QBank knowledge Flashcards
1
Q
Polycythemia for infants is what crit
A
> 65%
2
Q
What causes polycythemia
A
increase erythropoiesis (diabetes, HTN, smoking, IUGR) or Erythrocyte transfusion (delayed clamping time, twin -twin transfusion)
3
Q
What are kids disposed to after heart surgery?
A
pericardial effusion leading to tamponade
4
Q
What is beck’s triad for tamponade?
A
distant heart sounds, distended jugular veins, hypotension
5
Q
What are breathholding spells associated with
A
Iron deficiency anemia
6
Q
What 2 types of breathholding are there?
A
cyanotic - normal with crying and pallid - triggered by minor trauma.
7
Q
How does a VSD present?
A
harsh, holosystolic murmur at the lower left sternal border. The louder the better, because big VSD’s have less murmur activity. 75% close by age 2
8
Q
Ewings’s sarcoma?
A
x-ray shows onion-skinning, usually at the metaphysis or diaphysis of long-bones. pain and swelling for weeks. often confused with osteomyelitis.
9
Q
Osteosarcoma
A
asdf
10
Q
What is the most common congenital adrenal hyperplasia and what level will be raised. Presentation?
A
21-hydroxylase deficiency. presents with virilization of females, salt-wasting, and INCREASED 17-hydroxyprogresterone levels.
If complete deficiency, then you see it as a baby with tons of salt-wasting
If partial deficiency, presents in adolescents as hyperandrogenism (hirsutism, virilization), elevated 17-hydroxyprogesterone, and some salt wasting.
11
Q
How does acquired aplastic anemia present
A
History of drug or toxin exposure/ingestion or infection. Pallor, weakness, fatigue, loss of appetite. labs show normocytic anemia and ALL things are down (retics, leukocytes, thrombocytes). Bone marrow biopsy shows total decrease
12
Q
What are other types of anemia
A
fanconi’s - pancytopenia + CONGENITAL ANOMALIES (cafe au lait macules, hyperpigmentation of the trunk/neck/intertrig, upper limb abnormalities, renal abnormalities, hypogonadism, ). Presents between 4-12 years. IT IS AUTOSOMAL RECESSIVE and caused by chromosomal breaks.
Diamond-blackfan - congenital PURE RED CELL APLASIA in first 3 months of life. pallor and poor feeding. congenital abnormalties in 50% including short stature, webbed neck, cleft lip, shield chest, and triphalangeal thumbs.
Transient erythroblastemia of childhood - present 6 months to 5 years. pallor and tachycardia.
Leukemia - fever, lethargy, bruising and bleeding. CBC can show mixed results. bone marrow shows crazy cells.
13
Q
What is only infant factor contraindication to breastfeeding?
A
galactosemia
14
Q
What is tx and dx for esophageal coin ingestion?
A
flexible endoscopy
15
Q
Eczema - where does it present in infants
A
face, chest, and extensor surfaces of extremities. flexural involvement in older kids and adults.
16
Q
What kidney condition does Hep B put at risk of?
A
membranous nephropathy - presents with edema, hypoalbuminemia, and elevated urine protein consistent with nephrotic syndrome.
17
Q
How does epiglottitis present and what is major cause?
A
abrupt fever, sore throat, dysphagia, drooling. HIB is major pathogen
18
Q
when does pyloric stenosis present and how? dx? risk factors?
A
4-8 weeks after birth, non-bilious projectile vomiting, can show hypochloremiac metabolic acidosis. “olive shaped” mass
dx: Ultrasound
risk factors: first born boy, erythromycin tx, formula feeding
19
Q
when and how and dx of hirchsprung and meconium ileus?
A
failure to pass meconium within 48 hours and dilated bowel loops on x-ray. dx by contrast enema
20
Q
malrotation with midgut volvulus presentation, dx and when?
A
neonates <1 month. bilious vomiting. dx: upper GI study
21
Q
CF presentation, dx
A
autosomal dominant recessive, chronic sinpulmonary infections + nasal polyps, sweat testing
22
Q
How do you treat staph pneumonia?
A
Iv vanc
23
Q
Describe presentation and tx of tinea corporis
A
superficial fungal infection with erythematous, scaly, pruritic rash with central clearing. treated with topical antifungals such as terbinafine.
24
Q
What is the triad of Wiskott-aldrich? inheritance
A
X-linked disorder. Triad is thrombocytopenia, eczema, recurrent bacterial infections (strep pneumo, N meningitidis, H influenzae). thrombocytopenia is due to decreased production.
25
After when is bedwetting (enuresis) abnormal? How common?
tx?
>2x per week after age 5. boys train later than girls. 15% of boys 2% of girls
tx: 1st line, enuresis alarm - 3-4 months before it works
Pharmacotherapy: 1st line, desmopression
2nd line, TCA's
26
What is todd's paralysis
a postictal condition that rapidly improves over 24 hours. Sudden loss of consciousness (seizure) followed by hemiparesis and slow restoration (todd's).
27
What is hemophilia A and B? Who affects? what are side effects?
deficiencies of factor VIII and IX. only males, females are carriers. It can cause hemarthrosis leading to hemosiderin deposition and fibrosis.
28
What is classic presentation of Henoch-schonlein purpura and what are kidney findings? What is it?
IgA mediated vasculitis of small vessels.
1. palpable purpura in lower extremities
2. NORMAL PLATELETS (if thrombocytopenia, think more down the HUS road)
3. arthralgias
4. abdominal pain leading to intussusception and GI bleeding
5. Renal disease (mesangial deposition of IgA leading to hematuria, RBC casts, and mild proteinuria)
6. SCROTAL SWELLING
Rash comes first (symmetric and over legs, butt, arms). Arthralgias/arthritis. Majority also have abdo pain. renal comes in up to 50% and then occurs 4-6 weeks later.
29
When to operate on umbilical hernia?
most disappear by 1 year. If persist more than 3-4 years, exceeds 2 cm, causes sx or strangulates, or enlarges, then operate.
30
What are the clinical manifestations of osteogenesis imperfecta?
blue sclerae, hearing loss, recurrent fractures, and "opalescent teeth".
31
Describe presentation of scarlet fever? cause? tx?
cause by strains of group A strep that produces erythrogenic toxins. starts with strep pharyngitis (or cellulitis) after 1-7 days of incubation. rash starts on neck, axillae, groin and then generalizes withint 48 hours. rash is punctuate, or finely papular texture that is "sandpaper-like" . pharynx has grey-white exudate. mouth has "circumoral pallor". By end of 1st week, there is desquamation
tx: Penicillin V. THEN erythromycin, clinda, and 1st generation cephalosporins for those with pen allergy
32
What is erb-duchenne and what is prognosis?
C5,6,7 branchial plexus injury due to vaginal delivery. due to macrosomia (male sex, african american, and post-term pregnancy also a problem). 80% have recovery within 3 months. consider surgery if not better within 3-6 months.
33
How does atlantoaxial instability present and who does it affect?
downs children 10-15%. usually laxity in C1 to C2. presents with upper motor sx (spasticity, +babinski, hyperreflexivity, clonus) + other sx (behavioral changes, urinary incont, torticollis, vertebrobasilar sx, vertigo, diplopia). Down's are normally hypotonic.
34
presentation of cephalohematoma?
subperiosteal hemorrhage. several hours after birth and limited to one cranial bone. resorb within 2 weeks to 3 months.
35
Fragile X buzzwords? gene?
appearance is large head, long face, prominent forehead and chin, protruding ears, joint laxity, macroorchidism. behavior - autism, hyperactivity, short attention span. Gene is FMR1 - CGG repeats
36
Kawasaki disease presentation and dx criteria? Complications?
FEVER LONGER THAN 5 DAYS. 4 of the following
- cervical lymphadenopathy with at least one node >1.5 cm
- erythematous polymorphous rash
- extremity changes (edema/erythema)
- Bilateral nonexudative conjunctivitis
- Mucositis (strawberry tongue, injected pharynx, injected or fissured lips)
Complications: coronary artery aneurysm, myocardial infection + ischemia
Tx: high dose aspirin +IVIG
37
Vit A def presentation?
bad adaptation to the dark, photophobia, scaly skin, xerosis conjunctiva, xerosis cornea, keratomalacia. follicular hyperkeratosis +Bitot spots of shoulder buttocks and extensor surfaces.
38
What to think of with severe coughing + subq ephmysema
pneumothorax
39
Presentation of craniopharyngioma
increased intracranial presure (headaches, vomiting), bitemporal hemianopsia, and a CYSTIC CALCIFIED PARASELLAR LESION practically makes this dx. from remnants of rathke's pouch.
40
What happens when you swing kids by arms/
subluxation of the radial head. go for forearm hyperpronation and full recovery should occur.
41
How does one dx an iron deficient anemia and how to distinguish from thalassemias?
microcytic anemia. RDW is > 20%. In thalassemias (alpha trait and beta minor), it is normal at 12-14%.
42
How does sickle cell present in babies?
vaso-occlusive disease leading to dactylitis. dactylitis is symmetric swelling of hands and feet. present 6 months to 2 years with acute onset of pain. may show osteolytic lesions on x-ray.
43
What are the catalase positive organisms and who gets infected? what is test? tx?
staph aureas, aspergillus, serratius marascens, burkholderia cepacia. Chronic granulomatous disease (recurrent or unusual lymphadenitis, hepatic abscesses, osteomyelotis). dx by nitroblue tetrazolium, cytochrome c reduction, or flow. tx: daily tmp-sx and gamma-interferon 3x per week.
44
What enzyme and what is typical presentation of Von-gierkes disease
G6 phosphatase deficiency. presentation generally is "DOLL-LIKE FACE" (fat cheeks), PROTUBERANT ABDOMEN (due to enlarged liver and kidneys), thin extremities, short stature. Labs show hypoglycemia, lactic acidosis, hyperuricemia, and hyperlipidemia. hypoglycemic seizures are common.
45
What to do with croup as it worsens?
give racemic epi as it decreases need for intubation.
46
What is the choana and how does choanal atresia present? What syndrome associated with it? dx?
choana - back of nasal passage. atresia presents as cyanosis with feeding, relieved by crying. due to bony (90%) or membranous (10%) obstruction. Syndrome is CHARGE:
```
C - coloboma (hole in the eye)
H - heart defects
A - atresia of choana
R - renal anomalies
G - growth impairment
E - ear abnormalities/deafness
```
dx? failure to pass a catheter through the nose. Can also CT the thing.
47
What is an intraventricular hemorrhage and what are risk factors?
IVH is seen in premature and LBW babies. Patients present with pallor, cyanosis, hypotension, seizures, focal neurological signs, bulging or tense fontanels and is seen mostly in PREMATURE BABIES.
48
What is anemia of prematurity? labs?
common anemia in LBW and preemies. labs show normocytic, normochromic RBC's, retics low and precursors in bone marrow are decreased, Normal bili, WBC, and platelets
49
How do kids get a carotid dissection?
ONLY WAY is trauma to the soft palate compressing the ICA (thrombosis and stroke) or dissection. onset is 24 hours after trauma. Image with MRI.
50
What is the presentation retinoblastoma? pathophys?
retinoblastoma is the most common intraocular tumor in children due to inactivation of the RB tumor suppressor gene - highly malignant. presents with leukocoria.
51
What labs are abnormal in muscular dystrophy AND what is gold standard
gold standard = genetic testing. labs elevated are creatine phosphokinase and aldolase levels. muscle biopsy shows fatty infiltration and fibrosis. gower sign and bilateral calf pseudohypertrophy
52
Risk for clavicular fracture and management?
all risk factors for shoulder dystocia (maternal diabetes, fetal macrosomia). fractures heal spontaneously in 7-10 days without sequelae. pain decrease by pinning the sleeve to shirt.
53
what is beckwith-wiedemann and what are clinical features? what do you get eventually? monitoring
overgrowth disorder alteration of chromosome 11p15 (sporadic or inherited) that predispose to neoplasms. Mnemonic for presentation - HOMO
H - hypoglycemia and HEMI-hyperplasia
O - Omphalocele
M - Macroglossia
O - Organomegaly
eventually you get wilm's tumor and hepatoblastoma.
Monitor with this with abdo US.
54
Where does medulloblastoma present and affect?
2nd most common posterior fossa tumor. 90% affect the cerebellar VERMIS.
What is the 1st most common: benign astrocytoma.
55
What is the triad of kartagener's
recurrent sinusitis, bronchiectasis, dextrocardia (heart points towards right)
56
What is immediate management of gastroschisis and ompahalocele?
immediately wrap the exposed bowel in sterile saline dressing and plastic wrap to minimize heat loss and fluid losses.
57
Where can pinworms present?
anal nighttime itching AND in prepubescent girls, vulvovaginitis.
58
What is a good apgar score
>7 means leave them alone. <60 bpm, intubate, chest compressions, and if not correction, IV epi.
59
What are clinical manifestations of Coarctation of Aorta? What genetic defect associated?
upper body HTN + lower body hypoperfusion, mild continuous murmur all over the chest due to development of collaterals between hypertensive and hypoperfused vessels. CXR shows rib notching.
7% of Turner's kids have it.
60
What are clinical sx of congenital hypothyroidism and major cause?
typically appear normal at birth, but gradually develop
Jaundice, LARGE TONGUE, NEW UMBILICAL HERNIA, abdominal bloating, apathy, weakness, hoarse cry, and sluggishness. Most common cause: thyroid dysgenesis is 85% (aplasia, hypoplasia, ectopic gland). Is a genetic thing..
One of 3 things always checked in babies: hypothyroidism, phenylketonuria, galactosemia.
61
What are the confirmatory tests for lupus? what other things are elevated?
anti-smith and anti-double stranded DNA are confirmatory. Clinical features include malar rash, joint pains. Labs show anemia, leukopenia, normal platelets. ANA and RPR are positive.
62
What is probably normal jaundice and what are jaundice to workup?
NORMAL, physiologic jaundice is unconjugated 12-14 between 1 days and 10 days after life. more common in preemies, diabetic moms, and asian babies
Always workup conjugated hyperbili.
Workup for the following:
1. Jaundice before 36 hours of life
2. serum bili rising > 5 mg/dl/day
3. serum bili >12 in term and >10 in preemies
4. Jaundice after 10 days
5. signs and sx of jaundice
63
triad of congenital toxo?
1. chorioretinitis
2. hydrocephalus
3. intracranial calcifications
ChoHy InCa
64
Triad +M's of congenital rubella?
1. deafness
2. cataracts
3. cardiac defects
M's = microcephaly, micropthalmia, meningoencephalitis
65
What are contraindications to breastfeeding?
Maternal
1. active, untreated TB
2. HIV
3. illicit drug and alcohol abuse
4. chemo
5. varicella infection OR herpetic breast lesions
Baby
1. galactosemia
66
What are some common benign skin and diaper findings within 1 week of birth
1. dry, flaky peeling skin of hands and feet
2. pink stains or "brick dust" in diaper is normal uric acid crystals. uric acid crystal excretion is high at birth and seen in 1st week as mom's milk comes in.
67
Normal loss of birthweight?
Lose up to 10% and regain by 10-14 days
68
Name 3 systems involved in Freidrich ataxia? age of onset? inheritance? cause of death?
1. neurologic (ataxia, dysarthria)
2. skeletal (scoliosis, feet deformities)
3. cardiac (concentric hypertrophic cardiomyopathy)
Age of onset: before 22. Death by 35
Autosomal recessive
death: cardiomyopathy and respiratory problems
69
Growing pains. age of presentation? presentation? epi?
Occur in 10-30% of children ages 2-12.
bilateral, lower extremity pain (thigh, calf)
occurs at night and resolves by morning
normal physical exam
Tx: massage, stretching, analgesia, reassurance
70
What are the clinical features of cystic fibrosis?
respiratory (bronchiectasis, recurrent pneumonia, chronic rhinosinusitis)
GI (obstruction as a baby of meconium ileus, pancreatic disease)
repro (infertility in 95% of men and 20% of women)
MSK (osteopenia, clubbing)
actually, having oily stools rarely have pancreatitis because stuff is getting out.
71
What is myotonic muscular dystrophy?
and AUTOSOMAL DOMINANT type of muscular dystrophy that presents from age 12 to 30 and causes myotonia. Classic finding: patient is unable to release a hand shake (grip myotonia). Dysphagia leading to aspiration pneumonia. Cardiac conduction problems. Cataracts, and TESTICULAR ATROPHY, frontal baldness, and insulin resistance. Skeletal muscle weakness of FACE, forearms, hands, ankle dorsiflexors (foot drop).
72
Why do we give erythromycin drops at birth
for gonococcal eye infection and NOT for chlamydia.
73
When does intrapartum chlamydia present and how? How does one treat?
chlamydia trachoma conjunctivitis 5-14 days after birth.
pneumonia - 4-12 weeks after birth.
tx: ORAL erythromycin for 14 days.
74
How long duration must there be antalgia for legg-calve-perthe disease? What are other features? prognosis?
LCP is osteonecrosis of the femoral head that affects kids 4-10 years. Must have > 1 MONTH of antalgia. pain is insidious onset and has mild chronic pain. self-limited in 18 months
75
What are the 3 P's of McCune-Albright?
1. precocious puberty
2. pigmentation (cafe au lait)
3. polyostic fibrous dysplasia (results = bone fractures)
76
How does Klumpke palsy present? What is the main manifestation?
really only due to shoulder dystocia (risk factors: maternal diabetes and obesity + baby >4 kg). Damage to C8 and T1.
CLAW HAND + no grasp reflex (ERB-DUCHENNE HAS INTACT GRASP REFLEX - involved 5th and 6th cervical nerves).
Horner syndrome
Tx: can be permanent, but physical therapy to prevent contractures.
77
What marks B-cell deficiencies?
start at 6 months after mom's antibodies are gone. lack of IgA leads to giardia. Lack of other stuff leaves encapsulated organisms like sinopulmonary infections like H influenzae and Strep pneumo
78
What is the mnemonic for DiGeorge
```
C - conotruncal cardiac defects
A - abnormal facies
T - thymic aplasia/hypoplasia
C - cleft palate
H - hypocalcemia
```
22.11.2 deletion leading to defective development of pharyngeal pouches.
79
What are hallmarks of leukocyte adhesion deficiency?
1. delayed separation of the umbilical cord
2. recurrent bacterial infections of skin and mucosa
3. necrotic periodontal infection
80
Prader Willi. What is the genetic defect? What is presentation? What are complications?
It is due to maternal uniparental disomy (i.e. LOSS of paternal 15q11-q13). ALMOND SHAPED EYES + downturned mouth. hypotonia, weak sucking, short stature, hypogonadism, intellectual disability,
```
complications?
sleep apnea
T2D
gastric distension/rupture
death by choking
these kids are SUPER obese
```
81
clubfoot description and tx
presents with equinus and varus of calcaneum and talus, varus of midfoot, and adduction of the forefoot.
Stretching, manipulation, serial casting IMMEDIATELY
82
What is clinical manifestation of reye syndrome? What brings it on.
Pathology in the liver?
Lab findings?
kids <15 years old treated with aspirin during a varicella or flu infection
Clinical features: acute liver failure and encephalopathy (presentation of vomiting, agitation, irrational behavior progressing to lethargy, stupor, and restlessness)
Pathology: bx of liver, kidney, brains shows microvesicular steatosis.
Labs:
- increased transaminases
- increased PT, INR, PTT
- increased ammonia
treatment: supportive
83
What is the mutation in osteogenesis imperfecta?
mutation in type 1 collagen
84
Lesch-Nyhan. inheritance? enzyme? clinical presentaiton
X-linked recessive (only men); deficiency of hypoxanthine-guanine phosphoribosyl transferase (HPRT). increased levels of purines leads to...
@ 6 months. hypotonia and persistent vomiting. progressive mental retardation, dytonia, SELF-INJURY (biting of upper extremities). Gouty arthritis, tophus formation, obstructive nephropathy.
give fluids and allopurinol.
85
vaginal bleeding of infants?
at <3 months, maternal estrogens can cross the placenta and enter the fetal blood stream before birth causing withdrawal bleeds.
86
hemolytic-uremic syndrome triad? how to tell from HSP
hemolytic anemia, thrombocytopenia, acute renal failure.
other symptoms include: petechiae, purpura, abdom tenderness.
In HSP has NORMAL PLATELET COUNTS
87
What is the ddx or a single, painful, lytic long bone lesion?
If with hypercalcemia and overlying swelling, consider langerhans histiocytosis
With fever, consider osteomyelitis and a brodie abscess
endocrine (hyperparathyroid osteitis fibrosa cystica)
Neoplastic (Ewing sarcoma, langerhans histiocytosis, mets)
idiopathic
88
In children <3 what should you include on DDX for finding on CXR if you suspect schmootz in the right lung?
THYMUS. It is known by the "sail sign" due to its triangular shape, scalloped border, and uniform density to on the upper right border of the heart. Like a little flag hanging above the heart <3
89
What is a common skeletal complication of sickle cell?
ASEPTIC NECROSIS of the femoral head. Classic story, a sickler has gradually progressing hip pain for several weeks and is afebrile.
Why? There are two main arteries in the femur and one an become obliterated later in life which means that older kids only have 1 which, if it sickles, causes AVN.
90
Tetraology of fallot. 4 things? pathophys? presentation
Main pathology is Right Ventricular Outflor Obstruction. Caused by overriding aorta, RVOT, Right ventricular hypertrophy, big VSD.
Presentation: toddlers who tire easily and get cyanotic. Gets better with squatting because you increase the peripheral vascular resistance DECREASING the right to left shunt.
Physical: harsh, systolic ejection murmur over mid to leftupper sternal border
91
Where are most brain tumors found in kids and what is the most common type?
WAY more infratentorial rather than supratentorial.
benign astrocytomas are definitely the MOST common types.
92
Turner Syndrome presentation in infancy? genetic defect? problems later on?
Presentation later?
XO. Only girls.
infant presentation: webbed neck, horseshoe kidney, carpal and pedal edema, nail dysplasia.
later presentation: delayed puberty, short stature, bicuspid aortic valve
why carpal and pedal edema? Due to abnormal development of the lymphatic system.
Later on, because of gonadal dysgenesis, they all have osteoporosis. Always give HRT.
93
Galactosemia. What is the defect? What is presentation? Complications?
Dx
Galactose-1-phosphate uridyl transferase (GALT) deficiency
Presentation?
1. CATARACTS + convulsions
2. vomiting and poor weight gain + HYPOGLYCEMIA
3. jaundice and hepatomegaly
dx: newborn elevated galactose levels and decreased GALT activity
Tx: remove milk
Complications: E. coli sepsis
94
developmental dysplasia of the hip. presentation? management?
palpable clunk with barlow or ortolani maneuver. Soft-click, leg-length discrepancy, asymmetric inguinal skin folds
if soft-click
up to 6 months, do US
after 6 months, do X-ray
if CLUNK: straight to ortho.
95
conjunctivitis (bacterial) in neonates
first 24 hours - chemical from AgNO3 application - symptom management
days 2-5 - gonococcal (swelling and mucopurulent eye discharge) - IV or IM ceftriaxone or cefoxatime
Day 5-14 - chlamydia (blood-stained eye discharge, chemosis [thickened injected conjunctivae], conjunctival pseudomembrane, neovascularization PANNUS) - oral erythromycin
96
Edwards syndrome. Genetics? Presentation? Prognosis?
trisomy 18
1. ROCKER BOTTOM FEET
2. ABSENT PALMAR CREASES
3. overlapping fingers
4. micrognathia + microcephaly +prominent occiput
5. 50% of kids have an enormous VSD (HEART)
80% dead in 1 month, 90% by 1 year
97
What is cri-du-chat associated with. genetics and other symptoms?
5p deletion
presentation microcephaly, hypotonia, short stature, with the cri-du-chat.
98
What are the complications for small for gestational age babies? even those born full-term? what is cutoff
if <10th percentile, be worried for hypoxia, polycythemia, hypoglycemia, hypothermia, hypocalcemia
99
Presentation of phenylketonuria? Biochem?
1. MUSTY ("MOUSY") ODOR
2. fair complexion
3. intellectual disability and seizures
Why? body can't convert phenyalalnine to tyrosine leading to neurotoxicity.
tx: low phenylalanine diet.
100
What is the x-ray of duodenal atresia?
double bubble
101
what is the x-ray of jejunal atresia?
triple bubble
102
Sturge weber presentation
4 year old with port-wine stain or nevus flamus along trigeminal nerve territory (congenital hemangioma). Seizures start at any age. Xray shows intracranial calcification in tramlines
```
S - sporadic
T - tram track calcification
U - upper left trigeminal stain
R - retardation
G - Glaucoma
E - Epilepsy
```
103
What is a rare, fatal complication of meningococcemia?
Waterhouse-friderichsen.
It is when there is massive adrenal hemorrhage.
Characterized by sudden vasomotor collapse and large purpuric lesions on the flank and petechiae
104
Supplementation of infants?
All breastfeeders: Vitamin D
Iron
at 4 months for normal babies
at birth for preemies
105
Meckel's diverticulum. Presentation? Dx? Tx?
```
PAINLESS HEMATOCHEZIA (can be significant anemia)
recurrent intusussception (esp in kids >2)
```
dx: technetium-99 scan or exlap
tx: surgery
106
Intussusception presentation? Considerations in a baby 2?
Presentation: sudden episode of excruciating abdo pain. kids draw legs up to make pain go away. currant jelly stool from ischemia of bowel wall. Target sign on x-ray.
107
Marfan's. Genetic? Presentation? complications
Autosomal dominant from fibrillin 1 mutation.
Presentation: JOINT HYPERMOBILITY, arachnodactyly (thumb sign), pectus excavatum, scoliosis
face: long, palate with high arch, crowded teeth
eye: lens dislocation, iridodonesis, myopia
Complications: AORTIC ROOT DILATATION and regurgitation (diastolic murmur). requires annual echos for aneurysm and dissection. Also, mitral valve prolapse (mid-systolic click and late systolic murmur)
108
Congenital diaphragmatic hernia. presentation? US findings in utero? complications? tx in the newborn?
abdominal viscera herniate into the chest resulting in PULMOMARY HYPOPLASIA and PULM HTN. 85% on the left.
US: polyhydramnios due to esophageal compression
Tx: intubation
109
Sudden back pain in a kid with stepoff? pathology? presentation? tx?
Spondylolisthesis is a developmental disorder where there is a slip forward of the vertebrae (usually L5 over S1) usually in preadolescent kids.
Presentation: back pain, neurologic stuff (incontinence), palpable stepoff at lumbosacral area
Tx: surgery
110
Slipped capital femoral epiphysis (SCFE). presentation and epi? Risk factors? dx? tx? complication
usually boys 10-16 years (OBESE is major risk factor). insidious onset of dull hip pain or referred knee pain and altered gait WITHOUT trauma.
dx: x-ray of hip show a posteriorly and inferiorly displaced femoral head
tx: immediate surgical screw fixation
complication: without surgery will progress to AVN
111
metatarsus adductus? risk factors? presentation? tx?
adduction of anterior aspect of the foot with medial concavity (kidney bean foot). found at birth
Risk factor: first born is stretching uterus and gets its foot molded.
tx: Type 1 - when push the foot, it's normal. OVERcorrection with active and passive abduction. nothing
Type 2 - normal with active and passive abduction. Orthotics and other shoes
Type 3 - no correction with active or passive. serial casting
112
What are the organisms that sicklers need to be wary of
The encapsulated ones that the spleen (infarcted and dead at an early age) clears
SHiN SKiS
S - strep pneumonia
Hi - haemophilus influenzae
N - Neisseria
S - salmonella
Ki - Klebsiella
S - Strep Group B
113
What's prophylaxis for sicklers?
BID penicillin and pneumococcal vaccination
114
What condition predisposes to Vit K deficiency? What factors use it
any fat malabsorption thing (like CF).
Factors II, VII, IX, X and protein C and S
115
What is hereditary spherocytosis? Inheritance? Triad of symptoms? dx?
HS is due to a defective membrane resulting in extravascular hemolysis as the RBC's pass through the spleen.
It is Autosomal Dominant
Triad: Coombs-negative hemolytic anemia, jaundice, splenomegaly. Key finding is Mean Corpuscular Hemoglobin Concentration of >36%
Dx: acidified glycerol lysis test and flow cytometry (eoson-5-maleimide binding test)
116
What anemia does HUS cause? What is dx?
HUS will occur after an acute diarrheal illness with e. Coli 0157, Shig, salmonella, yersinia, campylobacter. It is ACUTE RENAL FAILURE. GI bleeding is a common sx.
Microangiopathic Hemolytic Anemia (MAHA) will give schistocytes and giant platelets. Labs show thrombocytopenia and (due to increased RBC hemolysis) , increased LDH, indirect bili, and retics.
117
What is the outlook for sickle cell trait kids? What do their electrophoreses look? any abnormal lab findings or general findings?
GOOD. They lead normal lives.
Normal electrophoresis: 99% hgb A
Sickler: 85-95% hgb S, 5-15% fetal
Sickle cell trait: 50-60% hgb A, 35-45% hgb S
weird finding is gross hematuria from sickling in the renal medulla.
118
What is the classic finding in a pinealoma? where do these form? tx?
Parinaud syndrome:
1. upward gaze (sun-setting sign)
2. bilateral ptosis
3. bilateral lid retraction (collier sign where sclera is visible above the superior corneal limbus)
Also, HYDROCEPHALUS with headaches and vomiting.
Occur in the quadrigeminal cistern blocking the aqueduct of sylvius
tx? surigcal resection, shunt, and/or radiation
119
What's a good story for IgA deficiency?
recurrent sinopulmonary and GI infections and ANAPHYLAXIS with transfusions
120
what are lab and smears showing for acute lymphoblastic leukemia?
ALL is the most common leukemia. lymphoblasts lack peroxidase positive granules (like myeloblasts), but do stain brightly for periodic acid Schiff (PAS). ALSO, immunostain for TdT is + in most patients.
Presents with high grade fever that won't go away with NSAIDS
121
What are manifestations of fanconi's anemia? What is it caused by pathophys?
aplastic anemia and progressive bone marrow failure.
HYPO/HYPERPIGMENTED AREAS, cafe au lait, large freckles
low-set ears, middle-ear problems (hears pounding), strabismus
Short stature, microcephaly, hypogonadism
pathophys - chromosomal breaks
122
What is the most common primary bone tumor in children and young adults? Where does it present? How?
Osteosarcoma!!
involves metaphyes of long bones and will have a "sun burst" pattern and codman's triangle. Physical shows a large and tender mass.
Alk Phos and LDH are high!
Tx: excision and chemo
123
What is the presentation of an angiofibroma?
Epistaxis!
nasal obstruction, visible mass. most common in males
CUT IT OUT
124
What syndromes is Wilm's tumor associated with'?
WAGR (wilms tumor, aniridia, genitourinary, intellectual disability)
Beckwith-wiedemann
Denys-Drash
125
What is presentation of a wilm's tumor? Who? dx?
Toddlers with an abdominal mass. Most common renal malignany of childhood. often asymptomatic. does not cross midline
Maybe abdominal pain, HTN, hematuria
Dx: contrast CT
126
What do you suspect with an abnormally low platelet count <100k (isolated), asymptomatic petechiae, mucocutaneous bleeding after a viral illness? Who is most common in? tx?
Idiopathic Thrombocytopenic Purpura!
Most common in kids 2-5.
Tx: no bleeding and platelets > 30k. Observation
bleeding OR platelets <30k: IVIG and corticosteroids.
127
What is the presentation of acute lymphoblastic leukemia? who? dx? tx?
peak age 2-5 M>F. most common leukemia.
Features:
- bone pain
- lymphadenopathy
- hepatosplenomegaly
- pallor
- petechiae
- mediastinal widening
dx: bone marrow biopsy. >25% lymphoblasts is diagnostic.
tx: chemo
128
What is the presentation of Vesicoureteral Reflux? complications? tx? pathophys? dx?
If kid is s will cause renal scarring which is bad.
dx: screening is with US for these kids. If problem persists, gold standard is voiding cystourethrogram
129
Define Colic
>3 hours per day, >3 days per week, for > 3 weeks in healthy infants
130
What do you do with a kid who is having delayed puberty, but also had poor growth as a kid? Dx?
Constitutional growth delay.
Normal birth weight kid. between 6 months and 3 years, heigh velocity slows and kid drops on growth curve, but follows it at 5-10th percentile. puberty and adolescent growth spurt are delayed, but occur later. bone radiographs are also abnormal
131
What is the workup for bilious emesis in a neonate with CF
x-ray to rule out pneumoperitoneum then water-soluble contrast enema.
microcolon should raise the concern for meconium ileus. giving hyperosmolar enema can break up the inspissated mass, but if this fails, then surgery
132
What are some of the complications of constipation in children? urinary specifically?
Risk factors are things like introduction of solid food, toilet training, and school entry.
presentation is : straining with hard stools, crampy abdominal pain, S DUE TO STASIS (presents with suprapubic pain, dysuria, pyuria, and bactiuria)
tx: more dietary fiber, limit cows milk, laxative, suppository
133
What are things characteristic of iron poisoning? What is antidote?
Big clue: ON X-RAY THERE WILL BE RADIOOPAQUE OPACITIES.
pregnant mom in the house
```
30minutes to 4 days
abdominal pain
hematemasis
shock
HIGH ANION GAP METABOLIC ACIDOSIS
```
Days 2: hepatic necrosis
2-8 weeks: pyloric stenosis
Tx: deferoxamine which makes it excretable in the urine
134
Lead poisoning. Risk factors? presentation? screening and dx? tx?
risk factors:
```
homes built before 1978 with peeling paint
pica
sibling with lead poisoning
low SES
immigrant or international adoptee
```
Presentation: cognitive and behavioral problems
screening: capillary blood specimen for screening, but high false positive. confirmatory is venous lead level
tx: 75 = Dimercaprol + EDTA
135
How to deal with a caustic ingestion?
SECURE AIRWAY
Decontamination
CXR
endoscopy within 24 hours
complications
- upper airway compromise
- perf
- strictures
- ulcers
- cancer
136
What is hallmark of TCA toxicity? What is tx?
TCA's have crazy anticholinergic stuff:
CNS: seizures, respiratory depression, mental status changes
Cardiovascular: prolonged PR/QRS/QT intervals, sinus tach, arrythmia, hypotension
Anticholinergic: dry mouth, blurred vision, dilated pupils, urinary retention, flushing, hyperthermia
tx:
IF QRS>100 MSEC, SODIUM BICARBONATE: alleviates anticholingeric inhibitory action on fast sodium channels of heart improving hypotension and decreasing risk of fatal arrythmias.
Supportive therapy, charcoal within 2 hours of ingestion, IV fluids, oxygen
137
Definition of primary amenorrhea? What is the next step?
Absence of menarche by age 15. Pelvic Ultrasound.
138
What is conn's Syndrome? presentation
aldosterone-secreting adenoma or bilateral adrenal hyperplasia.
hypokalemia and hypertension
139
What is the most common cause of secondary hypertension in kids? Presentation? Diagnosis
fibromuscular dysplasia
HTN, headaches,
PE: soft to-and-fro bruits at the CV angle
R is more often affected than L
Dx: angiography with "string of beads" pattern
140
What are things to consider for secondary enuresis?
psychological stress, UTI, DM type 1, Diabetes insipidus, OSA
141
What is the most common cause of nephrotic syndrome in kids? Presentation? Pathology? tx?
Minimal Change Disease accounts for 80% of nephrotic syndrome.
Light microscopy looks normal. Electron microscopy shows podocyte effacement.
90% respond to steroid therapy
Presentation: Edema, fatigue, no hematuria
dx: proteinuria, hypoalbuminemia, renal biopsy that is normal
142
Describe the basic pathology of renal tubular acidoses? Major findings to distinguish. Presentation in infancy
RTA 1 - Poor hydrogen ion secretion. urine pH is >5.5. K+ low
Cause: genetic disorder, med tox, autoimmune, NEPHROLITHIASIS
RTA 2 - poor bicarb resorption. Urine pH is <5.5 K+ HIGH.
Cause: CAH, obstructive uropathy. COMMON IN KIDS
Presentation: failure to thrive, chronic normal-anion gap acidosis, metabolic acidosis.
tx: oral bicarb replacement
143
Cryptorchidism. When do testicles descend? What is tx? What are complications? Risk factors?
Testicle should descend by 6 months, if not, then orchiopexy
complications: inguinal hernia, testicular torsion, subfertility, testicular cancer
Risk factors: preemies, small for gestational age, low birth weight, neural tube and genetic defects, exposure to pesticides and DES
144
Urine Dipstick shows proteinuria in an asymptomatic kid.
10% of school age kids have proteinuria. follow-up is to repeat the urine dipstick on 2 occasions.
Transient proteinuria (due to fever, exercise, seizures, stress, or volume depletion is commone) or orthostatic proteinuria (weird, right?)
145
What is the most common cause of sepsis in sickle cell kids?
pneumococcus followed much later by salmonella
146
What are the 4 centor criteria for Strep pharyngitis? tx?
exudative pharyngitis, fever, tender ANTERIOR cervical lymphadenopathy.
tx? penicillin or amoxicillin which reduces the incidence of rheumatic fever
147
What is the triad presentation of infectious mononucleosis?What should you avoid for how long?
tonsillar exudates, fever and POSTERIOR cervical lympathdenopathy, +/- hepatosplenomegaly.
No contact sports 3 weeks
148
What do you treat infectious mono with? What can be a consequence and describe it.
Treated with ampicillin or amoxicillin.
Consequence is a polymorphous maculopapular rash. This is NOT a drug rash and these drugs can be safely given in the future.
149
What is the most classic presentation of PDA-dependent congenital heart diseases? What are the 5? What do you treat with?
An oxygen saturation of 70-90% that does NOT get better with oxygen + central cyanosis
'1. coarctation of the aorta
2. transposition of the great vessels
3. tricuspid atresia
4. hypoplastic left heart syndrome
5. total anomalous pulmonary venous connection
Give prostaglandin E1 to keep it open
150
What is a consideration for a cat bit? What bug is special? how do you treat?
watch for pasteurella multicoda cellulitis.
prophylax with amoxicillin/clavulanate
151
What is Potter's disease? Describe underlying pathophys, development and consequences? How do you see it on prenatal US? Newborn presentation?
It is when boys have posterior urethral valves causing urinary tract obstruction.
On prenatal US you will see crazy dilation of bladder, ureters, and kidneys.
Development is anuria/oliguria in utero and oligohydramnios leading to
- pulmonary hypoplasia
- flat facies
- limb deformities
152
Pertussis stages and presentation
What about labs? dx?
tx?
```
First 2 weeks (catarrhal phase): mild cough and rhinitis
Weeks 2-6 (paroxysmal phase):
- 20-30 minute paroxysms of coughing
- inspiratory "whoop"
- "staccato" cough
- POSTTUSSIVE EMESIS
```
labs? lymphocyte-predominant leukocytosis
dx: throat PCR or pertussis culture
Tx: macrolides (azith, eryth, clarith)
153
how to deal with dehydration? Mild and moderate? Acute? Mainenance
Mild - no signs or symptoms but decreased intake
Moderate - decreased urine output, tachy, delayed cap refill (2-3 seconds)
Severe - sunken fontanelle, sunken eyes, tachy, minimal to no urine output. Hypotension and shock
Mild - ORS
Moderate-Severe - bolus with isotonic.
Mainenance - give D5
154
Duodenal atresia? Which kids are affected? how does it present?
Strongly associated with Down's Syndrome.
Bilious vomiting in the first 2 days of life and a "double bubble" sign on X-ray
155
What are some of the causes of intussusception? dx? tx?
75% have no lead point, but is thought to be a post-viral GI sequelae.
25% are due to Meckel's followed by polyps and hematomas (from HSP)
dx: US showing target sign
tx: air or contrast enema
156
What is the MAJOR way to tell breast milk jaundice from breastfeeding failure jaundice?
Breastfeeding failure jaundice has SIGNS OF DEHYDRATION.
Breastmilk jaundice has kids who are normovolemic.
157
Describe and contrast pathophys of breastmilk vs. breastfeeding jaundice. time? Presentation?
Breastfeeding failure jaundice - Presents in 1st week with DEHYDRATION and suboptimal feeding
Breastmilk jaundice - starts day 3-5, PEAKS AT 2 WEEKS with adequate breastfeeding and normal examination
failure - little lactation leads to decreased bilirubin elimination and thus increased enterohepatic circulation.
breastmilk - high levels of beta-glucuronidase in breastmilk will deconjugate bilirubin in the intestine and increase enterohepatic circulation
158
How much should neonates feed?
8-12 times per day for >20 minutes on each side
159
What is cyclical vomiting syndrome. Give the criteria.
a recurent, predictable pattern of acute and frequent vomiting resolving sponateously. usually resolves in 5-10 years.
```
criteria:
>3 episodes in a 6 month period
family agrees it is sterotyped
lasts 1-10 days
vomiting at >4 times/hr at peak
```
160
What are the GI things associated with Down's syndrome?
Duodenal atresia and hirchsprung disease.
161
Contrast hirchsprung vs. meconium ileus
hirchsprung
- associated with Down's
- obstruction at rectosigmoid
- normal meconium
- "squirt sign" positive (you put your finger in the rectum and an explosive squirt of gas and fecal matter jet out)
meconium ileus
- associated with CF
- obstruction at ileum
- meconium is inspissated
- no squirt when finger in rectum
162
Describe epi of Milk or soy induced enterocolitis. clinical features? tx? prognosis?
Presents at 2-8 weeks with severe reflux or vomiting and/or painless bloody stools often with ECZEMA. family hx of allergies, eczema, and asthma are present often.
tx: eliminate soy and milk from maternal diet OR initiate hydrolyzed formula
Prognosis - resolved by 1 year
163
Risk factors for Necrotizing Enterocolitis? Classic X-ray findings? Presentation?
85% of cases are PREMATURE BABIES. Also caused by reduced mesenteric perfusion due to congenital heart disease or hypotension.
X-ray shows pneumotosis, portal venous gas, pneumoperitoneum
Presentation: vomiting, bloody stool, abdominal distension/tenderness, vital sign instability, lethargy
164
What is the triad of niacin deficiency. What number is niacin
Vitamin B3
triad (pellagra)
- diarrhea
- dermatitis
- dementia
165
What are the most common heart defects of Down's syndrome?
1. Complete atrioventricular Septal Defect (MOST COMMON BY FAR).
2. VSD
3. ASD
166
What is the presentation of the most common cardiac defect in Down's?
Complete atrioventricular septal defect leads to significant regurge leading to heart failure at 6 WEEKS.
Auscultation:
- Loud S2 (due to pulmonary HTN)
- systolic ejection murmur (loud systolic ejection murmur from increased flow across the pulmonary valve due to the R --> L shunt)
- holosystolic murmur of VSD may be absent if defect is large
167
What is the best abortive measure for anaphylaxis AND what receptors does it work on?
IM epinephrine.
B2 agonist blasts open the lung
A1 agonism vasoconstricts and raises the blood pressure and decreases airways edema
168
Presentation of bronchiolitis? bug? Prevention for whom? Complications?
rhinorrhea and cough
wheezing/crackles and respiratory distress
Bug: RSV in kids < 2
169
Respiratory distress syndrome. Pathology? Risk Factors? Findings on X-ray. Tx?
Path: immature lungs and surfactant deficiency
risk factors: prematurity and DIABETES (delays maturation of pulmonary surfactant production)
Findings on X-ray:
- diffuse reticulogranular pattern ("ground-glass opacities")
- air bronchograms
tx: antenatal steroids, postnatal exogenous surfactant and respiratory support (CPAP)
170
Hereditary angioedema. Presentation? Pathology? labs?
angioedema = rapid-onset edema of face, acral extremities, genitals, trachea and abdominal organs WITHOUT URTICARIA.
hereditary angioedema:
1. noninflammatory edema of the face, limbs, and GENITALIE
2. laryngeal edema (life-threatening)
3. Edema of the intestines leading to colicky pain
Pathology: way too much bradykinin. Genetically acquired by a defect or deficiency of C1 inhibitor leading to elevated leves of C2b and bradykinin
Labs: LOW LEVELS of C4 for all
C1q, normal for hereditary; low for acquired later in life
171
What are criteria for a real acute bacterial rhinosinusitis? common bugs? what is tx?
1. symptoms greater than 10 days
2. severe symptoms: temp >102, prurulent discharge, face pain
3. worsening symptoms >5 days after improving
bugs: strep pneumo (30%), h. flu (30%), moraxella catarrhali (10%)
tx: amoxicillin-clavulanate
172
Laryngomalacia. Presentation. pathology. dx. management
presents:
- inspiratory stridor
- WORSE WHEN SUPINE, BETTER WITH SITTING UP OR PRONE
- present 4-8 months
- better by 12-18 months
path: laxity of supraglottic structures
dx: laryngoscopy showing collapse of supraglottic structures with inspiration AND omega shaped epiglottis
management: reassurance, supraglottoplasty for severe symptoms (poor weight gain, apnea, cyanosis, worsening stridor)
173
epiglottitis. bugs? triad of presentation? X-ray findings? tx?
bugs: HiB, nontypable HiB, strep, staph
triad:
- distress ("tripoding" and insp stridor)
- drooling
- dysphagia
X-ray fidings:
"Thumbprint sign" (enlarged epiglottitis)
loss of vallecular space
tx: intubation
174
Torticollis. presentation. causes. dx.
presentation:
neck swelling, decreased movement and weird positioning
causes: URI, trauma, cervical lymphadenitis, retropharyngeal abscess
dx: x-ray
175
Retropharyngeal abscess. presentation? X-ray findings? epi? spread from where?
Presentation:
- fever (acute onset high)
- odynophagia
- drooling
- neck stiffness
- MUFFLED VOICE
- INABILITY TO EXTEND THE NECK
- trismus (unable to open mouth all the way)
USUALLY UNILATERAL!!!
PE: A mass may be seen in the posterior pharyngeal wall on visual inspection.
X-ray: WIDENED PREVERTEBRAL SPACE. If patient has trouble breathing, a contrast CT should be used.
usually seen in kids 6 months to 6 years
Direct spread from pharyngitis, tonsillitis, otitis media, sinusitis.
176
Rabies. Presentation? hosts?
Presentation:
- HYDROPHOBIA
- AEROPHOBIA (these two are pathognomonic)
- pharyngeal spasm, spastic paralysis, agitation
ascending paralytic paralysis
Hosts? Wild carnivores and bats
177
Difference between preseptal and orbital cellulitis. presentation?
Both have fever, leukocytosis, eyelid erythema, and swelling.
Red flags that distinguish orbital cellulitis:
- decreased visual acuity
- DIPLOPIA
- opthalmoplegia
- proptosis
both of these can come from local trauma, or extension from dental stuff or sinusitis.
preseptal can have outpatient abx
orbital requires inpatient
178
Neonatal Sepsis. Characteristics and presentation. Most common bugs. tx?
poor PO, irritability, hyper-hypothermia, respiratory distress, vomiting, jaundice. bacterial meningitis may have hypotonia, full or bulging fontanelles, nuchal rigidity, seizures.
tx? AMP AND GENT
Neutrophilia with a significant left shift - bands >700 is sepsis and not infection
Bugs: GBS and E. Coli are most common. Early onset - consider listeria. Late onset in ICU- consider Klebsiella, Enterobacter, Pseudomonas
179
Impetigo. micro, clinical features, tx. Complications
micro: staph and Group A strep
Clinical: painful, non-itchy, honey-crusted lesions
Bullae can also occur
tx: topical mupirocin for non-bullous. oral abx for bullous
complications: post-streptococcal glomerulonephritis
180
lymphadenitis. What is it? tx?
rapidly enlarging, fluctuant, tender lymph nodes in children are usually caused by staph and strep. ALMOST ALWAYS UNILATERAL (if bilateral, could be a systemic process).
tx? I&D plus CLINDAMYCIN.
181
What is post-exposure prophylaxis for VZV
Just give the vaccine. if immunocompromised give immunoglobulin too.
182
Bug that causes nighttime anal pruritis? dx? Tx?
enterobius vermicularis (pinworm).
dx: eggs on tape test
tx: albendazole and pyrantel pamoate
183
How do you treat Lyme disease in the children?
children 8 - doxycycline which covers against anaplasma
184
Describe presentation of N. Meningitidis.
Meningeal signs that progress rapidly and 75% of people present with a PETECHIAL RASH in axilla, wrists, flanks, and ankles.
185
What are jones criteria for rheumatic fever? minor criteria? tx?
```
J - joints (migratory arthritis0
<3 - pericarditis
N - nodules (subcutaneous)
E - erythema marinatum (an evanescent pink rash with sharp edges)
S - syndeham chorea
```
minor: fever, arthralgias, elevated ESR/CRP, prolonged PR
tx: pharyngitis with penicillin x 10 days. If rheumatic fever, then benzathine penicillin G until adulthood.
186
Congenital measles triad?
PDA, sensorineural hearing loss, cataracts/glaucoma
187
congenital toxo triad?
chorioretinitis, hydrocephalus, intracranial calcifications
188
congenital CMV?
periventricular calcifications, deafness, purpura, hepatosplenomegaly, jaundice
189
What is the most common cause of osteomyelitis?
Staph Aureas
190
Herpangina. Bug? Presentation? epi. tx?
Coxsackie A Virus
Presentation:
- pharyngitis
- fever
- GRAY VESICLES ON POSTERIOR PHARYNX
epi
3-10 year olds in the summer/early fall
tx: supportive
191
herpetic gingivostomatitis. Bug? Presentation? Epi? Tx?
HSV 1
Presentation:
- fever
- pharyngitis
- CLUSTERS OF VESICLES ON OROPHARYNX/LIPS
192
Strep pharyngitis. Presentation?
fever
pharyngitis
TENDER CERVICAL LYMPHADENOPATHY
TONSILLAR EXUDATES
193
What are the most common causes of viral meningitis?
90% are caused by non-polio enteroviruses like echovirus and coxsackie viruses.
194
What are criteria for a bacterial septic arthritis? Clinical? Physical? labs?
Clinical.
- acute onset of fever and joint pain
- fatigue or malaise
- refusal to bear weight
- often preceded by a skin or URI
Clinical
- erythema
- warmth and swelling
- pain with ACTIVE AND PASSIVE rom
Labs
- elevated WBC
- elevated ESR and CRP
- synovial WBC>50,000
195
Most common bugs for bacterial arthritis (0-3 months, and >3 months) plus tx
birth to 3 months
staph and GBS and gram-neg bacilli
tx: naf or vanc PLUS gent and cefotaxime
>3 months
staph Group A Strep and Strep Pneumo
tx: naf, clindamycin, cefazolin, or vanco
196
What are x-ray findings of congenital syphilis?
metaphyseal dystrophy and periostitis
197
What are some presentations of mumps? Complications?
parotitis, orchitis.
complications: aseptic meningitis, encephalitis
198
bacterial meningitis in <1. Presentation. workup. indications for imaging. tx?
Presentation
- fever
- vomiting
- decreased PO
- altered mental status
- NUCHAL RIGIDITY
- POSITIVE KERNIG AND BRUDZINSKI
- BULGING ANT. FONTANELLE
Workup
- CBC + lytes
- blood cultures
- LP and CSF
```
Imaging considerations?
- FOCAL NEUROLOGIC FINDINGS
- hx of hydrocephalus or neurosurgery
- hx of trauma
Kids <1 have open fontanelles and thus have a really LOW risk of herniation in the absence of these findings
```
tx?
ceftriaxone (cover strep pneumo and Neisseria meningitides, the big ones) and vanc. (resistant strains of strep pneumo)
199
What is prophylaxis for contacts after a pertussis outbreak? How long do you isolate cases
age 1 month - any macrolide
respiratory isolation for first 5 days of abx
200
What are the guidelines for chlamydia and gonorrhea testing?
All sexually active women <24 years should be tested.
201
What's a dangerous complications of eczema? presentation? tx?
eczema herpeticum.
Usually on healing atopic dermatitis lesions, after an exposure to HSV, you will find umbilicated vesicles. Often accompanied by fever and adenopathy.
Can be life-threatening. Treat with Acyclovir
202
Measles vs. rubella distinguisher.
Presentation of rubella
Measles - Koplik Spots (blue spots on buccal mucosa). HIGHER FEVER. Darker spots than rubella
Rubella - FORSCHEIMER SPOTS (patchy erythema on the soft palate)
Rubella presentation:
- low-grade fever
- conjunctivitis, coryza, cervical LAD
- cephalocaudal spreading of blanching, erythematous maculopapular rash
203
Describe cystic hygroma. What is it?
it is a lymphangioma. It is a benign tumor consisting of dilated lymphatic spaces lined by endothelium.
Commonly occur on the neck. Physical exam lobulated, compressible, transilluminate with light.
204
What is seborrheic dermatitis and what is outlook and tx?
transparent yellow papules and occasional scaling plaques on eyebrows, nasolabial folds, bases of eyelashes, and paranasal skin. Also on the scalp thus "cradle cap"
tx: moisturizers, topical antifungals, anti-dandruff shampoo, topical steroids
205
Erythema Toxicum neonatorum. Presentation.
presentation:
- asymptomatic, scattered erythematous macules, papules, and pustules throughout the body.
Common in full-term infants. can change in appearance. It is eosinophilic.
206
Cholesteotoma. Presentation. tx
Presentation:
new-onset hearing loss or EAR DRAINAGE DESPITE ABX THERAPY. GRANULATION TISSUE AND SKIN DEBRIS seen in the retraction pockets of the tympanic membrane on otoscopy.
207
What type of immune rash is it to poison oak? What about anaphylaxis
Type IV - cellular immunity. Develops about 24 hours after exposure.
anaphylaxis is Type I - IgE mediated and happens immediately
