Peds Uworld Flashcards
Metatarsus Adductus vs Clubfoot
MA- Medial deviation of the forefoot that moves laterally with passive and active movement
Clubfoot- Medial and upward deviation of the fore and hind foot. Tx- serial manupuliation and casting as soon as born. Consider karyotyping b/c associated with chromosomal abnormalities.
Preseptal (perirbital) vs postseptal (orbital)
Periorbital- Eyelid edema, erythema, tenderness, leukocytosis, fever
Orbital- above PLUS opthalmoplegia, pain with movement, proptosis and vision impairment. Tx iwth IV AB b/c risk of blindness, abcess of the brain, venous sinus thrombosis
Pediatric Viral Myocarditis
Presentation, causes, tx
Presentation- viral prodrome then heart failure *dyspnea, syncope, tachy, N/V, hepatomegaly
Dx- x-ray, echo, ekg, Gold STANDARD- biopsy to show infiltrate of myocardium with myocyte necrosis
Bugs- adeno and coxsackie
PE- can have large liver and holosytolic murmur from dilated cardiomyopathy
Vesicoureteral reflux
Presentation- 2-24 months with UTI
Dx- first get renal US afer 1st UTI. IF they have recurrent UTIs get a voiding cystourethragram
VCUG
Grade 1- into a non dilated ureter
Grade 2- into pelvis and calyxes without dilation
Grade 3- mild to moderate dilation of ureter, pelvis and calyces with minimal blunting
Grade 4- moderate urethral touristy and dilation of pelvis
Grade V- Gross dilation of the ureter, pelvis and calyxes and loss pf papillary impressions and urethral tortousity
Spondylooslisthesis
Developmental disorder characterized by a forward slip of the vertebrae (L5/s1). Presents with progressive back pain and neurological symptoms.
Vs primary/metastasis to spine- usually doesn’t have step off
Primary Amenorrhea
If no menses by 14 start work up
Pelvis US
Uterus–> FHS
FSH low get MRI, FSH high karotype
No uterus–> karotype
46XX abnormal mullerian
46XY- androgen insensitive
Tension Pneumothorax
Triad of Sudden hypoxia, trachea deviation, and unilateral absent breath sounds
Tx- needle thoracostomy
Niacin defeciecny
Pellagra- diarrhea, dermatitis (sun exposed areas), and dementia. and glossitis
Patient either in a 3rd world country with corn and starch as main diet or bowel absorption
Prepubertal bleeding
Trauma- unintentional fall, sexual abuse
Rhabdomyosarcoma- rare, kids over 3, protruding vaginal nodules
Estrogen withdrawal- neonatal period, <1 week and exam otherwise normal
fanconi
Apastic anemia and progressive bone marrow failure. Autosomal recessive
Appearance- kids <16 short stature, microcephaly, abnormal thumbs, hypogonadism, hypo/perpigmented area, cafe au lait spots, eye and ear abnormalites
Cause- chromosomal break
Nec
Presentation- premature, small, heart disease (decreases profusion to the gut)
Clinical- vital sign instability, GI signs- vomitting, lood in stool, abdominal tenderness/distension
Xray- pneumotosis intestinalsis, portal venous gas
Tx- NPO, borad spectrum AB, possible sx
Levels of dehydration
Mild- 3-5% volume loss no clinical signs
MOderate 6-9%- decreased skin tugor, dry mucus membranes, tachy, irribility, decreased UOP
Severe >10% cool, clammy skin, dry mucous membranes, sunken eyes, sunken fontanelle, tachy, lethargy, NO UOP
Vit K in neonates
Give two paraenteral injection of Vitamin K becauase it has poor placental transfer, absent gut flora, and immature liver so they cant produce their own.
Signs may be bruising, bloody stool, IC hemorrhage, and elevated PT with normal or elevated PTT
Presentation, Labs and Diagnostics of Hereditary Spherocytosis
Increase indirect bili, splenomegaly, jaundice, hemolytic anemia
Labs- increase bili, Increase RDW, increase MHCH
Dx- esosin 5 maleimide binding test, osmotic fragility test
Tx- splenectomy
Risk factors for RDS in neonates
Premature Maternal DM C section with no labor Male sex perinatal asphyxia
Presentation of SSTrait
HbA 50% and HbS- 35% Hb F<2%
increased risk of renal issures and usually have painless hematuria that results from sickling in the medulla. Isosthernuria (impairment in concentration) is also common and they have nocturia and polyuria.
Lymphadenitits in children
Presentation kids under 5 nontoxic appearing and the affected node is warm, tender, erythematous and 3-6cm in size— acute and unilateral is usually bactieral (staph Aureus or strep)
Iron poisoning
Presentation
Diagnostic
Tx
Abdominal pain, N/V, hypotensive shock, metabolic acidosis. Within 2 days hepatic necrosis, within 6 days pyloric stenosis
Diagnostic- anion gap metabolic acidosis and radioopaque pills
tx- bowel irrigation, deferoxamine, supportive care
RTA Type 1, 2, 4
Primary defect, urine pH, serum K, and causes
RTA 1- distal, poor hydrogen secretion into urine, pH> 5.5, serum K- low-normal, causes- genetic, medicaiton, AI
RTA 2(proximal) - poor bicarb resorption, pH urine<5,5 (urine is acidified by alpha- intercalated cells in the Collecting ducts ), serum K- low/normal, fanconi syndrome
RTA 4- aldosterone resistance, urine ph <5.5, serum K high, Causes obstructive uropathy and congential adrenal hyperplasia
All RTAs present with failure to thrive due to poor cellular growth and divisin in acidici conditions
Clinical features and management of caustic ingestion in kid
Features- laryngeal damage- hoarseness and stridor, esophageal damage, hysphagia gastric damage- bleeding, epigastric pain
Management- ABC, decontamination so remove clothing and DO ENDOSCOPY within 24 hours
Avoid anything that could induce vomitting like milk, water, activated charcoal, vinegar, NG lavage as this could icnrease injury. BG should be placed with endoscopy as to not damage or perforate.
Benign vs pathologic murmur in kids
Benign- kid otherwise asymptomatic, usually a mid systolic murmur taht DECREASES WHEN STANDING AND WITH VALSALVA. Don’t work up
Pathologic- chest pain, diaphoresiss, syncope, heart defect, fam hx
Harsh, holosytolic increases with standing and valsalve.
Get EKG and Echo and refer to cardio
Most common organisms for osteo in <2months, 2months-4, >4, SSD
<2 months- E coli and group B
2months-4yrs- Kingella kingae
>4 yo- Staph Aureus
SSD- salmonella (3/4 of all SSD osteo), S aureus– remember that microinfarcts can impair flow and increase risk of osteo. Tx empiraically with ceftriaxone and anti-staph dxs (oxacillin, vanc)
OSteoid OSteom
CP
TX
DX
Benign bone-forming tumor common in adolesecents
CP- focal tenderness, deformities, or swelling but usually no findings in adolescents. Pains worst at night and better with NSAIDS
X-ray- hypodense lesion on x-ray
TX- NSAIDs for pain, serial examination and x-rays for 4-5 months to monitor
Reyes- Etiology CP Lab Dx Tx
Etiology- ASA in kids in the setting of viral infection (Flu or varicella usually)
CP- Acute liver failure and encephalopathy
Lab- elevated liver enzymes, increase PT/PTT, increase NH3
Dx- liver biopsy showing MICROvesicular steatosis
Tx- Supoprtive
HUS- pathogenesis
CP
Labs
Tx
Shiga toxin from Ecoli causing vascular damage and microthrombi form
CP- FATRN- fever, prodrome of bloody diarrhea, bruising and petechia, edema/oliguria
Labs- low platelets, anemia, AKI- Increased BUN and Cr
Tx- dialysis, fluids, electrolyte correction
Workup for bilious vomitting in a newborn
- X-ray to make sure there isn’t pneumoperitoneum requiring immediate sx
- Water soluble contrast enema- if there is microcolon we would consider meconium ileum and hope the hyperosmolar enema breaks up the meconium.
- If the contrast enema shows a transition zone then consider rectal biopsy for hirschsprung
common resp tract infection in children
Tx for who
Complications
Bronchiolities caused RSV <2 years old= most common
Clinical presentation- wheezing, crackles, resp distress… can have nasal congestion and cough
tx- supportive
Palivizumab for premature <29 weeks, chronic lung develop prematurity, hemodynaically significant heart disease
Complications- apnea and resp failure
Presentation of trachoma/bug/tx
Child in unsanitary conditions presenting with conjunctival injection, tarsal inflammation and pale follices. Kids can often concomitant nasopharyngeal infection.
Due to Chlamydia serotypes A, B, and C
Complications- repeated infection can lead to scarring and inversion (trichiasis) and blindness.
Dx- can be clinical- TARSAL CONJUNCTIVAE or use giemsa stain.
Tx- azithromycin or eyelid sx.
Risk factors for UTI in kids and when to do a workup
Risk factors- girls, uncircumcised penis, underlying renal anomaly
Any kids with a fever >102.2 should have a occult UTI investigation. If they kid is in diapers straight cath, ua, and culture. If they aren’t they UA and culture
Anemia of Prematurity Etiology Clinical P Labs Tx
Etiology- low EPO, short RBC life span, iatrogenic blood sampling
Clinical manifestations- usually asymptoamtic, tacycardic, apnea,, poor weight gain
Lab findings-low Hb and low hemotocrit, low RC, normocytic, normochromic RBCs
Tx- iron, minimize blood draws, minmize transfusion
igA
CP
Dx
Tx
CP- can be asymptomatic, asthma/eczema AI Anaphylaxis to igA containing blood Recurrent sinopulmonary and GI infections,
Dx- Low or absent igA with normal IgG, IgM
Tx- supportive, medical alert bracalet for transfusions
Tx of croup
Mild (no stridor at rest)- steroids
Moderate/severe- stridor at rest- steroids and nebulized epinephrine
If they fail this then intubate
Biliary Atresia
CP
Dx
Tx
CP- pale stool, direct >2 o2 20% of the total bili. Hepatomegaly, mild elevated transaminases
Dx- Liver US (is there a gallbladder)
Hepatobiliary scintigraphy (does the liver excrete the tracer to the small bowel)
LIver biopsy
Intraopertive cholangiogram (Gold standard)
Tx- Hepatoportoenterostomy or liver transplant
Osgood-Schlatter
Common knee pain in adolescent male. During rapid periods of growth in which the quads tendon puts traction on the apophysis of the tibial tubercle where the patellar tendon inserts. Worst during sports.
PE- tenderness and edema over the tibial tubercle.
Retropharyngeal abcess vs. epiglottis
BOth- fever, dysphagia, muffled voice, drooling
RPA- inability to extend neck and widened preveretebral space. Get a CT with contraast
Work up for precocious puberty
Secondary sexual development girls <8 and guys <9
- Check bone age
- Advance- basal LH
- Low- GNrh independent precocious puberty
- High- GnRH (central) dependent - Normal
Acute Cervical Adenitis
Bugs for Bi/UNilateral
Bugs
CP
CP- kids under 5, enlarged, markedly tender, warm and erythematous. Clinical dx and treat with AB
Unilateral- staph and strep
Bilateral- Adenovirus and EBV/CMV
Presentation of Herpangina
Bug
Coxsackie A
Early fall/summer
Fever, phayngitis, gray vesicles ulcers on the POSTERIOR oropharynx
Can also have rashes on hands and foot
vs Strep (positive for TENDER adenopathy and exudate)
Contraindications to rotavirus
- Anaphylaxis to vaccine ingredients
- Hx of intussuception
- Hx of uncorrected congenital malformations of the GI tract
- Severe combined immuno disease
Neonatal Conjunctivitis
Chemical <24 hours- mild conjunctival irritation and tearing after silver nitrate. Tx with lubricational
Gonococcal 2-5 days. Marked eye swelling, profuse prulent discharge and corneal edema/ulceration- Tx. sigle IM dose of 3rd gen cephalosporin
Chlamydial 5-14days. Mild eyelid swelling, watery, seroanguinous or mucoprulent eye discharge- Tx PO macrolide
Impetigo
Non-bullous- staph or group A strep, painful non-pruitic pustules, honey contrusted
Bullous- staph, rapidly enlarging flaccid bullae with yellow fluid.
Tx- Limited skin involvement topical AB- mupriocin
Extensive skin involvement- oral AB- cephalexin, dicoxacillin, clinda
MCune Albirght
3 ps Precocious puberty, Pigementation- cafe au lait spots
Poloyostotic firbous dyaplasia - bone defects.
G-protein cAMP kinase functions
Eczema/atopic dermatitis
Etiology- dysfucntion in synthesis of stratum corneum
Infant- itchy, red, scaly, crusted on extensors
Tx- topical emolients and possible steroids
Complciations- cellulitis, eczema herpeticum and discomfort interrupting sleep
Laryngomalacia
Pathophys- increased laxity of the supraglottic structures
CP-stridor and “weird breathing” that peaks at 4-8 months. Worst when feeding and supine.
Dx- clinically but confirmed on flexible laryngoscopy
Management- reassurance for most, supraglottoplasty for severe
Usually self resolve by 18 months
Vascular rings
Biphasic stridor and feeding difficulties 2/2 compression of teh trachea and esophagus.
Dx- Barium swallow and MRI with angio
X-linked agammaglobulenemia
CP- recurrent sinopulmonary and GI infections (pneumo Giardia) AFTER 6 MONTHS OF AGE , Absence of lymphoid tissue (scant LN, tonsils)
Dx- Low B cells, and normal T cells, no response to vaccines
Tx- Immunoglobulin replacement therapy and prophylactic antibiotcs
Iron Poisoning
CP- N/V, abdominal pain, hypotensive shock, metabolic acidosis with anion gap, 30mins to 4 days, radio-opaque pills. Iron can be corrosive to the GI tract, gastric scarring and hematemesis
vs acetoaminophen that takes usually like 24 hours
2 days- hepatic necrosis
2-8 weeks- pyloric stenosis
Tx- whole bowel irrigation, deferoxamine, supportive care
Aplastic Crisis
SSD- chronically low anemia, high retic count
aplastic crisis- acute drop in Hb, without compensatory rise in RC and WITHOUT spelnomegaly
Coartaction of the aorita
Pathology- thickening of tunica media of aortic arch near ductus arteriosus
CP- HTN in upper extremity, weak femoral pulse, low post ductal oxygen saturation
Heart failure (irritability/poor feeding/diaphoresis)
Tx- surgical repair
Leukocyte Adhesion Defeciency
LAD
Lots of infections skin and mucosal infections
Absent pus formation
Delayed Umbilical Cord seperation
MARKED PERIPHERAL LEUKOCYTOSIS WITH NEUTROPHILIA- neutrophils can’t go to the site of infection because of defect in LFA-1 (CD-18) gene inhibiting adhesion and migration
TET
Murmur type
Harsh sytolic Murmur ejection murmur over left upper ejection murmur. Single S2 becuase pulmonic is inaudible
Breastfeeding vs Breast Milk Juandice
vs Biliary Atresia
Breastfeeding failure jaundice- first week of life. High UNCONJUGATED bili Lactation failure resulting in decreased bilirubin elimination, increase enteroheptic circulatin and suboptimal breastfeeding with signs of dehydration
Breast Milk Jaundice starts at age 3-5 peaks at 2 weeks, high levels of B-glucoronidase in breast milk decojugate inttestinal bilirubin and increase enterohepatic ciruclation
Biliary atresia- high CONJUGATED bili
Legg Calve Presentation
Progressive Antalgic gait, unilateral subacute hip pain in a male, thigh muscle atrophy, decreased ROM, collpase of ipislateral femoral headon plain pelvic x-ray .
Tx of DiGeorge
thymic transplant
Should have dysmorphic facial features, paltal defects, cardiac deformatives
tx of WAS
Hematopoietic stem cell transplant b/c of the x-linked impaired cytoskelton
Absence Seizures
Occurence during all activities
Length <20 seconds
Lack of response to verbal or tactiles stimulation
Presence of automatism ((eyelid fluttering)
Provoked by hyperventilation and dignosed by 3Hz psike waves on ECG
Spondylolisthesis
Developmental disorder (usually presents in preadolescents) characterized by a forward slip of vertebrae L5 or S1. Can cause chronic back pain and neurologic problems. Palapble STEP OFF on exam.
INsulin in refeeding
carbs trigger insulin release and that causes an uptake of K+, phos, and mag. The decrease
Mumur in
1, Ebstein
2. PDA
- triple or quadruple gallp widely slspilt S1 and S2 sounds plus loud S3 and/or S4 and holosytolic murmur at LLSB
- Machine like associated with rubella
- TOF- cres-decres systolic murmur heard best at and single second heart sign
Workup for abnormal uterine bleeding
CBC, coag studies, pregnancy test
In peds like immature axis- treat with high dose oral estrogen/progestin contraceptive pills. stabilizes the endometrium and stops menstrual bleeding
Indications for renal and bladder US
Infants and children <24 months with first febrile UTI
Recurrent febrile UTIs in children of any age
Non response to AB
UTI in child of any age with family hx or renal or urologica disease or personal hx HTN or poor growth
Indications of Cystourthrogram
Less than <1 month and children <2 yo with recurrent UTI, or first UTI with an organism other than Ecoli. Or abnormalities on US
Choanal Atresia
Aggravated by feeding, relieved by crying.
dx- failure to pass catheter and confirmed on CT
CHARGE Coloboma Heart Defects Atresia chonae Retardation of growth/development GU abnormalities Ear abnormalties
Retropharygneal Abcess
Dyspagia, drooling, muffled voice, neck stiffness, trismus likely in the setting of pre existing URI in a kid 6 months to 6 years old
PE- inability to extend neck and widened pre-vertebral space (vs epiglottitis which shows thumb sign)
CGD
X-linked disorder that prevents phagocytic oxidative burst (formation of H2O2) and therefore impairs intracellular killing by phagocytes
Recurrent infections from catalase positive organisms in the lnungs and soft tissue.
Dx is neutrophil function testing- dihydrohodamine 123 test and nitroblue tetrazolium test
Test for different immunodef
- CGD
- X-linked Brutons
- Complement defeciecny
- DiGeorge
- Neutrophil levels- dihydrodamine 123/nitroblue tetrazolium test
- B cell and immunoglobulin levels
- CH50
- T cell
Seborrheic dermatitis
Peaks in infancy
Erythematous plaques and thick/yellow/greasy sclares
Located on scalp and face face
Tx- emolients
2nd line- topical antifungals and low potency steroids.
Biliary Atresia
Presentation
Pathophys
Dx
Tx
Presentation- normal at first then week 2-8 juandice and elevated conjugated bili. Light colored stool and dark stool, mild elevation in transaminases
Pathophys- progressive obilteration of the extrahepatic biliary ducts so no connection the liver to small bowel. Without tx will cause inflamed liver (hepatomegaly and hepatitis)
Dx-
US- no or abnormal GB
Hepatobiliary scinitigraphy- failure of tracer excretion
Liver biospy- expanded portal tracts with portal tract edema
GS- intraoperative chlangiogram- biliary obstruction
Tx- liver transplant (number one reason for pediatric liver trasnplant)
Croup treatment-
No stridor then steroids and himidifed air
Moderate/severe stridor- steroids and nebulized epi
Pending resp failure- intubate
Murmur in each cardiac problem
Transposition of the great vessels- Single S2 could have no murmur (POF) or VSD/PDA murmur- egg on a a string
TOF- left upper border single S2, cres/des systolic murmur + VSD murmur
Tricuspid Ateriosus- single S2
TAPVRWO = severe cyanosis, resp distress- pulm edema and snowman sign
Resp failure in asthamatics
Minimal to no wheezing Cyanosis Chest wall retrations Altered mental status Extreme fatigue
Lab findings low PO2
High PCO2
Low pH- resp acidosis
varicella immunity
Children are not considered immune unti lthey have two doses (1 and 4) or they’ve been infected. If not immune and exposed >1 yo, exposed int he last 5 daysand immunocompetetn given them a varicelle vaccine
If pregnant or immunoincompetent give then varicella immunogolbulin
Under <1 don’t need anything
Pathological Juandice
- Day one elevated- do coombs b/c likely hemolytic
- Over 12 at any time
- Direct is >2- always consider sepsis
Bonus- fast rate of rise
X-ray findings
- TTN
- RDS
- Peristant Pulm HTN
- TTN- peri-hilar streaking/air trapping due to retained fluid
- White out- diffuse reticulogranular appearance, air bronchograms
- Clear lungs with decreased pulmonary vascularity
