Toddlers (Age 2-3 years) and School (Age 4-11) Flashcards
Wilms’ Tumor (Nephroblastoma)
Kidney tumor (Cancer)
-Asymptomatic abdominal mass that extends from the flank toward the midline.
-smooth/ nontender
-rarely crosses the midline (of the abdomen)
tx:
DO NOT vigorously palpate
-get U.S.
-Refer
“i decided to palpate the flank on a WhIM- its a good thing I did”
Epiglottitis
presentation:
typical cause?
what will you see on an X-Ray?
How is it prevented?
EMERGENCY! (reportable dz)
presentation:
-Acute and rapid onset of high fever
-severe sore throat
-drooling
-Will not eat or drink;
-has muffled (hot potato) voice
-Characteristic tripod sitting posture
-hyperextended neck / open-mouth breathing.
-Stridor, tachycardia, and tachypnea.
Usually occurs between ages 2 and 6 years.
typical cause?
Hib
what will you see on an X-Ray?
“Thumbprint sign”
How is it prevented?
Hib Vaccine
Osteomyelitis
if this spreads it can lead to:
Bone infection
-Boys two times more likely than girls.
-Infections typically occur at the metaphyses (Long Bone)
-tender to the touch.
-Patient is febrile and toxic appearing.
-Usually will not weight bear or move extremity due to pain.
-Requires emergent hospitalization, intravenous (IV) antibiotics, and operating room (OR) debridement.
-Growth plate infection can result in growth stunting of the affected limb.
***if this spreads it can lead to: Septic Arthritis
Orbital Cellulitis
rare:
infection of the ocular fat pads and muscles
-Young child complains of abrupt onset of deep eye pain
-aggravated by eye movements
-high fever and chills.
-Affected eye will appear to be bulging (proptosis or exophthalmos)
A serious complication of rhinosinusitis, acute otitis media, or dental infections. Refer to ED. (CT scan or MRI is done in the ED.)
Preseptal Cellulitis (Periorbital Cellulitis)
-More common than orbital cellulitis.
-An infection of the anterior portion of the eyelid that does not involve the orbit/globe or the eyes.
-Rarely causes serious complications (compared with orbital cellulitis).
-Young child complains of a new onset of red, swollen eyelids and eye pain, sometimes none (Figure 1).
-Eye movements do NOT cause pain, and EOM exam is normal
(both are abnormal with orbital cellulitis)
The most common cancer in children is ________
specifically:
Leukemia
The most common type of leukemia in children is acute lymphocytic leukemia (ALL)
Wilms’ tumor is a
More common in
congenital tumor of the kidneys.
More common in African American girls.
Epiglottitis presentation:
Sitting posture with hyperextended neck and open-mouth breathing.
Speech of a 2-year-old includes
Speech of a 3-year-old includes
-two-word phrases mostly understood by family members.
-three- to-five-word sentences that can be mostly understood by strangers.
Three-year-old can ride a
Three-year-old can copy a
tricycle. Can ride a bicycle at the age of 6 to 7 years.
circle. (An easy way to memorize this fact is that when you take the “3” and join the two halves, it forms a circle.)
Four-year-old can copy a
Five-year-old can draw a
cross (the number “4” resembles a cross at the center) and draw a “stick person” with three body parts.
person with at least six body parts.
Oedipal stage is when the child (age 3–6 years) expresses the desire to
marry the parent of the opposite sex.
Red flags for autistic behavior are
-loss of skills at any age
-no pointing, reaching, or babbling by 1 year
-no words by 16 months
-no two-word phrases by 2 years.
Kawasaki Disease/Syndrome
**Onset of high fever (up to 104.0°F) for 5 or more days.
-enlarged lymph nodes in the neck
-bright-red rash (more obvious on groin area)
-bilateral conjunctivitis (dry, no discharge)
-**oral mucosal changes (e.g., dry cracked lips, “strawberry tongue”)
-swollen hands and feet.
-**After fever subsides, skin peels off hands and feet.
Treated with high-dose aspirin and intravenous (IV) gamma globulin.
-can lead to serious cardiac conditions
Leukemia
Complains of extreme fatigue and weakness.
Pale skin and easy bruising. May have petechial bleeding (pinpoint to small red spots).
May have bleeding gums and nosebleeds.
Leukemias are the most common type of cancer in children and adolescents; the most common type in children is acute lymphocytic leukemia (ALL).
Reye’s Syndrome
Case:
History of febrile viral illness (chickenpox, influenza) and aspirin or salicylate intake (e.g., Pepto-Bismol) in a child.
Stage 1: Severe vomiting, lethargic/sleepy, elevated ALT and AST
Stage 2: Deeply lethargic, restless, confused/delirious/combative, hypERactive reflexes, hyperventilation
Stage 3: Obtunded or in light coma, decorticate rigidity (stiff with bent arms, clenched fists, and legs held out straight)
Stage 4: Coma, seizure, decerebrate rigidity, fixed pupils, loss of reflexes
Stage 5: Seizures, deep coma, flaccid paralysis, absent deep tendon reflexes (DTRs), respiratory arrest, death
Down Syndrome: Atlantoaxial Instability
Up to 15% of Down syndrome patients have atlantoaxial instability (excessive mobility at the articulation of C1 and C2).
-Medical clearance is recommended for some sports participation.
-Children/adolescents (or older) with Down syndrome who want to participate in sports need cervical spine x-rays (including lateral view).
-Patients with atlantoaxial instability are restricted from playing contact sports (e.g., basketball, tackle football, soccer) and other high-risk activities (e.g., trampoline jumping).
Medical Conditions That May Disqualify Youth From Sports Participation:
Hypertrophic cardiomyopathy
Atlantoaxial instability (Down syndrome, juvenile rheumatoid arthritis)
Marfan syndrome
Ehlers–Danlos syndrome (vascular form)
Acute rheumatic fever with carditis
Mitral valve prolapse
Fever
Infectious diarrhea
Pink eye
Hypertrophic cardiomyopathy
-Risk of sudden cardiac death with intense exercise
Atlantoaxial instability (Down syndrome, juvenile rheumatoid arthritis)
-Instability between C1 and C2 can cause spinal cord compression
Marfan syndrome
-Risk of aortic aneurysm and cardiac death, lens eyes displacement, joint hypermobility
Ehlers–Danlos syndrome (vascular form) -Risk of cerebral or cervical artery aneurysm, spondylolisthesis, joint hypermobility
Acute rheumatic fever with carditis
-Worsens condition, heart inflamed
Mitral valve prolapse
-Risk of sudden cardiac death
Fever
-Risk of heat illness, hypotension, and increased cardiopulmonary effort
Infectious diarrhea
-Risk of dehydration and heat illness; contagious
Pink eye
-Contagious
Absence Seizures
Brief episodes during which child suddenly stops whatever they are doing and stares. If in school, teacher may tell parent that child is daydreaming and inattentive. A common type of pediatric seizure.
Also called petit mal seizure. First-line therapy is ethosuximide. Refer to pediatric neurologist.
Hand–Foot–Mouth Disease
Multiple small blisters appear on the hands, feet, and around rectum. Small ulcers inside the mouth, throat, tonsils, and tongue.
Treatment Plan
-Most common cause is the coxsackievirus A16.
Treatment is symptomatic; self-limited illness; complete recovery usually occurs within 5 to 7 days.
Ibuprofen or acetaminophen for pain and fever every 4 to 6 hours; do not use aspirin.
Use salt-water gargle (1/2 teaspoon salt in one glass of warm water).
Drink cold fluids (avoid soda, orange or lemon juice, tomato juice).
Impetigo
“Honey-colored” crusted lesions. Fragile bullae (bullous type).
Measles (rubeola)
Koplik’s spots (small white papules) inside the cheeks (buccal mucosa) by the rear molars.
Erythematous maculopapular rash that begins on face and spreads from head to feet but spares palms and soles.
Varicella
Generalized rash in different stages; new lesions appear daily for about 5 days.
Papules → vesicles → pustules → crusts. Pruritic. Very contagious.
Scarlet fever
“Sandpaper” rash with sore throat. Strawberry tongue is not specific (also seen in Kawasaki disease).
Pediculosis capitis (head lice)
Ovoid white nits on hair hard to dislodge. Red papules that are very itchy and nits are initially located in the hairline area behind the neck and the ears.
Molluscum contagiosum
Smooth waxlike round (dome-shaped) papules ranging in size from a pinhead to the size of a pencil eraser (2–5 mm). Central umbilication with white plug.
Scabies
Maculopapular rash located in interdigital webs of hands, feet, waist, axillae, groin. Very pruritic, especially at night. Can resemble pimples, eczema, and insect bites.
