PEDs Flashcards
Tx of pyloric stenosis?
IVF! correct electrolyte abnormalities(hypochloremic, hypokalemic, metabolic alkalosis) first then do pyloromyotomy
6hr old baby with cyanosis of extremities since birth. temp = 97, bp 80/45, been breast feeding well. whatcha gonna do to her?
put her under a warming lamp!Acrocyanosis – blue hands and feet due to vasomotor instability = warm baby up and they will be fine. Often seen w/Cutis Marmorata(lattice like mottling seen when baby gets cold)
kid with vesicles on erythematous base in mouth(soft palate, tonsils, uvula), hands, feet & butt. dx?
HFMD = Coxsackie A virus
baby with bloody diarrhea and “pneumatosis intestinalis” on xray. dx? tx?
Necrotizing Enterocolitistx: NPO, TPN, IV Abx
DX criteria for Lupus
The ACR’s diagnostic criteria for SLE include the following: Malar rash Naso-oral ulcers Photosensitive rash Discoid rash Arthritis Pleuritis or pericarditis Proteinuria (>500 mg/d) or evidence of nephritis in urinalysis Hemolytic anemia, thrombocytopenia, leukopenia, or lymphopenia Seizure or psychosis Positive ANA finding Positive anti–double-stranded DNA, anti-Smith, or antiphospholipid antibody/lupus anticoagulant
Which vaccines can immunocomp kids not get?
MMRV, Live Flu, Rotavirus, yellow fever
what food allergies will kids often get over as they grow up?
wheat, soy, milk, eggs
kid w/unilateral ear pin, pain on palpation of pinna. dx? tx?
otitis externa, ciprofloxacin drops + steroids
7 month old w/bloody stool, FTT, vomiting, poor feeding. Babys on formula. dx? tx?
Milk-Protein Allergy = Ask what type of formula! its prob soy based = switch to cows milk untill 2-3 yoa
Intestinal atresia, rf?
atresia of the intestins at many locations due to VASCULAR ACCIDENT = look for this in a mom who uses vasoconstrictors(cocaine or smoking)*bilious vomiting
tx of SS dz
hydroxyurea
Tetanus sx + tx*how do they often get this?
often acquired from dirty wound, lockjaw, spastic paralysistx: intubate, sedate, Mrelaxers, IV Abx(metro), Tetanus antitoxin
14 yo girl never had a period, breast development at 12, high is equilvalent to that of a 8yo. bp 140/100. breast stage 2, pubic hair stage 4, weak femoral pulses. dx?
This is Turner syndrome. There are two tip-offs in this question: 1) She’s as tall as an 8-year-old (it actually doesn’t say bone age, it only mentions her height). 2) What you didn’t put in your excerpt is that she has decreased femoral pulses, indicative of a coarctation of the aorta. Coarctation is associated with Turner’s. In summary: Coarctation + short stature + primary amenorrhea = Turner syndrome.
sx of down syndrome
mental retardation, flat face, prominent epicanthal folds, slanted palpebral fissures, simian crease, protruding tongue, heart shit(av canal defect, endocardial cushing defect), gap in 1 & 2 toescomplications:early alzhimers, ALL, hirsprungs, duodenal atresia
SSD is caused by
substitution of glut to a val
Pyloric stenosis sx?
nonbilious vomiting in a 2-8 wk old baby who was previously normal, olive-shaped mass, visable perstaltic waves + abnormal CMP
MC pneumos in kids(not neonates)
step pneumo > haemophilus > moraxella
tx of gon conjunctivitis
IM cephalosporin
sx of fetal alcohol syndrome
mental retardation, developmental delays, SHORT palpebral fissures, SMOOTH philtrum, THIN vermillion boarders(thin upper lip), microcephaly, micrognanthia, murmer? = ASD or VSD
WAGR syndrome
Wilms tumor, aniridia, GU abnormaliites, mental retardation
2 month gross motor, fine motor, speech, social?
GM: lifts headFM: tracks past midlineSp: coosSoc: social smile
Retts Syndrome
girls who regress after a period of normal development around 6 months of age. looks like autism but results in death.
RDW in iron deficiency vs thalassemia
RDW is increased in iron but normal in thalassemia
What do you do for a baby who has hip laxity?
re-examine at 2 weeks. will usually resolve by then. if not do U/S<6m or xray >6m
Kid with major trauma or abuse, loss of consciousness, CT punctuate hemorrhage….dx? tx? causes?
Cerebral Contusion = tx w/management of ICPCause: Sport injury, football
common causes of meningitis in kids >11yo
N. Men
SIDS Prevention tips
put baby on back to sleep, dont share a bed, stop smoking, baby head flat on occiput –>baby stares at ceiling
Conduct Disorder vs Oppositional Defiant
- Conduct = <18, criminal, hurts ppl/animals purposely = tx w/juvy to try to correct behavior2. oppositional = punks, confronts authority but is fine wiht friends
What is billious Emesis in a baby? what does this mean?
green throw up! This means that obstruction is pass the biliary tree/distal to the ligament of trietz
Rotavirus…what weird GI shit u worried about?
Live vac, risk of intussusception & C/I if previous Intussusception
baby w/conjunctivitis on day 5-14. cause?
Chlamydia!, can be unilateral or bilatera, may be bloody! tx w/erythromycin PO
another name for Hemolytic uremic syndrome?
microangiopathic hemolytic anemia
how do you correct strabismus?
cover good eye and force brain to strengthen bad eye
Vaccines 12-15 months? 15-18 months?
Hey Very HiP MDHepA, Varicella, HiB, PVC, MMR, DTap(given 15-18m)
Kid comes in for check up and you find no probs other than protinuria. what do you do?
Recheck on 2 seperate occations. if present then workup. if not present = dx Transient Proteinuria
tx of Tic disorders
redirect or D-antagonist(antipsycotics)
what is serous otitis media?
Serous Otitis Media – nonpurplent(clear) effusions of the middle earo Usually involves hearing loss and fullnesso Typically does not have pain or fever
2 most common R –> L shunts?
Transposition of the great arteries & Tetralogy of Fallot
baby with chlamydia conjunctiivtis what else do you need to look for?
pneumonia!
pneumona in CF pt who is between birth - 20yoa cause…
S.Aureus
Pertussus ppx for baby
erythromycin
Which nephrotic syndrome is most associated with…1. HBV?2. HIV?3. A1AT?
- HBV = membranous2. HIV = FSGS3. A1AT = membranoproliferative
what else should be be on the look out for in retinopathy of prematurity?
intraventricular hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis
describe a shingles rash
painful rash in dermatomal distrubtion of DRG, NEVER crosses midline, seen in immunocomp pt
dx of pinworms
tape on butt in am to catch eggs
baby with worsening jaundice @ 2 weeks of age, baby +/- phenobarbitol with no improvement, elevated direct hyperbilirubinemia +/- HIDA showing atresia. dx? tx?
biliary atresia, tx w/resection
4 yrs gross motor, fine motor, speech, social?
GM: hopsFM: crossSp: 4 wordsSoc: n/a
baby w/jaundice, elevated unconj/indirect bili, coombs +. dx?
Isoimmunization = Rh Dz or ABO incompatability
Benefits & Drawbakcs of breastmilk
- improves gastric emptying due to increased Whey- lactoferrin, lysozyme and IgA to boost immunity- Lower Ca & P but body absorbs it better than regular formula- Inadequate VitD = need suppliment
Tay-Sachs Dzdef? inheritance?
AR, B-hemosaminidase A
Vaccines 4-6 yoa?
Very DIMVaricella, DTap, IPV, MMR
Diaphragmatic Hernia occurs more often where?
L > R & Back > front
what effect doesn PROM have on RDS?
decreases RDS due to increase stress = cort = help lungs mature
3yo comes in with 2month hx of r sided limp, most obvious when she waked up and plays. Rknee is swollen + warm but not tender. ESR is elevated. What other exam should you perform on this kid? why?
This child presents with pauciarticular juvenile rheumatoidarthritis (JRA). Characteristics of pauciarticular JRA include chronic asymmetric arthritisof four or less large weight-bearing joints. Systemic features are uncommon, but themost feared complication is the development of asymptomatic iridocyclitis, which cancause blindness if untreated. Iridocyclitis/uveitis may be present in all subtypes of JRA,but it is particular to the pauciarticular disease of early childhood, in which approximately30% of patients develop the complication. All children with JRA should have regularophthalmologic examinations, including slit lamp examinations,to ensure promptmanagement with corticosteroids.
tx for kid with hip dysplasia?
Pavlik hip harness if <6 months if >6m surgery
Is meckels diverticulum a true or false diverticulum?
true!
tx of chemical conjunctivitis?
lube
What is the APGAR Score? How do you score it? (1 pt vs 2pts)
*Appearance = 1:Acrocyanosis, 2: pink*Pulse = 1: <100, 2:>100*Grimace = 1:with HIGH stim, 2: w/stim*Activity = 1: Flexion, 2: extension*Respiration = 1: irregular, 2: strong/regular0 = shits absentnormal = 7-10
dx + tx of annular pancreas?
dbl bubble + no distal air on baby gram. tx w/surgery to reconnect*same as duodenal atresia = cant tell them apart untill surgery!
when does T1 DM usualy present?
4-6 yo or early puberty
how do you repair ASD?
Catheter-directed device closure
What can you give to close the PDA?
indomethacin
how long should you wait for a un-descended testicle to descend before doing surgery?
6m then do surgery.*increased risk for cancer
6month old kid with 1 wk hx of unprovoked startle-like movements. sudden quick flexion of the head,arms and legs/ cries during these movements which usually occur in clusters after awaking from sleep. heart murmer since birth. father has mental impairment. PE: 3 areas of skin hypopigmentation. for periventicular nodules that disort the normally smooth venticular margins on CT. dx?
F. Tuberous sclerosis – hamartomas of skin and CNS. MR is the murmur heart (holosystolic high-pitched blowing murmur). Cardiac rhabdomyoma. Mental retardation (seen in father)
what is pellagra?
def of B3 - Niacin = dermatitis, dementia, diarrhea
Sx of Intussusception
abrupt onset of colicky abdominal pain, knee to chest position, sausage shaped mass in abdomen, currant jelly diarrhea
kid who is 16 and never started puberty. what do you do?
measure FSH and LH
baby with bloody diarrhea + fever. dx? tx?
infectious colitis(salmonella, E.Coli, Yersinia, Shigella, etc)tx: hydration + electrolytes
common presentation of cerebral palsy in infants
Spastic Diplegia = hypotonia, hyperreflexia, equinovaris, resistance to movement
DTap vs Tdap vs Td
DTap = for kids + comes in 5 doses and is higher doseTdap = for adutls and given 1xTd = booster for Tdap
Breast feeding jaundice
baby isnt being fed enough = decrease bowel movment = baby reabsorbes crap(conjugated bilirubin) = turns yellow
Erythema Toxicum Neonatorum(ETN) symptoms
asymptomatic, blotchy, erythematous papules and pustles seen in neonates = BENIGN! can change color and always spares palms and sole.dnt know cause but it will go away so just reassure parents
Classic sx for Henoch-Schonlein Purpura
usually follows viral illness, rash, joint pain, abdominal pain, hematuria
What is imperforate Anus? whats it part of?
imperforate anus, can be either low = close ot anus or high = away from anus; part of VACTERL
What is a PDA?
aorta to pulmonary artery connection = machine like/multi-phase murmer
What is FTPM?
failure to pass meconium after 48h
What is adequate breastfeeding?
breastfeeding 8-12 times a day every 2-3 hrs for about 10-20 min per breast during the 1st month
baby w/conjunctivitis on day 2-7. cause?
gonorrhea!, usually bilateral tx with ceftriaxone IM or erythromycin ppx
Tx of tracheoesophageal fistula?
surgery!
Dx of intestinal atresia?
babygram = dbl bubble, air fluid levels throughout bowel == atresia can happen at multiple locations at different points in time due to vascular accident(excessive vasoconstriction)
Biggest RF for meconium ileus? cause? sx?
cystic fibrosis, meconium is too thick to be passed due to pancreatic insufficiency. FTPM, bilious vomiting
Chronic Granulomatous Diseaseinheritance?
XLR
SIDS prevention
Sleep on back, Dont share beds, smoking cessation
Fragil X syndrome sx? inheritance?
XL mutation, anticipationsx: flatfooted, flexable joints, low muscle tone, long face, prominent forhead and chin, large ears, macrocephaly, large testicles, MVP
Pt presents w/a wheel, erythema and is normotensive. dx? tx?
urticaria, tx w/ removal of offending agent, 2nd gen H1 blockers(cetirizine, loratadine, fexofenadine)
How do you work up and treat osteomyelitis in kids?
- if toxic give abx then xray + bx 2. but if not toxic do Xray, if neg do MRI then bx then do abx
14 yo girl w/lower ab pain, intermittent pain in knee & hips for 6wks, cramps relieved by bowel movements. 6-10 urgent, bloody bowel movments daily. PE: swollen, tender L knee. WBC 16K, Platelet 790,000 joint fluid: straw colored, wbc = 2000. dx?
UC! = bloody stools, leukocytosis, thrombocytosis, ab pain, arthralgias.Any of the IBDs can be associated with joint pain & can be relieved with bowel movement!*knee aspirate <10,000 = not likely infectionNormal Synovial Fluid = ~200 wbc & <25%PMNNon-inflammatory = 200-2,000Inflamm = 5,000-50,000Septic = >50,000
pregnant women gets infected with parvo…whats the comp?
hydrops fetalis for baby =(
Klumpke Paralysis
C7-C8 nerve roots, useles hand on useful arm, can have ipsilateral ptosis and miosis*claw hand
Enuresis is normal up untill…definition?
age 7. >2x per week for 3 months or >5yoa
HR and RR do newborn?
Rr = 40-60HR= 120-160
1 yr gross motor, fine motor, speech, social?
GM: walkFM: pincer graspSp: 1 wordSoc: separation anxiety
How do you check to see if the bloody stool is blood from mom baby swallowed or an actual GI bleed?
Apt test
Chronic Granulomatous Diseaseinfections with which type of organisms? what will you see on bx?
catalase +, numerous organism filled segmented neutrophils
what type of lymph nodes should just be observed in kids?
<1cm, soft mobil, cervial.*any supracavicular nodes shoudl be investigated no matter what
how can you distinguish central/hypothalamic/pituitary 1 ammenorhea vs peripheral/gonadal
check FSH!- decrease FSH = central = do MRI-increased FSH = peripheral = gonadal prob
Prader Willi vs Angelman Syndrome
PW: dad deletion, fat, dumb, hypothalamic Angelman: maternal deletion, happy, ataxia(puppet), severe MR
can adults get kernicterus?
nope! effects babies bc brain is still developing
CXR of croup look like?
clear lungs with steeple sign = subglottic narrowing
What is Malrotation/volvus? Cause?
incorrect alignment of the intestines due ot failure to rotate during development. =kink in gut causes billious vomiting after birth*seen in mom w/normal prenatal course
Posterior font. Closes @…
2-6m
3 important L–>R shunts in peds
ASD, VSD, PDA = all have D!
ss pt with low hg and low hct. dx?
aplastic crisis!
Diptheria sx + tx?
high fever, dyspnea, dysphagia + gray pseudomembrane
Absance seizures can be triggered by…
hyperventilating!
hypersensitivity reactions
ACIDT1 = anaphylaxis = IgET2 = Cytotoxic/AI = IgG & IgM auto-antibodiesT3 = Immune complex = Ab-AgT4 = Delayed = Tcells and macrophages
tx of childhood lead poisoningmoderate vs severe
- moderate(45-69): Meso-2,3-dimercaptiosuccinic acid(DMSA)- severe(>70): DMSA + Calcium disodium edetate(EDTA)
non-organic causes of FTT?
Formula, Feeding, Frequency
Common organic causes of FTT?
Genetic(CF), Cardiac Disease, Pyloric Stenosis, GERD
Marfans vs Homocystauriawhich one has mental retardation?
homocystauria
MCC of sepsis in SS dzWhat can you do for them?
S. Pneumo = pplx with PCN till the age of 5
how do you dx tracheoesophageal fistula?
coiled NG tube on Xray
Kid with singly hot, swollen, tender joint. what do you do 1st?
- Arthrocentesis, WBC >50,000 = septic, culture with chocolate agar2. drain + abx
Between birth - 1 min what do you do? normal?
- Stimulate baby via rubbing back wiht towel + tap feets(1 apnea)2. O2(2nd apnea)–O2 = 60-65% - suction nose and mouth *PPV or intubate?3. HR– >100 = good!– <100 = PPV - baby may not be getting enough air immediately
common causes of meningitis in kids <3m
GBS, Ecoli, Listeria, HSV
Kid whose 6 months of age presents with FFT and hematochezia + some IgE symptoms…what are you thinking this could be? what could you do to fix it?
Milk-Protein Allergy!switch to hydrolyzed formula! = bloody diarrhea will resolve*usually outgrow around age 2-3
sx of galactosemiatx?
Sx:Enlarged liver(galactose accum)Vomiting, nausea, irritabilityMental retardation(gala in brain)Cataracts if dnt stop feeding baby shitThe urine tests positive for reducing substances, indicating the presence of sugars with aldehyde groupsTx:Remove galactose & lactose(dairy, breast milk)Start on soy
sx of scabies
burrows in skin, located in webs of hands and genitals,
Absence Seizures sx?
<20sec, utually 4-10yo, may be accompanied by simple AUTOMATISMS(eye fluttering, lip smacking)
Intraventricular Hemorrhage(IVH)path? dx? tx?
Path: @34 wks intraventricular lining vascular involutes. before this any changes in BP(birth, sepsis, RDS, BPD) can cause hemorrhagedx: <30 wks gets cranial U/Stx: craniotomy, VP shunt + F/U 36-40 U/S
9 yo kid with T1 DM, lethargy, labored breathing, vomiting, flushed appearance and appears severly dehydration, fruity odor to breath, blood glucose is >500. Tx? why high glucose?
DKA = def of insulin = glucose builds = body tries to remove by peeing it out + body hungry = making ketones trying to produce glucose for bodyManagement:REPLACE FLUIDS = isotonic salineWhen glucose reaches 200 give dextrose + salineIf K <3.3 give K + IVFIf K is above 3.3 and pt is not volume deplete you can give insulin
HUS causes hematuria by….
vascular dmg causing microthrombi = mechanical dmg
complications of premature baby
hypocalcemia, hypoglycemia, hypothermia, polycythemia, IVH, ret of premat, mercon asp, perinatal asphix, hypoxia
Gaucher Dzdef? inheritance?
AR, glucocerebrosidase
tx of Slipped Capital Femoral Epiphysis
surgery to fix
Tx of lyme in kid <8 yo. why?
amox! bc doxy has bone shit and you dnt wannt fuck with their bones
dx of scabies
scrap skin to see eggs on scope
Kid who gets kicked in head at MMA match and has some FND, LOC >60 sec, headache, some amnesia….dx? what do you do?
concussion, do CT to assure its just a fucking concussion adn not some other weird ass shit
Anterior font closes….
12-18m –> midway though year 2
koplik spots vs forchheimer spots
koplik = white spots in mouth = measlesforchheimer = red spots my be blochy in mouth = rubella
Dx of Malrotation/volvus?
baby gram –> dbl bubble + normal gas, upper GI series may show abrupt cut off point, contrast enema will show abnormal cecum position*bilious vomiting
onion skin bone tumor
ewings sarcaoma
5d old baby comes in whos list 4oz in weight, has hands+feet that are peeling and “brick dust/pink stain” in diaper. baby is not cranky and has been breastfeeding normally, urinating and poopin normally and sleeping well. dx?
normal!- peeling hands and feet = dry skin, babys skin is adjusting to the enviroment- babies loose 7% of body weight in the first 5 days but gain it back by d10-14- pink = uric acid crystals! this is normal in babies and will decrease. only think lesch nyhan if baby wasnt feeding well or not urinating normally.
what is Developmental Dysplasia of the Hip? how do you dx?
click on well-baby exam of a newborn. Dx w/4-6 week follow up reexamination + U/S if still present = put kid in harness
Gaucher Dzsx?
anemia, thrombocytopenia, HEPATOSPLENOMEGLY, no regression just fatigue and usually appears older kids.*both this and neimann-pick have hepatosplenomeg but np appears 2-6m w/o blood shit
tx of pneumonia in kids. typical vs atypical?
typical = amoxatypical = azith
What is VACTERL? How do you f/u?
Vertebral Anomalies = Sacral U/SAnus Imperforate = cross table baby gramCardiac defects = echoTE fistula = NG tubEsophageal atresia = NG tubeRenal Anomalies = voiding cystourethral gram(VCUG)Limb Anomalies = xray*must look for this before you correct imperforate anus
Kid with major trauma or abuse, loss of conciousness & stay in coma, CT crescent concave….dx? tx? causes?
Subdural hematoma = tx w/evacuation and ICP managementcauses: Peds struck, MVA, Abuse
what are allergic shiners?
venous congestion underneath the eyes
2 characteristics of Autism Spectrum Disorder
- impaired social communication = failure to meet social milestones, failure to maintain eye contact and relationships2. Restrictive Repetitive Behaviors = stereotypes movements, insistence on sameness, preoccupation with particular objects
adolescent with muffled voice, drooling, sore throat + on PE = displaces uvulua to one side… dx?
peritonsillar abscess = I&D + abx
What are the rules of 2 for meckels diverticulum?
<2 yo, 2x MC in males, 2 inches in length, 2 feet from ileocecal valve, 2% of the population
bulging fontanels in a baby is indicative of…
increased ICP
how do you dx intussusception?
U/S to look for it
Bone tumor associated with retinoblastoma?
Osteogenic sarcoma
Cephalohematoma/subperiosteal hemorrhage
hematoma that does not cross the suture lines. no discoloration of scalp, resolves in weeks to months.
Erythematous plaques with yellow oily scales around scalp, eyebrows, eyelids, behind ear, nasolabial folds, umbilicus & diaper dx?
seborrheic dermatitis
tx of chalmy conjunctivitis
PO Macrolide
congenital hypothyroidism
Thyroid Dysgenesis(Cretinism) – Increased TSHDecrease T4Normal APGARProlonged Jaundice/indirect hyperbiliLarge posterior fontanelle6-12 weeks:Poor feedingLethargyHypotoniaCoarse facial featuresLARGE PROTRUDING TONGUEDevelopmental delay**TX by replacing hormone!!
Neurofibromatosis T2sx?
NF2 mutation = bilateral acoustic neuromas
causes of bilious vomiting in newborn
Duodenal Atresia, Annular Pancreas, Malrtoation/volvus, Intestinal Atresia
Ureteropelvic junction obstructionwhat do you need to do to work this up?
exactly what it sounds like. colicky pain, usually see with kid who binge drinking, dx with U/S and check UCUG for contralateral reflex
Why do kids with VSD squat?
increase venous return and increase SVR to overcome pulmonary HTN
2 yrs gross motor, fine motor, speech, social?
GM: stepsFM: circleSp: 2 wordsSoc: 2 step commands
what is premature 2nd sex development in girls and bosy?
girls <8; boys <9
sx of pinworms
itchy butt
Describe ring worm lesion
scaly, erythematous, pruritc patches that spread centrifugally
posterior urethral valves tx?
catheritization, confirm sx with VCUG, surgery
2yo boy w/fever, r elbow pain + swelling and redness. HX of GBS @5m & septic arthrits caused by HFlu B @9yoa. Had a brother and 3 uncles taht died in infancy of septicemia. all immunization are up to date. Luekocytes = 34,000. Seg Nutrophils = 60% Bands = 15%, Lymphocytes = 15% dx?
history of effecting males! + has bacteria infections = B, Boys, Bacteria BURTONS!Burtons XL Agammaglob
what population will have complications with a parvo infection?
those with SS or other hemoglobinopathies = aplastic crisis
Tx of Malrotation/Volvus?
NG tube to decompress and relieve baby of gas then do surgery to correct
3m-3yo kid whos sick with a URI, presents with cough, inspiratory stridor. dx? tx?
Croup! = bark-like cough, steeple sign on xray, give EPI to help, steroids, and O2
What is sail sign?
thymus visable on xray till age of 3
Tx of nursemaids elbow?
- Hyperpronation of forarm(better)or 2. supination of forearm and flexion of elbow
dafuq is Diamon-Blackfan Anemia?
sportation mutation causing defect in progen cells = early apoptosis*neonate who presents with pallow ~3m, webbed neck, cleft lip, sheilded chest, triphalangeal thumbs
Retinopathy of Prematurity(ROP)path? rf? tx?
path: abnormal growth of capillaries in eyes = neovasculizationRF: prematurity, worsened by high O2 delivery(may see in baby tx for RDS or BPD!)tx: laser photocoagulation**F/U for Glaucoma development!
Kawasaki Disease diagnosis criteriawhat are they at increased risk for?
fever >5d +4 or more:1. conjunctivitis2. mucositis(strawberry tongue)3. cervical lymphadenopathy4. rash5. erythema & edema of the hands and feet*increased riks of coronary artery aneuryms
What are you worried about with diaphragmatic hernia?
hypoplastic lungs! = give surfactant and stablize before surgery
Neoblastoma Vs Wilms Tumor
*Neuroblastoma = MC extracranial tumor in children. Commonly presents as an abdominal mass.Often calcifiedDoesn’t invade vascularPoorly marginatedMay extend to chestElevated aorta away from vertebraMore commonly will cross the midlineNephroblastoma(Wilms Tumor)Usually not calcifiedDisplaces structesWell circumscribed“Claw Sign” w/kidney May invade vascular = IVC/Renal vein
baby born normal and a day or so later develops milky white apearance in front of the eye…cause, dx?
catarcts, galactosemia
long term complication of shingles. tx?
postherpetic neuralgia after rash has resolvestx: TCA or gabapentin
Scoliosis tx?
brace back or if severe do rod placement
5 yrs gross motor, fine motor, speech, social?
GM: skipsFM: triangleSp: 5 wordsSoc: n/a
What do you have to check immediately after birth (assuming baby is 7+ APGAR)?
- umbilical cord(2a +1v)2. Weight3. Length4. head circumference5. glucose6. shots and drops(Vit K, Hep B, PPx of conjunctivitis w/erythromycin unless another organism already ID.)
T/F when you do shit for abuse..tell parent what your doing and why your doing it and that you are required by law to do so.
T
what peds population would you see anal fissures in?
children or teens with a history of constipation = tear anal mucosa. or those with IBD
kid with previous runny nose now has fever, resp distress, wheezes, murmer, hepatomegaly, CXR shows enlarged heart. dx?
viral myositis
what vitamin can you give that will decrease mortality in measles?
vitamin A
4 month gross motor, fine motor, speech, social?
GM: roll overFM: clumsy graspSp: laughs, squealsSoc: looks around
tx of allergic conjunctivitis?
artificial tears, mast cell stablizes and antihistamines
Kid with toothache has been using numbing cream to treat. now presents w/cyanosis, pulse ox 85%. dx? why? tx?
methemoglobinemia, caused by oxidizing agents = dapson, nitrates, topical anesthetics(benzocaine & lidocaine)*will see normal PaO2, saturation gap, normal arterial partial pressuretx: methylene blue
def of vita B2/riboflavin sx
cheilosis, ocular(keratitis, conjunctivitis), anemia, dermatitis, photophobia
which congential cardiac defect will have a harsh holosystolic murmer, FTT, right sided hypertrophy and increased R heart pressure?
VSD
What is the big risk factor for transposition of the great arteries?
Pre-existing diabetes in prego mom = @ week 8 when heart twists = failure!
Which defect is associated with Fixed wide split S2?
ASD
Achrondroplasia, Marfans, Ehlers-danlos syndrome mutation?
A: FGFR3 M: FBN1 ED: T1 Collagen
Define Amblyopia
cortical blindness and defect in development = can be one or both eyes
Vaccines @ birth?
Hep B
after you tx meconium ileus what else do you need to do for the baby?
F/U w/sweat test, check ADEK, pan enzymes, pulmonary toliet all to check for CF + tx
common causes of Amblyopia
Strabismus and congenital cataracts
2 yo girl w/hx of irritabiltiy, poor appetitis, occational cough & reluctance to walk, 4.4lb weight loss over last 6 months, fever, bluish discoloration under eyelids. low neutrophils, elevated lymphocytes + mass in posterior mediastinum. dx?
Neuroblastoma = posterior mediastinum massvsthymoma = anterior mediastinum mass
Vaccines @ 2,4,6 months?
HI HiP DR!*Hep B skips 4 months HepB, IPV(polio), HiB, PVC, DTap, Rota
What is the most common CYANOTIC cardiac defect in NEWBORN?
Transposition of the Great Arteries
Tx of meconium ileus
Gastrografin enema = water soluble to break down obstruction and pass; sometimes surgery
CF infertility in men. why?
congential absence of vas def
GI “target sign” is associated with….
intusseption
epispadias
kid pees in his own face *dnt circumsize as you need the tissue to reconstruct
kid with cyanosis in the first 24 hrs, normal S1 but single loud S2 + narrow mediasteinum. dx? tx?
transposition of the great arteries - give PG to keep PDA open till you can operate!
Galactosemia inheritance pattern? defect?
Galactosemia – AR absence of Galactose-1-P = accumulation in liver, kidney, & brain.
Spondylolisthesis
developmental disorder resutling in forward slip of vertebra causing: slowly developing back pain, neurologic dysfunction, palpebal step off
Subgaleal hemorrhage/subaponeurotic Hemorrhage
superficial edema or hematoma that crosses suture lines, suually located on crown.*head feels squishy, tachycardia due to hypovolemia, looks like cephalohematoma but crosses midline.tx: IVF ressuscitation and observation
Dx of Duodenal Atresia? tx?
dbl bubble + no distal air on baby-gram. tx w/surgery to reconnect
why the increased risk of intussusecption after GI infection?
hypertrophied peyers patches = increase risk
SS trait causes spontaneously resolving hematuria due to….
microthrombi causing renal papillary necrosis
pt with retinoblastoma need to be monitored for what in the future?
osteoscarcoma
Friedreich Ataxia sx?
ataxia, dysarthria, degradation of spinocerebellar tracts, hypertrophic cardiomyopathy, diabetes, skeletal deformities(kyphosis, scoliosis)
classic urine color for glomerular causes of hematuria vs post-glomerular causes?
glomerular = RBC casts + dysmorphic rbc+ Coca-cola colored urinepost-glomerular = red/pink urine + normal rbc
what is zyrtec?
Cetirizine = 2nd gen H1 blocker
What is an Apparent Life Threatening Event(ALTE)?
change in baby color, tone & breathing
what would a radiograph of sinusitis show?
air-fluid levels on XR and opacification on CT
kid with nasal congestion and LOW grade fever, + copious clear rhinorrhea thats <10 days…whats the probable dx?
viral cold = just ride it out
causes of nonbilious vomting in a newborn
pyloric stenosis, tracheoesophageal fistula
kid with ss needs to be on…
PCN if <5 and possible till age 18 to prevent pneumococcal infection
Dx of pyloric stenosis?
U/S showing Donut Sign
Werdnig Hoffman dz vs Botulism
WH: anterior horn degen; upper ext > lower, lacks eye shitBot: hx of ingestion; Ptosis, sluggish pupillary light reflexBOT SPORES: no hx of ingestion, kid will be breast fed; Ptosis, sluggish pupillary light reflex
Transient Synovitiswhat will you see on xray?tx?
synovial inflammation seen up to 4 weeks after URI or GI viral illness, no fever, no leukocytosis, decreased inflammatory markers, Xray looks normaltx: supportive
What is Right Middle Lobe Syndrome? causes?
This is “RIGHT MIDDLE LOBE SYNDROME”Clinical presentation:Most pt present w/chronic coughHaemoptysisChest painDyspneaPath: largely unknown!Chronic bronchitis, Bronchiectasis, granulomatous inflame, pneumoniaRadiographic Shit:Right middle lobe collapse – linear consolidation, wedge-shaped densityBronchiectasis obstructing bronchial lesion is usually not found
MCC of congenital cyanosis?
transposition of the great arteries
causes of baterial rhinosinusitis
Strep. Pneumo > H. Influenza > Moraxella Cat
tx of pinworms
albendazole
sx of tracheoesophageal fistula?
nonbilious vomiting, bubbling and gurgling with respirations –> this is bc baby is breathing into stomach as well.
Transient Tachypnea of the Newborn(TTN)
abnormal rapid breathing w/grunting + hyperexpanded and wet appearing CXR. due to delayed clearance of fetal lung fluid, usually seen with C-sections. Usually resolves w/in 6hrs but may be present for up to 48h.tx: Supplemental O2, CPAP/intubate is needed
MCC of osteomyelitis in kids? What about a kid with SS?
Staph Aureus unless they have SS then think Salmonella
pediatric stroke mc cause?
SSD
What are Shots & Drops?
Vit K, Hep B, PPx of conjunctivitis w/erythromycin unless another organism already ID–> given to baby w/ APGAR 7+
what was silver nitrate used for with babies?
thought it prevented chlamydia in babies but it doesnt =/ we use erythromycin topical instead
dx of lice
comb through hair to see
Caput Seccedaneum
edema that can cross suture lines, soft tissue swelling of the scalp that involves the presenting delivery potion of the head, can be ecchymotic.*resolves in a few days
which cardiac defect requires a patent PDA for the kid to live untill surgery?
transposition of the great arteries
what is Claritin?
Loratidine = 2nd gen H1 blocker
Osgood-Schlatter Disease/Osteochrondrosistx?
teenage athletes, painful knee with swelling over the tibial tubercletx: 1. play thorugh it = taes a long as time to heal2. stop & rest and let heal
person ate meat + egg salad 1 hr ago and now is puking. bug?
s.aureus = 1-6h
CMP for pyloric stenosis
Hypochloremic, hypokalemic, metabolic alkalosis
Kid previously had HiB. Does this mean they dnt need the vaccine?
Nope! Getting HiB doesnt confer immunity in those <2 yoa.
How do you treat infantile spasms?
ACTH helps wiht spams
dx of Slipped Capital Femoral Epiphysis
xray
causes of septic arthritis in peds pts?
sexually active? = gonorrhea(hematogenous spread)not sex active = staph(direct inoculation)
Exstrophy of the bladder
midline defect thats bright red, shiny & wet with urine*bladder is out of belly
screen <5 yrs old for tb? screen >5 yo for tb?
<5 = ppd>5 = interferon gama release assay
hypospadis
kid pees on his feet *dnt circumsize as you need the tissue to reconstruct
Pertussis(Whooping Cough) sx + Tx?
begins w/general illness = looks like common cold. Then…kids develops alot of coughing w/big wheezes(inspiratory whoop).tx: supportive, Erythromycin
Define Strabismus
lazy eye
dx hirschsprungs dz?
- contrast enema shows transition zone followed by bx2. child presents w/overflow incontinence +/-encopresis & has stool eruption on DRE, anorectal manometry shows INCREASED TONE.
What heart shit is characterized by “boot shapped heart”, and associated with down syndrome and DiGeorges?
tetralogy of fallot
When’s the baby get teeth?
9-12m
Kid has high lead on capillary finger stick. What do you do?
Draw venous lead levels bc cap can be false.
MC pneumos in neonates
Ecoli, GBS, Chlamydia
tx of pharyngitis?
amox-clav == always do rapid strep and treat bc ur worried about rheumatic fever!
HTN emergencies tx
- Sodium Nitroprusside = #1 for HTN emergencies
Causes of Seizures mnemonic
VITAMINS: Vascular, Infection, Trauma, Autoimmune, Metabolic, Idiopathic, Neoplasm, Syndromes
Which type of cardiac shunts have increased vascular markings?
L to R
test for chronic granulomatous disease?
check for neutrophils w/dihydrorhodamine 123 tests & nitroblue Tetrazolium test
RF for RDS in newborns?
Prematurity, male sex, perinatal asphyxia, maternal DM, C-section w/o labor
When do you fix an umbilical hernia in baby?
3-4 yoa if >2cm or probs. usually will resolve on own in 1 year
Club Foot on PE what do you do?
serial casts and stretching at first if that doesnt work surgery between 3-6m and always before 1yr
what bug causes “Hand-Foot-Mouth Disease(HFMD)”?
Coxsackie A virus
What is the most common cause of constipation in kids? tx?
voluntary constipation due to kid holding it in either bc they are embarrassed or bc of paintx: disimpaction in OR + education
Physiologic jaundice vs beastmilk vs biliary atresia
- Physiologic jaundice: CONJUGATED within 24hr2. Breast milk jaundice: UNCONJ/indirect in 2nd week3. Biliary atresia: initially ok then within 2m develops CONJ bili
which type of cardiac shunts has cyanosis?
R to L
baby w/jaundice, elevated unconjugated bili, coombs -, hgb high. dx?
blood transfusion! = twin-twin transfusion syndrome, material-baby transfusion, delayed cord clamping
kid with unilateral ear pain that is relieved by pulling on pinna, moderatly bulging tympaic membrane. dx? tx?
otitis media1. amox-clav2. cefdinir3. axithromycin
why should you try to avoid transfusions in a pt with ss?
iron overload. if you do give deferoxamine also
baby w/conjunctivitis on day 1. cause?
chemical! caused by use of silver nitrate
Erb-Duchene Paralysis
C5-C6 nerve roots –>usefl hand on useless arm(unable to abduct shoulder or externally rotate and supinate arm)*waiters tip
bedwetting is normal before the age of….
5 = wait to treat untill then.
Juvenile Idiopathic Arthritis
>6wk multiple joint pain, morning stiffness +/- hepatospleo, salmon rash, serositisElevated CRP, ESR, Ferritin, gammaglobin, thrombocystosis*anemia due to chronic infllamation
What is Hand-Foot Syndrome in SSD?
early manifestation of vaso-occlusion in 6m-4yo causing swelling of hands and feet
Legg-Calve-Perthe Diseasetx?
~6yoa, avascular necrosis of the hip = insidious onset, knee pain, antalgic gait.dx: xray and tx w/cast
complication of measles later in life?
subacute sclerosing panencephalitis
Septic Hipdx? tx?
any age group with previous or current febrile illness who is now complaining of joint paindx: xray then aspiration/culturetx: abx + drain
3 food poisoning bugs that are mostly vomiting.
s.aureus, Bcereus, Norovirus
baby born with milky white apearance in front of the eye…cause, dx?
TORCH, cataracts
What is the allergic salute?
transverse nasal crease
tx cat bite vs cat scratch
bite = augmentinscratch = azithromycin
Which vaccines can not be given to ppl with egg allergies?
Yellow Fever, some influenza
kid w/purulent nasal discharge, congestion, sinus tenderness, that >10d old, high fever. dx? tx?
sinusitis = amox-clav or cefdinir
which type of NTD is associated with a chiari malformation?
myelomeningocele = chiari 2 malformation
What is a Brief Resolved Unexplained Event(BRUE)?
<1yo w/<1 min duration of change in color, tone, respirations
Metatarsus adductus on PE what do you do?
toes curled inward on PE, if overcorrect w/abduction just reassure parent, if not needs orthosis or corrective shoes
Infantile Spasm definition
<1 yo with SYMMETRIC JERKING without fever.
If they have a family history of adverse reaction to a vaccine can they still get that vaccine?
yes! only personal history matters
How do you repair VSD?
open surgical repair
tx of hirschsprungs dz?
resect + connect and if severe = colostomy
17 yo kid who has never started puberty with an elevated FSH. whatcha thinking?
due to hypergonadotropic = karyotype to check for turners, resistant ovaries
kid w/drooling, muffled voice, high fever + rapid onset, no vaccines. dx? tx?
epiglottitis = OR for intubation + abx
Umbilical cord will fall off…
7-10d ; turns bluish then falls off—> come in if pus or red
kid with unilateral ear pain for the last few days now comes in with swelling behind the ear and anteriorly rotated ear. dx? tx?
mastoiditis, surgical consult for decompression
kid w/drooling, muffled voice, fever + refusal to move neck, unilateral cervical lymphadenopathy + tender area of neck. dx? tx?
retropharyngeal abscess = CT scan, surgical for I&D + culture + abx
tx of acute ss crisis?
IVF, pain control, oxygen
causes of constipation in newborn
Hirschsprungs, voluntary holding, baby whos mom got opiates or Mg for preeclampsia, electrolyte derangements(hypoglycemia, hypokalemia, hypermagnesemia, hypercalcemia)
kid comes in with obviouse Guillian-barre what is an important test for you to run? why?
spirometry to assess respiration = GB pts are at high risk for respiratory failure
Trendelenburg Gait
hip drop due to dmg to superior gluteal N = weak gluteus muscles
6 month gross motor, fine motor, speech, social?
GM: sit upFM: rakesSp: babblesSoc: stranger anxiety
Components of Tetralogy of Fallot
- VSD2. Overriding aorta3. Pulmonary Stenosis4. RV hypertrophy
tx of imperforate anus
Low/close to anus = dilation or minor sugical procedureHigh/away from anus= colostomy with future correction
kid <8 yo has breast buds or axially hair. 1st test you do to work this up?
xray to check bone age! if >2 yrs older than you need to do GnRH test
what is the most common congential heart defect?
VSD
Tay-Sachs Dzsx?
loss of motor milestones around 2-6m, hypotonia, feeding difficulties, cherry red macula, HYPERFLEXIA
Rota virus vaccine C/I?
immunocomp & personal history of intussusception as rotat can cause intussusception
kid with joint hypertrophy and “ping-pong skull”(soft skull wiht wide fonts) whatcha thinking?
vita D deficiency!
Neurofibromatosis T1(T1 von rec)mutation? sx?
NF1 gene; 1. cafe-au-lait spots2. axillary freckling3. monocular eye proptosis & visual changes = OPTIC TRACT GLIOMA4. lisch nodules5. neurofibromas
Hirschsprungs Dzpath? sx?
failure of meissner and auerbach INHIBITORY neurons to migrate to distal colon = distal is always contracted. can present as constipation later in life or as FTPM. Look for Xray showing dilated proximal colon= normal & normal looking distal colon = abnormal.
Marfans vs Homocystauriawhich one has fair complection?
homocystauria
What is Failure to Thrive(FTT)? What goes first?
<5th percentile for age.Weight > Height > head Circumference
normal rr for babies & toddlers
babies = 40-60 toddlers = 12-14
Ped tx for Meningitis in kids <30days? why not ceftriaxone?
Vanc, Steroids + Ampicillin(cover listeria) & ceftaximine*not ceftriaxone bc it can cause hyperbilirubinemia in babies
Which type of bilious vomiting is associated with down syndrome?
duodenal atresia & annular Pancreaus
what medications given to mom can cause constipation in newborn?
Mg for preeclampsia or Opiates
baby whose blue at rest and pink when crying. dx? tx?
choanal atresia = anatomically stenosed connection between nose and mouth = needs surgery to fix
liver bx of kid with reye’s syndrome would show?
microvascular fatty infiltrate of the liver
Coxsackie A pharyngitis vs Herpes pharyngitis
Coxsackie = gray vesicles/ulcers on posterior oropharynxHerpes = clusters of small vesicles on anterior oropharynx + ginival involvement
Necrotizing Enterocolitis(NEC)rf? presentation? dx? tx?
RF: premature, aspirationPresentation: baby w/bloodly bowel movementdx: Xray = “pneumatosis intestinalis, air in the wall of the bowels”tx: NPO, IV Abx(amp,gent, metro), TPN
Sx of Lyme dz infection
mild pain + joint stiffness that may be on and off, flu like symptoms, fatigue, variable joint pains
Primary Ciliary Dyskinesia vs CF
Both have: chronic sinus infections, nasal polyps, bronchiectasis, digital clubbingCF: pancreatic insuff like vit K def(brusising), vit D def, poor growth
Sx of ALL in 4 yo kid?
fever, recurrent infections, bleeding(bone marrow failure) fatigue, mediastinal mass due ot thymus infiltration, hepatosplenomegaly, lymphadenopathy, TdT+(pre B/T cell marker)
Criteria for a Febrile Seizure
- generalized = total body + LOC2. <15 min duration3. Single episode in 24hr4. no underlying neuro prob*MUST HAVE ALL!
Neimann-Pick Dz sx?
loss of motor milestones about 2-6m, hypotonia, feeding difficulty, cherry red macula, HEPATOSPLENOMEGLY, AREFLEXIA
3 yrs gross motor, fine motor, speech, social?
GM: TrikeFM: circleSp: 3 wordsSoc: n/a
Scarlet Fever sx + tx?
*seen w/untreated strep shitfever, chills, sore throat, strawberry tongue, rash(sunburn w/goosebumps or sandpaper or rough texture)
15 month old girl with 1day hx of rash & fever for the last 3 days. got MMR vaccine 10 days ago. dx?
normal! this is just the replication of the live vaccine virus strain. it will pass
When can I give solid foods to baby?
4-6m
mom gives birth to kid who initially is fine but later is the day the kid starts turning blue. what should you do asap? how can you dx?
PROSTAGLANDINS to maintain PDA, Dx transposition of great arteries with U/S
normal hg for ss pt
7-9
pt presents with swelling of airway + generalized edema n shit, hx of C1 esterase def. dx? tx?
angioedema = c1 esterase or acei is causing this(usually)tx: remove, intubate, H1/H1 blocks and if hereditary angioedema = FFP
kid with HIGH fever (104) then fever goes away and rash starts on trunk and spreads, kid had a seizure yesterday. dx?
Roseola = HHV-6
Tx for TB if PPD+ but CXR-. dx?
thsi is latent TB = tx with INH for 6-9months
Anemia of Prematurity
due to decrease in EPO, short RBC life & multiple blood draws in NICU
leuprolide stim test shows no change in LH in <8 yo kid with breast buds. what you thinking? ddx?
peripheral = do U/S, testosterone, DHEA, 17OH progest all looking for tumor, CAH, or cysts
Standard regimen of care for TB
4 for 2 then 2 for 4.So start INH, Rifam, Pyrazin, Etham. stop pyra+etham after 2 months and continue INH + Rif for another 4 months.
What is annular pancreas?
failure of apoptosis of panreaus causing it to constrict the duodenum = looks IDENTIAL to duodenal atresia*bilious vomiting
pt with hypotension, hives, wheezing. tx? additional tx?
anaphylaxis!1:1000 epi IM immediatly! then can do H1/H2 blocks and albuterol to help after epi
What is a long term consequence of intestinal atresia? why?
Short Gut Syndrome = diarrhea + malnutrition. this is bc in order to repair you have to remove atretic areas and reconnect bowel
common causes of meningitis in kids 3m-10yo
S.pneumo, N. Men
How do you dx intussusception if you have a really high suspicion of it? what else is this good for?
Air-contrast Barium Enema = also used to cure intussusception bc air will push out bowel. If this doesnt work then surgery will be needed
What is a normal reaction to vaccine?
Temp <104, Erythema, tenderness but consolable*if temp high or not consolable or obv anaphylaxis = dnt give that vaccine again! but can still get other vaccines
defect in which vitamin causes increase in ICP
vitamin A
you look in kids ear and see peripheral granulation tissue w/debri near ear drum. dx?
cholesteatoma
Pathogenesis & Tx of Retinopathy of Prematurity
premature babies w/hypoplastic lungs need O2, this increase in O2 causes forming blood vessels in eyes to proliferate = retinopathytx: lazer ablation
Cervical Lymphadenopathy in children
mcc S.aureus = enlarged, tender, erythematous lymph nodes
12 yo boy is concered he is the shortest kid in the class. father says he was short untill his senior year in high school. Which test would you do to confirm the dx?
check bone age to distinguish constitutional vs familial
How do you confirm Infantile Spasms?
EEG showing HYPSARRHYTHMIA
tx of lice
permethrin, malathion
looks like hypothyroid in newborn baby + “Horse cry”
thyroid dysgenesis
What’s neonatal acne?
Acne peaks between 2 to 4 weeks occurs due to maternal hormone transmission
18 hr old f has jaundice, difficulty feeding, no bowel movement and dark urine. Tbili = 11. direct = 0.1. is this physiologic jaundice or hemolytic dz of the newborn? why?
HEMOLYTIC DZ OF THE NEWBORN! = <24 hrs!!!!*physiologic will only present >24h
What’s a herald patch?Tx?
Pityriasis Rosea ! Associated w/HSV 6/7 but not sure which. Lasts 2-12 weeks tx w/topics steroids
causes of failure to pass meconium
Imperforate anus, meconium ileus, hirschsprungs, bilious emesis(duodenal atresia, annular pancreas, malrotation, intestinal atresia)
whats the biggest difference between rubella and measles?
rubella has a prodrome generalized tender lympadenopathy
2yo boy, 2hr onset fever + difficulty breathing, Rhinorrhea for the past 24 hrs. noisy breathing most noticabble when inhalation, sx improved when she took him outside to come to teh ED, supraclavicular retraction, inspiratory stridor. wheres the edema? epiglottis edema? or subglottic edema?
LOOK AT THIS KIDS AGE!!! He is only 2yo.Edema of the epiglottis = HiB/epiglottisSubglottic edema = croup! + cold air imporves sx
sx of HUS
microangiopathic hemolytic anemia, thrombocytopenia and acute kidney injury
Premature baby give vaccinations according to —– age. What the exception?
chronological; exc: HepB! baby must be >2kg for this vaccination
17 yo Low WBC, splenomegaly, hepatomegly, lymph nodes enlarged, and now has diarrhea.Leukocytes = 2100IgA 340(low) others are normalPlatelet 180,000dx?
Low WBC, splenomegaly, hepatomegly, lymph nodes enlarged, and now has diarrhea! = immunocomp! Since hes 17 its prob due to HIV
McCune-Albright Syndrome
de novo mut in G-protein cAMP(GNAS)Triad: precocious puberty, cafe-au-lait spots, fibrous dysplasia of bones + HYPERENDOCRINE due to increased cAMP activity = elevated cortisol = cushing symptoms
Trachoma
chlamydia infection in the eye that can spread in unsanitary condition like a refugee camp.1. conjunctival injection2. tarsal inflammation(eye lid)3. pale follicles(bumps under eye lid)4. often seen w/rhinorhea, pharyngitistx: azithromycin
when do you do pox parties?
NEVER! get vaccinated(MMRV)! bc now we know singles is fucking shit
leuprolide stim test shows elevated LH in <8 yo kid with breast buds. what you thinking? ddx?
central prob! needs MRI to look for tumor or constitutional
Flonase & Nasacort are….
Flonase = flucortizone, nasacort = steroid*both are intranasal steroids for allergic rhinitis
Breast milk storage?
3-6m
You should be concerned about —– murmers in kid or murmers that are grade — +.
diastolic, 3
Sx of kid with Posterior Urethral Valves
potters sequence + hydroureter/nephrosis, usually seen in males
What is Duodenal Atresia? sx?
Duodenum failes ot recanalize in utero. will have polyhydramnios.*bilious vomiting*assoc w/down syndrome
which type of conjunctivitis of the newborn can be bloody?
chlamydia
babys drinking only cows milk. what do you need to give them?
iron! cows milk is low in iron
Tetralogy of Fallot is associated with…
down syndrome
Posterior Urethral Valvessx?
MC in males, low to no urine output + palpable bladdder, due to redundent tissue, hx of oliohydraminos
viral prodrome and rash that distrubted along lines of tension, puritis + herald patch
pityriasis rosea
Criteria for Physiologic Jaundice
Physiologic: Appears 2-3 dayPeaks 2-3 dDisappears by day 7Peak bilirubin <13Rate of bilirubin rise <5
baby with red cheeks rash + fever for the last few days that now has lacy or reticular rash on arms and trunk. dx?
parvovirus B19
VSD is associated with what congenital disorder?
Down syndrome
blood smear of G6PD vs SSD
G6PD = bite cells & heinz bodiesSSD = howell-jolly bodies
sx of rubella
rash + fever that starts at head and moves down body = faster than measles, forchheimer spots = red spots in mouth*prodrome = tender generalized lymphadeopathy
where is the obstruction if you have an inspiratory stridor?
extrathoracic obstruction
HSV vs Impetigo
HSV only around oralabial region, impetigo all around face
use a rear-facing car seat for ages —– then use booster seat untill—-.
0-2yo, until 4’9’’ and 8-12 yoa
When do you do an exchange transfusion for jaundice?
Bilirubin >20 do exchange is sx. Bilirubin >25 = do exchange. This case the bilirubin is approaching 25 = should prob just do the exchange
2 kids come in with rashes. one has rash on face the other has it on the trunk and it has begun to spread outward. PE: vescular rash on erythematus base in various stages of healing. dx?
Chicken pox! = Varicella zoster virus
4yo girl with vaginal bleeding for 12 hours, 3m history of purulent vaginal discharge. pubic hair stage 1. dx?
vaginal foreign body
3m old kid has hypoglycemia, hyperlipidemia, doll like face, round cheeks, thin extremities, short statues, protuberant abdomen(hepatomegaly). dx?
T1 glycogen storage dx(von gierk) = G6PD def causing impaired glycogen –> glycose
CHARGE syndrome
Coloboma
physiologic jaundice vs. pathologic jaundice
physiologic(uncon): 1-7 days onset, slow rise, <10% direct bili, resolves by day 10Pathologic(conj): <24h onset, rapid rise, direct bili >20%, lasts >2 wks
gynocomastic in boys is normal till….
Normal in prepubertal boy! Usually subsides within 1 year. If mass doesn’t regress by 16-17 yoa then it should be removed.
7yo girl, fainting during feild trip, progressive lethargy over the past winter + darkened complextion. bp 80/40. what test to determine dx?
plasma cortisol = this is addisons! = adrenal insufficiency*ACTH stim test to see if there is a change in cort. a + test will be no change in cort = addisons
Kid whos sick with URI, cough, inspiratory stridor who was given epi but doesnt respond. what do you do next? dx?
prob bacterial tracheitis = scope + culture = abx
how do you tx febrile seizures? what infectious rash is this associated with?
Benzos for seizures & acetomenophen for fever! (do not use ASA as it will cause ryes syndrome!)HHV6 = Roseola
7yo boy with progressively worsening HA, difficult walking over the past 6 weeks, bilateral papilledema, right abductions palsy & gait ataxia. dx?
Medulloblsatoma can impair CSF flow = causing the papilledema
Cleft Lip/Cleft Palate presentation
shit fails to close w/ FTT, mostly cosmetic. May be associated with recurrent infections.tx? fix surgically!
Vaccines 12 yoa?
HPV, Meningiococcal
can diastolic murmers be innocent?
never!
Risk factors for abuse of child in kid? in parent?
kid: intellectual disability, premature birth, physical disability, cognitive disabilityparent: single parent, young parent, low SES, non-biological care-giver
bilateral parotid swelling and orchitis in pebertal males. dx?
mumps
when should strabismus be corrected
should be corrected around 6 months
Whats normal baby spit up?
small volume, nonprojectile, formula colored
if you have jaundice which type of bilirubin do u want to have(better of two evils)? why?
conjugated/direct! bc this will not cross the BBB & can be peed out.
Friedreich Ataxiamutation? inheritance?
AR mut in fraxtin = GAA triplet
Neimann-Pick Dz def? inheritance?
sphingomyelinase, AR
baby w/jaundice, elevated unconjugated bili, coombs -, hgb low, rectic count high. dx?
hemolysis! = spherocytosis, G6PD def, Pyruvate kinase def, hematoma bleed, ccephalohematoma
When do you get Tetanus Ig? (TIG)
*If <3 doses + dirty wound = Tdap + TIG*if >3 doses do not need TIG only Tdap if >10 w/clean or >5 w/dirty
CAP tx
ceftriaxone and azithromycin
when would you see sx of galactosemia?
1st week of life!
Riboflavin B2 deficiency
Chelioliss, Glossitis, seborrhetic dermatitis, pharyngitis,
Sturge-Weber Syndrome sx?
focal or generalized seizures, mental retardation, “Port-wine” stain, IC calcifications
Retinoblastomatx?
tumor in BACK of eye = pure white retinatx: resect
baby w/jaundice, elevated unconjugated bili, coombs -, hgb low/normal, rectic count normal. dx?
reabsorption prob! = hemorrhage, breast feeding jaundice, breast milk jaundice
sunburst bone tumor
osteogenic sarcoma
Fanconi anemiasx?
XLR aplastic anemia with progressive bone marrow failure, short stature, hypergonadism, hypo pigmentation, low set ears, deafness, abnormal thumbs, microcephaly, cafe au lair spots
What is a “tet” spell? what is this associated with?
cyanosis relieved by squatting. seen with tetralogy of fallot
what food allergies are kids at higher risk of developing anaphlaxis too?
nuts, fish
ddx for BRUE?
GERD, Lower Airway Infection, Seizure, Spesis, Heart Disease, Abuse
What is the most common CYANOTIC cardiac defect in CHILDREN?
Tetralogy of Fallot
tx of scabies
cover head to tow in permethrin or lindane
Tuberous Sclerosis sx?
Angiofibromas, Ash-leaf spots(pale patches), Cortical Tubers on CT + severe intellectual disability & seizures
Marfans vs Homocystauriawhich one has aortic root dilation?
marfans
kid who doesnt have MMR vac comes in with rash on face + fever that is starting to spread to the rest of hte body…what do you need to look for to dx?
tender lymphadenopathy! = this will tell u rubella vs measles
Describe Dermatatitis Herpetiformis. What its associated with?
“red spots on arms and legs filled with clear fluid that later crusts over”
kid brought in by baby sitter with appendicitis. do you need consent to operate?
nope! this is an emergency
Barlow vs Ortolani exam
barlow = adduction and push lowortolani = abduction and push up
Henoch-Scholein Purpura sx
low grade fever, cough, nonblanching rash on butt and legs, arthralgias, abdominal pain, intussecption, kidney shit
baby being fed cows milk can be deficient in what…
- Cows milk is a poor source of iron = can cause iron deficiency anemia in children strictly fed this
absence seizures will increase the risk of developing what later in life?
anxiety and ADHD
what is elevated with NTD?
AFP
what type of kid would you see meconium ileus in?
one with CF, baby whos mom recieved no prenatal care or testing for CF
What can you give to maintain PDA?
prostaglandins if needed for transposition of the great arteries
sx of measles?
fever +rash, cough, runny nose that starts at head and moves down the body. + Koplik spots = white spots on buccal mucosa
tx of hydrocele
observation! = usually resolves in 12m if not need surgery
Retinoblastomamut? sx?
mut Rb; optic nerve retinoblastoma*associated with osteosarcoma
sx of lice
itchy scalp
what are 2 complications of chickenpox?
scarring and scondary infectiosn with staph and GAS.
7 yo girl w/7day hx of bloody diarrhea, fatigue, no fever, pallow, scleral icterus, normal liver, Hg 6, MCV 80, Leukocytes 18,000, retic 12%, platelets 50,000. dx?
Bloody diarrhea + hemolysis + low platelets = HUS. This patient probably had enterohemorrhagic E. Coli (O157:H7 blablabla) colitis. The picture of icterus, anemia, and increased reticulocytes showed you hemolysis was occurring. ALL is suggested against by a leukocytosis better explained by hemorrhagic diarrhea and a bone marrow that is responding well with reticulocytosis.
Strawberry Hemangiomas in children vs Cherry Hemangiomas in adults
strawberry = benign vascular tumors of children, regress by 5-7 yoacherry = benign vascular tumors of adutls that are small and red but do not regress
how do food allergies often present?
NVDiarrhea
Tx of tourettes
1st line = A2 ag: Clonidine or Guanfacine2nd line = antipsychotics: Risperidone
pale boogy nasal mucosa, polyps, cobblestoning in posterior oropharynx…what is this describing?
allergic rhinitis
why does voluntary constipation cause diarrhea & encopresis?
kid holds in stool = absorbs water = bc hard. only stool that can get past this rock is soft/liquid = diarrhea + encopresis.
where is the obstruction if you have an expiratory wheezing?
intrathoracic obstruction
what is the most common congenital heart defect in kids with DS?
complete AV septal defect
>5 yo kid has nocturesis & all other treatment has failure…what do you do?
give desmopressin
Respiratory Distress Syndrome of Newborn(RDS)
usually due to surfactant deficiency causing atelectasis. baby is usually premature. CXR: low lung volumes and uniform granular pattern.tx: surfactant + mechanical ventilation
baby acute onset w/LRQ pain + bloody diarrhea bug?
yersinia = 24-48 hr and mimic diarrhea
Kids with juvenile idiopathic arthritis obv have arthritis but also have chronic ——. Complications? Tx?
Chronic uveitis! Can go blind! Tx w/steroids
Between 5 - 10 min what do you do? normal?
- APGAR2. O2(2nd apnea)–O2 = 90-95% is good*FiO2 to improve! = supp O2*PPV or intubate?3. HR– >100 = good!– 60-100 = PPV–<60 = CPR 3:1 + Epi ==> run code
Krabbe Dzdef? inheritance?
AR galactocerebrosidase
Between 1 - 5 min what do you do? normal?
- APGAR2. O2(2nd apnea)–O2 = 80-85%*FiO2 to improve! = supp O2*PPV or intubate?3. HR– >100 = good!– 60-100 = PPV–<60 = CPR 3:1 + Epi ==> run code
Bow legs is normal till…
2y
breast milk jaundice
moms milk isnt allowing conjucation of bilirubin = elevated unconjugated bilirubin! = switch to formula for a bit then can go back to breastfeeding.
Long term consequence of vesicouretral reflux?
Renal scarring
Slipped Capital Femoral Epiphysis
adolescent who is obese or under going a growth spirt
Kid with temple trauma, loss of conciousness w/lucid interval, CT biconvex lens….dx? tx? causes?
epidural hematoma = tx w/evacuation and ICP managmentcauses: ball sports, skiing
heat exhaustion vs Heat stroke
Heat exhaustion is the precursor to heat stroke. Body tries to compensate for excess body heat.Profuse sweatingWeaknessNV, HA, lightheadednessM crampsHeat stroke is a failure of the body to compensate for excess heat = temp will be above 40.AMSLethargicSeizure>40 C
Bronchopulmonary Dysplasia(BPD)path? cxr? tx? if not fixed what can this cause?
path: underdeveloped lungs + lack of surfactantCXR: ground granular opacitiesTx: dnt let it progress to DPLD! = Decrease FiO2, Ante-natal steroids, Perinatal Surfactant, try to avoid premature birth
Breast Milk Jaundice vs Breasfeeding Failure Jaundice
- breast milk jaundice: appears in week 1, seen with adequate breastfeeding, normal exam, due to increase conjugate intestinal bilirubin.2. breastfeeding failure jaundice: appears in week 1, due to decrease lactation and increase bili, seen w/suboptimal breastfeeding, sx of dehydration = tx by increaseing feeding
Pellagra
Niacin B3 def = diarrhea, dermatitis, dementia, glossitis
which type of bilirubin can cross the BBB? what can this cause in a neonate?
unconjugated bilirubin/indirect bilirubin = lipid soluble can cause life-threatening Kernicterus(in baby only bc brain is sitll developing) = bilirubin deposits in basal ganglia and pons
17 yo kid who has never started puberty with an normal FSH. whatcha thinking?
hypogonadism = check prolactin, TSH, T4, CBC, ESR, LFT, MRI
If kid is sick can they still get vac?
yes
How long does it take for PDA to close on its own?
about 7 days. beyond this is abnormal
Causes of conjunctivitis in newborn at d1, d2-7, d7+, 3+ weeks?Tx?
Day 1 = chemical irritation due to silver nitrateDay 2-7 = gonorrheaeDay 7+ = chlamydiaWeek 3+ = herpes *erythromycin or silver nitrate
