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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
Q

extra abdominal acute pain

A
  • URI
  • Lower lobe pneumonia
  • torsion of testis
  • hip and spine
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26
Q

surgical abdominal acute pain

A
  • appendicitis
  • obstruction, intussiception
  • inguinal hernia
  • peritonitis
  • inflamed meckels diverticulum
  • pancreatitis
  • trauma
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27
Q

medical abdominal acute pain

A
  • 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
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28
Q

mimicking gastroenteritis

A
  • 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
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29
Q

malabsorption

A
  • 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
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30
Q

prolonged fever infective

A
  • localized: osteomyelitis
  • bact: typhoid, bartonella, brucella
  • deep abscess
  • inf endocarditis
  • TB
  • mycobacterium avid complex
  • viral: EBV, CMV, HIV
  • parasite: malaria, toxocaria, entameba
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31
Q

noninfective prolonged fever

A
  • JIA
  • SLE
  • vasculitis, Kawasaki
  • IBD
  • Sarcoidosis
  • Malignancy: leukemia, lymphoma, NB, Ewing
  • macrophage activation syndromes- hemophagic lymphohistiocytosis
  • drug fever
  • fabricated or induced illness
32
Q

stridor

A
  • 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
Q

wheeze

A
  • viral episodic wheeze
  • multiple trigger wheeze
  • asthma
  • recurrent anaphylaxis eg food allergy
  • chronic aspiration
  • CF
  • BPD
  • bronchiolitis obliterans
  • tracheo- bronchomalacia
34
Q

recurrent or persisten cough

A
  • 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
Q

breathless hd

A

ASD, VSD, PDA

36
Q

blue hd

A

ToF, TGA

37
Q

Breathless and blue

A

AVSD, complex hd: tricuspid atresia, mitral atresia, double inlet left ventricle, common arterioventricular trunk

38
Q

asymptomatic with murmur

A

pulm stenosis, AS, adult type CoA

39
Q

outflow obstruction in sick neonate, collapsed w shock

A

CoA, interuption w/o shunt, HPLH

40
Q

older child w heart failure

A
  • Eisenmenger sd
  • Rheumatic hd
  • Cardiomyopathy
41
Q

syncope

A
  • neurally mediated: standing too quickly, blood, sudden unexpected pain
  • cardiac: arrhythmic, heart block, SVT, VT, long QT, AS, hypertrophic cardiomyopathy
42
Q

hydronephrosis

A
  • PUJ, VJO

- bladder neck obstruction, posterior urethral valve

43
Q

daytime enuresis

A
  • lack of attention to bladder sensation
  • detrusor instabilirt
  • bladder neck weakness
  • neuropathic bladder (spina bifida)
  • UTI
  • constipation
  • ectopic ureter
44
Q

proteinuria

A
  • 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
Q

nonglomerular causes of hematuria

A
  • inf
  • trauma
  • stone
  • tumor
  • sickle cell
  • bleeding disorder
  • renal vein thrombosis
  • hypercalciuria
46
Q

glomerular causes

A
  • acute glomerulonephritis
  • chronic glomerulonephritis
  • igA nephropathy
  • familial nephritis, eg Alport sd
  • thin basement membrane disease
47
Q

acute nephritis

A
  • post inf
  • vasculitis: HSP, SLE, Wegner granulomatosis, microscopic polyarteritis, polyarteritis nodosa
  • igA nephropathy and mesangiocapillary glomerulonephritis
  • antiglomerular basement membrane disease (Goodpasture)
48
Q

hypertension

A
  • 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
Q

palpable kidneys

A
  • Unilateral: mylticystic, cenpensatory hypertrophy, obstructed hydronephrosis, tumor, renal vein thrombosis
  • bilateral: ARPCK, ADPCK, tuberous sclerosis, renal vein thrombosis
50
Q

fanconi sd ( polydipsia, polyuria, salt depletion/dehydration, hyperchloremic metabolic acidosis, rickets, faltering growth)

A
  • idiopathic
  • IEM: cystinosis, glycogen storage disease, Lowe sd, galactosemia, fructose intoleranse, tyrosinemia, wilson disease
  • acquired: heavy metals, drug and toxins, vitD def
51
Q

AKI prerenal

A
  • hypovolemia: gastroenteritis, burns, sepsis, hemorraghe, nephrotic sd
  • circulatory failure
52
Q

aki renal

A
  • vascular: HUS, vasculitis, embolus, renal vein thrombosis
  • tubular: acute tubular necrosis, ischemic, toxic, obstructive
  • glomerulonephritis
  • interstitial nephritis, pyelonephritis
53
Q

postrenal aki

A
  • congenital

- acquired eg blocked catheter

54
Q

CKD

A
  • renal dysplasia
  • obstructive uropathy
  • glomerular disease
  • congenital nephrotic sd
  • tubulointestinal disease
  • renovascular disease
  • polycystic kidney disease
  • metabolic
55
Q

neonatal hepatitis sd

A
  • cong. inf
  • IEM
  • alfatrypsin def
  • galactosemia
  • tyrosinemia
  • error of bile acid synthesis
  • progressive familial intrahepatic cholestasis
  • CF
  • intestinal failure ass liver disease
56
Q

intrahepatic biliary hypoplasia

A

Alagille sd

57
Q

itchy rashes

A
  • atopic eczema
  • VZV
  • urticaria
  • contact dermatitis
  • insect bite
  • scabies
  • fungal inf
  • pityriasis rosea
58
Q

hypoglycemia

A
  • 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
Q

pituitary disorders

A

Congenital: structural midline defect (septooptic dysplasia) , pituitary hypoplasia or aplasia

Acquired: tumor (craniopharyngioma), irradiation, trauma, inf, infiltration (histiocytosis), structural ( cerebral malformation, hydrocephalus)

60
Q

limp

A
  • inf: septic arthritis, osteomyelitis, reactive arthritis
  • transient synovitis
  • trauma
  • malignancy: bone, leukemia
  • perches disease
  • JIA
  • CRPS
  • mechanical, overuse
  • slipped capital femoral epiphysis
  • osteochondritis
61
Q

polyarthritis

A
  • inf: TB, viral, LYme, reactive
  • IBD
  • Vasculitis: HSP, Kawasaki
  • Hema: hemophilia, sickle
  • malignant: leukemia, NB
  • CTD: JIA, SLE, dermatomyositis, MCTD, PAN
  • Other: CF
62
Q

anterior horn cell

A

SMA, polio

63
Q

Disorder of peripheral nerve

A

hereditary motor sensory neuropathy, GBsd, Bells palsy

64
Q

NM transmission

A

MG

65
Q

Muscle disorders

A
  • Dystropht: Duchenne, Becker, congenital
  • Myopathy: Benign acute myositis, Poliomyositis, Dermatomyositis
  • Metabolic myopathies
  • Congenital myopathy
66
Q

central floppyness infant

A
  • HIE
  • IC bleed
  • malformation
  • Chr, genetic
  • cong. inf
  • acquired inf
  • peroxismal disorders
  • drug effects
67
Q

Other floppyness infant

A
  • 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
Q

ataxia

A
  • Friedrich ataxia
  • Ataxia telangiectasia
  • cerebellar agenesis/dysgenesis
  • postinf cerebellitis: VZV
  • Miller Fisher sd
  • Mitochondrial disease
  • Drugs: carbamazepine, lamotrigene
  • toxins eg ethanol
69
Q

hydrocephalu

A
  • 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
Q

upper GI bleeding in neonate

A

Hemorrhagic disease of the newborn
Swallowed maternal blood
Stress gastritis
Coagulopathy

71
Q

lower GI bleed in neonate

A

Anal fissure
Necrotizing enterocolitis
Malrotation with volvulus

72
Q

upper GI bleed in 1m - 1y

A

Esophagitis

Gastritis

73
Q

lower GI bleed in 1m - 1y

A

Anal fissure
Intussusception
Gangrenous bowel
Milk protein allergy

74
Q

upper GI bleed 1-2y

A

Peptic ulcer disease

Gastritis

75
Q

lower GI bleed 1-2y

A

Polyps

Meckel diverticulum

76
Q

child >2y upper GI bleed

A

Esophageal varices

Gastric varices

77
Q

lower GI bleed >2y

A

Polyps
Inflammatory bowel disease
Infectious diarrhea
Vascular lesions

Pediatrics (4 decks)

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