
Coarctation
Infantile type of coarctation of aorta
Tubular hypoplasia (preductal)
Type of coarctation seen as differential cyanosis
Tubular hypoplasia (preductal, infantile type)
Radiologic finding of adult type of coarctation
Increased size of subclavian artery
Notching of inferior border of ribs
Poststenotic dilatation of ascending aorta
Most common cyanotic cardiac lesion
TOF
What is tet spells?
Paroxysmal hypercyanotic attacks
Treatment of Tet spells
Place in knee chest position, give oxygen, inject subcutaneous morphine, give beta blocker
Cardiac auscultatory finding of TOF
Substernal right ventricular impulse, systolic thrill along 3rd to 4th intercostal space on left sternal border, lid and harsh systolic ejection murmur (upper sternal border), may be precedes by a click, EITHER A SINGLE S2 or soft pulmonic component
Radiologic finding of TOF
Boot shaped heart
Surgical procedure in TOF with palliative systemic to pulmonary shunt
Modified Blalock-Taussig shunt
Age of corrective surgery in TOF
4-12 months
Tricuspid atresia will present as _______cyanosis
Severe
Cardiac auscultatory finding of Tricuspid atresia
Increased left ventricular impulse, holosystolic murmurs along left sternal border (most have a VSD)
Radiologic finding of Tricuspid atresia
Pulmonary undercirculation
ECG finding of Tricuspid atresia
Left axis deviation plus left ventricular hypertrophy
The combination of severe cyanosis in the NB plus a chest cray showing decreased pulmonary blood flow plus an ECG with left axis deviation and left ventricular hypertrophy is most likely be a:
Tricuspid atresia
Treatment of Tricuspid Atresia
PGE1 until aortopulmonary shunt can be performed
Atrial balloon septostomy
Later, staged surgical correction
Drug that predisposes for the development of ebstein anomaly
Lithium
Cyanotic heart disease that has downward displacement of abnormal tricuspid valve into right ventricle, huge right atrium, regurgitant tricuspid valve, increased right atrium colume shunts blood through the foramen ovale or ASD causing cyanosis
Ebstein anomaly
Cardiac auscultatory finding of Ebstein anomaly which is the most characteristic
Holosystolic murmur of tricuspid insufficiency over most of anterior left chest
Ebstein anomaly most likely has this type of syndrome and present with episodes of SVT
Wolff-Parkinsonian-White syndrome
Radiologic finding of Ebstein anomaly
Normal to massive (increased right atrium)
ECG finding of Ebstein anomaly
Tall or broad P waves, RBBB and a normal or prolonged PR interval
Most common cyanotic lesion presenting in the immediate newborn period
Transposition of great arteries
Two cardiac lesions needed for TOGA
Foramen ovale and PDA
Cardiac auscultatory finding of TOGA
S2 usually single and loud, absent murmur: or a soft ejection murmur at midleft sternal border
Radiologic finding of TOGA
Egg on a string appearance (narrow heart base plus absence of main segment of the pulmonary artery
Cyanotic heart disease that is one of the major conotruncal lesions associated with CATCH-22 syndrome
Truncus arteriosus
Describe Truncus arteriosus
Single arterial trunk arises from the heart and supplies all circulations
Cardiac auscultatory finding of Truncus Arteriosus
SEM with loud thrill, single S2, wide pulse pressure with bounding pluses and hyperdynamic precordium
Describe TAPVR
Complete anomalous drainage of the pulmonary veins into the systemic venous circulation
Clinical manifestation of TAPVR due to obstruction (of pulmonary veins, usually infracardiac)
Severe pulmonary venous congestion and pulmonary hypertension with decreasing CO and shock
Radiologic finding of TAPVR
Snowman appearance
ECG finding of TAPVR
RVH and tall spiked P waves (RAE)
Describe Hypoplastic left heart syndrome
Atresia of mitral or aortic valves, left ventricle and ascending aorta
ECG finding in hypoplastic left heart syndrome
RVH and RAE with decreased left sided forces
Best treatment in Hypoplastic left heart syndrome
Three stage Norwood procedure
Cardiac auscultatory finding of mitral insufficiency
High pitched holosystolic murmur at apex
CHD that is a common finding with Marfan and Ehlers-Danlos syndrome
MVP
Cardiac auscultatory finding of MVP
Apical late systolic murmur, preceded by a click
CHD usually associated with Ebstein anomaly
Tricuspid insufficiency
CHD associated with neonatal asphyxia in neonate (ischemia of papillary muscle)
Tricuspid insufficiency
Organism in Infective endocarditis that are associated with the following: After dental procedure Large bowel or GUT manipulation IV drug user Open heart surgery Indwelling IV catheters
After dental procedure: S.viridans
Large bowel or GUT manipulation: Group D streptococci
IV drug user: Pseudomonas aeuruginosa and Serratia marcescens
Open heart surgery: fungi
Indwelling IV catheters: coagulase-negative staph
Common clinical presentation of IE
Prolonged intermittent fever, weight loss
New or changing murmur
Skin findings: osler nodes, janeway lesions, splinter hemorrhage, roth spots
IE skin finding described as tender, pea-sized intradermal nodules on pads of fingers and toes
Osler nodes
IE skin finding described as painless, small erythematous or hemorrhagic lesions on palms or soles
Janeway lesions
IE skin finding described as linear lesions beneath nail beds
Splinter hemorrhage
IE skin finding described as retinal exudates
Roth spots
Duke criteria for the diagnosis of IE
2 major or 1 major + 3 minor or 5 minor
HACEK are slow growing gram negative organisms that are part of normal flora. What is HACEK?
Haemophilus Actinobacillus, actinomycetemconcomitans Cardiobacterium hominus Eilenella corrodena Kingella kingae
Most common complication of IE
Heart failure from aortic or mitral lesion
DOC in Infective endocarditis with artificial valve
Amoxicillin
Most common form of acquired heart disease worldwide
Acute Rheumatic fever
Jones criteria is used in diagnosing Acute Rheumatic Fever. What is the absolute requirement? How many major and minor criterion?
Evidence of recent Streptococcus infection (microbiological or serology)
2 major or one major and 2 minor criteria
Presence of this Major criteria in Jones Criteria is sufficient for diagnosis
Sydenham’s chorea
Major criteria of Jones Criteria in diagnosis of IE
Carditis, polyarthritis (migratory), erythema marginatum, chorea, subcutaneous nodules
Minor criteria of Jones Criteria in diagnosis of IE
Fever, arthralgia, elevated acute phase reactants (ESR, CRP), prolonged PR interval on ECG plus evidence of preceding streptococci infection
Common clinical presentation of IE
Prolonged intermittent fever, weight loss
New or changing murmur
Skin findings: osler nodes, janeway lesions, splinter hemorrhage, roth spots
IE skin finding described as tender, pea-sized intradermal nodules on pads of fingers and toes
Osler nodes
IE skin finding described as painless, small erythematous or hemorrhagic lesions on palms or soles
Janeway lesions
IE skin finding described as linear lesions beneath nail beds
Splinter hemorrhage
IE skin finding described as retinal exudates
Roth spots
Duke criteria for the diagnosis of IE
2 major or 1 major + 3 minor or 5 minor
HACEK are slow growing gram negative organisms that are part of normal flora. What is HACEK?
Haemophilus Actinobacillus, actinomycetemconcomitans Cardiobacterium hominus Eilenella corrodena Kingella kingae
Most common complication of IE
Heart failure from aortic or mitral lesion
DOC in Infective endocarditis with artificial valve
Amoxicillin
Most common form of acquired heart disease worldwide
Acute Rheumatic fever
Jones criteria is used in diagnosing Acute Rheumatic Fever. What is the absolute requirement? How many major and minor criterion?
Evidence of recent Streptococcus infection (microbiological or serology)
2 major or one major and 2 minor criteria
Presence of this Major criteria in Jones Criteria is sufficient for diagnosis
Sydenham’s chorea
Major criteria of Jones Criteria in diagnosis of IE
Carditis, polyarthritis (migratory), erythema marginatum, chorea, suncutaneous nodules
Most important complication of acute rheumatic fever
Valvular disease
DOC in isolated chorea
Phenobarbital (then haloperidol or chlorpromazine)
DOC in Acute Rheumatic Fever
Benzathine Penicillin G IM
Heart disease that should be suspected in an athlete with sudden death
Hypertrophic cardiopathy
Pathophysiology of HOCM
Obstructive left-sided congenital heart disease
Cardiac auscultatory finding in HOCM
Left ventricular lift, no systolic ejection click (differentiates from aortic stenosis)
Pulsus parodoxus is a drop in BP for > ___mmHg in a child with pericarditis indicates:
20mmHg
Cardiac tamponade
Most common cause of pericarditis
Viral
Condition always to be considered in any patient with pericarditis
Systemic lupus
Most common initial finding of pericarditis
Precordial pain
Common findings in pericarditis
Sharp, stabbing, over precordium and left shoulder and back; worse supine relief with sitting and leaning forward, variable friction rub
Radiologic finding of pericarditis
Water bottle appearance
What age starts routing BP checking?
3 y/o
What is the BP in legs higher in than arms?
10-20mmHg
When a child presents with hypertension, think of ______causes
Renal causes
If mild HPN, repeat ________over next 6 weeks
Twice
Most common etiology of HPN in infants and younger childen
Secondary
Type of HPN more common in adults and adolescents
Essential
Surgical correction period of the following:
Cleft lip
Cleft palate
Cleft lip at 3 months of age
Cleft palate at <1year
Common causes of bloody diarrhea
Think of CASES
Campylobacter Amoeba Shigella E.coli Salmonella
Most common parasite causing acute diarrhea
Giardia lamblia
Schwachman-Diamond syndrome is defined as
Pancreatic insufficiency, neutropenia and malabsorption
Intestinal lymphangiectasia is defined as
Lymph fluid leaks into bowel lumen
Steatorrhea
Protein losing enteropathy
Disaccharide diarrhea is defined as
Osmotic diarrhea
Acidic stools
Abetalipoproteinemia is defined as
Severe fat malabsorption from brith
Acanthocytes
Very low to absent plasma cholesterol, triglycerides, etc
Most useful screening test for steatorrhea
Stool for fat (Sudan red stain)
Gold standard for steatorrhea
72-hour stool for fecal fat
Sign most prominent with pancreatic insufficiency
Steatorrhea
Test to measure reducing substances in stool
Clinitest
Describe breath hydrogen test
After a known CHO load, the collected breath hydrogen is analyzed and malabsorption of the specific CHO is identified
What is the screening tool for protein loss?
Spot stool alpha1-antitrypsin level
Most common congenital disorder associated with malabsorption
Cystic fibrosis
Most common anomaly causing incomplete bowel obstruction with malabsorption
Malrotation
Most common anatomy of EA and TEF
Upper esophagus ends in blind pouch and TEF connected to distal esophagus
Type of EA and TEF that present chronically and diagnosed later in life with chronic respiratory problems
H-type
What is the diagnostic modality of isolated TEF?
Esophagram with contrast media
Best test for GERD
Esophageal pH monitoring
Normal pH in lower esophagus
<4
Diagnostic modality for extraesophageal GERD
Laryngotracheobronchoscopy
Prokinetic agents (______, _______, ________) have no efficacy in the treatment of GERD in children
Metaclopromide, bethanechal, erythromycin
Age usually presents with pyloric stenosis
> 3 week old
What is the best test for pyloric stenosis?
Ultrasound
Jejunal or ileal atresia symptom present at what age?
First day
Both duodenal and ileal atresia have bile-stained emesis. However, duodenal has no abdominal distention
T/F
T
Radiologic finding of duodenal atresia
Double bubble with no distal bowel gas
Etiology of Jejunal and ileal atresia
Intrauterine vascular accident leading to segmental infarction and resorption of fecal intestines
Etiology of meconium ileus
Abnormal viscous secretions leading to distal 20-30cm of ileum collapse and proximal bowel dilated and filled with thick meconium impacted in ileum
Condition of 80-90% will be diagnosed with CF
Meconium ileus
Physical examination finding of meconium ileus
Doughy or cordlike masses
Etiology of meconium plugs
Decreased water content for many possible reasons leads to lower colonic or anorectal meconium plug
Maternal opiate use or treatment of MAGNESIUM SULFATE can predisposed the child to contract what congenital bowel obstruction
Meconium plug
What artery acts as the axis when the bowel rotates in and out of abdominal cavity (weeks 5-12)?
Superior mesenteric artery
Etiology of malrotation
Failure of cecum to move to the RLQ leading to failure to form broad adhesions to posterior wall hence SMA is tethered by a narrow stalk (causes volvulus) and Ladd bands can extend from cecum to RUQ and obstruct at duodenum
What comprises the Heterotaxy syndrome?
CHD, malrotation, asplenia/polysplenia
Upper GI finding of malrotation
Malposition of ligament of Treit and SBO with corkscrew appearance or duodenal obstruction with bird’s beak appearance
Most common cause of intestinal obstruction in neonate
Hirschprung disease
Short segment Hirschprung disease is usually male or female preponderance
Male
80% of Hirschprung is usually short segment involving what organ?
Rectosigmoid
The main concern of Hirschprung disease is the development of what condition?
Meconium enterocolitis
Procedure of choice in the management of Hirschprung dosease
Laparoscopic single stage endorectal pull-through
Ultrasound finding of Malrotation and Volvulus
Inversion of SMA and SMV (SMV to the left of the artery is suggestive) and duodenal obstruction with thickened bowel loops to the right of the spine
Most frequent congenital GInanomaly
Meckel diverticulum
Rule of 2 in Meckel diverticulum
2 y/o 2% of population 2 types of tissue 2 inches in size 2 ft from ileocecal valve
Lining of Meckel diverticulum is same as of what organ?
Stomach
What viral infection/s is/are associated with intussuception?
Adenovirus and rotavius
What immunologic disease condition is associated with intussuception?
HSP
What other condition aside from intussusception that has a leading point?
Meckel diverticulum Polyp Neurofibroma Hemangioma Malignancy
What test is used if the neonate accidentally swallowed the maternal blood?
Apt test
Most common cause of lower GI bleeding in infancy
Anal fissure
First diagnostic test to screen for intussusception? Next?
Ultrasound
Air enema
How to classify functional constipation?
Delay or difficulty in stooling for at least 2 weeks typically after age 2
Treatment for Hirschprung disease
Surgery (most with temporary colostomy) and wait 6-12 months for definitive correction (most achieve continence)
How many colonies should be present in urine culture that conclude that is positive for UTI (along with pyuria)?
> 50,000 colonies/mL
Urine culture should be requested how many weeks after stopping antibiotics for UTI?
1 week
Grading of Vesicoureteral reflux
I: into nondilated ureter (common for anyone)
II: upper collecting system without dilatation
III: into dilated collecting system with calyceal blunting
IV: grossly dilated ureter and ballooning of calycea
V: massive, significant dilatation and tortuosity of ureter; intrarenal reflux with blunting of renal pedicles
Most common cause of palpable abdominal mass in newborn
Hydronephrosis
Diagnostic modality of congenital hydronephrosis and in any with ureteral dilatation to rule out posterior urethral valves
VCUG
Most common etiology of obstructive uropathy
UPJ obstruction
Most common cause of severe obstructive uropathy and mostly in boys
Posterior urethral valves
Problem in the posterior urethral valves should be suspected in males with what physical examination findings
Palpable, distended bladder and weak urinary stream
What are the antibodies detected if you use streptozyme to diagnose glomerulonephritis?
Streptolysin O, DNase B, hyalurodinase, streptokinase, and NAD
Pathology of Acute glomerulonephritis?
Diffuse mesangial cell proliferation with an increase in mesangial matrix; lumpy-bumpy deposits of Ig and complement on glomerular basement membrane and in mesagium
When is acute glomerulonephritis develops?
After strep pharyngitis:
Skin infection (impetigo):
After strep pharyngitis: 1-2weeks Skin infection (impetigo): 3-6 weeks
Classic triad of acute glomerulonephritis
Edema, hypertension, hematuria
Low C3 in acute glomerulonephritis returns to how many weeks?
6-8 weeks
Best single test for acute glomerulonephritis
Anti-DNase antigen
When to consider biopsy in acute glomerulonephritis?
Presence of acute renal failure, nephrotic syndrome, absence of streptococcal or normal complement or if present, >2 months after onset
Hematologic finding in Acute Glomerulonephritis
Mild normochromic anemia
How long is penicillin given in severe acute glomerulonephritis?
10 days
Most common chronic glomerular disease worldwide
IgA Nephropathy (Berger disease)
Most common presentation of IgA nephropathy
Gross hematuria in association with URI or GIT infection then mild proteinuria, mild to moderate proteinuria, normal C3
Most important primary treatment of IgA Nephropathy
BP control
Renal biopsy result of Alport Syndrome
Foam cells
Describe Alport syndrome
Hereditary nephritis (X-linked dominant) characterized by asymptomatic hematuria and intermittent gross hematuria 1-2 days after URI
Other manifestation of Alport syndrome
Hearing deficit (bilateral sensorineural, never congenital) and ocular abnormalities (extrusion of central part of lens into anterior chamber)
Pathognomonic ocular abnormality of Alport syndrome
extrusion of central part of lens into anterior chamber
Most common cause of nephrotic syndrome in adults
Membranous glomerulopathy
Most common cause of chronic glomerulonephritis in older children and young adults
MPGN
Most common cause of acute renal failure in young children
HUS
HUS blood picture
Microangiopathic hemolytic anemia, thrombocytopenia, uremia
E.coli 0157:57 (shiga-toxin producing) which causes HUS comes from what food sources?
Undercooked meat, unpasteurized milk, spinach
Pathophysiology of HUS
Vascular occlusion, glomerular sclerosis and cortical necrosis from subendothelial and mesangial deposits of granular, amorphous material
Localized clotting from capillary and arteriolar endothelial injury
Mechanical damage of RBC as they pass vessels
Intrarenal platelet adhesion and damage
Prothrombotic state
Clinical presentation of HUS
Bloody diarrhea
Sudded pallor, irritability, weakness, oliguria after 5-10 days
Mild renal insufficiency to ARF
Cells found in HUS
Helmet cells, burr cells, fragmented cells
Is antibiotic warranted in E.coli O157:H7
No, it only increases risk of developing HUS
What genetic defect is Autosomal Recessive (Infantile) PKD associated with?
Potter sequence
2 complication of Autosomal Recessive (Infantile) PKD if not treated
Liver disease
Kidney failure
Clinical presentation of Autosomal Recessive (Infantile) PKD in infants if severe
Bilateral flank masses with pulmonary hypoplasia
Most common hereditary human kidney disease
Autosomal Dominant (Adult) PKD
Management of Autosomal Recessive PKD
Dialysis and transplant
Clinical presentation of Autosomal Dominant PKD
Presence of enlarged kidneys with bilateral macrocyts with affected first-degree
Management of Autosomal Dominant PKD
Control BP
Most common form of persistent proteinuria in school-aged children and adolescents
Orthostatic proteinuria
Suspect _________proteinuria in any patient with >1g/24hours proteinuria or with accompanying hypertension, hematuria or renal dysfunction
Glomerular
Type of proteinuria that has glomerular or tubular disorders
Fixed proteinuria
Most common nephrotic syndrome seen in children
Steroid-sensitive minimal change disease
Clinical presentation of nephrotic syndrome
Proteinuria
Hypoalbuminemia
Edema
Hyperlipidemia
Age group does Minimal change disease occurs
Between 2 and 6 years of age
Common clinical presentation of minimal change disease
Periorbital edema and LE edema then anasarca with serosal fluid collections less common
Preferred initial test to diagnose minimal change disease
Spot urine for protein/creatinine ratio >2
What are the two laboratory parameters elevated in Minimal change disease
Serum cholesterol and triglycerides
Most frequent complication of minimal change disease caused by S.pneumoniae
Spontaneous bacterial peritonitis
Initial treatment for minimal change disease
Steroids
Most common disorder of sexual differentiation in boys (more in preterm)
Undescended testes
Age wherein testes should have descended
4 months of age
Most common male genitourinary malignancy
Seminoma
Optimal time for orchiopexy for patietn with undescended testes
9-15 months
Most common cause of testicular pain over 12 years old
Testicular torsion
Window period for emergent scrotal orchiopexy in patient with testicular torsion
Within 6 hours
Most common cause of testicular pain in 2-11 y/o
Torsion of appendix testes
Part of testis that is affected in torsion of appendix testes
Upper pole of testis
Clinical presentation of torsion of appendix testes
Blue dot
Main cause of acute painful scrotal swelling in a young, sexually active male
Epididymitis
Most common surgically treatable cause of subinfertility in men
Varicocele
Varicocele is most common at what side?
Left
Definitive test in hypopituitarism
Growth hormone stimulation test
Genetic defect with tall males and decreased upper to lower body segment ratio may suggest
XXY
Genetic defect with tall males with MR may suggest
Fragile X
Most common etiology of precocious puberty in girls
Sporadic and familial
Most common etiology of precocious puberty in boys
Hamartomas
Definitive test to evaluate for precocious puberty
GnRH stimulation test
Premature thelarche may be a sign of _______precocious puberty
True
Clinical presentation of cretinism
Prolonged jaundice Large tongue Umbilical hernia Edema MR Wide anterior and posterior fontanels Open mouth Hypotonia
Type II autoimmune polyglandular disease is also known as
Schmidt syndrome
What is type I autoimmune polyglandular disease?
Hypopituitarism
Addison disease
Mucocutaneous candidiasis
Small number with autoimmune thyroiditis
What is type II autoimmune polyglandular disease
Addison disease plus insulin dependent DM with or without thyroiditis
Two MEN types medullary carcinoma seen
MEN IIA and IIB
What comprises in MEN IIA?
Hyperplasia or cancer of the thyroid plus adrenal medullary hyperplasia or pheochromocytoma plus parathyroid hyperplasia
What comprises in MEN IIB?
Multiple neuromas plus medullary thyroid cancer plus pheochromocytoma
Other name of MEN IIB
Mucosal neuroma syndrome
Usual first sign of acquired hypothyroidism
Deceleration of growth
Peak age of hyperthyroidism in pedia
11-15 y/o
Earliest presentation of hyperthyroidism
Emotional lability and motor hyperactivity
If child develops hypocalcemic seizure, what genetic defect you should think of?
DiGeorge syndrome
ECG finding of hypocalcemia
Prolonged QT
Foods high in phosphorous
Milk, egg and cheese
Other 3 main defect of CAH with associated features:
3-beta-hydroxysteroid deficiency:
11-beta-hydroxylase deficiency:
17-alpha hydroxyl/17,20 lyase deficiency:
3-beta-hydroxysteroid deficiency: salt-wasting, male and female pseudohemaphrodites
11-beta-hydroxylase deficiency: female pseudohemaphrodites
17-alpha hydroxyl/17,20 lyase deficiency: male pseudohermaphrodites
Definitive test in CAH
Measurement of 17-OH progesterone before and after an IV bolus of ACTH
Location of tumor (malignant) if Cushing syndrome is suspected in infants
Adrenocortical
Most common cause of insulin resistance
Childhood obesity
Barlow will (dislocate or reduce) an unstable hip?
Dislocate
Orthlolani will (dislocate or reduce) an unstable hip?
Reduce
Dynamic ultrasound of hips is the best test for DDH at the age of?
<4 months of age
After 4 months, what view of xray should be requested to diagnose DDH?
Frog lateral xray
Treatment of DDH
Pavlik harness for 1-2 months
Surgery, casting
Disorder of the hip described as idiopathic avascular necrosis of the capital femoral epiphysis in immature, growing child
Legg-Calvé-Parthes Disease
Clinical presentation of Legg-Calvé-Perthes Disease
Mild intermittent pain in anterior thigh with painless limp with restriction of motion
Most common adolescent hip disorder
Slipped capital femoral epiphysis (SCFE)
Earliest xray finding in SCFE
Widening of physis without slippge (preslip)
As slippage occurs, femoral neck rotates anteriorly while head remains in acetabulum
Complications of SCFE
Osteonecrosis and chondrolysis
Clinical manifestation of SCFE
Pre-slip stable; exam normal; mild limp external rotation
Unstable slip; sudden onset extreme pain,; cannot stand or walk; 20% complain of knee pain with decreased hip rotation on examination
Treatment for SCFE
Open or closed (pinning) reduction
Cause of viral synovitis
Viral; most 7-14 days after a nonspecific URI
Most common intoeing in firstborn (deformatiob)
Metataraus Adductus
Treatment for Metatarsus Adductus
Serial plaster casta before 8 months of age; orthoses, corrective shoes, if still significant in a child age >4 years, may need surgery
Congenital, positional deformation or associated with neuromuscular disease
Talipes Equinovarus (clubfoot)
Presentation of Talipes Equinovarus
Hindfoot equinus, hindfoot and midfoot varus, forefoot adductuon (at talonavicular joint)
Treatment of Talipes Equinovarus
Completion correction should be achieved by 3 months
Most common cause of intoeing >= 2 y/o
Internal femoral torsion (femoral anteversion)
Treatment for Internal Femoral Torsion
Observation; takes 1-3 tears to resolve
Most common cause of intoeing <2 y/o
Internal Tibial Torsion
Treatment for Internal Tibial Torsion
No treatment needed; resolves with normal growth and development
Disorder of knee characterized by traction apophysitis of tibial tubercle (oversue injury)
Osgood-Schlatter Disease
Disorder of the knee seen in active adolescent with swelling, tenderness, increased prominence of tubercle
Osgood-Schlatter Disease
Adams test >20 degrees may be indicative of what disorder of the spine
Scoliosis
Treatment for Scoliosis
Trial brace for immature patients with curves <30-45 degrees and surgery for those >45 degrees (permanent internal fixation rods)
Disorder of the upper limb when longitudinal traction causes radial head subluxation with hx of sudden traction or pulling of arm
Nursemaid elbow
Most common cause of osteomyelitis
Overall?
Puncture wound?
Sickle cell?
Overall: S. aureus
Punctured wound: Pseudomonas
Sickle cell: more salmonella (S.aureus still most common)
How many days is osteomyelitis changes seen in xrays?
10-14 days
Best imaging modality for osteomyelitis
MRI
Most common genetic cause of osteoporosis
Osteogenesis imperfecta
Clinical triad of osteogenesis imperfecta
Fragile bones, blue sclera, early deafness
Treatment for Osteogenesis Imperfecta
No cure; physical rehabilitation; fracture management and correction of deformities
Xray finding of
Osteogenic Sarcoma:
Ewing Sarcoma:
Osteoid osteoma:
Osteogenic Sarcoma - sclerotic destruction: SUNBURST
Ewing Sarcoma - lytic with laminar periosteal elevation: ONION SKIN
Osteoid osteoma - small round CENTRAL LUCENCY with sclerotic marin
JRA gene?
DR8 and DR5
Clinical presentation of JRA
Morning stiffness, but non-erythematous
Criteria for JRA diagnosis
Age of onset: <16 years old Arthritis in one or more joints Duration: >= 6 weeks Onset type of disease presentation in 1st 6 months Exclusion of other forms of arthritis
A positive RF in JIA is indicative of:
Poor prognostic outcome
Category of disease with 3 types of onset (JIA)
Pauciarticular (<5 joints) - joints of LE, never UE
Polyarticular (>5 joints) - both large and small joints (20-40 joints involved), rheumatoid nodules on extensor surfaces of elbows and achilles tendon), may have cervical spine involvement
Systemic onset - arthritis and prominent visceral involvement, daily temp spikes, salmon-colored evanescent rash mostly on trunk and proximal extremities
Labs for JIA
ANA - increased in 40-85%
RF - positive typically with onset of disease in an older child with polyarticular disease and development of rheumatoid nodule
Safest and most effacious of second line agent for JIA
Methotrexate
Pregnant women with SLE will transfer IgG autoantibodies (usually anti-Ro) across placenta at 12-16 weeks which causes manifestations, the most important being:
Congenital heart block
SLE gene?
HLA B8, DR2, DR3
Sensitive test for SLE?
ANA Abs
Specific test for SLE?
Anti-Smith Abs
Best test for SLE which is more specific for Lupus; reflects disease activity
Anti-dsDNA
Most serious sequelae for Kawasaki disease
Cardiac related: early myocarditis with tachycardia and decreased ventricular function, pericarditis and coronary artery aneurysm
Arteries that mostly affected by Kawasaki disease
Medium sized arteries especially coronary
Criteria for diagnosing Kawasaki disease
Fever >= 5 days plus 4 of the following: A. Non-suppurative conjunctivitis B. Oral mucosa changes C. Strawberry tongue D. Induration of palms and soles E. Polymorphous truncal rash F. Unilateral, non-suppurative cervical lymphadenopathy
Coronary artery aneurysm is seen in Kawasaki disease at what week of disease onset?
2nd to 3rd week
Kawasaki disease is one of the few instances in pediatrics for which you could use this drug
Aspirin
Most important test in Kawasaki
2D echo; repeated at 2-3 weeks and if normal at 6-8 weeks
Acute treatment for Kawasaki
IVIG and high dose aspirin
IgA mediated vasculitis of small vessels (IgA and C3 in skin, renal glomeruli and GIT)
HSP
Most common cause of nonthrombocytopenic purpura in children
HSP
Vasculitis wherein intussusception can occur?
HSP
Hallmark sign of HSP
Pink, maculopapular rash below waist; progresses to petechaie and purpura (red > purple> rusty brown); crops over 3-10 days
Renal biopsy result of HSP
IgA mesangial deposition and occasionally IgM, C3, and fibrin
Complications of HSP
Renal insufficiency/failure, bowel perforation, scrotal edema, and testicular torsions
What happens in physiologic anemia of infancy?
Progressive drop in Hgb over first 2-3 months until tissue oxygen needs are greater than delivery (typically 8-12 weeks in term infants to Hgb of 9-11g/dL)
Most common sign of IDA
Pallor
Blood lead level value that is acceptable
5ug/dL
Most common clinical presentation of lead poisoning
Behavioral changes
Blood lead level value wherein constipation starts to develop
20ug/dL
Gold standard test for blood lead level
Venous sample
Xray finding of long bones for lead poisoning
Dense lead lines
RBC finding in lead poisoning
Basophilic stippling
Congenital pure red cell anemia is also known as
Blackfan-Diamond
Congenital anemia characterized by increased RBC programmed cell death -> profound anemia by 2-6 months, short stature, cranifacial deformities, triphalangeal thumbs, increased ADA, very low reticulocyte count, marrow with significant decrease in RBC precursor
Congenital Pure Red Cell Anemia
Surgical management for Congenital Pure Red Cell Anemia
Splenectomy
Definitive management for Congenital Pure Red Cell Anemia
Stem cell transplant
Medical management for Congenital Pure Red Cell Anemia
Corticosteroid, transfusion and deferoxamine
Most common congenital pancytopenia
Fanconi anemia
Clinical manifestation of Fanconi anemia
Absent/hypoplastic thums, short stature
Cell lines of Fanconi anemia increased or decreased
Decreased
Definitive treatment for Fanconi anemia
Bone marrow transplant
Blood picture of Anemia of chronic disease and renal disease
Normochromic and normocytic (but may be mildly microcytic and hypochromic)
How many lobes are there in hypersegmented neutrophils as seen in megaloblastic anemia?
> 5
Megaloblastic anaemia is a result of what?
Ineffective erythropoiesis
Folic acid deficiency peaks at what age?
4-7 months
Vitamin B12 deficiency will be seen at what age if mothers have deficiency?
First 4-5 months
Structure that is deficient in hereditary spherocytosis and elliptocytosis
Spectrin
Virus that predisposes a patient with hereditary spherocytosis and elliptocytosis to aplastic crisis
Parvovirus B19
Confirmatory test for Hereditary Spherocytosis and Elliptocytosis
Osmotic fragility test
Two syndromes associated with G6PD
Episodic hemolytic anemia (most common)
Chronic nonspherocytic hemolytic anemia
Pathologic finding for G6PD
Heinz bodies
First clinical presentation seen in Sickle Cell anemia
Hand-foot syndrome (acute distal dactylitis)
Children with Sickle cell anemia develop hemolytic anemia starting at what age and functional asplenia at what age?
First 2-4 months
5y/o
Organism that shows increase risk of osteomyelitis if with sickle cell anemia
Salmonella
First sign seen in decreased renal function in patients with sickle cell anemia
Proteinuria
Cells seen in severe anemia of sickle cell
Target cells
Sickle RBCs
Howell Jolly bodies
Confirmatory test for Sickle cell anemi
Hb electrophoresis
Prophylactic drug for sickle cell anemia to be given at 2 months of age until age 5
Penicillin
Vaso-occlusive crises signs and symptoms commonly seen in sickle cell anemia
Osteomyelitis Splenic autoinfarction Acute chest syndrome Stroke Priapism
Skull xray finding of thalassemia
Hair on end
Deletion of 3 genes; Hgb barts >25% in newborn period and easily diagnosed with electrophoresis
HgB H disease
Deletion of 4 genes; severe fatal anemia resulting in hydrops fetalis
Alpha thalassemia major
Beta thalassemiaahor is also known as?
Cooley anemia
Thalessemia with excess alpha globin chain with increased HbF, with expanded medullary space with increased expansion of face and skull (hair on end)
Beta thalassemia major
Most common acquired cause of bleeding disorder in children
Thrombocytopenia
Measure the final step: fibrinogen -> fibrin
Thrombin time
Most common hereditary bleeding disorder
vWD
Autosomal dominant
Hallmark sign of Hemophilia (X-linked) day
Hemarthroses
Earliest location of hemarthroses in hemophilia
Ankles
Large volume blood loss pool into what muscle for hemophilia giving the symptom of groin pain?
Iliopsoas muscle
Common clinical presentation of vWD
Mucocutaneous bleeding
All clotting factors are produced exclusively in the liver, except?
Factor VIII
Usual clinical presentation of ITP
Sudden onset of petechiae and purpura with or without membrane bleeding
Transfusion is contraindicated in ITP because:
Platelet autoantibodies will bond to transfused platelet
If very low platelets in ITP with ongoing bleeding, what should be given?
IVIG
Platelet disorder that usually presents after a nonspecific viral infection
ITP
Blood picture of ITP
Platelet <20,000
Platelet size normal to increased
Other cell lines are normal
Bone marrow normal to increased megakaryocytes
Relapse complications of ALL
Increased ICP or isolated CN palsies, testicular relapse
Diagnostic hallmark of Hodgkin Lymphoma
Reed Sternberg cell (large cell with multiple or multilobulated nuclei)
Four major histologic subtype of Hodgkin Lymphoma
Lymphocytic predominant
Nodular sclerosing
Mixed cellularity
Lymphocyte deplete (high grade nonHodgkin lymphoma)
Most common presenting sign of Hodgkin Lymphoma
Painless, firm cervixal or supraclavicular nodes
3 histologic subtypes of Non-Hodgkin lymphoma
- Lymphoblastic usually T cell, mostly mediastinal mass
- Small, noncleaved cell lymphoma - B cell
- Large cell - T cell, B cell or indeterminate
Second most common malignancy in children
Brain tumors
Most are infratentorial (age 2-10 y/o juvenile pilocytic astrocytoma, medulloblastoma)
Classic site of juvenile pilocytic astrocytoma
Cerebellum
Most common supratentorial tumor
Craniopharyngioma
Most frequent tumor of the optic nerve
Optic nerve glioma
Clinical presentation of optic nerve glioma
Unilateral visual loss, proptosis, eye deviation, optic atrophy, strabismus, nystagmus
Increased incidence of what condition is seen in optic nerve glioma
NF
Second most common malignant abdominal tumor
Nephroblastoma (Wilms tumor)
Gene in neuroblastoma
N-myconcogene
Usual presentation of neuroblastoma
Painful firm palpable mass in flank or midline with calcification and hemorrhae
Initial manifestation of neuroblastoma
Metastasis to long bones and SKULL, ORBITAL, bone marrow, lymph nodes, live and skin
Lab test elevated in neuroblastoma
Urine HVA and VMA
Best initial test for wilms tumor
ultrasound
Confirmatory test for wilms tumor
Abdominal CT scan
Best initial test for pheochromocytoma
CT Scan
Major metabolites of neuroblastoma
Dopamine and HVA
Scan taken up by chromaffin tissue anywhere in body in pheochromocytoma
MIBG
Metaiodobenzylguanidine
Most common site for rhadomyosarcoma
Head and neck (40%)
Types of Rhabdomyosarcoma
Embryonal
Bottrpud (projects, grapelike) - vagina, uterus, bladder, nasopharynx, middle ear
Alveolar - very poor prognosis, trunk and extremities
Pleomorphic - adult form
NTD described as midline defect of vertebral bodies without protrusion of neural tissue, asymptomatic and of no clinical consequence, may have overlying midline lumbosacral defect
Spina bifida occulta
Ropelike filum terminale persists and anchors the conus below L2 mostly associated with midline skin lesion
Tethered cord
Fluctuant midline mass well covered with skin
Meningocele
NTD caused by folate deficiency
Myelomeningocele
Most common location of myelomeningocele
Lumbosacral
Midlumbar lesion physical finding most common
Flaccid paralysis below the level of the lesion
Type of Chiari malformation that is associated with myelomeningocele that may have symptoms of hindbrain dysfunction
Type II
Types of hydrocephalus
Obstructive (noncommunicative) - most are abnormalities of the cerebral aqueduct or lesions near the fourth ventricle
Nonobstructive - occurs mostly with SAH
CN nerve involved in Hydrocephalus
CN VI
Cystic expansion of fourth ventricle due to absence of roof associated with agenesis of posterior cerebellar vermis and corpus collosum
Dandy Walker malformation
Usual clinical presentation of Dandy Walker malformation
Prominent occiput, cerebellar ataxia
At least 2 unprovoked seizures occur > 24 hours apart
Epilepsy
Asynchronous tonic or clonic movements most of the face, neck and extremities. Average duration 10-20 seconds, aura, no postictal period
Simple partial seizure
EEG finding of simple partial seizure
Spike and sharp waves or multifocal spikes
Impaired consciousness at some point, automatisms common after loss of consciousness
Complex seizure
Interictal EEG finding in complex seizure
Anterior temporal love shows sharp or focal spikes
DOC of Complex seizure
Carbamazepine
Sudden cessation of motor activity or speech with blank stare and flickering eyes, more in girls, no aura, no postictal period
Absence seizure or Petit mal
EEG finding of Absence seizure
3/second spike and generalized wave discharge
DOC of absence seizure
Ethosuximide
May have aura (focal onset; may indicate site of pathlogy) then clonic rhythmic contractions alternating with relaxation of all muscle groups, tongue bitting, loss of bladder control, semicomatose for up to 2 hours afterward with vomiting and bilateral frontal headache
Tonic-clonic seizure
Brief symmetric muscle contraction and loss of body tone with falling forward
Myoclonic seizure
DOC of myoclonic seizure
Valproic acid
Often confused with myoclonic seizure, clusters confined to the neck, trunk, and extremities, normal EEG, goes aways after 2 years
Benign myoclonus of infancy
EEG finding of infantile spasms
Hypsarrhythmia (asynchronous, chaotic bilateral spike and wave pattern)
Symmetric contractions of neck, trunk and extremities (with extension episodes), begins at 4-8 months
Pathophysiology?
Infantile spasm
Increased CRH: neuronal hyperexcitability
Type of infantile spasm wherein infant is normal prior to seizure with normal neurologic examination development with good prognosis
Cryptogenic
Type of infantile spasm wherein disease present prior to seizure (eg tuberous sclerosis) with poor control and MR
Symptomatic
DOC of infantile spasms
ACTH
Most common cause of Neonatal seizure
Hypoxic ischemic encephalopathy
Usually seizure present within 12-24 hours after birth
IVH causes neonatal seizure present in 1-7 days associated with
Preterm
NF1 criteria
2 of the following
a. At least 5 cafe au lait spots > 5mm prepubertal OR at least 6 cafe au lait spots > 15 mm postpubertal
b. Axillary/inguinal freckling
c. > 2 iris Lisch nodules (seen on slit lamp only)
d. > 2 neurofibromas or one plexiform neurofibroma
e. Osseous lesions, splenoid dysplasia or cortical thinning of long bones
f. Optic gliomas
Complications of NF1
Optic gliomas, hamartomas, malignant neoplasms, seizure, cognitive defects, renovascular hypertension or pheochromocytoma, leukemia, rhabdomyosarcoma, wilms tumor
NF2 primary feature
Bilateral acoustic neuroma
Hallmark of Tuberous Sclerosis
CNS tubers found in convolutions of cerebral hemisphere
Clinical manifestation of Tuberous Sclerosis in infancy
Infantile spasms and characteristic skin lesion (ash leaf macule increased in Wood UV lamp)
Clinical manifestation of Tuberous Sclerosis in childhood
Generalized seizures and skin lesions:
Sebaceous adenoma - red or clear nodules on nose and cheeks
Shagreen patch - rough, raised lesion with orange peel consistency mostly in lumbosacral area
Retinal lesions of Tuberous Sclerosis
Either mulberry tumor from optic nerve head or phakomas (round, flat, gray lesions in area of disc)
Cardiac complication of Tuberous Sclerosis
Rhabdomyosarcoma of the heart (most spontaneously regress over first 2 years)
Most complication of Tuberous Sclerosis
Renal lesions - either harmartoma or polycystic kidneys
Facial nevus (port wine stain), seizure, hemiparesis, intracranial calcifications, and MR, glaucoma in ipsilateral eye
Sturge-Weber Syndrome
Clinical presentation of Sturge-Weber Syndrome
Seizure in most (focal tonic-clonic, contralateral to the nevus) becomes refractory and slowly develops hemiparesis, MR
Skull xray finding of Sturge-Weber Syndrome
Occipital-parietal calcifications (serpentine or railroad track appearance) and IOP pressure reading initially increased
CT scan finding of Sturge-Weber Syndrome
Unilateral cortical atrophy and hydrocephalus
Most obvious manifestation of Cerebral palsy
Impaired ability of voluntary muscles (rigidity and spasticity) has
Abnormal gene encoded in Friedrich ataxia (autosomal recessive)
Frataxin
Cardiac complication of Friedrich Ataxia
Hypertrophic cardiomyopathy - refractory CHF
Findings in Friedrich Ataxia
Ataxia before 10 years old (slowly progressive, loss of DTR, extensor plantar reflex, weakness in hands and feet, degeneration of posterior column), explosive dysarthic speech, skeletal abnormalities
Pathognomonic of Wilson disease
Kayser-Fleischer rings
Suspect in any child with acute or chronic liver disease, unexplained neurologic disease, or behavioral or psychiatric changes
Wilson disease (autosomal recessive)
Liver symptoms first or later in wilson
First
Best screening test for Wilson disease
Serum ceruloplasmin (decreased)
Confirmatory test for Wilson disease
Liver biopsy (increased copper content)
Definitive treatment for Wilson disease
Liver transplant
Splingolipidoses that has deficient beta hexosaminidase A, accumulate GM2, mostly in Ashkenazi Jews, normal developmental until 6 months then lag and lose milestones, seizure, hypotonia, blindness, CHERRY RED MACULA
Tay-Sachs disease
Purine metabolism disorder that is X-linked, excess uric acid, SELD-MUTILATION AND DYSTONIA, gouty, tophi, renal calculi, choreoathetosis, spasticity
Lesch-Nyhan disease
Diagnosis of Lesch-Nyhan disease
Analyze HPRT enzyme
Degeneratice disease of motor units beginning in the fetus and progressing into infancy, denervation of muscle and atrophy
Spinal Muscle Atrophy (autosomal recessive)
Type of Spinal Muscle Atrophy considered as severe infantile (Werdnig-Hoffman disease)
SMA1
Type of Spinal Muscle Atrophy that is late infancy, slower progression
SMA2
Type of Spinal Muscle Atrophy that is chronic juvenile (Kugelberg-Welander disease)
SMA3
Clinical presentation of SMA1
Progressive hypotonia, generalized weakness Feeding difficulty Respiratory insufficiency Fasciculations of the tongue and fingers Absent DTRs
Simple and most effective diagnosis of Spinal Muscular Atrophy
Molecular genetic marker in blood for the SMN gene
Neonates born to mothers with MG but will be normal after antibodies wane
Transient neonatal myasthenia
Earliest and most consistent finding in MG
Ptosis and EOM weakness
More diagnostic than muscle biopsy in MG
EMG
Other name of Hereditary Motor Sensory Neuropathy 1
Marie-Charcot-Tooth disease (autosomal dominant)
Progressive disease of peripheral nerves; peroneal muscle atrophy; peroneal and tibial nerves
Hereditary Motor Sensory Neuropathy 1 (Marie-Charcot-Tooth disease)
Clinical presentation of Marie-Charcot-Tooth disease
Stork-like appearance (clumsy, fall easily; muscles of anterior compartment of lower leg become wasted)
Pes cavus, foot drop
Claw hand
Slowly progressive
Diagnostic of choice for Marie-Charcot-Tooth disease
Sural nerve biopsy
Organisms involved in GBS
Campylobacter jejuni
Mycoplasma pneumoniae
Ascending paralysis of GBS
Landry ascending paralysis
Postinfectious polyneuropathy qpdays after nonviral illness presenting as ascending paralysisu
GBS
CSF finding of GBS
Increased protein, normal glucose, no cells
First sign of Duchenne
Poor head control in infancy
Gower sign is seen as early as
3 years old but filly developed at 5-6 years old
Most common of the neuromuscular disease in all races and ethnic groups
Duchenne (X-linked)
Cardiac complication of Duchenne
Cardiomyopathy
Death from Duchenne is usually at the age of
18 y/o
Diagnostic study used for initial screen for myopathy
CPK - 15,000 - 35,000 U/L
Best initial test for Duchenne
Molecular genetic diagnosis
Gene in Duchenne
Deficiency or defective dystrophin cytoskeletal protein from gene at Xp21.2
Which is better test for meningeal irritation?
Brudzinki
Initial empiric treatment (2 months to 18 years) for acute bacterial meningitis
Vancomycin plus with cefotaxime or ceftriaxone
Chemoprophylactic drug for N.meningitidis and HiB
Rifampin
Describe the characteristic meningococcal rash
Black central arch and surrounding ring or erythema
Petechiae and purpura +/- meningitis in acute meningococcemia
Purpura fulminans (DIC)
Aseptic meningitis caused by varicella most common presentation
Cerebellar ataxia and acute encephalitis
EBV and mumps caused by varicella most common presentation
Mild but with CNVIII damage
Anything that suggest temporal lobe involvement is highly suspicious of what virus?
HSV
Meningitis + mental status change = ?
Encephalitis
Best test for aseptic meningitis
PCR of CSF
Pertussis vaccination does not provide complete or lifelong immunity wanes after what age?
After 8-15 y/o
Phases of pertussis
Catarrhal phase (2 weeks) Paroxysmal phase (2-5 weeks) Convalescent phase (>2 weeks)
Phase of pertussis manifested by coldlike symptoms
Catarrhal phase
Phase of pertussis manifested by increasing to severe coughing paroxysms, inspiratory “whoop” and facial petechiae, post-tussive emesis
Paroxysmal phase
Gold standard for Pertussis
PCR of nasopharyngeal aspirate 2-4 weeks after onset of cough
Most common cause of lymphadenitis lasting >= 3 weeks
Cat-Scratch Disease caused by Bartonella
Incubation period of Cat-Scratch disease
3-30 days
Hallmark sign of Bartonella or Cat-Scratch Disease
Chronic regional lymphadenitis
Atypical presentation of Bartonella or Cat-Scratch Disease
Parinaud oculoglandular syndrome (unilateral conjunctivitis, preuricular lymphadenopthy, cervical lymphadenopathy, occurs after rubbing the eye after touching a pet)
Tissue diagnostic tools for Bartonella
PCR and Warthin-Starry stain (showing gram negative)
Structure in the brain affected by TB meningitis
Brainstem
Early disseminated presentation of Lyme disease
Secondary lesions smaller than the primary plus constitutional symptoms plus lymphadenopathy (uveitis and bell palsy may be only finding, carditis, CNS)
Late disease manifestation of Lyme disease
Arthritis
Target lesion of Lyme disease must be how many cm in diameter?
> 10 cm
DOC for Lyme disease > 8 y/o
Doxycycline
DOC for Lyme disease < 8 y/o
Amoxicillin
DOC for Lyme disease if with meningitis or carditis (heart block)
Ceftriaxone
DOC for Lyme disease if with Bell palsy
Doxycyline or amoxicillin
Consider in differential diagnosis of fever, headache and rash in summer months especially after tick exposure
Rocky Mountain Spotted Fever
DOC for Rocky Mountain Spotted Fever in all patients regardless of age
Doxycyline or tetracyline
Usual presentation of Rocky Mountain Spotted Fever
Skin rash after third day, vasculitis and thromboses leading to gangrene
DOC for catheter related fungemia
Amphotericin B
Most common presentation of crytococcus neoformans
Pneumonia
DOC for crytococcus if immunocompetent and only mild disease? If otherwise?
Oral fluconazole
Amphotericin B + Flucytosine
Initial presentation of Histoplasmosis and resembles what pulmonary disease
Bronchopneumonia
Tb because it calcifies
Chronic pulmonary histoplasmosis pulmonary finding
Centrilobular emphysema
If without improvement for histoplasmosis, DOC?
Itraconazole
DOC for progressive pulmonary disease or disseminated infection of histoplasmosis
Amphotericin B
Coccidioidomycosis is also known as?
San Joaquin Fever, Valley Fever
Type of Coccidioidomycosis that is fatal, more common in males, Filipino/Asians, blood group B
Disseminating
Clinical presentation of Coccidioidomycosis
Dry, nonproductive cough, tibial erythema nodosum
Disseminated Coccidioidomycosis triad
- Flu-like symptoms +/- chest pain
- Maculopapular rash
- Erythema nodosum
Incubation of Measles
10-12 days before prodrome appears
Most common complication of Measles
Otitis media
10-day measles
Rubeola
3-day measles
Rubella
Incubation of Rubella
14-21 days
Hallmarks of rubella
Retroauricular, posterior and occipital lymphadenitis
Roseola is also known as
Exanthem subitum
Incubation of Roseola
5-15 days
Roseola peaks at what age? Usually?
< 5 years old, usually 6-15 months
Characteristic rose colored rash begins as papules
Roseola
Clinical presentation of roseola
High fever lasting for a few days with only signs and symptoms
By the 3rd or 4th day, fever resolves and a maculopapular rash appears on the trun, arms, neck and face
Virus of mumps
Paramyxovirus
Incubation period of mumps
14-24 days
Contagious days of mumps
1 day before and 3 days after swelling appears
Clinical presentation of mumps
Unilateral or bilateral salivary glands swelling, predominantly parotids
Constitutional findings
Most common complication of mumps
Meningoencephalomyelitis
Other sequelae of varicella complication
GBS, encephalitis, cerebellar ataxia, post-herpetic neuraligia and Ramsay-Hunt syndrome
Erythema infectiosum is due to what viral infection?
Parvovirus B19
Clinical presentation of Fifth disease
Mild systemic symptoms Arthritis Intesely red slapped cheek appearance Lacy reticular rash over trunk and extremities Sparing of palms of soles Rash may last up to 40 days
Complication of fifth disease
Aplastic crisis in patients with hemolytic anemia
Hydrops fetalisnin neonates during maternal infection in first trimester
Infectious mononucleosis triad
Fatigue, pharyngitis, generalized adenopathy
Incubation period of EBV
30-50 days
Location of lymphadenopathy in EBV
Most in anterior and posterior cervical and submandibular nodes
Less often in axillary, inguinal, epitrochlear nodes
Drugs that cause immune mediated vasculitis rash in EBV
Ampicillin
Amoxicillin
Test for EBV
Monospot test (heterophile antibodies)
Most valuable and specific diagnostic test for EBV
IgM to viral capsid
Complications of EBV
Splenic hemorrhage or rupture (very rare) Airway obstruction Aplastic anemia Neurological complications rare, GBS Interstitial pneumonia Myocarditis
Coxsackievirus B is responsible for what cardiac manifestation
Viral myocarditis
Clinical presentation of AIDS in children
Recurrent bacterial infections, chronic parotid swelling, lymphocytic interatitial pneumonitis, early progressive neurological deterioration
HIV Ig antibodies that crosses the placenta
HIV IgG
How many (+) PCR should be present in newborn since screening will be positive in all newborns up to 18 months of age?
2 out of 3 in the first month of life
Approach to treatment of HIV infected mothers
Perinatal triple ART then IV ZDV at the start of labor until cord is clamped
Approach to treatment of HIV in infancy
Infants should be started on ZDV (birth) until neonatal disease is excluded PCP prophylacis (TMP-SMZ) at 1 month until disease excluded
Best single prognostic indicator of AIDS
Plasma viral load
Most common symptom of ascariasis
Pulmonary disease
Pulmonary ascariasis + hemoptysis
Loeffler syndrome
Anemia of hookworm
IDA
Chlorosis (green yellow skin discoloration) is seen at what parasitic infection
Hookworm
Ancylostoma and Necator americanus are what?
Hookworm
Intestinal location of pinwoe
Cecum, appendix, ileum, and ascending colon
DOC of enterobiasis
Single dose of mebendazole and repeat in 2 weeks
Strawberry cervix seen in vaginal trichomoniasis is attributed to what?
Hemorrhages in the mucosa
Single most effectice agent for comedonal acne
Tretinoin (Retin-A)
DOC for moderate to severe nodulocystic disease (from giant cell reaction to keratin and hair)
Isoretinoin
Major side effect of Isoretinoin (aside from it being teratogenic)
Increased triglycerides and cholesterol
Roseola is also known as
Exanthem subitum
Incubation of Roseola
5-15 days
Roseola peaks at what age? Usually?
< 5 years old, usually 6-15 months
Characteristic rose colored rash begins as papules
Roseola
Major side effect of Isoretinoin (aside from it being teratogenic)
Increased triglycerides and cholesterol
DOC for moderate to severe nodulocystic disease (from giant cell reaction to keratin and hair)
Isoretinoin
Single most effectice agent for comedonal acne
Tretinoin (Retin-A)
Strawberry cervix seen in vaginal trichomoniasis is attributed to what?
Hemorrhages in the mucosa
DOC of enterobiasis
Single dose of mebendazole and repeat in 2 weeks
Intestinal location of pinwoe
Cecum, appendix, ileum, and ascending colon
Ancylostoma and Necator americanus are what?
Hookworm
Chlorosis (green yellow skin discoloration) is seen at what parasitic infection
Hookworm
Anemia of hookworm
IDA
Pulmonary ascariasis + hemoptysis
Loeffler syndrome
Most common symptom of ascariasis
Pulmonary disease
Best single prognostic indicator of AIDS
Plasma viral load
Approach to treatment of HIV in infancy
Infants should be started on ZDV (birth) until neonatal disease is excluded PCP prophylacis (TMP-SMZ) at 1 month until disease excluded
Approach to treatment of HIV infected mothers
Perinatal triple ART then IV ZDV at the start of labor until cord is clamped
How many (+) PCR should be present in newborn since screening will be positive in all newborns up to 18 months of age?
2 out of 3 in the first month of life
HIV Ig antibodies that crosses the placenta
HIV IgG
Clinical presentation of AIDS in children
Recurrent bacterial infections, chronic parotid swelling, lymphocytic interatitial pneumonitis, early progressive neurological deterioration
Coxsackievirus B is responsible for what cardiac manifestation
Viral myocarditis
Complications of EBV
Splenic hemorrhage or rupture (very rare) Airway obstruction Aplastic anemia Neurological complications rare, GBS Interstitial pneumonia Myocarditis
Most valuable and specific diagnostic test for EBV
IgM to viral capsid
Test for EBV
Monospot test (heterophile antibodies)
Drugs that cause immune mediated vasculitis rash in EBV
Ampicillin
Amoxicillin
Location of lymphadenopathy in EBV
Most in anterior and posterior cervical and submandibular nodes
Less often in axillary, inguinal, epitrochlear nodes
Incubation period of EBV
30-50 days
Infectious mononucleosis triad
Fatigue, pharyngitis, generalized adenopathy
Complication of fifth disease
Aplastic crisis in patients with hemolytic anemia
Hydrops fetalisnin neonates during maternal infection in first trimester
Clinical presentation of Fifth disease
Mild systemic symptoms Arthritis Intesely red slapped cheek appearance Lacy reticular rash over trunk and extremities Sparing of palms of soles Rash may last up to 40 days
Erythema infectiosum is due to what viral infection?
Parvovirus B19
Clinical presentation of roseola
High fever lasting for a few days with only signs and symptoms
By the 3rd or 4th day, fever resolves and a maculopapular rash appears on the trun, arms, neck and face
Other sequelae of varicella complication
GBS, encephalitis, cerebellar ataxia, post-herpetic neuraligia and Ramsay-Hunt syndrome
Most common complication of mumps
Meningoencephalomyelitis
Clinical presentation of mumps
Unilateral or bilateral salivary glands swelling, predominantly parotids
Constitutional findings
Contagious days of mumps
1 day before and 3 days after swelling appears
Incubation period of mumps
14-24 days
Virus of mumps
Paramyxovirus
Roseola is also known as
Exanthem subitum
Incubation of Roseola
5-15 days
Roseola peaks at what age? Usually?
< 5 years old, usually 6-15 months
Characteristic rose colored rash begins as papules
Roseola
Clinical presentation of roseola
High fever lasting for a few days with only signs and symptoms
By the 3rd or 4th day, fever resolves and a maculopapular rash appears on the trun, arms, neck and face
Virus of mumps
Paramyxovirus
Incubation period of mumps
14-24 days
Contagious days of mumps
1 day before and 3 days after swelling appears
Clinical presentation of mumps
Unilateral or bilateral salivary glands swelling, predominantly parotids
Constitutional findings
Most common complication of mumps
Meningoencephalomyelitis
Other sequelae of varicella complication
GBS, encephalitis, cerebellar ataxia, post-herpetic neuraligia and Ramsay-Hunt syndrome
Erythema infectiosum is due to what viral infection?
Parvovirus B19
Clinical presentation of Fifth disease
Mild systemic symptoms Arthritis Intesely red slapped cheek appearance Lacy reticular rash over trunk and extremities Sparing of palms of soles Rash may last up to 40 days
Complication of fifth disease
Aplastic crisis in patients with hemolytic anemia
Hydrops fetalisnin neonates during maternal infection in first trimester
Infectious mononucleosis triad
Fatigue, pharyngitis, generalized adenopathy
Incubation period of EBV
30-50 days
Location of lymphadenopathy in EBV
Most in anterior and posterior cervical and submandibular nodes
Less often in axillary, inguinal, epitrochlear nodes
Drugs that cause immune mediated vasculitis rash in EBV
Ampicillin
Amoxicillin
Test for EBV
Monospot test (heterophile antibodies)
Most valuable and specific diagnostic test for EBV
IgM to viral capsid
Complications of EBV
Splenic hemorrhage or rupture (very rare) Airway obstruction Aplastic anemia Neurological complications rare, GBS Interstitial pneumonia Myocarditis
Coxsackievirus B is responsible for what cardiac manifestation
Viral myocarditis
Clinical presentation of AIDS in children
Recurrent bacterial infections, chronic parotid swelling, lymphocytic interatitial pneumonitis, early progressive neurological deterioration
HIV Ig antibodies that crosses the placenta
HIV IgG
How many (+) PCR should be present in newborn since screening will be positive in all newborns up to 18 months of age?
2 out of 3 in the first month of life
Approach to treatment of HIV infected mothers
Perinatal triple ART then IV ZDV at the start of labor until cord is clamped
Approach to treatment of HIV in infancy
Infants should be started on ZDV (birth) until neonatal disease is excluded PCP prophylacis (TMP-SMZ) at 1 month until disease excluded
Best single prognostic indicator of AIDS
Plasma viral load
Most common symptom of ascariasis
Pulmonary disease
Pulmonary ascariasis + hemoptysis
Loeffler syndrome
Anemia of hookworm
IDA
Chlorosis (green yellow skin discoloration) is seen at what parasitic infection
Hookworm
Ancylostoma and Necator americanus are what?
Hookworm
Intestinal location of pinwoe
Cecum, appendix, ileum, and ascending colon
DOC of enterobiasis
Single dose of mebendazole and repeat in 2 weeks
Strawberry cervix seen in vaginal trichomoniasis is attributed to what?
Hemorrhages in the mucosa
Single most effectice agent for comedonal acne
Tretinoin (Retin-A)
DOC for moderate to severe nodulocystic disease (from giant cell reaction to keratin and hair)
Isoretinoin
Major side effect of Isoretinoin (aside from it being teratogenic)
Increased triglycerides and cholesterol
