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Pediatrics > Symptoms and signs DDX > Flashcards

Symptoms and signs DDX Flashcards

1
Q

Hepatomegaly

A
  • Infection: cong., mono, hepatitis, malaria, parasite
  • Hema: sickle cell anemia, thalassemia
  • Liver disease: chronic active hepatitis, portal HT, polycystic disease
  • Malignancy: leukemia, lymphoma, NB, Wilms, hepatoblastoma
  • Metabolic: glycogen and lipid storage disease, mucopoly
  • CV: heart failure
  • Apparent: Chest hyper expansion from bronchiolitis or asthma
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2
Q

Splenomegaly

A
  • Inf: viral, bacterial, protozoal (malaria, leishmaniasis), parasites, infective endocarditis
  • Hema: hemolytic anemia
  • Malignancy: leukemia, lymphoma
  • Other: portal HT, systemic JIA (Stills disease)
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3
Q

Shock

A
  • Hypovolemia: sepsis, dehydration (gastroenteritis), DKA, blood loss from trauma
  • Maldistribution: sepsis, anaphylaxis
  • cardiogenic: arrhythmias, heart failure
  • neurogenic: SC injury
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4
Q

Resp distress

A
  • Upper airway: croup, epiglottitis, foreign body, cong. malf, trauma
  • Lower airway: asthma, bronchiolitis, pneumonia, pneumothorax
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5
Q

Unconsciious/ drowsy / seizure

A
  • Post-ictal status epilepticus
  • ing: meningitis, encephalitis
  • metabolic: DKA, hypoglycemia, electrolyte disturbance (calcium, magnesium, sodium, IEM
  • Head injury: trauma, non-accidental injury
  • drug/ poison ingestion
  • IC bleed
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6
Q

acute abdomen

A
  • appendicitis

- peritonitis

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7
Q

intestinal obstruction

A
  • intussusception
  • malrotation
  • bowel atresia / stenosis
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8
Q

preterm

A
  • idiopathic
  • uterine stretch: multiple gest., polyhydr, uterine abn
  • endocrine maturation: premature onset of labor
  • intrauterine bleeding: abruption, antepartum hemorrhage
  • intrauterine inf: chorioamnionitis, bact vaginosis, preterm prolonged rupture of membrane
  • fetus: IUGR, cong. malf
  • maternal medical cond: pre-eclampsia, HT, chronic medical conditions, UTI
  • Cervical weakness
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9
Q

HIE

A
  • Hypoxemia, hypercarbia, resp acidosis

- low cardiac output, decreased tissue perfusion, ischemia, metabolic acidosis, capillary leak, edema

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10
Q

Brain injury in preterm

A
  • Bleed: germinal layer, intraventricular, parenchymal
  • ventricular dilatation, may need shunt
  • periventricular leukomalacia: ischemic white matter
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11
Q

Jaundice < 24h

A
  • Hemolytic disorder: Rh, ABO, G6PD, Spherocytosis

- Cong. infection

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12
Q

Jaundice at 24h - 2w

A
  • Physiologic
  • Breastmilk
  • Inf eg UTI
  • Hemolysis: g6pd, ABO
  • bruising
  • polycythemia
  • crigler najjar
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13
Q

Jaundice at >2w

A
  • Unconjugated: 1) physiologic or breastmilk 2) inf (esp UTI) 3) hypothyroidism 4) Hemolysis 5) high GI obst, eg pyloric stenosis
  • Conjugated (> 25umol/L): Bile duct obstruction (atresia, choledochal cyst), neonatal hepatitis
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14
Q

Resp distress in newborn

A
  • Common: transient TP of the newborm
  • Less common: meconium asp, pneumonia, RDS, pneumothorax, persistent pulm HT if the newborn, milk asp
  • Rare: diaphragmatic hernia, TE-fistula, pulm hypoplasia, airway obst eg choanal atresia, pulm. hemorrhage
  • non pulm: cong. HD, HIE, severe anemia, metabolic acidosis
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15
Q

neonatal seizure

A
  • HIE
  • cerebral infaction
  • sepsis/meningitis
  • metabolic: hypo-glycemia/natremia/calcemia/magnesemia, hypernatremia, pyridoxine dependency
  • IC hemorraghe
  • cerebral malformations
  • drug withdrawal eg maternal opiates
  • kernicterus
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16
Q

short stature

A
  • familial
  • severe IUGR, restriction or prematurity
  • constitutional delay of growth and puberty
  • endocrin: hypothyroidism, GH def, steroid excess (Cushing, iatrogenic) , IGF-1 deficiency
  • nutrition/ long term illness: celiac, crohns, CKD
  • psychosocial: emotional deprivation/neglect
  • Syndromes: Turner, Noonan, Down, Russel Silver
  • Disproportion: dysplasia, storage disorders
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17
Q

tall stature

A
  • familial
  • obesity
  • Seconday: hyperthyroidism, excess sex steroids, excess adrenal androgen steroids (CAH), true gigantism (excess growth hormone secretion)
  • Syndrome: Marfan, Homocysteinuria, Klinefelter, Sotos
  • excessive growth at birth: maternal DM, primary hyperinsulinism, BW
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18
Q

Macrocephaly

A
  • tall stature
  • familial
  • increased ICP: chronic subdural hematoma, tumor, NF
  • cerebral gigantism (Sotos)
  • CNS storage disorders: mucopoly ( Hurler)
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19
Q

Microcephaly

A
  • familial
  • AR disorder, whenn ass w development delay
  • cong. inf
  • insult to developing brain: perinatal hypoxia, hypocalcemia, meningitis
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20
Q

weight faltering

A
  • immune deficiency
  • renal failure, William sd
  • liver, malabsorption, metabolic
  • hypo hyper thyroidism
  • inflammation
  • iron def anemia
  • celiac
  • intestinal infection, parasite
  • CF, other resp disorders
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21
Q

rickets

A
  • nutritional: northern latitude, dark skin, decreased sunlight, maternal vitD def, diet, vegan diet, prolonged parenteral nutrition in infancy
  • intestinal: small bowel: celiac, pancreatic insufficiency (CF), cholestatic liver disease, high physic acids in diet
  • defective production 25: chronic liver disease
  • increased metabolism: enzyme induction by anticonvulsants (phenobarbital)
  • defective production of 1,25: CKD, Falcon, inherited disorders
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22
Q

cause of vomiting in infant

A
  • GER
  • feeding problem
  • inf: gastroenteritis, resp tract/ otitis media, whopping cough, UTI, meningitis
  • food allergy and intolerance
  • eosinophilic esophagitis
  • obstruction: pyloric stenosis, atresia, intussuception, malrotation/volvulus, dyplication cyst, strangulated inguinal hernia, hirschprung disease
  • IEM
  • cong adrenal hyperplasia
  • renal failure
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23
Q

vomiting in preschool

A
  • gastroenteritis, other inf
  • appendicitis
  • intestinal onstreuction: intussiception, malrotation, volvulus, adhesion, foreign body (besoar)
  • increased ICP
  • celiac
  • renal failure
  • IEM
  • torsion of testis
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24
Q

vomiting in school age and adolescent

A
  • gastroenteritis
  • inf: pyelonephritis, sepsis, meningitis
  • peptic ulcer h pylori
  • appendicitis
  • migraine
  • increased ICP
  • celiac
  • renal failure
  • DKA
  • alcohol and drug
  • cyclical vomiting sd
  • bulimia and anorexia
  • pregnancy
  • torsion of testis
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25
extra abdominal acute pain
- URI - Lower lobe pneumonia - torsion of testis - hip and spine
26
surgical abdominal acute pain
- appendicitis - obstruction, intussiception - inguinal hernia - peritonitis - inflamed meckels diverticulum - pancreatitis - trauma
27
medical abdominal acute pain
- nonspecific pain - gastroenteritis - UT: pyelonephritis, hydronephrosis/ PUJ, UTI, calculus - HSP - DKA - sickle cell - hepatitis - IBD - constipation - recurrent abd pain of childhood - gynecological in female - psychological - lead poisoning - acute porphyria (rare) - unknown
28
mimicking gastroenteritis
- systemic inf: sepsis, meningitis - local inf: resp tract, otitis media, hep A, UTI - surgical: pyloric stenosis, intussuception, NEC, hirschprung - DKA - HUS - Other: celiac, cows milk protein allergy, lactose intolerance, adrenal insufficiency
29
malabsorption
- cholestatic liver disease or biliary atresia - lymphatic leakage or obstruction - short bowel sd - loss of terminal ileal function - exocrine dysfunction, eg CF - small intestinal mucosal disease
30
prolonged fever infective
- localized: osteomyelitis - bact: typhoid, bartonella, brucella - deep abscess - inf endocarditis - TB - mycobacterium avid complex - viral: EBV, CMV, HIV - parasite: malaria, toxocaria, entameba
31
noninfective prolonged fever
- JIA - SLE - vasculitis, Kawasaki - IBD - Sarcoidosis - Malignancy: leukemia, lymphoma, NB, Ewing - macrophage activation syndromes- hemophagic lymphohistiocytosis - drug fever - fabricated or induced illness
32
stridor
- croup - epiglottitis - bacterial tracheitis - foreign body - allergic lanyngeal angioedema - inhalation of smoke and hot fumes in fires - trauma - retropharyngeal abscess - hypocalcemia - severe LN swelling: TB, mono, malignancy - measles, diphteria - psychological
33
wheeze
- viral episodic wheeze - multiple trigger wheeze - asthma - recurrent anaphylaxis eg food allergy - chronic aspiration - CF - BPD - bronchiolitis obliterans - tracheo- bronchomalacia
34
recurrent or persisten cough
- recurrent inf - pertussis, RSV, mycoplasma - asthma - persistent lobar collapse following pneumonia - suppurative lung disease: CF, ciliary dyskinesia, immune def - recurrent asp, GER - persistent bacterial brochitis - inhaled foreign body - smoking - TB - habit cough - airway anomaly
35
breathless hd
ASD, VSD, PDA
36
blue hd
ToF, TGA
37
Breathless and blue
AVSD, complex hd: tricuspid atresia, mitral atresia, double inlet left ventricle, common arterioventricular trunk
38
asymptomatic with murmur
pulm stenosis, AS, adult type CoA
39
outflow obstruction in sick neonate, collapsed w shock
CoA, interuption w/o shunt, HPLH
40
older child w heart failure
- Eisenmenger sd - Rheumatic hd - Cardiomyopathy
41
syncope
- neurally mediated: standing too quickly, blood, sudden unexpected pain - cardiac: arrhythmic, heart block, SVT, VT, long QT, AS, hypertrophic cardiomyopathy
42
hydronephrosis
- PUJ, VJO | - bladder neck obstruction, posterior urethral valve
43
daytime enuresis
- lack of attention to bladder sensation - detrusor instabilirt - bladder neck weakness - neuropathic bladder (spina bifida) - UTI - constipation - ectopic ureter
44
proteinuria
- orthostatic - gloerulaer abn: 1) minimal change disease 2) glomeruli nephritis 3) abnormal glomerular basement membrane - increased glomerular filtration pressure - reduced mass in CKD - HT - tubular proteinemia
45
nonglomerular causes of hematuria
- inf - trauma - stone - tumor - sickle cell - bleeding disorder - renal vein thrombosis - hypercalciuria
46
glomerular causes
- acute glomerulonephritis - chronic glomerulonephritis - igA nephropathy - familial nephritis, eg Alport sd - thin basement membrane disease
47
acute nephritis
- post inf - vasculitis: HSP, SLE, Wegner granulomatosis, microscopic polyarteritis, polyarteritis nodosa - igA nephropathy and mesangiocapillary glomerulonephritis - antiglomerular basement membrane disease (Goodpasture)
48
hypertension
- renal: parchymal disease, renal artery stenosis, PKD, tumor - CoA - Chatecholamine excess: pheochromocytoma, NB - Endocrine: CAH, Cushing sd, corticosteroid tx, hyperthyroidism - essential HT: dx of exclusion
49
palpable kidneys
- Unilateral: mylticystic, cenpensatory hypertrophy, obstructed hydronephrosis, tumor, renal vein thrombosis - bilateral: ARPCK, ADPCK, tuberous sclerosis, renal vein thrombosis
50
fanconi sd ( polydipsia, polyuria, salt depletion/dehydration, hyperchloremic metabolic acidosis, rickets, faltering growth)
- idiopathic - IEM: cystinosis, glycogen storage disease, Lowe sd, galactosemia, fructose intoleranse, tyrosinemia, wilson disease - acquired: heavy metals, drug and toxins, vitD def
51
AKI prerenal
- hypovolemia: gastroenteritis, burns, sepsis, hemorraghe, nephrotic sd - circulatory failure
52
aki renal
- vascular: HUS, vasculitis, embolus, renal vein thrombosis - tubular: acute tubular necrosis, ischemic, toxic, obstructive - glomerulonephritis - interstitial nephritis, pyelonephritis
53
postrenal aki
- congenital | - acquired eg blocked catheter
54
CKD
- renal dysplasia - obstructive uropathy - glomerular disease - congenital nephrotic sd - tubulointestinal disease - renovascular disease - polycystic kidney disease - metabolic
55
neonatal hepatitis sd
- cong. inf - IEM - alfatrypsin def - galactosemia - tyrosinemia - error of bile acid synthesis - progressive familial intrahepatic cholestasis - CF - intestinal failure ass liver disease
56
intrahepatic biliary hypoplasia
Alagille sd
57
itchy rashes
- atopic eczema - VZV - urticaria - contact dermatitis - insect bite - scabies - fungal inf - pityriasis rosea
58
hypoglycemia
- insulin excess: 1) in DM 2) b-cell tumor, insulinoma, persistent hypoglycemic hyperinsulinism of infancy 3) drug induced 4) autoimmune 5) BWsd - w/o hyperinsulinemia: liver disease, ketotic hypoglycemia of childhood, IEM, hormonal ( GH def, ACTH def, Addison, CAH) - Reacting/nonfasting: galactosemia, leucine sensitivity, fructose intolerance, maternal DM, hormonal def, aspirin/alcohol poisoning
59
pituitary disorders
Congenital: structural midline defect (septooptic dysplasia) , pituitary hypoplasia or aplasia Acquired: tumor (craniopharyngioma), irradiation, trauma, inf, infiltration (histiocytosis), structural ( cerebral malformation, hydrocephalus)
60
limp
- inf: septic arthritis, osteomyelitis, reactive arthritis - transient synovitis - trauma - malignancy: bone, leukemia - perches disease - JIA - CRPS - mechanical, overuse - slipped capital femoral epiphysis - osteochondritis
61
polyarthritis
- inf: TB, viral, LYme, reactive - IBD - Vasculitis: HSP, Kawasaki - Hema: hemophilia, sickle - malignant: leukemia, NB - CTD: JIA, SLE, dermatomyositis, MCTD, PAN - Other: CF
62
anterior horn cell
SMA, polio
63
Disorder of peripheral nerve
hereditary motor sensory neuropathy, GBsd, Bells palsy
64
NM transmission
MG
65
Muscle disorders
- Dystropht: Duchenne, Becker, congenital - Myopathy: Benign acute myositis, Poliomyositis, Dermatomyositis - Metabolic myopathies - Congenital myopathy
66
central floppyness infant
- HIE - IC bleed - malformation - Chr, genetic - cong. inf - acquired inf - peroxismal disorders - drug effects
67
Other floppyness infant
- SC: birth trauma (esp breech), syringomyelia - Ant. horn cell: SMA - NM junction: MG, botulism - Muscle: dystrophies (congenital myotonic dystrophy), congenital myopathy - peripheral nerve: hereditary motor and sensory neuropathy - Metabolic: IEM, carnitine def
68
ataxia
- Friedrich ataxia - Ataxia telangiectasia - cerebellar agenesis/dysgenesis - postinf cerebellitis: VZV - Miller Fisher sd - Mitochondrial disease - Drugs: carbamazepine, lamotrigene - toxins eg ethanol
69
hydrocephalu
- noncommunicating: congenital malformation (1. aqueduct stenosis 2. atresia of the outflow foramina of the 4th ventricle 3. Chiari malformation) and post. fossa neoplasm and IVH in preterm - communicating: SAH, meningitis eg pneumococcal, TB
70
upper GI bleeding in neonate
Hemorrhagic disease of the newborn Swallowed maternal blood Stress gastritis Coagulopathy
71
lower GI bleed in neonate
Anal fissure Necrotizing enterocolitis Malrotation with volvulus
72
upper GI bleed in 1m - 1y
Esophagitis | Gastritis
73
lower GI bleed in 1m - 1y
Anal fissure Intussusception Gangrenous bowel Milk protein allergy
74
upper GI bleed 1-2y
Peptic ulcer disease | Gastritis
75
lower GI bleed 1-2y
Polyps | Meckel diverticulum
76
child >2y upper GI bleed
Esophageal varices | Gastric varices
77
lower GI bleed >2y
Polyps Inflammatory bowel disease Infectious diarrhea Vascular lesions

Pediatrics (4 decks)

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