Pediatrics Rosh 2 Flashcards
What is the treatment for Bronchiolitis?
In healthy infants and young children, bronchiolitis usually is a self-limited disease. Management in most cases consists of supportive measures to maintain oxygenation and hydration. Bronchodilator therapy may be used to provide short-term improvement.
Bronchiolitis is a clinical syndrome that occurs primarily in children younger than two years of age. Patients typically present with fever, cough, and respiratory distress (eg, increased respiratory rate, retractions, wheezing, crackles). Acute bronchiolitis often occurs following a 1 to 3 day history of an upper respiratory tract infection. Radiographic features of bronchiolitis include hyperinflation and peribronchial thickening.
is most often seen in preschool and school-age children. After an incubation period averaging 7–10 days, an illness develops that is indistinguishable from the common cold and is characterized by coryza, lacrimation, mild cough, low-grade fever, and malaise. After 1–2 weeks, this catarrhal phase evolves into the paroxysmal phase: the cough becomes more frequent and spasmodic with repetitive bursts of 5–10 coughs, often within a single expiration. The frequency of paroxysmal episodes varies widely, from several per hour to 5–10 per day. Episodes are often worse at night and interfere with sleep.
What is this and what is the treatment?
Bordetella pertussis treated with Azithromycin
a disorder that causes a triad of acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemia. It most often results from antibiotic treatment of gastroenteritis in individuals with Escherichia coli O157:H7 infection, as the dying organism releases a highly virulent, Shiga-like toxin. Symptoms of this include decreased urine output, irritability, lethargy, seizures, or encephalopathy. Unlike disseminated intravascular coagulation (DIC), the PT, aPTT, and fibrinogen are normal.
Hemolytic Uremic Syndrome (HUS)
What is the mnemonic for Kawasaki disease?
CRASH and burn: Conjunctivitis, Rash, Adenopathy, Strawberry tongue, Hand/feet edema, burn (uncontrolled high fever)
It presents with malodorous vaginal discharge, vulvovaginal irritation, dysuria, and dyspareunia. Physical exam may reveal a frothy discharge with vaginal erythema, and cervical hemorrhages (strawberry cervix) with the latter being a classic finding. The discharge usually has a pH of > 5. This may be recognized in vaginal secretions by using the wet mount technique which has a sensitivity of 60-70%.
Trichomoniasis vaginalis
It is usually seen in children < 5 years of age and often follows an upper respiratory infection. The rash usually starts on the face (perioral is classic), neck, axillae, and groin. The rash then spreads, becomes exfoliative, and is followed by the development of flaccid bullae and skin desquamation. The rash is characteristically tender to the touch, and gentle traction on the affected skin produces peeling (positive Nikolsky sign).
Staph Scalded Skin Syndrome
usually presents with painless rectal bleeding and is due to incomplete obliteration of the vitelline duct. It is located two feet from the ileal cecal valve, is two inches long and commonly seen in children younger than two years of age. Bleeding results from ulceration of the ileal mucosa caused by acid secretion from the gastric mucosa-lined epithelium.
What is this and how is it diagnosed?
Meckel’s diverticulum
Meckel’s scan using Tc99m pertechnetate, which is a radioactive chemical taken up by the gastric mucosa. The treatment is surgical resection.
Patient will be younger than 5-years-old Complaining of painless rectal bleeding Rule of 2s: 2 years old 2 feet from ileocecal valve 2 inches long 2% of the population 2 epithelial types (gastric/pancreatic) Diagnosis is made by technetium 99m scan Comments: Most common congenital malformation of the GI tract
Meckel’s Diverticulum.
What is the acronym for Major and minor Jones criteria for rheumatic heart disease?
JONES CAFE PPL
Joint involvement O that looks like a heart Nodules Erythema marginatum Sydendam chorea
CRP
Arthralgia
Fever
ESR
Prolonged PR
Prior rheumatic fever
Leukocytosis
This is defined by the triad of findings: (1) clusters of myoclonic seizures on awakening, (2) hypsarrhythmia pattern on electroencephalogram, and (3) developmental delay. Signs and symptoms of this usually begin at four to eight months of age. Infants will demonstrate brief contractions of the neck, trunk, and extremities lasting five to ten seconds each, occurring in clusters. These episodes may be accompanied by a cry. Imaging of the brain with CT or MRI is often abnormal; however, it is not diagnostic. These children are most frequently diagnosed by the presence of the characteristic electroencephalogram (EEG) finding of hypsarrhythmia, which has the appearance of high amplitude irregular waves and spikes in a background of chaotic and disorganized activity. A lumbar puncture should also be considered and performed to rule out meningitis or encephalitis.
What is this and what is the management?
Infantile spasms and treatment is primarily with adrenocorticotropic hormone (ACTH), prednisone, and antiepileptic medications.
most common cause of constipation in children is?
Functional constipation, meaning constipation without objective evidence of a pathological condition. Behavioral modification including unhurried time on the toilet after meals to discourage withholding of stool, as well as feeding children a diet of whole grains, fruits and vegetables is recommended as part of the treatment of constipation.
The clinical course begins abruptly with a maculopapular or vesiculopapular exanthem that includes the palms and soles, as well as the extremities. Involvement of the trunk may also be present. The oral enanthem typically involves the mucous membranes of the tongue and buccal mucosa and less commonly the palate or tonsils. The intraoral macules become vesicular and subsequently rupture to form ulcers with grey-yellow bases and circumferential erythema. Intraoral lesions are exquisitely painful, especially upon contact with salty or sour substances. As such, some children will refuse to drink and require admission for intravenous hydration. Preceding symptoms such as malaise or fever are typically absent.
Coxsackie virus (Hand foot and mouth dz)
What is the common physical exam of a Slipped Capital Femoral Epiphysis (SCFE).
Patients usually limp to some degree and have an externally rotated lower extremity. Physical examination of the affected hip reveals a restriction of internal rotation, abduction, and flexion. Commonly, the examiner notes that as the affected hip is flexed, the thigh tends to rotate into progressively more external rotation.
is the most common primary malignancy of the bone. It presents in a bimodal age distribution, with peaks in early adolescence and in adults over the age of 65. The most common presenting symptoms are pain and swelling in the affected area. Plain radiographs typically show a mixed radiodense and lytic lesion arising from the metaphyseal bone. Codman triangle or elevation of the periosteum of the bone at the periphery of the tumor is a classic but nonspecific feature. The use of ionizing radiation for treatment of childhood solid cancers is well implicated in the development of this bone cancer.
Osteosarcoma.
The majority of patients present within the first year of life and of those, most present within the first month of life with symptoms of obstruction. The classic presentation is an otherwise healthy infant who develops sudden onset bilious vomiting. Patients may also present with hematochezia which indicates bowel ischemia and has a poorer prognosis.
How is this diagnosed?
Intestinal malrotation is usually diagnosed with an upper GI series and confirmed by observing failure of the duodenal-jejunal junction to cross midline. Contrast studies often show a spiral or corkscrew appearance of the distal duodenum in cases of volvulus. Management of uncomplicated malrotation with or without volvulus is typically laparoscopic surgery (the Ladd’s procedure), although patients with significant bowel ischemia may require an open approach.
