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51 Cards in this Set
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- Back
- 3rd side (hint)
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Question
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Answer
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Hint
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Top Childhood Cancers - What are they
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1. Leukemia (ALL) 2. CNS tumors 3. Lymphoma 4. Neuroblastoma
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Neuroblastoma - What is it Associated with?
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Embryonal tumor of neural crest cell origin MC cancer in infants more than 1/2 kids < 2 y/o associations - neurofibromatosis Hirschsprung's n-myc oncogene
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Neuroblastoma - Hx/PE
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Can occur anywhere Sx vary with location nontender abdom mass (may cross midline) Horner's syndrome HTN cord compression anemia FTT fever site-specific mets can cause- proptosis periorbital bruising subq tumor nodules bone pain with pancytopenia opsoclonus/myoclonus "dancing eyes, dancing feet"
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Neuroblastoma - Dx
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Abdom CT 24-hr urinary catecholamines assess extent of disease - CXR bone scan CBC LFTs BUN/Cr coag panel
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Neuroblastoma - Tx
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■ Excision - localized tumors ■ chemo includes - cyclophosphamide doxorubicin ■ adjunctive radiation - if tumor spread beyond origin ■ prognosis improved for kids with low-risk dis. - < 1 y/o no N-myc amplification localized
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Wilms' Tumor - What is it Associated with?
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Embryonal cancer of kidney MC renal tumor in kids 2-4 y/o associated with - family Hx Beckwith-Wiedemann syndrome WAGR neurofibromatosis
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Wilms' Tumor - Hx/PE
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Painless, palpable abdom mass does not cross midline n/v fever weight loss hematuria HTN
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Wilms' Tumor - Dx
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Abdom CT or US - intrarenal mass check for metas - CXR chest CT CBC LFTs BUN/Cr
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Wilms' Tumor - Tx
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■ Transabdom nephrectomy ■ postsurgical chemo - vincristine dactinomycin ■ flank irradiation (for some) ■ prognosis good - depends on staging & histo
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RDS - What is it
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MCC of resp failure in premies surfactant deficiency => inc. surface tension (poor lung compliance) and alveolar collapse (atelectasis) surfactant made by T2 pneumocytes mainly ~35th week dipalmitoyl phospha- tidylcholine risk factors - maternal diabetes males 2nd born of twins
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RDS - Hx/PE
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Presents in 48-72 hrs of life RR > 60/min intercostal retractions expiratory grunting nasal flaring cyanosis progressive hypoxemia
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RDS - Dx
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ABGs CBC (to r/o infection) BC (to r/o infection) CXR - bilat diffuse atelectasis causing ground-glass appearance with visible air bronchograms lecithin:sphingomyelin ratio < 2
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RDS - Tx
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CPAP or intubation and mech vent artificial surfactant to prevent - mom gets corticosteroids monitor fetal lung maturity (L:S ratio)
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RDS - Complications
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Persistent PDA bronchopulmonary dysplasia retinopathy of prematurity intraventricular hemorrhage NEC
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Intussusception - What is it
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MCC of bowel obstruction in 1st 2 yrs. of life males > females usu prox to ileocecal valve cause - idiopathic in older kids - mass or intest. abnormality triggers the telescoping: adenovirus or rotavirus parasites CF celiac disease polyps intestinal lymphoma Meckel's diverticulum Henoch-Schonlein purpura
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Intussusception - Hx/PE
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Hx - colicky abdom pain in apparently healthy kids n/v too young to talk - cry draw knees up to chest dyspnea with pain advanced signs - red "current jelly" stool lethargy fever PE - abdom tenderness pos. stool guaiac palpable "sausage-shaped" RUQ abdom mass
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Intussusception - Dx
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Abdom XR abdom US air contrast barium enema CBC
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Intussusception - Tx
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Correct vol & electrolytes check CBC air-contrast barium enema - diagnostic and therapeutic surgical reduction or resection (if gangrenous)
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Pyloric Stenosis - What is it
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Hypertrophy of pyloric sphincter 1st-born males more affected
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Pyloric Stenosis - Hx/PE
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1st 2 wks - 4 mos. of life nonbilious emesis => projectile emesis after each feeding so, babies feed well init => malnutrition & dehydration palpable olive-shaped, mobile, NT epigastric mass visible gastric peristalsis
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Pyloric Stenosis - Dx
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Abdom US - diagnostic barium studies - string sign pyloric beak hypochloremic, hypokalemic metabolic alkalosis
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Pyloric Stenosis - Tx
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First - hydration correct acid-base & electrolyte abnormalities NG tube - possible long. pyloromyotomy
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Child Abuse - What is it
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Neglect physical abuse sexual abuse emotional abuse suspect - if Hx doesn't match physical findings if there was a delay in getting medical care
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Child Abuse - Hx/PE
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Infants may have apnea, seizures, FTT Exam findings include - . cutaneous - ecchymoses of varying ages patterned injuries . skeletal - . spiral fractures of femur and humerus in kids < 3 = abuse unless prove else . epiphyseal/metaphyseal injuries - can happen in infants from pulling/twisting limbs . rib injuries < 2 y/o . sexual abuse - STDs or genital trauma
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Child Abuse - Dx
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R/o conditions that mimic skeletal survey & bone scan - can show fractures in various stages of healing if sexual abuse suspected - test for gonorrhea, chlamydia and HIV to r/o shaken baby syn - check for retinal hemorrhages CT for subdural hemorrhages MRI for white matter changes
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Child Abuse - Tx
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Document injuries notify child protective svcs hospitalize if nec.
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Epiglottitis - What is it
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Serious, rapidly progressive infection of supraglottic before immunization - from H influ type B now - Streptococcus nontypable H flu viral agents
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Epiglottitis - Hx/PE
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Sudden-onset high fever dysphagia drooling muffled voice soft stridor cyanosis "sniffing dog" position "tripod" position insist on sitting up in bed untreated - life-threatening
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Epiglottitis - Dx
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Clinical DON'T EXAMINE THROAT unless anesthesiologist present definitive Dx - direct fiberoptic visual of cherry-red, swollen epiglottis & arytenoids lat XR - thumbprint sign
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Epiglottitis - Tx
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Emergency call anesthesiologist transfer pt. to OR endotrach intubation or trach IV ABx - ceftriaxone or cefuroxime
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Croup (Laryngotracheobronchitis) - What is it
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Inflammation of larynx and upper airway, mainly subglottic space => narrowing of airway kids 3 mos. - 3 yrs. MCC - parainfluenza virus 1 also - PIV-2, PIV-3, RSV, rubeola, influenza, adenovirus, Mycoplasma pneumonia
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Croup (Laryngotracheobronchitis) - Hx/PE
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Prodrome - URI Sxs 1-7 days stridor - worse by agitation fever - low grade hoarseness barking cough
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Croup (Laryngotracheobronchitis) - Dx
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Clinical XR - steeple sign
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Croup (Laryngotracheobronchitis) - Tx
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Mild - cool mist moderate - oral corticosteroids severe - (resp. distress at rest) admit nebulized racemic epi
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Bronchiolitis - What is it
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Acute inflammation of smallest airways acute viral bronchiolitis MCC - RSV infants & kids < 2 y/o can progress to resp. failure risk for severe RSV - < 6 mos. old premies heart or lung dis. immunodeficiency
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Bronchiolitis - Hx/PE
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Hx - low-grade fever rhinorrhea cough apnea - young infants PE - tachypnea wheezing hyperresonance to percussion
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Bronchiolitis - Dx
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CXR - hyperinflation of lungs interstitial infiltrates atelectasis ELISA of nasal washings for RSV - hi sens & spec
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Bronchiolitis - Tx
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Mild - outpt. fluids, nebulizers, O2 if nd admit if - marked resp distress O2 saturation < 95% toxic appearance dehydration/poor oral feeding premie (< 34 wks) < 3 mos. old underlying cardiopulmon dis. unreliable parents inpatients - contact isolation hydration O2 ribavirin RSV prophylaxis - RespiGam or Synagis high-risk pts. in winter
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Otitis Media - What is it Risk Factors
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Middle ear infection MCC - #1 - S. pneumoniae #2 - H. flu #3 - Moraxella catarrhalis kids predisposed - eusta tube risk factors - viral URIs trisomy 21 CF immunodeficiency smoke exposure day-care attendance bottle feeding cleft palate prior otitis media
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Otitis Media - Hx/PE
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Fever ear tugging hearing loss irritability Erythema bulging decreased mobility of tym memb loss of light reflex and bony landmarks tym memb may be perforated
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Otitis Media - Dx
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Clinical
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Otitis Media - Tx
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Amoxicillin - 10 days Tx failure after 3 days - switch to amoxicillin-clavulanic acid, ceftriaxone or cefuroxime
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Otitis Media - Complications
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Mastoiditis meningitis hearing loss cholesteatoma tympanosclerosis chronic suppurative OM
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Kawasaki Disease (Mucocutaneous Lymph Node Syndrome) - What is it
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Multisystem acute vasculitis usually kids < 5 y/o esp. Asian at risk for coronary artery aneurysms => MI
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Kawasaki Disease (Mucocutaneous Lymph Node Syndrome) - Hx/PE
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"CRASH and Burn" Conjunctivitis - b/l Rash Adenopathy - cervical lymph Strawberry tongue Hands and feet - swollen, red, desquamation fever > 40C for > 5 days
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Kawasaki Disease (Mucocutaneous Lymph Node Syndrome) - Dx
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Clinical thrombocytosis - wk 2 or 3 inc. ESR
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Kawasaki Disease (Mucocutaneous Lymph Node Syndrome) - Tx
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High-dose aspirin IVIG - to prevent aneurysms corticosteroids are contraindicated (they may inc. aneurysms)
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FTT - What is it
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Persistent weight below 3rd to 5th percentile or falling off growth curve organic - medical condition nonorganic - psychosocial nonorganic is MC risk factors - chronic illness poverty low maternal age chaotic envi genetic dis. (CF) inborn errors of metabolism HIV
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FTT - Hx/PE
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Low weight for age and height minimal weight gain or weight loss plot on growth chart ck for signs of systemic dis. diet Hx observe caregiver-child interaction
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FTT - Dx
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Calorie count CBC electrolytes Cr albumin total protein sweat chloride test UA/UC stool culture O&P assess bone age
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