peds101 Flashcards
antibiotic activity against pseudomonas for Cf patients
ceftazadime(or penicillin deriv) plus aminoglycoside like amikacin or gentamycin
digeorge syndrome
catch22- conotruncal cardiac defects; abnormal facies; thymic aplasia, cleft palate; hypocalcemia
2 year old vocab
150-300 words
micrognathia, microcephaly, overlapping fingers, rocker bottom feet, VSD, absent palmar creases
edwards syndrome, trisomy 18
heart defect in trisomy 21
ASD or endocardial cushion defect
william’s syndrome heart defect
supravalvular aortic stenosis, pulm stenosis, or septal defects
what are the CATCH-22 syndromes
digeorge and velocardiofacial
what cardiac abnormality is assoc with the catch-22 syndromes
conotruncal abnormalities (truncus, tet of fallot, interupted aortic arch)
interupted aortic arch
almost always assoc with VSD
congenital heart block assoc with what?
neonatal lupus
PDA assoc with what?
congenital rubella
coronary artery aneurysms
kawasaki disease
treatement of pertussis
macrolides in catarrhal stage; less effective later on
macrolide abx
azithromycin, clarithromycin
post-tussive emesis
think pertusis
hemophilic arthropathy
late complic of hemophilia and caused by hemosidern/iron dep leading to synovitis and fibrosis within the joint
patient with alkali ingestion
upper GI endoscopy
whenever IV access cannot be obtained, what do you try next?
intraosseus cannulation; osteomyelitis is a rare complication
vitD supplementation in breast fed babies
400 IU daily
treatment of rickets
1000-2000 IU daily of vit D
congenital syphilis
frontal bossing, anterior bowing of the shins (saber shins); saddle nose deformity; notch-gapped teeth (Hutchinson teeth)
cupping and fraying of the metaphyses of the lung bones
sign of rickets on xray
postpericardiotomy syndrome
pleuropericardial disease that occurs days to months after cardiac surgery; inflamm from surgery leads to pericardial effusion;
CHF on chest xray
pulm vascular congestion and interstitial edema
treatment for OCD
fluoxetine or other high dose SSRI
dermatitis herpetiformis
itchy blistering rash assoc with celiac disease
prolonged PR interval on EKG
think rheumatic fever
therapy in pericarditis
salicylates
paramyxo virus
measles and mumps
most common organism responsible for pericarditis
coxsackie virus
leukocyte def type 1
deficiency in ability of neutrophils to migrate; absence of pus with infection; delayed umbilical cord separation; poor wound healing; recurrent skin and mucosal bacterial infections; periodontiti, often necrotizine
leukocyte def type 1 on lab
leukocytosis with neutrophil predominance; bx shows inflamm infiltrate devoid of neutrophils
adenosine deaminase def
AR form of SCID; toxic accum of adenosine leads to def in mature B and T cell formation
nitroblue tetrazolium test
neg (abnormal) in chronic granulomatous disease
chronic granulomatous disease pathophy
defective intracellular killing due to impaired respiratory burst from activated phagocytes; nitroblue tetrazolium test is neg; dihydrohodamine 123 test is more sens and quantify the severity of illness
developmental defects in the pharyngeal arch system
digeoge
digeorge immune def
T cell def; also thymic hypoplasia
opsonization defects result from what
asplenia because spleen produces opsonizing antibody, which is required for clearance of encapsulated organisms
preseptal cellulitis
aka periorbital cellulitis
proptosis
eyes popping out
murmur in coarctation of the aorta
heard all over the chest due to collaterals developing
rib notching
caused by dilation of the collateral chest wall vessels in coarctation of the aorta
pericardial calcification
constrictive pericarditis
how to diagnose absence seizure
ask patient to hyperventilate; it should mimic the seizure
no post-ictal state in absence seizures
right
differentiating between typical and atypical absence seizure
atypical is slower (freq 2.5 hz as opposed to 3 hz)
iron poisoning tx
deferoxamine
TCA and aspirin overdose antidote
sodium bicarb
prolonged QT and torsade des pointes- what med to give patien?
mag sulfate
severe lithium toxicity
hemodialysis because lithium is very dializable
hyperkalemia- give what to protect the heart
calcium gluconate
oral succimer
lead poisoning chelating agent
pediatric viral myocarditis caused by what
coxsackie or adenovirus
why would heart failure due to myocarditis give you a holosystolic murmur
the heart dilates because it is filled with blood it cannot pump and then you get mitral regurg during systole
myocarditis on echo
global hypokinesis
why is strep pharyngitis (and rheumatic fever) uncommon in kids less than 3
they have fewer epithelial cells in the throat for the strep to infect
can you see wheezing in a patient with pulm edema?
yes
blue sclerae and hearing loss
osteogenesis imperfecta; defect in type 1 collagen
fibrillin-1 defect
marfans
the most common predisposing factor for bacterial sinusitis
viral URI
treatment for bacterial sinusitis
amox plus clavulonic acid
kid with uti less than 24 mos
treat and then do renal and bladder u/s to see if there is anatomic reason exposed to UTI
koplik’s spots
red spots with bluish specks over the buccal mucosa seen in measles; fade once the rash appears
rash in measles
starts on face and spreads to trunk and extremities
herpes virus 6 causes what rash
roseola infantum
croup aka
laryngotracheobronchitis
laryngeal diptheria
can present like croup; in an unvaccin kid
hypointense center with ring enhancement on brain CT
brain abscess
bullous myringitis
seen in patients with acute otitis media; bullous on the TM; more severe ear pain than normal OM; assoc with mycoplasma pneumoniae
cholesteatoma
growth of squamous epithelium in the middle ear
what condition is assoc with false pos RPR test results
lupus
cystic hygroma
lymphangioma; dilated lymphatic spacies lined by endothelium; commonly occur on the neck
clubfoot management
stretching, manipulation of the foot, and serial casting
terbinafine
a topical antifungal
mongolian spot
congenital dermal melanocytosis; fades spontaneously during the first decade of life
babinski reflex
normal (adult) is to have a plantar response; up to 2 year olds, an extensor response is normal
acute unilateral lymphadenitis
bacterial infection, usually staph aureus, next most common is group a strep
difference between craniopharyngioma and pituitary tumor
craniopharyngioma has calcifications; pit tumor secretes prolactin in addition
adolescent with nosebleeds, nasal mass, and nasal obstruction
think juvenile angiofibroma until proven otherwise
treatment of juvenile angiofibroma
if asymp, no tx; if symp, surgical removal but recurrance is common
what is an endocardial cushion defect?
AV septal defect; assoc with Down syndrome
midsystolic click with late systolic murmur
mitral valve prolapse
transposition of the great vessels often seen in what patients
infants of diabetic mothers; and males
larygoscopy shows collapse of supraglottic structures with inspiration and omega shaped epiglottis
laryngomalacia
management of laryngomalacia
reassurance; usually resolve by 18 mos; for some, surgery supraglotoplasty is indicated
stridor ddx
croup, laryngomalacia, foreign body,
stridor that is worse in the supine pos and exacerbated by crying or wheezing
laryngomalacia
when does laryngomalacia present
4-8 months, resolves by 18 mos
most common cause of chronic stridor in infants
laryngomalacia
vomitting, arching of the back with feeds, and poor weight gain
GER
vascular rings, biphasic stridor, and feeding difficulties
anomalous branch of the aortic arch encircles the trache and esophagus; confirm w MRI and angiography
toddler with fever, drooling, dysphagia, neck pain, and stridor
retropharygeal abscess
prevertebral soft tissue thickening
retropharyngeal abscess
pain with eye movements, proptosis, opthalmoplegia, and diplopia
orbital cellulitis; bacterial sinusitis is the most common predisposing factor
beckwith-weidemann genetics
11p15 mutation
beckwith-weidemann physical exam
fetal macosomia, rapid growth, oomphalocele or umbilical hernia, macroglossia, hemihyperplasia
complications of b-w
wilms tumor, hepatoblastoma
surveillance in w-d syndrome
serum alpha protein, abdominal/renal ultrasound
why do babies with B-W syndrome need to be monitored for hypoglycemia>
they produce excess insulin like growth factor
most common complication in patients with sickle cell trait
painless hematuria
hep B assoc with what renal disease?
membraneous nephritis
most common cause of nephrotic syndrome in kids
minimal change disease
classic triad of congenital rubella syndrome
deafness, cataracts, cardiac defects (PDA, ASDs)
eczema herpeticum
form of primary HSV that is associated with atopic dermatitis; superimposed on healing eczema lesions after exposure to herpes; umbilicated vesicles on an erythematous base; can be life threatening in infants
HSP
leukocytoclastic (destroy WBC) vasculitis; palpable purpura on LE with normal platelet count; can present with scrotal pain/swelling; igA dep; renal disease, abdom pain
complications of HSP
GI hemorrhage and intussusception
intussusceptions in HSP
more likely to be small bowel or ileo-ileal (as opposed to ileo-colic like in other cases)
small bowel intussusception on u/s
target sign; unlike ileocolic intuss, which can be seen on contrast enema
serum sickness like reaction occurs when
like 1-2 weeks after you have taking an antibiotic
how does maternal diabetes lead to RDS?
fetal hyperinsulinism antagonizes corticoids, which mature the lung; interestingly, intrauterine stress decr the risk of RDS
how to treat cervical lymphadenopathy
usually caused by staph and strep; use dicloxacillin
difference between simple partial seizures, partial seizures with generalization, and complex partial seizures
no loss of conciousness in simple only; the other two have loss of consciousness; partial generalized has tonic-clonic activity
diffuse muscle aches and elevated cpk in a seizure
indicates tonic-clonic
Lennox-gaustat syndrome
mental retardation, seizures,
cri-du-chat sndrome
cat like cry, hypotonia, short stature, microcephaly with protruding metopic suture, moonlike facies, hypertelorism, epicanthal folds, high arched palate, wide and flat nasal bridge, mental retardation
5p deletion
cru-di-chat
4 p deletion
wolf-hirschorn
wolf-hirschorn syndrome
microcephaly, epicanthal folds, greek helmet facies, ocular hypertelorism,
viruses that cause viral meningitis
enteroviruses like cocksackie and echovirus
myotonic muscular distrophy (aka steinert diseae)
autosomal dominant; second most common muscular dystophy; all types of muscles (striated, smooth, card) are involved; progressive weakness; delayed muscle relaxation
conjucntivitis first 24 hours of life
chemical
conjucntivitis days 2-5 of life
gonococcal; treat with IV or IM cef
conjunctivitis on day 5-14 of life
chlamydia, treat with oral erythromycin
blood stained eye discharge
chlamydial conjunctivitis
prophylaxis against gonoccocal conjunctivitis
topical erythromycin or topical silver nitrate (not available in the US)
treatment for absence seizures
ethosuximide or valproic acid
Reye syndrome
fatty liver with encephalopathy; URI with varicella or influenza PLUS aspirin
def of niacin (vit B3)
leads to pellagra (diarrhea, dermatitis, dementia, and death), glossitis, sunburn rash
def of thiamine (vit b1)
causes beriberi or wernicke-korsakoff; neuro sx; often seen in alcoholics and patients with recent weight loss surgery
supracondylar fracture associated with what other injury
brachial artery injury leading to decr radial pulse so always check radial pulse
most common fracture in kids
supracondylar fracture
technetium-99m pertechnetate scan
meckle’s diverticulum; painless hematochezia; technetium stains the ectopic gastric tissue in meckel’ss
hematochezia
bright red stools
WPW on ECG
shortened PR interval, delta waves, and widening of QRS
continuous antibiotic prophylaxis in rheumatic heart disease- why?
patients with a history of rheumatic fever are at high risk for recurrent GABHS pharyngitis; preferred regimen is IM penicillin every 4 weeks
muscle spasms
think tetanus; neonatal tetanus is fatal if left untreated; neonatal tetanus often follows umbilical stump infection
Wiskott-Aldrich syndrome
thrombocytopenia with skin lesions characteristic of eczema and a hx of multiple bacterial infections; decreased platelet production is the cause; x-linked
why howell jolly bodies in sickle cell diseae
these patients often have infarcted spleens that
heinz bodies and bite cells
g6pd def
basophillic stippling
thalasemmias or lead poisoning
freidrich ataxia
most common type of spinocerebellar ataxia; degeneration of the spinal tract; also causes concentric hypertrophic cardiomyopathy, diabetes, skeletal deformities, cardiomyopathy is most common cause of death; absent ankle jerks
allergic contact dermatitis
CELL-mediated hypersens; not igeE mediated
developmental dysplasia of the hip
dislocation of the femoral head from the acetabulum; in kids 2 wks- 6 mos, get a hip u/s. in kids more than 6 mos get a hip xray bc by now the femoral head and acet are ossified
DDH suspected less than 2 weejs
no imaging, may resolve on its own
functional asplenia puts you at risk for infection w what organisms
pneumococcus, h influenza,
intestinal obstruction in a neonate management
abdominal xray for pneumoperitoneum for a perforated bowel; next step is contrast enema, which will differentiate between meconium ileus and hirschsprung
microcolon on contrast enema
meconium ileus; underused contracted colon as a result of viscous meconium
treatment for meconium ileus
hyperosmolar enema to dissolve the meconium
when is sweat chloride testing indicated for suspected CF?
greater than 2 weeks old because they do not make sweat before then
contrast enema demonstrates transition zone between sigmoid colon and dilated megacolon
hirschsprung
Jervell-Lange-Nielson syndrome
long QT and congenital deafness;
nursemaid’s elbow
radial head slips through part of the annular ligament; child keeps arm pronated and refuses forearm supination
3 pathognomonic facial dysmorphisms for fetal alc poisoning
thin vermillion border; smooth filtrim; small palpebral fissues
fragile x syndrome face
long narrow face, prominent forehead and chin, large ears, macrocephaly
macroorchidism
fragile x syndrome
Werdnig-hoffman syndrome
AR disorder involving degeneration of anterior horns and CN motor nuclei
trachoma
caused by chlamydia trachomatis. Major cause of blindess, follicular conjunctivitis and pannus (neovascularization) formation in the cornea. Concurrent nasopharynx infxn.
treatment for trachoma
topical tetracycline or oral erythromycin
mild vit k def
prolonged PT and normal PTT; severe would be prolonged both
murmur with hypertrophic myopathy
increases with standing, which decr venous return
freidrich taxia
aut recess; excessive trinuc repeats; progressive; necrosis of cardiac muscle and myocarditis,
differential for t wave inversion
MI, myocarditis, old pericarditis, myocardial contusion and digoxin toxicity
copies a cross and circle
three years
copies a rectangle
four years
copies a triangle
five years
copies a diamond
six years
osteogenesis imperfecta type II
fractures, blue sclerae and short, ben extremities; aut dom; typically die in utero for type 2
lisch nodules of the iris
associated with neurofibromatosis type 1
tuberous sclerosis
ash leaf hypopigmentation, cardiac rhabdomyomas, kidney angioleiomyomas, mental retardatio, seizures
sturge weber syndrome
a neurocutaneous syndrome
cholesteatoma
growth of squamous epithelium in the middle ear; they are destructive; can lead to infection
meniere’s diseae
vertigo, tinnitus, hearing loss; more common in adults
otosclerosis
abnormal bone growth in the middle ear that causes hearing loss
osteoma
benign bony overgrowth that can form in the outer ear and lead to hearing loss
nonpitting vs pitting lymphedema
pitting is CHF, liver failure, nephrotic syndrome;
measles is more severe than rubella in what way?
higher fever, darker rash
erythema multiforme
target lesions; usually follows herpes simplex infection
choledochal cyst
cystic dilation of the bile duct
acholic stools
clay colored or pale; due to problems in biliary system
waterhouse-friderichson syndrome
seen w meningococcemia; adrenal gland failure causes death
pseudomonas
gram neg rod
gram pos diplococci
strep pneumo
gram pos cocci in clusters
staph
gram neg cocci
neisseria
gram pos rods
listeria and bacillus
GNRs
pseudomonase, h. flu, klebsiella, legionella
todd’s paralysis
post-ictal paralysis
treatment for minimal change disease
steroids
iron poisoning
anion gap met acidosis
TCA antidepressant intox
sodium bicarb
HUS preceded by what?
diarrheal illness like EHEC, shigella, salmonella, yersinia, and campylobacter; causes microangiopathic hemolytic anemia
diff between DIC and microangioathic hemolytic anemia
PTT and PT are prolonged in DIC
hepatosplenomegaly, target cells, microcytosis, hypochromia, and anisopoikilocytosis
thalasemmias
macrocytosis and hypersegmented neutrophils
B12 def or folate def
microcytic with basophilic stippling
lead poisoning
