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158 Cards in this Set
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child with recurrent intussusception
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meckel's diverticulum most common congenital anomaly of the GI tract and can be asymptomatic btw episodes of telescoping.
other risk factors include recent viral illness or rotavirus vaccination, henoch shonlein purpura, celiac dz, intestial tumor, or polyps |
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howell jolly bodies
basophilic stippling |
nuclear remnants of the RBCs which are generally removed by a functional spleen; therefore, their presence ina peripheral smear suggests functional asplenia in sickle cell pts
basophilic stippling > thalassemias and lead/heavy metal poisoning |
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waterhouse-friderichsen syndrome
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characterized by sudden vasomotor collapse and skin rash (LARGE PETECHIAE AND PURPURIC LESIONS) due to adrenal hemorrhage
occurs in infant with meningococcemia |
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QID 4829 thymus silhoutte
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nl finding on frontal cxr in children less than 3 due to relatively large size compared to young child's thorax
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osteogenesis imperfecta
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caused by mutations in type 1 collagen. typical features include blue sclera and recurrent fx, hearing loss, and opalescent teeth. nl intelligence
high yield! |
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growing pains
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bilateral!, lower extremity pains! that occur at night! in children age 2-12 yrs. no systemic sx, nl activity levels, and nl physical exams
tx consists of observation, parental reassurance, massage, and otc pain meds |
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neonatal conjunctivitis tx
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chemical first 24 hrs: supportive mgmt
gonococcal: day 2-5: IV or intramuscular CTX or cefotaxime chlamydial: day 5-14, oral erythromycin |
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neuroblastoma
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third most common CA in ped popu
tumor arises from NEURAL CREST CELLS, which are also the precursor cells of the sympathatic chains and adrenal medulla. Most common site is the abdomen. Calcifications and hemorrhages are seen on plan xray and ct scan. levels of serum urine catecholamines and their metabolites (HVA adn VMA) are usually elevated |
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anemia of prematurity
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most common anemia in premature and low birth weight infants.
pathology involves a combo of diminished RBC production, shortened RBC life span, and blood loss. Iron supplementation does not prevent falling hemoglobin levels, and iron deficiency is not the cause of anemia of prematurity |
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topical erythromycin
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not effective for chlamydial conjunctivitis. Effective only against gonococcal conjunctivitis.
chlamydia usually transmitted form motehr to neonate during passage through birth canal. |
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klumpke palsy
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rare but potentially permanent complication of shoulder dystocia. Injury to the 8th cervical and 1st thoracic nerves results in hand paralysis and ipsilateral horner syndrome
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sweat chloride test aka ?
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quantitative pilocarpine iontophoresis gold standard
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Reye syndrome
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less than 15yo treated with salicylates for a viral infxn. most common presentation: vomiting, agitation, and irrational behavior, progressing to lethargy, stupor, and restlessness.
convulsions may occur. treatment is supportive |
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deficiency of 21-hydroxylase
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most common CAH. p/w virlization of female infants, salt-wasting, and increased 17-hydroxyprogesterone levels
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muscular dystrophies
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see qid 3544
duchenne muscular dystrophy (x linked recessive) suspected in boy < 5 with proximal muscle weakness, gower sign, and bilateral calf pseudohypertrophy. serum CPK and aldolase levels are elevated even before manifestation of weakness. An absent dystrophin gene on genetic testing and undetectable dystrophin protein on muscle bx confirm the dx |
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contraindications to breast feeding
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active untreated TB, maternal HIV, herpetic breast lesions, varicella infection, some meds, chemo or ongoing radiation, active abuse of street drugs or alcohol
infant has galactosemia |
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celiac dz
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frequent cause of malabsorption and can lead to iron deficiency anemia. common include type 1dm and dermatitis herpetiformis
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tetrology of fallot
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p/w varying degrees of cyanosis depending on the degree of right ventricular outflow tract obstruction. squatting decreases R to L ventricular shunting, which improves cyanosis and increases the intensity of systolic murmur d/t increased blood flow across the right ventricular outflow tract.
clinical presentation depends on degree or right ventricular outflow obstruction. |
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hemophilic arthropathy
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delayed consequence of recurrent hemarthrosis. associated with HEMOSIDERIN DEPOSITION leading to synovitis and fibrosis within the joint.
risk of hemophilic arthropathy can be significantly reduced by ppx with factor concentrates |
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myotonic muscular dystrophy
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autosomal dominant! disorder characterized by grip myotonia (delayed muscle relaxation), facial weakness, foot drop, dysphagia, and cardiac conduction anoalies. other problems include cataracts, testicular atrophy,/infertility, and baldness
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local impetigo treatment
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topical mupirocin or oral erythromycin!
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HSP: see qid3554
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answer
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Rheumatic fever
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suspect in child with sore throat, fever, pericarditis, erythema marginatum, arthritis, chorea, and subcutaneous nodules.
condition caused by group A streptococcus 3443 |
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developmental milestones during first year of life 4199
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answer
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APGAR score interventions
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scores < 7 may require further evaluation and resuscitation. Maternal factors that increase risk for resuscitation include very young maternal age, h/o substance abuse, and h/o DM or HTN.
review! if pulse below 60, chest compressions required |
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friedreich ataxia
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autosomal recessive condition and genetic counseling is recommended for prenatal diagnosis for parents with one affected child
characterized by excessive trinucleotide repeats, resulting in abnormality of a tocopherol transfer protein. disorder is progressive with poor prognosis. most wheelchair bound by 25, and death by 30-35. |
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differential for t wave inversion
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mi, myocarditis, old pericarditis, myocardial contusion and digoxin toxicity
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according to qbank, should perform LP before starting antibiotics
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qid 3633
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most common cause of congenital hypothyroidism in the US
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thyroid dysgenesis
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young boy with increased ICP (headaches, vomiting), bitemporal hemianopsia, and a calcified lesion above the sella
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craniopharyngioma until proven otherwise.
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infertility a/w cystic fibrosis
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almost all have obstructive azoospermia from CONGENITAL BILATERAL ABSENCE OF VAS DEFERENS -> FAILS TO DEVELOP DUE TO ACCUMLUATIO OF INSPISSATED MUCUS IN THE FETAL GENITAL TRACT
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pt with apparent subcutaneous emphysiema 2/2 svevere coughing paroxysms. next step?
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cxr to r/o ptx
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conduct disorder vs oppositional defiant disorder
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conduct: disruptive behavioral patterns that violate basic social norms for at least one year in pts < 18yo. aggressive behavior towards others or animals, behaviors resulting in property damage, theft, or violations of societal rules.
antisocial if pt > 18yo oppositional defiant seen more commonly in late childood and adolescence, but is characterized by disruptive behavior such as negativity, hostility and defiance |
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screenign and dx of muscular dystrophies
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serum CK: screen
muscle bx: confirm gold standard: genetic studies required in atypical cases look for manifestations of duchennes: pseudohypertrophy of calves and positive gower's sign. |
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developmental dysplasia screening and mgmt
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barlow and ortolani maneuvers. palpable clunk should prompt referral to an orthopedic surgeon
soft click, leg-length discrepancy, or asymmetric inguinal skin folds require diagnostic imaging with US 9age < 6mo) or xrays (age >4-6mo tx of choice for less than 6mo is pavlik hip harness |
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initial sx of HIV in infants
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oral thrust, lymphadenopathy, and hepatosplenomegaly. more severe sx subsequently develop such as intractable diarrhea, refractory infections and failure to thrive.
detected via pcr viral culture and p24 antigen testing since serologic testing not useful due to passage of maternal antibodies to fetal circulation through placenta |
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duodenal vs jejunal atresia
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duodenal: 1/3 have chromosomal abnormalities, most commonly down syndrome. double bubble on radiography
jejunal: bilious vomiting and abdominal distention. abdominal xray shows "triple bubble" sign and gasless colon. risk factors include prenatal exposure to cocaine and other vasoconstrictive drugs |
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when to give varicella vaccine vs varicella zoster IG
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if immunocompromised, give vaccine + immunoglobulin with exposure to symptomatic person
if immunocompetent, give just vaccine |
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risk factors for vitd deficiency
exam findings? |
risk factors: exclusive breasfeeding, increased skin pigmentation, and lack of sun exposure
exam findings: craniotabes, rachitic rosary (bony prominences of the costochondral junctions noted bilaterally), and genu varum. xray findings include cupping and fraying of the metaphyses of the long bones |
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Digeorge syndrome
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defective development of pharyngeal pouches
clinical features: CATCH conotrunctal cardiac defects, abnl facies, thymic aplasia/hypoplasia, cleft palate, hypocalcemia |
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atlantoataxial instability
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seen in 10-15% of patients with DOWN SYNDROME, most commonly occurs due to excessive laxity in the posterior transverse ligament, which causes increased mobility between the atlas (C1) and the axis (C2).
presenting sx include behavioral changes, torticollis, urinary incontinence, and vertebrobasilar sx such as dizziness vertigo, and diplopia. ON exam, UMN sx such as leg spasticity, hyperreflexia, a positive babinki sign, and clonus often present. diagnosed with lateral radiographs of cervical spine. tx consists of surgical fusion of the first cervical vertebrae to the second |
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hyperIgM syndrome
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characterized by high levels of IgM with deficiency of IgG, Ig and poor specific antibody response to immunizations
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mongolian spots
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commonly found in african, asian, hispanic and native american infants and usually fade spontaneously during childhood.
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parinaud syndrome
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paralysis of vertical gaze that may be a/w pupillary disturbances and eyelid retraction (collier's sign)
involved lesion is on the rostral midbrain at the level of hte superior colliculus and CNIII. most comonly caused by GERMINOMAS AND PINEALOMAS at this region. endocrine syndrome results from interruption of hypothalamic inhibiting pathways, and sometimes beta-hcg secretion and consequent leydig's cell stimluation 3655 |
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lesch nyhan syndrome
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2/2 deficiency in HGPRT
sx include self-mutilation, neuro features (mental retardation, dystonea, choreoathetosis, spasticity), gouty arthritis, and tophus formation. gout usually seen in pts above 50yo; therefore, suspect lesch0nyhan syndrom eif you see a boy with gout x-linked recessive disorder |
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metatarsus adductus
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congenital foot deformity most frequent in first born infants, attributable to molding effect of primigravid uterus
about 10% also have hip dysplasia! spontaneous resolution in 95%! xray findings;mild adduction of metatrsals at hte tarsometatarsal articulation and an increased angle between the first and second metatarsals. |
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neonatal displaced clavicular fx. next step?
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reassurance and gentle handling
classic finding includes crepitus over clavicle, asymmetric moro reflex, and pain with passive motion of the affected extremity. |
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guthrie test
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urine test that is qualitative (coloration) that can detec tht epresence of metabolic products of phenylalanine in the urine
phenylketonuria signs? |
autosomal recessive, can produce mental retardation nd seizures, fair complexion, blue eyes, eczema and musty body odor.
low phenylalanine diet. high protein foods avoided. can have nl development and nl life span. |
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review tumors 3658
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review
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edwards syndrome
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commonly p/w microcephaly, prominent occiput, micrognathia, closed fists with index finger overlapping the 3rd and 5th overlapping hte 4th and rocker bottom feet
2488 |
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marfan's syndrome
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autosomal dominant disorder that results form mutations of the fibrillin-1 (FBN1) gene.
p/w tall stature, long and emaciated extremities, arachnodactyly, hypermobility of the joints, upward lens dislocation, and aortic root dilation |
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homocystinuria
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marfan's features + mental retardation + thromboembolic events + downward dislocation of lens
autosomal recessive 3687 |
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nursemaid elbow
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occurs when infants/children are lifted or pulled by the hand or arm.
mechanism involves radial head subluxation. child typically keeps hand in a pronated position, and refuses attempted forearm supination) |
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vitamin that reduces morbidity and mortality of measles
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vitA
helps through immune enhancement and also helps GI and respiratory epithelium regenerate |
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3192
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???
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Fragile X
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low to nl IQ with learning disabilities, generalized language disability, short attention span, autism, large head, prominent jaw, large low set ears and macroorchidism
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infantile colic
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presents by 3 wks of age with excessive crying for more than 3 hours a day, more than 3 days a week, and more than 3 weeks a mo, usually resolving by four mo
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supracondylar fracture
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brachial artery can be compromised, resultin gin the loss of the radial artery pulse; therefore, radial artery pulse must be assessed when fx is reduced
boy who falls on outstretched hand |
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midgut volvulus
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presents in child less than one month of age as bilious vomiting, abdominal distension and passage of bloodstained stools
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mccune albright syndrome
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3Ps: precocious puberty, pigmentation (cafe au lait spots), and polyostotic fibrous dysplasia.
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cyclic vomiting
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recurrent self-limiting episodes of vomiting and nausea in children, in the absence of any apparent cause
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leukocyte adhesion defect type 1
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suffer from delayed separation of the umbilical cord, recurrent bacterial infections of hte skin and mucosal surfaces, and necrotic periodontal infetions. Additional findings include leukocytosis with a neutrophil predominance and the complete absence of neutrophil sin inflamed or infected tissues
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kartagener's syndrome
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triad of recurrent sinusitis, bronchiectasis, and dextrocardia (aka situs inversus)
cause is primary ciliary dysplasia. |
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chronic pyelonephritis
uretopelvic obstruction |
characterized by focal parenchymal scarring and blunting of calices on IVP
uretopelvic obstruction would lead to hydronephrotic changes in the kidney with IVP showing the level of obstriction as a constricitoni n the flow of the dye |
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phenytoin use in pregnancy
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craniofacial abnl, fingernail hypoplasia, growth deficiency, developmental delay, cardiac defects and facial clefts
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biliary atresia
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neonatal cholestasis --> look for h/o jaundice in a/w light colored stools, hepatomegaly, and direct conjugated hyperbili (remember that gilbert and crigler-najjar are unconjugated).
either by extrahepatic obstruction or liver cell injury. |
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nephrotic syndrome with hepB
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often leads to dvlpt of membranous glomerulonephritis.
although minimal change dz still the most common cause of nephrotic syndrome in children |
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breastfeeding failure jaundice
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exaggerated unconjugated hyperbili in the FIRST WEEK OF LIFE that is caused by lactation failure!
can be caused by both maternal (inadequate milk supply, cracked/clogged nipples, engorgement, INFREQUENT FEEDING), and infant (POOR LATCH, ineffective suck, falling asleep) factors nl infants pass dark, sticky meconium during the first 2 days of life, after which they should transition to yellowish or green stool if ingesting adequate milk. inadequate stooling results in decreased bili elimination and increased enterohepatic circulation of bili appropriate amt = breastfeeding 15min per side every 2-3 hours |
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orbital cellulitis: most common predisposing factor?
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bacterial sinusitis
sx include proptosis, ophthalmoplegia and diplopia |
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tetrology of fallot
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right ventricular outflow tract obstruction (pulmonary stenosis or atresia)
right ventricular hypertrophy overriding aorta VSD |
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tricuspid atresia
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left axis deviation, decreased pulmonary markings on cxr due to hypoplasia of the right ventricle and pulmonary outflow tract
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rules with vaccines with premature infants
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premies are at especially high risk of dangerous complications from vaccine-preventable diseases.
vaccines for MEDICALLY STABLE preterm infants should be administered by CHRONOLOGICAL age not by gestational age. Vaccination of premies is safe and antibody productio is adequate to confer immunity. exception is that weight should be greater than 2 kg before first hepB vaccine |
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when would imaging studies be performed to identify any underlying structural abnl predisposing to UTIs?
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pt under 10, male, or a prepubertal nonsexually active female
most common identified structural abnormality in the pediatric range is vesico-ureteral reflux |
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seborrheic dermatitis
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common pediatric skin condition. papular, scaly rash tends to affect eyebrows, nasolabial folds and scalp. tx consists of moisturizers, antifungals and topical steroids
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mgmt of erb-duchenne palsy
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most infants recover arm function spontaneously within a few months -> affects c5-c6
surgical intervention in infants with no improvement by age 3-6mo but is not necessarily curative |
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congenital syphilis
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may also include hsm, cutaneous lesions, jaundice, anemia, ad rhinorrhea
metaphyseal dystrophy and periostitis may be seen on radiography |
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neonatal respiratory distress syndrome
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suspected when a premie presents with grunting, flaring, adn tretractions immediatley after birth. cxr includes characteristic fine reticular granularity of the lungs.
tx includes early continuous PPV |
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Reye syndrome
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can lead to fulminant hepatic failure. elevation of ammonia levels and transaminases, vomiting, and mental status changes arethe more common manifestations of the syndrome
characterized by diffuse mitochondrial injury that leads to N/V, HA, excitabilility, combativeness, hypoglycemia, liver failure, and progressive cns damage histologically, extensive fatty vacuolization of the liver without inflammation is present. tx? |
administration of glucose with FFP and mannitol to decrease cerebral edema
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acute iron poisoning
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IRON IS RADIOOPAQUE ON CXR
commonly occurs in children of pregnant women taking prenatal vitamins bc children often confuse brightly colored iron pills for candy. tx involves deferoximine, which binds ferric iron, allowing urinary excreion causes systemic manifestations such as abdominal pain, hematemesis!, shock, and metabolic acidosis! |
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concerning sexual behaviors
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extensive sexual knowledge, preoccupation with masturbation, touching other's genitals, excessive talk about sexuality, and simulating foreplay or intercourse
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reservoirs for rabies
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bats, wild carnivores (raccoons, skunks, foxes), should receive post exposure ppx for rabies
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type hypersensitivity
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type 1: immediate IgE mediated -> atopy, urticaria and anaphylaxis
type 2: antibody mediated, cytotoxic reactions involving specific reactions of IgG or IgM to cell-bound antigens. -> immune hemolytic anemia nad Rh hemolytic dz in the newborn type 3: immune complex mediated. serum sickness and arthrus reaction type 4:delayed cell-mediated, allergic contact dermatitis |
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acute otitis media vs otitis media with effusion vs otitis externa
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acute otitis media: middle ear effusion PLUS acute eardrum inflammation (bulging eardrum, fever)
otitis media with effusion: middle ear effusion w/o acute inflammation otitis externa: pain with tragal traction, erythematous and swollen external auditory canal +/- otorrhea |
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diagnostic features of acute bacterial rhinosinusitis
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1) persistent sx > 10d w/o improvement
2) severe sx, fever > 39, purulent nasal d/c, or face pain > 3d 3) worsening sx >5d after initially improving viral upper respiratory infxn |
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osgood sclatter dz
vs patellar tendonitis |
traction apophysitis of the tibial tubercle.
radiographic findings include anterior soft tissue swelling, liftingo f tubercle from the shaft, and irregularity or fragmentation of the tubercle tx: activity restriction, stretching exercises, and NSAIDs patellar tendonitis: overuse from repetitive jumping or kicking. point tenderness at inferior pole of the patella |
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presenting sx of type 1 DM in kids
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nocturnal enuresis, also diaper candidiasis (erythematous plaques and pustules) commonly seen in toddlers with new-onset disease
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risk factors for necrotizing enterocolitis
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prematurity, hypotension, and congenital heart dz
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esophageal coin treatmetn
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in asymptomatic pts can be observed for up to 24 hrs after ingestion. if pt is symptomatic or time of ingestion is unknown, the coin should be removed promptly by flexible endoscopy.
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partial vs complex partial vs partial seizures with secondary generalization
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partial: no loss of consciousness, feeling of familiarity (deja vu), can have aura, patient may remember event well
partial seizures with generalization: loss of consciousness, tonic-clonic activity complex partial: loss of consciousness, can have aura, motor autoamatisms!!! (chewing, swallowing, sucking), sometimes have bl motor findings |
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measles vs rubella
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measles tends to be more svere than rubella, with fevers up to 40C, coryza, and malaise. in addition, rash spreads more gradually and appears darker (reddish brown) in comparison to rublela
rubella: low grade fever, tender lymphadenopathy, adn a maculopapular rash that spreads cephalocaudally. |
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constipation in toddlers
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common due to transition to solid food and cow's milk, toilet trainign, and school entry.
complications include anal fissures, encopresis (stool holding) and enuresis (bedwetting) laxative therapy should be initiated promptly to soften stools |
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CF bacterial pneumonia -> what bugs to think of?
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staph A most common cause in young children with CF, especially with coexisting influenza infection. IV vanc is drug of choice for severe pna in this setting
once pt is 20 yo, pseudomonas is more common |
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pellagra
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4Ds! diarrhea, dementia, dermatitis, and possibly death
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children age < 24mo with first UTI. next step?
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7-14 course of oral antibiotics and should undergo a renal and bladder US to evaluate for structural abnormalities that could predispose them to UTIs.
Voiding cystourethrogram not indicated for first febrile UTI. instead, wait for renal and bladder us to determine if necessary, also for first UTI with family hx or with non Ecoli indications listed on 3692 |
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pneumatosis intestinalis
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aka intramural air and portal venous air
"abdominal xray with air in the bowel wall and portal veins" |
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atopic dermatitis
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in infancy presents with pruritis and skin lesions typically distributed symmetrically over the face, scalp, chest, and extensor surfaces of the extremities
diaper region typically spared |
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evaluation of primary amenorrhea
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first with pelvic exam or US
if uterus present, perform serum FSH if absent, perform karyotype 9566 |
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Turner syndrome
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complete or partial deletion of X chromsome. --> gold standard is karyotype analysis
if nl, but suspicion still high, FISH analysis can detect mosaicism (45,XO/46,XX) that is beyond the resolution of standard karyotyping. |
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central vs peripheral precocious puberty
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4239
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clinical manifestations of late onset CAH
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signs of androgen excess -> premature adrenarche/pubarche, severe cystic acne resistant to tx, accelerated linear growth, and advanced bone age
NORMAL ELECTROLYTES |
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measuring lead toxicity in children
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use venous blood draw
false positives on capillary draw! |
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most common cause of acute bacterial sinusitis
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strep (30%), nontypeable H. influenzae (30%), and moraxella catarrhalis 10%)
use augmentin |
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kawasaki disease
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vasculitis characterized by fever for > 5 d, nonexudative conjunctivitis, extremity changes (erythema, edema, desquamation of the hands and feet), cervical lymphadenopathy, oral mucosal changes (erythema, fissured lips, strawberry tongue), and polymorphous rash
at risk for developing coronary artery aneurysms and thrombosis. Tx with ASA and IVIG critical in decreasing cardiovascular morbidity and mortality within 10d of fever onset. (USE ASA EVEN THOUGH RISK OF REYE SYNDROME) |
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distinguishing between preseptal (periorbital) and postseptal (orbital) edema,
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look for ophthalmoplegia, pain with EOM, proptosis, and vision impairment
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benign cardiac murmur
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not a/w structural heart dz
typically grade II/VI or less intensity, early or mid-systolic, decrease with standing and Valsalva, have a nl associated S2, and occur in otherwise healthy, asymptomatic children. Benign murmurs are managed with observation and reassurance. |
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pubertal gynecomastia
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seen in up to 2/3 of adolescent boys during mid to late puberty.
can be unilateral, bilateral or painful no specific mgmt necessary and usually resolves in a few mo to 2 years |
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lyme dz according to stage
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early: erythema migrans, myalgias, arthralgias
early disseminated (weeks to months): carditis, cranial nerve deffects (usually VII), meningitis, encephalitis), muscular, conjunctivitis, lymphadenopathy late or chronic (mo to years): neurologic: encephalomyelitis, peripheral neuropathy, arthritis |
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milk or soy protein proctocolitis
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should be suspected when a well-appearing neonate p/w painless bloody stools. rectal bleeding should stop within 2 weeks of elimination of dietary dairy and soy products
meckel's diverticulum not observed in neonates |
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workup of simple febrile seizures?
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no required workup
can be discharged from emergency department with reassurance about a good prognosis |
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erythema toxicum neonatorum
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benign neonatal rash characterized by blanching erythematous papules and/or pustules. Resolves spontaneously within 2 weeks after birth.
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laryngomalacia
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p/w inspiratory stridor that worsens in the supine position and with crying and peaks at age 4-8mo. dx confirmed with flexible LARYNGOSCOPY, which shows collapse of the supraglottic structures during inspiration.
Usually self resolves! by age 18mo |
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asthma: when to endotracheal intubation?
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unresponsive to meds who have fatigue, AMS, CO2 retention, worsening hypoxemia, and poor air movmt on exam
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cryptorchidism
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most common congenital anomaly of the GI tract d/t failure of testicular descent. Orchipexy is performed in infancy preferentially to prevent testicular torsion, improve fertility, and decrese risk of testicular marlignancy.
greatest risk of sperm count being substandard. risk of testicular torsion removed as testis is surgically affixed to scrotal wall. does not eliminate testicular CA risk! |
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contraindications to rotavirus vaccines
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anaphylaxis to vaccine ingredients
h/o intussusception h/o uncorrected congenital malformation of the GI tract (meckel's diverticulum) SCID |
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infant botulism
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caused by ingestion of Clostridium botulinum spores, which colonize the gut and lead to production and release of a neurotoxin responsible for life-threatening, descending flaccid paralysis.
The dx should be considered when a previously healthy infant p/w bulbar palsies, constipation, and hypotonia, even if hte infant has not been fed honey. Human derived botulism immune globulin is the treatment of choice |
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rehydration therapy
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mild: p/w h/o decreased intake or increased fluid loss with minimal or no clinical sx
moderate: p/w decreased skin turgor, dry mucous membranes, tachy, irritabilty, delayed cap refill, and decreased UOP severe: cool, clammy skin, a delayed cap refill > 3sec, cracked lips, dry mucous membranes, sunken eyes, sunken fontanelle (if still present), tachy, lethargy, and minimal or no UOP). hypotension and severe shock possible oral rehydration should be initial tx for mild to moderate dehydration children with moderate to severe dehydration should be immediately resuscitated with IV fluids to restore perfusion -> use only isotonic saline (no D5, though this can be utilized as maintenance fluid) |
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cerebral palsy
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etiology often multifactorial, but PREMATURITY is leading risk factor
affected pts have uncoordinated and limited voluntary movmts spastic diplegio is the form most commonly seen in preterm infants. it presents as hypertonia and hyperreflexia that involve predominantly the lower extremities with both feet pointing down and inward (equinovarus deformity). Resistance to passive muscle movement increases with more rapid movement of the affected extremity (clasp-knife) many pts with CP suffer from vision, hearing, speech, or other impairments. Approx 50% of pts also have intellectual disability. |
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complex partial seizure vs atypical absence seizure
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complex partial seizure: brief episodes of impaired consciousness, failure to respond to various stimuli during the episode, staring spells, automatisms, and post-ictal confusion. EEG pattern usually nl
atypical absence seizure lasts longer and has characteristic EEG pattern that is slow spike-and-wave activity with frequency less than 2.5Hz |
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bedwetting nl until what age?
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5
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positives of breastfed babies
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decreased risk of otitis media, respiratory, GI, and UTI, and necrotizing enterocolitis
also have lower rates of DM1 and childhood CA absolute contraindications? |
galactosemia
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fetal alcohol syndrome
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pathognomonic facial features are small palpebral fissures (horizontal distance of eyes), smooth philtrum, and thin vermilion border (top lip)
also microcephaly |
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when to take out a battery in a child
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esophagus -> remove immediately under endoscopic guidance to prevent mucosal damage and esophageal laceration
distal to esophagus: pass uneventfully in most cases and need only be observed with stool exam and/or follow up xrays to confirm excretion. |
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respiratory distress in infant
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caused by surfactant deficiency -> more common in premies and infants of diabetic mothers
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dactylitis
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earlies manifestation of vaso-occlusion in sickle cell anemia
pts usually present at age of 6mo to 2yrs with an acute onset of pain and symmetric swelling of the hands and feet. Although only soft tissue swelling is initially seen, fever is sometimes present. the pathophys of dactylitis involves vascular necrosis of the metacarpals and metatarsals, which may be seen on plain radiographs as osteolytic lesions |
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vitA deficiency
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impaired adaptation to darkness, photophobia, dry scaly skin, xerosis conjunctiva, xerosis (dry) cornea, keratomalacia, Bitot spots and follicular hyperkeratosis of the shoulders, buttocks and extensor surfaces
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most likely cause of edema in neonate with Turner's syndrome
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dysgenesis of the lymphatic network
edema that is due to lymphedema is generally nonpitting on PE as opposed to the pitting edema seen with CHF, liver failure, or nephrotic syndrome |
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transient synovisitis
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if xrays negative for hip pain.
typically follows a viral infxn, sx should resolve within 1-4wks. |
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clubfoot (talipes equinovarus)
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patient who p/w equinus and varus of the calcaneum and talus, varus of the midfoot, and adduction of the forefoot.
(think tommy pickles) tx? |
stretching and manipulation of the foot, followed by serial plaster casts, malleable splints, or taping
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most common cardiac defects in Down syndrome
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in order of decreasing frequency
1) complete atrioventricular septal defect -> failure of endocardial cushion fusion results in atrioventricular septal defects. 2) VSD 3) ASD |
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unilateral cervical adenitis. tx?
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usually caused by streptococcal or staph infxn
tx is I&D plus an antibiotic like CLINDA (which can also battle MRSA) |
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congenital diaphragmatic hernia
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rare but lifethreatening
if in respiratory distress, must perform endotracheal intubation. bag-and-mask ventilation can exacerbate respiratory decline. A gastric tube should be placed immediately to decompress the stomach and bowel |
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neurofibrimatosis 1 vs 2
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1: cafe-au-lait spots, macrocephaly, feeding problems, short stature, and learning disabilities. patients may later develop fibromas, neurofibromas or different tumors
2) bilateral acoustic neuromas and cataracts |
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Lyme disease: tx
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children < 8: amoxicillin
otherwise, doxy! |
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trachoma
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p/w follicular conjucntivitis and pannus (neovascularization) formation in the cornea
repeated infections can lead to scarring of the cornea |
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major Jones criteria
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syndham chorea, migratory polyarthritis, carditis, subcutaneous nodules, and erythema marginatum
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ezcema herpeticum
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form of primary herpes infection a/w atopic dermatitis.
can be life threatening so treat with acylovir asap! |
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RSV infection predisposes infant to what later in life?
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bronchiolitis -> higher risk of getting asthma
tx: supportive care with humidified oxygen and bronchodilators ribavirin in high risk children |
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serum sickness-like reaction
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may occur one to two weeks after administration of certain drugs in the setting of a viral illness
prominent sx include fever, urticarial rash, polyarthralgia, and lymphadenopathy does not represent a true drug allergy |
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when to suspect pertussis
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anyone with a cough lasting greater than 2 weeks w/o a clear cause and one of the following sx: inspiratory whoop, paroxysmal cough, and posttussive emesis
in first four weeks, obtain nasopharngeal sampling for viral culture or PCR for confirmation of dx start azithro before obtaining final dx |
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proper sunscreen usage
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15-30 min before sun exposure 15-30 proof or higher
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small for gestational age babies are at risk of developing what complications?
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hypoglycemia, hypothermia, hypocalcemia, polycythemia, and hypoxia
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Fibromuscular dysplasia
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can present as new onset hypertension in young patients.
(most common cause of secondary hypertension) bruits or venous hum may be heart at the costovertebral angle angiogram reveals a "string of beads" sign |
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SCID
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life-threatening condition marked by recurrent bacterial, viral and fungal infxn
diagnostic features: absent lymph nodes and tonsils, lymphopenia, absent thymic shadow on xrays, and abnl T, B, NK cells enumerated by flow cytometry |
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transient synovitis
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commonly due to a virus
synovial inflammation leads to pain, decreased ROM and limping. pt may have hip partially flexed, abducted and externally rotated to maximize joint space (less painful) tx: NSAIDs and rest, though an xray may be taken to exclude leg calve perthes, bony lesions, or fx |
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development of secondary sexual characteristics
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generally considered premature in girls age < 8 and boys age >9.
Obese children of all ethnicities are at higher risk for precocious development as increased adiposity can stimulate sexual hormone production centrally and peripherally. |
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heroine baby
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aka neonatal abstinence baby -> usually presents in first few days of life.
irritability, high-pitched cry, poor sleeping, tremors, seizures, sweating, sneezing, tachy, poor feeding, vomiting and diarrhea what about alcohol? VPA? cocaine? phenytoin? |
alcohol: no withdrawal sx unless mother was drinking just prior to delivery
VPA: NT defects, cardiac anomalies, dysmorphic facies including cleft lip, midface hypoplasia, broad and depressed nasal bridge, and long philtrum cocaine: jitteriness, excessive sucking, and a hyperactive Moro reflex. |
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Beckwith-Wiedemann syndrome
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macrosomia, macroglossia, umbilical hernia/omphalocele, hemihyperplasia, and hypoglycemia
children must be closely monitored for development of Wilms tumor or hepatoblastoma. |
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red cell distribution width vs mean corpuscular hemoglobin concentration
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RDW values > 20% are suggestive of iron deficiency anemia (think of it like a catcher's mitt trying to catch iron); nl values of 12-14% are seen in thalassemia
mean corpuscular hemoglobin concentration is calculated by diving the hemoglobin by the hematocrit and is a measure of the hemoglobin concentration of each RBC. Decreased in conditions such as iron deficiency and thalassemia and elevated in pts with hereditary spherocytosis 2/2 loss of rbc surface area |
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unconjugated hyperbili in a newborn
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almost all newborns have jaundice that appears on day 2-4 of life. newborns have unconjugated hyperbili d/t several physiologic differences in bili metabolism.
1) at birth, RBC concentration is elevated with shorter life span resulting in high hemoglobin turnover and bili production 2) bili clearance initially slow bc hepatic uridine diphosphogluconurate glucoronsyltransferase (UGT) does not reach adult levels until age 2 weeks. ASIAN NEWBORNS have decreased UGT activity compared to other ethnicities 3) Enterohepatic recycling is increased as the STERILE newborn gut cannot break down bili to urobilinogen for ffecal excretion. More bili is resorbed in the gut and recycled in the enterohepatic circulation until the gut is colonized and produces bacterial enzymes for reduction to urobilinogen. |
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Todd's paralysis
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sudden LOC with following disorientation and slow gain of consciousness is a characteristic description of a seizure, if the convulsive episode was missed.
Postictal paralysis may follow generalized as well as focal seizures. motor deficit usually improves rapidly with restorationo f function within 24 hours. usually indicates that a structural abnormality underlying the seizure is present. |
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esophageal atresia with tracheoesophageal fistula
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suspected when a newborn chokes and coughs during the first feeding. attempts at naso- or orogastric tube insertion will fail and xray will show the tube in the proximal esophageal pouch
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long term neurologic sequelae a/w bacterial meningitis
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hearing loss, loss of cognitive functions (due to neuronal loss in the dentate gyrus of the hippocampus), seizures, mental retardation, spasticity or paresis
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CF patients increased likelihood of developing what?
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nearly all with sinopulmonary dz
also sensorineural hearing loss, fertility problems |
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tinea corporis, or ringworm
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treat with topical antifungals (ie terbinafine)
pruritic, erythematous, scaly, and have a red ring with central clearing. |
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boy develops sudden onset abdominal pain, bloody diarrhea
then develops anemia, thrombocytopenia and renal failure |
classic for HUS!
E.coli treatment usually supportive and involves plasmapharesis, dialysis if necessary, and steroids. antibiotics not indicated |
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angiofibroma
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male adolescent with epistaxis, localized mass (typically on back of nose or upper throat), and a bony erosion on the back of the nose
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cri-du-chat syndrome
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d/t 5p deletion and presents as microcephaly, hypotonia, short stature, adn cat-like cry
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spondylolisthesis
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developmental disorder characterized by forward slip of vertebrae (usually L5 over S1) that usually manifests in preadolescent children.
typical: back pain, neurologic dysfunction (urinary incontinence) and a palpable step-off at the lumbosacral area are present if dz is severe. |
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