Peds Flashcards
Noonan syndrome inheritance pattern
AD
Noonan syndrome cardiac defect
Pulmonic stenosis (20-50%), HCOM
Noonan syndrome features
cryptorchidism, downslanting palpebral fissures, heart defects (pulm sten), hypotonia, cognitive difficulties, short stature, webbed neck
Common presentation of Turner Syndrome
16yo female, short, amenorrhea, no secondary sex characteristics
Cardiac defects of turners
Bicuspid aortic valve, coarctation of aorta
NF1 diagnostic criteria
Need at least 2: 6 or more café au lait macules (at least 5 mm before puberty and 15 mm after) Axillary or groin freckling 2 or more neurofibromas Lisch nodules (iris hamartomas) Optic glioma Osseous lesions (sphenoid or tibial dysplasia) Positive family history
features of DiGeorge syndrome
CATCH 22: Cardiac (TOF, VSD), abnormal facies (long face, narrow palpebral fissures, bulbous nose), Thymus hypoplasia, Clefts, hypocalcemia. psych disorders
Fragile X cardiac defect
MVP
Trisomy 13
cleft lip, ocular hypotelorism, low set ears, holoprosencephaly, micropthalmia, polydactyly, cardiac malformations, visceral and genital malformations
Trisomy 18
closed fists with index finger overlapping 3rd digit and 5th digit overlapping 4th , short sternum, rocker bottom feet, microcephaly, micrognathia, cardiac and renal malformations
Williams syndrome genetics
7q11.23 deletion
Williams syndrome cardiac defect
Supravalvular aortic stenosis
Williams syndrome features
Round face with full lips and cheeks, long philtrum, strabismus, very friendly, mild MR, eye puffiness, supravalvular aortic stenosis, endo abnormalities (DM, hypercalc, hypothyr), congenital anomalies of kidney, hearing and vision issues
Prader-WIlli genetics
paternal deletion of chromosome 15 (imprinting) - when deletion of portion of chromosome 15 is inherited from the father. (vs. when inherited from mother = angelman) this type of genetics causes 70% of these syndromes OR 30% is caused by uniparental disomy (failure of disjunction in meiosis). In prader-willi, child gets both copies of maternal chromosome 15 thus missed out on the paternally active genes
Prader-Willi features
Feeding issues initially then voracious appetite and obesity. small hands and feet, hypogonadism, MR
Angelman genetics
deletion of 15 maternal imprinting. when deletion of portion of chromosome 15 is inherited from the mother. this type of genetics causes 70% of these syndromes OR 30% is caused by uniparental disomy (failure of disjunction in meiosis). In angelman, child gets both copies of paternal chromosome 15 thus missed out on the maternally active genes
Angelman features
hypotonia, fair complexion, seizures, inappropriate laughter, poor speech, severe MR
Alagille Syndrome
bile duct paucity with cholestasis, cardiac defects (pulm a stenosis), butterfly vertebrae
Klinefelter syndome genetics
47XXY
Klinefelter clinical features
hypogonadism and infertility, secondary sex characteristics late, gynecomastia, may have behavior issues, mild MR,
MSUD defect
defective branched chain alpha ketoacid dehydrogenase
MSUD clinical features
Poor feeding, coma, vomiting in first week. hypertonicity, hypoglycemia, ketosis
tay sachs enzyme defect
b hexosaminidases - lysosomal storage
Tay Sachs features
mental detioration, spasticity, cherry red spot
Gaucher disease defect
glucocerebrosidase - lysosomal storage
Gaucher disease features
HSM, mental detioration, myoclonus, spasticity
Ebstein anomaly
Annulus of tricuspid in correct place, but valves are stuck to right ventricle or displaced. Causes tricuspid regurgitation. Often have associated PFO or ASD. Risk factor is lithium during pregnancy. Associated with WPW syndrome.
CHARGE syndrome
Coloboma, Heart defect (ASD, VSD), atresia of choanae, Retardation of growth, GU abnormalities, Ear abnormalities
Galactosemia features
Neonatal cataracts, ovarian failure, boys have normal fertility, developmental and speech delays are common even if follow strict dietary restrictions, intellectual disability, liver disease, *cataracts reversible with diet changes.
Landau Kleffner Syndrome
Children who have normally acquired skills gradually or suddenly develop progressive aphasia between 3-7 yo. Acquired speech delay EEG pattern that shows electrical status epilepticus during slow-wave sleep. 80% have clinical seizures. Treat with IVIG, steroids, AEDs
How do you lower ammonia levels?
If greater than 200mcmol/L level must be reduced with benzoate and phenylacetate, if greater than 600 = dialysis
What disorders cause increased ammonia?
Prorionic Acidemia, methylmalonic Acidemia, fatty acid oxidation defects, Urea cycle defects,
Features of organic acidemias
Elevated Ammonia, Acidotic, Anion Gap, ketonuria. Usually present in first 2 days of life after protein has been introduced.
Treatment of methylmalonic Acidemia
Presents with tachypnea, poor feeding and lethargy. Elevated AG. may respond to B12
How to test for defects in fatty acid metabolism?
plasma acylcarnitine profile
Features of fatty acid metabolism defect
hypoglycemia, hepatomegaly, lethargy. NO reducing substances or ketones in urine. normal serum aa’s
How do urea cycle defects present?
hyperammonemia, no acidosis. Usually have symptom-free period followed by hypotonia and coma. no ketonuria. Sometimes have hepatomegaly, no hypoglycemia
DDx for hypoglycemia in infants
galactosemia, inherited fructose intolerance, IDM
Clinical features of fructose intolerance
seizures right after a meal and a child that stays away from sweets
Phenylketonuria
Most common amino acid disorder. 1:15000. Does not show up until has had 24 hours of protein intake. Moderate MR, autism, seizures, hypopigmentation, eczema. Treat with low phenylalanine diet
Homocystinuria
Clinical features: tall, scoliosis, osteoporosis, mild MR, ectopia lentis, hypercoag, stroke. Defect in cystathione beta synthetase deficiency. Supplement with betaine, folate, pyridoxine, ASA. Confirmation test measure methionine and homocysteine levels
MCAD
Hypoglycemia without ketonuria, at risk for coma, SIDS. Carnitine supplementation, avoid hypoglycemia
What syndromes cause elevated ammonia?
Urea cycle disorders, organic acidemias, biotinidase deficiency, reye syndrome
Treatment of urea cycle disorders
Avoid protein. Prevent protein catabolism - high calorie diet, supplement with arg. Utilize NH3 scavengers like phenylacetate, sodium benzoate.
What is the most common urea cycle defect?
OTC deficiency 1:14,000
Inheritance pattern of OTC deficiency
x linked
MELAS
Mitochondrial encephalopathy, lactic acidosis, and stroke like episodes. Maternal mitochondrial inheritance. Diagnose by mitochondrial mutational analysis. Features - myopathy, encephalopathy, lactic acidosis, stroke like episodes, shortness, deafness, DM
Gaucher Disease
Lysosomal storage disease. Painless splenomegaly, thrombocytopenia, excessive bleeding, bone pain, pathologic fractures, mod MR. Defect is B glucosidase def. Test for glucocerebrosidase
Tay-Sachs
Lysosomal storage disease. Developmental regression, failure to thrive, cherry red fovea, blindness, seizures, death by age 2 usually. Defect in hex A
Hurler Syndrome
lysosomal storage disease of mucopolysaccharide. Developmental regression, coarse features, organomegaly, corneal clouding. Defect in iduronidase. Treat with enzyme replacement or stem cell therapy (BMT)
Hunter Syndrome
XLR. Developmental regression, coarse facial features, organomegayl. Treat with BMT, enzyme replacement. Hearing deficits, but no corneal clouding
Rett Disorder
Normal development in the first 6 months then shows signs of autism, receptive and expressive language delay, psychomotor retardation, decreased head growth, poor coordination and seizures. Usually in females. Mutation in MECP2
Von Gierke Disease (glycogen storage disorder 1)
Defect in glucose 6 phosphatase. Hypoglycemic seizures, but more often they are diagnosed between 3 and 4 months of age with evidence of hepatomegaly, lactic acidosis, elevated lipid and uric acid values, and symptomatic hypoglycemia. Failure to thrive. Nephrolithiasis/renomegaly/renal dz, hepatic adenomas, osteoporosis, PCOS. Can have platelet dysfunction (type 1a) or WBC dysfunction/neutropenia (1b)
Cori Disease
Glycogen storage disease type III. Debrancher enzyme deficiency. Like Type I, presents with hepatomegaly, hypoglycemia, hyperlipidemia, and growth retardation.
No nephromegaly.
Normal lactic acid and uric acid levels.
Liver transaminases are elevated.
Hepatic symptoms improve after puberty, but muscle weakness may occur later in adulthood (20’s-30’s).
Andersen Disease
Glycogen Storage Disorder type IV. Branching enzyme deficiency. Unique because problem is with glycogen synthesis.
Presents in first few months with hepatosplenomegaly and FTT.
Progressive cirrhosis with death usually <5yo.
Hypoglycemia is not an issue (except with very severe cirrhosis). Treatment with transplant
Hers Disease
Glycogen storage disease type VI. Liver phosphorylase deficiency. Few cases, benign course.
Hepatomegaly and growth retardation in early childhood.
Mild hypoglycemia, hyperlipidemia, and hyperketosis.
Normal uric acid and lactic acid.
Treatment: Symptomatic with frequent meals
Pompe Disease
Lysosomal alpha glucosidase deficiency. Muscle glycogen storage disease. Classic infantile onset
Cardiomegaly, hypotonia, death prior to 2yo (cardiorespiratory failure). Very high CK levels.
Rapidly progressive weakness, marcroglossia, mild hepatomegaly.
Muscles appear hypertrophic despite weakness.
Intelligence is generally normal.
Juvenile onset
Primarily skeletal muscle involvement with minimal cardiac involvement.
Adult onset
Slowly progressive, adult onset myopathy
McArdle Disease
Muscle dephosphorylase deficiency. Clinical symptoms being in young adulthood.
No muscle glycogen supply available during exercise.
Exercise intolerance, muscle cramps, and episodic rhabdomyolysis.
Dark urine with elevated CK levels after exercise.
In general, treatment is avoidance of symptoms, developing exercise tolerance.
Apert Syndrome
AD disorder. Premature closure of the cranial sutures, resulting in craniosynostosis; syndactyly, choanal atresia, wide set eyes and midface hypoplasia, and intellectual disability.
Crouzon Syndrome
craniofacial dysostosis, high prominent forehead, shallow orbits resulting in preoptosis and a beak nose. Usually with intracranial anomalies