Peds Syllabus Flashcards
What are the absolute c/i for breast feeding
What two pediatric metabolic d/os are c/i for breast feeding
? is the MC type of abuse, ? is the down side to this MC, and what are the 3 forms
Antineoplastic/ImmSupp agents HIV TB Varicella H1N1 HSV on breast Alcohol: limit <0.5mg/day Radiopharmaceutical PCP Amphetamine Cocaine
Galactosemia, Phenylketonuria
Neglect- failure to provide for child’s needs;
Hardest to document/prove;
Physical Medical Emotional
How does Pt w/ neglect abuse present to clinic
What are 6 indicators neglect is occurring
? is the MC form of emotional abuse but this form also includes ? form of abuse
Type 1 growth deficiency: normal length/head, low weight
Begging/stealing food Assuming adult role Self-destructive behavior States no adult at home Inattentive adult Fatigue
Verbal- witnessing abuse
How is lice Tx first/second line
Launder anything worn/slept on in past ? long and how are items non-washable Tx
How are brush/combs cleaned
1st: Permethrin 1% 2nd, resistant: Mathalion 0.5% Ivermectin 0.5% Benzoyl 5% Spinosad 0.9% Retreat in 9-10 days since eggs can survie
Past 2days;
Air tight bag x 2wks
Detergent/rubbing alcohol soak x 1hr
How does scabies infection start
How can it present in infants
How can it present differently in adolescents
Sarcoptes burrows into dermis, lays eggs and dies, eggs hatch 3-4d
Sxs 3-4wks after infestation w/ bullae, pustules, eczematous eruption on neck/higher w/out burrows
Head, neck, palms spared
What causes Molluscum Contagiosum and how does this present
Where is the MC and rarely found on body
How is it Tx
Poxvirus in epithelial cells= smooth, dome shaped papule w/ central umbillication
MC: neck, axilla, thigh
Rare: face, periocular
Self-resolves in 6-9mon;
Extensive- cryo, Cantharidin 0.9% not face
Avoid sharing baths/towels
MC complication from measles
Two rare but possible outcomes
When is the MMR vaccine given
Otitis media
Encephalomyelitis, Sclerosing panencephalitis
12-15mon, 4-6yrs
Combo w/ MMRV at 4-6y/o only d/t febrile seizure risk
Post-exposure prophylaxis for measles
German Measles is AKA ? and causes ? in kids
IFetus acquires transplacental Abs and is protected x ? long
<72hrs: Vaccine
<6d: Immunoglobulin
Rubella; exanthematous dz in Peds; Blueberry muffin babies
First 6mon
Rubella microbe is sensitive to ? but stable in ? environment
How does virus cause infection
How is this passed/how long are Pts infectious
Heat, UV, pH; Stable: cold
Invades respiratory epithelium, spreads to nodes
Direct/droplet contact w/ secretions;
2d before and up to 7d after rash onset (virus found in secretions 7d before, 14d after rash)
When is Rubella Congenital infections the highest
How does post-natal infection present
What does this rash look like and present as
1st trimester, rare after 16wks
2-3wk incubation, mild prodrome w/ occipital, auricular, anterior cervical adenopathy
Face/neck to torso and fades w/ migration, lasts 3d
What spots may be seen during Rubella infections
What are 3 possible complications that can arise
How is this Dx confirmed
Forchheimer- rose colored petechiae in oropharynx
Thrombocytopenia Encephalitis Arthritis
Serological IgM or IgG w/ 4x increase
What are the adverse outcomes for Blueberry Muffin Babies
How long are these Pts infectious
How is post-exposure prophylaxis managed
Deaf Cataract Congenital heart dz
Secrete virus in secretions x12mon
Live vaccine <3d of exposure unless;
ImmSupp/Comp, Pregnant, Immunoblobulin <11mon
Roseola Infantum can AKA ? three names
What virus causes this
How is this infection spread
Exanthem Subitum; fever that precedes rash; 6th Dz
HHV 6/7
Salivary/Respiratory droplets of ASx adults/infants
How does Roseola present
What type of rash is present
? rare presentation can occur in 12-15mon old Pts
Abrupt onset of high fever x 3-5d
Maculopapular, rose colored AFTER fever resolves, move from trunk, to face, to extremities
Febrile seizures
How is Roseola Dx
How is it Tx if Pt is ImmComp
Two rare but possible complications
Viral culture- gold standard
Ganciclovir w/ hydration and antipyretics
Encephalitis
Virus associated hemophagocytosis syndrome
What is 5th Disease AKA and what causes this
Although an overall benign viral exanthema for healthy Pts, this microbe has a high affinity for ? part of the body that can cause ?
This microbe has the greatest overall risk to ? Pts and can cause ?
Erythema Infectiosum; Parvovirus B19
RBC progenitor cells;
Aplastic crisis/hemolytic anemia
2nd Trimester pregnancy:
HF Anemia Hydrops
How is 5ths Dz transmitted
How long does this incubate for and how does it present
When/How does the rash appear for this infection
Respiratory secretions
Blood product transfusions
4-14 days; HA w/ URI Sxs
7-10d later in three stages:
1: slapped cheek w/ circumoral pallor
2: erythematous, maculopapular trunk rash
3: central clearing leaving reticulated, lacy and pruritic rash w/out desquamation and spares palms/soles
How is Varicella transmitted
Where does the virus replicated and for how long
When are Pts infectious and when are they considered non-infectious
Airborne
Contact w/ conjunctiva or respiratory tract
Nasopharynx, Upper respiratory tract x 14-16d
2d before through 7d after rash
Once all lesions crusted= non-infectious
MC and 2nd MCC of fever/meningitis in infants
What are the 3 causes of pneumonia is 0-1mon olds
What is the MCC of early onset neonatal sepsis
1st: E Coli; 2nd: GBS
GBS, EColi, Strep pneumo
GBS
What causes Rheumatic Fever
This can affect all valves but ?
What lab is drawn for Dx using ? criteria
GABHS 2-6wks prior- Abs cross react w/ cardiac Ags causing damage/scars
Tricuspid
Anti-streptolysin O titer; strep Ab test;
Revised Jones w/ 2 major or 1 major and two minor
What are the Major Jones Criteria
What are the Minor Jones Criteria
Carditis Polyarthritis Sydenhames chorea Erythema marginatum Nodules, subcutaneous
Prolonged PR/heart block Arthralgia Fever inc ESR/CRP Leukocytosis Prior Hx of RF/RHDz
How is Rheumatic Fever Tx
What is added to Tx if severe carditis is present
What is done for long term Tx
Cards consult
ABX: Benzathin PCN G or PO Amoxicillin
PCN allergy: Erythromcyin
Salicylates: ASA, NSAID as alternative
PO CCS
PCN prophylaxis w/ PCN-G 1.2M units q28d
If myocardial/valvular defects- lifelong prophylaxis
Impetigo is a possible mild complication from ? Dz process
Secondary Impetigo is MC caused by ? two microbes and is Tx w/ ?
How does Impetigo appear on PE
Varicella
MC: Staph A, then GAS
Tx: Topical mupirocin
Wide/Generalized lesions: PO 1st gen cephalosporin (Cephalexin)
Single erythematous papulovesicle w/ honey colored crust MC on face or extremity
Exanthem numbering of Dzs
What causes Scarlet Fever
How does the rash present
1st: Measles (Rubeola)
2nd: Scarlet
3rd: German measles (Rubella)
4th: Staphylococcal
5th: Erythema infectiosum
6th: Roseola
GAS pharyngitis
24-48hrs later w/ rash on neck, spreads to extremities;
Finely papular, erythematous eruption feeling like sandpaper, that blanches w/ pressure and leads to desquamation in 3-4days
Scarlet fever can have ? presentation mimicking Kawasaki’s and how are they differentiated
Scarlet fever is a potential systemic complication from ? Dx
Strep pharyngitis is uncommon prior to ? age and most importantly w/out ? Sx
Strawberry tongue: GAS isolated from pharynx
Pharyngitis/Tonsillitis
<3y/o; no cough
MCC of pharyngitis is ? two microbes
Define the criteria used for Dx
How do the criteria score direct Tx
EBV, CMV
Modified Centor: Fever >100.4 Adenopathy Cough, none Exudate Age 45/>, subtract one point
0: Tx as viral
1-3: culture or rapid; ABX if pos
4-5: probable, culture and empiric Tx
How is pharyngitis Tx
How is this Tx if Pt is allergic to primary medications
Three possible local complications that can occur from pharyngitis/tonsillitis
Amoxicillin 50mg/kg QD x 10days
PO PCN V 10mg/kg BID/TID x 10 days
Benzathing PCN x 1 IM dose
PCN: Cephalexin, Cefadroxil, Clinda x 10days
B-lactam: Azith/Eryth-romycin x 10days
Sinusitis AOM Peritonsilar abscess
What are the possible systemic complications to arise from pharyngitis/tonsillitis
When is Pertussis vaccine given
How is this infection passed and where does it live in the body
TSS Rheumatic Fever Scarlet fever Post-strep glomerulonephritis PANDAS- basal ganglia infection causing OCD/tics
5 DTaP doses at 2, 4, 6mon and 4-6yrs
1 TDaP dose 11-12y/o
Aersolized droplet to pharynx, larynx, peribronchials
What would be seen on CXR in Pt w/ pertussis
? Pertussis variant may be seen as a milder illness and is not prevented by vaccine
How is Pertussis Tx
Segmental atelectasis w/ perihilar infiltrates
Bordatella prapertussis
<3mon: admit
All other age group/post-exposure: Azithromycin
Alternative if >2mon old: TMP-SMX
Why is Clar/Ery-thromycin no preferred when Tx Pertussis in Pts <1mon
Under immunized close contacts are Tx how
MC complication to arise from this Dz
Inc association w/ Infantile hypertrophic pyloric stenosis
<7y/o: DTaP booster
7-10y/o: Tdap booster
Pneumonia
Infants w/ fever and bacteremia have higher risk for infection and death if done by ? organisms
How many serogroups of N Meningitidis are covered by ? vaccine
Which serogroups are more common in different locations
Encapsulated: HIB Nmeningitidis Streppnemoa (same w/ Sickle Pts)
A B C X Y W-135- MCV4
A: Africa; B: USA
What can cause pneumonia in children >5y/o
Post-infectious autoimmune peripheral neuropathy occurs after ?
? is a common and most frequently ID’d pathogen of meningitis
Mycoplasma/Strep/Chlamydophyla pneumoniae
10d after respiratory/GI infection of M pneumoniae or Campybacter jejuni
Strep pneumoniae
What two populations are at higher risk for meningitis from Strep Pneumo
What complication can be seen after meningitis d/t Strep Pneumo
Why is this cause of meningitis feared
Functional asplenia from Sickle Cell
HIV
Subdural effusion- drained only if ICP/focal neuro signs
Highest Peds mortality rate from bacterial meningitis
HIB vaccine reduces Pts risk for ? two Dxs
? medical emergency can occur w/out this vaccine
What other microbes can cause this emergency
Meningitis, Epiglottitis
Epiglottitis- risk of airway obstruction
Vacc: GAS, Staph A,
Unvacc: HIB, Diphtheria
Secondary infections from Pertussis can occur if infected w/ ? three microbes
? population require the HIB vaccine to reduce sepsis risk
C. Trachomatis can cause ? neonatal eye infection that presents how and Tx w/ ?
Strep pneumo
HIB
Staph A
Asplenic w/ PCN prophylaxis along w/ Pneumococcal vaccine
Sickle Cell
Ophthalmia neonatorium on day 4-19; Tx w/ PO Erythromycin x 14days
Define Conduct D/o
What type of behaviors may be seen
Opposition/Conduct D/os are screened for using ? tool
Frequent and persistent behavior that violates basic right/society norms
Destruction of property
Aggression to people/animals
Deceit/theft
Serious rule violations
Vanderbilt
Although not FDA approved, ? meds may be used for Opposition/Conduct d/os
What types of Sxs are boys/girls w/ ADHD likely to show
Most Sxs will persist into adulthood, especially ?
Stimulants/Atypical antipsychotics
B: hyper/impulsive or combo
G: inattentive
Impulsivity, Inattention
? is at the core of ADHD Tx w/ ? as the first line agent
What meds may be used
What are two PE findings suggestive of an eating d/o
Core: behavior management
First: Methyphenidate, Amphetamine
SNRI: Atomoxetine
AAgonist: Clonidine, Guanfacine
Lanugo, Knuckle calluses
Define Nephroblastoma and the two MC stats it holds
This growth originates from ? and is associated w/ ? other abnormalities
? syndrome is at increased risk for developing a nephroblastoma
Wilms Tumor; presents as ASx abdominal mass
MC primary malignant renal tumor of childhood
2nd MC malignant abdominal tumor of childhood (1st- neuroblastoma)
Kidney;
WAGR- Wilms, Aniridia, GU malformation, Range of developmental delays
Beckwith-Wiedemann along w/ omphalocele
? stats does Lymphoma have
Although an unknown etiology, ? association may be present
What are the two types
MC in 15-19y/o
3rd MC malignancy <14y/o
EBV
NHL- incidence increases w/ age in Caucasian males
HL- MC lymphoma w/ bimodal peaks: 15-35, >50
Stats of NHL
This form almost always appears as ?
What are the subtypes
Incidence increases w/ age and more often in Caucasian males
Diffuse, highly malignant and w/ little differentiation
B-cell (Burkitt/Small noncleaved cell)- Sporadic in USA or Endemic in Africa d/t EBV
T-cell- lymphoblastic
Large- either T/B cell
What lab result makes lymphoma Dx reclassified to something else
How is Lymphoma Tx
? population is 10-20x higher risk for developing leukemia and ? population has a higher unvaccinated mortality rate
Bone marrow w/ 25% or more blasts= acute leukemia
HL- low dose chemo and field radiation
NHL- aggressive chemo, rarely surgery/radiation
Down Syndrome; Varicella
Collectively, ? is the MC malignancy in childhood and adolescence
Leukemia holds ? MC stat
What 5 inherrited syndromes are at increased risk for CNS tumors
CNS tumors
MC childhood Ca
NF Li-Fraumeni Syndrome TB Turcot syndrome Von Hippel Lindau Syndrome
? genetic conditions are more susceptible to leukemia
Ages 0-3 are more susceptible to ? type
What are the sub-types of leukemia
Downs, Fanconi anemia, NF
Downes Pts AML > ALL
ALL- more common in males 2-3y/o
AML- MC in neonates then late adolescents
CML
JMML
Common Sxs for leukemia
Common PE findings
What lab findings will be seen and aid w/ Dx
Lethargy Anorexia Malaise Pallor Fever Ortho pain
Hepatosplenomegaly
Ecchymoses
Adenopathy
Petechie
WBC >50K
Peripheral smear/marrow aspirate w/ immature blast cells
Anemia
Thrombocytopenia
How often Dx w/ Transient Myeloproliferative D/o f/u w/
How is a Dx of leukemia definitively made
What two translocations may be seen in ALL
q3mon w/ PE, CBC, blood smear in effort to catch early leukemia
Cytogenetic analysis- evals cell surface markers
t 12;21- MC and favorable prognosis
t 9;22- less common, poor prognosis
Define Henoch-Schonlein Purpura
This is usually seen in ? time and characterized by ?
Vasculitis of unknown etiology and is MC systemic vasculitis in childhood, most <6y/o
In winter after URI; Leukocytic infilatration Hemorrhage Ischemia Glomerulonephritis d/t IgA deposition
? is the MC childhood bleeding d/o
How does this MC present
What is the suspected etiology
ITP
1-4wks post-viral infection w/ abrupt onset petechiae, purpura and epistaxis
Anti-platelet IgG/IgM binding to platelet membrane causing spenic destruction of platelets
What lab results will be seen w/ ITP
What results would be seen after marrow biopsy
How is this Tx
Severe thrombocytopenia
Normal WBC, RBC, Peripheral smear, PT/PTT
Inc megakaryocytes
Normal erythroid, myeloid elements
Platelets >30K- monitor, most resolve <6mon
Platelets <10K: IVIG, Pred, Splenectomy if life threatening bleeds
Chronic ITP lasting longer than ? time needs ? secondary causes r/o
What is the only definitive Tx for these Pts
Hemophilia is linked to ? part of genetic make up and what are the two types
6mon or more; SLE, HIV
Splenectomy
X-linked;
A- factor 8 deficient
B- factor 9 deficient
If severe, how does hemophilia present
What coagulation study is used for Dx
How is the Dx confirmed
1st year of life w/ bleeding, hemarthrosis
Prolonged PTT that corrects when mixed w/ serum
Factor assay
How is Hemophilia Tx
? is the MC congenital bleeding d/o
This MC is lacking and element, ? is it’s normal function
Desmopressin (DDAVP)- inc Factor 8 and vWF production, no effect on Factor 9
Von Willebrand Dz- deficiency in quantity/function of vWF
Bridges platelets w/ collagen and protects Factor 8 from clearance
What are the 3 sub-types of Von Willebrand Dz
What lab work is ordered
How are they Tx
1- dec production of vWF, autosomal dominant and MC
2- normal production, defective vWF (dysproteinemia)
3- no production at all; rare
vWF quantity is measured then,
Function measured w/ Ristocetin
DDAVp for Type 1 and 2
vWF concentrate for Type 3
Sickle Cell and Thalassemias are ? category of hemolytic anemias
Define Thalassemia
What is the make up of a normal Hgb molecule
Intrinsic
Insufficient production of normal Hgb d/t dec production of A/B globin components
a2b2;
4a genes encode for 4a proteins
2b genes encode for 2b proteins
Sickle Cell Dz is d/t an abnormality located ?
Define Sickle Cell Anemia
Define Sickle Cell Dz
B-chain (HbS)
HbSS homozygous- HbS is 90% of total Hgb
HbS is >50% of Hgb
Define Aplastic Anemia
What drugs can cause this
What toxin can cause this
What infections can cause this
Macrocytic anemia most often d/t idiopathic cause
Felbamate, Chloramphenicol
Benzene
Mono, hepatitis
How long are Fe Deficient Anemia Pts Tx prior to f/u
Why is this timeframe needed
How is this prevented
When are screenings started
3mon
1-3mon to replete stores and is reflection of true effectiveness
Bottle fed infants= Fe formula
Breastfed infant- Fe supplements at 4mon
6mon= Fe solid foods
12mon= <24oz cow milk/day
12mon
? is the most sensitive test for thyroid function
What is the MCC for this MC to be elevated in Pts under Tx
? thyroid function tests is best for kids
TSH
Non-compliance
Free T4 and TSH d/t high incidence of secondary hypothyroid
? thyroid PE finding needs imaging and ? does this finding suggest
What are the two types of Congenital Hypothyroidism
What are the thyroid hormone crucial for
Nodular goiter- inborn error of metabolism (iodide use/thyroid hormone synthesis) or transplacental passage of anti-thyroid drugs (methimazole, popylthiouracil)
Primary: MC d/t dysgenesis
Secondary: pituitary/hypothalamic etiology
Tissue maturation/differentiation
How is Congenital Hypothyroidism Tx and if started in ? time frame is best for intellectual development
? is the MCC of Acquired Hypothyroidism
What is often a first but missed first sign
Levothyroxine in first month of life
Hashimotos; AKA Chronic Lymphocytic Thyroiditis
Slow linear/height growth
What lab results must be seen in Hashimotos Thyroiditis for a Dx
How are these Pts managed
Why is PTU not recommended for hyperthyroid Tx in PEds
Thyroid Ab
Consult Endo:
Hypo: Levothyroxine
Euthyroid w/ +Abs: f/u labs q6mon, Levo
Hyper- Propranolol, Methimazole; Reassess TSH q6-8wks
Liver Ca risk
? is the MCC of Pediatric Hyperthyroidism
This is caught d/t many Pts being referred for ? issue
What will lab results show
Graves
ADHD
Low TSH, Inc FT4, T3
What causes CAH
How does this present in M/F
21-OH deficiency w/ most being salt wasters
F: ambiguous genitals w/ elevated androgens
M: normal genitals but
a) salt loser- adrenal crisis at 2wks of age
b) non-loser w/ 6mon androgen s/e but no testicular enlargement
Define Cushing Syndrome and Dz
What does this lead to
How is Syndrome Dx
Syn: Exogenous glucocorticoids d/t meds
Dz: pituitary adenoma
ACTH secreting microadenoma in pituitary= Cushing Dz
24hr cortisol
Low dexamethasone suppression test
High dexamethasone suppression- differentiates Dx/syndrome
Late evening salivary cortisol
How is Cushing Syndrome Tx based on cause
Define Addison’s Dz
How will Pts present
Endogenous- remove ACTH secreting tumor
Primary Adrenal Insufficiency d/t absence of gluco/mineral-corticoids
Hyperpigmentation
Salt craving
Postural hypotnsion
Fasting hypoglycemia
What lab results may be seen w/ Addisons Dz
How are these Pts Tx
Define Primary Amenorrhea
HypoNa HyperK Inc renin
Hydrocortisone
Stress dose= 3x/day
Mineralcorticoid deficient= Fludrocortisone
No menses by 16y/o w/ 2* characteristics
No menses by 14y/o w/ NO 2* characteristics
What is the MCC of Primary Amenorrhea
Diabetes is characterized by ? and ?
What are the two types
Premature ovarian insufficiency
Mullerian agenesis
Hyperglycemia and glycosuria
T1: MC in childhood d/t autoimmune destruction of B cells
T2: MC in adulthood d/t obesity
Dx criteria for pre-diabetic
Dx criteria for DM
What is first line therapy for DMT2 Tx and what are the indications to start medical therapy
A1c 5.7-6.4%
8hr fasting 126 or higher or
2hr OGTT of 200 or higher or
A1c 6.5% or higher or
Sxs w/ random glucose of 200 or higher
Metformin;
Fasting >126, Random >200
What are the 4 phases of DMT1
How are these Pts Tx
What FamHx/genetics makes Pts more susceptible
Preclinical
Clinical onset
Transient remission/honeymoon
Established diabetes
Life long insulin
Father > Mother; Twins
? infections may cause DMT1
What are the 3 Ps of DMT1 presentation
How is Type 1/2 differed by Dx
Congenital rubella Enterovirus Mumps
Polydipsia Polyuria Plyphagia
Autoantibody screens
Define DKA
How are Pts Tx
Glucose >300, pH <7.3, BiCarb <15
Admit
10-20ml/kg bolus:
1/2 in <24hrs, 1/2NS w/ K until glucose <300 then switch to D5 for K component
D10% when glucose <200
What happens if DKA glucose is lowered to fast and is the most serious complication
What issue will correct fastest
What should a DM diet compose of
Cerebral edema if >100/hr;
Tx: IV Mannitol, raise HOB, dec IV fluid rate
Hyperglycemia > acidosis
55% carbs, 15% protein, <30% fat
High fiber, <300mg/24hrs cholesterol
Peds HgA1c goal ranges
What glucose ranges are optimal
What are Dawn/Somogyi Phenomenon
<6: 7.5-8.5%
6-13: <8%
13-18: <7.5%
<5: 80-180
School age: 80-150
Adolescent: 70-130
D: inc glucose d/t GH release and dec insulin; inc bedtime insulin
S: counter-regulatory low glucose causing hyperglycemia in AM; Tx w/ lower insulin at bedtime
What are the Sick Day Rules for DMT1
How is sliding scale established
What kinds of insulin can be used and how often
Check for ketones if glucose >240 If on pump- change location, give first correction via injection Check glucose q3hrs Minimum 8oz sugar free fluid/hr 15g carbs /hr
Rule of 1500:
1500/total= amount 1 unit will decrease glucose
Novolog/Humalog q3
Regular q4-6hrs
What are the 3 phases of Kawasakis
What increases the risk for coronary artery aneurysm development during Kawasakis
How is this Tx
Acute: fever, erythema, adenopathy, strawberry tongue
Subacute: desquamation, coronary artery aneurysm
Convalescent: from Sxs resolution until ESR normalizes
Prolonged fever
Inc ESR
<1y/o, >6y.o
Male
IVIG- mainstay and to prevent coronary aneurysms
ASA d/t low risk of Reye syndrome
Define Talipes Equinovarus
? structure is MC affected
? needs to be assessed for and how are Pts managed
Clubfoot, involves entire leg w/ hypoplastic tarsals and limb muscles
Talus- shortened foot
Hip dysplasia; Refer to Ortho
Define Legg-Calve-Perthes Dz
What is a believed association/cause
What is the classic presentation
Idiopathic avascular necrosis of capital epiphysis of femoral head (osteonecrosis) in 7y/o boys
Hypercoagulation d/t Factor 5 Leiden
7y/o boy w/ atraumatic, painless limp x several weeks preventing them from seeking care
? is the MC skin d/o of adolescence and what are the 3 components of its physiology
What are the two types
What type are women likely to get prior to menses
Acne Vulgaris-
Obstructed follicle (hyperkeratosis)
Inc sebum production
P acnes proliferation
Blackhead- open comedome
Whitehead- closed comedome
Stage 1- comedomal
How is acne classified
What are the 4 stages
Mild: Non-inflammatory w/ <10 pap/pust
Mod: 10-40 papule/pustule/comedome
Mod Sev: 40-100 pap/pustule w/ 40-100 comedome
Sev: cystic, pustulr and painful
1- comedomal
2- papular
3- acne
4- nodulocystic
How is acne Tx
What OCPs can be used
Define Erythema Multiforme
1st: retinoids (Tretinoin Adapalene Tazarotene)
Salicylic/Azelaic acid
B peroxide
Erythromycin, Clinda
Triphasic- first FDA approved but equal efficacy to monophasic
Self limiting hypersensitivity syndrome w/ deep red, demarcated macules w/ gray/bullous center (target lesion)
Erythema Multiforme is usually precipitated by ? are triggered by ? infection
What is through to be the cause of autism
What screening method is used
HSV infection; Mycoplasma pneumoniae
Disrupted neural connectivity
M-CHAT-R: Modified Checklist for Autism in Toddlers Revised at 18-24mon;
Two predictive/Three total= refer for eval
(predictive: hearing, finger movement near eye, noise sensitivity)
? is the MC foot d/o in infants and how does it present
How is this MC Dx
How is it Tx
Metatarsus adductus w/ medial deviation of mid/forefoot
Mid-heel bisector line between toe 2-3
V-finger test should not gap at base of 5th MT/styloid
No self resolution x 2yrs- refer to Ortho
MC sites for physeal Fxs
What classification is used
If SCFE occurs in Pts <10 or >16, ? is an appropriate referral
1: distal radius
2: distal tibia
3: distal fibula
SALTR:
Seperated Above Lower Through Rammed
Endo
How are SCFE imaged
What is the earliest sign seen on images
How is this Tx and what are the possible complications
AP, if strong suspicion/Hx- no frog leg view
Physis widening w/out slippage
Immediate non-weight bearing and Ortho referral;
Chondrolysis, Avascular necrosis
What microbe causes Cat Scratch Fever
What Pt populations have increased risk for seizure d/t fever
Febrile seizure is a possible outcome from ? vaccination combo
B Henselae
6mon - 5y/o, especially if w/ epilepsy
MMR + Varicella
? infectious fever can have a febrile seizure
What category are febrile seizures placed in
These are the MC type of seizure in ? population
Roseola
Generalized d/t them beginning diffusely
6mon-5yrs
What are the two categories of febrile seizures
How long is Febrile Status Epilepticus
Simple, tonic-clinic: lasts <15min and only one per 24hrs
Complex/Atypical- lasts >25min, recurs w/in 24hrs or child has pre-existing Neuro issues
> 30min
Define Epilepsy
What are the two types of seizures that can occur w/ this condition
This is not a potential complication that can arise from ? issue
Recurrent, unprovoked seizures
Focal- arise from one region in cortex
Generalized- arise from both hemispheres simultaneously
Febrile seizures
Why is epilepsy a potential complication after a concussion
Epilepsy is one of the cardinal features of ? other Neuro Dx
Epilepsy is a potential co-existing condition along w/ ? genetic Dx
Glial scarring 7d after concussion
Tuberous Sclerosis w/ facial angiofibromas, intellectual delay
Fragile X
What are S/Sxs of Secondary HAs
What are the indications to obtain imaging
What image is ordered
Worse when laying down/first awakening Awakens from sleep Worse w/ cough/valsalva/bending Papilledema Focal neuro deficit (CN6)
Abnormal/Focal neuro deficit
Altered LOC
Chronic, progressive pattern
S/Sx inc ICP
CT, if neg then LP
When are triptans c/i in Peds w/ migraines
When do these Pts need to be referred to Neuro
What may be prescribed by Neuro
Focal neuro deficit w/ migraine
Basilar migraine Sxs (syncope)
> 1 disabling HA/wk
BB TCA Anticonvulsant CCBs Antihistamines
Define Second Impact Syndrome
What are the 6 steps for returning to sports after a concussion
Brain swelling d/t secondary concussion before resolution of first concussion
24hrs per step:
1- physical/mental rest
2- light aerobic exercise w/out resistance
3- sport specific exercise
4- resistance training w/out contact sports
5- full contact practice
6- game
Historically, Cerebral Palsy is ? Dx as ?
What two PE findings may be present
How is an Incarcerated Inguinal hernia seen on PE
Non-progressive but changing motor impairment syndromes; Static encephalopathy
Athetosis, Chorea
Felt w/ valsalva
Painful exam w/ bowel sounds over swelling
What side of the diaphragm is usually involved in diaphragmatic hernia
Herniation MC occurs through ? foramen
How is this condition Tx
L > R w/ opening in posterolateral section
Bochdalek
Intubation
Decompression
Tertiary transfer for surgery
What causes umbilical herniation to occur
What is the common type that forms
These will usually self resolve unless larger than ? size
Intestines fail to completely return to abdomen at week 10 gestation
Ventral: contents covered by SQ tissue/skin
> 2cm
What are the two RFs for an umbilical hernia
When is surgical repair indicated
Umbilical hernias present similarly to ? other Dx
Low birth weight, AfAm
Persists >4y/o, Sxs, Larger after 12mon old
Omphalocele- bowel fails to return into abdomen, covered by peritoneum and amniotic membranes
MCC of Vesicoureteral Reflux
Half of males w/ a Dx of VReflux will have ? malformation
VUR associated UTI/obstructions have increased risk for developing ?
Congenital Ureteovesical Junction incompetence
Posterior urethral valves
Reflux nephropathy
What types of VUR rarely resolve on their own
What is the average age most will self-resolve
What is the goal for Tx
Bilateral 3 or 4-5
6y/o
Prevent pyelonephritis or renal injury
What are the two categories of UTIs
Most infections are caused by ?
What are the RFs for these to occur
Cystitis
Pyelonephritis
Colinic bacteria- Ecoli
Klebsiella Proteus Enterococcus Pseudomonas
<1yr: uncircumcised male
>1yr: healthy girl
Three times incidence of UTIs peak
Cystitis UTIs in males is more commonly caused by ? microbe
? is the MC serious bacterial infection in Pts <24mon old w/ fever without a focus
Infancy
Toilet training
Onset of sexual activity
Adenovirus
Pyelonephritis
What is a rare complication that can occur from pyelonephritis induced UTIs
How are UTIs in this population Dx
What results are indicative of positive Dx
Renal abscess
Catheterization if 2-24mon old or clean catch
UA w/ culture- gold standard, necessary for confirmation and ABX therapy
Bacteria/Pyuria w/ >50K CFU
Leukocyte esterase and nitrite
1K-50K CFUs- repeat culture
How are Peds w/ UTIs Tx
When is re-evaluation warranted
What ABX may be used
> 6mon old: PO ABX
Toxic/dehydrated/NPO: IV Ceftriax/Cefotax/Cefepime
No response x 2d
Cefdinir
Amoxicillin
Nitro- only in afebrile Pts
TMP-SMX
When is imaging warranted for UTIs
Define Hydrocele
What are the two types
First UTI in infancy or non-toilet trained Pt
VCUG if recurrent, febrile UTIs
Fluid collection in tunic vaginalis
Communicate: w/ peritoneal space
Non-communicating: MC; obliterated processus vaginalis
How do hydroceles present on PE
How are these Tx
? is the MCC of intestinal obstructions prior to 3mon of age
Smooth, non-tender and transilluminate
Non-Comm- self resolve by 12mon
Refer if persists past 18mon
Communicating: smallest in AM, associated w/ inguinal hernia
Refer for Uro surgical correction
Pyloric stenosis d/t muscle hypertrophy and spasm induced outlet obstruction
What are the two RFs for Pyloric Stenosis
What is the ‘classic’ presentation
What would be seen on lab results for this MC
Male, First born
2-6wks old w/ post-prandial, non-bilious projectile vomit w/ FTT
HypoCl, HypoK, Metabolic alkalosis
Inc BUN
Ho are Pts w/ Pyloric Stenosis managed
Defining criteria for constipation
What are 3 common times this occurs
IV fluids/E+
NS bolus then D5 w/ KCl (inelligible for surgery until alkalosis corrected
OG tube for slow feeding
2 or less stools/wk or
Passing hard/pellet stools x 2wks
Introduction of solids/cows milk
Toilet training (functional constipation)
Start of school (social stressors)
How is GI reflux Dx
After lifestyle mod, what meds may be attempted
Define Intussusception
24hr pH probe- was Gold Standard
Upper GI/Barium fluoroscopy
EGD- best for GERD progression
H2 blocker Ranitidine
Pro-kinetic- Metoclopromide
PPIs
Telescoping of intestine into downstream intestine
What are two RFs for Intussusception
? infection can cause this issue
How does this present to clinic
Lymphoid hyperplasia (peyer patches) Meckels
Rotavirus (old Rota imm)
Paroxysmal pain w/ currant jelly stool and sausage mass in RUQ
What are the 4 criteria must be met for a Dx of Toddlers Diarrhea
When does this cross into the realm of Chronic Diarrhea
C Diff work up can only be started in ? Pts
Daily passage of 4 unformed BMs w/out pain
Sxs >4wks
Onset 6-60mon
No FTT
> 2wks
> 2y/o w/ recent ABX use
How is C Diff Tx
Where are Campylobacter infections acquired from
Campylobacter infection can also induce ? Neuro complication
D/c offender, PO Metronidazole
Poultry, Raw milk/cheese
Post-infectious Autoimmune Peripheral Neuropathy
Celiac Dz is associated w/ ? other Dx
How is this condition Dx
How is the Dx confirmed
DM1 Thyroiditis Turners Trisomy 21
IgA Antiendomysial Ab
IgA tissue transglutaminase Ab
Endoscopic biopsy of small intestine
What alternatives are offered during Tx of Celiac Dz
Define Galactosemia
How does this present
Avoid gluten;
Ok: oats, rice, tapioca, corn, buckwheat
Autosomal recessive deficiency of galactose 1 phosphate uridyltransferase
Ingestion of milk induces liver failure, renal tubular dysfunction and cataracts
Pts w/ Galactosemia are at risk for ?
How are these Pts Tx
What issues may persist despite Tx
EColi sepsis
Eliminate galactose
Learning d/o
Premature ovarian failure
Define SIDS
What epidemiology stat does it own
Define Pneumonia
Unexpected death if infant <12mon that remains unexplained after investigation/autopsy
3rd MCC of mortality in US
MCC of death in 1-12mon old
Infection of lower respiratory tract causing consolidation of alveolar spaces
What are the causes of pneumonia for 0-1mon old
What are the causes of pneumonia for 1mon-5y/o
What are the causes of pneumonia in Peds >5y/o
GBS Ecoli Strep pneumo
RSV** Strep pneumo HFlu
Mycoplasma/Strep/Chlamydophyla pneumo
How does pneumonia present in neonates
What is the first sign of pneumonia present in young infant
What are the different presentations for viral/bacterial pneumonia
Fever or Hypoxia only
Apnea
V: Cough Wheeze Stridor Congestion URI
B: F/C/Dyspnea, auscultation findings
What lab results can help differentiate between viral/bacterial pneumonia
What will each look like on CXR
What ABX is used for out PT Tx
V: lyphocyte dominant leukocytosis
B: neutrophil dominant leukocytosis
V: diffuse infiltrates w/ hyperinflation
B: lobar consolidation w/ effusions
Amoxicillin 90mg/kg/day
How is Community Acquired Pneumonia managed in PT <5y/o who has immunizations
How is Tx changed if child is unvaccinated
How are kids 6-18y/o w/ CAP Tx
Amoxicillin or,
Cefuroxime w/ Augmentin
3rd generation cephalosporin or
Augmentin
Azith, Clarith, Doxy- >7y/o
How are neonates w/ CAP Tx inpatient
Infants born w/ intestinal atresia need ? DDx r/o
? enzyme difficiency can also indicate the above Dx
Ampicillin/Gentamycin
PO PCN
Cystic fibrosis
Lipase
When is Cystic Fibrosis tested for in routine care
This condition can also cause ? issue seen prior to d/c
Define Cystic Fibrosis
Newborn Screening
Pathologic jaundice, direct form
Autosomal recessive d/o- MC life limiting Dz in Caucasians; median 40y/o
What mutation causes Cystic Fibrosis
What tissues are affected by this Dz
These Pts can suffer from chronic respiratory infections d/t ? two microbes
Transmembrane regulator gene on Chromosome#7 (508)
Lung Exocrine pancrease GI tract Sinus Testes
Staph A, Pseudomonas
When do Cystic Fibrosis evals need to be done
? newborn screening result suggests CF
What is the Dx test of choice
Meconium ileus FTT Cholestatic jaundice E+ abnormals: HypoNa/Cl, Met alkalosis Chronic GI/respiratory Sxs Any child w/ nasal polyp Any sibling of CF+ Pt
Elevated immunoreactive trypsinogen level
Cl sweat test
Cl >60 mEq
Borderline: Cl 30-59 mEq
Neg: Cl <30
How are Pts w/ CF managed
Define Bronchiolitis
What will be seen/heard on PE
Enteric pancreatic enzyme capsules w/ lipase/protease- don’t exceed >2500U/kg of lipase= risk of fibrosing colonopathy
Inflammation of bronchioles MC d/t RSV
Retractions, nasal flaring w/ low fever
Wheeze, Crackles, Ronchi
How is a Dx of RSV Bronchilitis confirmed
? is the MC chronic Dz of childhood in industrialized countries
What are the two phases of this MC
How is asthma Dx
ELISA, PCR
Asthma- reversible airway obstruction d/t contraction/inflammation
Early- spasms; Late- inflammation
Obstructive PFT pattern reversed w/ B-agonists
How are these Pts classified
How are these classification criteria changed if Pt is 0-4y/o
Intermittent: Sxs 2/< days/wk, Awake 2/< x/month
SABA 2/< days/wk, No activity interference
Mild: Sxs >2day/wk, Awake 3-4x/mon, SABA >2 days/wk, Minor limitations
Mod: Daily Sxs, Awake 1/>/wk, SABA daily, Some limitations
Sev: Daily Sxs, Nightly awakenings, SABA several x/day
Extreme limitations
I: 0 awakenings Mi: 1-2/mon Mod: 3-4/mon Sev: >1/wk
What medications are used as acute asthma meds
What s/e can the rescue inhaler cause
What medications offer the greatest benefit
Albuterol- Bagonist
Ipatropium- anticholinergic
A: anxious, tremor, tachy, hypoK
Corticosteroids: Fluticasone (first line for persistent asthma)
? med is used for exercise induced asthma
? long acting B2-agonist is used for combo therapy
What other med is used for mod/sev asthma in PTs >12y/o
? medication is used status asthmaticus
Montelukast
Salmeterol
Omalizumab- Anti-IgE monoclonal Ab
IM Epi
What is a red flag in Pts w/ Status Asthmaticus
Define Still’s Murmur
MC etiology for pericarditis
Tachypnea w/ normal pCO2
Benign/Innocent functional murmur d/t LV outflow
Viral
Rarely Bacterial: MC Staph A/Strep Pneumo
Metabolic- uremia
When is the prognosis for pericarditis poor
Stats of PDA
What will be felt/heard on PE
<6mon old or recurrent Sxs
2nd MC defect
Bounding pulses w/ wide pulse pressure w/ continuous machinery murmur
How are PDAs Tx but w/ ? s/e
Where does coarctation tend to occur
Wheat will be seen on exam
Indomethacin- most effective in premature infants; may cause transient renal insufficiency
Thoracic region next to ductus arteriosus
Leg BP < Arm BP w/ radiation next to scapula
? is the MC cyanotic heart defect
What will be seen on lab results, CXR and EKG
How are they Tx
Tetralogy of Fallot- PROV
Lab: polycythemia
CXR: RVH and boot shaped heart
EKG: RAD
Prostaglandin E1, Surgical repair
? is the MC congenital heart defect
How does the size of this MC determine Sxs
How would a Pt present and how are they Tx
VSD- harsh, holosystolic murmur at LLSB
<3mm: ASx
3-5mm: moderate Sxs
>5mm: CHF w/ FTT
P-HTN or FTT;
Diuretic, Digoxin, After load reduction
How do ASDs present on PE
When is intervention closure indicated
Criteria for Peds White Coat Syndrome
Systolic murmur in LUSB w/ fixed, split S2
Significant shunt at 3y/o
> 95th percentile HTN w/ normal readings out of office
? is the MC cause of HTN in adolescents and is more likely in ? populations
What is the MC of secondary HTN
Criteria for Pre/Stage 1/2 and when are they f/u
Primary/Essential HTN in obese children
Renal Dz
Normal: <90th percentile
Pre: 90-95th; f/u 6mon
1: 95-99 +5mmHg; repeat in 1-2wks
2: >99th +5mmHg; eval/refer for Tx <1wk
What two findings/criteria should make a secondary cause of HTN evident
What are indications for meds
What meds are used
BMI <85th percentile
BP >140/100
Stage 2
Stage 1 w/ Sxs
DMT1/2
Failed life style changed
MC first line: CCBs/ACEIs
ARBs, BB, Diuretics
How is Croup Tx
What are the criteria for admission
When conducting new born exams, how do neck bulge locations hint at Dx
Dexamethasone- dec Sxs/hospitalizations and gets through worst part of Sxs
Racemic Epi- reduces edema
Suspected bacterial infection
ER bounce back
Age <6mon old
Stridor at rest
Anterior midline: thyroid d/o
Anterior to SCM: brachial cleft cyst
Posterior to SCM: cystic hygroma
How are epistaxis Tx
What is the most potent therapy for the Tx of allergic rhinitis
If antihistamines are going to be used, what considerations are considered per generation
Sit up, apply pressure x 10min
Afrin/Phenylephrine spray then pack
Site located- cauterize w/ silver nitrate
Persistent despite cautery- anterior packing x/ Augmentin/TMP-SMX
Persistent/Posterior- ENT referral
Intranasal CCS
1st: Diphenhydramine, Hydroxyzine-
Sedation, Paroxysmal hyperactivity, Anticholinergic
2nd: Cetirizine, Loratadine, Fexofenadine-
Less sedation
When/why would Montelukast be considered when Tx rhinitis
What last resort Tx is used for medical failures
What medication is reserved for non-allergic rhinitis or rhinitis associated w/ viral URIs
2nd/3rd line agent, best in concomitant asthma
Immunotherapy
Topical ipratropium
How is sinusitis Tx
MCC of acquired hearing loss in kids
? complication can arise from this MC and how does it present
First: Augmentin x 14d
PCN allergy= Levofloxacin for Type 1 hypersensitivity
Clinda + 3rd Gen cephalosporin for non-type 1 sensitivity
AOM
Mastoiditis- otitis media signs w/ tenderness/swelling/erythema and down/out displaced pinna
? is the leading cause of clinical visits and ABX
This leading cause also leads to the most surgeries of ? type
What are the MC microbes behind these stats
AOM
Myringotomy and adenoidectomy
HFlu
Catarrhalis
GAS
Step pneumoa
A Dx of AOM required ? criteria
What is the most frequent sequelae of AOM
How are Otitis Media Effusions Tx
3 of:
Acute onset
Effusion
Inflammation
OME/COM- effusion w/out any other S/Sxs
NSAIDs, f/u in 4wks
Should clear in 3mon
How are recurrent cases of Otitis Media managed
What vaccines should these Pts get
When are children considered candidates for tube insertions
<1mon since Tx- change ABX
>1mon- use same ABX
>3 episodes in 6mon or >4 episodes in 12mon:
refer to ENT for tube evaluation
Conjugate Strep pneumo
Annual influenza
Developmental risks
Recurrent AOM x3mon w/ effusion and bilateral HL
What are the MCC of Otitis Externa
How does this present to clinic
? Neuro Dx commonly develops cataracts
Swimmers Ear d/t Pseudomonas or Staph A
Pain, d/c w/ pinna tender to manipulation
Oflox/Ciproflox, Polymyxin B, Dexamethasone
NF-2
Cataracts in kids can cause ? type of vision loss
? congenital infection can induce cataracts
? malnutrition d/o can induce cataracts
Amblyopia d/t deprivation/obstruction
Rubella
Galactosemia
Direction of strabismus names
Timing of strabismus names
How is a pseudostrabismus r/o
Any/All strabismus need ? next step
Nasal: Eso
Temporal: Exo
Superiro: Hyper- rare
Constant: manifest strabismus/tropia
Interrupted fixation: latent strabismus/phoria
Normal corneal light reflex
Ophth referral
What is the MCC of visual impairment in children
How does Preseptal/Periorbital Cellulitis present
if child is non-toxic, no imaging needed and can be Tx w/ ? ABX
Retinopathy of prematurity
<5y/o w/ no proptosis/ophthalmoplegia infected w/ Staph A, Pneumococcus or GAS
F/u daily and Rx:
Cephalexin, Clinda, Augmentin
MRSA: Clinda, TMP-SMX
Orbital cellulitis is a complication arising from ? Dx
What microbes cause this
How does Orbital Cellulitis present differently from Pre-Septal
Sinusitis
Staph Strep HFlu
Vision loss
Pain w/ EOM
Chemosis/Proptosis
How is orbital cellulitis Tx
What complication can occur
Blood cultures for broad spectrum w/:
Cefazolin or Clinda
Cefuroxime w/ Metronidazole
MRSA: Vanc + Cefotax and Clinda
Cavernous sinus thrombosis- palsy of CN 3, 4, 6 and V1,V2
Subperiosteal abscess
Vision loss
How does the timing of conjunctivitis help w/ Dx the cause
How is this Dx
Most critical stages of embryonic development occur during ?
Day 2-7: Gonorrhea, Staph/Strep Pseudo EColi
Day 3-21: HSV
Day 4-19: C trachomatis
Gram stain w/ culture
HSV will have dendrite on cornea w/ stain and lamp
First trimester
How is Chlamydia conjunctivitis Tx
How is Ophthalmia Neonatorum Tx
How is HSV conjunctivitis Tx
How is Staph A conjunctivitis Tx
How is Pseudomonas conjunctivitis Tx
Erythromycin
Ceftriax
Opth consult w/ Acyclovir
Erythromycin or Polysporin
Gentamycin ointment w/ saline irrigation
How does post-neonatal viral conjunctivitis present
This is MCC by ? microbe
How is this Tx
Pre-auricular node
Adenovirus
Erythromycin, Polymyxin B
Charcoal can be used for ingsted poisons w/in ? time frame
This is ineffective against ? ingestion
When are multiple-doses of activated charcoal given
<1hr
Hydrocarbon
Glycols
Metal: Mercury Arsenic Iron Lead Lithium
Caustic/Corrosive
Carbamazepine Dapsone Theophylline Phenobarbital Quinine
Anion gap metabolic acidosis mnemonic
MUDPILES Methanol, Metformin Uremia DKA Paraldehyde Phenoformin Isoniazid, Iron Lacitc acidosis Ethanol, Ethylene glycol Salicylates, Starvation, Seizure
APGAR scoring system
Appearance
0: cyanosis 1: acrocyanosis 2: pink
Pulse:
0: none 1: <100 2: >100
Grimace:
0: none 1: grimace, feeble cry 2: sneeze, cough, pulls away
Activity:
0: limp 1: some flexion 2: active
Respiration:
0: none 1: weak 2: strong
Normal respiratory rate
How does respiratory rate change w/ prematurity
Normal HR and interventions done if low
30-60bpm
More premature= more tachy
120-160
>100: routine
60-99: ventilation support
<60: ventilation w/ compressions
NRP compression:breath ratio
How do neonates respond to hypoxia
BVM is done at ? rate and in ? position
3:1 w/ two thumbs > two fingers
Apnea
40-60bpm in sniffing position
Congenital heart dz screening is done at 24hrs of life/before d/c and is interpreted how
Spo2 95% or higher w/ 3% or less difference between right hand/foot= negative screening, plan for d/c
SpO2 90-94% in right hand/foot or 3% difference= repeat in one hour; same results- repeat again in one hour; 3 readings in same range= echo
SpO2 <90% in right hand/foot= +screen- order Echo
Infant length is done in ? position until ? time frame
When is the most inaccurate measurements expected
? is the number one cause of LBW and what is the criteria for Low/Very Low birth weights
Laying down until 2y/o
First week d/t position
Prematurity;
Low: <2500gm; Very: <1500gm
What are the RFs for LBW
Enlarged anterior fonanelle >5cm suggests ? and needs ? other co-existing DDx r/o
Fontanelles that are closed at birth suggest ? Dx
Previous LBW baby Age <16, >35 Socioeconomic status Tobacco/ETOH/Drugs Poor weight gain during pregnancy Education Antenatal care
Hypothyroid- umbilical hernia
Craniosynostosis
Define Caput Seccedaneum
Define Cephalohematoma
? head malformation is associated w/ vacuum deliveries and how is it Tx
Boggy, edematous swelling crossing lines, self resolves
RBC breakdown/jaundice causing swelling w/out crossing suture lines
Subgleal hemorrhage- swelling crosses suture lines pushing ears anteriorly;
Tx: Compression w/ resuscitation PRN
What do each of the following suggest for cardiac d/o/dz
Weak pulse
Bounding pulse
Single second sound
Holosystolic, continuous, harsh
Grade 3/>
Diastolic murmur
Hempatomegaly
Weak: poor CO/AS
Bounding: high CO, PDA
Second sound: cyanotic dz- truncus/hypoplastic heart
Holosystolic, continuous, harsh- pathologic
Grade 3/>: pathologic
Diastolic: pathologic
Hempatomegaly: left sided HF
Since all infants are born w/ limited laxity, what are the three concerns if this persists
RFs for Congenital Hip Dysplasia
What are the two maneuvers done for hip stability during newborn exam
Flat acetabulum
Muscle contraction limiting ROM
Capsule tightening
Female First FamHx
Breech
Oligohydramnios
Postnatal swaddling position
Barlow
Ortolani- hip relocating anteriorly
When is imaging for hip dysplasia warranted
Congenital Hip Dysplasia referred to Peds Ortho will be placed in ? device for ? age groups
? is the MC foot d/o in infants and what are these Pts at risk for in the future
Suspicious PE findings
Clunk or persistent click past 2wks old
RFs- obtain after 4-6wks of age to differ from normal laxity
Pavlik harness- up to 6mon old
Metatarsus adductus- medial deviation of mid and forefoot;
Developmental hip dysplasia
How is Metatarsus Adductus Dx
How are these Tx
Define Talipes Equinovarus
Mid-heel bisector line- should go between toes 2-3
V-finger- should not gap at base of 5th MT (styloid)
Most self-resolve
If not w/in 2yrs= Ortho referral cast/brace/surgery
Clubfoot- entire leg d/t hypoplastic tarsals and limb muscles
MC affected- talus, causes foot shortening/calf atrophy
Refer all after Dx
? testi/female genitalia abnormalities can be seen on newborn exam
Define Spina Bifida
When/How is this normally identified during pregnancy
Testi: retractile
Female: hypertrophy d/t maternal estrogen
Cleft Spine; Lumbosacral tube defect d/t incomplete brain/cord/meninge development
2nd-Tri Quad screen- maternal A-fetoprotein/US
Define Rachischisis and ? risk needs to be r/o
What are the categories of Spina Bifida
How is this Tx and avoided
Spina Bifida Occulta- hair tuft/minor defect w/out neuro S/Sxs; r/o connecting sinus d/t inc risk for meningitis
Meningocele- meninges herniates through neural arch
Meningomyelocele- meninges and cord herniate through neural arch
Myeloschisis- open skin w/ cord exposed
Neurosurgery;
Folate prior to tube closure at 4-6wks EGA
What are the primitive reflexes tested for on newborn exam
What do these reflexes evaluate
When do these normally disappear
Suck Moro Grasp
Brain stem, Basal ganglia
4-6mon d/t increased cerebral inhibition of cerebral influences
Only reflex not present at birth and never disappears
What reflexes disappear at 3, 4, 6 or 12mon
Facial palsy in newborn is associated w/ ?
Parachute- appears at 8-10mon; suspended face down, move towards table causes arm extension for protection
3: Asymmetric tonic neck
4: Rooting, Gallant, Placing
6: Moro, Grasp
12: Babinski
Forcep delivery
What syndrome is Klumpke’s Palsy associated w/ if a cervical sympathetic nerve root was injured
Define Vernix Caseosa
When is term infant desquamation typically seen
Ipsilateral Horner’s Syndrome
Chalky white mixture of shed epithelials cells, sebum, keratin and hair; common in preterms for suspected fetal protection
24-48hrs of life
Define Milia
Define Milia Rubra
Define Cutis Marmorata
Smooth, white papules on face/scalp d/t trapped keratin; self limited/resolves 1-4wks
Heat rash d/t overheated/febrile infant w/ erythematous papules; Tx/correct overheating
Mottling- cold response; persistent suggests hypothyroidism/vascular malformation
Define Slate Gray Nevi
Define Cafe Au Lait macules and when are further work ups indicated
Nevus Simplexes are AKA ?
Transient dark macule on lower back/buttocks that fade w/ time
Sharply defined, pigmented macules;
6 or more/ 5cm or bigger to r/o NF-1, TB, McCune Albright Syndrome
Salmon patches
Stork bite- nape of neck
Angel kiss- forehead/eyelids
Neonatal sepsis etiologies w/ early onsets
Neonatal sepsis etiologies w/ late onsets
Mycoplasma GBS- MC/#1 E coli Klebsiella Listeria Salmonella
Hflu Neisseria meningitidis CMV HSV Enterovirus Strep pneumo Staph
Early onset neonatal sepsis begins on ? day and presents w/ ?
Late onset neonatal sepsis begins on ? day and is more likely associated w/ ?
What orders are needed
0-7d old;
Fast onset, Hypo-thermia/tone/tension
8-28d old;
Insidious onset, Dec feeding/tone, Bulging fontanelle; associated w/ meningitis
CBC CXR if + resp Sxs Blood culture x2 UA w/ culture Blood glucose LP
How is Neonatal Sepsis Tx
Why would Vanc be added to Tx regiment
? PE finding is a sign of neonatal respiratory distress
Draw labs then:
IV Ampicillin+Gentamicin
IV Amp+Cefotaxime if >3wks d/t liver function
Late onset, + meningitis, MRSA coverage
Grunting (can sound like meowing) d/t: Dec functional residual capacity: Pneumonia Pulmonary edema Peripheral airway obstruction
Three steps for Tx infant born to a GBS pos mother
1: infant have S/Sxs?
Yes: eval w/ empiric Tx
No: step 2
2: infant <35wks EGS?
yes; limited eval w/ 48hr observation
no: step 3
3: Two maternal ABX doses prior to delivery?
Yes: no eval/therapy, observe x48hrs
No: limited eval w/ 48hr observation
Respiratory Distress Syndrome is AKA ? and caused by ?
RDS results in ? and looks like ? on CXR
How is RDS Tx prior to birth
How is RDS Tx after birth
Hyaline Membrane Dz: dec surfactant from Type 2 pneumatocytes in <34wks EGA
End expiration atelectasis; Ground glass
Maternal steroids 32-34wks EGA
Intubation w/ surfactant/support via ET tube
What complications can arise from RDS
Which one appears on day 2-4 of life and what does this look like
How is this Tx
PDA PTX
Bronchopulmonary dysplasia
Retinopathy of prematurity
PDA: L to R shunt (systemic to pulm) as pulmonary edema/hepatomegaly
Fluid restriction w/ diuretic
Indomethacin/Ibuprofen
How is RDS induced PTX Tx
What causes the Bronchopulmonary Dysplasia after RDS
What are the 3 RFs for this dysplasia
Sxs= chest tube
O2 toxicity/barotrauma
O2 dependence at 36wks old
RDS persists >14days
Prolong mechanical ventilation
How does RDS cause Retinopathy of Prematurity
Criteria for Apnea of Prematurity
What are the two types and causes
O2 toxicity causes vasoconstriction in developing vessels= obliteration/blindness (term infant eyes fully vascularized- no risk)
10-20sec w/out pulmonary airflow
Central: medulla/pons don’t stimulate phrenic nerve (more common in premature infants)
Obstructive: malformation/positional
How is Apnea of Prematurity Tx
When does this usually correct itself by?
? is the MC congenital tracheal abnormality
O2, Stimulants: caffeine/theophylline
36-40wks post-conceptual age
Tracheomalacia- weak/floppy tracheal wall worse during expiration (harsh, monophonic wheeze/normal voice/inspiration)
Four possible outcomes from Meconium Aspiration Syndrome
How are non-vigorous babies w/ aspiration managed
How does aspiration appear on CXRs
Respiratory distress
Pneumo-nia/nitis/thorax
Suction mouth/trachia
Unsuccessful: BVM w/ PPV
Coarse, irregular infiltrates
What causes Transient Tachypnea of the Newborn
How would this appear on CXR
When is this type of issue more commonly seen
Retained amniotic fluid causes hypoxia that resolves <24hrs
Fluid in fissures
C-section, LGA d/t no ‘squeeze’ during birth
How does P-HTN in term infant present
MCC of Hemolytic Dz of newborn
What are the three reasons all newborn have an elevated bili
Primary: Hypoxia w/out cardiac/pulm dz and normal CXR
Non-Primary: induced L to R shunt
ABO incompatibility
Inc RBC turnover
Dec hepatic clearance/gut motility
Neontal hyperbilirubinemia is ? levels
? is the MCC of neonatal jaundice
Define Kernicterus
Total Bili >5mg/dL
Hemolytic Dz of the newborn- ABO incompatability is MCC
Bilirubin Encephalopathy- indirect bili deposits in brain, disrupts neuron metabolism/function
Early signs of Kernicterus
Late signs of Kernicterus
Day 4 of life w/: Lethargy Emesis Hypotonia High pitch cry Irritable Poor Moro/feeding
Fever Hypertone Bulging fontanelle Opisthotonic posture Pulmonary hemorrhage Paralysis of upward gaze Seizures
What are the two classifications of hyperbilirubinemia
What is a common cause of jaundice in first time mothers
What causes Adequate Intake Breast Milk Jaundice
Unconjugated: estimated w/ indirect (MC)
Conjugated: direct; rare but more serious
Breastfeeding jaundice- lack of adequate feeds causes dec gut motility on day 2-3 of life
Defected milk w/ conjugation inhibitor, increased hepatic recirculation d/t glucuronidase; seen on day 7-10 w/ bili rarely above 20mg
Characteristic clues of Physiological Jaundice
Characteristic clues of Pathological Jaundice
When evaluating jaundice, ? is the first location that needs to be assessed
Evidence starts w/ bili at 5-6 or,
Preterm w/ bili <15 on day 5 of life:
Yellow skin started on face, moves down
Very early, very fast: Peak bili w/in 24hrs of life in term infant Bili rises 0.5/hr or 5mg/dl/day Jaundice w/in 24hrs of life Hepatosplenomegaly and anemia
Under tongue THEN sclera
? is first line test ordered for evaluation of neonatal jaundice
How are these Tx if Mild, Mod or Severe
What are the short and long term adverse effects of neonatal phototherapy
Transcutaneous then serum bili
Mild: lifestyle, breast feed, sunlight
Mod: phototherapy
Sev: exchange transfusion if levels >20
Short:
Diarrhea, Dec bonding, GI hypermotility
Temp instability
Long:
Inc risk for asthma and DMT1
What is included in a standard well visit
Define Neonate
Define Infant
Growth Development Imms Guidance Screenings
0-28d old
29d-1y/o
Define Toddler
Define Pre-Schooler
Define Child
1-3y/o
2-5y/o
1-12y/o
Define Adolescent
Define Growth
Define Development
13-18y/o
Increase in body size
Increase in function/process
Developmental Scales are AKA ? and use ? as more more detailed screening
Define Developmental Milestones
What growth chart is used from birth to 2y/o and which one is used from 2y/o to 20y/o
Ages and Stages;
Denver Developmental Screening Test 2
Observable traits/actions that present/fade at predictable ages
0-2: WHO; more accurate for breast fed
2-20: CDC; accounts for time/place/obesity
Pediatric weight percentiles/categories
How are heights predicted for fe/males
MC factor affecting growth
<5th: underweight
5-85th: normal
85-95th: over weight
>95th: obese
M: Paternal + Maternal/2 + 2.5
W: Paternal + Maternal/2 - 2.5
Hereditary factors
Babies born small/premature can be expected to go through ‘catch up’ growth during ? frame
When is medical interventions indicated for deficient growth patterns
Nutrition/growth during ? pat of life predict adult stature and health outcomes
First 6mon
<5% w/out cause
Crosses two percentile lines w/out cause
Discrepancy between Circumference/Weight/Length
First 3yrs w/ biggest risk for stunting between 4-24mon
It is recommended breast milk as sole nutrition source for premature infants d/t ? benefits
What are the three categories of formula
6mon;
Lower readmission rates
Long term IQ development
Cow milk based:
Fortified w/ Fe, no sterilization needed
Soy based:
Lactose free alternative w/ possible isoflavone effect
Casein hydrolysate:
Used when absorption/digestion problem exists, $$
Avoid cows milk until ? age
Avoid whole milk until ? age
Do not substitute formula w/ soy milk for infants under ? age d/t ? risks
12mon d/t risk for GI bleed/anemia
24mon
<12mon; Scurvy Anemia Malnutrition
What are the red flags for Gross Motor
What are the red flags for Language
Rolling <3mon old= inc tone
Poor head control at 5mon= dec tone
Lack of sitting at 7mon= dec tone
Hand dominance <18mon= contralateral motor abnormality
Vary pitch by 4mon Lack of babble by 6mon No word/gesture by 15mon No pointing by 18mon Less than 50% intelligible speech at 24mon
When do Well Child Exams take place
BP is not a standard part of VS until ? age and how is it calculated
All children w/ speech delay need ? tests
Day 3-5
Week 2
Mon 2 4 6 9 12 15 18 24 30, then annual
After 3y/o
SBP= 80 + Age x 2
DBP= 2/3 of SBP
Hearing eval w/ tympano/audio-metry
Auditory Brain Stem Response- r/o peripheral loss
When are anemia screenings conducted
When does cholesterol screening begin
What are the accepted cholesterol limits in kids
12mon if healthy
4mon if high risk
Non fasting 9-11y/o and 17-21y/o
Overweight/Obese- fasting
Parent cholesterol >240= high risk, start at 2y/o
Borderline: <170
High: >200
Acceptable LDL: <110; Border: 110-129; High: >130
HDL should be >40
Define Active Immunity
Define Passive Immunity
Define Primary Prophylaxis
Define Secondary Prophylaxis
Immunity from vaccine/toxoid
Maternal Ab transfer/administration of Abs
Prevent infection before first occurrence
Prevent recurrence after first infective episode
Rotavirus vaccine must be given w/ ? time line
? two vaccines have egg allergy cautions associated w/ them
How long should rear facing car seats be used and how long should kids ride in back seat
First dose before 15wks of age
2nd dose NLT 8mon
Influenza
Yellow Fever
2y/o;
Back seat until 13y/o
Risks of tobacco smoke
Sequence of teeth eruptions at ? ages
What labs are ordered if delayed tooth eruption is present
LBW
SIDS
Respiratory illness- asthma
Otitis media
Deciduous: lower central incisors to upper central incisors to lateral incisors;
Permanent 6-12y/o w/ 3rd molars by 18y/o
TSH, Ca for Hypothyroid/Hypopituitary, Rickets
Define SIDS
What stats belong to this Dx of exclusion
What therapy may be beneficial in prevention during the first year
Unexpected death <1y/o unexplained by autopsy/CSI and review of clinical history
Third leading cause of US infant mortality
MCC of death 1mon-12mon old
Pacifiers
Plagiocephaly is referred if no improvement after ? long
How much lead accumulation can cause irreversible developmental/behavior abnormalities
Where are lice nits MC found and rare found
4-6mon
5-10ug/dL; screen at 12mon
MC: occipital, above ears
Rare: beard, pubic hair
ABX are not used for diarrhea caused by ?
What are the 4 types of infectious diarrhea that can be Tx by ABX
Defining criteria for FTT
E Coli O157:H7- can induce hemolytic uremic syndrome
Shigella- Azith
Salmonella- Azith
Travelers only if bloody/febrile w/ Azith
C Diff- d/c and Tx w/ Metronidazole
Weight <3rd percentile
Crosses two major percentile lines
<80% of median weight for height
What are the three types of FTT
How is FTT Tx
Wasting: deficient weight gain d/t malnutrition
Stunting: deficient linear growth w/ head circumference spared d/t months of malnutrition
Symmetric: loss of length, weight, circumference d/t malnutrition, genetics, infection or exposures
Inc calories and protein >1.5x
What is the adverse outcome from Tx FTT
Autosomal dominant congenital malformations
Autosomal recessive congenital malformations
Refeeding Syndrome:
Dec metabolism forces storage for homeostasis
Rapid feeding- loss of fluid/E+; fluid retention, Hypo-Phos/Mg/K/Ca
Marfans Achondroplasia Huntingtons Neurofibromatosis Polycystic kidney
CF PKU CAH SS
What are the X-linked congenital malformations
RFs for Downs Syndrome
What do all Pts w/ Downs need to have ordered
Fragile X- excessive gene base repeats Muscular dystrophy Hemophilia A G6PD deficiency Color blindness
Inc maternal age, Parental genetics
Chromsomal analysis, + translocation= parental analysis
What are the three forms of Trisomy 21
What will be seen on PE of Down Syndrome
What are the face characteristics
What are the extremity characteristics
MC- maternal non-disjunction
Translocation- part of #21 is stuck on another chromosome prior to replication
Mosaicism- rarest; pehnotypical normal Pt
General hypotonia- dec Moro reflex
Small head
Flat bridge d/t midface hypoplasia Up slanting fissures Macroglossia Epicanthal folds Dysplastic pinna
Single palmar crease
Shortened mid-5th phalanx
Wide first toe interspace
All Down Syndrome Pts will have ?, two-thirds have ? and half will have ?
What type of hearing loss will majority have
What eye defects will they have
All- developmental delay
2/3: polycythemia
Half- cardiac anomalies
SNHL
Cataracts Refractive error Ectopic lens Brushfield spots Strabismus
? x-ray finding in Down Syndrome needs immediate surgical Tx
What is the routine health care check list for all Down Syndrome Pts
? is the most preventable cause of developmental delay/intellectual disability
Duodenal atresia; seen as “double-bubble” sign
Hearing screening q3mon until 3y/o, then annual
Cards for Echo
Optho by 6mon then annual
Annual TSH/CBC, Celiac screen
Fetal Alcohol Spectrum D/o
What are the classic facial features of FAS
What hand feature is seen in FAS
What developmental abnormalities are seen in FASD
Short palpebral fissures
Smooth philtrum
Thin upper lip
Clinodactyly- hockey stick crease
Fine motor delay
ADHD
Retardation
How much ingestion puts fetus at risk for developing FAS
Developmental/Neuro problems seen win Fragile X Syndrome
What physical attributes will be seen
> 7/wk or >3 drinks per period
Hyperarousal Anxiety Mood lability Epilepsy Sterotypy- hand flap
Joint laxity
Oblong face
Hypotonia
Macro-orchidism
How is Fragile X Syndrome definitively Dx
Define 45XO
Majority of defects arise from ? side of parents w/ ? presenting PE finding after birth
DNA amplification w/ direct analysis
Turner Syndrome d/t no/abnormal X
2/3 of X are maternal;
Extremity edema
What type of mental development is seen w/ Turner Syndrome
What CV issues are usually seen
What endocrine d/os are seen
Poor visual-spacial skills
Superior verbal skills
Coarctation
Early onset HTN
Bicuspid aorta
Hypothyroidism
Osteoporosis
DMT1
How is Turner’s Dx and what Dx method is not recommended
Define Klinefelter Syndrome
What issue can present
Direct karytotyping;
Barr body analysis
47XXY: phenotypically normal prior to puberty
Result of testosterone deficiency:
Irregular features
Violent tendencies
Severe MR
How is Klinefelter’s screened, Dx and what would be seen on lab results
How are these Pts Tx and what are they at risk for
What type of genetic defect leads to Marfans
Screen: Barr body
Dx: direct karytopying
Inc LH/FSH w/ low T
T replacement
16-30x inc risk for breast Ca
Fibrillin 1 gene on Chrom #15
What is the correlation to crying if infant is preterm
When is the diurnal variation more common
How loud can these reach
Little before 40wks old
More than term infant at corrected 6wks
Late afternoon/evening
80dB
? is the MC reported behavior problem in kid 2-3y/o
When does this MC become an abnormal
How can these be prevented
Temper tantrums
Lasting >15min Injury to self/others Negative mood swings w/ tantrum Continue past 4y/o >5/day
Parental education at 12-18mon
What are two labs that would be ordered for temper tantrum work ups
What is the goal of therapy for Peds w/ special needs
What will parents experience/go through after a Dx of special needs
Fe deficiency
Lead toxicity
Max potential for adult functioning
Kubler-Ross stages of grief
What are possible RFs for autism
What two populations are at increased risk
More than half of Pts w/ autism will also have ? comorbid d/o and why
Short pregnancy interval Prenatal infection Advanced parental age Maternal obesity Premature
Twins, Siblings
Sleep- d/t baseline melatonin abnormals
What perinatal RF put Peds at risk for Cerebral Palsy
Done w/ Deck 4: Neuro/Psych
Average age for female puberty onset is ? age w/ Precocious defined as ?
Intrauterine infection
Start on Adolescent
11y/o;
6y/o in AfAm; 7 y/o in Caucasian
Tanner stages associated w/ TAPuPMe
Completion of Tanner stages takes ? amount of time for male and female
Once female starts menarche, ? much expected height growth is expected remaining
Thelarche: Tanner 2
Ad/Pub: Tanner 2
Peak: one year after thelarche, tanner 3-4
Female: 4-5yrs
Male: 2.5-5yrs
2-5cm
Boys going through puberty pass through testicular Tanner 1 to 2 at ? age
When marks onset of adrenarche for boys
Both male and female Pts going through puberty will have ? elevated lab result and ? previous issue may worsen
9-11y/o
Pubic then axillary <12mon later
inc ALP d/t rapid bone turnover;
Scoliosis worsens
Normal male puberty growth sequence
Breast mass in adolescent females are usually ? type and evaluated by ?
Define Physiologic Leukorrhea
Testicular growth SMR 2
Pubarche
Penile growth SMR 3
Peak height velocity SMR 4
Fibroadenoma, cyst; eval w/ US
Tanner stage 3/peripuberty w/ clear, non-odorous vaginal d/c w/out pruritus
Define Premature Thelarche
What needs to be looked for in history
Define premature adrenarche
Isolated breast development in Pt 6-7y/o
Estrogen exposure
Odor/Hair/Acne in female <8/male <9y/o
Premature adrenarche causes are associated w/ ? two things
What needs to be searched for in their Hx
Define premature testelarche
Obesity, CNS injury
Androgen exposure
Testes >3cc or 2.5cm
<9y/o is abnormal and an endocrine emergency; 50% have brain tumor
Define Secondary Amenorrhea
PCOS can be Dx with two of ? criteria
? is the MCC of abnormal uterine bleeding
Cessation of menses x3mon any time after menarche
Hyperandrogenism
Infrequent menses/secondary amenorrhea
Polycystic ovaries on US
Anovulation
? is the mainstay of Tx for abnormal uterine bleeding in Pts w/ Von Willebrand dz
Define Primary Dysmenorrhea
Why is there pain associated w/ this condition
Combo E/P contraception
Pelvic pain during menstruation d/t prostaglandins/leukotrienes from degenerating epithelium
Pressure/ichemia heighten sensitivity to bradykinin
Define Secondary Dysmenorrhea
What are the two MCCs
How is dysmenorrhea Tx
Menstrual pain w/ pelvic pathology
Endometriosis, PID
NSAIDs then hormones w/ f/u and re-eval in 4mon
Most important part of sports physical
What MedHx prevents any sports activity
How long are Pts removed from sports after mono
Hx
Seizure, even if controlled
Stage 2/poorly controlled HTN
x28days
? is the MC psych d/o of childhood
What are the two MC types of abuse
What types of Fxs are highly specific for abuse
Anxiety
1st: neglect
2nd: physical/non-accidental trauma
Rib Scapular Vertebral Spiral
Metaphyseal corner/bucket handle
Define Moxabustion
Stages of bruising colors
Stages of bruising by days
Burning of moxa (mugwort) on acupunture sites
Red Blue Green Yellow Brown Gone
0-2 2-5 5-7 7-10 10-14 2-4wks
What x-ray series is done for suspected abuse
Deficiency of ? element can mimic osteo abuse
How can the age of a Fx be estimated on x-ray
Skeletal survey in Peds <3y/o
Cu
7-14d: new bone/callus
14-21d: loss of Fx line, matured callus
3-6wks: dense callus
>6wks: sclerotic thickening
What is the shaken baby triad
Hygiene hpothesis says infectious agents may be protective against ?
Why are the adverse effects of hypoglycemia in Peds more significant
Retinal hemorrhage
Brain swelling
Subdural hematoma
DMT1
Immature CNS is more susceptible to glycopenia
Define DMT1 honeymoon period
How is this period measured
Inborn errors of amino acid metabolism
Inborn errors of carbs metabolism
Residual B-cell function
C-peptide
PKU Tyrosinemia Homocystinuria Maple syrup
Galactosemia, Hereditary Fructose intolerance
Pts >2mon old may benefit from fever Tx if temp is higher than ?
Criteria for FOUO
Teething process rarely develops fever higher than ?
> 102.2
Temp >100.4 x 8d or more
> 100.4
Febrile Pts who appear well probably have ? etiology of sickness
What are the two MCC of fever in 0-3mon old
When is HSV the cause of a fever suspected
Virus
EColi then GBS
Child <28days old
Define Neonatal Sepsis Work Up <1mon old
Define Neonatal Sepsis Work Up 1-36mon
Admit CBC w/ culture LP US w/ culture Empiric ABX- Ampicillin/Gentamycin
Admit CXR if resp signs/>102.1 and WBC >20K CBC w/ culture US w/ culture LP if neuro/meningeal signs Empiric Ceftriax or Cefotax Stool WBC and culture if diarrhea
What is the MC reason Pts >3y/o seek medical care
Three categories of fever
Temp defines a fever
Timeline for FUO
Fever by benign viruses
Fever of short duration- majority, Dx by PE
Fever w/out focus/source- PE fails to Dx
Fever of unknown origin- >8d or 1wk of admission
> 100.4
> 8d w/out etiology or 1wk of admission
How are meningitis infections established
What two organ systems will have dysfunction
? vaccine has reduced the most cases
Respiratory secretion/droplets
Splenic/Complement C5-8
PCV-13
Define Rash of Meningococcemia
Most important step in the Dx process ?
What are 3 c/is for performing this step
What is the one relative c/i
Petechial rash evolving into purpuric lesions
LP for gram stain
Evidence of ICP other than bulging fontanelle
Severe CardioPulm compromise
Infected skin over LP site
Thrombocytopenia
CT scans prior to LP for meningitis work ups are not recommended, what is needed prior to performing one
Pts are at higher risk for ? during encephalitis compared to during meningitis
3 complications that can remain after Tx of meningitis
ABX- Vanc + 3rd gen Ceftriax
Meropenum if allergic to either
Seizures
SIADH
Hearing loss
Subdural effusion from Strep Pneumo/HIB
3 MCC of encephalitis
? complication post-measles has no Tx
? Sx can help differentiate 5th Dz from other fever rashes
Enteroviruses
Arboviruses- MC is west nile
Herpes virus
Subacute sclerosing panencephalitis
Pruritus
Transplacental Ab protection time frames
Varicella has a higher mortality rate in ImmComp and ? populations
Potential complication from Varicella Zoster
Measles x 12mon
Rubella x 6mon
Roseola x 6mon
> 20y/o
Ramsay Hunt syndrome w/ facial paralysis and ear canal vesicles
Two presentations of HSV
? is the MC chronic, relapsing skin dz of childhood
? genetic component plays a factor in this condition
Gingivostomatitis- gingiva and vermillion border
Labialis- cold sore/fever blister on membranes limited to vermillion border; MC manifestation
Atopic dermatitis/eczema
Filaggrin- epidermal structural protein
What are the cardinal features of Atopic Dermatitis
What parts of the body are commonly involved in Peds
Cornerstone of Tx is ?
Pruritus w/ cutaneous reaction- ithc that raches
Face Scalp Extensor surfaces sparing diaper
Hydrocortisone ointment > cream
? class of topical steroids are avoided in Peds
Along w/ short, warm baths, ? else can aid w/ Sx relief
What/When are topical calineurin inhibitors used
1-2
1/4 cup bleach bath
Pimecrolimus- mild to mod Tacrolimus- mod to sev Unresponsive, Intolerant to other therapies Steroid phobia Face/Neck dermatitis
? systemic medication may be used for severe atopic dermatitis
What are two possible complications from this Dx
How does candida diaper dermatitis present
Cyclosporine 5mg/kg/day
Impetigo- Staph > GAS
Tx w/ topical mupirocin (local) Cephalexin (wide)
Eczema Herpeticum- umbilicated papules w/ crust and punched out erosion
Beefy red tender skin w/ pustules that lasts >4days
How is candida diaper dermatitis Tx
What type of reaction is allergic contact dermatitis
What causes Seborrheic Dermatitis
First line: petroleum/zinc oxide barrier applied last if using multiple topicals
Low potency steroid
Nystatin/Clotrimazole
Type 4 or Delayed
Malassezia yeast
How does Seborrheic Dermatitis present differently from atopic dermatitis
How is Infantile Seborrhea Tx
How is this Tx in children/adolescents
ASx circumscribed, well define (AD- ill-defined) w/ thick/greasy, yellow scales
Ketoconazole
Scalp- antifungal shampoo
Inflamed scalp lesion- Fluocinolone
Non-scalp lesion- Ketoconazole
Once controlled- antifungal shampoo qWk
? is the MC skin d/o in adolescents
What is the mildest form of this MC
How doe males w/ this present
Acne Vulgaris
Comedones on central face
Trunk
What causes perianal dermatitis and how does it present
How is it Tx
Visual acuity of new born infants is ? and legally blind defined as ?
GAS- well demarcated, tender skin 2cm around anus
PO PCN or Amoxicililn
20/400; 20/200
Persistent eye deviation lasting ? long needs referral
Tears are not present until ? time
When are basic eye exams started
> 6mon old
1-3mon
6mon;
3-5y/o: shapes
>5y/o: snellen
What is the Rule of 8s for vision
How can Pts w/ hyperopia/myopia present
Define Amblyopia
Need for vision referral:
2y/o =6=20/60
3y/o +5=20/50
Equals 8 is great, nine or more, vision poor
Hyper: Lack of reading interest
My: squinting
Central vision loss d/t inappropriate visual development
What test ID’s which eye is having tropia
3 MCC of bacterial conjunctivitis
How is this form Tx
Cover test- covering unaffected eye makes affected eye move in opposite direction of deviation
HFlu Strep pneumo M catarrhalis
Topical erythromycin/polymyxin B
Define Bleb
What DDx is considered for conjunctivitis and how is it differentiated
How do blepharitis’ present and how are they Tx
Bump/blister on sclera d/t contact w/ allergens
Cilliary flush- injection around limbus
Eye lid inflammation w/ photophobia/foreign body sensation;
Lid scrub w/ meibaby shampoo/topical ABX
What microbes can cause Dacryocystitis
How is this Tx
Define Hordeolum/Stye
Staph A or Coag negative staph
Massage/warm water compress
Topical ABX if +drainage
Infected glands of Zeis at base of lash follicle w/ Staph A;
Tx: warm compress and NSAIDs
Define Chalazion
How are they Tx
Common cold is MCC by ? and less commonly by ?
Meibomiam gland obstruction causing NON-tender/erythematous swelling
Warm compress
Resistant- refer for steroid injection/surgery
Rhinovirus > Coronavirus
MC complication from common cold
Early and Late phase of allergic rhinitis includes ? events
? class of drug needs to be avoided in the Tx of allergic rhinitis
What are the 4 reasons we Tx Streph pharyngitis
Otitis media
Early: mast cell degranulation
Late: chemical mediator release
Decongestants
Prevent rheumatic fever, spread, and ENT complications
Shorten illness x 24hrs
Define Stridor
Define Wheeze
Define Rhonchi
Define Rales/Crackles
Harsh, INSPIRATORY sound d/t partially obstructed airway
Expiration-
Monophasic, low pitch= lower airway obstruction
High pitch, musical= peripheral airway obstruction
Rattling secretions in airway
Crumpling cellophane d/t fluid/secretions
What is the narrowest part of airway in Pts <3y/o
What is the narrowest part in older Peds/Adults
What is the MCC of stridor in infants
Cricoid ring
Glottis
Laryngomalacia- floppy larynx worse w/ swallowing/GERD
What are the 3 DDxs for Croup and how are they r/o
MCC of airway obstructions in infants
When are CXRs always needed
Epiglotitis- no barking cough
Laryngomalacia- infant <6mon w/ worse Sxs w/ GERD
Bacterial tracheitis d/t Staph A: stridor, leukocytosis
Liquids
First time wheezer, especially if unilateral
What rule is used to determine if Peds need daily anti-inflammatory meds for asthma management
What is the goal of Tx
Rule of Twos:
Day time 2/> per week
Night 2/> per month
Reduce need for SABA 2 or less per week (does not include exercise induced Sxs)
Step 1 Asthma Tx
Step 2 Asthma Tx
Step 3 Asthma Tx
Step 4 Asthma Tx
Step 5 Asthma Tx
Step 6 Asthma Tx
1- Intermittent
SABA PRN
2- Mild
Low ICS daily
3- Moderate
Low ICS + LABA daily
4- Moderate
Med ICS + LABA daily
5- Persistent
High ICS + LABA daily
6- Persistent
High ICS + LABA + PO CCS daily
How are pertussis exposures Tx after close contact
What are the 4 types of functional GI d/os of childhood and how are they characterized
Define GER
Azith x 5d
Clarith/Erythromycin x 7-14days
Pain Aerophagia IBS Dyspepsia;
Daily pain, worse in AM, unassociated w/ meals, not relieved w/ BMs and underlying tendency for anxiety/perfectionism
Effortless spitting up that is normal for Pts <12mon old as long as adequate nutrition maintained w/out respiratory/esophagitis complications
Older Peds w/ GERD are at increased risk for ?
If formula needs to be thickened for Sx relief, how is this done
How is visceral abdominal pain perceived
Esohpageal strictures
Asthma
Barrett’s esophagus
1 Tbsp of rice cereal / oz of fluid
Nonmyelinated fibers w/ slow onset of poorly localized pain
? sensation is a bases for functional abdominal pain and IBS
How is somatic pain perceived
? criteria is used for Functional GI D/os
Overactive visceral pain
Myelinated w/ rapid transmission of well localized pain
Rome 4: Recurrent pain 1d/week for past 3mon w/ two of: Association w/ defecation Change in stool frequency Change in stool form
Define Allergic Collitis
How is this Tx
Define Acute Gastroenteritis
Milk/Soy induced colitis and common cause of bloody stools in infants w/out N/V/ab pain
Breast fed: maternal diet modificaiton
Hydrolyzed protein formula- casein hydrolysate
Rapid onset F/D/N/V w/ 3 or more loose BMs/24hrs
How is non-typhoid salmonella acquired
How is Campylobacter infection acquired
How is E Coli 0157 infection acquired
How is Yersinia infection acquired
Chicken, Reptiles
Poultry, Raw dairy
Unpasteurized dairy, under cooked beef
Chitterlings
How are Pts w/ Acute Gastroenteritis PO rehydrated
How are these Pts re-hydrated w/ IV fluids
MIld: 50ml/kg over 4hrs
Mod: 100mL/kg over 4hrs
Rehydrate 10 mL/kg per each loose stool
Maintain w/ 100ml/kg over 24hrs until diarrhea stops
20mL/kg isotonic NS/LR
10mL/kg for neonates over 20min
Max of 3 boluses then admit
Chronic diarrhea can be d/t ? two enzyme deficiencies
Chronic diarrhea can be d/t ? two allergies
? chronic GI infection can cause chronic diarrhea
Disaccharide- lactase
Lipase- cystic fibrosis
Celiac dz
Milk protein allergy
Giardia lamblia
What is the function of the Foramen Ovale
What is the function of the Ductus Arteriosus
What is the function of the Ductus Venosus
Forament connecting atria to bypass lungs
Opening between pulmonary artery and aorta; kept open w/ Prostaglandin E to keep cyanotic lesion open
Opening between unbilical vein and IVC so placental blood can bypass liver and flow to heart
Infants w/ congenital heart defects may present w/ ? two PE finding
What are the S1-S4 sounds
? will be heard on Pts w/ ASDs
Sweating during feeding
FTT
S1: M/T closure
S2: A/P closure, hidden in holosystolic murmurs
S3: volume- normal variant
S4: ventricular vibration during atrial contraction
Fixed split S2
Clicks heard on cardiac exam indicate ? two things
What is the most important/valuable part of developing DDxs for murmurs
How are murmurs graded
Valve abnormality
Dilated great vessel
Timing/duration
1: very soft
2: easily heard
3: loud w/out thrill
4: loud w/ thrill
5: loud w/ thrill heard w/ stethoscope at 45*
6: heard w/ stethoscope 1cm off chest
? abnormal EKG findings are common in Peds and how can they be confirmed as such
What is the MC symptomatic arrhythmia and how is it Tx
What 4 functional/benign murmurs are there
PAC w/ abnormal axis
Sinus arrhythmia d/t cholinergic input;
Inc/dec w/ in/expiration
SVT-
Stable: valsalva, diving reflex
Unstable: adenosine, synchronized cardioversion
Functional peripheral artery pulmonary stenosis
Venous hum- continuous and dec w/ Pt upright
Stills- systolic LV outflow w/ vibratory/musical quality; dec w/ upright position
Pulmonary- RV outflow
What EKG finding is not normal for Peds
What can cause this to occur
PVCs are more common in older Pts and only need investigation if / criteria are present
Afib/Flutter
Post-surgical repair
Myocarditis
Drug toxicity
Syncope
FamHx sudden death
How is V-tach Tx in Peds
Complete heart blocks are associated w/ ?
How are acquired complete blocks made
Sxs/Unstable: synch’d cardioversion
Concious/ASx: lidocaine or amiodarone
Maternal SLE/Sjogrens
Secondary to cardiac surgery
MC congenital heart defect
PS is heard at ? location and radiates ?
AS is heard at ? location and radiates ?
VSD
LUSB to back
RUSB to neck
Acronym for cyanotic lesions
HE has 5 Ts:
Hypoplastic left heart syndrome- MCC cardiac defect death in 1st month of life
Ebsteins anomaly- TR leading to PFO and cyanosis
Tetrology- MC cyanotic defect
Transposition- 2nd MC cyanotic defect
Tricuspid- no valve, hypoplastic RV
Truncus- no division of pulm artery and aorta
Total anomalous- pulmonary veins don’t connect to LA, instead connect to RA; must keep ASD open for life
How does transposition of great vessels appear on PE
What would be seen on CXR
How is it Tx
Failure to pink up
Egg on a string
PGE to keep ateriosus patent
Ebsteins anomaly may develop w/ ? maternal MedHx
What will be seen on CXR
What causes Infective Endocarditis
Lithium exposure
Box shaped heart
Strep Viridians trapped in fibrin mesh of leaflets
Post-Op: d/t Staph A, Coag-neg Staph
Endocarditis is Dx by ? criteria
What are the major criteria
What are the minor criteria
Duke Criteria:
Two major, One major, two minor:
Blood culture x 2 >12hrs apart One culture w/ Cox Burnetti IgG titer >1:800 Endocardial involvement Positive echo
Predisposing heart condition/IVDA Fever >100.4 Vascular Sxs Immune Sxs Microbe evidence not meeting major critiera
How is infective carditis d/t Strep Viridians Tx
? Pts have the poorest outcome
How are high risk Pts prophylactically managed
PCN G x 4wks
Fungal endocarditis
PO Amoxicillin of Clina/Azith if:
Dental, Respiratory, Skin, Muscle procedures
? form of anemia is associated w/ systemic illnesses that impair marrow synthesis of RBCs
MC signs of anemia d/t hemolysis
Signs of anemia d/t coagulopathy/platelet dysfunction
Normocytic
Pallor, Jaundice
Petechiae, Purpura
DDx for microcytic anemia
DDx for macrocytic anemia
TAILS: Thalassemia Anemia of chornic dz Iron deficiency Lead Sideroblastic
FAT RBC Folate deficiency/Fanconi Alcohol/Aplastic anemia Thyroid, hypo B12 deficiency Cirrhosis/Chronic liver dz
MCC of Aplastic Anemia
How is it Dx
How are they Tx
Idiopathic
Marrow biopsy
Hematopoietic stem cell transplant
Intrinsic causes of hemolytic anemia
RBC membrane defect causes of hemolytic anemia
Extrinsic causes of hemolytic anemia
Systemic d/os causing hemolytic anemia
Thalassemia, Sickle
Spherocytosis
Immune mediated
DIC, Malignancy
What lab results will be seen w/ hemolytic anemia
What is the function of G6PD
What lab finding is created in Pts w/ this deficiency
Inc bili, free hgb
Dec haptoglobin
Keeps glutathione reduced to absorb free radicals
Heinz bodies, Bite cells
Exposure to ? can cause G6PD crisis
Dec G6PD and ? levels are Dx
Define Hemostatic Dz
Naphthalene Fava
Nitro ASA Primaquine Sulfa
NADPH production
Thrombocytopenia <150K
Bleeding/Trauma risk >80K
Spontaneous bleed risk <20K
Define Adjuvant Chemo
Define Neoadjuvant Chemo
What benefits does Neo Chemo offer
Chemo after tumor removal
Chemo while tumor present
Shrinks tumor size
More time for surgical planning
Earlier attack on metastatic dz
Peds w/ Ca can get ? unusual infections
MC and sometimes only presenting Sx of infection in Pts w/ Ca
Pts w/ this MC Sxs and ? need immediate admission
P jiroveci pneumonia
Aspergillosis
Crypto meningitis
HSV infection
Fever
Fever + Neutropenia
What are 3 unique complications only to brain tumor Tx
? is the MC solid neoplasm outside of the CNS and MC infant malignancy
What type of cells make this MC
Cerebellar mutism syndrome: dec speech/behavior
Posterior fossa syndrome: HA and aseptic meningitis
Somnolence syndrome s/p radiation therapy
Neuroblastoma
Neural crease that form adrenal medulla/sympathetic NS
Define Paraneoplastic Syndrome
What two catecholamines are tests for in neuoblastoma Dx work ups
What are the cancer presentation warning signs
Profuse sweating
Secretory diarrhea
Opsoclonus/Myoclonus- dancing eyes/feet
Vanillylmandelic acid
Homovanilic acid
Limp, especially if atraumatic Adenopathy >4wks HA Morning vomiting F/NS/WL
What are the 3 types of generalized seizures
What are the 2 types of focal seizure
Febrile Absensce (petite) Tonic-clonic (grand)
Simple- no altered LOC
Complex- altered LOC
What is seen during the Tonic/Clonic phase of generalized motor seizure
What occurs during the postictal phase
How are these Tx
Tonic: cry, eyes up, apnea, cyanosis
Clonic: spastic/rhythmic shaking
Gradual return of consciousness
Oxcarbazepine, Levetiracetem
What differs focal seizures from others
What are absence seizures precipitated by
How are they Tx
Consciousness is preserved
Hyperventilation
Ethouximide
Define Status Epilepticus
? is the MC recurrent pattern of primary HAs
Define Pseudotumor Cerebri
Ongoing seizure w/out return of consciousness x30min
Tension w/out N/V/phobia (light/noise)
Idiopathic Intracranial HTN- MC idiopathic or rapid onset of weight increasing ICP
What will be seen on PE in Pts w/ Pseudotumor Cerebri
What is a potential adverse outcome
How are they Tx
Abducens palsy
Permanent vision loss
Acetazolamide Topiramate CCS
3 RFs for concussion
Define Arnold Chiari Malformation types
Turf , BMI >27, Train <3hrs/wk
Type 1:
Cerebellar tonsils protrude through magnum into canal;
ASx early on, pregress to HA, urine frequency, LE spasticity
Type 2:
Hydrocephalus w/ myelomeningocele anomaly of hind brain d/t elongation of 4th ventricle causing stridor/weak cry/apena
Define Dandy Walker malformation
Almost all Pt will have ? Dx
How does botulism poisoning initially present
Cystic expansion of 4th ventricle into posterior fossa and cerebellar hypoplasia
Hydrocephalus
Constipation, Poor feeding
Define Duchenne Muscular Dystrophy
What will be seen on PE
? will be seen by 6y/o and ? will be seen by 12y/o
X-linked dystrophin gene mutation causing delayed milestones and toe walkers
Gower- clumsy/easily fatigued muscles
Pseudohypertrophy of calves d/t thigh atrophy
6: arm weakness
12: wheel chair bound
? lab result is elevated in muscular dystrophy
What lab result may be seen after muscle biopsy
? two organs have the same embryonic origin of the ectoderm
CK
Inc CT in muscle
Brain ,Skin
Congenital brain d/os are associated w/ ? abnormalities
What are the two neurocutaneous d/os and what PE findings suggest their Dx
Hair Skin Teeth Nails
NF-1: Cafe au lait macules
Tuberous sclerosis- adenoma sebaceum; fibrovascular lesions that look like acne on nose/malar region or Shagreen patches
NF-1 is AKA ?
What types of cells make up the neurofibromas
90% of adults w/ NF-1 have ? cardinal feature
Von Recklinghausen dz- auto-dom mutation of chrom #17
Schwann
Iris hamartomas- Lisch nodules
Criteria for Dx NF-1
6 or more cafe lait spots Axilla/Inguinal freckles 2 or more lisch nodules 2 ore more neurofibromas Optic gliomas 1* relative w/ NF Osseous lesions on sphenoid/long bones
NF-2 is a defect on ? chromosome that codes for ?
Tuberous Sclerosis has ? defected genes and what they code
This is a common cause of ? infantile issue
#22, merlin NF-1: #17 that coded for neurofibromin
#9: hamartin #21: tuberin
Spasms
What are the 3 cardinal features of Tuberous Sclerosis
What is the MCC of death in adults w/ TS
MC variable presentation of Pts w/ Sturge Weber Syndrome
Adenoma sebaceum/ash leaf spots/Shagreen patch
Intellectual delay
Epilepsy
Renal angiomyolipomas
Seizure d/t ischemic brain injury
What is the MC inherited kidney Dz
What opposite form usually presents w/ kidney failure early in childhood
? kidney malformation is associated w/ Turners
Autosomal dominant PKDz d/t polycystin 1 or 2 defects and w/ cerebral aneurysms
Autosomal recessive PKDz w/ portal HTN
ASx horse shoe kidney
How is an Epididymo-Orchitis differed on exam from testicular torsion
Cryptorchidism is more common in ? population and usually don’t self resolve after ? milestone
Define Hypospadias
+ prehn’s sign w/ EO
Premature; 6mon- refer
Failure of ventral urethral folds to fuse
What are the two etiologies of hypospadias
When is the ideal age for surgical correction
Fetus born w/ polyhydramnios may have ? issue
Congenital Adrenal Hyperplasia w/ female masculinization
Androgen insensitivity
6-12mon
Esophageal/Intestinal atresia
What PE findings suggest tracheoesophageal fistula
Drooling Single umbilical artery VACTERL: Vertebral anomalies Anal atresia Cardiac anomaly TEF Renal anomaly Limb anomaly
How are tracheoesophageal fistulas Dx
What type of contrast agent is used
? structure is defected during diaphragmatic hernia
OG catheter fails to pass, coiled on CXR
Gastrografin
Pleuroperitoneal
Intestinal atresia is associated w/ ? other issues
Define Gastroschisis
Developmental failures during gastrulation are usually accompanies by ? defects
Trisomy 21, CF
Open intestine d/t linear abdominal wall defect, R>L w/out umbilical involvement
CV, GU
Necrotizing Enterocolitis is MC in ? population
? reduces incidences
How is this Tx
Premature <34wks and fed enterally
Human milk feeding
TNP, Broad ABX, Laparotomy
? is the MC childhood surgery and ? causes this MC
How is this MC graded by criteria
Appendicitis d/t fecalith
Alvarado/Mantrels Rule:
1pt: Migrating pain Anorexia N/V Rebound pain Fever WBC >75% neutrophils
2pts: RLQ tenderness, Leukocytosis >10K
2mon milestones
4mon milestones
Lifts shoulder when prone
Tracks past mid-line to search for sound
Smiles and coos
Rolls, lifts on hands, no head lag
Reaches w/ raked grasp
Look at hands, moves to toys
Laugh, squeals
6mon milestones
9mon milestones
Sits
Transfers objects from hand to hand
Feeds/holds bottle
Babbles
Pulls to stand, can get into seated position
Pincer grasp/bangs objects together
Waves bye/patty cake
Non-specific two syllable words
12mon milestones
15mon milestones
24mon milestones
Walks, stoops, stands
Put block into cup/drinks from cups
Immitates
Specific one/two syllable words
Walks backward
Scribbles/stacks 2 blocks
Spoon/fork
Follows commands for house work w/ 3-6 word response
Walks up and down stairs
Stacks 6 blocks
Washes hands, understands ‘today’
What are the top 5 MCC of unintentional injuries in kids 9-18
Glasgow coma scale
What fluid needs to be avoided when giving pRBC transfusions
MVC Drown Burn Fall Toxin
Eye: Spontaneous Verbal Pain None
Verbal: Orient Confused Inappropriate Unspecific None
Motor: Follows Localizes Withdraws Flex Extension None
LR- causes hemolysis
What is the primary cause of cardiopulmonary arrest in children
MC type of shock in kids
MCC of distributive shock
Respiratory arrest
Hypovolemic
Sepsis
What causes dissociative shock
? are the MC types of trauma injuries in Peds
? is the 2nd and 3rd leading cause of traumatic death
Carbon monoxide poisoning
Head/limb injury
2nd: Thoracic trauma: MC being rib Fxs
3rd: abdominal trauma
? is the MC abdominal organ injured in kids
What PE sign helps find this injury
What imms are needed if this MC is taken out
Spleen
Kehr
Pneumococcal and HFlu w/ PCN prophylaxis
Define ALTE
What are the two MCCs
? prognostic factor is favorable after near drowning
Acute Life Threatening Event
GERD, Laryngospasm
Regains consciousness enroute to hospital
Rule of 9s in infant
When is a transfer to peds burn center indicated
What ABX are used
Head- 18
Chest/Back: 18 each
Legs: 14
Arms: 9
> 10% TBSA in <10y/o
20% in other age groups
Face/Hand/Feet/Genital/Perenium
Silver sulfadiazine
Polymyxin B
Bacitracin
Neomycin
Activated charcoal is ineffective against ? ingestions
? ingestions should received multiple doses
? two ingestions cause alkalinization of the urine
Caustic/Corrosive
Hydrocarbons
Metals: Mercury Arsenic Iron Lithium Lead
Glycols
Carbamazepine Dapsone Theophylline Phenobarbital Quinine
Salicylate, Methotrexate; bugger w/ IV BiCarb and D5
Classic triad of narcotic poisoning
? much Narcan can be used
What is the antidote for Fe ingestion poisoning
Miosis
Decreased mental status
Respiratory depression
<1y/o: 1 ampule
>1y/o: 2 ampules
Deferoxamine
When using Deferoxamine for Fe poisoning antidote, it’s use is c/i in ? Pts and may predispose them to ? sepsis
Antidote for tylenol poisoning
What lab results will be seen early/late in process
Renal failure, Yersinia
N-Acetylcysteine
E: respiratory alkalosis
L: metabolic acidosis w/ severe anion gap
How is lead poisoning Tx
Methanol ingestion is converted into ?
Ethylene glycol ingestion is converted into ?
Edetate Ca disodium
Dimercaprol- British antilewisite; peanut allergy
Formic acid
Oxalic acid
Methanol/Ethylene Glycol ingestions will both present w/ ?
How are they Tx
What two supplements are used during Tx
Metabolic acidosis
10% ethanol w/ D5
Fomepizole- alcohol dehydrogenase inhibitor
Thiamine/B6- ethylene
Folic acid- methanol
Organophosphate poisoning causes ? syndrome
How is this Tx
Aspiration of ? compound causes lipoid pneumonitis
SLUDGE:
Salivation Lacrimation Urination Defecation Gastroenteritis Emesis
Atropine then Pralidoxime
Petroleum hydrocarbons
Only time gastric lavage is used
MC foreign body ingestions
How are these ingestions Tx
Nicotine ingestion OD w/ charcoal and atropine
Coins
Endoscopy
What causes anaphylactoid reactions
MC type of non-pyseal Fxs
Buckle/Torus Fxs typically occur ?
Non-IgE reaction to anaphylatoxins- C3/5a
Complete Fx: Comminuted Oblique Transverse Spiral
Metaphysis w/out cortex breaking d/t FOOSH
Define Gymnast Wrist
How is this Tx
Distal radial physis injury from repetitive impact
Absolute rest from impact/weight bearing
Female Tanner Stages
No Budy Elevates 2 Mountains in Adulthood:
1: no glandular tissue
2: buds form
3: breast elevated
4: secondary mounds
5: adult size
No Small Cat Sparing Thighs
1: no hair
2: small amount of hair
3: coarse hair
4: adult like sparing thighs
5: adult like encompassing thighs
Male Tanner Stages
Genitals: 1- child 2- enlargement, scrotal reddens 3- length 4- girth 5- adult
No Small Cat Sparing Thighs
1: no hair
2: small amount of hair
3: coarse hair
4: adult like sparing thighs
5: adult like encompassing thighs
