Peds Flashcards
Tourette
Age, Comorbidities, Tx
Age: 6-15
Comorbidities: ADHD, OCD
Tx: CBT (habit reversal therapy)
1st line: Risperidone, Aripiprazole (2nd gen antipsychotic )
Conjunctivitis
Viral vs Bacterial vs Allergic
Sx, Bugs, Drugs
Comp of bacterial
Viral:
- Unilateral and bilateral, last 1-2 weeks, watery mucoid discharge, viral prodrome, sandy/burning eyes
- Bugs: Adenovirus
- Tx: supportive care
Bacterial:
- Unilateral and bilateral, last 1-2 weeks, purulent discharge, unremitting ocular discharge, isolated sx
–CONTAGIOUS D/T LARGE AMOUNT OF VIRUS IN DISCHARGE–
- Bug: Staph Aureus, Strep pneumo, Moraxella, H. Influenza –> Erythromycin ointment or polymyxin-trimethoprim drops
- Bugs: Pseudomonas (contact lens) –> Fluoroquinolone drops
Comp: Keratitis (inflammation of the cornea) –> photophobia, blurry vision, foreign body sensation. Dx: slit lamp exam. Can lead to scarring and blindness if not treated correctly.
Allergic:
- Always b/l, <30min - yearly, watery, ocular itching
- Airborn allergens
- Tx: Antihistamine plus decongestant or mast cell stabilizer drops
Spinal deformity
Kyphosis (2 types), Scoliosis (red flags)
Kyphosis: forward curvature of convexity of thoracic spine.
- Postural kyphosis: A “hump” that is easily corrected by back extension or lying supine. Convexity is typically 20-40 degrees. Asx
- Structural kyphosis: does not correct. Back pain. Must exclude more serious causes.
Tx with special exercises. Back brace or surgery is used for chronic pain or if convexity >60 degrees.
Scoliosis: Lateral S-shaped curvature
Red flags: Back pain, neurological sx, Rapid progressing curvature (>10degrees each year), vertebral anomalies)
Once skeletal maturity is reached, tx is unnecessary. No follow-up needed with Cobb angle <40
Sickle cell
Prevent, Tx ,CI
Acute chest syndrome tx
Sickle cell trait
Prevent: Hydroxyurea
Tx: NSAIDs, oral opiate (oxycodone, hydromorphone) then IV opiate (morphine), Hydration, Heat compress RBC transfusion
CI: cold compress, codeine and tramadol (<12 d/t risk of respiratory depression and death with rapid metabolism)
Acute chest tx:
Sx: >1 of the following: fever, hypoxemia, CP and respiratory distress
Tx: CTX & Azithromycin
Sickle cell trait
HbA:HbS ratio 60:40
Slipped Capital Femoral Epiphysis
Tx
Tx: Surgical pinning
Comp: Delay within >24hrs in unstable SCFE –> avascular necrosis, femoroacetabular impingement, osteoarthritis
Congenital Hypothyroidism
Sx <1 vs after, Tx,Comp
Lack signs initially d/t maternal T4 crossing placenta.
Age < 1month: jaundice, poor feeding, hypothermia
Age 1-4mo: failure to thrive, constipation
Dx: newborn screening, High TSH and low T4
Tx: Start levothyroxine immediately, US of thyroid. Excellent prognosis if started by 2 weeks old
Comp: Permanent neuro defects w/o tx
Minimal change disease
Labs, Dx, Tx, Prognosis, no remission? what to do next
Lab: Low albumin, high cholesterol, proteinuria
Dx: Clinical
Tx: steroids
Prognosis:
- Remission but relapse is common
- Low risk of CKD
- Must monitor for proteinuria
If remission does not occur –> biopsy
Congenital Adrenal Hyperplasia and other differentials
Central vs peripheral precocious puberty causes
Non-classical CAH
Idiopathic premature pubarche
Precocious puberty: onset of secondary sex characteristics in boys <9 and girls <8
1. Central precocious puberty: early maturation of hypothalamic-pituitary-gonadal axis –> tarts with breast and testicular growth
2. Peripheral precocious puberty: excess sex hormone production –> acne and early pubic hair
- Non-classical CAH: Low 21 hydroxylase –> elevated17 hydroxyprogesterone. Advanced bone age and growth, early pubic hair, acne,
- Idiopathic premature pubarche: isolated pubic hair development.
Androgen Insensitivity
Genotype/Phenotype
Path, Presentation
Genotype: 46XY Phenotype: Female
In development, testes produce Anti-mullerian hormone and testosterone. AMH prevent production of female organs, and nonfunctioning androgen receptors prevent male external genitalia.
Breast development and female external genitalia, absent or minimal axillary or pubic hair, absent uterus, cervix, upper 1/3 vagina, Cryptorchid testes
Preseptal vs Orbital Cellulitis
RF, Micro, Dx, Tx
Preseptal
RF: Sinusitis but most commonly breaks in the skin
Micro: Staph aureus of Strep pyogenes
Tx: oral antibiotics
Orbital:
RF: Sinusitis
Micro: Strep Viridans , Strep pneumo, Strep aures, H influenza
Tx: IV Antibiotics (Ceftriaxon or amp - sulbactam, possible add vanco) + surgery if orbital abscess forms
Dx: CT orbits and sinuses
Septic Arthritis vs Transient synovitis
Septic: caused by bacterial infection –> hip pain, ill-appearing, febrile, can’t bear weight, elevated WBC and inflammatory markers.
Transient: preceding viral illness, age 3-8y/o, well appearing, afebrile, low-grade fever, limp but able to bear weight, restricted ROM, normal WBC and inflammatory markers, small effusion. Can have unilateral pain but b/l effusion.
Tx: supportive, NSAIDs, full recovery in 1-2 weeks
Henoch-Schonlein Purpura vs Hemolytic Uremic Syndrome
Sx, Labs, Tx
HSP aka IgA vasculitis
- Deposition of IgA, C3 and fibrin in small vessels
Sx:
- Can be preceded by URI
1. Begin as macules that coalesce into Palpable purpura/petechiae on lower extremities
2. Arthritis/arthralgia,
3. Abd pain/ intussusception
4. Renal disease (similar to IgA nephropathy)
- Can also have scrotal pain/swelling
Labs:
- Normal plt, coags, cr.
- High WBCc, ESR
- Hematuria and possible RBC cast and/or proteinuria
Hemolytic Uremic Syndrome
- Can be preceded by acute bloody diarrhea illness (EHEC or Shigella producing Shiga toxins)
1. Microangiopathic hemolytic anemia
2. thrombocytopenia
3. Acute renal failure
Tx: fluids, electrolyte management, blood transfusion, dialysis
Constipation
RF: solid food and cows milk, toilet training, school entry
Sx: painful/hard bowel movements, stool withholding, encopresis (passing stool in underwear)
Comp: anal fissures, hemorrhoids, enuresis (bedwetting), UTI
Tx:
1. Increase fiber/water intake, limit cow’s milk, 2. Osmotic laxative like lactulose that cause retention of fluid in gut –> softening of stool
3. Stimulant laxative that increase peristalsis
4. Suppositories/enemas
Enuresis
Cause:
Constipation
Bladder dysfunction
Urinary tract infections
Chronic kidney disease
Diabetes mellitus
Diabetes insipidus
Obstructive sleep apnea
ACNE
Tx line (1-5)
1st: Retinoids (salicylic, azelaic, glycolic acid)
2nd:Benzoyl peroxide
3rd: Topical abx (clindamycin, erythromycin)
4th: Oral abx (docycline, minocycline)
5th: Oral isoretinoin
