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.
Patient will be a child 6 months to 3 years old
Colicky abdominal pain, vomiting, and bloody stools (currant jelly)
Diagnosis is made by ultrasound (target sign)
Most common cause is idiopathic
Although less common, it is important to be vigilant for pathologic lead points in children of any age
Treatment is air or hydrostatic (contrast or saline) enema
intussusception (Telescoping Bowel)
PE will show signs of liver failure (asterix, jaundice, mental status changes), Kayser-Fleischer rings in the cornea (pathognomonic)
Labs will show decreased serum ceruloplasmin
Most commonly caused by autosomal recessive disorder involving a defect in a copper transporting protein and is linked to chromosome 13
Treatment is dietary copper restriction, penicillamine (a copper chelator) + pyridoxime
Wilson Disease
What is the genetic inheritance pattern of Wilson disease?
Autosomal recessive
What is the whirlpool sign?
A sign diagnostic of volvulus secondary to twisting of the mesentery around the mesenteric pedicle base
By which mode of inheritance is Gilbert syndrome passed down?
Autosomal recessive.
Patient will be complaining of intermittent yellowing of the eyes
Labs will show a transient rise in unconjugated bilirubin
Most commonly caused by an inherited deficiency in uridine diphosphate glucuronosyltransferase (UGT)
Treatment is supportive care and reassurance
Gilbert Syndrome
What stool test can be used to rule out inflammatory bowel disease?
Fecal calprotectin.
Diagnosis is usually clinical, lactose tolerance test, lactose breath hydrogen test
Most commonly caused by a genetic condition or 2° to underlying conditions
Treatment is lactose restriction, calcium, vitamin D
Lactose Intolerance
Common in infants four months - one year of age
Most managed conservatively
Thickening feeds, avoiding overfeeding, continuing breastfeeding
Failure with conservative therapy
Trial of a protein hydrolysate or amino acid based based formula or, in breastfed infants, elimination of cow’s milk from the mother’s diet
Trial of proton pump inhibitor
Consider pediatric GI referral
Gastroesophageal Reflux - Pediatric
What is the recommended treatment duration for infants with severe esophagitis on endoscopic biopsy?
3–6 months.
What are some of the most common complications postappendectomy?
Wound infection, intra-abdominal abscess, constipation, paralytic ileus, intussusception, small bowel obstruction, and stump appendicitis.
Patient presents with fever, pain that began periumbilical then moved to RLQ, nausea, and anorexia
PE will show psoas sign (RLQ pain on extension of right hip), obturator sign (RLQ pain on internal rotation of flexed right hip), Rovsing sign (RLQ pain when the LLQ is palpated)
Diagnosis is made by CT (adults), ultrasound (pediatric or pregnant patients), MRI (pregnant patients with nondiagnostic ultrasound)
Most commonly caused by fecolith
Treatment is surgery, in some case Abx
Appendicitis
What laboratory findings are common in pyloric stenosis?
Hypochloremia and metabolic alkalosis.
Hypokalemia
Which two organs are responsible for converting vitamin D into calcitriol?
The liver and kidneys.
Which pathogen that frequently causes gastroenteritis in children can be vaccinated against?
Rotavirus
Patient will be complaining of frequent loose stools, with or without fever and vomiting, lasting from one day to two weeks
Most commonly caused by a viral pathogen
Treatment is supportive care
Gastroenteritis
What is the term used to describe short-term administration of high-dose vitamin D for patients who cannot adhere to oral therapy?
Stoss therapy.
What is the most useful laboratory test to assess the degree of dehydration in children?
Serum bicarbonate
Which syndrome is characterized by the presence of infantile hypertrophic pyloric stenosis and hyperbilirubinemia?
Icteropyloric syndrome.
What vitamin deficiency is associated with the use of isoniazid?
Vitamin B6 (pyridoxine).
Patient presents with diarrhea, steatorrhea, flatulence, weight loss, weakness, and abdominal distension
Labs will show IgA antiendomysial (EMA) and anti-tissue transglutaminase (anti-tTG) antibodies
Diagnosis is made by small bowel biopsy
Treatment is gluten-free diet
Associated with dermatitis herpetiformis (chronic, very itchy skin rash made up of bumps and blisters)
Celiac Disease
What is the dermatologic manifestation of inflammatory bowel disease that is characterized by multiple painful red nodules commonly found on the shins?
Erythema nodosum
Patient will be a newborn within the first day of life
PE will show recurrent bilious vomiting without abdominal distention
Plain radiograph will show “double-bubble” sign
Most commonly caused by a congenital malformation
Treatment is surgical repair
Comments: associated with Down syndrome
Duodenal Atresia
How is Hirschsprung disease diagnosed?
Rectal biopsy.
What are the contraindications to using ceftriaxone in neonates?
Infants with clinically significant hyperbilirubinemia and infants who are receiving intravenous calcium
True or false: the risk of sudden infant death syndrome increases when infants sleep in car safety seats while not in the car.
True.
What is the starting dose of ethosuximide for treating absence seizures in children younger than 6 years old?
5 to 10 mg/kg/day in two divided doses.
Patient will be a child 5–10 years old
Sudden mental status alteration without motor activity, blank stare
EEG would show symmetric 3 Hz spike and wave activity
Treatment is ethosuximide
No aura or postictal state
Absence Seizures (petit mal)
True or false: recurrent febrile seizures increase the risk of future epilepsy
False. Febrile seizures are benign and do not increase the risk of epilepsy in adulthood.
Age: 6 mos to 5 yrs Simple: Number of seizures: 1 Duration: < 15 mins Type: generalized Complex: Number of seizures: > 1 seizure in 24 hrs Duration: > 15 mins Type: focal or generalized Simple: no further workup, reassurance Complex: further workup depending on age and clinical picture
Febrile Seizure
True or false: car safety seats are an appropriate place for infants to nap while at home.
False, sleeping in car safety seats is not recommended outside of the car.
What are the five levels of alertness in infants?
Quiet sleep, active sleep, awake or drowsy, alert, and crying.
What portions of the meninges are affected in meningitis?
The arachnoid mater and the cerebrospinal fluid in the subarachnoid space and cerebral ventricles
What condition is the Cobb angle used to evaluate?
Scoliosis.
PE will show short stature, webbed neck, and delayed secondary sexual characteristics and menstruation
Labs will show 45,X on karyotype
Diagnosis is made by karyotype analysis
Management may include recombinant human growth hormone and/or oxandrolone
Turner syndrome
True or false: the height and weight of twins are less than singletons on average at 12 months of age
True. On average, the height and weight of twins are lower until 30 months of age.
What is Todd paralysis?
The presence of focal weakness after seizure activity, typically lasting up to 24 hours.
What medications can be used in patients with ongoing seizures despite use of first- and second-line therapies?
Midazolam, propofol, or pentobarbital.
Which developmental reflexes should have resolved by age 4 months?
Galant reflex, asymmetric tonic neck reflex, and rooting
Brushfield spots (small, white or grayish/brown spots on the periphery of the iris) Developmental delay Heart defects Large tongue Poor muscle tone Sandal toe deformity Single palmar crease Upward slanting eyes
Down Syndrome (Trisomy 21)
Which congenital heart defect is most common in patients with Down syndrome?
Complete atrioventricular septal defect.
Which class of medications should be avoided within 5 weeks of discontinuing fluoxetine?
Monoamine oxidase inhibitors.
What gastrointestinal complication of recurrent forceful vomiting presents with bright red blood in addition to gastric contents?
Mallory-Weiss syndrome.
Patient with a history of binge eating followed by purging via forced vomiting, purging via laxative misuse, driven exercise, or fasting
PE will show dental erosions and callused knuckles
Diagnosis requires at least one episode of binge eating with inappropriate compensatory behavior per week for a minimum of 3 months in a patient whose self-evaluation is unduly influenced by body shape or weight
Treatment is cognitive behavioral therapy, SSRIs, or both
Bulimia Nervosa
What disorder is characterized by at least 2 weeks of a major depressive episode and at least one hypomanic episode?
Bipolar 2 disorder
What portion of children with oppositional defiant disorder progress to conduct disorder?
Approximately one-third.
Which patients warrant inpatient nutritional rehabilitation and medical stabilization?
hose who weigh less than 75% of their ideal body weight or have a body mass index < 15 to 16 kg/m2.
Three core features Restriction of energy intake relative to requirements leads to significantly low body weight Intense fear of gaining weight or persistent behavior interfering with weight gain Disturbance in body image Two types Restricting Binge-eating and purging type Recommended interventions Determination of setting Medical stabilization Nutritional rehabilitation Psychotherapy For youth, best evidence is for family-based therapy, including parental management of ongoing weight restoration
Anorexia Nervosa
True or false: sensitivity is more important than specificity in screening tools designed to identify early signs of autism spectrum disorder.
True. A false-positive with repeat normal screening is favorable to children with false-negative initial testing and therefore delayed diagnosis.
atient with a family history of similar symptoms
Complaining of hearing loss, easy bruisability, or multiple fractures
PE will show blue sclera, increased laxity of joints and skin, short stature, scoliosis, basilar skull deformities
Most commonly caused by autosomal dominant mutation in collagen
Osteogenesis Imperfecta (Brittle Bone Disease)
What are some treatments for osteogenesis imperfecta?
Bisphosphonates, especially pamidronate, are commonly used off-label for treatment and have been shown to increase bone mineralization and decrease the rate of fractures. Surgery is indicated to prevent or correct deformities.
Evaluate BMI percentile Overweight: BMI 85-94% Obese: BMI ≥ 95% Offer healthy eating guidelines Encourage exercise Monitor sleeping patterns Limit screen time
Obesity
What is the body mass index percentile that describes a condition of being underweight?
< 5th percentile for age and sex.
What are the most common pharmacologic agents used during a growth hormone stimulation test?
Clonidine, arginine, and glucagon.
Most common cause: pituitary tumor ↓ Muscle mass ↓ Bone density ↑ Lipids ↓ Memory ↓ IGF-1
Growth Hormone Deficiency
What genetic disorder is often associated with hypothyroidism?
Trisomy 21.
What medication is administered during pregnancy if congenital adrenal hyperplasia is discovered during the prenatal period?
Dexamethasone
Patient will have new onset type 1 DM, or known type 1 or type 2 DM with precipitating factors: infection, nonadherence to insulin therapy, MI, cocaine, SGLT2 inhibitors
Sx: abdominal pain, vomiting, fruity-odor breath, mental status and neurologic changes
Dx: glucose > 250 mg/dL, anion-gap metabolic acidosis, positive urine and plasma ketones
Tx
Treat precipitating cause
Correct volume depletion with NS, add dextrose to fluids once glucose is < 250 mg/dL
Replete K+ deficit (usually falsely elevated), do not start insulin if K+ < 3.3 mEq/L
IV insulin drip until anion gap closes
Subcutaneous insulin 2 hours prior to stopping IV insulin
DKA
Anion gap calculation
anion gap = serum sodium − (serum chloride + bicarbonate).
What therapeutics are used for chelation therapy?
Succimer, calcium disodium edetate, or penicillamine.
What anatomic structure must be excluded from the differential diagnosis in a child with an anterior mediastinal mass?
The thymus, which reaches maximal size at age 10.
Patient will be complaining of lymphadenopathy (often cervical and painless), pruritus, fever, night sweats, unintentional weight loss, and frequent infections
Diagnosis is made by lymph node biopsy showing Reed-Sternberg cells
Hodgkin Lymphoma
Patient will be an adult
Fever, fatigue, anemia, easy bruising or bleeding, petechiae, bone and joint pain, and persistent or frequent infections
PE will show hepatosplenomegaly
Labs will show Auer rods, normocytic, normochromic anemia, blast cells
Acute Myeloid Leukemia (AML)
Which leukemia is associated with smudge cells on the peripheral smear?
Chronic lymphocytic leukemia.
True or false: the intramuscular influenza vaccine is contraindicated in children undergoing chemotherapy.
False. Intranasal influenza vaccination should be avoided during chemotherapy, as it is a live virus.
Patient will be a child
Limping, bone pain, fever, and lymphadenopathy
PE will show hepatosplenomegaly
Labs will show anemia, thrombocytopenia, and lymphoblasts on peripheral smear
Most common acute leukemia in children
Children with Down syndrome are at a higher risk
Acute Lymphocytic Leukemia (ALL)
What is the recommended dosage of ferrous sulfate when treating children with iron deficiency anemia?
3 mg/kg once daily.
atient will be complaining of weakness, dizziness, and fatigue
PE will show pallor, tachycardia, atrophic glossitis or koilonychia (spoon nails)
Labs will show microcytic, hypochromic red blood cells. Decreased serum iron level, an increase in the total iron binding capacity (TIBC), and decreased serum ferritin levels
Comments: the most common cause of microcytic anemia
IDA
What gene is affected in patients with cystic fibrosis?
The cystic fibrosis transmembrane conductance regulator (CFTR) gene.
What conditions are associated with encopresis without constipation according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)?
Oppositional defiant disorder and conduct disorder.
What is the pathogenesis of infertility in men with cystic fibrosis?
Patients with cystic fibrosis are missing the vas deferens bilaterally, which results in obstructive azoospermia and infertility.
Which disease caused by Epstein-Barr virus presents with white patches on the sides of the tongue that cannot be scraped off?
Oral hairy leukoplakia.
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
What species is the most common cause of tinea capitis in the United States?
Trichophyton tonsurans.
Trichophyton tonsurans > Microsporum canis Prepubertal children Pruritic, scaly, hair loss Kerion, favus with scutula Tx: griseofulvin or terbinafine
Tinea Capitis
Patient will be complaining of a rash
PE will show an erythematous, scaly plaque that is annular, has raised edges, sharply marginated, with a central clearing
Diagnosis is confirmed by KOH preparation of skin scrapings
Most commonly caused by dermatophyte
Treatment is topical antifungal clotrimazole
Tinea Corporis (Ring Worm)
What differential diagnosis of Kawasaki disease also presents with a strawberry tongue and has a sandpaper-like rash?
Scarlet fever.
Patient will be complaining of hypopigmented areas that do not tan
PE will show scaly patches on the chest and trunk
Diagnosis is made by KOH preparation of skin scraping
Most commonly caused by Malassezia species (ie Malassezia furfur)
Treatment is topical selenium sulfide
Tinea Versicolor
Patient with a history of a larger lesion one week prior, herald patch
Complaining of rash on the back
PE will show diffuse papulosquamous rash on the trunk, Christmas tree-like distribution
Treatment is self-limiting disease, topical corticosteroids or oral antihistamines for itching
Pityriasis Rosea
What ear condition was historically associated with Mycoplasma pneumoniae infection?
Bullous myringitis.
PE will show pitting edema
Labs will show proteinuria > 3.5 g/24 hr, hyperlipidemia, hypercoagulability (renal vein thrombosis), fatty casts
Comments:
Minimal change disease: children, preceded by URI, rx: steroids
Focal segmental glomerulosclerosis: HIV/IVDA, end stage kidney disease
Membranous nephropathy: HBV, HCV, SLE, gold, penicillamine, malignancy
Nephrotic Syndrome
