✅PEDS Flashcards
Identify possible causes of this rash - 3
THE STRAWBERRY TONGUE!
- [GASP +/- mononucleosis]
- Kawasaki disease
- Toxic Shock Syndrome
3 classic Clinical Manifestations of [Tetralogy of Fallot]
A:
- [Systolic Ejection HARSH Murmur @ L Sternal 2/3 ICS] from [RVOO -R Vt Outflow Obstruction]
- Squatting relieves sx (INC afterload–> [DEC amount of R to L shunt]
- [Cyanotic lethal Tet Spells] (tx: Knee chest positioning and inhaled O2)
“VOIR is to have See + Sight & Cry”
What is a BRUE ?
Brief Resolved Unexplained Event
when there is an IDIOPATHIC sudden, brief and now resolved episode occuring in an infant < 1 yo that included at least:
- cyanosis
- breathing ∆ (absent, ⬇︎, irregular)
- Hyper/hypotonia
- altered LOC
this is a dx of exclusion
What’s used to keep the PDA Patent?
Prostaglandin E1
What should you always suspect in a pediatric pt who recently had a viral illness, now p/w SOB and cardiomegaly?
Viral myocarditis (coxsackie B vs adenovirus)
2 main sx of Bronchiolitis
________________
cause?
- [Wheezing w/respiratory distress]
- Fever
_________________
RSV
Laryngomalacia etx
As a neonate, collapse of supraglottic structures during inspiration –> chronic inspiratory stridor worst when supine
[T or F]
LAD is actually normal in kids and young adults
TRUE - AS LONG AS THEY’RE SOFT AND MOBILE
tx = observation
Why is cessation of breast feeding in a jaundiced 20 day old pt who is lethargic not necessary?
Galactosemia (Conjugated Hyperbilirubenima) is unlikely considering pt is 20 days old. Sepsis should be r/o first with blood cx and px abx
What are the 2 major complications of Mumps
- Orchitis
- Aseptic Meningitis
A child comes in with neonatal conjunctivitis
DDx?-3
________________
How do you differentiate each?
Tx for Neonatal Chlamydia Conjunctivitis?
________________
Tx for Neonatal Gonococcal Conjunctivitis?
ncC = [Macrolide PO]
________________
ncG = [CefTriaxone IM]
________________
- nc = neonatal conjunctivitis*
- Topical macrolides are only PX for Gonococcal conjunctivitis*
What is the most common cause of Chronic renal failure (and urinary tract obstruction) in pediatrics?
Posterior Urethral valves (THIS ONLY AFFECTS BOYS-including newborns)
All kids with a febrile UTI at age 2mo-2yo should undergo ⬜ to evaluate for ⬜
Renal US–>[cystourethrogram if recurrent] ; Vesicoureteral reflux
Oligohydramnios –> ⬜ sequence.
Describe this clinical presentation for this Sequence
Oligohydraminos –> POTTER Sequence
Pulmonary hypOplasia
Oligohydraminos from renal agenesis/damage (cause)
[Twisted Face & Extremities]
Twisted Skin
Ears set low
Renal Failure
Oligohydramnios –> ⬜ sequence.
Name the 3 most common causes of Oligohydramnios
Oligohydraminos –> POTTER Sequence
POSTERIOR URETHRAL VALVES are the most common cause of obstruction in newborn boys (which causes renal damage –> oligohydramnios during utero)
Minimal change disease is most common cause of nephrOtic syndrome in kids
Tx?
Prednisone
Minimal change disease is most common cause of nephrOtic syndrome in kids
When is renal biopsy indicated?-2
- >10 yo
- Child has NOT responded well to CTS
What MAIN dx should be suspected in a neonate with painless bloody stools
________________
mngmt?
[Milk/Soy ALLERGIC proctocolitis]
________________
[Hematochezia cessation in 2 wks] >
these pts usually also have eczema and regurgitation from Milk/Soy
DDx for neonatal rectal bleeding - 4
- [**Milk/Soy ALLERGIC Proctocolitis** = PAINLESS]
- Meckel Diverticulum = PAINLESS
- Volvulus (bloody stool from intestinal ischemia)
- Intussuception (dx= AIR contrast enema)
cp for neonatal Lactose Intolerance - 3
- NONBLOODY diarrhea
- flatulence
- crampy abd pain
Lactose Intolerance = no Lactase ➜ NONBloody Flatulence & Diarrhea
etx for Choanal atresia in kids
________________
cp
Congenital falure of posterior nasal passage to canalize –> bony obstruction instead
________________
cyanotic infant whose cyanosis worsens with feeding and relieves by crying
Dx = inability to pass catheter thorugh nares
Demographic for Hypertrophic pyloric stenosis
First Born boys [3-5 wks old]
image showing “oilive mass”
Pts with Beckwith-Wiedemann syndrome should be monitored for what 2 CA?
- Hepatoblastoma
- Wilms tumor
cp for Reye syndrome - 2
- [encephalopathy from ⬆︎ICP –> seizure, vomiting, lethargy –>eventually DEATH]
- liver dysfunction
Dx? ; Mngmt?
Congenital Diaphragmatic Hernia ; Intubation without any preceding bag mask ventilation
Image = Scaphoid concave abdomen with Barrel Chest
Why do pts with this condition often have polyhydramnios?
Hernia of Diaphragm compresses esophagus –> polyhydramnios
Congenital Diaphragmatic Hernia
Image = Scaphoid concave abdomen with Barrel Chest
Constipation is common in Toddlers
Why? - 3
- Transition to solid food and cow’s milk
- toilet training
- school entry
Tx = PO Laxatives
When should ingested batteries be emergently and endoscopically removed?
ONLY when the battery is still IN the esophagus and not distal to it. If distal –> obs
this also includes sharp objects, or multiple magnets
[T or F] Gastroesophageal reflux is common in infants
Why or why not? ;
TRUE
- More time spent supine
- Shorter esophagus
Physiological Gastroesophageal reflux is common in infants
What is the mngmt for this?-3
________________
When should you be concerned for GER Disease in infants?-2
*REASSURANCE
*[hold infant upright after feeds]
*[(if GERD) = thicken feeds with oatmeal + PPI]
________________
GERD =
- failure to thrive
- opisthotonic posturing after feeds
What is the mngmt for an ingested coin? - 3
- Obs for up to 1 day after ingestion UNLESS
- Pt is symptomatic = flexible endoscopy
- Pt has no recollection of ingestion time = flexible endoscopy
Zollinger Ellison etx ; cp-2
gastrin producing tumor in pancreas or duodenum –> ⬆︎⬆︎gastric acid > 1000 –>
- multiple duodenal/jejunal ulcers REFRACTORY to PPI
- steatorrhea from pancreatic enzyme inactivation
Be sure to screen Zollinger Ellison pts for MEN1 using PTH, Ca+ and Prolactin studies
What is Hepatic Hydrothorax
Liver Disease pts cause damage to R diaphragm –> small defects that allows R pleural effusions to form
[T or F]
UNILATERAL cervical LAD in kids (typically from ⬜ bacteria ) is not common and needs further workup
FALSE!
________________
ped uL cervical LAD (typically from Staph > GASP) is common
cp for Bronchiolitis in neonates - 3 ; px for this?
- Wheezing and/or Crackles
- URI sx
- Respiratory distress eventually –> APNEA
Px = Palivizumab for kids<2 yo
What does APGAR stand for? ; How is it done? ; How is it used?
Appearance, Pulse, Grimace(reflex irritability), Activity(tone), Respiration
Performed at 1 and 5 min postpartum, All scaled from 0 to 2 and then added together
[< 3 = Critical] / [4-6 = fair: PPV] / [7-10 = normal: No intervention]
APGAR is used to assess newborn status immediately postpartum
Describe the grading system for Respiration?
APGAR
0 = not breathing
1 = breathing slow/irregular
2 = crying
APGAR is used to assess newborn status immediately postpartum
Describe the grading system for Pulse?
APGAR
0 = No HR
1 = < 100 bpm
2 = > 100 bpm
APGAR is used to assess newborn status immediately postpartum
Describe the grading system for Activity & tone?
APGAR
0 = no motion
1 = arms & legs flexed but not active
2 = Active Motion of extremities
APGAR is used to assess newborn status immediately postpartum
Describe the grading system for Grimace & reflex irritability?
APGAR
Test response to stimulation (i.e. pinch)
0 = no rxn
1 = grimace
2 = grimace AND cough/cry/sneeze
APGAR is used to assess newborn status immediately postpartum
Describe the grading system for Appearance?
APGAR
0 = entirely blue
1 = pink with blue extremities
2 = entriely pink
In a neonate, when should compressions be started?
HR <60
Neonatal Respiratory Distress Syndrome is caused by ⬜
What are the major risk factors?-2
Surfactant Deficiency
- Prematurity
- Maternal DM
Enuresis (nocturnal urinary incontinence/bed wetting) tx - 3
Dx criteria: occurs ≥2/week AFTER 5 yo
- LIfestyle change (no fluids at bedtime/void before bedtime/reward system)
- Enuresis alarm
- Rx: DESMOPRESSIN –> add Oxybutynin if minimal change
Any neonate who presents with Bilious emesis should be worked up for _____
Bowel Obstruction!
AbdXray (r/o perf bowel) –> water-soluble contrast enema
A Contrast enema demonstrating microcolon is indicative of what condition? ; etx?
Meconium iLeus 2/2 Cystic Fibrosis
viscous meconium accumulation obstructs terminal iLeum –> underused colon –> contracted microcolon
In regards to timing, what is the difference between Breastfeeding Failure jaundice and Breast Milk jaundice?
In terms of physical exam, what is a difference between Breastfeeding Failure jaundice and Breast Milk jaundice?
In BreastFeeding Failure jaundice there will be clinical signs of Failure to thrive/dehydration
these dehydrated neonates may have brick red urate crystals in their diapers from dehydration
In terms of etiology, what is a difference between Breastfeeding Failure jaundice and Breast Milk jaundice?
BFF jaundice within the First week of life: inadequate feeding –> inadequate stooling –> ⬇︎bilirubin elimination –> ⬆︎Unconjugated bilirbuin recycling with Failure to thrive/dehydration
Tx for BreastFeeding Failure jaudice - 3
- Optimize lactation
- ⬆︎BreastFeeding frequnecy
- Supplement with Cow’s formula ONLY if mom’s milk is inadequate
Why is human milk better absorbed than formula?
Protein Whey in human milk is more easily digested than casein which –> ⬆︎absorption and ⬆︎gastric emptying
cp for Physiological Jaundice ; etx?-2
Unconjugated hyperbilirubinemia that appears the first 24 hours of life and resolves by the end of that week ; comes from ⬇︎hepatic UGT activity and ⬆︎bilirubin production
Describe Metatarsus Adductus
Most common congenital foot deformity in which there is BL medial deviation of the forefoot usually in 1st born infants
Tx = this corrects spontaneously
[Atlantoaxial joint] Instability MOD
________________
Which demographic are at most risk for this?
excessive laxity in the Posterior transverse ligament ➜ ⬆︎mobility between [C2 aXis: dens] and the [C1 atlas] –> spinal cord compression ➜ UMN signs
________________
Down Syndrome (remember pts with down syndrome are usually hypOtonic but not with Atlantoaxial instability!)
Tx for Croup-2
- Mild = Humidified air +/- CTS
- > Mild = CTS +/- Racemic Epi nebulized
Croup = paraflu that –> subglottic edema and narrowing
Dx for Intussuception
AIR contrast enema ultrasound guided
Intussuception age = 3-36 mo
Look for the Target Sign on US!
Diagnostic Criteria for Colic - 4 ; tx
Colic = the 3’s
excessive crying during first 3 weeks of life that’s
≥3hrs/day (usually evenings) for
≥3days / week for
≥3weeks in a healthy infant
Tx = Soothing and feeding techniques
Necrotizing Enterocolitis cp - 3
________________
X ray finding?
- Bloody stools
- feeding intolerance
- abd distension
X-ray = Pneumotosis Intestinalis
Risk factors= prematurity, congenital heart disease, hypotension
Dx
X-ray = Psuemoatosis Intestinalis
Necrotizing Enterocolitis
What are the risk factors for Necrotizing Enterocolitis cp - 3
- Congenital heart disease
- Prematurity
- hypotension
X-ray = Psuemoatosis Intestinalis
Why should a pediatric pt with fever and rash who received MMR 1 week prior only receive reassurance
small fraction of pts who receive MMR may develop fever and mild rash that are self-limited
What Mothers are at high risk of having Neonates with [TGA - Transposition of Great Arteries]?
Diabetic Mothers
What is the most common congenital cyanotic heart defect in the neonatal period?
Transposition of Great Vessels
Look for the single Loud second heart sound!
A: Clinical Manifestations of DiGeorge Syndrome (5)
B: Genetic Cause
“CATCH 22 & Pa3”
Cardiac (Aortic Arch abnormalitites, Tetralogy of Fallot)
Abnormal face (Bifid Uvula/low set ears)
Thymus Aplasia
Cleft Palate
[HypOcalcemia from PTH deficiency] may–> Carpopedal Spasms
22q.11.2 deletion
Pharyngeal arch - 3rd/4th both fail to develop
What does Constitutional Short Stature refer to
“late bloomer” but will attain normal adult height later
pts have normal birth wt and ht but ht velocity slows between 6 mo-3 yo, picks back up after and slows again at adolescence. bone radiographs will show delayed bone age
What is the most common cause of hip pain in kids?
________________
Dx?
Transient Synovitis
________________
Clinical but obtain Xray to r/o Legg Calve Perthes
may have ⬆︎inflammatory markers but xrays will be normal
Transient Synovitis is the most common cause of hip pain in kids
Tx for Transient Synovitis - 2
obtain Xray to r/o Legg Calve Perthes
Tx = NSAID and rest
Cerebral Palsy is a group of clinical syndromes generally characterized as ⬜
How does it present? - 3
Nonprogressive motor dysfunction (Prematurity>EtOH = RF) ;
Cerebral Palsy is SAD
- BL equinovarus club feet (image)
- UMN signs LE >UE
- Mental Retardation
Greatest RF = prematurity ( < 32 wks gestation)
Mangement for [Equinovarus Clubfoot] - 3
START THIS MNGMT IMMEDIATELY!
1st: Stretch and Manipulate [equinovarus club foot] –>
2nd: [serial plaster cast, malleable splints or taping]
3rd: Surgery between ages 3-6 mo if refractory to #1-2
Langerhans cell histiocytosis cp - 3
- solitary painful lytic bone lesion in child
- overlying swelling
- hypercalcemia
Craniopharyngiomas and Pituitary adenomas both can cause bitemporal hemianopsia
How can you differentiate the two? - 2
- Craniopharyngiomas are calcified (show up white on CT)
- Craniopharyngiomas results in pituitary hormonal deficiency (adenomas result in pituitary hormone ⬆︎)
Craniophyarngiomas are calcified epithelial remnants of Rathke’s pouch that reside in the SUPRAsellar region
Craniopharyngioma etx
Calcified low grade malignancy dervied from epithelial remnants of Rathke pouch within the pituitary stalk and reside in the SUPRAsellar region
What is Erythema Toxicum Neonatorum ; tx?
benign neonatal rash with blanching erythematous papules and/or pustules ; self limited to 2 weeks after birth
Malrotation and Volvulus are both diagnosed with ⬜
Describe how both would look on this diagnostic?
Upper GI Series barium swallow
________________
Malrotation = Ligament of Treitz on the R side of the abd in a gasless abd
________________
Volvulus = corkscrew image on barium swallow Upper GI series
Malrotation and Volvulus are both diagnosed with ⬜
What would Volvulus look like on this diagnostic?
[Upper GI series barium swallow]
corkscrew image
Try not to use CT scans in kids
cp for Meckel’s Diverticulum
________________
dx
PAINLESS hematochezia
________________
technetium 99 pertechnetate scan
Describe general characteristics of intentional child scald burns - 3
- uniform depth
- sparing of flexor surfaces
- sharp lines of demarcation
[Strabismus ocular misalignment] after the age of ⬜ is abnormal and requires intervention to prevent ⬜
________________
Which intervention is employed for this? - 3
4 mo ; Amblyopia(vision loss from disuse of the deviated eye)
- CTL eye patch to strengthen deviated eye OR
- CTL cycloplegic eye drops (blurs normal eye to strengthen deviated eye)
- Corrective lens
Dx = asymmetric corneal light reflex
What is Legg Calve Perthes Disease?
________________
Demographic?
________________
mngmt-2?
Avascular necrosis of the Capital Femoral Epiphysis ; [Boys 4-10 yo) ;
- Self limited but can –>deformity/degeneration
- contain femoral head within acetabulum during encounter
Slipped Capital Femoral Epiphysis is a complication of childhood obesity
When does this present?
________________
How does this present?
________________
dx?
puberty (most common hip disorder in fat teens!)
________________
[M: Months of vague hip/knee pain] without acute onsets
________________
pelvis XRay
posterior displaement of capital femoral epiphysis thru cartilage growth plate
Risk factors for Developmental Dysplasia of Hip - 3
________________
when should you stop screening for this?
- Breech Delivery - GET HIP IMAGING IF FEMALE AND BREECHED
- Female - GET HIP IMAGING IF FEMALE AND BREECHED
- Fam hx
12 months old
pediatric pt presents with apparent leg length discrepancy and is diagnosed with ⬜
________________
What is the work up for this?-2
Developmental Dysplasia of Hip
________________
hip ultrasound < 4 mo < hip xray
What is the treatment for Developmental Dysplasia of Hip?
Pavlik Harness that holds hip in flexion and ABduction
Newborns with congenital hypothyroidism appear normal because ⬜
________________
Describe Physical Exam for [congenital hypothyroidism] ? - 10
protected by maternal thyroid hormone for 6 wks;
- G: ⬇︎Feeding
- G: ⬇︎Activity
- P: Mental retardation (check for Down Syndrome)
- H: Large Fontannel
- H: Macroglossia
- H: Puffy Face
- A: Umbilical Hernia
- A: Constipation
- S: Jaundice
- S: Skin Mottling
EARLY DETECTION IS KEY, AS NORMALIZING TSH BY 1-2 MONTHS OLD PREVENTS NEURO DAMAGE!
Common characteristics of Down Syndrome pts - 7
the SHEEPPS of genetics
- Skin excessive at the nape of the neck = nuchal skin
- HypOtonia w/ ⬇︎ Startle Moro reflex
- Epicanthal folds
- Ears that are small
- Protruding tongue w/flat face
- Palpebral fissures are upslanted
- Single palmar crease
these pts also have ⬆︎risk for hypothyroidism
cp for Laryngomalacia
________________
dx?
________________
tx?
[P2: inspiratory stridor that improves when prone]
________________
Direct laryngoscopy
________________
self limited to 18 mo
tx for Physiological Jaundice
Phototherapy
Unconjugated hyperbilirubinemia that appears the first 24 hours of life and resolves by the end of that week
What is the most common pediatirc renal cancer?
Wilms tumor
unilateral abd mass with hematuria
⬜ is a [pediatric renal tumor that crosses the midline] and presents in the ⬜ year of life
Neuroblastoma
________________
first
What is the major (and contraindicating) side effect of the Rotareovirus vaccine?
Intussuception
Live attenuated vaccine
Both Croup Laryngotracheitis and Epiglottitis can cause inspiratory stridor
How do you discern the two?
Epiglotitis causes Drooling!
Pink Stains or Brick Dust in neonatal diapers indicates the presence of ⬜
Uric Acid Crystals
At what age does Bedwetting start to become pathological for kids?
5 yo
Infants that are Small for Gestational Age (SGA) are at risk for developing what complications? - 4
“I’m small, GOT Calcium?”
- low Glucose
- [low Oxygen –> (high RBC polycythemia)]
- low Temperature
- low Calcium
