Random problems Flashcards
Crying that occurs in otherwise healthy infant for >3 hrs daily (usually evening), >3 times a wk and for a duration of >3 wks
Colic
Colic rx
calming techniques
feeding patterns checked
Gynecomastia in pubertal boys causes
transient increased testicular production of estrogen over testosterone and peripheral conversion of prohormones to estrogen
kid with Fever> 5 days, conjunctivitis oral muosal changes rash cervical LAD
Kawasaki Disease
acute vasculitis of small/medium arteries
Peak age: 18-24 months
Do Dx kawasaki what do you need?
Should have fever >5 days and 4/5 findings:
Conjunctivits: bilat, nonexudative, spares limbus
Oral mucosal changes: erythema, fissured lips, “Strawberry tongue”
Rash
Extremity: erythema, edema
desquamtion of hand/ft, (usually last manifestation)
Cervical LAD: >1.5cm
Supporting lab values for Kawasaki Disease
Increased CRP/ ESR
leukocytosis w/ neutrophilia
Reactive thombocytosis
Sterile pyuria on urinalysis
Complications of Kawasaki disease
Coronary artery Aneurysms
MI or ischemia
Rx of Kawasaki disease
Aspirin plus IVIG
What to be aware with Rx of kawasaki and when to stop?
Aspirin can cause Reye syndrome: hepatic encephalopathy
but it prevents coronary thrombosis
Clopidogrel can be substitued during acute influenca or VZV
Intussusception can be assoc with
Henoch-Schonlein purpura
Meckels diverticulum
Mongolian spots are
congenital dermal melanocytosis
benign usually on lower back and buttock
Fade by 1st decade of life
Adrenal enzyme: 21-hydroxylase deficiency symptoms
Ambigous genitalia in girls Salt wasting(vominting, hypotension, Decrease Na, increased K)
Dx 21 hydroxylase def
Inc 17-hydroxyprogesterone
inc testosterone
decr: cortisol/aldosterone
Adrenal enzyme 11B-hydroxylase deficiency symptoms
Ambigous genitalia in girls
Fluid and salt retention
HTN
DX 11B hydroxylase def?
Incresed testosterone and 11-deoxycorticosteone & 11 deoxycortisol
Decreased Cortisol and aldosterone
Adrenal enzyme 17a hydroxylase deficiency C/F
All patients: phenotypicaly female
Fluid&salt retention
HTN
Dx 17a hydroxylase
Decreased cortisol & testosterone
Increased Mineralocorticoids
Increased corticosterone
Normal anion gap acidosis
failure to thrive
urine alkolotic
Dx?
Renal tubular acidosis
RTA type 1
Distal: poor H ion secretion into Urine
Urine pH> 5.5
Serume K: low to normal
Causes of RTA1
Genetic disorders
medication toxicity
AI disorders (SS, RA)
RTA type 2
Proximal: poor hCO3 resorption
urine pH: below 5.5
Serum K-low to normal
Causes of RTA2
Fanconi syndrome (glucosuria, phosphaturia, AAuria)
RTA type 4
Aldosterone resistance
Urine pH: Below 5.5
Serum potassium: High
Causes of RTA4
Obstructive uropathy
Congenital adrenal hyperplasia
Kid with sickle cell comes in with ABD pain and jaundice. type of blood issue
Chronic hemolysis: extravascular
Increased LDH, unconjugated bilirubin, reticulocytes
Low haptoglobin
Seperation anxiety is normal when
9-18 months
Child (9 months)with history of otitis media and used to babble but stopped. raises concern for?
Hearing problem
Do a audiology evaluation
Girl seen due to hair loss for a week. Mom has vitiligo
P/E: scaling slightly erythematous patch on scalp; no LAD
Tinea capitis infection
Tinea capitis C/F
Scaly, erythematous patch on scalp Hair loss w/ residual black dot Possible painful LAD Blacks Human->huma or fomite transmission
Dx/Rx tinea
KOH exam of hair shaft to document spores
Rx: Griseofulvin or oral terbinafine
Smooth and discrete circular areas of hair loss w/out scaling… DX?
Alopecia areata
well demarcated plagues, inflammation and scarring of hair follicles, cutaneous lesions, and maybe photosensitivity…. Dx?
Discoid lupus erythematosus
Itchy scalp, neck and ears or asymptomatic. Whole family some how got it… Dx?
Lice: Pediculosis humanus capitis
MCC of 2ndry HTN in kids
Fibromuscular dysplasia (FMD) 20% of all cases of renal htn
Physical exam for FMD in kid with HTN?
hum or bruit in the costovertebral angle due to well -developed collaterals
R renal artery more affected than L
Angiography pattern in FMD
“string of beads” pattern to the renal artery
Kid OD’s on grandmas TCA meds cause he is a moron. What to give him to help?
SUpplemental O2, intubation IV fluids Charcoal within 2 hrs Seizures= BZs IV Sodium Bicarb for QRS widening or ventricular arryhthmias
Kid comes in with bleeding from bottom, bruises, multiple pneumonias, and thrombocytopenia.. Dx?
Wiskot aldrich syndrome
X-linked WAS gene
T cells cunable to reorganize atin cytoskeleton
Wiskot aldrich syndrome mnemonic?
WAS gene A: IgA/IgA Increased Infections Thrombocytopenia= purpura Eczema= truncal Response to bacterial polysacharides decreased
typical infections in WAS?
S. pneumonia
N. meningitis
H.influenzae
Febrile seizure R/Fs?
Fever from mild viral or bacterial infection (influenza, adenovirus, HHV-6)
Immunizations (DTaP, MMR)
Family Hx
Dx febrile seizure
Age 6m- 6 yrs Temp>38 (100.4) No hx of seizure No CNS infection No acute systemic metabnolic cause of seizures
Rx Febrile seizure
Reassurance/education
Kid with a infection, conjunctival redness, rhinorhea and high fever spike next day. Has seizure. upon arrival to ER feels better. Dx?
Febrile seizure
Bacterial vs viral conjunctivitis?
B- thick mucopurulent discharge
V- watery
Kid comes in with a scotal swelling after a fever and cough which progress for 2 weeks. Also has rash on buttock, bloody urine. Dx?
Henoch-schonlein purpura
HSP C/F
Palpable purpura Arthritis/arthralgia Abd pain, intussusceptions Renal disease similar to IgA nephropathy Severe cases: scrotal pain
Cause of HSP?
IgA mediated leukocytoclastic vasculitis
Rx of HSP
Supportive: hydrate and NSAIDS
Hospitilization and systemic steroids if severe
R/F for cholecystitis
Sickle cell anemia
Hereditary spherocytosis
obesity
Increased incidence of colonic diverticula and abd wall/inguinal hernia are seen in?
ADPKD
Recurrent Sinopulmonary infections, chronic cough, Nasal polyps, and digital clubbng…. Dx?
Cystic fibrosis
episodes of impaired consciousness, failure to respond to various stimuli during the episode, staring spells, automatism and post ictal confusion. Dx?
Complex partial seizure
EEG-normal
Brief (few s) periods of impaired consciousnes, have automatisms, NO post ictal state
typical abscence seizure
EEG generalized 3hz spike waves
EEG slow spike and wave activity with frquency less than 2.5 hz, 20 second impaired consciousness, Dx?
Atypical absence seizure
Adolescent w/ unilateral or bilateral myoclonic jerks
usually in Am and precipated by sleep deprivation, Dx?
juvenile myoclonic epilepsy
Childhood seizures of multiple types, impaired cognitive function, Spike and wave activity on EEG; Dx?
Lennox-Gastaut syndrome
Cyclic vomiting syndrome
>3 epidose in 6 month period last 1-10 days vomits >4 times/hr at peak no symptoms btw vomiting episodes no underlying condition
Rx CVS
Hydration
antiemetics
reassurance to parents
CVS is associated w/
FH of migraine headaches in parents
more like a abd migraine
Vomiting electrolyte imbalance
Hypochloremic, hypokalemic M. alkalosis ph: high- alkalosis PaCO2: increased HCO3: increased K: decreased Cl: decreased
Fever, uriticaria and polyarthralgia 1-2 wks after first exposure;
H, Edema, LAD & splenomegaly less common
Serum sickness- like reaction
usualy from antibiotics (B-lactams, sulfa)
Breath holding spells
Cyanotic: crying followed by breath holding in forced expiration, apnea, cyanosis, limpness & LOC
Pallid: Minor trauma followed by LOC, breath holding, pallor & diaphoresis
Rx: breath holding spells
Check CBC
Serume ferritin
Refeeding syndrome in purger
Increased insulin:
Incred glycogen synthesis
increased protein synthesis
inc intracellular uptake of phosphorus, K, Mg, thiamin
In refeeding syndrome electrolyte issues
Drop in Phosphorus, K, Mg
decreased thiamine
Increased Na and H2O
Clinical manifestations of refeeding syndrome
Arrhythmia
CHF (pulmonary edema, peripheral edema)
Seizures
Wernicke encephalopathy
when to check lipid levels in kids?
screen for dyslipidemia 9-11 and 17-21
relatively stable just prior and after puberty
normal weight loss in newborn in first 5 days of life?
7% birth weight
regained by 10-14 days
Heroin abuse in mom, kid has… c/f
Neonatal abstinence syndrome (NAS):
irritability, high-itched cry, poor sleeping, tremors, seizures, sweating, sneezing, tachypnea, poor feeding, V/D
W/drawal around 48hrs
Methadone withdrawal in newborn occurs when
48 to 72 hrs after birth
prenatal exposure to cocaine, c/f of kid
jitteriness,
excessive suckling
hyperactive MORO relfex
long term, behavior, attention and intelligence problems
infants shouldnt drink cow milk until what age? and why?
until age 1 and
Continued ear drainage for several weeks despite appropriate antibiotic therapy think of
Cholesteatoma
Cholesteatoma is what
Chronic middle ear disease leads to formation of a retraction pocket in tympanic membrane which can fill with granulation tissue and skin debris
Rx a cholesteatoma
referr to otolaryngologist
possibly Ct or surgical visualization to confirm Dx
erythematous vesicle symmetrically distributed on extensor surfaces
Dermatitis herpetiformis
Newborn with cyanosis that is aggravated by feeding and relieved by crying; dx?
Choanal atresia
watery Diarrhea, dermatitis, dementia(poor concentration, mental status change, aggressive), beefy red tongue
Pellagra, Def of Vit B3= Niacin
Cheilosis, glossitis, seborrheic dermatitis (often affecting genital areas), pharyngitis, edema or erythema of mouth; Dx?
Def of Vit B2: Riboflavin
Breastfeeding benefit for kid
Improved immunity
Improved GI function
Prevents infections: Otitis media, gastroenteritis, Resp Illness, UTI
Decreased risk of childhood cancer DMI, NEC
Maternal benefit to breastfeeding
Reduced risk of ovarian and breast cancer
rapid uterine involution and decreased postpartum bleed
faster return to prepartum weight
improved child spacing
Bonding
Lethargic newborn, hoarse cry,, poor feeding, constipation, jaundice, scleral icterus, dry skin,
TSH high, low free T4; Dx?
Congenital hypothyroidism
mcc: Thyroid dysgenesis
C/I to rotavirus vaccine
Anaphylaxis to vaccine ingredients
History of intussusception
Hx of uncorrect congential malformation of GI tract (e.g meckels)
SCID
Late onset (nonclassical) congenital adrenal hyperplasia C/F
severe facial acne, advanced pubic/axillary hair, normal testicular volume, advanced bone age;
Late onset CAH labs
LH low at baseline and doesn’t increase with GNRH stimulation
Vit B2: riboflavin def c/f
Angular cheilitis: fissures Glossitis: hyperemic tongue Stomatitis: hyperemic/edematous oropharyngeal mucous membranes, sore throat Normocytic-normochromic anemia Seborrheic dermatitis
Drugs for Enuresis management
1st line: Desmopressin
2nd: Imipramine, amitriptyline, desipramine
Lead poisoning screened by capillary blood; next step?
Venous lead measurements
Rx to lead poisoning 3 types:
Mild: 5-44 mcg/dl- no meds, repeat in 1 month
Moderat: 45-60- DMSA
Severe: >70- Dimercaprol + EDTA (calcium disodium edetate)
Congenital hypothyroidism C/f
Apathy weakness hypotonia large tongue sluggish mvts abd bloating umbilical hernia prolonged jaundice
Maternal factors that lead to abnormal fetal growth(5)
Preeclampia malnutrition placental insufficiency multiparity drug use
Infants who are small for gestational age are at risk for (7)
hypoxia perinatal asphyxia meconium aspirationi hypothermia hypoglycemia hypocalcemia polycythemia
Large for gestational age infants are at risk of
hip subluxation
talipes calcaneovalgus
SSSS is what
exfoliative toxin producing strains of S.aures;
toxins against desmoglein: keratinocyte adhesion in superficial epidermis
In SSSS what starts in 24-28 after fever, irritability, skin tenderness
erythema starts on faces and generalizes in that ime
Nikolsky sign
gentle lateral pressure on skin surface adjacent to a blister causes slipping and detachment of a superficial layer of skin
Cystic fibrosis most patients will have
Pulmonary and pancreatic insufficiency
95% f men: infertile: congenital bilateral absence of vas deferens
hyperaldosteronism causes
Hypokalemia
hypernatremia
hypercholeremia
alkalosis
SIADH causes
Hyperkalemia
hypernatremia
inability to take in water,(Concentrate urine)
Addisons crisis labs
hyponatremia
hypokalemia
shock
Glucose 6 phosphatase def na/k labs
as a rule are hyperlipidemic: increased TG concentration decreases the volume of aqueous compartment
hypokalemia, hyponatremia can be factiticously seen
Neonatal presentation with neonatal thyrotoxicosis
mom with Hx of Graves low birth weight tachycardia warm skin irritability
Rx neonatal thyrotoxicosis
dx: anti-TSH R ab transplacental
Rx: methimazole and B-Blocker if severe
What are infants of diabetic mothers at increased risk for?
Hypoglycemia/Hypocalcemia
Caudal regression syndrome
Congenital heart disease/septal hypertrophy
polycythemia
RDS (insulin delays surfactant production)
What is acrodermatitis enteropathica?
Zinc deficiency with chronic diarrhea, alopecia, and rash around the mouth/anus/hands/feet
