Peds Flashcards
Definition of Colic? When does this stop?
3hr for 3 d for 3 wk . Resolves in 4 months. Reassure
Ingestion protocol.
What if sx?
When to give charcoal? aa
Upper Gi endoscope w/in 24 hours - If sx after upper GI, Do a water barium in 2-3 days for followup.
Avoid NG lavage in all cases.
Avoid charcoal in all cases
EXCEPT TYLENOL - give charcoal .
Breast Milk
- For how long
- When and what to supplement?
Cows milk?
- What to supplement?
Breast milk - 6mo minimum, 1+ preferred.
Must supplement with Vit D.
Cows Milk - Causes Iron deficiency
Enuresis - when does it begin? When should it end?
First line in tx?
Occurs at 2 -> Goes on normally until ~5y.o.
After 5, consider
- Incontinence alarm
- DDAVP
Jaundice.
2 major timelines at birth. What are the causes?
- Dehydration - breast feeding failure.
- Can start within first days.
INC enterohepatic circulation and DEC blirubin excretion. - Breast milk jaundice - milk has HIGH lvl of bilirubin
Can start at 4 days and peaks at 2 wk.
Breath holding? What to do?
Check Ferritin and CBC - associated. If normal - reassure
Timeline of normal?
Separation anxiety
Stranger Anxiety
Separation - 9-18mo ok
Stranger - Up until 3y.o
H& W change by 1 year?
heigh INC by 50 percent,
Weight x3
What vaccines do you give at birth?
When do you give the rest?
Birth - Hep B
2 mo - Hep B x 2 , Rota, Tdap, Hflu, Pneumococus, Inactivated polio
When do start vision test?
3 y.o - similar timeline as stranger danger!
What is the ppx and t x for conjuncitivitis in neonate
timeline?
GC
CT
GC - 2-5 d
- ppx w topical erythromycin
- tx - IM/IV cefotaxime (NOT ceftriaxone!)
Chlamydia
- ppx is tx mom
- Tx - PO erythromycin
When is rotovirus contraindicated?
Intussusception, Meckles, SCID
GENERAL PRINCIPLES
B cell def
vs
T cell - when do they present? Tx?
After 6mo - Tx IVIG except IgA
T cell - 1-3 mo - Fungal viral intracelllualr bacteria
list 3 B cell def
X linked agamma - Tyrosine kinase
DEC/ABSENT B cells = Low Ig
Common Variable - Acquried - 20-30 y.o . INC risk of autoimmune conditinos and lymphoma. Normalish Cell count, DEC Ig
IgA - after viral/GI infection. Anaphylaxis to IgA/blood. Normal IgG, IgM
4 T cell def
Di george - DEC T Cell, PTH, Ca. FISH testing
IL -12 (AR) - DEC Th1 - Disseminated mycobacterial/fungal. DEC IFNgamma (Th1) . May occur after Anti-Tb vaccine
HyperIgE (Jobs - AD) - DEC Th17, DEC N! recruitment - FATED - Coarse facies, Abscess (Cold), Teeth (primary retained), IgE INC, Ezcema (Derm)
Cronic Mucocutaneous Candidiasis - T cell dysfunction - NO SYSTEMIC since B cells are fine.
4 types of Combined immunodef
SCID - AR - ADA
SCID XR - IL2,7. Absent thymic shadow, no GC, T cels. MUST IRRADIATE RBC in transfer
Ataxia- Telangiectasia - DNA breaks (ATM gene) - INC AFP, DEC IgA, G, E
Hyper IgM - XR - CD40L - class switch prblem - Pyogenic infections etc. INC IgM, DEC A, E, G
Wiskott Aldrich - XR - WAS gene - T cell actin cytoskeleton - Thrombocytopenia (small), Eczema, Infections. INC autoimmune risk . INC IgE,A, DEC IgG, M
List 3 types of phagocyte disfunction
Leuk Adhesion - CD18 - Recurrent skin/mucosal infection. NO PUS- Delayed umbilical separation. INC N! but NOT at the site ofinfcetion.
Chediak Higashi - AR - phagolysosome microtubule problem - Staph/Strep, ALBINISM, NEUROPATHY, PANCYTOPENIA - Giant granules in N!
Chronic Granulomatous D - Xr - NADPH oxidase - o respiratory burst - Catalase negative infections - Nitroblue test is clear. Tx - IFNg
VSD - What to do if heard?
75% resolve by 2.yo
Congenital Heart block?
heart failure?
Transposition?
Heart block - lupus
HF - thyrotoxicosis
Transposition - DM
PDA - presentation - more than just machine like
Continueous - Loud S2, wide pulse pressures. Bounding pulses
Long QT tx?
B blocker. _ Pacemaker
Hirshsprungs - Dx/Tx?
Barium enema
Biopsy . ACH
Timeline:
Dx?
pyloric stenosis
Malrotation
Biliary atresia?
Pylori stenosis - 3k - first bone marle, erythromycin,. US if needed
malrotation w/in 1 month - Upper GI dx -> birds beak,.
w/in 2 months - Cong hyperbili. Light stool. CHOLANGIOGRAM. Tx Kasai -> Liver tx
NEC
workup and tx?
Complications?
Serial abd films Q6h. NPO, Abx.
if worsens -> surgery
Complications - stricture, short bowel syndrome
Biliary cyst ? Presentation? Location?
Mass and jaundice
Can be extra OR intra
Laryngomalacia
vs
Vascular ring
(presentation, timecourse?)
Laryngomalacia - improves w/ prone . Peaks at 4-8 months in presentation. Most resolve by 18mo. Dx - Laryngoscopy.
Vascular ring - improves with neck extension. If sx - Surgery
COngential Diaphragmatic Hernia?
Dx? Tx?
If cliical suspicion and unstable vitals -> intubate BEFORE cxr. NG decompress. DO NOT bag mask! as it may worsen.
Diamond BLackfan
vs
Turners?
Diamond blackfan - Macrocytic Anemia, No hyperseg N!
Short, cleft lip, shield chest, webbed neck, abdnormal thumbs. Tx Steroids.
Turners - Webbed neck, shield chest etc, Coarctation, Bicuspid A, OSTEOPOROSIS. Lymphadema, HORSEHOE KIDNEY
Edwards presentation
T18. Rocker bottom, micrognathia, ABSENT PALMAR CREASE (shaked off hand), VSD
Prader Willi - presentations and risk factors
Paternal - DMT2, hyperphagia, gastric rupture!
Neuroblastoma - presentation? When?
Wilms Tumor
Neuroblastoma - Mass - irregular, corsses midline. \
By 1 year. OPSOCLONUS MYOCLONUS.
Wilms Tumor - 2-5 yr. Abd mass w/ HEMATURIA. . Beckwith W, Anaridia.
McCune Albright rpesenetation?
Precocisous puberty, cafe au lait spots, bone defects.
Beckwith Wiedeman presentation
Screening?
Macrosomia, hemihyperplasia. Omphaloceine/umbilical hernia. DONT confuse w/ DM.
In these pt screen for Wilms tumor.
AFP + Abd US q3mo until they are 4-8 y.o
Renal US until adolescent after 8.
Hipl dysplasia - screening methods?
Hip dysplasia
US 2wk - 6mo
4/6 mo or more, use Hip Xray.
IVH- screening? prevention?
Newborns.
Screen w/ US. Maternal steroids can prevent.
Legg Calve Perthe
Vs
Slipped Femoral Cap
vs
Osgood Shattler
Legg Calve Perth - Avasc Necrosis - 4-5 yo bohys
Femoral - 12 y.o B
Osgood shatller - patellar shatters off by being pulled.
Spondylolisthesis presentation?
Boney step off - (palpable) - slipped vertebra - DEVELOPMENTAL DISORDER
Metatarsus Adductus
If foot overcorrects - reassure
if does not overcorrect - IMMEDIATE CAST
Clavicular fracture at birth -What to do?
Analgesics - restri motions. Heals in 7-10 d./
Torticollis cause? presentation - what to do?
From trauma, URI, Abscess, AA subluxation
MUST get a c spine xray to rule out AAs.
Presentation in neonates
Syph
CMV
Rubella
Syph - HSM - ulcers on palms/feet, JAUNDICE, ANEMIA, rhinorrhea
CMV - HSM - Chorioretinits, Hearing, Petechiea
Rubellma - HSM - Cataracts, Hearing, PDA
Bacterial Meningitis
Tx algorythm?
Tx?
Blood cultures, Tx, LP last
Neonate - Amp + Cefotaxime/Gent
Adult - Ceftriaxone Vanc+ STEROIDS. If it comes back as NOT strep pneumo, then take off roids.
Unilateral cervical adenitisi.
What is it?
Tx?
staphy/strep
Tx - Clinda + I and D
Impetigo
vs
Cellulits
Culture?
Impetigo - nonbullous - GAS - Mupirocin (topical) of no
Impetigo bullous - Staph - Oral ceph, diclox, clinda
Clinical dx - DO NOT NEED TO CULTURE!!! Unless fail initial tx.
Cellulitis - poorly demarkated - staph/strep.
Herpetic gingivostomatitis?
Herpangina?
Presentation and age?
Herpetic gigivostomatitis - 6m to 5y.o. - Herpes. Vesciesl.
Herparnagina 3-10 y.o Coxsackie - Vescles - aka NOT strep
Varicella - post exposure tx?
Normal and ICH
Varicella post exposure - give vaccine.
In ICH - give Varicella Antibodies
Tachoma - wpresentation cause?
Blindness, folliculitis, conjuncitivit.s
CHlamydia A-C
Minimal Changes disease - Dx?
Clinical diagnosis - Do not need to Bx.
UTI in infant- workup??
Culture - CATH - No clean catch in babies!
2mo-2y.o - Bladder and renal US.
IF RECURRENT - Voiding cysorethrogram.
Acute Hepatitis tx in neonate?
Active and passive Ig.
Rheumatic Fever tx?
IM penicilling Q4w for YEARRRS.
Lyme Tx?
In kids?
Amox, Cefuroxieme, DOxy are all about the same.
In kids - amox.
Dont give doxy to anyone under 8 y.o
Bronchiolitis?
VS Croup?
Causes and Tx?
Bronchiolitis - Run of the mill RSV> Para
Tx - O2, Albuterol, NO STEROIDS
- Ribavarin in comorbid
- Palivizumab PPX in winter in HIGH RISK COMORBID PT LESS THAN 2 YEARS OLD
Croup - Paraflu - Barking, steeple sign.
O2, Racemic Epinephrine, STEROIDs,
Epiglotitits - presentation/causes
tX/
Rapid. Strep, H flu, Viral.
High fever, drooling. Better in SNIFF dog position. THUMPRINT SIGN.
ET tube in OR, IV cetriaxone/cefuroxime
Tracheitis - Causes - presentation
Tracheitis - S aureus > Viral. Prodomal. Sublgottic narrowing.
Bordetella - whoooping cough.
Presentation - Tx?
Lymphocytosis >70% - Culture is gold standard.
Tx - Erythromycin/Azithromycin (MACROLIDE) 14d to kid AND PEERS/CONTACTS.
Tx - Erythro - 14 d. Azithro - 5d
Acute Bacterial Rhinosinusitis
predisposition pathway
Tx
Strep > Hflu > Moraxella
viral sinusitis -> bacterial sinusitis -> orbital sinusitis
Tx - Amox Clavulonic.
Acute Otitis Media - Causes tx?
Strep H flu, moraxella
HIGH DOSE amox x 10 d
Bilious Emesis
- Dx pathways -
NPO, NG, X ray (rule out pneumoperitoneum)
- Upper GI - malrotation - corkscrew sign
Lower - Meconium, Hirshprungs - Water contrast enema
Intususseption - Dx? Tx?
RISK FACTORS
Dx - US . Tx/dx - air contrast bariun enema
Less tahn 2 - peyes patches
Greater than 2- meckles.
Febrile seizure -At what age what do you do.
Less than 6 mo - sepsis workup. If >18 mo - no workup.
Chloroma - dx/workup?
Green/colored tissue in skin/spinal cord.
Bone marrow aspirate - CXR to rule out mediastinal mass.
Kawasaki tx?
Aspirin and IVIG.
CVID inc risk of what?
LYMPHOMA!
Cherry red macula WITH HSM, without?
WITH - NP
WITHOUT - Tay sacks
Cystic hygroma - mech and appearance
– benign klymphangioma in neck – soft, transilluminates. Asosc w/ Turner and Trisomy 21,18,13
Club foot
– tx immateied stretching, manipulation w/ serial plasters/splints. Surgery between 3-6mo if not working.
Neonatal polycythemia can cause … how?
respiratory distress by hyperviscocity
Downs findings
– Low AFP, estriol. INC bhcg, inbhitinA
A and E
Breast feeding supplement
– Add VitD within 1st month of life (this is correct!), + - Iron (if preterm until age 1). Introduce pureed food at 6mo, cows milk at 1.
Acute otitis media vs otitis media with effusion
OM w E is just effusion. Acute has inflammatory signs.
Vaccines by chronological or gestational, meaning?
Chronological. Regardless of preme, give Hep B AT BIRTH and others 2mo after birth. Youre not going not delay giving hep b because they are preterm.
Normocytic normochromic RBC with low retic and low Hb in preterm baby?
– Anemia of prematurity, low retic w/ normocytic and normochromic anemia.
DTap frequency and contraindication
– 5 doses of DTap from 6wk to 6 years. If pt has a febrile seizure that’s fine – continue to immunize. Only stop if anaphjylaxis or encephalopathy.
Rash after birth
erythema toxicum neonatorum – benign evanescent. Common in first 2 wk of life. Spares palms/sole
Milk/soy protein induced colitis presentation, etiology, mech prognosis
2-8 wk – painless bloody stools, may have eczema . Eliminate soy/milk from maternal diet. Start formula if needed. NON-IGE MEDIATED!! – Bleeidng usually stops 2 wk after eliminating products and as a whole Usu spontaneously resolves by 1 y.o,
Classic Galactosemia
– infantile cataracts, failure to thrive, HSM, E Coli Sepsis – Galactose 1p Uridyltransferase def/
Glactokinase def
– infantine cataracts only, nothing else.
Homocysteine vs Marfans
– Homocysteine will have fair complexion, devo delay, and CVA
Cholesteatoma vs Otosclerosis
chronic middle ear infection – granulation tissue, hearing loss. EAR DRAINAGE PRESENT in cholesteosteatoma.
Transiet synovitis
viral disease + joint pain without septic appearance (no fever, able to bear weight), but may still have abducted and externally rotated hip. Ibuprofen, rest and followup.
Bacterial and giardia infections in kid think?
B cell – IgA in particular, but Giardia is IgA def, not necessarily T cell.
ARDS surfactant deificency risk factors (2
prematurity and maternal DM.
Henoch SP raises risk for what GI
– ileo ileo! Intussusception
Strep throat vs Viral/EBV
both can have white exudates and LAD. Difference is EBV/viral have clear viral signs aka COUGH, RHINORRHEA AND CONGESTION. Strep throat will not. If many signs of strep (fever, no cough, etc, can rapid strep with empiric penicillin).
In first week of life, how many wet diapers?
Every day should have the same number of diapers, 4d -> 4+ wet diaperes.
How frequently should bebes be breastfeeding in first month?
Every 2-3 hr for 10-20 minutes.
What abx do SS kdis get?
BID ppx penicillin until 5 y.o . Also PCV13 of course.
Intestinal atresia etiology
vascular accident in utero
Biliary atresia presentation timeline and workup
6-8wk old, sweat test to rule out other problems, PHENObARBITAL with HIDA scan followup in 1 wk. If that fails, surgery.
Unilateral Undecended testes
no tx until 1 year of age! Then surgery.
Defect in the iris is?
Workup? Coloboma of iris. CHARGE (Coloboma, Heart, Atresia of Choana, Retardation, GU, Ear)
Double bubble ddx –
duodenal atresia, annular pancreas, malrotation, volvulus.
Failure to pass meconium algorithm
– Rectal exam, then Bariun enema.
Which bili causes kernicterus. Tx.
Unconju. Water insoluble, but can cross the BBB. Tx immediate exchange transfusion.
Baby in withdrawal from opioids what to do?
Tx opioids and phenobarbital. NEVER naloxone (suden withdrawal -> seizures )
Malabsorption workup
Initial screening: Sudan blak stain .Comfirmatory 72 hr stool fecal fat.
GERD in baby workup , tx
GERD in baby workup – Usually normal. If severe, interfereing with weigeht gain, dx clinical, but initial test is esophageal pH monitor. Thicken feeds and H2 receptor blockers in kids.
Intussusception workup
Ab Xray to rule out obstruction. Air enema. US not ideal but usually occurs due to practicality.
When can you begin to give sulfonamides in kids? Example of its use?
Can give sulfa to kids after 1 mo. Giving to kids with vesicoureteral reflux , as they need antibiotic prophylais for the 1st year following diagnosis to revent kidney scarring.
PSGN tx in kids
penicillin. Complete recovery in 95% of kids.
When do kids get anemia? Nadir? What is acceptable?
? Nadir at 12 wk w/ hg of 9-11. No tx needed. Response in preterms is earlier3-6wk and 7-9 hc. May need transufion.
Fever without a focus , age, workup and tx –
Until 3 y.o. Pan culture and give IM ceftriaxone if well appearing. Toxic IV abx.
