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Rotation 4: FMI > peds > Flashcards

peds Flashcards

1
Q

Epitaxsis

where is this most common?

what do you do about? 3 OPTIONS

A

MC from kiesselbach plexsus. unilateral anterior bleeding

Tx:

  1. pressure leaning forward
  2. topical cocaine if wont stop, constricts or oxymetazalone
  3. cautery or packing
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2
Q

primary strabismus

what are 3 RF?

4 classifications?

A

RF:

  1. family hx
  2. low birth weight
  3. prematurity

types:

  • Eso= nasal deviation
  • Exo= temporal deviation
  • Hyper= eye more superior in vertical deviation
  • Hypo= eye depressed relative to fixing eye
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3
Q

secondary strabismus

6 causes?

3 tx options?

A

causes:

  1. retinoblastoma
  2. optic nerve hypoplasia
  3. head trauma
  4. cranial nerve palsies
  5. orbital fracture
  6. graves disease

TX:

  1. refferall to optamolgoy
  2. correcy amblyopia with glasses or optical penalization
  3. surigical correction
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4
Q

pseudostrabismus

what is this?

2 dx methods?

A

most common form of stabismus

optical illusions seen in newborns with wide nasal bridge during first year of life

DX:

  1. corneal light reflex-shine like on both eyes and should be symmetrical on either side
  2. cover uncover test

**both reveal normal alignment**

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5
Q

nasal foreign bodies

where MC?

MC age?

6 sxs of this?

1 dx? don’t do?

3 tx options?

A

MOST COMMON IN RIGHT NOSTRIL SINCE CHILDREN RIGHT HANDED, often right below the inferior turbinates

less than 5 y/o

sxs:

  1. unilateral purulent nasal drainage
  2. epitaxsis
  3. nasal obstruction
  4. mouth breathing
  5. cyanosis
  6. foul odor from kids, ear drainage

DX:

  1. CHEST xRAY

***don’t do any blind sweeps of the oral cavity**

Tx:

  1. ABCs (airway, back blows, chest thrusts)
  2. have child occlude nostrol and blow, or have the mom occuld and blow in hard through the mouth
  3. extraction via forceps
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6
Q

4 complications that can come from strabismus

A
  1. ambylopia-decreased vision
  2. diplopia
  3. secondary contracture of EOM
  4. torticollis-use neck mucles to compensate
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7
Q

measles

what virus causes this? what type of rash? what are the 3 things you should relate to this? what can you see in the mouth and what do they look like? where does the rash start? what is the treatment? 4

A

paramyxovirus=

maculopapular rash

HIGHLY CONTAGIOUS, AIRBORNE

CONTAGIOUS 5 DAYS PRIOR TO RASH

URI prodrome with 3 C’s:

COUGH, CORYZA, CONJUNCTIVITIS

FEVER, COUGH, ANOREXIA

KOPLIK SPOTS IN THE MOUTH: small red spots in the buccal mucosa with blue/white paler center “grains of salt on red dot”

Brick red rash on skin begining at the hairline and spreads over body from head to toe!!

(not on palms or soles)

Tx: supportive and antiinflammatories!!

1. if withing 72 hours of expsosure, give the vacccine!!

2. IM IG after 72 hours if infants less than 12 months, pregnant women

3. vitamin A administration

4. supportive

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8
Q

rubella (german measles)

what virus is this caused by? how long does the rash last? what is the important thing to consider if the woman is pregnant and what 3 things can it cause? what do you see for lymphadenopathy? what is the buzz word rash?

A

togavirus

Transmission: inhalation of particles

infectious 1-2 weeks prior to infection being apparent

rash lasts 3 days!! pink maculopapular rash head and spreads to toe TERATOGENIC! DOESNT COLASCE

can see lymphadenopathy posterior cervical and posterior auricular

Forcheimer spots: appear on soft palate

can see transient joint pain and photosensitivity in young women

TERATOGENIC IN 1ST SEMESTER: congenital syndrome, sensineural deafness, “BLUEBERRY MUFFIN RASH!”

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9
Q

MUMPS

how is it spread?

when?

5 sxs?

A

paramyxovirus

HIGHLY INFECTIOUS

transmission: droplet, direct, fomites

viral shedding preceeds onset of sxs and is most contagious prior to onset of parotitis (6 days and 9 days after parotitis)

SXS:

  1. low grade fever
  2. fatigue, headache
  3. parotitis within 2 days of prodromal sxs

can be preceeded with earache

can see enlargement of contralateral parotid occur several days later

  1. orchitis-testiscular swelling in some
  2. erythema and enlargment of stensens duct

TX: SUPPORTIVE

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10
Q

what are two objects you need to be particullary carefule about children sticking up their nose?

A
  1. SMALL BATTERIES-CAUSES SEPTAL PERFORATION IN 4 HOURS AND TISSUE NECROSIS

2. SMALL MAGNETS-SEPTAL PERFORATION AND HARD TO REMOVE

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11
Q

epiglottitis

what is this caused by?

what is this?

age?

prevalance?

5 key sxs?

A

haemophilis influenzae B causing cellulitis edema of the epiglottis

4-7 years

****incidence has fallen due to HIB vaccine***

SXS:

  1. high fever
  2. stridor
  3. drooling KEY!!!!
  4. sore throat!!
  5. TRIPODING!!! KEY!!!
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12
Q

measles

6 complications of infection

A
  1. death
  2. pulmonary complications
  3. encephalitis 25%
  4. acute disseminated encephalomyelitis

dmyelinating disease 2 weeks after rash, paraplegia, coma, confusion, back pain

  1. keratitis

common cause of blindness

  1. subactue sclerosing panencephalitis-RARE

progressive degenerative disease of the CNS that occurs 7-10 years after infection that is fatal

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13
Q

MUMPS

6 complications

A
  1. orchitis

MOST COMMON COMPLICATION IN ADULT MALE

40% of males effected

abrupt testicular pain and scrotal swelling

  1. oophoritis
  2. aseptic meningitis
  3. deafness
  4. encephalitis
  5. guillain barre
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14
Q

congenital rubella syndrome (CRS)

A

maternal-fetal transmission from infection spreading from placenta

risk highest in first trimester, lower after 18 weeks gestation

FETAL INFXN IS CHRONIC

complications:

  1. meningoencephalitis
  2. hearing loss 80%

3 cataracts 25%

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15
Q

epiglottitis

what to keep in mind of this?

what should you never do?

2 dx methods?

4 t options?

A

MEDICAL EMERGENCY BECAUSE CAN CAUSE COMPLETE OBSTRUCTION OF AIRWAY

***NEVER LEAVE THIS KID ALONE***

DX:

  1. DO NOT ATTEMPT TO VISUALIZE AIRWAY
  2. THUMB SIGN OF SOFT TISSUE XRAY

TX:

  1. antipyretics for fever
  2. ROCEPHIN

3. secure an airway!!!

  1. racemic epi, IV steroids
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16
Q

asthma

what is this?

hypersensitive to 4 things

3 key sxs?

A

CHRONIC AIRWAY INFLAMMATION DISORDER

reversible!!!

hypersensitivity to allergies, irritants, exercise, infection

SXS:

  1. wheezing, respiratory distress, episodic dry cough
  2. atopic dermatities thickening of the knees and elbows)
  3. nasal polyps
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17
Q

Asthma

3 ways to sx?

2 tx options?

A

DX:

  1. PFTs pre and pos bronchodilation
  2. xray shows hyperinflamation
  3. methacholine challange if no sxs at office

TX:

  1. beta2 agonists bronchodilation
  2. stepwise approach
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18
Q

sudden infant death syndrome (SIDS)

when does this occur?

key fact to know about this?

8 RF for this?

A

less than 1, occurs during sleep

leading cause of death in less than 1 y/o

not exactly sure why it happens buy hypothesis is brainstem abnormality or maturational delay in neuroregulation or cardiovascular control, combined with trigger event such as airflow obstruction

RF:

  1. Exposure to cigarette smoke
  2. Maternal Age < 20
  3. Prematurity and Low Birth weight
  4. Prone sleeping position (“Back is best”)
  5. Soft bedding (No pillows or toys in crib, or blankets, bumper pads)
  6. Overheating
  7. Bed sharing is not recommended (under 3 months old)
  8. Siblings of a SIDS victim increases risk 5-6 Fold
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19
Q

croup

what are the 3 types?

sxs of each?

A
  1. laryngotracheitis

3-36 months

fever

hoarseness

barking cough

stridor

stridor at rest is a sign of severe airway obstruction

  1. spasmodic croup

always occurs at night

afebrile with mild URI sxs

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20
Q

suddent infant death syndrome (SIDS)

4 ways to reduce risk?

A
  1. Room Sharing
  2. Breastfeeding
  3. Use of a Pacifier during sleep
  4. Place infant on back to sleep
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21
Q

peritonsillar abscess

what is this?

4 sxs?

2 tx options?

A

collection of puss between the palantine tonsil and pharyngeal muscles

  1. hot potato voice
  2. drooling
  3. trismus-jaw spasm and tightness of jaw
  4. ipsilateral ear pain

tx:

  1. drainage
  2. oral: amoxicillin-clavulanate or clindamycin
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22
Q

developmental dysplasia of the hip (DDH)

4 dx?

tx goal?

3 tx and for what age group?

A

DX:

  1. barlow
  2. ortalani
  3. AP xray
  4. US at 6 weeks if female and breech

TX:

**goal is to keep the hip located so that the ligaments and bones have time to form and strengthen to hold it in place**

1. PAVLIK BRACE/harness

  • use under 6 months for 8-12 weeks
  • 90-95% successful
    2. casting if older than 6 months

8-12 weeks

3. surgical reduction/fixation if older than 2 y/o

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23
Q

pertussis

who do you consider this in?

bacteria?

4 stages? SXS of each?

A

consider in any child coughin over 14 days regardless of immunization status, infectious until completes abx

bordetella pertussis

“100 DAY COUGH”

“whooping cough”

**colonizes the cilia causing necrosis and inflammation**

STAGES:

catarrhal: 1-2 WEEKS URI sxs mild cough, runny nose, afebrile, worsening cough, MOST CONTAGIOUS PART

paroxysmal:** lasts 2-6 weeks **with inspiratory WHOOP (cough cough cough cough whooop) after paroxysms and post-tussive cyanosis with vomiting!! KEY KNOW THIS!!!

convalescence:“recovery” weeks to months, cough lessons but takes so long

infants: short or absent, feeding difficulty, tachypnea, cough, gagging, apnea, bradycardia (may be the only sign)

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24
Q

what are the complications of pertussis?

5

A
  1. apnea
  2. pneumonia
  3. vomiting
  4. seizures
  5. death
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25
Q

pertussis

2 tx groups? who else?

2 options each

A

DX:

  1. isolation of bacteria from sample
  2. PCR

less than 2:

macrolide

azithromycin or clarithromycin

infants older than 2: macrolide or TMP-SMX

**those in close contacts should recieve prophylaxsis**

tx no reccomended for those if over 21 days since sxs onset

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26
Q

croup

what causes this? 2 others?

age?

5 key sxs?

how to dx?

tx for mild, then mod/severe 3?

A

parainfluenza virus 1 affecting larynx, trachrea aka upper respiratory

also RSV and adenoviruses

6mo-3 years

rare over 6

  1. steeple sign
  2. barking seal cough
  3. inspiratory stridor
  4. coughing at night esp while laying down
  5. respiratory distress (retractions, low O2 stat)

DX: clinical

TX:

  1. mild:oral dexamethasone/decadron
  2. mod/sev:
    - oxygen
    - racemic epi

condsider admission

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27
Q

varicella

2 complications

A
  1. pneumonia

major cause of morbidity and mortality

can lead to respiratory failure

  1. hepatitis

can occur in immunocomprimised hosts

frequently fatal

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28
Q

developmental dysplasia of hip (DDH)

3 causes?

which side MC? when present?

4 sxs

A

causes:

  1. generalized hip laxity
  2. complete hip dislocation
  3. acetabular abnormality

MC in left hip, present at birth

SXS:

1. initally asymptomatic

2. then with walking, limp and decreased leg length

3. asymetry of the skin folds

4. loss of adduction

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29
Q

Bronchiolitis aka RSV

what causes this?

age?

path? 2 things can cause?

3 RF?

A

RSV-paramyxovirus

causes airtrapping, winter months

peaks in 2-6 months, common respiratory illness til age 5

PATHO

virus attacks therminal bronchiolar epithelial calls, cells causing inflammation in small airways

can cause edema, excessive mucous production leading to obstruction

RF:

  1. prematurity
  2. low birth weight
  3. less than 12 weeks old
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30
Q

bronchiolitis

7 sxs of this?

2 DX?

3 tx options?

A

sxs:

  1. starts as URI sxs
  2. FEVER, WITH EXPIRATORY WHEEZE “JUNKY SOUND”
  3. gradual onset to RESPIRATORY DISRESS,

-tachypnea over 70

-nasal flaring

-retractions

-grunting

LOW O2 EXAM!!!!

DX:

  1. RSV NASAL SWAB
  2. HYPERINFLAMATION ON XRAY

TX:

  1. nasal suctioning
  2. hydration
  3. hospitalization if severe for respiratory support

***DONT GIVE STEROIDS or ABX***

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31
Q

diphtheria

what is this caused by?

what does it infect?

2 complications?

3 types?

2 tx options?

A

corynebacterium diphtheriae producing toxin

**classifid based on the mucous membrane it is infected*

MC COMPLICATIONS:

  1. MYOCARDITIS
  2. NEURITITS

1. laryngeal

a. upper airway/bronchial obstructions

2. pharyngeal

a. MOST COMMON FORM!!

b. GRAY MEMBRANE “pseudo membrane” COVERS TONSILS AND PHARYNX

c. BULL NECK

from swelling of cervical nodes

3. myocarditis/neuropathy

this occurs when the bacterial gets into the blood and settles other places creating that membrane and preventing the organs from working

TX:

  1. diphtheria horse antitoxin as soo as this is suspected, obtained through CDC
  2. ISOLATE FOR 3 DAYS UNTIL A NEGATIVE CULTURE CAN BE OBTAINED
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32
Q

pneumonia

what are the 3 agents that cause this? MC?

4 sxs of this?

1 dx of this?

2 tx options?

A

infectiion of the LOWER respiratory tract

  1. strep pnuemonia MC
  2. haemophilis influenza
  3. mycoplasma

SXS:

  1. fever

2. focal crackles/rales on asucultation

3. PRESENT WITH EGOPHONY

  1. rapid breathing tachypnea

DX:

  1. consolidation on xray

TX:

  1. amoxicillin 1st choice
  2. 2nd line: macrolide
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33
Q

developmental dysplasia of hip

4 RF

A
  1. first child
  2. girl
  3. breech presentation
  4. family hx
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34
Q

when would a case of pertussis be considered infectious for?

A

for 21 days after onset of sxs

OR

5 days of abx completed

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35
Q

who should get the MMR vaccine?

A

1st dose: 12-15 months of age

  1. 2nd dose: 4-6 years
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36
Q

DTAP vaccine

dosing regimen

A

5 doses

dosing: 2, 4, 6, 15-18months, and 4-6 years

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37
Q

Tdap

who do you give this to?

A

single dose routine use for:

  1. adolescents 11-18 who have gotten the childhood vaccine

2. 19-64 year HCW also

***can be dosed regardless of interval since last tetnus**

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38
Q

when would you want to admit a patient with pneumonia?

A
  1. Oxygen Sat < 92%
  2. RR > 70 in infants, or 50 in children
  3. Intermittent Apnea or Grunting
  4. Dehydration
  5. Family unable to provide good observation
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39
Q

what is the most common congenitial pediatric heart condition?

A

VSD

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40
Q

Ventricular septal defect

what is this?

where are the 2 locations these can occur?

2 types?

A

opening in the septum that separates the two ventricles

80% involve the thin membraneous septum

20% involve the muscular septum

can be isolated or compllex lesions (can be associated with other cardiac issues)

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41
Q

ventricular septal defect:

small “restrictive” VSD

what is this?

what is normal? what is abnormal that occurs?

2 key sxs to know?

A

MOST COMMON SIZE

large resistance through small hole

normal right ventircular pressure and pulmonary artery pressure

small left to right shunt (since left side of hear it high pressure and right is low pressure)

**aka no enough blood is going left to right that it increases the pressure on the right side of the heart*

SXS:

  1. harsh holosystolic murmur along left sternal border, present about 36 hours after birth

**think about it, there is a bunch of blood trying to fit through a tinny hole, so the whole time it is pumping you get a murmer

2. possible systolic thrill at left lower sternal border

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42
Q

ventricular septal defect:

mod-large ventricular SD

what happens in this?

what are 5 things that can happen that are bad as an effect?

sxs resemble?

A

increase the pressure in the RV and pulmonary ateries because enough blood is pumping over to increase it

can cause as a result:

  1. pulmonary artery Hypertension
  2. pulmonary vascaulr obstructive disease
  3. if large, LV dilation and failure
  4. HF in 80% of infants with large​
  5. endocarditis

SXS:

SIGNS AND SXS OF HF!!!

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43
Q

ventricular septal defect:

mod-large ventricular spetal defect

2 TX options?

A
  1. tx HF as if in adults
  2. surgical repair once HF improves

**closure in early childhood if pulmonary artery pressure is increased**

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44
Q

ventricular septal defect:

how to dx?

A
  1. CXR-possible cardiomegaly, enlarged PA, HF if large defect

  1. echo doppler is diagnostic!!!
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45
Q

ventricular septal defect:

small “restrictive” VSD

3 TX OPTIONS?

A

TX:

  1. 24% CLOSE BY 18 MONTHS
  2. 50% BY 5 YEARS
  3. REGULAR FOLLOW UP WITH PERIODIC DOPPLER
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46
Q

what are the long term complications of ventricular septal defect?

3 key things?

1 overall change?

two outcomes?

A
  1. pulmonary arterial hypertension PAH can lead to irrersible pulmonary vascular obstructive disease PVOD
  2. significant PVOD leads to pulmoary vascular restistance and pulmonary artery pressure increase and can lead to shunt reversal, and right to left shunting

**think about it!!!…as more blood going from left to right the damange on the right side fo the heart and pulmonary artert increases,causing back up into the RV this creases the pressure to increase here and then flow from the highp pressure of the right ventricle to the relatively low pressure of left ventricle**

eisenmenger’s physiological complex

  1. leads to hypoxemia and right sided HF since this gives out and the oxygen then bypasses the lungs ​
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47
Q

atrial septal defect

what is this?

what percent of people does this occur in? why?

2 main physiology things occur? why?

A

a hole between the two atria in the heart

occurs in 25% of people

caused by lack of fusion leaving patent foramen ovale

physiology:

  1. left to right shunting from:

rt atrium more distensible than left

RV more compliant that LV

PuVR more than SVR

LA pressure higher that RA

  1. hemodynamic burden: from right ventricular oolume overload since more is going from the right atrium into right ventricle well tolerated for many years
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48
Q

atrial septal defect

what are the 4 physical findings?

what are the 2 ways this is dxed?

A
  1. hyperdyanamic RV: RV vlume increases leading to increase contraction via starling mechanism
  2. accentuated S1 at LLSB

3. S2 wildly split through inspiration and expiration

  1. Grade II-III cresendo-decresendo murmur

DX:

  1. EKG: afib/aflutter
  2. echodoppler
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49
Q

atrial septal

what are the three options and when are they appropriate?

A
  1. catheter closure at the ASD once sxs present

  1. if no sxs closure is reccomend if the Qp (pulomnary):Qs(systemic) blood flow 1.5:1 OR PAH present
  2. surgical closure-reccomended in pre-school or pre-adolescent years
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50
Q

pulmonic stenosis

what are the characteristics of the stenosis?

3 physiology (2 things it can lead to)?

difference in mid/mod to severe?

A

“domed shaped” stenosis with concentric hypertrophy

physiology:

a. must be reduced by 60% to be hemodynamicaly significant
b. causes RV pressure overload
c. can lead to RT ventricular overload

mild-mod: well tolerated, monitor

severe: leads to RV failure and premature death

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51
Q

pulmonary stenosis

1 dx?

1 tx? (qualifications)?

A

dx:

echo

TX:

  1. cath balloon vulvoplasty

gradient less than 25=no intervention

gradient over 75 always vulvoplasty

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52
Q

what is the most common cause of congenital heart disease in adults?

A

atrial septal defect

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53
Q

what are the 3 anatomical type of atrial septal defect?

A
  1. ostium secundum: defect in middle septum

  1. ostium primum: defect in the lower atrial septum

3. sinus venous defect: high in atrial septum

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54
Q

explain the course of atrial septal defect throughout a persons life?

5 sxs

A
  1. MOST CHILDREN ARE ASYMPTOMATIC SO DX OFTEN MISSED IN CHILDREN
  2. systolic ejection murmer and sxs (fatigue, dyspnea, decreased stamina) present in 20s
  3. 3rd-4td decased adults become increasingly symptomatic incidence of atrial fib and flutter increase
  4. paradoxicl emboli can result in stroke (venous emcbolism)
  5. premature death and heart failure occur in adults who go untreated
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55
Q

in atrial septal defect, what 3 parts of the heart become enlarged? why?

A

RA

RV

and pulmonary artery

volume overload

since there is so much coming from the left atrium over, it effects everything after the RA this can cause pulmonary HTN to occur late in the disease

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56
Q

what are the 2 different pressure gradients between the right ventricle and pulmonic artery indicate?

A

RV to PA: 40 mmHG=mod pulm stenosis

RV to PA: 75 mmHg=severe pulm stenosis

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57
Q

pulmonic stenosis

3 clinical manifestations

A
  1. systolic thrill at supersternal notch
  2. early systolic click upper LSB
  3. murmer is harsh, cresendo-decresendo at upper right SB radiating towards clavicle and louder with inspiration
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58
Q

patent ductus arteriosus

what is this/ what two things is ths between?

when does this normally close?

what is a RF for staying open?

what are the charactersitcs of small, mod and severe?

A

patentcy of the vessel that normally connects the pulmonary arterial system and the aorta in the fetus, between left pulmonary artery and lower aortic arch

normally closes 2-3 days after birth

BUT

OFTEN REMAINES OPEN IN PRE-TERM BABIES

small: well tolerated

mod: elevated PAP, significant shuntin from aorta to PA

severe: AO and PA in free communication marked left to right shunting and LV dysfunction (since the left is the higher pressure system)

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59
Q

patent ductus arteriosus

what are the 3 PE findings of this?

A
  1. HF occurs in the first weeks of life!!!!!!
  2. continous murmer through systole and diastole “machinery murmer”

heard loudest at LST 3-4th ICS

3.murmer peaks during S2

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60
Q

patent ductus arteriosus]

2 DX OPTIONS

3 TX OPTIONS

A

DX:

  1. ECG: LAE, LVH
  2. echodoppler: LAE, LVE, might see shunt

tx:

  1. INFANTS: TOC IS INDOMETHACIN (CLOSES IT)
  2. SURGICAL OR CATHETER CLOSURE IS THE TOC FOR EVERYONE ELSE
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61
Q

coarctation of the aorta

what is this?

5 things i causes?

A

discrete narrowing of the distal segment of the aortic arch, just distal to the origina of the subclavian artery

causes:

  1. obstruction to outflow to the lower half of the body
  2. LVH from pressure backload
  3. arterial HTN
  4. elevated pressure prior to coarction, lower pressure after
  5. collateral circulation to lower body dvelops via the internal mammary and subcostal arteries (notches on the ribs)
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62
Q

coarchtation of the aorta

3 sxs?

3 PE findings?

A

SXS:

fatigue, dyspnea

faituge while running

HTN IN CHILDHOOD

PE findings:

  1. difference in BP in arm and legs of over 10 mmHG with high systolic
  2. marked HTN of the upper part of the body and high renin from decreased profusion of the kidneys
  3. upper body well developed with thin legs
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63
Q

what are 2 RF for patent ductus arteriosus?

A
  1. PREMATURE DELIVERY
  2. premature maternal exposure to rubella
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64
Q

coarchtation of the aorta

4 dx

A
  1. CXR: notching of interior margin of ribs in adolescence
  2. echo: show coarct
  3. cardiac MRI/MRA and CT mos useful
    4: EKG: LVH
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65
Q

how will infants with coarchtation of the aorta present?

A

50% present with HF

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66
Q

coarchtation of the aorta

2 tx

A
  1. direct resection/repair via surgery
  2. stenting with cath but less feasible
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67
Q

tetralogy of fallot

what is this?

2 antomical things that are caused by this?

what are 2 things this causes?

A

biventricular origin of the aorta (aka the aorta isn’t in the right place)

1. LARGE VENTRICULAR SEPTAL DEFECT

2. OBSTRUCTION OF THE PULMONARY BLOOD FLOW BECAUSE THERE IS SUBVALVUALAR NARROWING OF PULMONIC OUTFLOW TRACT

this causes:

1. RVH

2. BLOOD PUMPS FROM THE RV ACROSS THE VSD AND INTO THE AROTA, MEAN IT BYPASSES THE LUNGS AND SO IT LEADS TO CYANOSIS

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68
Q

rheumatic fever

what is this caused by and when?

5 sxs?

A

2-4 weeks after GAS pharyngitis

SXS:

  1. migratory athritis
  2. pancarditis/valvitis
  3. CNS involvement
  4. erythema marginatum
  5. subcutaneous nodules
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69
Q

strep pharyngitis

what is this causes by?

4 sxs?

2 DOC?

A

group A streptococcus

  1. sore throat
  2. myalgias
  3. abdominal pain
  4. exudative tonsilitis

DOC:

  1. penicillin V 10 days
  2. Amoxicillin 10 days
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70
Q

Transesophageal fistula and esophageal atresia

what is this?

4 sxs?

3 dx?

1 tx?

A

congenital abnormality of the respiratory tract

incomplete separation of the trachea and esophagus

the esophagus is attached to the trachea

SXS:

  1. drooling
  2. choking
  3. unable to feed
  4. respiratory distress

DX:

  1. unable to pass a NG tube into stomache
  2. definitive: upper GI studies
  3. endscopy

Tx: SURGERY

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71
Q

pyloric stenosis

what is this?

when does it show up?

3 key sxs?

1 key dx finding?

1 tx?

A

hypertrophy around pyloric spincter causing gastric outlet obstruction

4-6 weeks of life

SXS:

  1. projectile vomiting

2. hungry despite no weight gain

3. OLIVE SHAPED MASS in right upper/epigastric region

DX: STRING SIGN ON BARIUM SWALLOW

TX: SURGERY

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72
Q

volvulus

what is this?

what age group?

what does it cause?

2 main sxs?

A

malrotation in utero wih causes incomplete fixation of the small bowel, typically less than 1 y/o

ladds band develops between the cecum and peritenum which obstructs the duodenum and causes obstruction

SXS:

  1. sudden onset of BILIOUS VOMITING (green vomit)

2. severe inconsolable abdominal pain

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73
Q

volvus

what are 2 key findings dx?

1 tx?

A

DX

  1. barium study “BIRD BEAK” or “CORKSCREW”
  2. xray shows “double bubble” air fluid levels in duodenum and stomach ONLY

TX: sugery!!! NOW!!

74
Q

GERD in children

what is this?

what is important to remember about dxing this?

3 DX methods?

A

passage of gastric contents into the esophagus causes troublesome symptoms or complications

****even if a kid is spitting up thats normal, its only when it causes problems or sxs that its a disease***

SXS:

  1. heartburn
  2. respiratory sxs cough, wheezing asthma reccurent pneumonia
  3. vomiting

DX:

  1. trial of acid suppresion with PPI

2. barium swallow-shows abnormalities

3. endoscopy if persists 2 years after tx

75
Q

GERD in children

2 tx options?

what to remember about this?

A

TX:

  1. lifestyle modifications (weight loss, head elevation, no chocolate)
  2. PPI’s or H2

DON’T FORGET THAT ASTHMA AND GERD OFTEN GO TOGETHER

76
Q

hirschprungs disease

what is this? where?

2 sxs of this?

A

motor disorder of the gut

congenital absence of ganglion cells and in the distal rectum and colon

SXS:

  1. failure to pass meconinum (first stool) within first 72 hrs of life
  2. explosive expulsion of stool and gas after DRE
77
Q

hirschprungs disease

1 dx?

1 tx?

A

DX:

  1. rectal bx
    tx: SURGERY!!

resect the affected bowel and bring normal ganglionic bowel down close to the anus and preserve the spinchter funciton

78
Q

meckles diverticulum

what is this?

KEY RULE TO KNOW HERE? 5

A

most common congenital anomaly of the SI

incomplete obliteration of the vitelline duct

RULES OF 2’s:

  1. 2% of population

2. male to femal 2:1

3. within 2 ft of the iliocecal valve

4. can be 2 inches long

5. usually present before 2

79
Q

Meckel Diverticulum

what are 4 sxs of this?

3 dx options?

A

SXS:

  1. painless GI bleedinging

2. children with intussusception

  1. presents with signs like appendicitis
  2. signs of bowel obstruciton

DX:

  1. meckel scan (nuclear med)
  2. mesenteric angiography
  3. resection
80
Q

Intussception

what is this?

2 things it can cause?

age?

what can it be associated with?

A

invagination of one part of the intesting into itself telescoping!!!

causes bowel obstruction and ischemia

less than 2 y/o

***can be associated with viral influence**

also look into: meckles diverticulum, polyp, tumor, vascular malformation

81
Q

intussusception

what are 2 key sxs?

3 key exam findings?

1 key tx?

A

sxs

  1. sudden onset of intermittent sever abdominal pain that is episodic
  2. kid drawing legs up to their abdomen repetitively

EXAM:

  1. sausage shaped abdominal mass on right side of colon
  2. CURRANT JELLY STOOL

3. TARGET SIGN/BULLSEYE ON US

TX: barium or air enema

82
Q

hernias in children

what are the three things that can happen?

3 types of hernias and what are they?

A

reducible-all goes back in

incarcerated-can’t be reduced

strangulated-incarcerated and blood supply cut off

Umbilical Hernia

Common surgical condition in children. High incidence in African-Americans. Most will close by 4-5 years of age.

Diaphragmatic Hernia

Developmental defect in the diaphragm, allowing abdominal viscera to herniate into the chest, compromising normal lung development. Respiratory distress in the first few hours of life. Diagnose with a chest x-ray. Treatment is Surgery.

Inguinal Hernia

Infants at risk due to anatomic alignment- the inguinal canal is shorter, and more perpendicular

Indirect- Pass through the inguinal canal (most common)

Direct- Do not go through inguinal canal (rare)

83
Q

appendicititis

what is this?

caused by?

when does the neg things occur?

6 key sxs with 4 positive tests

A

most common condition in children requiring emergency abdominal surgery

Caused by a nonspecific obstruction of the appendiceal lumen

Peritonitis from inflammation, perforation occurs within 72 hours

SXS:

  1. anorexia
  2. periumbical pain that MIGRATES TO RLQ
  3. VOMITING
  4. POSITIVE ROVSINGS, OBTURATOR, AND PSOAS SIGN!!!!!!!!!

5. TENDERNESS AT MCBURNEYS POINT

1/3 THE DISTANCE BETWEEN SUPERIOR ILIAC SPINE AND UMBILICUS

  1. pain with running, coughing, jumping
84
Q

appendicitis

4 dx things to do?

1 tx?

A

DX:

  1. increased WBC
  2. pregnancy test ALWAYS to R/o ectopic pregnancy
  3. clinical dx most often
  4. CT IMAGING

Tx:

  1. APPENDECTOMY
85
Q

celiac disease

WHAT IS THIS? where?

3 things?

2 sxs?

2 dx methods?

1 tx?

A

genetic correlation

immune-mediated inflammation of the small intestine caused by sensitivity to gluten

wheat

barely

rye

SXS:

  1. MALABSOROPTION AKA DIARREAH, STEATORREAH, WEIGHT LOSS, VITAMIN DEFICIENCY

2. HERPETIC DERMATITIS

DX:

  1. SERUM CELIAC-ANTIGEN TESTING

2. IF POS-ENDOSCOPY FOR BX

TX: GLUTEN FREE DIET

86
Q

Lactose intolerance in children

3 groups common in?

lacking what?

2 types in kids?

4 sxs?

A

Common:

caucasions

native americans

asians

lactase deficiency

developmental: low lactase levels due to prematurity

congenital: no lactiacse at all….rare!

SXS:

  1. adominal pain
  2. bloating
  3. flatualance
  4. diarreah
87
Q

lactose intolerance in kids

2 DX?

3 TX?

A

DX:

  1. lactose breath hyrdogen test
  2. lactose absorption test

TX:

  1. reduced dairy intake
  2. subsitiute nuitriens like calcium and vitamin D
  3. enzyme supplement
88
Q

when does toileting start and when are most kids dry through the night?

A

starts 2-3 and most kids are dry from age 5

89
Q

voiding dysfunction

who does this occur most commonly in?

connection with?

6 things that can cause this?

A

nocturnal enuresis more common in boys

50% cases have family hx

pathogenesis:

  1. delayed maturity level that allows voluntary control of micturation

2. sleep disorders **so always ask about sleep apnea/snorning**

3. reduded ADH

4. genetic factors

5. UTI

6. trauma

90
Q

voiding dysfunction

1 dx?

4 tx options? key age?

2 meds?

A

DX:

  1. UA/UC to r/o infection

TX:

  1. REASSURANCE
  2. LIMIT EVENING FLUID INTAKE
  3. REFERR TO ENT FOR SLEEP ISSUES
  4. AVOID PHARM TX TILL 7

DESMOPRESSIN: synthetic ADH analog

IMPIRAMINE: tricyclic antidepressant

91
Q

what are four ways to decrease the risks for daytime incontinence?

A
  1. frequent toileting
  2. establish routines
  3. take break during extended play
  4. labial adhesions common in girls and can be txed with topical estrogen
92
Q

hypospadias

what is this?

4 complications?

1 tx?

**1 considering**

A

urethral opening located on venral surface of penis

from incomplete development of dorsal hood

complications:

voiding

sexual dysfunction

meateal stenosis

infertility

TX:

  1. surgical repair reccomended from 6-12 months of age!!

******avoid circumcision because the foreskin may be used in surigcal repair****

93
Q

phimosis

what is this?

who does this occur in?

2 tx options?

A

inability to retract the foreskin

90% of uncircumcised men, should retract by age 3

TX:

1. topical steroid 3 weeks to loosen skin

2. circumcision definite tx

94
Q

paraphimosis

what is this?

what can it lead to?

2 tx options?

A

when foreskin is retracted beyond the glands penis and can’t be pulled forward

THINK OF RUBBER BAND ON WRIST

MEDICAL EMERGENCY–LEADS TO STRANGULATION FROM VENOUS CONGESTION

TX:

  1. lubrication to push the penis back through the ring to relieve pressure

2. SURGICAL INTERVENT OFTEN NEEDED!!!!!!!

95
Q

roseola

what causes this?

who does it occur in?

2 key sxs? 5 total?

A

herpesvirus 6

90% less than 2 y/o

sxs:

  1. high fever over 104
  2. diffuse maculopapular rash as fever ends
  3. anorexia
  4. erythematous tympanic membrane
  5. nagayama spots in the mouth
96
Q

roseola

how to dx?

4 possible lab results?

tx?

A

dx:

clinical

neutropenia

atypical lymphocytosis

elevated WBC

sterile pyuria

TX:

supporitve! its a virus!!

97
Q

fifth’s disease

what causes this?

4 sxs?

A

parvovirus B19

SXS:

  1. “slapped cheek” rash
  2. low grade fever
  3. rhinnorrhea
  4. polarthropathy in adults

***keep these pts away from pregnant women and immunocomprimised adults***

98
Q

impetigo

what are the 2 MC causes of this?

age?

3 tx options?

A

1: staph aureus MC

MC 2-5 y/o

TX:

  1. topical mupirocin
  2. dicloxicillin severe
  3. gently clean skin and remove crusts
99
Q

tx for a MRSA skin infection in child?

3

A

DOC: doxy if over 8

DOC: TMP/SMX

DOX: clindamycin

100
Q

Epstein barr virus

what is this associated with? 4

8 sxs?

2 dx?

1 tx?

A

herpes virus

associated with development of B-cell lymphoma, T cell lymphoma, hodgkins lymphoma, nasopharyngeal cancers

SXS:

  1. malaise
  2. exudative tonsillitis
  3. pharyngitis
  4. posterior cervical lymphadenopathy
  5. petechiae on palate
  6. periorbital edema
  7. maculopapular rash
  8. splenomegaly/rupture

DX:

  1. CBC with elevated lymphocytes
  2. Monospot

TX:

  1. prednisone for swelling
101
Q

bacterial meningitis

what are the 3 most common bacteria?

5 sxs? including 2 signs?

2 dx? 5 findings?

A

neisseria meningitidis

“meningococcal meningitis” MC cause

SXS:

1. FEVER CHILLS!!!

2. meningeal signs

  • kernig-can’t extend leg
  • brudzinskis- head flexion causees knee raise

3. nuchal rigidity

  1. nausea vomiting

5. altered mental status

6, RASH

what are the 3 most common bacteria?

5 sxs? including 2 signs?

2 dx? 5 findings?

DX:

1. CT PRIOR TO LP

2. LP!!!!

  1. increase turbidity
  2. increased pressure

3. INCREASED PMN, neutrophils

4. decreased glucose

5. increase proteins

102
Q

meningococcal vaccine

A

reccomended for all children 11-12 years old with a booster at age 16

***if given after age 16 only one dose needed***

103
Q

post-exposure prophylaxsis for meningococcal disease

A

anyone who has had close contact with the cases respiratroy secreteions within infectious period

most effective if given 24 hours of illness onset of the case

104
Q

wnat is absolutely crucial to do when txing a patient for bacterial meningitis?

A

repeat the lumbar puncture within 24 hours of starting tx because should see improvement in the quality of the CSF

105
Q

viral meningitis

4 main causes of this?

4 sxs and 2 signs?

A

enteroviruses

coxsackievirus A or B

echoviruses

HSV

SXS:

1. meningeal signs

-kernig-can’t extend leg

-brudzinskis- head flexion causees knee raise

2. nuchal rigidity

3. nausea vomiting

4. moderate altered mental status

106
Q

viral meningitis

1 dx and finding

tx?

A
  1. LP
    - lymphocytes

other stuff normal

tx:

  1. supportive unless HSV origin, then give acyclovir
  2. tx sxs
107
Q

constapation in peds

1 dx?

4 tx options?

A

dx:

plain xray

tx:

  1. glycerin suppository
  2. prune juice
  3. polyethelene glycol (miralax)
  4. disimpaction
108
Q

constapation in peds

4 causes of thsi?

when should first stool occur?

what are 4 exams you should do?

A

causes:

  1. introduction of solid foods into infants diet
  2. toilet training
  3. start of school, new stressful environment
  4. functional constipation leads to voluntary stool withholding ***Kid scared to go to the bathroom so they hold it in and don’t get it go****

FIRST STOOL SHOULD OCCUR WITHOUT 72 horus of life!!!!!!

exam:

  1. abdominal distention
  2. palpable stool mass
  3. soilded underware (small amounts that gets around the stoool blockage)
  4. impacted stool on rectal exam
109
Q

diarrhea in kids

what is this defined as?

most common cause? 2 others?

what should you always do?

4 dx things you wanna do?

A

3x or more a day

acute gastroenteritis MC cause—viral!!!

rotavirus and norovirus 2nd

******ALWAYS ASK ABOUT TRAVEL HX****

DX:

  1. ALWAYS EVALUATE FOR DEHYDRATION

(URINARY FREQUENCY, SKIN TURGOR, MUCOUS MEMBRANES)

  1. plain abdominal film

3. stool culture

4. UA to rule out UTI

110
Q

check for this at birth:

mongolian spots

A

document this in the hospital because it looks like a bruise!!!

**this doens’t fade like a bruise, and doesn’t have as distinct outline as bruise**

most commonly on the back

111
Q

check for this at birth:

milia

A

common on nose, labial folds

fade over 4-6 weeks

small white dots

112
Q

kawasaki disease

what is this a disease of?

where most common and age?

3 stages of dxs?

6 sxs

2 sxs with 1 key thing to remember

0

A

inflammation of small and medium vessels

MC in JAPAN, children less than 5

stages

1. acute

a. 1-2 weeks
b. high fever

C. bilateral conjunctivitis

d. dry lips and STRAWBERRY TONGUE

e. swelling of hands and feet with cervical lymphadenopathy

f. rash in inguinal area

2. subacute

sxs get better

platelets start to increase

**************HIGHEST RISK HERE FOR CORONARY ARTERY ANEURYSMS AND SUDDEN DEATH*******

3. covalescent

all clinical sxs disappear, sed rate returns to normal

often 6-8 weeks

113
Q

kawasaki disease

dx criteria?

tx?

A

DX:

criteria:

FEVER + 4/5

a. conjunctivits
b. mucous membrane changes
c. extremity swelling
d. rash
e. lypmhadenopathy

tx: IV Ig and ASA

114
Q

varicella

what causes this?

how transmitted?

when infectious?

describe the rash and how it spreads?

4 sxs?

tx?

A

VARICELLA-ZOSTER virus

highly contagious with secondary attack rate over 90%

Transmission: aeroisolized droplets or direct contact with vesicle fluid

infectious 2 days before rash

varicella (chicken pox): 1st exsposure vesicles on a erythematous base “DEW DROPS ON A ROSE PETAL” describe the different stages

macules->papules->vesicles “dew drops on a rose petal”->pustules->crusts **appeare in crops!**

BEGIN ON FACE AND TRUNK AND SPREADS TO EXTREMITIES

SXS:

  1. rash
  2. headache
  3. fever
  4. sore throat

TX: SYMPTOMATIC IN HEALTHY CHILD, acyclovir at risk of severe disease but most supportive

115
Q

varicella

2 complications

A
  1. pneumonia

major cause of morbidity and mortality

can lead to respiratory failure

  1. hepatitis

can occur in immunocomprimised hosts

frequently fatal

116
Q

legg-calve perthes disease

what is this?

age?

where is it?

3 causes?

what happens?

A

idiopathic osteonecrosis of femoral head, 4-8 y/o MC, unilateral in 90%

causes:

  1. coagulation disorders
  2. increased intracapsulr pressure
  3. second hand smoke

leads to osteonecross from decreased blood supply and then looses structual rigidity and the femor head collapses

117
Q

osteogenisis inperfecta

what is this?

what does it cause?

6 sxs? one really key!

A

genetic disease

defect in Type I collagen causing fragility of the skeleton

sxs:

  1. short statue
  2. lax ligaments
  3. many bony deformities
  4. BLUE SCLERA
  5. decreased hearing
  6. poor teeth
118
Q

legg-calve-perthes disease

3 sxs?

1 dx with key finding?

4 tx options?

A

sxs:

  1. pain and limping worse with activity

2**. pain radiates to **groin/proxima thigh

3. DECREASED AROM/PROM

****abduction only 20-30* and internal rotation!!****

DX:

  1. AP and frog lateral with cresent sign!!!

TX:

  1. observation

femoral head can revascularize ususally 12-18 months

  1. restrict vigrous activity
  2. NSAIDs
  3. crutches
119
Q

lower extremity rotational disorders

WHAT IS THIS?

Most common cause and 3 examples?

5 dx techniques?

how do you do each?

A

“intoeing and outtoeing”

MC cause is intrauterine contraint of the fetus

includes:

small uterus

twins

uterine fibroids

causes:

  1. femoral anteversion/retroversion
  2. tibial torsion/rotation

DX:

  1. ROTATIONAL PROFILE

2. FOOT PROGRESSING ANGLE

angle the foor is rotated during walking

outward is +, inward is negative -

normal is 0-30

3. MEASUREMENT OF THIGH-FOOT ANGLE

prone with knee at 90*

rotation of foor compated to femor, 20-30 is normal

4. MEASUREMENT OF FEMORAL ANTE/RETROVERSION

patient laying prone, with knees bent 90*

push away from each other 40-50 is normal

5. FOOT ABDUCTUS

120
Q

lower extremity rotational disorders

internal tibial torsion

key?

gets more pronounced with?

tx?

A

most common cause of toeing in, exagerated with weight bearing

Tx: none, spontaneous resolution

consider braces or orthotic shoes

121
Q

lower extremity rotational conditions

femoral anteversion

key about this?

another finding?

tx?

A

most common cause of toeing in after 3

patella may be shifted medially!!

tx: corrects by 8

braces and orthotics not helpful

122
Q

lower extremity rotational disorders

external tibial torsion

what is one thing you might find?

tx?

A

normal in older children or adutls

  1. pes planus “flat feet”

TX: none, surgery in very extreme

123
Q

lower extremity rotation conditions

femoral retroversion

A

less common than anteversion

NO TX

124
Q

metatarsus adductus

what is this? where does it occur?

who is it most common in?4 sxs?

A

medially rotated forefoot, present at birth and often occurs at TMT joints

25% of pre-term births (esp twins)

SXS:

  1. hindfoot and midfoot have no defmormity

2. adducted forefoot

3. medial skin crease at TMT joint

4. forefoot is flexible! can be brought back into normal alignment

125
Q

metatarsus adductus

2 dx methonds?

2 tx methods?

A

DX:

  1. serial weight bearing photocopies
  2. consider xray
    - MODERATE BISETS 3rd/4th digit

Tx:

  1. resolves by 6 months spontaneously
  2. serial casting at 6 months for 2 weeek intervals

**usually 2 monts is enough time**

126
Q

talipes equinovarus

what is this? 3 anatomical positions?

4 sxs? 2 key?

A

congenital deformity of foot including “CLUB FOOT”:

1. plantar flexion of ankle

2. adduction of heel

3. high arch

some hereditary effect, 50% billateral

SXS:

  1. present at birth
  2. noticeable defomormity not reducible
  3. can’t dorsiflex
  4. transverse crease along sole of foot
127
Q

talipes equinovarus

1 DX?

3 tx options? length of time?

A

DX:

  1. must access muscle and nerve function

TX:

  1. immediate casting before leaving hospital
  2. serial casting Q1-2 weeks

Usuall 2-4 months of treatment

  1. surgery after 4 months of tx
128
Q

scoliosis

what is this defined as and where is it most common to occur?

4 causes? which is most common?

when is it usually dxed?

A

LATERAL curvature of spine over 10 degrees, ussualy LUMBAR OR THORACIC

causes:

  1. IDIOPATHIC: MOST COMMON!!!!!! GENETIC BASIS
  2. Congenital: fialure of segmentation or formation 2nd most common
  3. Neuromuscular
  4. vertebral disease (tumor, infection, MBD)

**usually dx preteen**

129
Q

scoliosis

sxs?

2 dx techniques?

A

SXS:

USUALLY ASYMPTOMATIC

MAY NOTICE POSTURAL CHANGE

DX:

  1. Adams forward bend most sensitive test!!-one side of back higher than the other
  2. if greater than 5-7* xrays needed

MEASURE THE COBB ANGLE

130
Q

scoliosis

3 tx options

A
  1. monitor progression while growing
  2. 20-40*-brace!! 80% effective if compliant
  3. Over 50%-surgical intervention fusion or rodding
131
Q

lower extremity rotational disorders

3 sxs?

3 tx?

A

SXS:

  1. usually present by age 2 with walking
  2. noticed by parents first
  3. rarely pain, but present limp or instability

TX:

  1. monitoring of rotational measures
  2. reassurance
  3. referral if no change or improvement
132
Q

what is important to remember about the gender and scolosis

A

7x greater liklihood of progression in girls

133
Q

Osteogenesis Imperfecta

3 dx

1 tx

A

DX”

  1. bowed long bones

2. osteonpenia

3. many fractures on xray

TX:

symptomatic, tx fractures, and modify fracture risk

134
Q

seizure disorder

what is this with 4 functions?

2 sxs she listed?

2 workup?

2 tx?

A

transient disturbance of brain function that can present as:

  1. involuntary motor
  2. sensory
  3. autonomic or psychic phenomena
  4. LOC/altered conciousness

SXS:

hold breath spells

staring spells

Workup:

  1. ECG
  2. brain MRI (if significant cognitive or motor impairment)

Tx:

benzodiazepines

antieleptic rx

135
Q

what are 6 causes of seizures in children?

A

metabolic

traumatic

anoxic

infectious

genetic mutations

spontaneous

136
Q

what is the most common reasons why seizures are misdiagnosed?

A

misinterpreation of behaviors in child…they are just ruled out as being weird and not an actual sxs of seizure

137
Q

epilepsy

what is this?

who has the highest incidence?

what are the risks or reccurence? 2

remission?

A

repeated seizures

highest incidence is in newborn!!!

after a single exposure: 50% risk of reccurence

after 2 seizures: 85% risk of recurrence

70% who are txed with have remission

138
Q

febrile seizures

what is key to remember about this?

3 dx criteria?

3 workup tests?

1 tx options?

A

most common neurological d/o of infants and children

criteria:

1. age 3 months - 6 years

2. fever over 38 C

3. non-CNS infxn/inflammation

workup:

  1. CBC
  2. Blood culture
  3. LP to check for meningitis

TX:

reassurance

prohpylactic NOT reccomended

139
Q

what type of febrile seizures are most common?

A

90% are generalized and last less than 5 minutes!!

140
Q

status epilepticus

what is the qualification for this?

when so the cases occur? 2

3 tx options?

A

seizure lasting 15 mins or more w/o full recoverying in 30 mins

MEDICAL EMERGENCY

85% of clases in children less than 5, most common around age 1

TX:

  1. benzodiazepam

2. phenytoin

3. phenobarbitol

141
Q

what can status epilpeticus lead to that makes it a medical emergency?

9 things

A
  1. hypoxia and acidosis
  2. depletion of energy stores, cerebral edema, and structual damage

3.

high fever

hypotension

respiratory depression

death

142
Q

cerebral palsy

what is this? does it get worse?

3 sxs

5 things it often coexists with?

tx?

A

nonprogressive

motor and postural dysfunction, with sustained or intermittent muscle contraction causing twisting and repetitive movements

SXS:

1. spasticity of the limbs most common in 75%

2. hyperreflexia

3. involuntary movements

Often co-exists with speech, vision, hearing, seizures, and mental retardation

Tx: multidisplinary

143
Q

what are 5 etiologies of cerebral palsy?

A

prematurity (most common!)

IUGR

intrauterine infection

antepartum hemorrhage

perinatal hypoxia

144
Q

toxoplasmosis

what is this?

5 sxs?

1 tx?

A

from materna exposure from cats, raw meat, or immunosuppresion

sxs:

  1. hydrocephalus
  2. intracranial calcifications
  3. chorioretinitis
  4. jaundice
  5. fever

Tx:

pyrimethamine plus sulfadiazine

145
Q

juvenile idiopathic arthritis

what are the 5 subtypes of this?

what are 5 sxs you see with these dxs?

A

SUBTYPES:

  1. systemic arhritis
  2. polyarthritis
  3. oligoarthritis
  4. enthesitis-related arthritis
  5. psoratic arthritis

SXS:

1. red, warm, swelling of joint

2. stiff

3. bony abnormalities

4. decreased ROM

  1. UVEITIS-leading cause of blindness in children
146
Q

what tests would you want to do when suspecting juvenille idiopathic arthtiris?

7 labs/tests

A
  1. CBC
  2. sed rate
  3. CRP
  4. rheum factor
  5. ANA
  6. xray
  7. athroscentesis
147
Q

juvenile idiopathic arthritis

systemic

what is the other name for this?

percent of JIA?

age?

4 key sxs?

A

aka “stills disease”

accounts for 10-20% of JIA cases

younger than 16

sxs:

  1. arthalgia of wrists, knees, ankles MC
  2. extra-articular fevers with spontaneous oscillations quotidian fever pattern

3. macular salmon rash usually waist and axilla that comes and goes with kobner phenomenon gets worse with rubbng skin

  1. hepatosplenomegaly
149
Q

juvenile idiopathic arthritis:

systemic

3 dx finding?

3 complications that can occur?

A

DX:

  1. DX of exclusion
  2. leukocytosis common

3. anemia common

(ANA and rheum usually negative)

COMPLICATIONS:

  1. joint damage
  2. spinal fusions
  3. macrophage activating syndrome
    - bleeding from gums, seizures, coma
    - WBC, hemoglobin, platelet, and sed rate start dropping
150
Q

juvenile idiopathic arthritis:

polyarthritis

what is the age pattern that is effected by this?

4 sxs seen in this? ***key to keep in mind about older children?****

A

bimodal age distribution

2-5 and 10-14

*****SXS IN YOUNGER****

1. 1-2 joints spreads to 5 or more within 6 months

  1. knees, wrist, and ankles more common
  2. dactylitis
  3. uvetits possible

***in older children: starts in small joints of hands and feet***

151
Q

juvenile idiopathic arthritis:

polyarthritis

3 dx findings?

3 complications?

A

DX;

  1. 4 or more joints within 6 months
  2. possible + ANA in younger group
  3. possible +rheum in older group
  4. elevated sed

Complications:

  1. contractures and weaknes, hard time walking

2. if positive rheum factor, more likely for poor outcome

152
Q

juvenile idiopathic arthritis

oligoarthritis

what is key to keep in mind with this? age?

2 presentation types?

2 sxs?

A

most common subgroup** **50% of cases

common in under 5 y/o

Persistent: no other joint involvment after the first 6 months than the original joints involved

extended: for or less joints over the first 6 months and the increase over time

***KID STARTS WALKING WITH A LIMP***

  1. KNEES, ANKLES, ELBOWS
  2. warm joints but not red
153
Q

juvenile idiopathic arthritis

oligoarthritis

1 key dx?

1 complication?

A

DX:

  1. 2 or more joints in 6 weeks
  2. ANA+
  3. rheum -
  4. sed rate often normal since localized

COMPLICATIONS:

  1. leg length discrepancies
154
Q

juvenille idiopathic arthritis:

enthesitis-related arthritis

what does this mean?

age?

what does it have a strong relationshop with?

5 key sxs seen with this?

A

enthesis: tenderness at the insertion point

age 8-12, 10-20% of GIA cases

strong relationship to HLA B27

sxs:

  1. SI joint tenderness
  2. spinal pain
  3. HLA-B27
  4. anterior uveitis
  5. fam hx of spondyloarthropathy or IBS
155
Q

juvenille idiopathic arthritis:

enthesitis-related arthritis

1 key dx?

A

dx:

  1. HLA B27
156
Q

juvenille idiopathic arthritis:

Psoratic arthritis

who is this most common in?

6 sxs?

A

MC IN FEMALE CHILDREN IN PRESCHOOL THEN IN MIDDLE-LATE CHILDHOOD

SXS:

  1. KNEES ANKLES WRISTS
  2. DIP INVOLVEMENT
  3. SKIN RASH PLAQUES
  4. NAIL PITTING
  5. ONCHOLYSIS

seperation of nail from nailbeds

  1. uveitis
157
Q

juvenille idiopathic arthritis:

Psoratic arthritis

dx?

158
Q

treatment for Juvenille idiopathic arthritis?

4 tx options

A
  1. NSAIDS!! (no ASA=reye)
  2. corticosteroids (injection), esp as bridge to DMARD
  3. methotrexate

hydroxycholoquinolone

sulfasalazine

etanercept

  1. PT/OT
159
Q

ORBITAL CELLULITIS

what is this and what age group?

how to dx?

6 sxs?

what is the tx and what is this important?

A

MC IN CHILDREN 7-12

***associated with sinusitis*

pathogens:

strep pneumoniae

staph aureus

haemop influenza

SXS:

PTOSIS

eyelid edema

exophthalmous

purlurent discharge/conjunctivits

limited ROM

sluggish puppilary response

DX: CT TO DETERMINE THE EXTENT OF DISEASE in soft tissue

tx: MEDICAL EMERGENCY with hospitalization cause it can lead to MENINGITIS BIG DEAL

_***broad spectrum abx!! naficillin and metronidzole or clinda***_

160
Q

obstruction

5 causes

explain last 3

4 sxs

A
  1. tumor
  2. foreign body
  3. paralytic ileus-trauma, surgery, infection, metbaolic disease with DM

4. volvulus-twisting of intesinte

5. intusssception-telescoping of intestine

sxs;

  1. severe abdominal cramping
  2. inability to pass stool
  3. increased bowel sounds first, then decreased
  4. abdominal swelling, distention
162
Q

obstruction

3 dx

3 tx

A
  1. abdominal xray
  2. CT
  3. barium enema

tx:

  1. NG tube (relieve pressure)
  2. relieve obstruction
  3. surgery often needed
163
Q

what are four complications from obstruction?

A

tissue death

perforation

sepsis

death

164
Q

Reye syndrome

what is this?

when does it occur and drom what?

age?/

tx?

A

fatty liver with encephalopathy

30% fatality

2-3 weeks after influenza or varicella infxn if given ASA!!! 5-14 years old, peaks after 18

TX: supportive

165
Q

Coxsackievirus

“Hand mouth and foot”

what sxs does this have?

tx?

A

red papules or vesicles occur on the touch, oral mucosa hands and feet and butt

mild fever and malaise

TX: supportive

166
Q

Scarlet Fever

what does the rash look like of this?

2 other key buzz words?

how do you tx this?

A

STREP THROAT WITH DIFFUSE RASH that blanches, FINE RED PAPULES THAT APRRECIATED BY TOUCH FEEL LIKE SANDPAPER

“THINK SUNBURN WITH GOOSE PUMPS”

CIRCUMORAL PALLOR
STRAWBERRY TOUNGE

**rash fades in 2-5 days, tx strep with amoxicillin**

168
Q

what is the most common cause of neonatal sepsis?

A

Group B streptococcus

169
Q

early onset sepsis

when does this occur?

4 MC bacteria?

3 things to monitor

A

birth-7 days

1. group B streptococcus

2. E. coli

3. Klebsiella

4. listeria

monitor:

PROM

chorio

maternal and baby fever

170
Q

late onset sepsis

when does this occur?

3 bacterial that cause this?

A

7-28 days of life

  1. haemophilus influenzae

2. staphlococcus pneumoniae

3. neisseria meningitidis 75% of cases!

171
Q

sepsis

3 sxs of this?

tx?

A

SXS:

  1. fever/temp instablitly over 100.4, abnormal only if less than 2 months old
  2. Resp difficulty
  3. poor feeding

DX:

bascially everything from CBC to LP

tx:

Gentamicin and ampicillin

172
Q

transient tachypnea of the newborn

what is this?

A

difficulty with transition to breathing on their own, may need a little support oxygen in the begining of life

breath faster and work harder to breath

if they don’t get better work up for sepesis

173
Q

hyperbilirubinemia in infant

HOW DOES THIS PRESENT? 3

2 CATEGORIES AND CAUSES?

A

PRESENTS WITH:

1. JAUNDICE/SCLERAL ICTERUS

2. KERNICTERUS

TYPES:

  1. DIRECT (CONJUGATED)= ALWAYS PATHOLOGIC
  2. INDIRECT (UNCONGUATED)= PHYSIOLOGIC VS PATHOLOGIC
174
Q

DIRECT (CONJUGATED)

HYPERBILIRUBINEMIA

when does this present?

what are 4 causes of this?

A

often presents first 24 hours

ALWAYS PATHOLOGIC

pathologic causes:

  1. extrahepatic obstruction
  2. persistent intrehepatic cholestatsis
  3. acquired intrahepatic cholestasis
  4. genetic and metabolic disorders
175
Q

INDIRECT UNCONJUGATED BILIRUBIN

when does this occur?

what is its nickname and what is it secondary to?

6 causes?

A

occurs after 24 hours of life

“physiologic jaundice”

secondary to decreased amount of UDP-glucouronyl transferase activity

causes:

hemolytic** **process like

1. polycythemia

2. bruising

3. breast milk jaundice

4. sepsis

5. endocrine disorders

6. genetic disoders that affect bili metabolism

176
Q

what are the 3 tx options for hyperbili?

A
  1. treat cause
  2. phototherapy
  3. exchange transfusion
177
Q

what are 4 things that put a person at increased risk for hyperbilirubinemia?

A
  1. premature infants
  2. maternal DM
  3. asian
  4. native american
178
Q

epstein barr virus

what is this caused by?

nickname for this?

what should they avoid?

5 symptoms?

2 dx? findings?

tx?

A

human herpes virus 4

“kissing disease” spread by saliva

**don’t participate in contact sports because of potential spleen rupture**

SXS:

  1. EXUDATIVE PHARYNGITIS

2. SOFT PALATE PETECHIAE

3. POSTERIOR CERVICAL NODE ENLARGEMENT

4. SPLENOMEGALY IN 50% OF PATIENTS

5. MACROPAPULAR/PETECHIAL RASH

DX:

  1. ATYPICAL LYMPHOCYTES THAT ARE LARGER AND STAIN DARKER AND VACULOATED
  2. MONOSPOT
    tx: supportive
179
Q

what should you not give to someone with mono?

180
Q

what can administration of amoxicillin cause in someone who has EBV?

181
Q

what test can give a false positive if the pt has EBV?

A

false positive syphilis test

182
Q

what are some complications that can come from from EBV?

5

A
  1. splenic rupture

pericarditis

myocarditis

encephalitis

aseptic meningitis

Rotation 4: FMI (11 decks)

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