PEDS Flashcards
acute otitis media vs otitis media with effusion
OME can be distinguished from AOM by the lack of acute inflammatory signs (fever, bulging, TM immobility)
loss of the paternal copy of 15q11
loss of the maternal copy of 15q 11?
loss of paternal = prader willi
loss of maternal = angelmans
drooling + tripod
dx?
org?
epiglottitis
HiB
kawasaki dz tx?
complication?
ivig + aspirin
coronary artery aneurysms
normal RR and HR for babies
rr 40-60
hr 120-160
low apgar score does not
predict future wellbeing/cerebral palsy
apgar scoring
appearance 0 blue, 1 blue extremities, 2 pink
pulse 0 <60, 1 60-100, 2 >100
grimace 0 no response, 1 grimace, 2 sneeze/cough
activity 0 no tone, 1 some flexion, 2 active movement
respiration 0 absent, 1 weak/irregular, 2 strong
neonate conjunctivitis day 1 day 2-7 day 7+ 3 weeks +
1 chemical irritation (due to silver nitrate)
2-7 N gonorrhoeae
7+ chlamydia
3weeks herpes simplex
why do we give neonates IM vitamin K at birth
gut is not colonized yet so e coli is not producing enough vitamin K to make clotting factors 2 7 9 and 10 + protein c and s
prevents VKDB (hemorrhagic disease of the newborn)
PKU
AR deficiency in phenylalanine hydroxylase
mental retardation
tx: diet low in phenylalanine
cause of cretinism?
congenital hypothyroidism
all neonates get what: hep B vaccine or immunoglobulin
all get vaccine
those who have HBsAg positive mothers will get immunoglobulin as well
if transient tachypnea of the newborn last longer than 4 hours…
consider it sepsis and get blood and urine cultures
caput succedaneum vs cephalohematoma
caput does cross suture lines vs cephalohematoma that does NOT cross suture lines
what is risk factor for brachial plexus injury?
macrosomic infants of diabetic mothers
differentiate klumpke vs erbs palsy
klumpke - c7-T1, claw hand + horners syndrome (ptosis, miosis, anhydrosis)
duchenne erb - C5-C6, waiters tip, unable to abduct or externally rotate or supinate
tx for both immobilization
causes of polyhydramnios
fetus not swallowing werdnig hoffman (neurological) intestinal atresias
causes of oligohydramnios
fetus cannot urinate
prune belly (lack of abdominal muscles)
renal agenesis (ass with potter syndrome)
flat facies from compression of face with low amniotic fluid
mc cause of an elevated AFP
what two conditions does it otherwise indicate?
incorrect dating
neural tube defect or abdominal wall defect
omphalocele vs gastrischisis
what is elevated?
omphalocele has a sac covering (failure of the sac to retract)
gastroschisis has NO sac and is due to wall defect lateral to midline
AFP
tx for omphalocele?
what is omphalocele associated with?
surgical replacement
w edwards syndrome tri 18
umbilical hernia is associated with what congenital issue?
mech?
congenital hypothyroidism
weakeness of the lateral rectus abdominis muscles
must repair after age 4 if it hasnt spontaneously closed
tx for gastroschisis
slow return to abdomen (gradual surgical closure)
mc kids abdominal mass?
wilms tumor
WAGR syndrome
wilms tumor (hemihypertrophy of kidney)
aniridia
genitourinary malformations
retardation
mc cancer in childhood?
neuroblastoma
will see jerky eye movements and elevated VMA and metanephrines
hydrocele vs varicocele
hydrocele - painless, transilluminates, within scrotum, self resolves
varicocele - swelling of pampiniform plexus, dull ache and heavy scrotum, bag of worms sensation, dx with U/S, often on BOTH sides
cryptorchidism
absence of one testicle in the scrotum and is usually in the inguinal canal
tx with orchiopexy after age 1 to avoid sterility
hypospadias vs epispadias
hypo - ventral opening of the urethra, ass with inguinal hernias and cryptorchidism, DO NOT CIRCUMCISE until srgical correction
epi - dorsal urethral opening, ass with urinary incontinence, ass with bladder exstrophy, tx w surgery
normal babinski reflex in babies
extension of toes
kid with hx of exercise intolerance (cyanosis) and squatting to relieve
tet spells = tetralogy of fallot
overriding aorta
pulmonary stenosis
RV hypertrophy
VSD
presents with cyanosis, holosystolic murmur LLSB, squatting to decrease right to left shunting and increased sats, boot shaped heart
in transposition of the great vessels, no oxygenation can occur without…
a patent ductus arteriosus, ASD, or VSD
what is given to keep PDA open
prostaglandin E1
indomethacin / NSAIDs are A NO GO because they will close it
gray cyanosis + absent pulses
hypoplastic left heart syndrome
cxr = globular shaped heart
what do patient develop in first 4 months in truncus arteriosus?
pulmonary htn
total anomalous pulmonary venous return
no venous return between the pulomonary veins and the left atrium –> oxy blood returns to the SVC
obstruction may or may not be present (angle at which the veins enter)
without obstruction presents later (1-2yo) with right heart failure and tachypnea
eisenmenger syndrome
left to right shunt due to a vsd reverses into a right to left shunt due to RV hypertrophy
all 5 cyanotic heart defects feature what
R to L shunt
high pitched holosystolic murmur over LLSB
VSD
FIXED WIDE SPLITTING OF S2?
ASD
how long into life is a PDA “normal”
up to 12 hours
machine like murmur + wide pulse pressure + bounding pulses
PDA
rib notching?
coarctation of the aorta
coarctation of the aorta is associated with what sex abnormality?
turners syndrome (wide neck, shield chest, streak gonads, horseshoe kidney)
consider phototherapy for bilirubinemia if it rises to…
20-25 mg/dL
common complication with a tracheoesophageal fistuladistal esophagus
aspiration pneumonia
most common type of TEF
Esophageal atresia with distal TEF (blind esophagus + trachea that opens up into two bronchi and 1 distal esophagus
donut sign?
string sign?
donut = intussusseption
string = pyloris stenosis
olive sign?
pyloric stenosis
best initial and most accurate tests for pyloric stenosis?
best initial = abd U/S
most accurate = upper GI series
choanal atresia
born with membrane between nostrils and pharyngeal space that prevents breathing during feeding
blue when feeding and pink when crying
dx with CT scan
CHARGE syndrome
coloboma of the eye heart defect choanal atresia retardation of growth or development genitourinary abnormalities ear abnormalities or deafness
hirschprung disease is associated with
down syndrome
hirshprungs
lack of innervation in distal colon
dont pass meconium in first 48 hours
dstended bowel loops with lack of air in the rectum and high pressure in anal sphincters
dx with full thickness biopsy = lack of ganglionic cells in the submucosa
imperforate anus is associated with
down syndrome
VACTERYL syndrome
vertebral abnormalities anal atresia cardiovascular abnormality TEF esophageal atresia renal anomalies limb abnormalities
double bubble sign
duodenal atresia
duodenal atresia
mech?
dx?
lack or absence of apoptosis for canalization of the lumen of the
cxr = double bubble
best initial tx for volvulus
endoscopic decompression
curant jelly…seen in which two settings?
currant jelly sputum = klebsiella pneumonia
currant jelly stool = intussusseption
intussusception
best dx?
tx?
ultrasound is best initial dx = doughnut sign with hypoechoic and echogenic bands (mucosa and submucosa)
barium enema is dx and tx = most accurate test BUT contraindicated in perforation or peritonitis
reccurence rate of intussusception
10% occur again in 24 hours
painless bright red blood per rectum in male kid under age 2
dx?
meckels diverticulum ( a true diverticulum)
dx with meckels scan (technetium 99)
rules of 2s
for meckels diverticulum
affects 2% of population occurs 2 feet from ileocecal valve affects 2 types of tissues (gastric and pancreatic) males are 2x more affected patient <2 yo 2 inches long
when air is seen in the wall of the bowel in a sick patient….
nectrotizing enterocolitis!
CT is NOT necessary after xrays,,,,just start antibiotics!! then give IV fluids
metabolic findings in infants of diabetic mothers
hypoglycemia
hypocalcemia
hypomagnesemia
hyperbilirubinemia
CAH three types
17alpha hydraxylase def – no cortisol or sex hormones = lots of aldosterone, HTN
21 hydroxylase def – lots of sex hormones NO aldosterone or cortisol + HYPOTENSION, virilized
11beta-hydroxylase def – you get some deoxycorticosterone but not aldosterone, no cortisol, yes sex hormones, virilized, HTN
beading of the ribs and genu varum
rickets (vit D deficiency)
kartagener syndrome is characterized by…
infertility and situs inversus
tx for neonatal sepsis
amp and gent
presentation,dx,and tx of toxoplasmosis
chorioretinitis, hydrocephalus and multiple ring enhancing lesions onCT
most accurate dx is PCR
pyrimethamine and sulfadiazine
presentation,dx,and tx of neonatal syphilis
rash on palms and soles, snuffles, frontal bossing, hutchinson eighth nerve palsy, and saddle nose
beat initial is VDRL or RPR; most accurate is FTA abs or darkfield microscopy
penicillin
presentation,dx,and tx neonatal rubella
PDA, cataracts, deafness, hepatosplenomegaly, thrombocytopenia, blueberry muffin rash, hyperbili
maternal IgM status
supportive
presentation,dx,and tx of neonatal CMV
periventricular calcifications, microencephaly, chorioretinitis, hearing loss and petechiae
urine or saliva PCR is most accurate
ganciclovir when signs of end organ damage
presentation,dx,and tx and herpes
week 1 shock and dic, week 2 vesicles on skin, week 3 encephalitis
most accurate PCR, initial tzanck smear
tx acyclovir
cough, conjunctivitis, and coryza (stuffy nose) + muscosa koplik spots (gray macule)
paramyxovirus (rubeola/measles)
croup
steeple signs on cxr + barky cough, and inspiratory stridor
due to parainfluenza
give rac epi if severe/respiratory distress
epiglottitis
h influenza b (Hib)
hot potato voice + fever and tripod drooling + thumbprint sign
INTUBATE!
galactosemia
neonate with bilateral cataracts, failure to thrive, jaundice, and hypoglycemia
galactose 1 phosphate uridyl transferase deficiency
biggest risk factor for intraventricular hemorrhage of newborn
prematurity
doll face and seizures/hypoglycemia and lactic acidosis
glycogen accumulation in von gierke dz ( glucose 6 phosphotase deficiency)
