Peds EOR Flashcards
Patient will be a child 6 months to 3 years of age
With a history of high fever lasting 3–4 days
Complaining of a rash that started after the fever went away
PE will show blanching macular or maculopapular rash with a distribution that begins at the neck and trunk region and spreads to the face and extremities
Roseola
(Exanthem Subitum), “sixth disease”
Patient presents with viral prodrome and maculopapular rash
PE will show clear vesicles on an erythematous base (dew drop on a rose petal), crops of lesions in multiple stages
Treatment is
< 12 years old: supportive care
> 12 years old: acyclovir
Varicella
Rash ("blueberry muffin")
Microcephaly
IUGR
Hepatosplenomegaly
Seizures
Retinitis/Vision loss
Hearing loss, baby will need follow up hearing tests
Test urine /saliva for CMV
Treat with oral valganciclovir/ IV ganciclovirCongenital Cytomegalovirus
Streptococcus pyogenes Sandpaper rash Strawberry tongue Circumoral pallor Pastia’s lines: petechiae in skin folds Complications: PSGN, rheumatic fever Rx: PCN
Scarlet Fever
Patient with a history of recently being in the woods hiking or camping
Complaining of abrupt onset of severe headache, photophobia, vomiting, diarrhea, and myalgia
PE will show maculopapular eruption on the palms and soles
Most commonly caused by Rickettsia rickettsii
Empiric treatment based on clinical presentation
Diagnosis confirmed by serologic testing
Treatment is ALWAYS doxycycline, even in children
Rocky Mountain spotted fever (RMSF)
Patient will be a child
Nocturnal pruritus ani
Diagnosis is made by tape test
Most commonly caused by ingestion of Enterobius vermicularis eggs
Treatment option include mebendazole, albendazole, or pyrantel pamoate
Dose is repeated in 2 weeks
Pinworms
Patient with a history of nasal congestion, cough, and low-grade fever
Complaining of rapid fire repetitive coughing followed by an inspiratory whoop” and post-tussive emesis
Most commonly caused by Bordetella pertussis
Treatment is a macrolide - azithromycin
Pertussis “whooping cough”
↑ miscarriage, stillbirth
Chorioretinitis, hydrocephalus, intracranial calcifications
Most are asymptomatic at birth
Chronic: seizures, motor deficits, intellectual disability, vision loss, hearing loss
Tx: pyrimethamine + sulfadiazine + leucovorin for baby & mom
To prevent: no raw or undercooked meat, wash fruits & vegetables, do not change cat li
Congenital Toxoplasmosis
Patient will be an unvaccinated child between two and nine years of age
With a history of fever, headache, vomiting, and malaise
PE will show fever and parotid swelling and tenderness
Labs will show leukopenia, lymphocytosis and an elevated serum amylase
Most commonly caused by Paramyxoviridae
Comments: Most common complication in adult males is orchitis
Mumps
Patient presents with low-grade fever, headache, malaise, severe fatigue
PE will show mildly tender lymphadenopathy involving the posterior cervical chain, hepatosplenomegaly
Diagnosis is made by heterophile antibody test (mononuclear spot test) or a generalized maculopapular rash following administration of amoxicillin
Treatment is self-limiting, refrain from contact sports for 4 weeks postinfection
Mononucleosis - EBV
Patient with a history of URI symptoms 3 - 4 days prior to rash
PE will show “slapped cheek” rash
Erythema Infectiosum (“Fifth Disease”)
Patient will be a child younger than five years of age
Complaining of decreased appetite and fever
PE will show an oral enanthem plus a macular, maculopapular, or vesicular rash on the hands and feet
Hand, foot, mouth disease
MCC of Hand, foot, mouth disease
Coxsackie virus A
Patient will be an unvaccinated young child
With a history of a maculopapular rash that started on head and spreads toward feet
Complaining of high fever, cough, conjunctivitis, coryza
PE will show red spots with blue/white center on buccal mucosa (Koplik spots)
Diagnosis is made clinically
Treatment is supportive care
Measles
Rubeola
Patient with a history of being in the woods, hiking or camping
Presents with
Stage 1: erythema migrans (pathognomonic), viral-like syndrome (fever, fatigue, malaise, myalgia, headache)
Stage 2: myocarditis, bilateral Bell palsy
Stage 3: chronic arthritis, chronic encephalopathy
PE will show slightly raised red lesion with central clearing, erythema migrans (bull’s-eye) rash
Treatment is doxycycline; children: amoxicillin or doxycycline (if used for < 21 days); pregnant: amoxicillin
Bilateral facial nerve palsy is virtually pathognomonic for
Lyme Disease
MCC of Lyme disease
Most commonly caused by Borrelia burgdorferi carried by Ixodes tick
Patient will be a premature infant
Complaining of respiratory difficulty within a few hours after birth
PE will show tachypnea, tachycardia, cyanosis, nasal flaring, expiratory grunting, and chest wall retractions
CXR will show decreased lung volume, air-bronchograms, and a ground-glass appearance
Diagnosis is made clinically and radiographically
Most commonly caused by a deficiency of surfactant
Treatment is O2, intubation, CPAP, surfactant
Infant (neonatal) Respiratory Distress Syndrome (Hyaline Membrane Disease)
Patient will be an infant
Difficulty breathing
PE will show respiratory distress, polyphonic wheezing, and rales
Diagnosis is made by history and physical exam
Most commonly caused by respiratory syncytial virus (RSV)
Treatment is supportive care
Bronchiolitis
Patient will be a child
Complaining of a sudden episode of coughing, wheezing, or stridor
Comments: most common site is the right main bronchus
Foreign Body Aspiration
Patient with a history of repeated respiratory tract infections
Cough with large amounts of mucopurulent, foul-smelling sputum
PE will show crackles and wheezing on lung auscultation
CXR will show dilated and thickened airways (tram tracks)
Diagnosis is made by high-resolution CT showing airway dilatation, signet-ring sign (the jewel on the ring), bronchial wall thickening, and mucopurulent plugs and debris accompanied by postobstructive air trapping (tree-in-bud)
Treatment is antibiotics, bronchodilators, hydration, and chest physiotherapy
Bronchiectasis
MCC of Bronchiectasis
Cystic Fibrosis
Patient with a history of multiple recurrent respiratory infections or failure to thrive
Diagnosis is made by elevated quantitative sweat chloride test
Most commonly caused by autosomal recessive disorder in CFTR gene that results in the abnormal production of mucus
Comments: Pseudomonas aeruginosa most common infecting bacteria in recurrent pulmonary infections
Cystic Fibrosis
Patient will be 3–5 years old
High fever, barky cough, stridor
Treat as airway emergency!
Patient will look like croup but appear toxic
Bacterial Tracheitis
Patient will be a premature infant
Complaining of respiratory difficulty within a few hours after birth
PE will show tachypnea, tachycardia, cyanosis, nasal flaring, expiratory grunting, and chest wall retractions
CXR will show decreased lung volume, air-bronchograms, and a ground-glass appearance
Diagnosis is made clinically and radiographically
Most commonly caused by a deficiency of surfactant
Treatment is O2, intubation, CPAP, surfactant
Infant (neonatal) Respiratory Distress Syndrome (Hyaline Membrane Disease)
Patient will be complaining of sudden onset of cough, fatigue, and fever
PE will show focal rales with auscultation of lung fields
Most commonly caused by Streptococcus pneumoniae
Confirm dx with CXR or ultrasound (operator-dependent)
CURB-65 to stratify risk, inpatient vs. outpatient management
Tx: 2019 IDSA guidelines for adult CAP, guidelines for empiric pediatric CAP
Community acquired Pneumonia
Most common in children < 5 years old
With a history of high fever for five days
Complaining of conjunctivitis, rash, adenopathy, strawberry tongue, hand/feet edema, fever
Treatment is IVIG + aspirin
Comments: #1 cause of pediatric acquired heart disease, risk for coronary artery aneurysm
Mnemonic: CRASH and burn: Conjunctivitis, Rash, Adenopathy, Strawberry tongue, Hand/feet edema, burn (uncontrolled high fever)
kawasaki Disease
PE will show a loud, harsh, holosystolic murmur at the lower left sternal border
Diagnosis is made by echo
Treatment: most close spontaneously by adulthood
Comments: Most common pathologic murmur in childhood
VSD
Patient with a history of GAS infection
Fever, red skin lesions on the trunk and proximal extremities, and small, nontender lumps located over the joints
PE will show JONES criteria: joints, oh no, carditis!, nodules, erythema marginatum, Sydenham chorea
Labs will show anti-streptolysin O, anti-DNase B, positive throat culture, or positive rapid antigen test
Treatment is antibiotics, NSAIDs
Modified Jones criteria for a first episode of acute rheumatic fever: need 2 major or 1 major and 2 minor plus evidence of recent GAS infection
Rheumatic Fever
What is the name for the short mid-diastolic murmur that indicates moderate-severe mitral regurgitation secondary to increased blood flow across this valve?
Carey Coombs murmur
True or false: angiotensin-converting enzyme inhibitors are used in the treatment of hypertrophic cardiomyopathy to aid in cardiac muscle remodeling
False. They decrease peripheral resistance and worsen the outlet obstruction.
Patient will be a young athlete
Dyspnea on exertion (most common presenting symptom)
PE will show harsh crescendo-decrescendo systolic murmur that increases in intensity with Valsalva maneuver and decreases with squatting
Diagnosis is made by echocardiography
Most commonly caused by an autosomal dominant genetic defect
Management includes refraining from vigorous physical activity
Rx options: beta-blockers or calcium channel blockers
Most common cause of sudden death in young athletes
hypertrophic cardiomyopathy
Patient will be complaining of failure to thrive, poor feeding, tachycardia, and tachypnea
PE will show continuous, rough, “machinery-like” murmur, heard best in the first interspaces of the LSB
Diagnosis is made by echo
Management includes indomethacin, conservation observation, surgical ligation or percutaneous transcatheter occlusion
Patent ductus arteriosus
What is the most commonly associated cardiac defect in adults with coarctation of the aorta?
Bicuspid aortic valve
PE will show higher blood pressure in the arms than in the legs
EKG will show LVH
CXR will show notching of ribs
Diagnosis is made by echo
Treatment is balloon angioplasty with stent placement or surgical correction
Associated with Turner syndrome
Coarctation of aorta
What is a common valvular complication of percutaneous balloon aortic valvotomy?
aortic regurgitation
Patient will be older
History of diabetes, hypertension
Dyspnea, chest pain, syncope
PE will show crescendo-decrescendo systolic murmur that radiates to the carotids, paradoxically split S2, S4 gallop
Most commonly caused by degenerative calcification (bicuspid valve in kids)
Treatment is aortic valve replacement
Murmur decreases with Valsalva
aortic stenosis
What formula helps to estimate the fifth percentile for systolic blood pressure in pediatric patients?
Systolic pressure (fifth percentile) = 70 mm Hg + 2 x age in years.
Which two aortic disease states, in addition to coarctation of the aorta, may cause blood pressure to be lower in the lower extremities than the upper extremities?
Aortic dissection and supravalvular aortic stenosis
Which rare complication of Kawasaki disease is characterized by activation and proliferation of macrophages and T cells?
Macrophage activation syndrome
When can patients with a repaired atrial septal defect return to competitive sports?
3 to 6 months after closure if they have normal pulmonary pressure and ventricular function and no dysrhythmias.
PE will show wide, fixed split S2
Most commonly caused by persistent ostium secundum
May lead to Eisenmenger syndrome
ASD
What in utero infection is associated with a patent ductus arteriosus?
Answer: Rubella.
Rubella
What is the most common congenital heart defect?
VSD
What is Eisenmenger syndrome?
It occurs when the pulmonary pressure becomes so high that it causes a reversal of blood shunting to right to left, leading to cyanosis in an acyanotic heart disease.
What is Jaccoud arthropathy?
A rare late manifestation of rheumatic fever involving painless loosening and lengthening of the joints in the hands and feet.
What are the symptoms of subacute infective endocarditis?
Fatigue, decreased exercise tolerance, weight loss, arthralgias, and diaphoresis.
What form of vitamin D is best to determine serum concentrations?
25-hydroxyvitamin D (25OHD), due to its half-life of 2 to 3 weeks and decreased susceptibility to fluctuations by parathyroid hormone concentration.
What is the term for the surgical management of pyloric stenosis?
Ramstedt pyloromyotomy.
Patient more likely to be a boy or have Down Syndrome
With a history of delayed meconium passage
Diagnosis is made by rectal biopsy
Most commonly caused by an absence of ganglion cells in the submucosal and myenteric plexus
Hirschsprung Disease
Which acid and base abnormality is most common in children with diarrhea?
Metabolic acidosis because of the bicarbonate lost in stool.
What is a common physical exam finding for patients with intussusception?
A sausage-shaped mass to the right upper quadrant.
Patient will be 2–8 weeks of age
Complaining of nonbilious projectile vomiting after feeding and early satiety
PE will show RUQ olive-like mass (hypertrophied pylorus)
Labs will show hypochloremic hypokalemic metabolic alkalosis
Diagnosis is made by ultrasound or UGI series (string sign)
Treatment is surgical
Pyloric Stenosis
Which condition is defined by dilated veins of the pampiniform plexus of the spermatic cord?
Varicocele.
What is the pathophysiology for Hirschsprung disease?
Absence of enteric ganglion cells, which leads to functional intestinal obstruction.
