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537 Cards in this Set
- Front
- Back
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what does APGAR stand for |
appearance pulse grimace activity respiration |
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newborn care (x5) |
vit K IM prophylactic eye erythromycin umbilical cord care hearing test newborn screening tests |
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skull fractures: linear vs depressed |
linear -- most common due to pressure or foreceps; no tx and no symptoms depressed -- elevate to prevent cortical injury |
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spinal regions: erb-duchenne klumpke |
erb = C5-6 -- waiters tip klumpke = C7-8 + T1 -- paralyzed hand and Horner's syndrome |
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caput succedaneum |
diffuse edematous swelling of soft tissues of scalp; crosses suture lines
disappears in first few days of life; may lead to molding for weeks |
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cephalohematoma |
subperiostal hemorrhage -- does not cross suture lines
may have underlying linear fracture resolves in 2wk - 3mo; may calcify; jaundice |
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cutis marmorata |
lacy, reticulated vascular pattern over most of body when baby is cooled improves over first month |
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milia |
firm, whie papules; inclusion cyst on palate midline: ebstein pearls spontaneous resolution |
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salmon patch (nevus simplex) |
pale, pink vascular macules found in nuchal area, glabella, eyelids usually disappears |
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mongolian spots |
blue to slate-gray macules seen on presacral, back, post thighs > in nonwhite infants arrested melanocytes usually fade over first few years ddx = CHILD ABUSE |
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erythema toxicum neonatorum |
firm, yellow-white papules/pustules with erythematous base peaks on second day of life contain eosinophils benign |
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hemangioma: superficial and deeper |
superficial = bright red, protuberant, sharply demarcated; first 2mo of life -face -scalp -back -anterior chest deeper = bluish hue, firm, cystic, less likely to regress (tx = steroids and pulsed laser) |
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neonatal acne |
erythematous papules on face high maternal androgens no tx |
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preauricular tags/pits |
look for hearing loss and genitourinary anomalies |
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coloboma of iris -- definition |
cleft at "6 oclock" CHARGE association |
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CHARGE |
leading cause of deaf/blindness Coloboma of the eye Heart defects Atresia of the nasal choanae Retardation of growth and/or dev Genital and/or urinary abnormalities Ear abnormalities and deafness. |
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aniridia |
associated with Wilms tumor (WAGR) |
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syndactyly |
fusion of fingers/toes |
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polydactyly |
>5 fingers/toes no tx if good blood supply |
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finger tag |
thin stalk, poor circulation ties off at base -> autoamputation |
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PKU: 1. defect 2. presentation 3. associations 4. tx |
1. phenylalanine hydroxylase (accumulation of PHE in body and CNS) 2. retard, vomit, growth retard, athetosis, seizures 3. fair hair, fair skin, blue eyes, normal baby at birth then gradual decline 4. low PHE for life |
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athetosis |
a condition in which abnormal muscle contractions cause involuntary writhing movements. It affects some people with cerebral palsy, impairing speech and use of the hands. |
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classic galactosemia 1. defect 2. presentation 3. assoc 4. tx |
1. gal-1-P uridylyltransferase def -- accum of gal-1-p with injury to kidney, liver, brain 2. jaundice (direct), heptomegaly, vomit, hypoglycemia, cataracts, retard, seizure 3. e.coli sepsis predisposition 4. no lactose (but never reverses neurodevelopmental problems |
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lanugo |
fine, soft hair, especially that which covers the body and limbs of a human fetus or newborn. |
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low birth weight vs large birth weight (grams) |
<2500 grams >4500 grams |
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plethoric |
ruddy -- polycythemia (diabetic mother) |
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diabetic mother -- congenital anomalies |
VSD ASD transposition small left colon syndrome caudal regression syndrome
macrosomia tachypnea cardiomegaly (asymmetric) septal hypertrophy polycythemia renal vein thrombosis hypoglycemia |
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initial halmark of RDS? |
hypoxemia then.... hypercarbia and respiratory acidosis |
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RDS chest radiograph |
ground glass appearance atelectasis air bronchograms |
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most likely to get transient tachypnea of the newborn |
c-section rapid second stage of labor |
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meconium aspiration: 1. xray 2. prevention 3. tx 4. other complications |
1. patchy infiltrates, inc AP diameter, flattening of diaphragm 2. endotrachial intubation and airway suction of depressed infants with thick meconium 3. positive pressure ventilation 4. air leak (pneumothorax, pneumomediastinum) |
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necrotizing enterocolitis: Define Symp |
transmural intestinal necrosis symp with intro to feeding: -bloody stools -apnea -lethargy -abdominal distention once perforation occurs
***pneumatosis intestinalis on abd film |
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pneumatosis intestinalis |
air in bowel wall |
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VACTERL |
Vertebral anomalies Anal atresia Cardiac defects Tracheoesophageal fistula and/or Esophageal atresia Renal & Radial anomalies Limb defects assoc with imperforate anus |
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kernicterus |
unconjugated bilirubin in the basal ganglia and brain stem nuclei hypotonia seizures delayed motor skills choreoathetosis SENSORINEURAL HEARING LOSS |
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choreoathetosis |
occurrence of involuntary movements in a combination of chorea (irregular migrating contractions) and athetosis (twisting and writhing). |
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complications of phototherapy in infants |
loose stools erythematous macular rash overheating -> dehydration bronze baby (photo-induced change in porphyrins) |
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most common organisms of neonatal sepsis |
group B strep e. coli listeria |
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tx of neonatal sepsis (w/ and w/o meningitis) |
w/ = ampicillin and 3rd ceph (not ceftriaxone) w/o = ampicillin and aminoglycoside until 48-72hr cultures are negative |
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symp of toxoplasmosis |
jaundice/heptaosplenomegaly thrombocytopenia/anemia microcephaly chorioretinitis hydrocephalus intracranial calcifications seizures |
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congenital rubella symp |
blueberry muffin spots PDA cataracts congenital hearing loss thrombocytopenia hepatosplenomegaly |
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CMV symp in neonate |
hepatosplenomegaly/jaundice periventricular calcifications IUGR deaf retard microcephaly thrombocytopenia chorioretinitis |
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congenital syphilis symptoms 1. birth-2yrs 2. >2yrs |
1. snuffles, maculopapular rash (palms/soles), jaundice, periostitis, osteochondritis, chorioretinits, congenital nephrosis 2. hutchinson teeth, clutton joints, saber shins, saddle nose, osteochondritis, rhagades |
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rhagades |
assoc with syphilis thickening and fissures of corners of mouth |
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clutton joints |
assoc with syphilis symmetrical swelling of joints |
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neonatal features in opiate abuse |
inc low birth weight inc stillborns no inc in congenital abnormalities early withdrawal symp (w/in 48hr) tremors/hyperirritability inc SIDS diarrhea, apnea, poor feeding, high pitched cry, weak suck, weight loss, tachypnea, hyperacusis, seizures |
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neonatal features of cocaine abuse |
no withdrawal symp preterm labor, abruption, asphyxia IUGR impaired auditory processing developmental delay learning disabilities CNS ischemic and hemorrhagic lesions vasoconstriction -> other malformations |
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most common cardiac anomaly in trisomy 21 |
ECD = endocardial cushion defect |
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brushfield spots |
speckling of iris assoc with down's syndrome |
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trisomy 18 (survival rate and symp) |
death by 1yr retard low-set ears clenched hand (overlap) short sternum VSD, ASD, PDA rocker-bottom feet hammer toe omphalocele |
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WAGR |
wilms aniridia GU anomalies retard |
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cubitus valgus |
turner assoc |
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symp of fragile x |
retard large ears large jaw long face large testes |
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beckwith-wiedemann syndrome |
IGF-2 disrupted macrosomia macroglossia (big tongue) pancreatic beta cell hyperplasia -> hypoglycemia omphalocele hemihypertrophy -> inc Wilms risk check AFP every 6mo for Wilms |
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angelgman syndrome -- communication deficiency |
no speech or <6 words
use sign language |
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pierre-robin sequence |
mandibular hypoplasia --> cleft palate micrognathia retroglossia (possible airway obstruction) cleft palate |
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micrognathia |
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arachnodactyly |
marfan syndrome |
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ehlers-danlos |
type 1 is most common (6 total) droopy ears stretchy skin joint hyperlaxity blue sclera ectopic lentis |
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ectopic lentis |
marfan and ehlers-danlos |
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cardiac anomalies in fetal alcohol syndrome |
VSD > ASD tetralogy of fallot |
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fetal hydantoin sydrome |
growth deficiency mild retardation short neck abnormal palmar crease hirsutism cupid's bow lips |
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fetal valproate syndrome |
midface hypoplasia/cleft lip cardiac defects long thin fingers and toes convex nails meningomyelocele |
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retinoic acid embryopathy (isotretinoin) |
bilateral microtia/anotia (no ears) facial nerve paralysis ipsilateral to ear conotruncal malformations CNS malformations dec intelligence thymic/parathyroid abnormalities NO PROBLEMS IF STOPPED BY 15TH POSTMENSTRUAL DAY |
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weight loss in first week of life |
normal = up to 10% in first week of life due to elimination of extravascular fluid regain birth weight by 2wks |
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infant weight gain and growth (until teen) |
double at 6mo triple at 1 yr (myelination complete at 7yrs) 6-12yr = 3-6 growth spurts each year for 8wk periods each 10-20yr = acceleration boy -- stop at 18yrs (peak at 13.5) girls -- stop at 16yrs (peak at 11.5) |
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CI in breastfeeding |
absolute: antineoplastics radiopharmaceuticals ergot alkaloids iodide/mercurials atropine lithium chloramphenicol cyclosporine nicotine alcohol relative CI: neuroleptics sedatives tranquilizers metronidazole tetracycline sulfa drugs steroids |
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side effect of early introduction of cow's milk (<1yr) |
Fe deficiency |
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how many calories in breast vs cow milk |
same -- 20 cal/oz |
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how to assess development in premature infants? |
6mo born at 32 wks: that is 2mo preterm so infant should be assessed as if a 4mo infant until the age of 2. |
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predisposing factors of pica |
mental retardation and lack of parental nuturing family disorganization poor supervision psychologic neglect more common in... -autism -brain-behavior disorders -low socio-economic status |
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inc risks in pica |
lead poisoning iron deficiency parasitic infections |
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uveitis |
third leading cause of blindness in kids infection or HLA-B27 herpes/varicella tx = steroids and methotrexate is aggressive complications = cataracts, glaucoma, band keratopathy,macular edema and permanent vision loss |
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posterior uveitis |
Floaters Blurred vision Photopsia or seeing flashing lights |
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anterior uveitis |
Redness of the eye Blurred vision Photophobia or sensitivity to light Irregular pupil Eye pain Floaters Headaches Synechia = iris adheres to either the cornea |
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pharmacological method for nocturnal enuresis if behavioral therapy failed |
imipramine (TCA) |
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define secondary enuresis |
>6mo of a dry period before voluntary/involuntary peeing girls cause = psychological, UTI, constipation, diabetes |
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encopresis |
passage of feces at inappropriate places cause = psychological (toilet phobia), early toilet training, aggressive management of constipation, painful defecation, fissures |
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sleepwalking/sleep terrors |
first third of night during slow-wave sleep no daytime sleepiness of recall high arousal threshold when awoken common family hx tx = parental education, reassurance, safety |
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nightmares |
last third of night REM sleep daytime sleepiness and vivid recall easily awakened no family hx tx = none unless persistent (anxiety or abuse) |
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at what age is HiB stopped being given |
>5yrs |
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bucket handle fracture |
wrenching or pulling (child abuse) |
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spiral fracture |
child abuse!!! twisting arm/leg |
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immersion burns: abusive hot bath vs accidental |
abuse: demarcation is uniform flexion creases spared (vs falling in) no splash burns (held down) hands and feet spared (baby raises them) |
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most common sexual abuse in pediatrics |
brother-sister incest also common to be father/stepfather |
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tx of croup |
nebulized epinephrine followed by corticosteroids |
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epiglossitis |
toxic-appearing sniffing-position difficulty swallowing drooling tx = intubate then abx |
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laryngomalacia |
congenital most freq cause of stridor in infants/kids starts first 2wks of life surgery = supraglottoplasty |
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congenital subglottic stenosis |
recurrent croup and stridor tx = cricoid split or reconstruction |
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associations with vocal cord paralysis |
meningomyelocele chiari malformation hydrocephalus |
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bronchiolitis: symp duration tc |
symp = mild URI, apnea, wheezing, work to breath duration = 12 days (worst in first 2-3 days) tx = supportive, no steroids |
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most likely organism of pneumonia: <5yrs >5yrs |
< = viral (RSV) > = bacterial (M., C., and S. pneumonia) |
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viral pneumonia symptoms
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low grade fever tachypnea scattered crackles and wheezing |
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bacterial pneumonia symptoms
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--sudden shaking chills with HIGH fever --acute onset --sign cough and chest pain --splinting on affected side --markedly diminished breath sounds and dullness to percussion |
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chlamydia trachomatis pneumonia symptoms
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no fever or wheezing 1-3mo of age w/ or w/o conjunctivitis staccato cough peripheral eosinophilia |
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chlamydia pneumonia and mycoplasma pneumonia symptoms
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atypical bronchopneumonia gradual onset persistent cough/hoarseness |
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dx and WBC of pneumonia 1. viral 2. pneumococcal 3. mycoplasma 4. chlamydia |
1. hyperinflation with bilateral interstitial infiltrates and peribronchial cuffing -- <20k with lymphocyte dominance 2. confluent lobar consolidation -- 15-40k with neutrophil dominance 3. unilateral or bilateral lower-lobe interstitial pneumonia; looks worse than presentation -- 15-40k with neutrophil dominance 4. interstitial pneumonia or lobar; looks worse then presentation -- eosinophilia |
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genetic info of CF and pathogenesis
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Aut rec chromo 7 CFTR - transmembrane regulator unable to secrete Cl -> cant clear mucus inc salt in sweat |
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first presentation of CF
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10% = meconium ileus (obstruction) -- dilated loops, air filled, ground glass in lower central abdomen malabsorption of pancreatic exocrine insufficiency (freq bulky, greasy stools and failure to thrive) ADEK deficiency rectal prolapse acute pancreatitis inc DM |
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CF: determination of mortality and morbidity
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rate of progression of lung disease
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sweat test levels for CF
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>60 mEq/L
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xray results of CF
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hyperinflation of chest nodular densities, patchy atelectasis, confluent infiltrates, hilar nodea w/progression = flattening of diaphragm, sternal bowing, narrow cardiac shadow, cysts, extensive bronchiectasis |
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SIDS
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peak = 2-4mo; most by 6mo males>females smoking pacifier DECREASES risk |
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allergic shiners and Dennie lines
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allergic rhinitis
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physical examination of allergic rhinitis
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allergic shiners dennie lines chemosis (edema) -- picture transverse nasal crease turbinate hypertrophy pale nasal mucosa postnasal drip OME |
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ddx of allergic rhinitis (x5)
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nonallergic inflammatory rhinitis (no IgE Ab) vasomotor rhinitis (physical stimuli) nasal polyps (CF) septal deviation overuse of topical vasoconstrictors |
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ddx of eosinophilia
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neoplasm allergy asthma Addison parasite collagen vascular disorder |
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desensitization -- immunotherapy should NOT be used in the following... |
atopic dermatitis food allergy latex allergy urticarial kids <3 |
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how to remove bee stinger
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scraping |
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urticarial -- define
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HIVES
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in food allergies, is it more likely hypertension of hypotension |
hypotension
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hereditary angioedema
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aut dom c1 esterase-inhibitor deficiency recurrent episodes of nonpitting edema |
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most common anaphylaxis and tx
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peanuts injectable epinephrine + oral liquid diphenhydramine O2 and airway mangagement |
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atopic dermatitis (eczema)
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half start by 1 year PRURITIS worse at night scratching -> lesions |
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atopic dermatitis (eczema) skin patterns: 1. acute 2. subacute 3. chronic |
1. erythematous papules, intensely pruritic, serous exudate, excoriation (open wound/ulcer) 2.erythematous, excoriated, scaling papules 3. lichenification (picture) |
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distribution of eczema 1. infant 2. older |
1. face, scalp, extensor 2. flexor |
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safe on face for eczema tx? 1. topical corticosteroids 2. tacromilus (what's MOA?) |
1. no 2. yes -- calcineurin inhibitor |
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most common complication of eczema
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Kaposi varicelliform eruption
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normal onset of asthma in pediatrics |
<6yrs triggered by viral infections |
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risk factors for persistent asthma
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perennial allergies atopic dermatitis allergic rhinitis food allergy LRI (ie pneumonia) wheezing (exercise/emotions) low birth weight smoke exposure |
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duration of albuterol
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4-6hr
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symptom = recurrent infections what can u exclude in following: 1. normal lymphocyte count 2. normal neutrophil count 3. normal platelet count 4. normal ESR |
1. not T-cell 2. not congenital/acquired neutropenia and not leukocyte adhesion deficiency 3. no Wiskott-Aldrich 4. not chronic bacterial or fungal |
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what is recurrent if have phagocytic deficiency
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recurrent staph and gr neg infections
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bruton agammaglobinemia
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--x-linked --fine until 6-9mo --pyogenic infections, hepatic viruses, enteroviruses --lymphoid hypoplasia --dec in all Ig and absent B cells |
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peritonsillar abscess |
symptoms are 2-8d before visualization uvula displaced Streptococcus, Staphylococcus and Haemophilus clindamycin or metronidazole in combination with benzylpenicillin (penicillin G) |
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common variable immune deficiency |
hypoglammaglobinemia with phenotypically normal B cells bact. infections plus enteroviral meningitis normal or even increased lymphoid tissue inc in lymphomas males and females |
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IgA deficiency |
most common males and females resp, GI, urogenital, skin infections inc autoimmune diseases and malignancies FATAL ANAPHYLACTIC RXNS IF GIVEN BLOOD WITH IgA |
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DiGeorge |
third and fourth pharyngeal pouches -- 22q11.2 thymic hypoplasia parathyroid hypoplasia -> hypocalcemia seizure right aortic arch ASD/VSD esophageal atresia short philtrum hypertelorism mandibular hypoplasia fish mouth low absolute lymphocyte count inc fungi, virus, p.carinii infections GVHD rx = transplantation of thymic tissue of MHC compatible sibling or half-matched parental bone marrow |
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9p minus syndrome |
Trigonocephaly (keel-shaped forehead caused by premature fusing of metopic suture) or minor ridge on forehead Choanal atresia (nasal passage narrow or blocked by tissue) Globalized hypotonia (low muscle tone)/Delayed gross motor development Seizures GERD constipation cardiac defects scoliosis kidney reflux mental retardation |
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SCID |
opportunistic and viral infections diarrhea pneumonia/AOM/sepsis/cut infections GVHD from maternal incompetent T cells crossing placenta severe lymphopenia small or no thymus no immunoglobins x-linked (most common) aut rec = ADA deficiency rx = bone marrow transplant or death by 1 yr |
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wiskott-aldrich syndrome |
x-linked rec eczema thrombocytopenia recurrent infection palpable adenopathy; splenomegaly 1. prolonged bleeding in circumcision rare survival beyond teen if no bone marrow transplant |
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ataxia telangiectasia |
mod dec in B and T cell dec CD3/CD4 hypoplastic thymus mask-like facies tics drooling irregular eye movement cerebellar ataxia telangectasias high risk of malignancies - lymphoreticular and adenoCA |
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chronic granulomatous disease |
x-linked and aut rec catalase-positive microorganisms lymphadenitis, pneumonia, skin infections osteomyelitis tx = bone marrow transplant |
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catalase positive bugs (x6) |
s. aureus norcardia s. marcescens b. cepacia aspergillus c.albicans |
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coloboma of iris |
aut dom ALWAYS INFERIOR key appearance of iris; in lid, manifests as cleft CHARGE association |
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leucokoria |
retinoblastoma cataract retinal detachment retinopathy of prematurity larval granulomatosis |
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causes of cataracts (x6) |
prematurity aut dom TORCH, measles, polio, flu, varicella, vaccina galactosemia chromosomal steroids, contusions, penetrations (trauma) |
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ectopia lentis ddx |
trauma = #1 uveitis congenital glaucoma cataract systemic = 1. marfan 2. homocystinuria 3. ehlers |
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strabismus |
misalignment due to muscles dx = hirschberg corneal light reflex (should be symmetric and slightly nasal to center of pupil) PATCH good eye to eliminate amblyopia then eye muscle surgery |
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pseudostrabismus |
epicanthal folds and broad nasal bridge caused by unique facial characteristics of infant |
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ophthalmia neonatorum |
first 24hr of life gonorrhea = 2-5d incubation trachomatis = 5-14d incubation |
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bacterial conjunctivitis |
mucopurulent exudate hyperemia edema eye discomfort s. pneumonia h. influenza s. aureus rx = warm compress and topical antibiotics |
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viral conjunctivitis |
watery discharge, bilateral, usually with URI adenovirus, enterovirus good hand-washing epidemic keratoconjunctivitis |
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epidemic keratoconjunctivits |
adenovirus type 8 |
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keratitis |
infection of cornea h. simplex adenovirus s. pneumoniae s. aureus pseudomonas chemicals |
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corneal abrasion |
caused by foreign body pain and photophobia anesthetize the flourescein and blue-filtered light (woods lamp) tx = pain relief and abx |
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retinopathy of prematurity |
-prematurity -hyperoxia -general illness progressive vasoproliferative scarring and blinding retinal detachment tx = cryosurgery or laser photocoagulation |
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retinoblastoma |
most common primary malignant intraocular tumor dx by 15 mo for bilat and 25 mo for unilat initial sign = leucokoria --- appears as white mass --- strabismus never biopsy cuz spreads easily |
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periorbital cellulitis |
trauma infected wound abscess of lid sinusitis bacteremia tx = oral or IV abx inflammation of lids and periorbital tissue with NO ORBITAL INVOLVEMENT (normal vision) |
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orbital cellulits -- symp, causes and tx |
ophthalmoplegia (eyeball doesnt move) chemosis (edema of conjunctiva) inflammation proptosis (exophthalmus) paranasal sinusitis, direct infection frm woud, bacteremia bugs = nontypable h. influ, s.aureus, beta hemolytic strep, s. pneumoniae tx = IV abx and drainage |
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otitis externa 1. bugs 2. symp 3. malignant external otitis 4. tx and prevention |
swimmer's ear 1. pseudomonas, s. aureus, staph, strep viridans 2. sign pain esp when move ear, conductive hearing loss, edema, erythema, thick otorrhea 3. invasive to temporal bone and skull base -> facial paralysis/vertigo --- needs surgery! 4. cortico and topical otic prep; ear plugs, drying of canal, 2% acetic acid after getting wet |
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otorrhea |
ear discharge |
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otitis media |
s. pneumo, h. influ, moraxella catarrhalis mobility of TM = NOT OME amoxicillin, NSAID/acetaminophen azithromycin if allergy >2yr, no fever or severe pain the observe 2-3d cont pain = augmentin, cefuroxime, IV ceftriaxone, cefdinir |
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OME |
monthly evaluation >3mo --> send to ENT no abx tubes = bilateral and impaired hearing for >3mo |
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OME complications (x2) |
acute mastoiditis -- displacement of pinna inferiorly and anteriorly inflammation of posterior auricular area; pain on percussion of mastoid cholesteatoma -- cyst within middle ear/temporal bone lined with keratinizing strat sq epithelium |
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choanal atresia -- symp |
unilat = asymp until first URI then persistent nasal discharge bilat = cyanosis while trying to breathe through nose, then becoming pink with crying CHARGE assoc |
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clinical symp of foreign body in nose |
unilateral purulent, malodorous bloody discharge |
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epistaxis - location and causes |
anterior septum (most common -- keisselbach plexus) digital trauma dry air (esp winter) allergy inflammation (URI) nasal steroid sprays severe GERDin infants clotting disorder congential vascular anomalies |
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tx epistaxis |
1. compress, upright, head forward 2. local oxymetazolone or phenylephrine 3. anterior nasal packing then maybe posterior 4. cautery humidifier, saline drops, petrolatum for prevention |
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nasal polyps |
most common = CF (<12yr -- first symp of CF) may cause obstruction glistening gray grape-like masses tx = intranasal steroids/systemic steroids may provide some shrinkage (good in CF); may need surgery |
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samter triad |
nasal polyps ASA sensitivity asthma |
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sinusitis bugs |
s. pneumo nontypable h. influ m. catarrhalis s. aureus in chronic cases |
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sinusitis symp and tx |
congestion, discharge, fever (102 for 3d), cough, persistent URI without improvement for at least 10d amoxicillin alt = cefuroxime, cefpodoxime, azythromycin 7d treatment |
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acute pharyngitis presentation |
strep = rapid onset, severe sore throat, fever, headache, GI symp, red pharynx with exudate, red swollen uvula, lymphadenopathy scarlet fever = pharyngitis plus circumoral pallor, sandpaper rash, pastia's lines viral = more gradual with URI symp, no pus --coxsackie = hand-foot-mouth disease |
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pastia's lines |
scarlet fever |
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circumoral pallor |
scarlet fever |
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tx of strep pharyngitis |
penicillin or erythromycin if allergis early tx hastens recovery by 12-24hr and prevents acute RF if treated within 9d of illness |
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complications of strep throat |
retropharyngeal and lateral pharyngeal abcess -- drainage and 3rd ceph + amp/sul or clind pertonsillar abcess --needle aspiration, incision, drainage, tonsillectomy is recurrence |
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torticollis |
congenital or retropharyngeal abscess (with muffled voice) |
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tonsillectomy indications |
>7 documented infections within past year 5/yr for 2 years 3/yr for 3 years |
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adenoidectomy indications |
chronic nasal/sinus infection recurrent/chronic OM in kids with tubes persistent otorrhea nasal obstruction with chronic mouth-breathing and snoring |
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tonsillectomy + adenoidectomy indication |
>7 infections upper airway obstruction secondary to hypertrophy resulting in sleep-disordered breathing and complications |
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when to evaluate cardiac fxn in kids: 1. infant symp 2. child symp |
1. feeding difficulty easily fatigued sweating while feeding rapid respirations 2. SOB dyspnea on exertion |
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heart murmur grading 1 2 3 4 5 6 |
1 - soft, difficult to hear 2 - easily heard 3 - louder but no thrill 4 - thrill 5 - thrill, audible with edge of stethoscope 6 - thrill, audible with stethoscope off chest |
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cardiac thrill |
a vibration felt by the examiner on palpation |
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innocent murmur |
30% children ages 3-7 easily heard during fever, infection, anxiety never more than 2/6 reassurance |
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VSD |
most common when PVR>SVR --> Eisenmenger harsh holosystolic murmur dyspnea feeding difficulties poor growth sweating pulm infection and heart failure surgery in first yr; small ones will close in first 1-2yrs of life |
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|
VSD complications (x3) |
large defects lead to heart failure; failure to thrive endocartitis pulm HTN |
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ASD |
most common = ostium secundum few symp early in life wide fixed splitting of S2 systolic ejection murmur along left mid to upper sternal border ECG = right-axis deviation and RVH tx = most symp dont appear till third decade surgery if severe |
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|
ASD complications (x2) |
dysrhythmia low-flow lesion; does not require endocarditis prophylaxis |
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|
endocardial cushion defect |
down's ASD and VSD plus abnormal atrioventricular valves wide fixxed split S2 pulm systolic ejection murmur, low-pitched diastolic rumble at left sternal border and apex |
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|
endocardial cushion defect: surgery vs no surgery complciations |
surgery = arrhythmias, congenital hear block w/o surgery = death from heat failure |
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PDA |
more common in girls assoc = maternal rubella infection common in premature infants machine murmur LV hypertrophy tx = indomethacin, surgical closure |
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PDA complications (x2) |
CHF infective endocarditis |
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pulmonic stenosis |
RV hypertrophy first month of life RV failure signs = hepatomegaly, edema, exercise intolerance tx = balloon valvuloplasty then maybe surgery |
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|
pulmonic stenosis complications (x3) |
heart failure endocarditis (lower risk) secondary subvalvular muscular and fibrous hypertrophy |
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aortic stenosis |
bicuspid aortic valve -- usually asymp if severe... LV failure and dec CO usually not discovered unless routine physical examination -- most dont know they have it inc severity = dec pulses, inc heart size, LV apical thrust early systolic ejection click at apex of left sternal border tx = balloon valvuloplasty, surgery on valves, valve replacement |
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|
names of adult vs infantile coarctation of aorta |
adult = discrete juxtaductal coarctation infantile = tubular hypoplasia (preductal) |
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|
adult coarctation of aorta |
discrete juxtaductal coarctation narrowed at descending aorta LV hypertrophy and HTN delay in femoral pulse compared to radial rib notching (dilated intercostal art) tx = medicate for HTN and heart failure then follow with surgery |
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|
infantile coarctation of aorta |
tubular hypoplasia preductal (asc aorta) PDA stays open upper body is pink and lower is cyanotic symp = lower body hypoperfusion, acidosis, severe heart failure with ductal closure, large heart, systolic murmur along left sternal border tx = PGE1 then surgery |
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complications of coarctation of aorta (x4) |
associated cerebrovascular disease systemic HTN endocarditis aortic aneurysms |
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|
tetralogy of fallot |
pulm stenosis VSD overriding aorta RV hypertrophy most common cyanotic lesion squatting = inc vascular resistance and dec R-L shunt either single S2 or soft pulmonic component |
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|
define tet spells (tetralogy) |
paroxysmal hypercyanotic attacks acute onset of hyperpnea and restlessness -> in cyanosis -> gasping -> syncope syncope = inc infundibular obstruction with further R-L shunting tx = place in lateral knee-chest position, give O2, inject subcut morphine, give b-blockers |
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tetralogy of fallot complications before surgery takes place (x4) |
none of there are common cuz usually corrected surgically early in life cerebral thromboses brain abscess bacterial endocarditis heart failure |
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tricuspid atresia |
no outlet from RA to RV must have ASD to survive pulmonary blood flow depends on size of VSD severe cyanosis and inc LV impulse holosystolic murmurs cuz of VSD xray = pulmonary undercirculation |
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|
ebstein anomaly |
lithium huge RA and tricuspid regurg inc RA vol shunts blood through foramen ovale or ASD -> cyanosis may have no symp till teen/adult holosystolic murmur tx = PGE, shunt, surgery |
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|
transposition of great arteries |
PDA must stay open to survive S2 usually single and LOUD, murmurs absent "egg on a string" cxr tx = PGE, balloon atrial septostomy, arterial switch surgery in first 2wks of life |
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|
truncus arteriosus |
single arterial trunk truncus overlies a VSD (ALWAYS PRESENT) and receives blood from both ventricles (total mixing) SEM with loud thrill, single S2 and minimal cyanosis inc pulm blood flow -> rapid heart failure ECG = biventricular hypertrophy tx = tx heart failure and then surgery |
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|
TAPVR |
total anomalous pulmonary venous return TOTAL MIXING enlarged: RA, RV, Pulmonary Artery small: LA, LV tx = PGE, surgery |
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|
TAPVR cxr |
"snowman" appearance pulm vascularity inc |
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|
TAPVR ECG |
right axis deviation RVH tall spiked P waves |
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|
hypoplastic heart syndrome |
ATRESIA: MV or AV, LV, Asc Aorta open ASD or foramen ovale PDA supplies desc aorta ECG = RVH and RAE with dec left-sided forces tx = maybe nothing or three-stage norwood procedure |
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|
RAE -- define (cardiac |
right atrial enlargement |
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|
describe 3-stage norwood procedure used in hypoplastic heart syndrome |
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mitral insufficiency |
dilated annulus abnormal chordea tendineae deformed leaflets high pitched holosystolic murmur at apex ECG = bifid P waves, LVH CXR = inc LA size, prominent LV tx = mitral valvuloplasty |
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|
mitral valve prolapse |
billowing of one or both leaflets into LA towards end of systole girls>boys apical late systolic murmur preceded by a click normal CXR and ECG! no tx.... not progressive |
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|
tricuspid insufficiency |
associated with ebstein anomaly RV dysfunction -- dilatation with enlargement of annulus (vol overload or intrinsic myocardial disease) perinatal asphyxia in neonate (ischemia of papillary muscles) |
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|
infective endocarditis bugs |
strep vir. and s. aureus are most common vir. = dental group D strep = large bowel surgery pseudo. and serratia = IV drug users fungi = open heart surgery coag neg staph = IV catheters |
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|
infective endocarditis symp |
prolonged intermittent fever weight loss new/changing heart murmur osler nodes janeway lesions splinter hemorrhage roth spots (retinal) |
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|
osler nodes |
tender, pea sized intradermal nodules on pads of fingers and toes |
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|
janeway lesions |
painless, small erythematous or hemorrhagic lesions on palms and soles |
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|
HACEK |
hemophilus actinobacilus actinomycetemcomitans cardiobacterium hominus eikenella corrodens kingella kingae slow-growing gr neg organisms that are part of normal flora |
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|
acute rheumatic fever -- bug? tx? |
group a strep most common form of acquired heart disease worldwide tx = oral penicillin ASA for arthritis (prednisone if have CHF hx) |
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|
JONES (rheumatic fever) 5 major criteria 5 minor criteria |
Major: carditis polyarthritis (migratory) erythema marginatum chorea subcutaneous nodules Minor: fever arthralgia elevated ESR and CRP prolonged PR interval on ECG plus evidence of preceding strep infection |
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|
HOCM: define symp dx tx |
hypertrophic obstructive cardiomyopathy SUDDEN DEATH OF ATHLETIC TEEN obstructive left-sided congenital heart disease palp, angina, dizzy, syncope, risk of sudden death ECG = LVH + ST dep and T inversion CXR = cardiomegaly tx = no sports or hard exercise b-blockers (propanolol) and CCB (verapamil) DIGOXIN AND DIURESIS = CI |
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|
pericarditis: define most common cause symp dx |
inflammation --> accum of fluid in pericardial space viral is most common cause pericordial pain!! sharp, stabbing over heart, L shoulder, & back relief when lean forward friction rub is variable cough, vomit, dyspnea, abd pain ECG = low-voltage QRS CXR = water bottle appearance |
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|
what do u think of when its pediatric HTN? |
RENAL CAUSES!! UTI glomerulonephritis henoch-schonlein with nephritis HUS ATN renal trauma renal artery stenosis |
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|
secondary pediatric HTN: most common 1. newborn 2. early childhood 3. adolescent |
1. umbilical artery catheters -> renal art thomb 2. renal disease, coarctation, endocrine, meds 3. essential HTN |
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|
Cleft lip and palate tx |
Lip - surgery at 3mo Palate - surgery at <1yr |
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|
Cleft lip and palate tx |
Lip - surgery at 3mo Palate - surgery at <1yr |
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|
Blood diarrhea. 5 common bugs (CASES) |
Campylobacter Amoeba (e. Historlytica) Shigella E. Coli Salmonella |
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|
Most common viral acute diarrhea |
Norovirus
Rotavirus Enteric adenovirus Astrovirus Calcivirus |
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|
Most common parasitic acute diarrhea |
Giardia |
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|
Should anti diarrheal med be used in pediatrics? Like loperamide? |
Never! |
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|
Rotavirus 1. Assoc 2. Therapy |
1. Watery diarrhea, vomiting, maybe fever
2. Supportive |
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|
Entamoeba histolytica 1. Assoc 2. Tx |
1. Acute bloody diarrhea 2. Metronidazole |
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|
Giardia 1. Assoc 2. Tx |
1. Anorexia, nausea, abd distension, watery diarrhea, weight loss 2. Metro or furazolidone |
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|
Cryptosporidium 1. Assoc 2. Tx |
1. Mild diarrhea in immunocompromised infants, severe diarrhea in AIDS pts 2. Best tx is raise CD4 count Supportive, may try rifabutin |
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|
Schwachman-diamond |
Pancreatic insufficiency Neutropenia Malabsorption |
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|
Intestinal lymphangiectasia |
Lymph fluid leaks into bowel lumen
Steatorrhea
Protein-losing enteropathy |
|
|
Disaccardase deficiency |
Osmotic diarrhea Acidic stools |
|
|
Abetalipoproteinemia |
Severe fat malabsortion from birth
Acanthocytrs
Very low to absent plasma chooesterol, triglycerides, etc |
|
|
Most useful sceening test for fat in stool |
Sudan red stain |
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|
Three basic types of Esoph atresia and tracheoesoph fistula
Symp |
Isolated EA Isolated (h type) TEF EA and distal TEF
Frothing Bubbling Cough Cyanosis Resp distress Immediate regurg with feeding Aspiration |
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|
GERD
Resolves by when? Symp? |
Resolves by 12-24mo
Postprandial regurg Esophagitis Obstructive apnea Lower airway disease (cough/wheezing? |
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|
Enteropathogenic e. Coli
1. Assoc 2. Tx |
1. Nurses, daycare 2. Supportive, severe -- neomycin or colostin |
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|
Etiology of pyloric stenosis |
Firstborn white males |
|
|
Describe dehydration in pyloric stenosis |
Hypochloremic Hypokalemic Met alk |
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|
Enter tocopherol e. Cold 1. Assoc 2. Tx |
1. Travelers diarrhea 2. Supportive, tmp-smx if severe |
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|
Enterohemorrhagic e. Coli 1. Assoc 2. Tx |
1. Hemorrhagic colitis, HUS 2. No antimicrobial therapy cuz inc HUS!! Supportive only |
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|
Salmonella 1. Assoc 2. Tx |
1. Infected animals and contaminated eggs/milk/poultry 2. Tx only if |
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|
Shigella 1. Assoc 2. Tx |
1. Person to person spread, contaminated food 2. Tmp-smx |
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|
Campylobacter 1. Assoc 2. Tx |
Person to person spread Contaminated food
Self limiting; erythromycin speeds recovery or if severe |
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|
Yersinia enterocolitica 1. Assoc 2. Tx |
1. Pets, contaminated food, arthritis, rash 2. No abx
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|
Clostridium difficile 1. Assoc 2. Tx |
1. Hx of abx use 2. Metronidazole or vancomycin and discontinuation of abx |
|
|
Staph aureus 1. Assoc 2. Tx |
1. Food poisoning--onset within 12hr 2. Supportive |
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|
duodenal atresia |
--down's --bilious vomiting without abd distention on first day of life (obstruction just distal to ampulla) --polyhydramnios --jaundice (inc enterohepatic circulation) --double bubble with no distal bowel gas --tx = nasogastric decompression, IV fluids, duodenoduodenostomy |
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|
jejunal and ileal atresia 1. causes 2. symp |
1. cigarette or cocaine use 2. polyhydramnios, abd distantion at birth or with first feeds + vomiting, may be bilious, few with delayed or no meconium, jaundice |
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|
meconium ileus |
proximal bowel dilated and filled with thick meconium impacted in ileum "doughy" cordlike masses tx = hypertonic water-soluble contrast enema to attempt wash-out then laparotomy if failed |
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|
gold standard confirmation for hirschprung disease |
the suction rectal biopsy |
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|
delay in treating volvulus can result in...
|
short bowel syndrome
|
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etiology and presentation for malrotation/volvulus
|
etiology = incomplete rotation, ladd bands may extend from cecum to RUQ to produce duodenal obstruction presentation = bilious emesis, recurrent abd pain and vomiting, acute small bowel obstruction in a pt without previous bowel surgery is suspicious of volvulus |
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|
meckel diverticulum: disease of 2's |
remnant of embryonic yolk sac, lining similar to stomach most freq congenital anomaly 2y/o 2% of population 2 types of tissue (true) 2inch in size 2ft from ileocecal valve tx = surgical excision |
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|
intussusception: etiology clinical presentation physical examination dx tx |
telescoping (ileal-colic) from 3mo-6yr (80% are <2yrs) assoc with henoch-schonlein purpura black currant jelly stool sudden onset of severe colicky pain legs flexed progressive weakness lethargy/shock with fever vomiting slightly tender, sausage-shaped mass on R in cephalocaudal axis US (doughnut appearance) tx = resection |
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|
functional constipation |
delay or difficulty for at least 2wks (usually 2y/o) voluntary withholding to avoid pain tx = relief of impaction (enema, stool softeners) diet, behavioral, bowel training program |
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|
hirschsprung disease
|
most common reason for bowel obstruction in neonates absence of ganglion cells in bowel wall beginning at internal anal sphincter and extending variably proximally delay in passage of meconium |
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|
most common UTI bugs
|
e. coli klebsiella proteus s. saprophyticus |
|
|
types of UTI (x3)
|
cystitis pyelonephritis asymptomatic bacteriuria |
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|
cystitis symp & tx
|
dysuria, urgency, freq, suprapubic pain, incontinence, no fever (unless very young) amoxicillin, TMP/SMX, methoxazole, nitrofurantoin |
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|
pyelonephritis symp & tx
|
abd or flank pain, fever, malaise, nausea, vomiting, diarrhea, nonspecific in newborns and infants start with oral abx unless hospitalization and IV fluids |
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|
FU for UTI
|
Do urine culture 1 week after stopping abx to confirm sterility; periodic reassessment for next 1-2yrs US for anatomy, suspected abscess, hydronephrosis, recurrent UTI Voiding cystourethrogram (VCUG) in recurrent UTI or UTI with complications or abnormal US findings |
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|
VUR - vesicoureteral reflux
|
1. predisposition to pyelonephritis 2. scarring 3. reflux nephrology (HTN, proteinuria, renal insuff to ESRD) 4. impaired kidney growth dx = VCUG |
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|
obstructive uropathy: 1. define 2. symp 3. dx 4. tx |
1. obstruction of urinary outflow tract 2. hydronephrosis, upper abd pain, pyelonephritis, UTi recurrent, weak urine stream, failure to thrive 3. palpable abd mass -- VCUG, US 4. decompress bladder with catheter, abx, transurethral ablation or vesicostomy |
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|
obstructive uropathy etiology
|
ureteropelvic junction obstruction ectopic ureter ureterocele posterior urethral valves |
|
|
obstructive uropathy complications
|
if lesion is svere, may present with pulmonary hypoplasia (Potter seq) prognosis dependent on lesion severity and recovery of renal fxn |
|
|
ectopic ureter
|
drains outside bladder; causes continual incontinence and UTI
|
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|
ureterocele
|
cystic dilatation with obstruction from a pinpoint ureteral orifice; mostly girls
|
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|
posterior urethral valves
|
--most common cause of severe obstructive uropathy --boys --can lead to ESRD --mild hydronephrosis to severe renal dysplasia --palpable distended bladder and weak urinary stream |
|
|
acute poststreptococcal glomerulonephritis pathophys |
lumpy-bumpy deposits of Ig and complement on glomerular basement membrane and in mesangium
|
|
|
acute poststreptococcal glomerulonephritis 1. presentation 2. dx 3. tx |
1. 5-12y/o; 1-2wks after strep pharyngitis or 3-6wks after skin infection (impetigo) edema, htn, hematuria 2. RBD casts, proteinuria, low C3, anti-DNase antigen 3.abx (penicillin 10d); Na restriction; fluids; control htn 95% patients = complete recovery |
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|
acute poststreptococcal glomerulonephritis complications |
HTN ARF CHF electrolyte abnormalities acidosis seizures uremia |
|
|
Berger disease |
IgA nephropathy most common chronic glomerular disease worldwide URI and GI infections normal C3 mild proteinuria and mild/mod HTN HTN = most important thing to control |
|
|
alport syndrome |
x-linked renal biopsy = foam cells -- accumulation of neutral fats and mucopolysaccharide asymp hematuria (usually 1-2d after URI) hearing deficit (bilat sesorineural, never congenital) ocular abnorm (extrusion of central part of lens into anterior chamber) |
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|
1. most common nephrotic syndrome in adults 2. most common chronic glomerulonephtritis in older kids/young adults |
1. membranous glomerulopathy 2. membranoproliferatic glomerulonephritis |
|
|
henoch-schonlein purpura |
small vessel vasculitis good prognosis purpurie rash joint pain abdominal pain IgA deposits in kindey steriods or spont resolve |
|
|
HUS: symp and bugs |
hemolytic uremic syndrome most common ARF in young kids 1. microangiopathic hemolytic anemia 2. thrombocytopenia 3. uremia e. coli 0157:H7 shigella salmonella campylobacter |
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|
HUS: pathophys |
|
|
|
how many days after infection does HUS occur? Lab results? |
5-10d = sudden pallor, irritability, weakness, oliguria, mild renal insuff helmet cells, burr cells, fragmented cells platelet = 20k-100k hematuria and proteinuria |
|
|
burr cells |
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|
HUS tx |
FLUIDS AND ELECTROLYTES tx HTN aggressive nutritition early peritoneal dialysis maybe plasmaphoresis/fresh frozen plasma no abx if e. coli 0157:H7 is suspected (will inc risk of developing HUS) |
|
|
PKD -- aut rec (infantile) |
large kidneys microcysts --> progressive interstitial fibrosis and tubular atrophy --> renal failure liver disease symp = potter's, HTN, oliguria, ARF, pulm hypoplasia (if severe) tx = dialysis and transplant; 80% have 10yr survival |
|
|
PKD -- aut dom (adult) |
most common hereditary kidney disease enlarged kidney with cortical and medullary cysts 40-50s macrocysts = kidney, liver, pancreas, spleen, ovaries, Berry tx = HTN control and transplant |
|
|
types of proteinuria (x3) |
1. transient = from fever, exercise, dehydration, cold exposure, CHF, seizure stress 2. orthostatic = slightly inc in supine position and greatly inc in upright (esp school aged kids); most common 3. fixed = glomerular/tubular disorders; >1g/24hr or with HTN, hematuria, or renal dysfunction |
|
|
1. most common nephrotic syndrome in kids 2. features of nephrotic syndrome |
1. steroid-sensitive minimal change disease 2. proteinuria (>40mg/m2/hr) hypoalbuminemia (<2.5 g/dL) edema hyperlipidemia |
|
|
minimal change disease |
most common between 2-6y/o may follow minor infections edema (eyes and lower extremities) diarrhea, abd pain, anorexia uncommon = HTN, gross hematuria proteinuria albumin <2.5 Cr normal or inc inc chol and TG C3 and C3 normal tx = prednisone Na restriction multiple relapses but gradually dec |
|
|
minimal change disease complication |
infection: vacc for pneumococcus and varicella most freq is spontaneous bacterial peritonitis (s. pneumo) inc risk of thromboembolism |
|
|
undescended testes |
more common in preterm should be descended by 4mo usually stuck in inguinal canal untreated = in seminoma malignancy treated = bilateral (50% pt are fertile) unilateral (85% pt are fertile) |
|
|
testicular torsion |
most common cause of testicular pain over 12y/o acute pain swelling tenderness on palpation ER surgery -- >90% of testicles survive if within 6h and <360 degree rotation |
|
|
torsion of appendix testes |
most common cause of testicular pain 2-11 y/o gradual onset 3-5mm, tender, inflamed mass at upper pole of testes blue dot through scrotal skin |
|
|
epididymitis |
ascending, retrograde urethral infection -> acute scrotal pain/swelling rare before puberty main cause of acute scrotal swelling in sexually active men pyuria tx = bedrest and abx |
|
|
pyuria |
the presence of pus/WBC in the urine, typically from bacterial infection |
|
|
varicocele |
dilatation of pampiniform plexus (valvular incompetence of spermatic vein) tx = surgery "bag of worms" and painless |
|
|
testicular tumors |
65% malignant palpable, hand mass that doesn't transilluminate usually painless dx = US, AFP, b-HCG tx = radical orchiectomy |
|
|
most common acquired hypopituitarism |
craniopharyngioma |
|
|
most common hyperpituitarism |
hormone-secreting adenomas |
|
|
define precocious puberty and most common etiologies for boys/girls |
female = <8; sporadic and familial male = <9; hamartomas |
|
|
hamartoma |
composed of tissue elements normally found at that site, but which are growing in a disorganized mass benign, focal malformation that resembles a neoplasm in the tissue of its origin |
|
|
define thelarche, adrenarche, menarche |
thelarche = boobs adrenarche = hormones (adrenal production) -- hair (genital, axillary, inguinal) and sexual features (hips) menarche = period |
|
|
defect in thryoid hormone synthesis |
goitrous aut rec |
|
|
cretinism |
prolonged jaundice large tongue umbilical hernia edema retard ant/post fontanels wide mouth open hypotonia |
|
|
most common acquired hypothyroidism |
hashimoto (caused by thyroiditis) usually teens |
|
|
first sign of acquired hypothyroidism |
deceleration of growth then myxedema, constipation, cold intol, dec energy, inc sleep, delayed osseous maturation, delayed puberty, headache, visual problems |
|
|
myxedema |
swelling of the skin and underlying tissues giving a waxy consistency |
|
|
most common hyperthyroidism; peak age; findings |
graves 11-15yrs 1. infiltration of thyroid and retro-orbital tissue with lymphocytes and plasma cella -> exopthalmos 2. lymphadenopathy and splenomegaly 3. thymic hyperplasia |
|
|
Graves HLA assoc in white people |
HLA-B8 HLA-DR3 DR3 = Addisons, DM, MG, Celiac |
|
|
autoimmune polyglandular disease 1. type 1 2. type 2 |
1. hypoparathyroidism addisons mucocutaneous candidiiasis small # with autoimmune thyroiditis 2. addison DM w/ or w/o thyroiditis |
|
|
Addison's disease |
|
|
|
hypo vs hyperthyroidism symptoms |
|
|
|
tx for acute symptoms of hyperthyroidism in thyroid storm |
beta blockers!! |
|
|
thyroid storm |
|
|
|
symptoms of hypoparathyroidism |
muscle cramps/pain numbness tingling laryngeal and carpopedal (hands) spasm seizures (hypocalcemic seizure in newborn -- think DiGeorge) |
|
|
EKG in hypoparathyroidism |
prolonged QT |
|
|
rachitic rosary |
vitamin D deficiency (also see bowing and fractures) |
|
|
21-hydroxylase deficiency -- labs plus tx |
aut rec dec cortisol -> inc ACTH -> adrenal hyperplasia inc adnrogens dec aldosterone and cortisol inc 17-OH progesterone inc K, renin acidosis low Na, glucose tx = hydrocortisone fludrocortisone if salt losing inc both doses in times of stress correct sex organ in females |
|
|
cushing's syndrome |
adrenocortical tumor (malig) = infants disease = >7yrs dexametasone-suppression test |
|
|
moon face |
cushing's |
|
|
3-beta-hydroxysteroid deficiency |
salt wasting pseudohermaphrodites precocious pubarche inc 17-OH pregnenolone and DHEA |
|
|
adrenal pathway |
|
|
|
11-beta-hydroxylase deficiency |
female pseudohermaphroditism postnatal virilization HTN inc androgens hypokalemia |
|
|
17-alpha hydroxyl deficiency |
male pseudohermaphroditism sexual infantilism HTN hypokalemia |
|
|
diabetic ketoacidosis |
hyperglycemia ketonuria inc anion gap dec HCO3 dec pH inc serum osmolarity |
|
|
metabolic syndrome |
DM hyperlipidemia HTN acanthosis nigricans |
|
|
developmental dysplasia of the hip (DDH) barlow vs ortolani |
barlow = dislocate an unstable hip (most important test) -- clunk sound ortolani = fixes dislocated hip; not possible after 2mo cuz of soft-tissue contractions |
|
|
another picture of barlow vs ortolani |
|
|
|
pavilk harness |
tx = duration for 1-2months for developmental dysplasia of the hip |
|
|
legg-calve-perthes disease -- define |
idopathic avascular necrosis of the capital femoral epiphysis in immature, growing kid males 20% bilateral |
|
|
legg-calve-perthes disease -- symp; tx |
mild intermittent pain in anterior thigh with plainless lump with restriction of motion tx = containment with orthoses or casting bedrest abduction stretching exercises if sig femoral deformity ppersits, surgical correction |
|
|
Slipped capital femoral epiphysis (SCFE) |
most common teen hip disorder obese or delayed skeletal maturation or thin with recent growth spurt tx = pinning |
|
|
transient synovitis |
viral 7-14d after URI 3-8 y/o acute mild pain with limp and mild restriction movement pain in groin, ant thigh, and knee tx = bedrest and no weight bearing (<1wk) then 1-2wk of limited activity |
|
|
metatarsus adductus |
most common in firstborn tx = serial plaster casts before 8mo, orthoses, corrective shoes |
|
|
orthosis |
brace (knee, foot, arm, etc) |
|
|
talipes equinovarus |
clubfoot correction should be done by 3mo; if not then surgery needed |
|
|
internal femoral torsion (femoral anteversion) |
most common cause of intoeing >2yrs most secondary to abnormal sitting habits (W-sitting) tx = observation; take 1-3yr to resolve; surgery only if significant at >10yrs |
|
|
W-sitting |
|
|
|
internal tibial torsion |
most common <2yr no tx -- resolves in normal growth/development (takes 6-12mo) |
|
|
osgood-schlatter disease |
overuse injury (traction apophysitis of tibial tubercle) active teen swelling, tender, inc prominence of tubercle tx = rest, restriction of activities, knee brace resolution = 1-2yrs |
|
|
scoliosis |
most idiopathic >11yrs Adams test bending forward at hips tx = brace if <30-45 degrees and surgery if >45 degrees |
|
|
hemivertebra |
rare causes scoliosis |
|
|
nursemaid elbow |
hx of sudden traction or pulling on arm radial head subluxation |
|
|
osteomyelitis bugs |
s. aureus (most common) pseudomonas (puncture wound) salmonella (sickle cell) |
|
|
septic arthritis bug |
almost always s. aureus |
|
|
definitive dx for osteomyelitis vs septic arthritis |
osteo = bone biopsy for culture and sensitivity septic = US guided arthrocentesis for culture and sensitivity |
|
|
osteogenesis imperfecta |
most common genetic osteoporosis aut dom 1. fragile bones 2. blue sclera 3. early deafness defect of type 1 collagen |
|
|
osteogenic sarcoma 1. age 2. M vs F 3. cxr 4. malignant? 5. metastases 6. tx 7. prognosis |
1. second decade 2. males 3. sunburst (sclerotic destruction) 4. yes 5. lung, bone 6. chemo and surgery 7. 70% cure w/o mets (<20% w/ mets) |
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ewing sarcoma 1. age 2. M vs F 3. cxr 4. malignant? 5. metastases 6. tx 7. prognosis |
1. second decade 2. Males 3. onion skin -- lytic with laminar periosteal elevation 4. yes 5. lungs, bone 6. radiation and surgery 7. 60% cure w/o mets (20-30% w/ mets) |
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osteoid osteoma 1. age 2. M vs F 3. cxr 4. malignant? 5. metastases 6. tx 7. prognosis |
1. second decade 2. 3x greater in males 3. central lucency with sclerotic margin 4. no 5. n/a 6. NSAID and surgery only if painful 7. resolve spontaneously 8. n/a |
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juvenile idiopathic arthritis (JIA) 1. define 2. pathophys 3. symp 4. age/duration |
1. iopathic synovitis or peripheral joints assoc with soft-tissue swelling and joint effusion 2. vascular endothelial hyperplasia and progressive erosion of cartilage and bone; DR8 and DR5 3. morning stiffness; easy fatigability; joint swelling/warm with decreased motion; NO REDNESS 4. <16yr and duration >6wks |
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juvenile idiopathic arthritis 3 types of onset |
1. pauciarticular (<5 joints) = lower extremity but never hip; HLA B27 2. polyarticular (>5) = both small and large joints plus rheumatoid nodules on extensor surfaces of elbows and achilles tendon 3. systemic onset = visceral (hepatosplenomegaly, lymphadenopathy, serositis, iridocyclitis); daily temp spikes (102) for >2wks; salmon-colored evanescent rash |
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salmon-colored evanescent rash |
linear or circular mostly trunk and proximal extremities systemic juvenile idiopathic arthritis |
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JIA labs and tx |
labs = RF+; inc ANA in 40-85% pts; inc ESR; inc anemia of chronic disease tx = NSAID; methotrexate; maybe corticosteroirs |
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SLE labs M or F symp: -general -skin -renal -neuro -pulm -hemato -serositis -GI |
anti-dsDNA HLA: B8, DR2, DR3 drug induced = anticonv, sulf, antiarry females <8yr gen = fever, fatigue, arthralgia, arthritis, rash skin = malar, discoid lesions, livedo reticularis renal = glomerulonephritis, nephrotic, HTN neuro = seizures, stroke pulm = pleuritic pain, pulm hemorrhage hemato = coomb +, thrombocytopenia serositis = pleural, pericardial, hepatospleno GI = vasculitis (pain, diarr, bleeding, hepatitis) |
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raynaud phenomenon |
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SLE tx |
NSAID if no renal disease methotrexate DMARDs steroid for kidney disease and acute disease cyclophosphamide for severe disease |
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kawasaki disease |
affects medium arteries leading cause of acquired heart disease in USA and Japan fever >5d no improved by NSAID or acetaminophen possible early myocarditis or pericarditis inc ESR sterile pyuria tx = IVIg and high dose ASA (no Reye's syndrome) |
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Reye's syndrome |
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henoch-schonlein purpura |
IgA vasculitis of small vessels after URI rash = red -> purple -> rusty brown intussesception occult blood; diarrhea arthritis nephrosis hepatospleno inc platelets, WBC, ESR, IgA, IgM anemia maybe anticardiolipin or antiphospholipid Ab corticosteroids and symp tx |
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henoch-schonlein purpura complicaions |
renal insufficiency/failure bowel perforation scrotal edema testicular torsion chronic renal insufficiency (<1%) |
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iron-deficiency anemia |
typically anemic at 9-24mo due to cows milk pallor, irritability, lethargy, pagophagia, tachycardia, systolic murmurs, long-tern neurodevelopmental effects |
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iron-deficiency labs |
1. dec hemosiderin (bone marrow) 2. dec ferritin 3. dec serum iron and transferrin saturdation 4. inc TIBC 5. inc FEP (free erythrocyte protoporphyrin) 6. microcytosis, hypochromia, poikilocytosis |
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review blood cell morphology |
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poikilocytosis |
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lead poisoning |
>5 ug/dL housing before 1960 symp = behavioral (hyperactivity; aggression) --cognitive (impaired growth) --GI (constipation, anorexia, pain, vomit) --CNS (cerebral edema, ICP) --gingival lead lines >70 = immediate hospitalization (EDTA and dimercaprol) 45-70 = chelation 20-44 = repeat1month 15-19 = tell health dep 5-14 = repeat 3month |
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Blackfan-Diamond: define and symp |
congenital pure red-cell anemia inc RBC programmed cell death -> profound anemia by 2-6 months short stature craniofacial deformities defects of upper extremities triphalangeal thumbs |
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Blackfan-Diamond: labs and tx |
labs = macrocytosis; inc HbF; inc ADA; very low reticulocyte count; inc iron tx = corticosteroids; transfusions and deferoxamine; splenectomy definitive = stem cell transplant |
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congenital pancytopenia: symp, labs, tx |
most common is fanconi anemia (spont chromosomal breaks) symp = hyperpigmented; cafe-au-lait; absent/hypoplastic thumbs; short labs = dec RBC, WBC, platelts; inc HbF; bone marrow hypoplasia tx = corticosteroids; androgens; bone marrow transplant |
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cafe-au-lait |
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transient erythroblastopenia of childhood (TEC) |
6mo-3y/o transient immune suppression of erythropoiesis dec reticulocytes ad bone-marrow precursors recovery = 1-2months |
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anemia of chronic disease and renal disease |
little/no inc in erythropoietin mild dec in RBC lifespan normochromic and normocytic iron low w/o inc in TIBC ferritin normal or slightly inc |
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folic acid deficiency |
megaloblastic peaks at 4-7months of age (goat milk feeding) hypersegmented neutrophils |
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vitamin B12 deficiency |
megaloblastic vegans sufficient stores for 3-5 years first 4-5months of life if mothers deficient weak; fatigue; failure to thrive; irritable; pallor; glossitis; diarrhea; vomiting; jaundice; neuro symptoms |
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hereditary spherocytosis and elliptocytosis |
aut dom spectrin def -> deformed -> early removal by spleen symp = anemia, hyperbilirubinemia, hypersplenism, gallstones (biliary) inc MCHC, inc bilirubin, inc reticulocytes confirmatory test = osmotic fragility test tx = transfusion or splenectomy (after 5-6yrs) |
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pyruvate kinase deficiency |
pallor, jaundice, splenomegaly inc reticulocytes, mild macrocytosis, polychromatophilia tx = exchange transfusion for sig jaundice in neonate; transfusions; splenectomy |
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polychromatophilia |
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G6PD deficiency: 2 syndromes |
episodic hemolytic anemia (most common) chronic nonspherocytic hemolytic anemia |
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G6PD deficiency: genetics etiology 24-48hr after ingestion of an oxidant.... |
xlinked mediterranean, middle eastern, african, asian oxidant (ASA, sulfa, antimalarial, fava) or infection and severe illness --> rapid drop in Hb, hemoglobinuria, jaundice heinz bodies |
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sickle cell anemia: age of onset and first presentation |
hemolytic anemia over first 2-4 months by age 5 -- all have functional asplenia hand-foot syndrome (acute distal dactilitis) |
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hand-foot syndrome |
symmetric painful swelling of hands and feet ischemic necrosis of small bones |
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acute painful crises (sickle) |
younger = mostly extrmities w/ inc age = head, chest, back abdomen precipitated by illness, fever, hypoxia, acidosis, or without any factors (older) |
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vaso-occlusive crises (sickle) |
--skin ulcers --retinopathy --avascular necrosis of hip/shoulder --infarction of bone and marrow (salm osteomyelitis) --splenic autoinfarction --acute chest syndrome (most common mortality) --stroke (peak @ 6-9yrs) --priapism |
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priapism |
painful boner that won't go away |
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sickle cell -- inc susceptibility to which bugs |
encapsulated!! -s. pneumonoccus -h. influenza -n. meningitidis -salmonella osteomyelitis -parvo --> aplastic crisis |
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sickle cell kidneys |
proteinuria = first sign UTI papillary necrosis |
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sickle cell blood smear |
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what abx for sickle cell prophylaxis |
penicillin at 2 months until age 5 |
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age limit for bone marrow transplant in sickle cell |
<16 y/o |
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alpha thalassemia--3 types: etiology type of anemia |
1. alpha thalassemia trait (2 gene del) african americans, mediterraneans mild hypochromic, microcytic anemia w/o clinical problems 2. HgB H disease (3 gene del) microcytosis and hypochromia with mild to mod anemia SW asians no transfusion/splenectomy required 3. alpha thalassemia major (del 4 gene) transfusion is cure |
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beta thalassemia major (Cooley anemia) |
excess alpha globin chains -> alpha tetramers form; inc in HbF second month of life --> progressive anemia, hypersplenism and cardiac decompensation |
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beta thalassemia major labs |
with HbF only severe anemia, low reticulocytes, inc nucleated RBC, hyperbilirubinemia microcytosis NORMAL BLOOD SMEAR bone-marrow hyperplasia, Fe accumulates --> inc ferritin and transferrin saturation |
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tx of beta thalassemia major |
transfusions deferoxamine (asses iron overload with liver biopsy) may need splenectomy bone-marrow transplant curative |
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two diseases: minor bleeds vs deep bleeds |
minor = vWD deep = hemophilia |
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intrinsic pathway vs extrinsic pathway |
intrinsic = PTT, 8,9,11,12 extrinsic = PT, 7,13 |
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INR normal range INR on warfarin? |
0.8–1.2 2.0–3.0 |
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what does thrombin time measure |
fibrinogen -> fibrin |
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ristocetin |
previously used to treat staphylococcal infections It is no longer used clinically because it caused thrombocytopenia and platelet agglutination |
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hemophilia A and B -- symp |
A = factor 8 and B = factor 9 xlinked easy bruising hemarthroses (ankle first) |
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hemarthroses |
hemophilia A/B |
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hemophilia A/B labs and tx |
2x or 3x inc in PTT correction with mixing studies tx = prophylaxis now recommended for young children -- prevents chronic joint disease desmopressin avoid ASA |
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vWD |
most common bleeding disorder aut dom vW is carrier protein for factor 8 mucocutaneous bleeding (bruises; superficial) lab = in BT and PTT tx = DDAVP or also may need replacement |
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factors for vit K |
factors 2,7,9,10,C,S |
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ITP -- symp and duration |
1-4wks after viral infection 1-4 y/o sudden onset of petechiae and purpura w/ or w/o mucous membrane bleeding <1% w/ intracranial hemorrhage resolve in 6mo (10-20% get chronic) |
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ITP -- labs and tx/CI |
labs = platelets <20k; platelet size normal to inc; bone marrow is normal to inc megakaryocytes tx = transfusion CI!! (unless life-threatening bleeding); IV Ig for 1-2d if prednisone doesn't work; splenectomy if severe |
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ALL - early symp |
acute lymphoblastic leukemia bone and joint pain (esp lower extremities) bone marrow failure (see other card) |
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signs of bone marrow failure |
pallor bruising epistaxis petechiae purpura mucous membrane bleeding lymphadenopathy hepatosplenomegaly joint swelling |
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ALL (leukemia) dx and tx/complications |
anemia thrombocytopenia leukemia cells not often seen early WBC <10k poor prognosis if WBC >100k bone marrow aspirate --> lymphoblasts tx = remission induction then CNS tx maintenance for 2-3yrs prognosis = >85% 5yr survival relapse (15-20%) = ICP, isolated cranial nerve palsies, testicular relapse, pneumocystitis pneumonia, tumor lysis syndrome |
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tumor lysis syndrome |
from initial chemotherapy (cell lysis) hyper: uric, K hypo: P, Ca (tetany, arryth, renal calcinosis) |
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Hodgkin Lymphoma |
15-19 y/o EBV Reed-Sternberg cell painless firm cervical/supraclavicular nodes anterior mediastinal mass B symptoms 90% cure if eary and >70% if late |
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child with anterior mediastinal mass. dx? |
hodgkin |
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4 types of Hodgkin lymphoma |
1. lymphocytic predominant 2. nodular sclerosing 3. mixed cellularity 4. lymphocyte depleted |
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non-hodgkin lymphoma: types of cells 1. lymphoblastic 2. small, noncleaved cell lymphoma 3. large cell |
1. T cell (mediastinal mass) 2. B cell 3. T, B, or indeterminate cell |
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second most frequent malignancy in children and mortality rate? |
brain tumors 45% mortality average age = <7y/o infratentorial (cerebellum) |
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most common infratentorial tumor |
juvenile pilocytic astrocytoma 80-100% survival surgery, radiation, chemo CEREBELLUM |
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name 5 infratentorial tumors |
juvenile pilocytic astrocytoma malignant astrocytoma (includes glioblastoma) medulloblastoma (midline cerebellar) brain stem tumors ependymoma (posterior fossa) |
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most common supratentorial tumor |
craniopharyngioma calcification on cxr major morbidity = panhypopituitarism, growth failure, visual loss surgery and radiation (no chemo) |
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most frequent tumor of optic nerve and symp |
optic nerve glioma benign slowly progressive unilateral visual loss; proptosis; eye deviation; optic atrophy; strabismus; nystagmus |
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wilms tumor: assoc, age |
nephroblastoma second most common malignant abdominal tumor 2-5y/o assoc = hemihypertrophy, aniridia, genitourinary anomalies, WAGR |
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wilm tumor - symp and tx |
asymptomatic abdominal mass chemo, radiation, surgery. unilateral nephrectomy |
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proptosis |
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neuroblastoma: patho, symp |
from neural crest cells, due to N-myconcogene (at any site) 8% of all kid malignancies "dancing eyes and dancing feet" = ataxia opsomyoclonus also Horner (maybe) firm, palpable mass in flank or midline; painful; with calcification and hemorrhage |
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common locations of neuroblastoma |
adrenal retroperitoneal sympathetic ganglia cervical, thoracic, or pelvic ganglia |
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neuroblastoma dx |
inc HVA and VMA cxr/CT/MRI |
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pheochromocytoma: location, age, assoc, symp, tx |
Epi and NE from chromaffin cells adrenal medulla (usually, but can occur anywhere along abdominal sympathetic chain) 6-14y/o aut dom assoc = neurofibromatosis, MEN 2A, MEN 2B, tuberous sclerosis, sturge-weber, ataxia-telengiectasia episodic severe HTN, palp, sweat, headache, dizzy, pallor, retinal papilledema, retinal hemorrhages/exudate tx = give a- and b-blockers before removal |
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rhabdomyosarcoma location |
head/neck = 40% genitourinary = 20% -- grapes out vagina extremities = 20% retroperitoneal/other = 10% inc freq in neurofibromatosis |
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neurofibromatosis |
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types of rhabdomyosarcoma (x4) |
embryonal (60%) = intermediate prog botryoid (grapelike) = vagina, uterus, bladder, nasopharynx, middle ear alveolar (15%) = very poor prog, trunk and extremities pleomorphic = adult form (rare in kids) |
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spina bifida occulta |
inc AFP midline defect w/o protusion asymptomatic lumbosacral |
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tethered cord |
inc AFP ropelike filum terminale persists and anchors the conus below L2 abnormal tension = asymmetric lower extremity growth, deformities, bladder dysfxn, progressive scoliosis, diffuse pain, motor delay MRI needed surgery = tx |
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meningocele |
well covered with skin meninges herniate surgery |
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myelomeningocele |
folate reduces risk lumbosacral lower sacral -- bowel/bladder incontinence, saddle anesthesia |
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myelomeningocele assoc and tx |
80% assoc with hydrocephalus; type 2 chiari malformation which may cause hindbrain dysfunction tx = ventriculoperitoneal shunt and correction of defect |
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hindbrain dysfunction symp |
feeding difficulty choking stridor apnea vocal cord paralysis upper extremity spasticity |
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hydrocephalus: obstructive vs nonobstructive |
obstructive = cerebral aqueduct (stenosis/gliosis) or lesions in 4th ventricle (tumor, malformation, hemorrhage) non-obstructive = subarachnoid hemorrhage, meningitis |
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hydrocephalus symp: infant vs older kids |
infant = inc head circ bulging anterior fontanel distended scalp veins broad forehead "setting sun" sign (eyes pointed down) inc DTR spasticity, clonus older kid = subtle irritable lethergic dec appetite vomting headache papilledema 6th nerve palsy |
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papilledema |
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dandy-walker malformation: define and assoc |
cystic expansion of 4th ventricle due to absence of roof assoc agenesis of posterior cerebellar vermis and corpus callosum |
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dandy-walker malformation: symp |
inc head size prominent occiput cerebellar ataxia delayed motor positive transillumination |
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define epilepsy |
at least 2 unprovoked seizures occur >24 hours apart |
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febrile seizures |
6mo-5yrs peak at 14-18mo positive family hx inc rapidly to 102 degrees generalized tonic-clonic <10-15min brief postictal period atypical = >15min, more than one day |
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postictal period |
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simple partial seizures |
asynchronous tonic or clonic movements most of face, neck, extremities aura (some pt) no postictal period EKG = spike and sharp waves or multifocal spikes tx = phenytoin usually |
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complex partial seizures |
impaired consciousness 1/3 with aura automatisms (lip-smacking) EEG = anterior temporal lobe shows sharp waves or focal spikes tx = carbamazepine |
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absence seizure |
petit mal blank stare/flickering eyes girls >5yrs no aura <30sec no postictal period EEG = 3/second spike and generalized wave discharge tx = ethosuximide or valproic acid (2nd choice) |
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tonic-clonic seizures |
aura loss of consciousness eyes roll back apnea tonic contraction then clonic rhythmic contractions tongue-biting loss of bladder control semicomatose for up to 2 hrs w/ vomting and bilateral frontal headache tx = valproic, phenobarbital, phenytoin, carbamazepine |
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myoclonic seizures |
brief symmetric muscle contractions and loss of body tone with falling forward tx = valproic acid |
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infantile spasms |
hypoxic iscemia is most common (12-24hr after birth) intraventricular hemorrhare = 1-7d after birth tx = lorazepam, phenobarbital |
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NF-1: criteria |
aut dom 2 criteria needed: --5 cafe-au-lait >5mm --axillar/inguinal freckling -->2 iris Lisch nodules -->2 neurofibromas or one plexiform neurofibroma --osseous lesions (thinning of bone) optic gliomas |
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NF-1 complications |
CNS = optic gliomas, hamartomas, malig cancer, TIA, generalized seizures, learning disab, ADD renovascular HTN or pheochromocytoma leukemia rhabdomyosarcoma wilms tumor |
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NF-2 |
bilateral acoustic neuromas hearing loss facial weakness headache unsteady gait CNS tumors |
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tuberous sclerosis |
aut dom infantile spasms ash-leaf macule (pic) seizures sebaceous adenoma shagreen patch complication = rhabdomyoma of heart renal lesion in most -- wither hamartomas or polycystic kindeys |
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shagreen patch |
rough, raised lesion with orange-peel consistency most in lumbosacral area (midline) |
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erythema toxium |
50% of infants aka body acne or body rash clears within 2 weeks and up to 4 months |
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sturge-weber syndrome symp |
facial nevus seizure hemiparesis intracranial calcification retarded glaucoma seizure |
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facial nevus |
port-wine stain |
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what type of seizure in sturge-weber syndrome |
focal tonic-clonic contralateral to port-wine stain becomes refractory and slowly develops hemiparesis and/or retardation |
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sturge-weber syndrome dx and tx |
dx = occipital-parietal calcifications and intraocular pressure inc unilateral cortical atrophy and hydrocephalus tx = possible lobectomy (may prevent retard/seizures); tx seizures; pulsed laser for face |
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cerebral palsy |
most born with uncomplicated labor and delivery impaired voluntary muscles maybe seizures, dec speech, vision, intellect risks = low weight, intrapartum infection, intraventricular hemorrhage |
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friedrich ataxia |
ataxia by <10y/o progressive loss of DTRs plantar reflex weak hands/feet explosive dysarthric (weak) speech hypertrophic cardiomyopathy --> CHF, death aut rec GAA triplet repeat |
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DTR |
deep tendon reflex |
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wilson disease: symp, MRI, tx |
copper aut rec dystonia tremors basal ganglia problems kayser-fleischer -- + neuropsych symp MRI = dilated ventricles with atrophy of cerebrum and lesions in thalamus and basal ganglia decreased ceruloplasmin tx = penicillamine with chelation and liver transplant |
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tay-sachs disease |
deficiency b-hexosaminidasa-A Ashkenazi jews normal developmental until 6 months the lag and lose milestones seizures hypotonia blindness cherry-red macula |
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lesch-nyhan disease |
x-linked disorder of purine metabolism--excess uric self-mutilation and dystonia gouty arthritis tophi renal calculi dx = analyze HPRT enzyme tx = tx renal complications; anxiety; behavior |
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spinal muscle atrophy (SMA) -- types |
1 = severe infantile (Werdnig-Hoffman) 2 = late infancy, slower progression 3 = chronic juvenile (Kugelber-Welander) |
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spinal muscle atrophy -- symp, dx, tx |
aut rec progressive hypotonia generalized weakness (flaccid) feeding difficulty resp insuff fasciculations of tongue and fingers absent DTRs dx = SMN gene; denervaion tx = supportive; death by 2y/o |
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myasthenia gravis |
ACh rec Ab -- block receptors ptosis and extraocular muscle wekaness dysphagia facial weakness poor head control rapid muscle fatigue tx = neostigmine; prednisone; thymectomy (if symp <2yrs) |
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transient neonatal myasthenia |
neonates born to mother with myasthenia hypotonia and weakness feedin difficulties respiratory insufficiency (days to weeks) ventilation and nasogastric feedings no inc risk of disease.... Ab fade out |
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ptosis |
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HSMSN -- whats it stand for |
hereditary motor-sensory neuropathies |
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marie-charcot-tooth disease |
peroneal muscle atrophy (and tibial) aut dom clumbsy pes cavus (high arch) foot drop claw hand (severe) sural nerve biopsy is diagnostic tx = stabilize ankles; surgical ankle fusion; phenytoin/carbamaz |
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guillain-barre syndrome bugs |
campylobacter jejuni mycoplasma pneumoniae 10 days later |
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guillain-barre syndrome symp |
polyneuropathy symmetric (ascending) may have tender, pain, paresthesias early bulbar involvement autonomic: BP, bradycardia, asystole |
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define bulbar involvement |
dysphagia facial weakness respiratory insufficiency |
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guillain-barre syndrome dx and tx |
dx = inc CSF protein with normal glucose and no cells tx = admit all patients! supportive (watch resp) IV Ig 2-5d |
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gower sign |
duchenne muscular dystrophy |
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duchenne muscular dystrophy (ages 1-10): SYMPTOMS |
1st sign = poor head control (maybe) 2 y/o = hip=girdle weakness gower sign @ 3y/o or 5y/o calf pseudohypertrophy need orthotic device by age 12 sig accel of scoliosis |
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duchenne muscular dystrophy (ages 11-20): SYMPTOMS |
resp insuff repeated pulm infections pharyngeal weakness (aspiration) contractures scoliosis cardiomyopathy IQ <70 in most death @ 18 from resp failure/cardiac failure |
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duchenne muscular dystrophy labs and tx |
labs = CPK 15k-35k (norm <160) dystrophin deficiency (muscle biopsy) tx =digoxin; pulm tx; supportive |
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3 bugs in maternal vaginal flora |
group B strep e. coli listeria |
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most common bugs 2mo - 12y/o |
s. pneumo n. meningitis HiB (less cuz of vaccinations) |
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kernig sign |
flexing of hip 90 degrees and subsequent pain with leg extension meningitis |
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brudzinski sign |
involuntary flexing of knees and hips after passive flexing of the neck while supine meningitis |
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CI to immediate LP |
--evidence of inc ICP --severe cardiopylmonary problems requiring resuscitation --infection of skin over site --dont delay abx for the CT scan |
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meningitis: bacterial cell # cytology glucose protein gram stain culture latex agglutination pressure |
200-5k polymorphonuclear neutrophil low high + + + high |
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meningitis: partially treated cell # cytology glucose protein gram stain culture latex agglutination pressure |
200-5k mostly polymorphonuclear neutrophil low high variable variable + high |
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meningitis: TB cell # cytology glucose protein gram stain culture latex agglutination pressure |
100-500 lymphocytes low high - + - high |
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meningitis: aseptic (viral) cell # cytology glucose protein gram stain culture latex agglutination pressure |
100-700 mostly lymphocytes normal normal/slightly high - - - normal |
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tx of meningitis (bacterial) |
vancomycin plus cefotaxime/ceftriaxone |
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acute menigococcemia |
any organ: vasculitis and thromboembolic dis meningococcal rash (black with ring of red) high dose IV penicillin |
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acute menigococcemia -- fulminant |
septic shock DIC (purpura) acidosis adrenal hemorrhage renal failure heart failure |
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encephalitis |
meningitis + mental status changes |
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anything that suggests temporal lobe involvement is highly suggestive of.... |
HSV! -- herpes examples: focal seizures CT scan MRI EEG findings |
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pertussis: phases and tx |
vacc wanes after 8-15 years 1. catarrhal phase (2wk) = coldlike 2. paroxysmal phase (2-5wks) = severe cough; whoop; facial petechiae; post-tussive emesis 3. convalescent phase (>2wk) = gradual resolution of cough tx = supportive and 14d erythromycin (tx all family in household) |
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bartonella |
most common cause of lymphadenitis lasting >3wks incubation = 3-30d red to white papules along the linear scratch fever; malasie; headache; anorexia atypical = perinaud oculoglandular syndrome self-limiting and resolves in 2-4mo |
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|
perinaud oculoglandular syndrome |
looks like pink eye but NOT Bartonella henselae Francisella tularensis herpes simplex virus type 1 Paracoccidioides brasiliensis |
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|
positive PPD measurements |
5,10,15 mm 5 = previously positive or AIDS pts 10 = in high risk pop 15 = in low risk pop |
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TB extrapulmonary (miliary) |
spleen liver bone/joints (POTT) meningitis -- CN 3,6,7 palsies hydrocephalus |
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define miliary |
disseminated |
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TB tx |
latent = INH x 9mo primary pulm disease = INH + rifampin x 6mo ------plus pyrazinamide in first 2mo resistance? = + strptomycin, ethambutol/ethionamide dec morbidity and mortality if add corticosteroids in meningitis |
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BCG vaccination |
TB vaccination variable efficacy time-limited efficacy |
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|
perinatal TB |
mom (+)PPD = get cxr crx (-) = give mom INH for 9mo (no baby tx) possible TB @ delivery = separate baby from mom until cxr obtained crx (+) = give infant INH and mom full TB drugs until (-) for at least 3 months |
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lyme disease symp |
hx of tick bite usually absent (don't notice) erythema migrans (3-32d after bite) --fever --headache --malaise then uveitis and bell's palsy (bilateral); carditis; neuropathy; aseptic meningitis |
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erythema migrans |
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lyme dx and tx |
dx = hx plus ELISA (Western confirms) tx = doxycycline 14-21d (>8 y/o) amoxicillin (<8 y/o) ceftriaxone if meningitis/carditis |
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rickettsia rickettsii symp and tx |
north carolina; SE april-september incubation 2-14d then headache; fever; anorexia; myalgias; GI symptoms 3d = RASH (distal first) vasculitis and thromboses --> gangrene hepatosplenomegaly; coma; delirium tx = doxycycline or tetracycline (chloramphenical if allergy) |
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candida |
thrush = nystatin diaper dermatitis = topical nystatin and hydrocortisone catheter-related fungemia = amphotericin B chronic mucocutaneous candidiasis (T cell defect; plus DM usually) |
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cryptococcus neoformans |
HIV pts -- soap bubble lesions in grey matter meningitis inhalation of spores (soil or pigeon poop) usually just pneumonia or asymptomatic latex agglutination test india ink -- old method |
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cryptococcus neoformans soap bubble lesions (picture) |
only grey matter |
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histoplasmosis: location/source |
bird poop and decayed wood Midwest (Ohio and Mississippi River valleys) bat poop in caves |
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histoplasmosis symp, dx, tx |
symp: acute pulmonary (usually asymp) pic = --flulike in young kids --hepatosplenomegaly --patchy bronchopneumonia and hilar adenopathy chronic = centrilobular emphysema erythema nodosum dx: serum/urine Ag tx: none; maybe oral itraconazole; amphotericin B if disseminated |
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erythema nodosum picture |
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coccidioidomycosis |
aka san joaquin fever; valley fever inhaled from dust (SW) self-limiting usually dry-nonproductive cough disseminating = flu-like; chest pain; maculopapular rash; erythema nodosum |
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measles |
rubeola RNA paramyxovirus is very contagious incubation 10-12d 1. cough 2. coryza 3. conjunctivitis, then koplik spots tx = support and vit A |
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VERSES: rubeola rubella roseola infantum |
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define coryza |
head cold, fever, sneezing |
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measles complication |
otitis media (most common) pneumonia encephalitis |
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rubella |
rash begins on face then rest of body (faster rash then measles) --retroauricular, posterior, and occipital lymphadenitis --forscheimer spots (pic) --polyarthritis tx = supportive |
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roseola |
aka exanthem subitum high fever (106) for 3 days then URI maculopapular rash on trunk, arms, neck, face AFTER FEVER |
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mumps |
paramyxovirus winter/spring incubation = 12-24d fever; headache; malaise unilateral/bilateral parotid swelling orchitis (one or both) and only if after puberty -- sterile if both tx = support |
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mumps complications |
meningoencephalomyelitis pancreatitis thryroiditis myocarditis deaf dacryoadenitis |
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dacryoadenitis |
inflammation of lacrimal gland complication of mumps |
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varicella -- progression of rash |
incubation 10-21d 1. macule 2. papule 3. vesicle 4. open vesicle 5. crust crops of lesions at same time acyclovir and VZIG if immunocomp |
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fifths disease |
parvovirus B19 (DNA) --arthritis --slapped cheek --lacy, reticulated rash over trunk and extremities (no palms/soles!!) rash = up to 40d |
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fifths disease complications |
aplastic anemia in sickle (hemolytic anemia) hydrops fetalis if mom has it in first trimester |
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EBV |
1. fatigue 2. pharyngitis 3. generalized adenopathy incubation: 30-50d splenomegaly (no sports) prodrome for 1-2wks (fever, fatigue, headache, sore throat, abd pain) get rash if given ampicillin or amoxicillin tx = steroids |
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influenza virus symptoms |
abrupt onset with coryza, conjunctivitis, parhyngitis, dry cough fever (2-4d), myalgia, malaise, headache |
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coxsackievirus |
oral ulcers supportive care |
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adenovirus symptoms |
fever pharyngitis conjunctivities diarrhea |
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poliovirus |
assymetric flaccid paralysis URI symptoms |
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tx of AIDS (infant) |
ZDV until confirmation that disease not present TMP/SMX at 1mo F/U = CBC, platelets, CD4, CD8 |
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ascariasis |
loeffler's syndrome (pulm eosinophilia) = cough and blood-stained sputum poverty; human feces; preschool obstructive intestinal/biliary disease tx = albendazole, mebendazole, or pyrantel pamoate |
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hookworm (2 bugs) |
ancylostoma and necator penetrate through skin --> veins --> lungs --> swallowed --> attach to mucosa up to 5 years morbidity from blood loss --iron def --hypoalbuminemia (edema) --cough, colicky abd pain, diarrhea, anorexia --chlorosis (picture); green-yellow eosinophilia!! tx = mebendazole or albendazole plus ferrous sulfate |
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enterobiasis (enterobius vermicularis) |
perianal laying of eggs at night (anal itching) restless sleep tx = single oral dose of medendazole and repeat in 2wks |
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gonorrhea |
asymptomatic pts are at higher risk for dissemination (fever, chills, arthritis) purulent discharge tx = single-dose ceftriaxone or single-dose azythromycin tx partners |
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chlamydia |
mucoid discharge or lymphogranuloma vernerum tx = single-dose azythromycin or doxycycline for 7d erythromycin in pregnant |
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trichomonas |
frothy-foul smelling males asymptomatic strawberry cervix tx = metronidazole motile protozoans |
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herpes tx |
acyclovir valacyclovir famcyclovir |
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tzanck prep |
HSV |
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open comedone vs closed |
open = blackhead closed = whitehead |
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tx of acne |
benzoyl peroxide tretinoin (most effective) adapalene erythromycin/clindamycin topicals allow 4-8wks to assess effect before changing or adding medication THEN..... tetracycline isoretinoin (teratogenic) hormonal therapy corticosteroid injections heal painful nodulocystic lesions dermabrasion may help decrease visible scarring |
