Peds 4 Flashcards
Jerky dancing in eyes and limbs, bluish skin nodules and tender abd mass? Dx test?
Neuroblastoma
Dx = urine homovanillic or vanillylmandelic acid
CALLA and TDT positive testing
ALL
Tx ALL
VDP (vincristine, dexamethasone and prednisolone) + Intrathecal methotrexate
14yo boy with enlarged, painless rubbery LN, diaphoresis and weight loss
Hodgkin’s Lymphoma
CD15/CD30 and Reed Sternberg Cells
Hodgkin’s Lymphoma
7yo girl, nonproductive cough and large anterior mediastinal mass
Non-hodgkin’s lymphoma
kid with high fever for 3 days THEN a pink, maculopapular rash develops on trunk and extremities
Roseola (HHV^ or 7) = exanthema subitum
2yo with fever, lacy reticular rash on face and upper body (not on palms/soles)
Parvo b19 5th disease = erythema infectiosum
Parvo is particularly bad in (3)
pregnancy, SS or thalassemia
Sandpaper rash
Scarlet Fever
Kid with sore throat develops 1-2 weeks later a maculopapular rash, desquamating that begins centrally and extends peripherally with strawberry tongue
Scarlet fever
Kid with a cough and runny nose, fever develops a macular rash around ears that spreads downwards, PE with gray spots on buccal mucosa
paramyxovirus = measles
Tx measles
supportive care and VITAMIN A!!!
kid with a sore throat develops fever, joint pain, fine rash on face that spread downwards with red spots on palate noted on PE
Rubella
Kid with poor feeding, vesicles on mouth, palm and soles with rash on butt/LE, +/- similar kids in daycare
Hand foot and mouth = coxsackie A virus
16yo male with swollen cheeks, fever and HA
paramyxovirus = MUMPS
2 serious sequelae of mumps
orchitis and/or sterility
Tx lyme disease
amoxicilin if <8yo, doxy of older
2 possible complications of RMSF
vasculitis and gangrene
Tx RMSF
doxycycline at ALL ages
Tx scabies
5% permethrin for ENTIRE family
kid with conjunctiva, multiple blisters and positive nikolsky sign, Tx?
SSS syndrome
Tx = IV oxicillin or nafcillin
MC tx for meningitis
ceftriaxone and vanc
Tx TB meningitis
RIPE and* steroids
Tx lyme meningitis
ceftriaxone
Tx listeria meningitis
ampicillin
Tx acute OM
amoxicillin or azithro
if no improvement, augmentin
Tx otitis externa
ciprofloxacin
strep throat criteria
Fever, anterior cervical LAD, exudates and lack of cough
Tx retropharyngeal abscess
aspirate or I&D plus: 3rd gen cephalosporine, ampicillin or clindamycin
indications for tonsillectomy
6x/year for 2 yrs or 3x/yr for 3+ years
Steeple sign
croup
Hot potato / muffled voice
retropharyngeal abscess
Tx croup
mist, epinephrine nebulizer and steroids
“tripod” position
epiglotitis
thumbprint sign
epiglotitis
MCC pneumonia in neonate
GBS, E coli or listeria
MCC pneumonia infant 1-3mo
Chlamydia, RSV, parainfluenza or strep
MCC pneumonia 4mo-5yo??
RSV or strep pneumo
MCC pneumonia in kid>5yo
mycoplasma or strep pneumo
“staccato cough”
chlamydial pneumonia
Tx whooping cough (pertussis)
erythromycin 14d AND for ENTIRE family
Tx pyelonephritis
ceftriaxone OR amp+gent
Anterior knee pain with swelling over tibial tubercle
Osgood-Schlatter
Dandy Walker Malformation
cystic expansion of the 4th ventricle and agenesis of the cerebellar vermis
multiple symmetric contraction episodes of neck, trunk and extremities in infant? Tx?
infantile spasms
Tx = ACTH, 2nd line is prednisone
Infant EEG with asychronous, chaotic bilateral hyperarrhythmia
infantile spasms
8yo with poor balance, weak/no DTRs, upgoing babinski and dysarthric speech
friedreich ataxia
triad of friedreich ataxia
neuro (ataxia, dysarthria)
skeletal (scoliosis, hammer toes)
cardiac (HCM)
MCC death in friedreich ataxia
HCM, within 20yrs
Friedrich Ataxia inheritence
AR
2 yo with gait issues, loss of intellectual fxn, nystagmus and optic atrophy
metachromatic leukodystrophy
Pathophysiology metachromatic leukodystrophy
patho = deficiency of arylsulfatase A –> cerebroside sulfate accumulation
12 yo. Decreased school performance, behavior change, ataxia, spasticity, hyperpigmentation, hyperkalemia, hyponatremia, acidosis
Adrenoleukodystrophy
inheritance of metachromatic and adreno-leukodystrophies
MLD = AR ALD = XLR
6yo who is clumsy, frequent falls, thin legs, pes cavus and claw hand? Dx tests?
Charcot-Marie Tooth
Dx EMG, bx +/- DNA testing
normal* CPK
fanconi anemia vs diamond-blackfan anemia?
- fanconi - older kid (8 yo). progressive pancytopenia, macrocytosis. cafe au lait, absent thumbs, horseshoe kidneys
- diamond-blackfan/ congenital hypoplastic anemia - most dx <1 yo. macrocytic pure red cell aplasia. short, webbed neck, cleft lip, shield chest, triphalangeal thumbs.
Kid with gout? pathophys
Lesch-Nyhan syndrome, HGPRT deficency
Pathophys and dx of homocysteinuria? Tx?
patho = AR deficiency of cystathionine synthase dx = increased homocysteine AND methionine Tx = VIt B6 first then restrict methionine, supplement cysteine
Neonate with pustules containing eosinophils
erythema toxicum = self-limited benign
Supplementation of breastfed-only infants?
Vit D
bilious vomiting WITHOUT abd distention?
MC duodenal atresia (a/w downs)
increased gastric residual volume after decompression in premature infant?
Necrotizing eterocolitis
frog leg position. Small secondary to feeding problems, hypotonic, fasciulation fo tongue. Absent DTR. Dx?
neonate with big body and tongue, but small head, omphalocele, hepatosplenomeg, hypogly/hyperins
Beckwith-Weidmann Syndrome
GI finding in congenital hypothyroidism
umbilical hernia
few days or weeks after birth with FTT, liver failure (jaundice, hepatomegaly), abn renal function, emesis, anorexia, glycosuira, infantile cataracts, later MR? enz? tx?
- galactosemia
- galactose-1-phosphate uridyltransferase
- tx: limit lactose and galactose