Peds Block 3 Cram Flashcards
What is the MC nutritional d/o in the world?
What are the risk factors?
Fe deficient anemia
Cows milk intake @ 9-24mon
Under nutrition
Blood loss
Celiac/Giardiasis/H Pylori
Breast fed infants need to have iron supplementation starting @ ?
At what age can Fe foods be introduced to infant diets?
When can they start drinking cows milk?
4mon
6mon
12mon; <24oz/day
Microcytic anemia DDx
What is the MC congenital bleeding d/o
FLATS Fe deficiency anemia Lead poisoning Anemia of chronic Dz Thalassemia Sideroblastic anemia
Von Willebrand Dz
Functions of vWF?
How is it Dx?
How is it Tx?
Joins platelets and collagen
Protect Factor 8 from rapid clearance
Measured vWF quantity
Function measured w/ Ristocetin
Desmopressin for Type 1,2
vWF concentrate for Type 3
What Sx combo is a medical emergency for PTs w/ Sickle Cell?
By ? age they are functinoally asplenic leaving them vulnerable to ? microbes
If Sickle PT has osteomyelitis, consider ? microbes?
Fever + Sickle Cell anemia
5y/o
Encapsulated: HiB, Strep Pneumo, N Meningitidis
Salmonella
Staph A
What is the most common type of vasooclusive event?
What is the other form of this occlusive crisis?
Pain crisis
2-7 days of leg/arm pain w/ possible femoral head necrosis
Tx w/ Fluids, Pain, O2
Acute Chest Syndrome
CXR w/ new infiltrates
1st Sx= chest pain-> respiratory distress
Tx: Fluid Pain Transfusion O2 ABX Dilators
What meds are used for Sickle Cell management?
Hydroxyurea @ 9mon old- inc Hgb F and dec occlusive severity/frequency
Daily PO PCN
Vaccines: HIB, HBV Influenza
Folate
What is the most common childhood systemic vasculitis?
What adverse outcome can occur but usually in adults?
HSP after URIs
Inflammation of small blood vessels w/ Hemorrhage Ischemia and Leukocyte infiltration
IgA deposition= glomerulonephritis
How does HSP present?
What other outcomes can be seen?
Palpable purpura
Arthralgia
Renal involvement
Abdominal pain
Orchitis Pancreatitis
Edema Encephalopathy
What are the 3 phases od Kawasakis
Acute:
Fever Conjunctival erythema Cracked lips Strawberry tongue
Cervical lymphadenopathy
Subacute: desquamation, coronary aneurysms (Inc ESR, <1yr, >6yrs)
Convelescent: from Sx resolution until ESR normalizes
When are f/u Echos done for Kawasaki PTs?
How is it Tx?
2wks
6-8wks
IVIG- reduces aneurysm risk
High dose ASA
What are the “B-Sxs” of Hodgkins?
What 3 Sxs are less likely to be seen?
What will be seen on PE?
Fever x 3 days
Weight loss +10% in 6mon
Drenching night sweats
Fatigue Anorexia Pruritus
Cervical/Supraclavicular lymphadenopathy
Pleural effusion
What is seen on tissue biopsies in Hodgkin results?
Why are CXR and CTs ordered for these PTs?
What info do marrow aspirations provide?
Reed-Sternberg cells (owl eyes)
CXR- mediastinal mass eval
CT- Dz staging
Dz staging
+25% blasts= acute leukemia
What is the MC primary malignant tumor of childhood?
This type of tumor is #2 of?
Wilms Nephroblastoma tumor
2nd MC malignant abdominal tumor of childhood (#1= neuroblastoma)
What other abnormalities is Wilms tumors associated w?
Why are there so many issues w/ these PTs?
WAGR: Wilms tumor Aniridia GU malformation Retardation
Germline deletion Chrom #11p
Wilm tumors make PTs more susceptible for ? syndrome
What are the 3 common sites for these tumors to show?
Beckwith-Wiedemann- macroglossia, umbilical hernia, omphalocele
Lungs
Lymph nodes
Liver
What are the 2 MC presenting Sxs of a nephroblastoma?
What labs are drawn and what test is Dx?
What images are ordered?
Abdominal mass
Abdominal pain
CBC UA Liver/Renal function
Histology exam= Dx
Abd CT/US: renal or adrenal mass
CXR: pulmonary metastases
CT of chest, abdomen, pelvis
What are oncological emergencies in Peds?
Sepsis- chemo causes severe neutropenia TLS- common in leukemia/lymphoma Txs Anemia/Thrombocytopenia Inc ICP Airway obstruction
What is the MC childhood CA?
What are the 3 subtypes of this kind of CA?
Leukemia
ALL: males
AML: neonates, adolescence
CML
JMML
What will be seen on lab results of PTs w/ leukemia?
What type of analysis is done for Dx?
Peripheral smear w/ blast cells
Anemia
Thrombocytopenia
WBC >50K
Cytogenetic
Osteosarcomas are assoicated w/ ? hereditary issue
What syndrome is susceptible to this CA?
Retinoblastoma
Li-Fraueni Syndrome
What can trigger osteosarcoma and what would be seen on lab results?
What bones are MC affected?
Radiation
Osteoid substance
Distal femus
Proximal tibia and humerus
How does Ewing Sarcoma appear under microscopy?
What Sxs does it present w/ that causes it to be mis-Dx as osteomyelitis
Small Round Blue cell tumors
Pain and Fever
Although it can occur anywhere, where does Ewings occur MC?
What is the MC childhood solid neoplasm outside of the CNS?
Femur and Pelvis
Neuroblastoma
What is the MC infant malignancy
What tissues does this grow from?
Neuroblastoma
Neural crest cells that form adrenal medulla and SNS
Half- adrenal glands
Half- paraspinal ganglia
What are the MC presenting Sxs of Neuroblastomas?
What paraneoplastic syndromes can it present w/?
Abdominal mass and pain
Sweating Diarrhea Clonus
Horners
Where are neuroblastomas likely to metastasis to?
How is this Dx?
Lymph nodes Long bones Liver Skull Marrow Skin
24hr UA catecholamine
What type of infections do CA PTs tend to get?
What is the MC if only presenting Sx of a CA PT w/ an infection
Catheter/Port infections Crypto meningitis HSV Aspergillus P jiroveci
Fever
CA PTs w/ what 2 Sxs are immediately admitted?
When do parasomnias tend to occur and MC in ? PTs?
Fever + Neutropenia
NREM
In association w/ REM
Preschool kids
Parasomnias are linked w/ ? FamHx?
What are the different types?
Sleep walking
Night terrors
Sleep walking
Terrors if first 1/3 of night
Mares if last 1/3 of night
Confused arousal- less dramatic and more gradual than terrors
What type of seizure is MC between 6mon and 5yrs
What part of the PT Hx has to be present for a Dx of febrile seizure to be given?
Febrile
+100.4 before, during or after the seizure
What are the two types of febrile seizures
Febrile status epilepticus can last for how long?
Simple: <15min and only one in 24hrs
Complex/Atypical: >15min, repeats in 24hrs or Hx of neuor issues
> 30min
What meds can be given during a febrile seizure
What two meds are not used?
What lab result needs to be checked?
Rectal diazepam
Antconvulsant
Antipyretics
Fe deficiency
What are the cardinal Sxs of NF Type 1
What imaging is needed during Dx?
Cafe au lait spots
Lisch nodules
Axilla/Inguinal freckles
Neurofribromas, cutaneous
Cranial imaging to r/o neoplasms
What is the first Sx of botulism poisoning?
How are these poisonings Tx?
Constipation
Poor feeding
IVIG
Respiratory/supportive care
What type of HA is most recurrent and MC
What Sxs are/not seen?
What is the etiology of these types of HA?
Tension
Squeezing pressure
No N/V/phobias
Stress/Psych illness
How do PTs w/ migraines describe the pain?
What Sxs will they complain of?
What will be seen in their Hx 90% of the time?
Pounding/throbbing
N/V/Phobia
1* or 2* relative w/ recurrent HA
What part of the head is measured for circumference?
What does accelerated/decelerated patterns mean?
What is the criteria for macro/micro cephalus?
Occipitofrontal
Accelerated= hydrocephalus Decelerated= brain injury, degenerative d/o
Macro= 2 SD above mean Micro= 2 SD below mean
When does the anterior fontanelle become tense/bulging?
Define craniosynostosis
Crying Inc ICP Febrile
Premature closure of 1 or more sutures causing unusual/ridge feeling head
Who is more likely to have a UTI <1yr and over 1yr
What type of microbes are MC cause?
What are the 2 forms of UTIs?
Under: uncircumcised male
Over: healthy female
Colonic: E Coli Klebsiella Proteus Enterococcus Pseudomonas Sapro GBS
Pyelonephritis
Cystitis
How are UTIs Dx
How are these samples recommended to be collected?
UA
Cath if 2-24mon
Clean catch if toilet trained
NO perineal bags
What lab results are Dx for UTIs
What finding is concerning for contaminated samples
Pyuria >10
Pos LE/Nitrite
Pos LE/bacteria
3-5 epithelial cells
What is the gold standard for Dx UTIs and these are needed for ?
What results are Dx or indicative of repeat testing
UA culture: confirmation and appropriate therapy
> 50K CFU + pyuria
100K if older/adolescent
1-50K= repeat UC
When is imaging warranted for UTIs in Peds?
When is a VCUG study warranted?
Renal/bladder if 1st UTI in infant or non-toilet trained
1st UTI in 2-24mon w/ abnormal US or recurrent/febrile UTI
Define Enuresis
Define Diurnal
Define Nocturnal
Incontinence in child who is mature enough to have achieved continence
Daytime enuresis
Night time enuresis
Define Primary/Secondary Enuresis
What are the etiological factors behind enuresis
Primary: incontinence in child who has never achieved dryness
Secondary: child who has been dry x 6mon
Psych distress
Organic illness
Developmental difference
What type of enuresis often has a FamHx and least likely to have an identifiable cause?
What type is more likely to be due to organic etiology?
What labs are done for these PTs?
Primary nocturnal
Secondary diurnal/nocturnal
UA clean catch and culture
How are non-organic causes of enuresis Tx?
What meds can be used?
Fluid intake restriction
Bedtime void
Snoring= adenoidectomy
Desmopressin, 90% relapse when d/c
Rare- Imipramine, TCA
What lab results are Dx for Nephrotic Syndromes?
Proteinuria: 3-4+ Hematuria Spot urine protein: creatinine ratio >2 Serum albumin <2.5g/dL Serum cholesterol/TG elevation Complement levels normal
Minimal change nephrotic syndrome
How do these PTs present?
No progression to renal failure
Inc BUN
Normal complement
Remission after 8wks of steroids in 90% of PTs
Sudden dependent pitting edema/ascites
Anorexia Malaise Abdominal pain
HTN
What finding on PE of a nephrotic syndrome is indicative of tubular necrosis and significant HOTN?
What deformity makes PTs are risk for testicular torsion?
Sudden decline of serum albumin and volume depletion
Bell-clapper
What PE findings are indicative of testicular torsion?
Define Hydrocele
High/tender testicle
Absent cremaster
Negative Prehn’s sign
Fluid collection in tunic vaginalis
What are the two types of hydroceles
How are these Tx?
Communicate- w/ peritoneal space
Non-communicating- MC; processus vaginalis obliterated
Non-Comm: self resolve by 12mon, refer by 18mon
Comm: smallest in AM, refer for surgery
Communicating hydroceles are associated w/ ? injury/issue
What is the MC cause of intestinal obstruction before 3mon old
Inguinal hernias
Pyloric stenosis: m>f and more in first born
What type of issue is a pyloric stenosis
What is the classic presentation of this issue?
What will be seen on lab results?
Muscle hypertrophy and spasm= outlet obstruction
Non-bilious projectile vomit w/ FTT
Hypochloremic, Hypokalemic, Metabolic alkalosis
Inc BUN
What PE finding is indicative of a pyloric stenosis?
What finding is seen on imaging?
Olive sign
String sign on barium upper GI seris
What is the Rule of 2s for Meckels?
How do these PTs present?
2% of population 2 ectopic mucosae: gastric/pancreatic Presents by 2yrs W/in 2ft of cecum 2" long
Massive, painless GI bleed
What type of scan is ordered for suspected Meckels?
What complications can occur even after surgery?
Umbilical hernias ? size are less likely to close on their own?
Technetium scan- labels acid producing mucosa
Perforation Obstruction Diverticulitis Bleeds
> 2cm
What are the predisposing risk factors for umbilical hernias?
What two tissues can be contained w/in the hernia?
Low birth weight
African American
Omentum
Small intestine
When are umbilical hernias referred for surgical repair?
Define Intussusception and the origin they’re associated w/
After 5y/o
Sxs / Strangulated
Grows after 1-2yrs
Telescoping of proximal bowel into downstream bowel
Rotavirus infection/vaccine
What are the two lead points of intussusception?
How do these PTs present?
Lymphoid hyperplasia- Peyers patches
Abnormal anatomy- ileocecal valve, Meckels
Paroxysmal cramping abdominal pain
Currant jelly stools- mucous and blood mixture
What is the MC surgical emergency of kids
What are the MC causes of the obstruction
What emergency occurs after 48hrs of Sx onset?
Appendicitis
Fecalith
Lymphoid hyperplasia after viral infection
Neoplasm
Rupture
Hirschsprung is AKA ?
What is the pathological reason for this issue
Where does the dilation occur in the PT
Congenital Aganglionic Megacolon- absent motility and functional obstruction
Failure of ganglion cell precursors to migrate to distal bowel
Proximal to aganglionic segment
How do PTs w/ Hirschsprung’s present?
What causes polyhydramnios
95% don’t pass stool in first 24hrs
Distal obstruction w/ distension
Bilious vomit
Fetus w/ esophageal atresia can’t swallow amniotic fluid, prevents transfer for fetus wastes to maternal blood
How do PTs w/ tracheoesophageal fistulas present
What type of Peds Fx is and is not conerning
Drooling
Mucus/saliva bubbling from nose/mouth
Single umbilical artery
Is: metaphyseal bucket handle
Not: spiral
What bones in Peds are not likely to be Fx accidentally
What type of images are taken when investigating?
Scapula Posterior ribs Spinous process/vertebrae Skull Sternum
Skeletal surveys if child is <3y/o
What type of head traumas are seen in abuse?
What is the Shaken Baby triad?
Rape kit can be performed it assault occurred within how many hrs?
Shaking
Blunt impact/force trauma
Retinal hemorrhage
Brain swelling
Subdural hematoma
72hrs
What are the top causes of death in PTs <1yr, 1-4yr, 5-14yr and 15-24yrs old?
What are the top 5 unintentional injuries in kids 9-18y/o
<1: development/genetic issues/SIDS
1-4: accidental injuries
5-14: accidental injuries
15-24: accidental injuries
MVC Drown Burn Falls Toxins
What organ is the MC injured in kids?
What type PE finding is indicative of damage to this organ?
Spleen
Kehr sign- LUQ pressure causes L shoulder pain
If PT has spleen removed due to trauma, what management meds are they put on?
Define Nurse Maid elbow
PCN
Pneumococcal/H Influenza vaccine
Radial head subluxation
Annular ligament passing around radial head partiall slips off w/ elbow traction
How is Nurse Maid elbow Tx
When are images needed for this injury?
Supinate hand w/ pressure on radial head and flex elbow to 90*
Unable to reduce
Concern for Fx- swelling/bruising
PTs that are ? old w/ SCFE need an endocrine work up
What is the earliest sign of this issue?
<10yrs
>16yrs
Preslip condition
How are SCFEs classified
What complications can develop?
1: 0-33% slip
2: 34-50% slip
3: >50% slip
Chondrolysis
Avascular necrosis
What is the MC foreign body ingestion object
When do Peds w/ burns need to be referred?
Coins
> 10% of body and under 10y/o
20% and older than 10
Face, Hands, Feet, Genital, Perineum burns
Electrical Chemical Inhalation burns
What is 1st line Tx of anaphylaxis
These PTs must be monitored for how long due to likelihood of relapse?
Epinephrine, 0.3mg max dose NS for hypovolemia Nebulized B-agonists for bronchospasms Diphenhydramine/steroids 20% relapse w/in 4-6hrs
What parent is more likely to to be reported as a perpetrator or as the infliction of serious injury?
What is the MC types of child abuse and the 3 types?
Mother- perp
Father/maternal boyfriend- injury
Neglect, hardest to prove
What 4 types of Fxs are highly specific for abuse?
What type of trauma injury is most common in infant/toddlers?
Rib Metaphyseal/Bucket handle Vertebral Scapular
Blunt trauma
What medicinal practice is common in Vietnam/SE Asia
Define Quat Sha
Define Moxabustion
Shaved wind, coining
Spoon rubbing
Burning of moxa (mugwort) on accupuncture point
What color are bruises at specific days of healing?
What are the names of visible blood types during the healing phases?
Red: 0-2 Blue/purple: 2-5 Green: 5-7 Yellow: 7-10 Brown: 10-14 Gone: 2-4wks
Hbg- red/blue
Biliverdin- green
Bilirubin- yellow
How are Fxs healing stages estimated?
What is the leading cause of morbidity and mortality in abused minors?
7-14 days: new periosteal bone, callus
14-21: loss of Fx line, trabecular formation
3-6: callus inc w/ density
+6wks: sclerotic thickening
Shaken baby: retinal hemorrhage, brain swelling, subdural hematoma
What 3 STDs in Peds are almost always due to abuse?
What can be seen on PE due to the MC form of abuse?
GC/C
Syphilis
Neglect- Type 1 growth deficiency= normal head/length, low weight
What are the legal ramifications for not reporting child abuse in TX?
What are neonatal surgical red flags?
Class A midemeanor
Delayed meconium passage
Abdominal distention
Maternal polyhydramnios- can’t swallow amniotic fluid
Perinatal vomiting
Why do tracheoesophageal fistulas occur
What is the MC type
Both tissue develop between 4-6wks of gestation
Fistula= dysgenesis
Esophageal atresia w/ distal TEF
What is the VACTERL association w/ T/E fisulations?
Vertebral anomalies Anal atresia Cardiac anomalies TEFistula Renal anomaly Limb anomaly
How are E/T fistulas Dx?
How are difficult cases Dx?
OG catheter won’t pass
CXR showing catheter curled in esophagus
Gastrografin swallow
Methylene blue challenge
How are PTs w/ pyloric stenosis managed?
What is the name of the Tx procedure?
NS bolus
D5 w/ K+
Surgery won’t take them until alkalosis is fixed
Pyloromyotomy
Congenital diaphragmatic hernia usually occurs on ? side
What developmental issue causes this deformity
Where is the herniation MC?
Left
Defective fusion of pleuroperitoneal membranes
Leaves large opening in posterolateral diaphragm
Bochdalek foramen: bowel herniation through diaphragm impeding lung development
What will be found on PE if child has congenital diaphragmatic hernia
How is it Dx
Respiratory distress
Scaphoid abdomen w/ bowel sounds in L chest
CXR
What is a common type of ventral hernia
Intestinal malrotation/midgut leaves PT predisposed for ?
Umbilical hernia- protruding contents covered by subcutaneous tissue/skin
Midgut volvulus- intestines twist on themselves causing obstruction/artery occlusion
How does an intestinal malrotation/volvulus present
If there’s no rotation, what else can cause the PT to vomit?
Bilious vomit in 1st mon of life
Ladd’s bands- duodenal constrictors
What will be seen on barium imaging of intestinal malrotation/volvulus
What sign is seen?
How is it Tx?
Cecum in RUQ
Corkscrew effect due to volvulus in upper GI
Fluid, OG decompression, Laparotomy
If Peds PT has atresis, what Dz needs to be screened?
What deformities is this associated w/?
CF
Trisomy, Malrotation, Annular pancreas, Meconium ilieu w/ CF
What is the classic x-ray finding of an intestinal atresia?
Define Gastroschisis
Double bubble sign
Split/open stomach, usually on R side, w/out involving umbilicus
Gastroschisis is thought to be due to the absence of ? artery
Define Omphalocele
Omphalomesenteric
Impaired mesodermal/ectodermal (muscle/skin) growth of abdominal wall
Intestines remain out and covered by peritoneum and amniotic membrane
Herniation of bowel contents through umbilical ring
PTs w/ omphalocele are more likely to have ? d/o?
Meckel’s develop due to lack of obliteration of ?
Bechwith-Wiedemann syndrome
Omphalomesenteric duct
? is a true diverticulum on anti-mesenteric border of ileum
All infants/ w/ imperforate anus require ? and commonly have ? dysfunction
What causes necrotizing enterocolitis
Meckels
MRI of lumbosacral spinal cord
Urologic
Ischemia secondary to immature GI system
MC premature births <34wks
What is the Alvarado/MANTRELS rule for appendicitis?
1 Pt:
Fever Rebound pain Anorexia Migration to RLQ N/V
WBC >75% neutrophils
2Pts: RLQ tenderness, Leukocytosis >10K
<4pts: unlikely
>7pts: likely
What Peds issues cause non-bilious vomit?
Which ones cause bilious vomit?
Non: Pyloric stenosis
Bilious: Malrotation/Volvulus, Atresia, Hirschsprung, NEC, Intussusception
Which Peds issues present w/ pain?
Which ones present as painless issues?
Pain: intussusception, Appendicitis
Painless: Meckels
What GI Tx can be curative for enuresis?
Define Hypospadias
10% of these PTs will also have ? issue
Chronic constipation
Failure of ventral urethral folds to fuse
Undescended testes
Inguinal hernias
When are hypospadias’ Tx
If baby is born w/ this, this automatically means no ? procedure
Ideal 6-12mon
Before 18mon
No circumcision
Cryptorchidism usually don’t spontaneously descend after ? age
Orchidopexy presentation under 2y/o is uncommon presentation for ? issue
4-6mon
Testicle CA
What are the 3 DDx for testicular torsions?
Epidiymo-orchitis: abnormal UA, no scrotal edema/erythema, + Prehns sign
Appendiceal torsion- blue dot on top of scrotum, swelling on upper pole of testicle
Incarerated inguinal hernia: hernia felt w/ valsalva, difficult exam due to pain
What PT population has renal agenesis presentations the most?
Uni/bilateral renal agenesis is often associated w/ ? other issues?
Diabetic mother
Black races
Unilateral: VUR Vacterl Turner syndrome
Lateral: Potter syndrome
Define characteristics of Potter Syndrome
Why does this issue cause fetal malformations?
Flat face
Club foot
Pulmonary hypoplasia
Reduced fetal urine excretion= oligohydramnios leading to compression
Hemolytic uremic syndrome is characterized by what 3 things
What is the MC type?
Microangiopathic hemolytic anemia
Thrombocytopenia
Renal injury
Prodromal diarrheal illness from E Coli O157:H7 in food/water
How does HUS present in clinic
Since Tx is supportive, what two meds are avoided?
CNS/Seizure involvement
Pancreatitis
Cardiac dysfuntion
Colonic perforation
ABX, Anti-diarrheals
