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105 Cards in this Set

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What pediatric dx do the following four characteristics define: Inappropriate inattention, impulsivity, lack of focus, disruptive behavior.
What age group is most commonly dx'd with ADD/ADHD?
4-10 year olds
What specific test is done to dx ADD/ADHD?
There is no specific test for ADD/ADHD.
What contributing factors should an ND investigate with a pt dx'd with ADD/ADHD?
Neruotransmitters, diet, digestion, homelife (emotional components), toxin exposure, amount of exercise, time spent out doors.
According to Dr. Skowron what factor should be addressed first in all pts with ADD/ADHD?
Diet. Remove all artificial ingredients, all procressed foods, and allow kids to eat as much as they want of only whole foods.
Name the epidemic in children in the US
What causes autism, in a general sense. - 1 in 100 from:
Environmental toxicity.
Autism is defined by developmental delays affecting what aspects of the pt's behavior?
Delays ranging from speech, to sociability, to sleep, and Including Hypersensitivities.
Name 3 other areas affected in children with autism.
Immune system is altered. GI function is altered. Adrenal imbalance occurs.
Recurrent Yeast infections, imbalanced neurotransmittes, and shifted brain size may all be observed in children with what dx?
Why were all of Dr. Skowron's video examples of children with Autism male?
Testosterone some how holds heavy metals in the body, while estrogen helps discharge heavy metal toxicity. 80% of autistic pts are male.
What does PDD stand for?
Pervasive Developmental Disorder.
What is PDD?
An umbrella term for children having one of multiple developmental delay dx.
What 7 dx fall under the PDD umbrella?
1) ADD (2) ADHD (3) Childhood developmental disorder (4) Asperger's (5) Autism (6) Rett's (7) PDD-NOS
What is ppd-NOS?
PPD-Not Otherwise Specified.
lead poisoning - what level and what does it result from
>10mcg/dl, results from eating or delivered from mom
How is Asperger's characterized?
Social Immaturity. Speech is fully developed, yet pt is socially immature/awkward/different.
What is the etiology of Asperger's?
Toxic etiology.
:::::When tylenol is metabolized in the liver the product(N-acetyl-p-benzoquinoneimine)is toxic to what cells?
Liver cells.
What is the official toxic dose of tylenol?
>150mg/kg. Although toxicity is very individualized, depending on pt's metabolic capacity. - cleared via glutathione stores
How does a tylenol OD cause mortality.
Liver damage, leads to renal failure which is fatal.
Before renal failure and death what s/s will a kid who was given toxic amounts of tylenol display.
GI irritability, N/V, elevated LFTs.
::::What system of the body is commonly affected by heavy metal poisoning?
CNS, causing mental retardation and seizures (sz)
Common ways exposed to heavy metals include?
eating, pica, delivered from mother in utero.
True of False: Heavy metal poisoning can result in hypersensitivity reactions to the metal.
This is true.
::::What is the prevelance of child abuse (physical, emotional, mental)in US?
List major red flags seen in families where child abuse occurs.
Parents who lack afection. Drugs and alcohol. Pornograph. "difficult child". Isolated parents. Crisis situations. Placent child.
When seen in your office a family in which child abuse is occuring may present in this manner.
Depressed, reluctant to give history (hx), injury reporting is skewed, reporting is delayed.
Give several findings that would make you question child abuse.
Skin lesions (multiple stages of healing, unlikely places, by unlikely means), failure to thrive (FTT), UTI, avoidance of GU/GI habits.
:::::Pediatric pt presents with: URI, high fever, conjunctivitis, cough, malaise, and photophobia, you suspect what illness?
You could suspect almost any viral infection. Measles is the one listed in the notes - but you would look for the pathognomonic to dx measles.
What is the key diagnostic finding for Measles?
Koplick's spots: small white specks on a red base in bucal mucosa.
What does the rash of Measles look like?
it is a macularpapular rash, spreading across the skin and forming fine scales.
Give three other major findings related to Measles.
Splenomegaly, pharyngitis, and Cervical lymphaednopathy.
::::This viral infection can cause abortions in the 1st trimester.
Rubella has many of the same s/s we see with other childhood infectious diseases, such as.
malaise, sore throat, and a maculopapular rash.
Rubella's rash has two somewhat unique characteristics.
the rash blanches, the rash clears after 3-4 days. - incubation of Rubella is 14-21 days
Systemic effects of Rubella are?
Like the other viral infections that affect children, and against which there are vaccinations, when is Rubella most contagious, and when is it least?
most during incubation period, and less contagious when rash is apparent.
This childhood disease causes cataracts.
:::::This viral infection has the briefest rash, lasting only 24 hours.
Roseola affects what age group?
3 months old - 2 years old.
Mom presents with baby she says that baby had a fever as high as 105 yesterday, and that today the baby's temp is down to 103, you diagnose the baby with Roseola and tell the mom she can expect what tomorrow?
The baby will develope the typical rash that accompanies Roseola.
Describe the typical rash of Roseola.
Blanchable, pink, lasts 24 hours, no desquamation, no itching
Additional effects of Roseola include what findings?
Pharyngitis, OM, lymphadenopathy.
::::Erythema Infectiosum is also known by what name?
Fifth's Dz. Incubation = 6 - 16 days spread via respiratory
How is the the rash of Erythema Infectiosum distinguished from other viral rashes?
Malar facial rash, aka "slapped cheek" rash -presents as if pt has been slapped on cheeks of face or on buttom.
Why is Erythema Infectiosum called fifth's disease.
Becasue it is the fifth disease that a child would contract
::::This viral infection may be asymptomatic, or will present with fever, malaise, and HA (headache) like other infections, but also presents with Swollen Parotids and submandiblar lymphadenopathy??
Mumps (Submandibular lymphadenopathy). Note 14-21 days incubation
What is the the concern for male patients diagnosed with mumps?
Orchitis; with the major complication of sterility. - presents with new fever, unilateral pain
::::Both Shingles and Chickenpox are caused by what virus?
Varicella Zoster.
At what age range is a pt most likely to present with Chickenpox?
5-10yrs. - incubation 11-21 days
When would you tell a parent that their child's chickpox are most likely to not be contagious?
When all the lesions are crusted over the contagiousness of this virus decreases significantly.
The rash of this virus is described as being maculopapular then becoming vesicular before crusting and becoming very pruritic.
The rash of Chickenpox.
Name a major difference between the rash of chickenpox and that of our oter viral infections.
Chickenpox appears sporadically around the entire body. They are single points that don't blend into one large patch.
::::On inspection of a child's throat you notice a fibrous pseudomembrane covering the mucosa in the posterior oral cavity, what diagnosis do you suspect?
Diptheria (Cornyebacterium Diptheriae).
Diptheria presents with common symptoms such as sore throat, dysphagia, and fever but also has a high mortality rate what two factors account for the high mortality?
The fibrous pseudomembrane on the respiratory mucosa can occlude airways leading to asphyxiation.
Exotoxins from Diptheria can cause damage to the heart, nervous system, and kidneys.
Why would a child with Diptheria present with tachycardia?
Tachycardia occurs as a compensatory mechanism d/t the respiratory compromse.
:::A father calls your office and states that his child is coughing so hard and so consistently that he has a hard time catching his breath between the coughs, he has hugh amounts of mucus, he vomited, but the boy doesn't have a fever. What Dx do you suspect?
Pertussis (Bordatella Pertussis, or Whooping Cough).
Why did the boy with Pertusis vomit?
Part of the spasmodic cough is the spasming of the diaphragm - this squeezes the stomach = emesis.
The boy's father says his son is 10 months old, should he worry about this infection or just ride it out?
He should worry. The copious mucous and spasmodic, powerful coughs can lead to asphyia in infants.
::::19 yo college freshmen reports to your office with CC fatigue lasting for over a week, fever came and went, pharyngitis came and went, and pt has some cervical lymphadenopathy. What do you suspect?
Infectious Mononucleosis.
What virus causes Infectious Mononucleosis?
Epstein-Barr virus (a herpes virus). note fatigue can last 2-3 weeks or months
What immune cells are affected by Infectious mononucleosis?
B lymphocytes are infiltrated by Epstein-Barr virus.
The student with mono wants to know why she can't play rugby this weekend.
Splenomegaly is common (50%)with mono and can rupture if trauma occurs.
What other organ systems are affected by Epstein-Barr virus?
Neuro (encephalitis), pulmonary, hepatic complications.
You tell the 19 yo pt to educate her friends about the four classic s/s of mono, what are they?
Sore throat
Swollen lymph glands
::::80-90% of pts with this disease have only mild s/s: fever, malaise, sore throat, HA, vomiting, and recovery with in 1-3 days. The other 10-20% will develop paresthesias, muscle paralysis, and may die of respiratory failure. What disease can do this?
Poliomyelitis (polio).
What feaute of polio accounts for its recurrent nature in chronic cases, and the resultant paresthesias?
Poliomyelitis invades the CNS; it can directly damage motor nerves which leads to decreased function and atrophy, it can also lay dormant on a nerve root waiting between exacerbations.
::::How does Herpangina present in its early stages?
Pharyngitis, HA, anorexia, pain in neck, abdomen, and extremities.
Describe the lesions of Herpangina.
Grayish papulovesicular lesions, erythematous areolae on tonsilar pillars, palate, uvula, and tongue.
Herpangina looks like other herpes viruses, what is your differential diagnostic finding?
Test the pt's blood for antibodies.
:::What is the common name for the disease process caused by coxsackievirus?
Hand, Foot, and Mouth disease.
How does coxsackievirus present?
hand, foot, and mouth causes vesicular exanthem over distal extremities, mouth, and diaper area (i.e. at the pt's hands, feet, mouth and ass, but they couldn't call it the hand, foot, mouth, and ass disease; just knowing that the virus that causes it is the CockSacyvirus is bad enough).
::::This syndrome is defined as an acute encephalopathy involving fatty infiltration of the liver occuring postviral infection. What syndrome is this?
Reye's syndrome.
What medication if used during an infectious event can increases the risk of Reye's syndrome?
Aspirin (ASA)
Considering that Reye's syndrome is an acute encephalopathic condition what s/s would you expect?
Sudden change in mental status, amnesia, lethargy, disorientation, agitation, unresponsiveness, Seizures (Sz), respiratory arrest - acidosis, alkalosis
Considering that Reye's syndrome involves fatty infiltration of the liver what diagnostic procedure can be done to reach a definatively diagnosis?
Liver biopsy.
::::This inherited disease is characterized the presence of COPD, pancreatic insufficiency, and salty sweat??
Cystic Fibrosis
On delivery the OB nurse notes that the baby did not pass a meconium stool for quite a while after deliver, and that when it did pass it looked like a large, thick, hard plug; what disease does this sound characteristic of?
Cystic Fibrosis.
The copious sputum and COPD of Cystic Fibrosis lead to what s/s as this pt grows?
Coughing, wheezing, vomiting, digit clubbing, and delayed growth.
A pt with Cystic Fibrosis will have bulky, oily, foul smelling stools, abdominal protuberance, and rectal prolaspe, in addition to vitamin deficiencies, especially A,D,E,K, why?
These are all due to pancreatic insufficiency.
In hot summer weather what does the care giver of a child with CF need to be work hard to prevent?
Shock d/t dehydration that resulted from excessive sweating.
Two diagnostic tests for CF are?
Testing stool for absence of trypsin, absence is a positive finding indicative of CF. Genetic testing can also be perfomed to dx CF.
CF pt's have COPD, therefore what would you expect to see on their Chest x-ray?
Hyperinflation (also infiltrates, and hilar adenopathy).
Were a sweat test performed on your CF patient what electrolyte would you expect to elevated the most?
In one word what is the major factor leading to the respiratory conditions and digestive disorders of CF?
Mucus. It plugs the lungs, and it plugs the ducts of the pancrease preventing digestive enzymes from reaching the intestines.
::::What the hell is Still's Dz?
Juvenile Rheumatoid Arthritis.
What are the s/s of Juvenile rheumatoid arthritis?
Fever, rash, splenomegaly - all of which precede arthritis.
Why is it possible to have Still's dz yet test negative for RF and ANA?
It takes time for the autoantibodies to emerge - the arthritic symptoms of this disease therefore also emerge slowly. - note once you have arthritis, may have + ANA and HLA-B27
JRA may progress to a number of musculoskeletal diseases such as?
Ankylosing spondylitis, and Reiter's.
:::What is the inheritied disorder of connective tissue that causes pts to be tall, have long digits, etc.?
Marfan's syndrome.
Name other classic findings associated with Marfan's?
deformity of the sternum, hperextensibility of joints, backward leg curve, hernias.
What ocular findings may develop in marfan's syndrome?
dislocation of the lens causing myopia.
What are the cardiac effects associated with marfan's syndrome?
aortic dissection, mitral regurg, and endocarditis.
::::An X-ray reveals derangement/deformity of the epiphyseal growth plate at the femoral head, what diagnosis is most likely?
Legg-Calves-Perthes Dz.
The typical Legg-Calves-Perthes pt would present as?:
5-10yo male with unilateral hip pain, changes to his gait, and wasting of his thigh muscle.
::::What is Osgood-Schlatter disease?
Osteochondritis of the tibial tubercle.
What demographic group is most likely to be diagosed with osteochondritis of the tibial tubercle?
Osgood-Schlatter primarily affects 10-15 yo males.
Explain the progression of Osgood-Schlatter?
Excessive traction of the patellar tendon leads to growth of the tibial tubercle.
the pt with osgood-schlatter complains of?
pain, swelling, tenderness at site - rest relieves
::::Tell me something I don't already know about Childhood obesity.
Kids don't officially have a BMI because of their growth patterns; therfore you can say a kid is overweight, but you can't say he is obese, as this is a matter of his weight to height (ie BMI).
After what age does weight no longer rely on genetics?
age 7.
End PEDS 2
Fifth's Dz (aka Parvovirus B19)
fever malaise, sore throat, 3-4 day prodrome, malar facial rash, slapped cheek, on buttocks, maculopapular for 10 days