Peds Flashcards
streptococus occurs secondary infection with
GRoup A strep
symptoms for mono
fever, tonsillar enlargement and exudates, cervical lymphadenopathy, and fatigue
- *posterior cervical adenopathy (differentiate b/w this and strep)
- *possible generalized lymphadenopathy
- **splenomegaly ((not happen with strep))
Symps for strep
fever, tonsillar enlargement and exudates, cervical lymphadenopathy, and fatigue
*tender bilateral anterior cervical adenopathy (differentaite b/w this and mono
what medication do we avoid with MONO (if mistaken for strep) and what happens if administered
amoxicillin
-maculopapular rash
DX test done for Mono
heterophile antibody test aka mononuclear spot test
Bronchiolitis pathogen causes
- when to refer?
- s/s
RSV MC Hameohpilous influenza Rhino Ecovirus Flu
S/S: tachypnea cough wheezing mild fever
TX:
- fluids (textbook)
- nebulizer (dr. georgy)
- *when to refer to ER:
1. <3 MO
2. sp02 under 92
3. RR >70
4. any underlying disease
1) inability to retract foreskin
2) inability to reduce foreskin to anatomical position
* *which is the emergency
1) phimosis
2) paraphimosis–>EMERG
phimosis
- s/s
- tx
urinary outlet obstruction, glans ischemia, and infarction
TX hygiene, topical steroids, dorsal slit (if signs of ischemia), circumcision
CROUP
- mc age groups
- pathogen
- tx for mild, mod, severe (and s/s)
MC b/w 6MO-36MO—uncommon >6YO
parainfluenza virus
MILD: symptomatic tx, single dose of PO/IM/IV dexamethasone,
MOD: nebulized epi, single dose PO/IM/IV dexamethasone,
SEV:
*barking cough, stridor at rest, marked retractions, and significant distress and agitation
*tx: inpt admission, single dose PO/IM/IV dex, neb epi
fever, malaise, rash, cough, coryza, and conjunctivitis
measles
incubation period for measles
6-19 days
MEDIAN 13
period of contagiousness measles
5 days before onset of rash-four days after appearance of rash
rash for measles–where does it start and then spread to
-other pathopneumonic PE finding found
starts on forehead/head—>towards trunk—>feet
red spots with blue or white center on buccal mucosa (Koplik spots)
Kawasaki
- affects?
- s/s—which is last to show up?
- lab findings
- tx
- comps
affects medium sized BVs—>like coronary arteries
S/S: fever lasting more than 5 days, bilateral nonexudative conjunctivitis, mucositis with fissured lips and a “strawberry tongue”, and edema of the dorsal aspect of the hands and feet (LAST to show up). +/- rash
+/- lymphadenopathy
Labs: elevated inflammatory markers and reactive thrombocytosis
TX:
1) IVIG + ASA
2) need complete cardiac WU + cardiac monitoring
COMPS
- MI
- HF
- coronary artery aneruysm
Adenovirus can cause
***common cause of febrile illness + self limiting
- conjunctivitis
- Tonsilitis
- OM
- Gastroenteritis
- Pnma
- cystitis
what can present with strawberry tongue
Kawasaki
Scarlet fever
uncontrolled high fever* think what?
kawasaki
ophthalmia neonatorum -cause? -s/s -dx tx
- aka neonatal conjunctivits
- MCC=gonorhea during vaginal delivery
S/S: conjunctivitis and discharge typically begins in the first two to five days after birth
*****chlamydia starts to show later like 5 days-5 weeks
dx= culture
tx–> IV ceftriaxone
What is a common side effect of ceftriaxone in neonates?
hyperbilirubinemia
TOC for neonatal conjuncitvitis due to chalmydia
erythromycin PO
In the neonatal period, the most likely cause of lower gastrointestinal bleeding is
swallowing maternal blood
either from delivery or cracked nipples during breastfeeding
Meckle diverticulum MC at what age?
s/s?
painless hematochezia
2 years old——-rules of 2
What is the most common cause of neonatal hemorrhage?
Failure to administer vitamin K in the immediate postpartum period (associated with home births).
Barlow test vs Ortolani Test descriptions
BARLOW:
1) flex and ADDuct hips
ORT:
-abduction hips
MC pathogens for OM
- strep pneumoniae
- Haemophilus *****
- Moraxella catarrhallis
What is the first-line antibiotic treatment for uncomplicated acute otitis media? according to ROSH`
High-dose amoxicillin at 80–90 mg/kg/day.
according to rosh**
tx for recurrent or persistent OM
augmentin
PCN allergy: Clinda + Cefixime or Cedinifir
stage 1 acne
small, inflammatory bumps from clogged pores
- Open comedones (blackheads): incomplete blockage
- Closed comedones (whiteheads): complete blockage
stage 2 acne
Stage II: Inflammatory: papules or pustules surrounded by inflammation
stage 3
: Nodular or cystic acne: heals with scarring
how to differentiate between acne and rosacea
rosacea does not have comodomes
Treatment for acne
- mild
- mod
- severe
MILD—>topical – azelaic acid, salicylic acid, benzoyl peroxide, retinoids, Tretinoin topical (Retin A) or topical antibiotics
[Clindamycin or Erythromycin with Benzoyl peroxide]
MOD—>above + oral antibiotics [Minocycline 50mg PO qd or Doxycycline 100 mg PO qd], spironolactone
SEVERE—->e (refractory nodular acne): oral Isotretinoin 0.5-1.0 mg/kg/d BID x15-20 weeks
Isotretinoin: affects all 4 pathophysiologic mechanisms of acne
• Adverse effects: dry skin and lips (MC), highly teratogenic, increased triglycerides & cholesterol, hepatitis
4 main pathophys for acne
4 main factors – follicular hyperkeratinization with plugging of sebaceous ducts, increased sebum production,
Propionibacterium acnes overgrowth within follicles, & inflammatory response
mcc of bronchiolitis
RSV
acute bronchiolitis
- age range
- s/s
- dx how and findings
clinical syndrome mc <2 YO
S/S:
- *fever, cough, and respiratory distress (eg, increased respiratory rate, retractions, wheezing, crackles).
- *often occurs following a 1 to 3 day history of an upper respiratory tract infection
XR: -hyperinflation -peribronchial thickening - TX -most of the time self limiting--esp in healthy kids -supportive
Children develop clinical signs of dehydration during progression to ___-____% loss of body weight.
3-9%
other name for croup
Laryngotracheitis
SE isotretinoin
causes dry lips, liver damage, increased triglycerides/cholesterol, pregnancy category X
treatable causes of alopecia
thyroid–TSH
anemia —CBC
autoimmune—ANA
TX alopecia
Topical: Minoxidil/Rogaine 2%, %5; *hair loss first before regrowth
Finasteride 1mg ⇒ inhibits T and DHT
Spironolactone ⇒ blocks DHT
flexor surfaces
atopic dermatitis
- AC and popliteal folds
- wrist
- hands
- feet
extensor surfaces
Psoriasis
-elbow
what type of hypersensitivity is atopic dermaitits
1
IGE mediated
**atopic individuals— asthma
burns caused by acid s/s
coagulation, necrosis, eschar; irrigate
burns caused by alkaline s/s
liquefaction necrosis, deep damage
first degree burns
Erythema of involved tissue, skin blanches with pressure, the skin may be tender
**sunburn
2nd degree burns
-
partial thicknes
Skin is red and blistered, the skin is very tender
3rd degree
full thickness
Burned skin is tough and leathery, skin non-tender
4th deg burn
Into the bone and muscle
allergic contact dermatitis type of hypersensitivity
-exs
4
- *poison ivy
- *nickle
tx for diaper rash
TX: Keep area dry to allow airflow
Barrier creams zinc oxide/petroleum jelly
Candidiasis: Nystatin, Clotrimazole, Econazole x 2 wks.
Discuss proper diaper changes, disposable, avoid tight-fitting
Young women. Papulopustular, plaques, and scales around the mouth Lip margin (vermillion border) is spared
perioral dermatitis
tx for perioral dermatitis
- mild
- moderate
TX: Topical metronidazole, avoid steroids
Mild: topical ALONE 1st line Topical Pimecrolimus 0.1% Erythromycin solution q12h Metronidazole 0.75% gel q12h Clindamycin lotion q12 hours Oral ABX: Doxycycline if necessary - no gels, solutions, or lotions on eye
Moderate: topical + oral ABX
what drug is not effective for dermatophyte infections aka any tinea
nystatin
RF for devleop hip dysplasia
- female
- breech **
- fam hx *****
- firstborn
- oligohydraminos
- race—-less common in black **
clinical dx of AOM
- bulging TM
or - other s/s of inflammation—-erythema, fever, ear pain, middle ear infussion
MC bugs for AOM
Strep pneumoniae 25%
H influenzae 20%
M catarrhalis 10%
define recurrent AOM
3 episodes in 6 MO or 4 in 12 with clearings in b/w
tx for AOM and age groups and duration
- kids
- adults
- high dose amoxicillin or Augmentin or cephalosporin (PCN allergic)
* ** <6 MO- up to 6 MO - Azithromycin or clarithromycin in kids who have immediate hypersensitivity rxn or delayed rxn to amoxicillin or other beta-lactam agents
UNDER 2— 10 days
OVER 2— 5-7 days
adults–> Augmenetin PO 5-7 days
-cant tollerate augmenitn– then just use amoxicillin
tx for recurrent AOM
tympanostomy, tympanocentesis, myringotomy
complications from AOM
mastoiditis, bullous myringitis
Acute Pharyngotonsilliits
- s/s
- Mc bugs
**NO COUGH
**NO RHINORRHEA
+fever
MC viral–> Adenovirus mc
*mononucleosis: EBV, fever, sore throat, lymphadenopathy, splenomegaly, + heterophile aggulintation test
STREP
- Group A hemolytic streptococci
- **not suggestive of strep= coryza, hoarseness and cough
Centor Criteria
- no cough
- exudates
- fever > 100.4 F
- cervical lymphadenopathy
3 out of 4—->get rapid strep test
sensitivity >90%
TX for pharyngitis
*all bugs
STREP
- Penicillin first line
- azitrhomycin if penicillin allergic
VIRAL= supportive
MONO= supportive, avoid sports (three weeks from onset), amoxicillin or ampicillin can cause rash
FUNGAL
- clortrimazole
- miconazole
- nystatin
GONORRHEA
- IM ceftriaxzone 250 mg
- azitrhomycin
comps of strep pharyngitis
rheumatic fever
glomerulonephritis
how long to use intranasal decongestants and for why
no more than 3-5 days
can cause rhinitis medicamentosa
mcc of viral conjunctivitis
mcc for bacterial
Newborns? do what test for it
adenovirus
bacterial
- s. pneumonia
- s aureus (common)
NEWBORN
*chlamydia—– do a Giemsa stain–>inclusion body, scant mucopurualt discharge
cobbelstone mucosa on inner/upper lid
allergic conjuncivitis
Bacterial conjuncivitis tx
- non contact users
- contact users
0.5 inch (`1.25 cm) of ointment or 1-2 drops 4x daily for 5-7 days of:
NON CONTACT
- Gentamicin/tobramycin (TOBREX)
* *aminoglycoside abx for gram- coverage
* most cases will respond to this - Erythromycin oinment (E-MYCIN)
- Trimethoprim and polymyxin B (POLYTRIM)
- Ciprofloxacin (CILOXAN)
CONTACT USERS
**pseudomonas
TX=fluoroquinolones —ciprofloxacin/Ciloxan drops
- *Neisseria= prompt referral
- chlmydial= systemic tetracycline or erythromycin x3 weeks
when do you give HIB vaccine
2
4
6
12-15 MO
3 D’s of eppiglottitis
drooling
dysphagia
resp Distress
what is this
thumbprint sign
epiglottitis
if outpatient tx is option for stable epiglottits what is tx
ceftriaxone
anterior causes of nosebleed and four aspects of the area
posterior causes of bleeds
kesselbach’s plexus/Littles area —- MC Site
- anterior ethmoid
- superior labial
- sephnopalatine
- greater palatine
Woodruff’s plexus
-sphenopalatine
OM with effusion
-define
***middle ear fluid that is NOT infected
-also called serous, secretory or nonsuppurative OM
-precedes development of AOM or follows resolution
**very common in young kids–> 90% will get it before school age
MC 6MO-4 YO
effusion + fever + ear pain with bulging + erythema of TM
ACUTE om
perforated TM + persistent or recurrent purulent ottorrhea, otalgia, ear fullness, varyig degrees of conductive hearing loss
chronic OM
asymptomatic effusion + no s/s of inflammation (fever, ear pain, red or bulging TM)
serous OM or OM with effusion
describe eustation tube of kids vs aadults
shorter, narrower and horizontal
when do we do tympanocentesis
recurrent OM
describe recurrent for OM
3 episodes in 6 MO
OR
4 episodes in 12 MO
with clearing in b/w episodes
nasal packing to tx epistaxis must also get ____ and why
abx– to avoid TSS
-cephalopsorin
weber test
rene test
WEBER–> tuning fork placed on center of head—- see if sound lateralizes—-
- it will lateralize to AFFECTED ear in conductive loss
- will lateralize to unaffected ear in SENSORInerual loss
RINNE— tuning fork placed on mastoid and then up to ear (should continue to hear)
- conductive hearing loss if B > A
- sensoruneural A > B
mcc for conductive hearing loss
-describe weber and rene findings
OM mcc
Other: cerumen impaction, OE, exostoses, TM perf, neoplasms
WEBER–>hear in BAD ear
RINNE–> B > A
sensorineural loss describe rinne and weber findingd
mcc
MCC= presbycusis—- gradual, symmetric hearing loss assoc with aging
other causes noise induced, infection, drug-induced, meniere disese, CNS lesion
wber: hear in good ear
Rinne: A > B
describe otoscopy findings for OM with effusion
effusion with TM that is RETRACTED or FLAT
Hypomobility with insufflation
PE shows edema of external auditory canal producing an anterior and inferior displacement of auricle with percussion tenderness posteriosly
mastoiditis
mastoiditis
- bugs
- s/s and PE
- dx ****and the findings for the test
Organisms: S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus, S. pyogenes
fever, otalgia, erythema posterior to ear and foward displacement of external ear
DX
*CT scan with contrast is first line test for ill appearing PTs or complicated mastoiditis– scan the temporal bone
FINDINGS: Radiographic findings would be the destruction of the mastoid air cell septa with an accumulation of pus
-MRI
TX
-PO abs for simple
IV ABX like ceftriaxone complicated
does candidia plaques bleed when scraped?
yes
tx for thrush
Nystatin
PO fluconazole
swollen and erythematous eyelid, proptosis, pain with movement of the eye, and an inability to adduct or abduct his eye.
orbital cellulitis
what is orbital cellulitis
- how does pt presnt
- assoc with? or compl of?
- mc age population
- mc bug
- dx
- tx ****
infection of orbital muscles and fat behind the eye—- DIFF FROM PERIOBRITAL WHICH IS ONLY INFECTION OF THE SKIN
pt presnts with decr extraocular movement— pain with movement of eye and proptosis (bulging of eyeball)
aossc with untreated sinusitis
kids»_space;> adults
7-12 YO
MCC- staph aureus
dx— TOC is CT with contrast
TX 1. admission 2. optho eval 3. IV broad spectrum abx---- VANCO*** PLUS one of the following: creftri or cefotaxmine this will cover MRSA
OE
-weber test will show?
-rinne test
tx
weber test= lateralizes to affected ear
rinne= B > A
pseuodomonas aeruginosa** (swimmers ear) staph A (digital trauma)
TX *ABX DROPS ---- aminoglycoside or fluoroquinoline +/- corticosteroids + avoid mositure ***ciprofloxacin + dexamethasone OR Neomycin ***/Polymyxin-B/Hydrocotrisone
- **DO NOT USE AMINOGLYCOSIDES IF TM PERF or TM CANT BE VISUALIZED BC THEY ARE OTOTOXIC
- neomycin
- tobramycin
- gentamicin
malignant OE is seen in who
-tx
diabetics
TX= hosp and IV ABX due to aspergillus fungus
trismus and muffled voice
peritonsilar absces
bug involved with peritonsilar abscess
-tx
strep pyogenes
TX
-I/D
-ABX: amoxicillin, ampicillin-sulbactam, and clindamycin IV!!!
-
tx for TM perf
Most TM perforations are nonurgent and do not require immediate evaluation by an otolaryngologist.
If going to use abx---ABX drops-- only class of abx that are non otoxic are the FLOXIN drops--- should heal on its own with few days A significant portion of TM perforations heal spontaneously without intervention because of the TM’s regenerative abilities.
SURGERY indicated if persists > 2 MO
what are vestibular signs
- nystagmus
- vomiting
- ataxia
acid-fast bacilli on Ziehl-Neelsen staining
mycobacterium
tx for Mycobacterium Avium complex (MAC)
1st
2nd
Clarithromycin + Ethambutol + a rifamycin (either rifabutin or rifampin)
second line
*ethambutol + rifamycin + aminoglycoside
Atypical Mycobacterial infections in children are most frequently located in??
mc age group ?
transmission route
superior anterior cervical or in submandibular nodes– 91%
- swelling in painless, firm and not erythematous
- s/s rarely ocur in immunocompetent patients
MC 1-5 YO
transmitted via soil and water– not person to person
Mycobacterium MArinum
-tranmission
- **AQUARIUM
- fresh and saltwater
- infection occurs after inoculation of skin via abrasion or puncture in PT with contact of aquarium, saltwater or marine animals
tx= tetracyclines, fluroso, marolides, sulfonamides 4-6 wks
EBV
- tranmission
- triad
- dx
- do not give ___ because ____
- *part of human herpes family
- *saliva– kising disease 15-25 YO
Fever + lymphadenopathy (esp posterior) + pharyngitis (can be exudative)
- splenomegaly
- hepatomegaly
DX= + heterophile antibody screen (monospot)—-TOC
do not give AMPICILLIN bc it will cause diffuse maculopapular rash
TX
- supportive
- s/s can last for months
- no sports for 3-4 weeks if splenomegaly present
COMPS
- hodgkin lymphoma
- burkitt lymphoma
- CNS lymphoma
- Gastric carcinoma
- Nasopharyngeal ca
erythema infectiosum
- also called
- bug
- tx
slapped cheek or fifths disease
s/s= low grade fecer, HA, ST, bright red rash on cheeks—spreads to trunk, arms and legs
** parvovirus B19
tx is supp
HFM disease
- s/s
- rash
LGF, loss of appetite,
rash: small tender erythematous papules or vesicles on pharynx, mouth, hands and feet
* palms
* soles
Coxsackievirus type A
Influenza
-s/s
bug
-tx***
SUDDEN fever, chills, malaise, ST, HA, coryza +/- myalgia (legs and lumbosacral)+/- cervical lymphadenopathy
- othomyxovirus– A, B, C
- ** A assoc with severe outbreaks
everyone over 6MO get vaccinated
*avoid: egg allergy, previous rxn, GBS, <6MO
TX
-
** antivirals within 48 hours of symptom onset—- only for PT who are hospitalized or at risk of complications
1. Tamiflu or oseltamivir— fights A and B— neuraminidase inhibitor
2. inhaled relenza (zanamivir)
3. IV Rapivab (peramivir)
4. PO baloxavir
indications for antiviral tx for influenza
hospitalized OUTPT: -severe progressive illness, immunocomp >65+ Pregnant or 2 wks PP
fever, conjunctivitis, runny nose and cough
measles
mumps
-bug
paramyxovirus
MCC of pancreatitis in kids?
mumps
when is MMR given
12-15 MO
4-6 YO
severe hacking cough followed by a high-pitched intake of breath
whooping cough aka pertussis
bug for pertussis
gram negative bordetella pertussis
VERY Contagious
stages of pertussis
tx
- Catarrhal stage: cold like s/s, anorexia, sleepy
2, Paroxysmal stage: high pithced inspiratory whoop - Convalescent stage: residual cough (can be up to 100 days)
tx= macrolides… azitrhomycin or clarithromycin, supportive care with steroids/ albuteol
what is the vaccine for pertussis
DTaP
2, 4 ,6, 15-18 MO ,and 4-6 yrs (5 doses)
11-18 YO= 1 dose of TdAp
preg should get one dose during each pregnancy at 27-36 weeks
tx for pinworms
albendazole or mebendazole
Roseola
- caused by>
- age group
- s/s
- assoc with?
- tx
HHV 6– also called sixth disease or roseola infantum
6MO-2 YO
s/s
- SUDDEN high fever (102-104) and child appears normal
- few days after fever—> red rash appears
assoc with Nagayama spots—- red/papules uclers on soft palate
ONLY VIRAL EXANTHEM TO START ON TRUNK **
tx=supportive
high fever for few days—– then as pt gets better rash appears
*PT only s/s is fever.. they appear genrally well
roseola
3 day rash
rubella or german measles
rubella
- s/s
- when can s/s be bad
s/s often mild **rash **fever **lymphadenopathy RASH Starts on face-- spread caudially--discrete maculipapular exanthems--- and dissapers in 3 days----
*can be bad during pregnancy— teratogenic– deafness in infant
-month old infant presents with a three-day history of a mild respiratory tract infection with serous nasal discharge, fever of 38.5 C (101.4 F), and decreased appetite. Physical exam reveals a tachypneic infant with audible wheezing and a respiratory rate of 65. Flaring of the alae nasi, use of accessory muscles, and subcostal and intercostal retractions are noted. Expiratory wheezes are present.
acute bronchilolitis
caused by RSV
Bronchiolitis
- s/s
- mc age group
- MCC
- time of year
- how to dx **
- tx
s/s
- mild resp tract infection to severe
- serous nasal discharge
- fever
- decr appetite
- wheezing
- tachypnic
<2 YO
MCC=RSV
fall and winter
DX= nasal washing for RSV culture and antigen assay
CXR will show hyperinflation and peribronchial cuffing
tx
- supportive
- nasal suctioning
- humidified oxy —– only tx demonstrated to improve!!! ****
- antipyretics
CXR shows hyperinflation and peribronchial cuffing
bronchiolitis aka RSV
indications for hospitalization for bronchiolitis
- spo2 under 95 % RA
- toxic apperance—poor feeding, lethargic, dehydrated
- mod-sev resp distress: nasal falring, retractions, RR >70, cyanosis
- apnea
- parents unable to take care for them at home
MCC of lower resp tract infections in kids
RSV
s.s Rhinorrhea Wheezing and coughing can persist for several months Low-grade fever Nasal flaring and retractions Nail Bed cyanosis
when do we give Palivizumab prophylaxis
speical populations
once per month for 5 months beg in november
what is MC in a hhistory for pt with asthma
eczema and seasonal rhinitis
pt is taking deep slow breaths to try and catch his breath. He has diminished breath sounds in all lung fields with prolonged, expiratory wheezes.
cute asthma
lack of wheezing in an acute asthma attack means
IMPEDING RESP FAILURE
EMERGNECY
dx for asthma
GOLD STANDARD= peak expiratory flow rate
Spirometry with pre and post-therapy (albuterol inhalation) readings
Decreased FEV1/FVC (75-80%)
> 10% increase of FEV1 with bronchodilator therapy
croup
*steeple sign
croup
- bug
- age group
- tx
parainfluzena virus
6MO-3yrs— winter months
steeple sign on PA CXR
**narrowing of the trachea in subglottic region
mild=supporitve with air humidifier and antipyreitcs
severe= IVF and neb recemic epi, steroids
Cystic fibrosis— transmission + patho
- maintenance tx
- extra pulm complications
- bugs invovled
autosomal recessive
gene mutation on CFTR gene —cystic fibrosis transmembrane conductance receptor—>leads to abnormal chloride and water transport across exocrine glands— causing thick and viscous secretions of lungs, pancreas, sinuses, intestines, liver and GU tract
EXOCRINE LGLANDS*
MC in whites
maintenance= chest physio, high fat diet, supplement fat soluble vits A, D E K, pancreatic enzyme replacement,
acute exacerbations- ABX like. macrolides
**can cause pancreatitis and steatorrhea– why we need to supp fat sol vits
mean survival about 31
***Initially in the first few months of life, respiratory infection is common with staphylococcus aureus and Haemophilus influenzae
After that pseudomonas aeruginosa becomes the major causative organism for infections
a 4-year-old boy with unilateral purulent, foul-smelling nasal discharge for three days. The child has no other respiratory symptoms.
FB
tx for FB in bronchus
bronchoscope
- rigid bronchoscopy pref in kids
- flexible bronchoscope in adults
tx for FB In nose
before removing— use oxymetazoline drops to shrink mucous membrane
what to do with insect before removal in ear
drown it/immobilize it with mineral oil or viscous lidocaine
hyaline membrane disease
- another name
- age
- dx and finding
- tx
ALSO CALLED NEWBORN RESPIRATORY DISTRESS SYNDROME
*premature infants— under 30 weeks gestation– born before the lungs are producing enough surfactant– this helps prevent lungs to collapse—atelectasis and poor lung compliance
CXR– ground class apperance and diffuse bilateral atelectasis and air bronchograms
tx
- betamethasone IM x2
- aritifiical surfactant via ETT
- intubtion with PP
MCC of respiratory disease in preterm infant
hyaline membrane disease
ground glass apperance on cxr
hyaline membrane disease
when does surfactant production begin
24 weeks
cold hemagglutinin titer is elevated
mycoplasma pnemonia
PE findings for typical pneumonia
atypical
signs of consolidation: dullness to percussion, bronchial breath sounds, increase tactile fremitus, egophony, crackles/rales,
atypical will have no pulm PE findings
who does mycoplasma pneumonia usually affect
- s.s
- comps
- dx
young teens living in dorms aka walking pnma
RF= young healthy school aged kids, college students
S/S:
Extra pulonary: URI prodrome with pharyngtis— followed by persistent dry non prod cough—PE normal
*bullous myringitis—blisters on TM—-rare
*COMPS= SJS, TEN, erythema multirforem, cold autoimmune hemoltic anemia IgM
DX
+ cold hemagluttiin titer —PCR is TOC
CXR= atypical pattern—reticulonodular pattern MC
tx
- macrolides—Azitrho
- doxycycline
- *LACKS CELL WALL SO RESISTENT TO BETA LACTAMS
viral pnemonia– mcc
and s/s
RSV
fever, nonprod cough, otalgia, anorexia, dyspnea. wheeze, rale and rhonchi
OTHER COMMOM CAUSE OF VIRAL = parainfluenxa virus
tx for RSV pnemonia
Ribavirin only effective antiviral tx
Causes for CAP
1st MC
2nd MC
1st = strep pneumoniae 2nd= Haemophilis influenzae --- <6 YO can get very sick --- gram - rod
outpt tx and inpt tx for bacterial pnemoniae
OUTPATIENT=doxy, macrolides**
INPT= cefrtri + azitrhomycin/respiratory floruo
s/s of RSV
Rhinorrhea, wheezing/coughing that persists for months, low-grade fever, nasal flaring/retractions, nail bed cyanosis
rheumatic fever affects what valve
MC?
2nd?
MC= mitral valve—- stenosis
2nd=aortic valvue
3rd= tri
what causes rheumatic fever
peak incidence
dx
tx
follows strep infection with GABH strep — 2-4 weeks after
M protein is most virulent factor for GABH strep—> anti-M antibodies against the strep infection that cross react with heart tissue
5-15 YO
dx= ASO + titer
jones criteria
2 major or 1 major 2 minor
tx
- PCN
- ASA
Jones Criteria
major
minor
*need two major or 1 major and 2 minor req for dx
MAJOR carditis chorea erythema marginatum polyarthritis subcutaneous nodules
MINOR arthralgia elevated ESR or CRP fever prolong PR leukocytosis
what is commonly seen with coarcttion of aorta
bicuspid valve—- increase incidence of cerebral berry anerurysms too
tx for coarcation of aorta
prostaglandins E1
surgical repaiar
hypertrophic cardiomyopathy
-transmission
autosomal dominant
murmur due to HCM will increase in intensity with ___ and decrease intensity with____
anything that decrease blood volume in LV
INCREASES— standing or valsalva
DECREASES—squatting
tx for HCM
Beta-Blockers + Disopyramide (Norpace®)
Calcium channel blockers
Diuretics should be avoided
a lasting fever is the first sign of
kawasaki
s/s of kawasaki
CRASH and BURN (fever)
C--conjunctival injection--spares limbus R---rash all over body--flakes A--- adenopathy S--- strawbery tongue H--- hand and foot rash
Fever— 5+ days doesnt resolve with antipyretics
cardiac sequelase of kawaski
Coronary artery aneurysm– 25%
myocarditis
mi
5 days or more of high fever; arthritis may be reported
Bilateral non-purulent conjunctival injection
Erythematous morbilliform rash with desquamation on the trunk that may spread
red tongue and or cracked lips
kawasaki
DX for kawasaki *****
four of five CRASH symptoms + high fever lasting 5 days
-vasculitis in coronary arteries= definitive sign
LABS
*incr inflam markers—- CRP, ESR, incr plats, incr wbc
ECHO
*at the time of diagnosis and again at 6-8 wks after dx
machine like murmur
PDA
rough and continuous murmur
pda
what wil close a PDA
prostaglandin E-2 inhibitors— bc the prostaglandings keep the PDA open
so NSAIDs are tx
why are NSAIDs contraindicated in pregnancy
bc it keeps PDA open
tx for PDA
indomethacin aka NSAIDs
what makes up tetrollogy of fallot
PROVe
P— pulmonary stenosis
R—right ventric hypertrophy
O— overriding aorta
V—-ventricular septa defect
cxr shows boot shaped heart
tetrollagy of fallot
Difficult feeding, failure to thrive. “tet spells” ⇒ a baby with cyanosis and loss of consciousness with crying
tetrollagy of fallot
mc pathologic murmur in childhoood
VSD
RLQ pain with internal rotation of hip
obturator
RLQ pain with hip extension
psoas
rules of 3 for colic
3 hrs/day
3 days/wk
for 3 months
define constipation
<2 BM per week
>1 episode of encopresis per week—- poop in rectum, loose stool leaks
diagnosis for constipation
ROME III
*at least 2 of the following < 4YO:
- two or fewer BM per week
- at least one episode of incontinence per week after potty training
- hx of excessive stool retention
- hx of painful or hard BM
- large fecal mass in rectum
- hx of large diameter stools that may obstruct toilet
sunken eyes
dry mucous mems
generalized skin hyperpigmentation
dehydration
define dehydration
-mild
mod
severe
mild= 3-5%
mod=6-9%
severe= >10%
the most accurate signs of moderate or severe dehydration are
prolong cap refill
poor skin tugor
abnormal breathing
**others– sunken eyes, decr activity, lack of tears, dry mouth
AXR shows double bubble apperance with total absence of distal bowel gas
duodenal atresia
what can duodenal atresia cause in pregnancy
polyhydraminos— incrs aminotic fluid
increased assoc of duodenal atreis with?
down’s syndrome
early biliary vomiting in newborn
duodenal atresia
encopresis define
Fecal incontinence, also known as encopresis or soiling, refers to the repetitive, voluntary or involuntary, passage of stool in inappropriate places by children four years of age and older, at which time a child may be reasonably expected to have completed toilet training and exercise bowel control.
encopresis is always assoc with
severe constipation
M> F
what would be radio-lucent on xray in terms of FB
wood
plastic
glass
fish/chicken bones
what would be radio-opaqe on xray in terms of FB
coins, screws, button batteries, small toy parts
what is indicated for all PTs with suspected inhaled FB
bronchoscopy– diagnostic and therapeutic—even if CXR is normal
what to do if acid or alkali ingested
DO NOT induce emesis
ABCs
edoscopy 2-3 weeks later to assess damage
MCC gastroenteritis
rotavirus
_________ occurs in 1% of people following infections with Campylobacter species
Reactive arthritis
comps from GERD
ailure to thrive, aspiration pneumonia, esophagitis, choking or apneic episodes, hematemesis, anemia, and fussiness
MCC of GERD
overfeeeding—-
GERD health maintenanc
INFANTS-small frequent feedings in upright positioin and kept prone head up for at least 20 mins post meals
feeds can be thickened with cereal
eliminate cows milk protein
older kids—small frequent meals, eat slowly, maintain upright position after meals and avoid eating after 7 pm
–PPIs if needed
mcc of cholestasis in newborn
hepatitis
*idiopathic
tx neonatal hepatitis
-genreally self limiting
full recovery during infancy up to 70%
- incr nutritinoal
- fat sol vitamins a d e k
which strains of hepatitis mc in kids
a and b
precense of ____ confirms diagnosis of HAV
anti-HAV IgM
HCV Antibody is present in?
acute and chronic infection
+ HBsAG
active HBV
*antigen used in vaccine
+ HBV surface antibody
vaccinated
or
natural infection
+ core antibody HBV
only can get from natural infection—- not from vaccination — and persists lifelong
+ HBV e antigen
rises early in active infection
Infants of infected mothers should receive
both vaccine AND HBV immunoglobulin at delivery
2-week-old boy with constipation. His mother reports that he has not had a bowel movement for over 5 days and is quite concerned. On further examination, you discover that the boy is in the 5th percentile for weight. Physical examination shows a distended abdomen. Rectal examination shows an absence of stool in the rectal vault. A contrast enema reveals dilated loops of bowel and megacolon
hirschsprung dz
hirschsprung dz
-cause
- caused by lack of caudual migration of ganglion cells from neural crest
- causes obstruction with proximal dilation
Absent plexuses (regulate bowel function) → intestine muscles permanently constricted → passing stool difficult, impossible
5x more freq in males
80% have fam hx
inability to pass meconium 48 hrs PP
Hirschsprung dz
**this is the first sign
OTHER s/s = constipation, vomiting and abd distention
DX for hirschsprung dz
tx
Rectal suction biopsy—- shows absence or paucity of ganglion cells
TX= resection of affected segment or colostomy
which is mc– indirect or direct
INDIRECT
indirect
-describe
Passage of intestine through the internal inguinal ring down the inguinal canal, may pass into the scrotum. Often congenital and will present before age one
**** I for an I—> indirect goes THRU inguinal ring
direct inguinal
-describe
Passage of intestine through the external inguinal ring at Hesselbach triangle, rarely enters the scrotum
bloody with mucous stool
intussusception
*****currant jelly
Sausage shaped abd mass in RUQ
intussusception
intussucueption
- peak incidence
- can happen in kids after?
5-9 MO
-can occur in kids after viral infection
MCC of bowel obstruction in neonatal period <2 yrs
intussusception
Previously healthy infants or children may present with sudden onset of crampy or colicky abdominal pain. The pain often occurs in intervals followed by periods of calm. Infants may cry and draw their legs toward the chest
intussucpetoin
DX and TX for intussusception
barium enema
-both diagnosic and therapeutic
ab xr shows crescent sign
intussuception
ab xr shows target sign
intussception
neonatal jaundice appers when bilirubin is greater than?
2
explain physiologic jaundice
unconjugated hyperbili appearing 24 hrs after birth in infant with NO s/s– and total bili rises sloewr than 0.2 mg/dL per hour— or 5 mg/dL per day—— reamins UNDER 18……. resolves within 1 week for FT infant or wihtin 2 weeks for preterm
**PHYSIOLOGIC JAUNDIC
define pathologic jaundice
unconjugated hyperbili appers wtihit first 24 hrs after birth or infant shows s/s of illness– orr if total bili rises faster than 0.2 per hr or 5 per day or becomes > 18 OR lasts more than 1 wk for FT and >2 wks for preterm
**prehepatic cause
borborygmi
rumbling of stomach
**lactose intol
what supplemet might lactose intol pt need
calcium
def diangnossis for lac intol
lactose hydrogen test
**The hydrogen breath test is positive for lactose malabsorption if the post lactose breath hydrogen value rises greater than 20 ppm over the baseline measurement
niacin
B3
niacin deficiency causes
pelagra— means raw skin
Pelagra s/s
- photosensitive pigmented dermatitis—— mc in sun exposed skin areas
- diarrhea–sometimes vom
- dementia–someitmes also anxiety, disorientation
- progress to death
PE
- wide stance gait
- unstable on feeet
- easily sunburns
causes of pelagra
diets low in tryptophan or niacin—– corn staple diets
how to assess niacin status
measure urinary N-methylnicotinamide or erythrocyte NAD: NADP ratio
pelagra tx
RDA for niacin is 6 to 12 mg daily in children, 16 mg for adult males, and 14 mg daily for nonpregnant adult females
projectile vom after feedings
pyloric stenosis
pyloric stenosis
- can cause
- age
- dx
- labs
- tx
- projecticle vom
- met alkalosis
- dehydration
<3 MO
DX= US —– will show double track
-can also do barium studies—- string sign
LABS— hypochloremic, hypokalemic, met alkalosis sec to dehydration
TX=pyloromyotomy (Ramstedt’s procedure)
at what age is the umbilical ring completely closed
by age 5
when to refer for surgery for umbilical hernia
if persists >2 yrs of life
causes of VIT A def
inadequre intake fat malabsoprtion (foul smelling feces) liver disorders
s/s of vit A def
dry skin/ rashes
ocular effects— dry eyes or **NIGHTTIME Blindness
foul smelling feces/diarrhea from fat malabsoprtion
retinol
vit A
dx of VIT a
retionl levels under 20 micrograms/ dL
vit C deficiency s/s
swollen, bleeding gums bruising petechiae hemarthrosis anemia poor wound healing perifollicular and subperiosteal hemorrhage corkscrew hair
rickets causes
bones to soften–>bowed legs, fxs, costochondral thickening
populations that are more prone to rickets
- darker skin
* exclusively BF beyond 3 to 6 MO
epicanthal folds, a broad nasal bridge, a large tongue, small ears, hypertelorism, Brushfield spots, a single palmar crease on each hand, and a harsh holosystolic murmur.
downs
chromosme affected in down’s
21
Most common issues for those affected with Down’s Syndrome
- ***septal defects b/w atria
- ***sterility in men
duodnel atresia
incr risk for leukemia
alzhemier dz
dz for down’s
-prenantal
PRENANTAL US= nuchal translucency and hypoplastic nasal bone (wks 11-14) first tri
labs prenatal–>chorionic villus sampling/amniocentesis
amniocentesis
-performed when
15th week or preg or later
this has less risk than chorionic villus sampling
indicated in moms >35 YO
chorionic villus sampling
-done when
10-12th week
**placental tissue sample is retrieved via vagina and cervix
-more risk to fetus
inds for mom >35 YO
when is the quad prenantal screen done
15th adn 22nd week
looks for four specific substances: AFP, hCG, estriol, inhibin-A
Hep B vaccine dosing
First dose within the first 24 hours of life
Second dose at 1-2 months of age
Third dose at 6-18 months of age
Rotavirus dosing
First dose at 2 months
Second dose at 4 months
Third dose at 6 months
DTAP
First dose at 2 months
Second dose at 4 months
Third dose at 6 months
Fourth dose at 15-18 months
Fifth dose at 4-6 years of age
Booster doses are given starting at 11 years of age
HIB dosing
first at 2 MO
second at 4 MO
third at 12-15 MO
PCV 13 dosing
2 mO
4 MO
6 MO
12-15 MO
Polio dosing
2 MO
4 MO
6-18 MO
4-6 YO
MMR dosing
12-15 MO
4-6 YO
Varicella dosing
12-15 MO
4-6 YO
Hep a dosing
12-24 MO
2nd dose at least 6 MO after first
TDAP
11-12 YO
HPV
two doses at 9-14 YO
**doses are 6-12 MO apart
three doses after 15 YO
0
1-2
6
meningococcal
11-12 YO
16 YO
when does moro reflex go away
3 mo
HA, fever and stiff neck (nuchal rigidity)
meningitis
MCC of meninigitis
viral
knee extension causes pain in neck
Kernig
Leg raise when bending neck
Brudzinski sign
Bacterial etiologies for meningitis in
-neonate
viral etiologies
neonate= E coli and S. agalactae (GB strep)
viral= enteroviruses— mc late summer to early fall– can also be caused by HSV, mumps, west nile
spinal tap finding for
- bacterial men
- viral men
bacterial = incr protein, decr glucose
viral=no specific charactersitics
tx for bacterial meningitis
*household contacts tx with?
dexamethasone + IV ABX — ceftri, vanco*
**vanco + rocepfin + ampicillin
household contacts tx with rifampin
tx for focal seizrues
phenytoin
carbamazepine
list types of generalized seizures
absence tonic cloinc atonic clonic tonic myocloinc
tx for absence or petit mal
ethosuximide
or
valpric acid
tx for grand mal or partial focal seizures
carbamazepine
phenobarb
phenytoin
define SE
a seizure lasting >5 mins OR two or more seizures in a five min period without person reutnirng to baseline
what is the preferred initial treatment for SE
-what is given next
lorazepam
next is phenytoin
when does teething occur
6-24 MO
what not to give for teething
Avoid over-the-counter (including homeopathic remedies) or prescription-strength topical analgesics (eg, lidocaine, benzocaine) for teething pain
CAN GIVE tylenol or advil if fussy
first dental appointment should be when
1 yo
delayed menses
short stature
wide torso
tanner stage 1 for a teenager
tanner syndrome
genetics behind tuner syndrome
missing X chromosome in famles
45XO
MCC of primary amenorrhea
turner syndrome
low anti-Mullerian hormone
turner
tx for turner
growth hormone tx
sex hormone replacement
tx for turner
growth hormone tx
sex hormone replacement
tx for GAD
SSRIs— paroxetine and escitalopram
SNRI—Venlafaxine
Busprione— but takes 2 weeks for effects to work
benzos= short term tx and BB
therapy
tx for panic disorder
SSRI**** paroxetine, sertraline, fluoxetine
benzos for acute attack
CBT
first line tx for phobias
exposure therapy
SSRI + CBT
benzos- ex prior to flying
treat agoraphobiga jsut like GAB with SSRI and CBT
tx for dystonic rxn
diphenhydramine and benztropine
tx for ADHD
- 1st lines
- 2 lines
FIRST LINES = STIMULANTS
Methylphenidate—- Ritalin, Concerta, Daytrana
Dexmethylphenidate (Focalin)
Amphetamine/dextroamphetamine— Adderal/Dexedrine
SECOND LINE/adjuncts
Antidepressants (guanfacine, clonidine, imipramine, bupropion, venlafaxine)
behavioral mod, fam, edu management
some medication tx for autism
second gen antipsychotics (risperidone, aripiprazole) for aggression/hyperactivity, mood lability, can also use haldol and carbamazepine
SSRIs for sterotyped/repetitive behavior
tx for major depressive disroder
Treatment:
SSRIs are the first-line treatment
Continue to increase dosage q 3–4 wks until symptoms in remission
The full medication effect is complete in 4–6 weeks
Augmentation with 2nd medication may be necessary
See within 2–4 weeks of starting medication and q2wk until improvement, then monthly to monitor medication changes
depressive symptoms for >2 years is called
persistent depressive disorder
what is precursor to antisocial personality disorder
conduct disorder
conduct disorder vs antisocial personality disorder
conduct disorder= under 18
antisocial = over 18
oppositional defiant disorder
less intense form of conduct disorder
-children who develop with chronic behavior are at risk for condut disorer
MC in boys— problems worse at school
pattern of angry/irritable mood, argumentative/defiant disorder, or vindictiveness lasting at least 6 MO as evidnedced by four of the following
Frequent temper tantrums Arguments with adults and authority figures. Does not conform to rules and regulation Intentional exasperation of others Easily annoyed by others. Revenge-seeking & vindictiveness Angry attitude Harsh and unkind.
**conduct disorder you are aggressive to aniamls and humans, destroy property, show pattern of theft or deceit
intense fear of beocming fat— even tho you are underweight
anorexia
weight is <85% of ideal body weight
anorexia
a 17-year-old female who is in your office for an annual sports physical. She is the star of her high school track team. She has not menstruated for 5 months. Her BMI is 15 kg/m2. On physical exam, you note calluses on the back of her hands and fine hair on her arms. She states that she only eats vegetables but has been trying to cut back as she thinks she is holding excess body fat.
anorexia
differentiate anorexia from bulemia
BMI < 17 or body weight <85% of ideal weight= anorexia
highest suicide rate of eating disorders
anorexia
two types of anorexia
- binging/purging
- laxative use/diuretic use
- excessive exercise - restricting
- eat little
- exercise to excess
when do you hospitalize anorexia
if weight is under 75% expected body weight
scars on knuckles, swollen parotid glands + dental erosions + normal weight +hypokalemia
bulemia
tx for bulemia
-restore nutritional state
Fluoxetine 60 mg PO—- 60 mg– higher dose than used for depression
seocond line= TCA, MAOIs
therapy
what is second leading cause of death in 15-19 YO
suicide
what is second leading cause of death in 15-19 YO
suicide w
what is second leading cause of death in 15-19 YO
suicide
limp and knee pain shorter kid pain worse after sports exacerbated by internal rotation of hip Pain can be very bad that pt refuses to walk
avasc necrosis of proximal femur
hip XR shows left proximal femoral epiphysis to be misshapen and more horizontal than the unaffected hip
-femoral head can appear collapsed
avasc necrosis of proximal femur
insidious onset of dull ache or throbbing localized pain to groin, lateral hip or butt
MC affecting one hip
asvasc necrosis of proximal femur
another name for AVN in kids
legg-calve perthes disease
persistent pain and a limp
AVN / leg calve perthes disease
Diagnostic TOC for AVN
MRI
7-17 YO obese male during a growth spurt
+limp
+knee pain with external rotation of affected leg
SCFE
main diff b.w AVN and SCFE
AVN = YOUNGER PATIENTS—- 2-11 YO with peak incidnece at 4-8
**pain with internal rotation
SCFE– OLDER— 7-16 YO and OBESE—–pain with external rotation
DX for SCFE
AP and frog leg lateral XR
**lateral radiograph is best way to identify a subtle slip
xr negative– then do MRI
tx for congenital hip dysplasia
< 6 MO
6-15 MO
15-24 MO
< 6 MO = pavlik harness (abducting bracing)
6-15 MO hip spica cast
15-24 MO= Open reduction then hip spica cast
Juvenille idiopathic athritis starts at or before
age 16
mc form of JIA
oligoarticular JIA – affects young girls– <4 joints
tx for JIA
NSAIDs, intra-articular corticosteroids, and disease-modifying antirheumatic drugs - methotrexate
progrssively worsening pain at night— bone swelling or joint swelling
osteosarcoma
xr= hair on end apperance or sun ray/burst
mc site of mets for osteosarcoma
-age range
lungs
then bone
kids 10-14 YO
pain of bone/joint with fever
palpable mass over joint, swelling, local tenderness
5-25 YO
ewing’s sarcoma
XR shows lytic lesion… onion skin apperance
ewing
MC benign bone tumor in 10-20 YO
osteochondroma
xr shows pedunculate or sessile lesions found on the surface of bones
osteochondroma
nursemaid elbow tx
The supination-flexion technique is the classic method of reducing a subluxed radial head. It has a success rate of 80-92%
Always ensure the child spontaneously uses the arm after reduction before discharging to confirm success
tibial tubercle is pronounced and tenderess to palpation over tibial tubercle
osgood-schlatter
osgood-schlatter age range
mc in 9-14 YO doing sports or rapid growth spurt
tx for osgood
TX: consists of reducing physical activity, applying ice to the tuberosity to reduce swelling, physical therapy, as well as short term NSAIDs
surgery if conservative fials for pt with closed growth plates
tx for radial head subluxation
supination-flexion technique
adams forward bending asymmetry in scapular height noted
scoliosis
define scoliosis
cobb angle > 10 +
MC ednocrine illness in kids
insulin dep DM
dx of DM
-gs?
- random BGL > 200 + DM s/s
- two separate fasting (8 hours) gluclose levels of >126
- GS= two hour plasma glucose of >200 on an oral glucose tolerance test (3 hr GTT)
- A1C > 6.5
DM TX
1
2
1= intensive insulin therapy—- basal level of insulin + premeal boluses of rapid acting insulin
*** MDI== multiple daily injfections– consistes of injections of long acting insulin once or twice daily and a rapid short acting insuin b4 meals/snacks
OR
**insulin pump–continuous subcu infusion of rapid or short acting insulin — supplemented with boluses at meal time/snacks
High fasting insulin and C-peptide levels suggest
dm 2
presence of prolonged candidal infection should prompt consideration of diabetes mellitus in a PT <2 Y
consider dm
target A1C for dm pt
<7.5
most causes of hyperthyroid in kids is from
graves dz
tx for graves
tx for neonatal graves
propylthiouracil
methimazole *** has less SE
radioiodine
neonatal= propranolol +/- methimazole
-most cases remit within 2-3 mo
mcc of juvenile or acquired hypothyroid
hashimotos
congenital hypothyroid also called
cretinism
hypotonia, lethargy, macroglossia, large fontanelles and dry skin in infant
cretinism— aka congenital hypothyroid
when do most children present with s/s of hashimoto
5 yrs and older
**unusual to present before 5
tx for hashimoto
levothyroxine
CHILD + Lymphadenopathy + bone pain + bleeding + fever in a CHILD, bone marrow > 20% blasts in bone marrow
acute lymphocytic leukemia (ALL)
dx for
acute lymphocytic leukemia
bone marrow with >20% blasts
ANC <1000
painless cervical or supraclavicular lymphadenopathy
hodgkin lymphoma
**Upper boddy lymph nodes— neck, axilla, shoulder, chest
weight loss >10%, temp > 38C and night sweaths
B symptoms of hodgkin lymphoma
what is assoc with 40% of pt with hodgin lymhoma
EBV
tx for lead poisoning
Dimercaprol
CaNaEDTA
chelation therapy if levels are over 45
cyrptochordism
define
tx
failure of testicles to descene– both or one
tx= orchiopexy by age 1 *******
correct ASAP after 4 MO
tx for cystitis
cephalosporin for 14 days first line PO—– Keflex for low risk renal involvement OR cefuroxime, cefdinir etc for those with higher likehood of renal invovleet
enuresis
- define
- dx
invol loss of urine in kid >5 YO
DX
- first r.o infection with UA and urine culture
- full hsitory
tx for enuresis
- nighttime audio alarm
MEDS= desmopressin acetate (DDAVP)
glomerulonephritis
-halmark s/s
hallmark= hematuria
postinfectious— group A strep infection– skin or throat
urethral meatus is found located proximal to the tip of the glans on the ventral aspect of the penile shaft.
hypospadias—– urethra opens onto the bottom aka underside of penis
more common than epispadias
ntrapment of the foreskin in the retracted position
paraphimosis
emergency
Lifting of the affected testicle does not relieve pain and there is a loss of a cremasteric reflex.
testicular torsion
negative phren sign
- describe it
- dx
testicular torsion
—lifting of testicle does not relieve pain
urologic emergencies
paraphimosis
torsion
young female patient with recurrent cystitis or pyelonephritis trigger eval for what diseae?
vesiculoreteral reflux
tx for diaper candiasis
nystatin, clotrimazole, econazole x2 weeks
satellite lesions
diaper candiasis
a 9-year-old girl with multiple lesions on her hands and feet. She reports that these are not painful or itchy, but they are very embarrassing. Her best friend will no longer hold her hand and refuses to come to her house for a sleepover. Her past medical history includes atopic dermatitis. On physical exam, she has multiple 4-5 mm flesh-colored, sharply demarcated, rough, round, and firm nodules on her hands and feet.
verrucae
first line tx for utricaria
allegra claritin carinex zytrec
2nd gen
peds epi dose for anaphylaxis
0.01 mg/kg SC or IV
widespread rash composed of blanchable, edematous, pink, papules, and wheels on the face, trunk, and lower extremities
urticaria
TEN is over ____% of body
30
main diff b/w TEN and SJS
TEN= older patients and 30% of body affected
SJS= younger pt and <10% affected
dx for celiac
IgA antiendomysial (EMA) and antitissue transglutaminase (anti-tTG) antibodies.
Tissue Transglutaminase Antibodies—- + in 98% patients
IgA Endomsysial antibody– almost 100% specificity but not as sensitive as the one above
*Endoscopic intestinal mucosal biopsy of the proximal duodenum (bulb) and distal duodenum is the standard method for confirmation of the diagnosis in patients with a positive serologic test (IgA endomysial antibody) for celiac disease.
DX KOH
- long branching fungal hyphae with septations
- budding yeast and pseudohyphae
- short hyphae and clusters or spores– “sphagetti and meatballs”
- dermatophyte
- candidia
- tinea
MC fungal infection in peds
tinea capitis
tx for tinea capitis
PO griseofulvin– DOC
+
topical therapy with selenium sulfide or ketoconazole shampoo
Lesions consist of hypo or hyperpigmented macules that do not tan
tinea versicolor
tx for tinea versicolor
Selenium sulfide 2.5% to skin for 10 mins– then wash off
what medicaiton is not effective to treat dermatophyte infections
Nystatin
AKA ANY TINEA INFECTION DO NOT TREAT WITH NYSTATIN
purplish, itchy, flat-topped bumps. On mucous membranes, such as in the mouth, it forms lacy white patches, sometimes with painful sores
lichen planus
purple papule polygonal pruritis planar
lichen planus
tx for lichen planus
topical steroids
impetigo
-tx
- topical bactroban (mupirocin) x 5 days
warm water soaks 15-20 min before abx
bright red rash
measles aka rubeola
only childhood exanthem that starts on the trunk and spreads to the face
roseola aka sixth disease
type of hypersensitivity erythema multiforme
4
MCC erythema multiforme
infection
HSV
mycoplasma pneumonia
URI
target “iris” lesions
dull “violet red”
multiforme
Macules, vesicles, central bullae with pale red rim and peripheral red halo
multiforme
blanching and lack of itchiness
multiforme
raised, papular, target lesions and dusky center
multiforme
annular lesion
urticaria
what bleeding disorder presents with prolonged pTT and normal platelet count
-tx
hemophilia A
-Factor VIII concentrate or ccryoprecipitate
infant will ____ their birth weight by 1 yr
triple
5-day history of fever, erythema, edema of the hands and feet, a generalized rash over the body, bilateral conjunctival injections, fissuring and erythema of the lips, and cervical adenopathy
kawasaki
The rooting reflex starts to disappear at about ____ of age.
2-3 MO
moro reflex is gone by what age
4-5 MO
tx for torus or buckle fracture of disal radius
ace wrap or anterior splinting
**very stable fx occuring fter fall on hand
____is the definitive test to diagnose spina bifida occulta
xray or mri
abx of choice for epiglottitis
ceftriaxone or cefotaxime
Homocystinuria is a disorder of amino acid metabolism and is best treated with
high dose vit b6
what GI disorder is diagnosed in the frirst day of life
duodenal atresia
The side effects of the psychostimulants
wt loss
anorexia
sleep disturbances
he preferred method of prophylaxis for rheumatic fever
Benzathine pen G evry 4 wks
___ is the treatment of choice for an infant with Chlamydial pneumonia.
erythromycin
or
sulfisoxazole
which bone CA in kids has pain relived with ASA and pain is worse at night.
osteoid osteoma
alternative for tx of strep if PCN allergic
erythromycin
we do not use _____ in kids for epistaxis because ___
silver nitrate
-incrs risk of nasal septal perforation
reye syndrome is a complication of
influenza— also assoc with ASA use in viral infections
fetal alcohol syndrome can cause
low brith weight
extensive bullous impetigo tx
penicillinase resistant abx—- dicloaxcillin
characterized by an abrupt onset of fever that ceases upon the onset of the maculopapular rash.
roseola
Patients with sickle cell disease should receive prophylactic
penicillin V starting at 2 months of age and folic acid starting at 1 year of age.
