Pediatrics Rosh 1 Flashcards
a benign bone tumor and is characterized by a well-defined or sclerotic border, lack of destruction of the cortex, and lack of extension into the soft tissue on radiograph.
Chondroblastoma.
is a neoplastic disease where radiographs show periosteal reaction that produces layers of reactive bone, deposited in an “onion peel” appearance.
Ewing sarcoma
Laboratory findings show elevated alkaline phosphatase and elevated lactate dehydrogenase. Radiograph reveals destruction of the normal trabecular bone pattern and a soft tissue mass that is ossified in a radial or sunburst pattern. Which of the following is the most likely diagnosis?
Osteosarcoma
a toxin-mediated type of exfoliative dermatitis that causes separation of the epidermis from the dermis. Patients typically have widespread painful erythema and large, flaccid bullae and desquamation typically in the groin, body orifices and axillae. The initial infection can range from purulent conjunctivitis, abscess, otitis media or occult nasopharyngeal infection. Initial symptoms usually include fever, irritability and a generalized erythematous, painful rash. Positive Nikolski sign.
Staph scalded skin syndrome
is characterized by erythema, necrosis and bullous detachment of the epidermis from the dermis. It also includes mucous membranes and can even lead to gastrointestinal hemorrhage. While SJS typically involves less than 10% of the body surface, this involves more than 30% of the body surface.
Toxic epidermal necrolysis
Patient will be a military recruit or student
Complaining of fever, HA, arthralgias, rash
PE will show petechiae, skin lesions with gray necrotic centers
Diagnosis is made clinically and can be confirmed by blood cultures and Gram stain, as well as lumbar puncture
Most commonly caused by Neisseria meningitidis, an aerobic, gram-negative diplococcus
Treatment is ceftriaxone
Meningococcemia
bilateral adrenal hemorrhage + meningococcemia
Waterhouse-Friderichsen syndrome:
in a child with acute respiratory distress, mother states that he has had a fever and sore throat for the past few days. Physical exam reveals drooling, retractions, and inspiratory stridor. Which of the following is the best first-line pharmacologic treatment? What is the leading diagnosis?
Acute epiglottitis. ceftriaxone or cefotaxime plus vancomycin is appropriate first-line treatment for epiglottitis. These medications cover the most likely pathogens of H. influenzae and Group A Streptococcus (GAS).
Patient will be complaining of rapid onset of fever and dysphagia
PE will show patient leaning forward, drooling, inspiratory stridor
Imaging will show “thumbprint” sign
Most commonly caused by Strep. and Staph. species, H.influenzae (prior to the Hib vaccine)
Treatment is IV antibiotics and airway management
Epiglottitis
When does Sudden Unexpected Infant Death Syndrome usually occur?
2-4 months
Treatment for candidal diaper dermatitis, including beefy red plaques and satellite lesions. Inguinal fold involvement.
topical antifungal such as nystatin ointment. Other topical antifungal options include azoles such as clotrimazole, miconazole, or ketoconazole. Antifungal ointment should be applied at least two to three times per day and continued until the rash has fully resolved for 48 hours.
What condition is this and what pathogen is this caused by?
Patient will be 3 - 5-years-old
Complaining of high fever, barky cough, stridor
Treat as airway emergency!
Comments: Patient will look like croup but toxic appearing
Bacterial tracheitis, Staphylococcus aureus
a rare upper airway obstruction in children. It may occur in isolation or following a viral respiratory illness, including croup. This should be suspected in any child with clinical worsening after improvement of croup symptoms. In children without a preceding illness, symptom onset may begin insidiously with one to three days of viral upper respiratory infections prior to decompensation with respiratory distress, inspiratory stridor, and high fevers. Other children will not demonstrate prodromal symptoms and will present acutely toxic and in extremis. The most common causative organism is Staphylococcus aureus. Less common causes include S.pneumoniae, S.pyogenes, M.catarrhalis, and H.influenzae. Bronchoscopy is necessary to establishing a definitive diagnosis, but it should take place in a setting where airway supplies and personnel are readily available, such as the operating room or the intensive care unit.
Bacterial tracheitis
the vast majority of cases are seen in children under two years old. The disease is characterized by a high fever (often as high as 41 oC) for 3–5 days, which ends abruptly and is followed by the onset of a diffuse fine maculopapular rash on the trunk which may spread to the face and extremities. There is no mucous membrane involvement. Children affected are typically not ill appearing. The illness is self-limited, with the rash lasting only a few days. Treatment consists of fever control as needed.
Roseola caused by HSV 6
characterized by cough, coryza, conjunctivitis, and fever followed by a maculopapular rash on the head which spreads to the body. Patients with this are typically still febrile when the rash appears.
Rubeola
