Peds Flashcards
Cerebral Palsy
Non-progressive
d/t brain injury
4 types: Spastic*, ataxia, dyskinetic, mixed
Hydrocephalus
Increased volume of CSF –> ventricular dilation and increased ICP
2 types: obstructive vs non-obstructive
Hydrocephalus sx
Bradycardia
HTN
HA, behavior change, papilledema, spasticity
Hydrocephalus dx
Newborn: Ultrasound
Children: MRI/ CT
Hydrocephalus tx
Neurosurgeon –> Shunt
Microcephaly
> 2SD below mean OR
<5th%
If sx: delay milestone, seizure, Early fontanelle closure, Prominent suture
Macrocephaly
> 2SD above mean OR
>97th%
Rate of growth of Macrocephaly hints at Etiology
Rapid: increased ICP
Catch up: Premie, neuro intact
Normal: Familial
Chari malformation Type 1
Type 1: cerebellum disp caudally, Syringomyelia- fluid filled cyst in spinal cord “cape like sensory loss”
sx onset teen or adult
Chair malformation type 2
NEED SURGERY
all sx of type 1 + Myelomeningocele
Sx earlier (Prenatal or AT BIRTH)
dysphagia, apneic spells
Spina Bifida
Closed: occulta
Open: Meningocele, myelomeningocele
Risk factors:
Low folate, fever, genetics, poor managed DM, obesity
Spina bifida Occulta
Hairy patch
Dimple
Dark spot
Spina bifida meningocele
Outpoutching of spinal FLUID and MENINGES
Spina bifida myelomeningocele
Outpouching of SPINAL CORD and MENINGES
Spina bifida myelomeningocele (THE WORST)
Sensory loss, paralysis, Incontinence (urinary and bowel)
Often also has: Chairi II and Hydrocephalus
NF1
Autosomal Dominant Macrocephalus, seizures, cognitive delay "Cafe-au-lait" spot Axillary/inguinal freckles Lisch nodules Optic pathway glioma
Migraine
Focal
2-72 hrs
Pulse/throbbing
Associated sx: N/V, photophobia, maybe aura
Tension HA
Diffuse, can last up to 7 days
Constant pressure
Not worse w activity
maybe photophobia
Pseudomotor Cerebri
Idiopathic intracranial HTN (increased ICP but no mass or hydrocephalus)
OBESE TEEN GIRL
Pseudomotor Cerebri classic sx
OBESE TEEN GIRL
HA and Papilledema
Also: pulsatile tinnitus, neck stiff
Pseudomotor Cerebri Dx
LP would show increased opening pressure
Tx for Pseudomotor Cerebri
intracranial HTN
Acetazolamide
Topiramate, weight loss
Absence seizure
Considered generalized (both hemispheres) Sudden impaired consciousness w/o loss of tone
Provoked by hyperventilation
Abscense seizure
often gone by age 10
Dx: EEG
lasting 10 sec, may have up to 10/day
Absecne seizure tx
Ethosuximide
Febrile Seizure dx
EEG not indicated!! not necessary
Febrile Seizure dx, IF lasting LONGER than 5 min
IV Benzos
Guillian Barre
C. Jejuni
Acute flaccid paralysis
Ascending symmetric weakness
Dx of Guillian Barre
EMG/NCV
CSF has increased protein, normal WBC
Spinal MRI (with AND without contrast): enhanced nerve roots and cauda equina
Tx of Guillian Barre
IVIG or plasma exchange
Botulism
Honey Ach <6 mo usually Descending weakness Constipation, hypotonia
Dx of Botulism
Stool sample, EMG/NCV
Tx of Botulism
Immunoglobulin-
BIG-IV or BabyBIG
Duchenne MD
X. link recessive
MORE SEVERE FORM
earlier onset, death by 18YO
“Gower sign”
Dx of Duchenne MD
Increased muscle enzymes
genetic testing
Tx of Duchenne MD
Glucocorticoids
Becker MD
sx onset later
less severe, BUT
Cardiomyopathy may be more severe
Chiari Malformation Type 1
Neck pain
If syingomyelia: cape like sensory loss, loss of abd reflex
Dx of Chiari
MRI
Tx of Pseudomotor cerebri
Acetazolamide
Epilepsy
> 2 unprovoked, more than 24 hrs apart
Most common generalized seizure
Tonic and Clonic
Absence
provoked by Hyperventilation
tx for Abscence seizure
Ethosuximide
Croup (viral)
Parainfluenza: most common
Barking cough “Seal”
Hoarse, Stridor
Steeple sign on CXR
Croup
Croup
Mild: no stridor
Mod: stridor, some retractions
Severe: stridor, retractions, AND agitation
Stridor
inspiratory squeaking
Tx of Croup
Mild: Supportive, maybe steroid
Moderate: Steroid, Epi
Severe: ED
Epiglottitis
EMERGENCY
Usually bacterial: Hib
Vaccine available
Triad:
Dysphagia, drooling, distress
Epiglottitis
and “Hot potato voice”
Thumb sign on CXR
Epiglotitties
Epiglottitis tx
3rd gen Cephalosporin (Ceftriaxone)
If you suspect Aspiration from foreign body,
PROMPT Bronchoscopy should be performed
Tracheomalacia
Floppy trachea- abn collapse d/t inadequate supporting cartilage
Cause of floppy trachea “tracheomalaica”
Craniofacial abn
Genetic
Conn tissue disorder
Tracheomalacia
Harsh, barking cough
EXPIRATION worse
Most improve 6-12 mo
CPAP if severe
Triad:
Paroxysmal cough
INSPIRATORY whoop
Post-tussive emesis
Pertussis
Gold standard Pertussis dx
Nasal culture OR PCR from nasopharyngeal swab
Tx of Pertussis
Macrolides (Azithro, Clarithro)
Bactrim is backup
Bronchiolitis (viral)
Lower respiratory infection
Bronchiolitis (viral)
RSV most common
Leading cause of hospitalization in infants and young children
Bronchiolitis
non severe vs
moder-severe
non severe: f/u in 2 days
mod-severe: hospitalize and supportive (bronchodilator)
RSV Broncholitis
Pariticularly severe
Worse with RF: <6 mo, premie, 2nd hand smoke, immunocompromised, severe asthma
Can have PNA or Apnea with it
RSV Broncholitis tx or prevention
RSV Prophylaxis- Palivizumab
FOR HIGH RISK CHILDREN <2YO
Round PNA on CXR are usually caused by:
Staph or Strep
Atypical PNA are usually ____ on CXR
Diffuse
Tx for bacterial PNA
Amoxicillin
Tx for Atypical PNA
Macrolide (Azithro) or Doxy
Cystic Fibrosis
CFTR gene
Cl transport faulty –> thick mucus
newborn screen
Diagnostic test for Cystic Fibrosis
Sweat chloride >60
Bronchiectasis
Abn dilation and distortion of bronchial tree –> COPD
Cause of Bronchiectasis
Cystic Fibrosis is most common cause in children
chronic cough w purulent sputum
crackles, rhonch, digital CLUBBING, increased AP diameter
CF causes
Bronchiectasis
Obstructive pattern on PFT
CXR: “Tram track” “ring shadows”
Infant Resp Distress Synd
“Hyaline membrane dz”
Deficient surfactant
Alveolar collapse
Cause: Prematurity, genetic disorders
Infant Respiratory Distress Synd
Sx start almost immediately after birth
Tachypnea, retractions, flaring, EXPIRATORY grunting, cyanosis
Tx for Infant Respiratory Distress Synd
PRENATAL steroids
Exogenous surfactant
CPAP w O2
CXR shows “Ground glass appearance” and Air bronchograms
Infant Respiratory Distress Syndrome
Bronchodilator test for Asthma
Reversible IF:
> 12% or
>200 mL after use
Ratio in asthma is
DECREASED
Stepwise approach for Asthma
SABA
ICS
LABA (with a steroid)
LTRA
Risk factors for Obstructive sleep apnea
Adenotonsilar hypertrophy
Obesity
Dx and Tx of Obs sleep apnea
Polysomnography
PE
Focused sleep hx
Tx: Adenotonsillectomy, CPAP
Highest risk for Type 1 DM
White (non hispanic)
Two peaks of Type 1 DM in childhood
4-6 and
10-14 YO
Gene that increases risk of DM Type I in peds
HLA-DR3
HLA-DR4
(in whites)
Environmental risk factors for type 1 DM
Viral infection
Further from equator
Diet (cows milk early, not breastfeeding, solid foods too early)
Higher socioeconomic status
Type 1 DM clinical presentation
3Ds + weight loss and fatigue
Type 1 DM diagnosis
Classic
DKA
Silent (incidental) discovery
Glucose control as you age
Can be more strict as you get older
<5 YO: 80-200
6-11: 70-180
>12: 70-150
Syringe insulin method
Good: cheaper, less training
Risk: higher risk for Hypoglycemia
Overweight
85-95th percentile
Obese
> 95th percentile
Exercise recommendation for kiddos
30-60 min per day
Screen time for kiddos
<2 hours of non-academic per day
Sx of Type 2 DM
Thirsty, Polyuria
Visual disturbance
Frequent infections
Peds: No sx, fatigue, irritable, difficulty concentrating
Signs of Type 2 DM
Acanthosis Nigricans (posterior neck, axilla, abdomen, thigh, elbow space)
Who to screen for Type 2 DM
> 10 YO, overweight/obese, AND 2 of the following risk factors
The 4 risk factors for Type 2 DM for screening
Type 2 in first or second deg relative
High risk ethnic
Insulin resistance signs
Maternal hx of DM/gestational Dm
How often to repeat type 2 DM screening
every 3 years
When to use Insulin
Ketosis
Severe hyperglycemia
Mixed Type 1 and 2
Recommended when plasma glucose >250 or A1C > 9%
After starting new DM med, how often do we monitor A1C?
3 months
How often to measure blood glucose if on insulin?
3x/day
Comorbidities to monitor if Type 2 DM
HTN
Hyperlipidemia
Med to treat HTN if pt (over 13 YO) has Type 2 DM
ACE-I or ARB (first line)
Thiazide, CCB (2nd line)
Lipid goals for teens w Type 2 DM
LDL <100
Trig <150
HDL >35
When to use Statin to tx Type 2 DM teen with Hyperlipidemia?
LDL >130
pt is >10YO
Obesity/other CVD risk factors are present
AND if you have already tried non-pharm therapy for 6 mo with no luck
Short stature
2 or more SD below mean
OR
<2.3 %
Skeletal age: most widely used system to test
Greulich-Pyle Atlas method
left hand wrist X ray compared
use age and gender
“Normal” causes of short stature
Familial
Constitutional delay of growth
Pathologic causes of short stature
GH deficient Turner Prader willi Noonan Achondroplasia
How would I check my parental mean height?
Subtract 5” from my dad, and average w my mom
How would Jared check his parental mean height?
Add 5” to mothers, then mean with dad
Tx for GH deficiency
Recombinant Human GH is 1st line tx
Tx for GH deficiency
rhGH 1st line
Must tx prior to epiph plate closure
Daily SubQ injections
Side effects of Recomb Human GH replacement
Pseudotumor cerebri
Hyperglycemia
Gynecomastia
Turner Syndrome
45 X0
Loss of all or part of X chromo
SHORT STATURE
Shield shaped thorax, low hairline, underdeveloped gonads, amenorrhea
Noonan syndrome
SHORT stature
Auto-Dominant
CHD (heart)
Variable gene mutations
Triangle head, curly wooly hair, neck webbing
Prader Willi
Chromosome 15
Obesity
SHORT stature
Achondroplasia
Auto-DOMINANT
FGFR3 gene
*Most common bone dysplasia in humans
Achondroplasia
Disproportionate with Rhizomelic short- long bones are short
Autosomal Dominant causes of short stature
Noonan
Achondroplasia
What are IGF-1 levels in Turner, Noonan, Prader willi, Achondroplasia?
Normal, even though they are short
Complications assoc with Achondroplasia
Rhizomelic shortening
Macrocephaly
Brachydactylyl
Obestiy
Tall stature
Gigantism, GH excess b4 epiphyseal closing
GH excess Gigantism dx
Serum IGF-1
GH suppression test
MRI
GH suppression test
(give glucose, if GH does not fall in response= abnormal)
Tx for GH excess
Octreotide*
Bromocriptine
Surgery/radiation
Precocious puberty
Girls: before 8
Boys: before 9
Central precocious puberty
Gonadotropin dependent
Elevated LH and FSH
Peripheral precocious puberty
Testes are the problem
Elevated gonadal steroids, but low LH and FSH
Central/ gonadotropin dependent Precociosu
Girls > boys
MRI brain/ Pit
Tx: GnRH agonist
Peripheral precocious puberty
gonadotropin-indep
Rare 50% cases in boys Cause: steroids Congenital Mccune Albright
Tx: underlying
21 a hydroxylase deficiency
Too much Androgens (virulizing)
Not enough Aldosterone or Cortisol
Klinefelters
most common cause of primary testicular failure
Gynecomastia
Tx for 21 a hydroxylase deficiency
High Androgen
Low Cortisol and Aldosterone
GnRH analog
Hydrocortisone
Fludrocortisone