Clipp Pediatrics Cases

Front 1

1) Benefits of human breast milk to infants
- any contraindications?

Back 1

- stimulates GI growth and motility
- decreased risk of acute ilness during time infant is fed breast milk
- lower risk of acute illness during time infant is fed breast milk
- lower rates of diarrhea, acute adn recurrent otitis media, and UTI
- associations between duration of BF and a reduction in incidence of obesity, cancer, adult CAD, certain allergic conditions, type 1 DM, and IBD
- Small neurodevelopmental advantages, including cognitive and motor development
- maternal benefits, including decreased risk of breast and ovarian cancer and osteoporosis

- contraindications: HIV, active drug use and infants with galactosemia

Front 2

1) Intrauterine factors affecting growth of fetus

Back 2

maternal factors: poor weight gain in 3rd trimester, poor nutrition, preeclampsia, maternal prescription or illicit drug use, maternal infections, uterine abnormalities, maternal asthma

placental abnormalities: placenta previa, placental abruptions or abnormal umbilical vesel insertions

fetal abnormalities: fetal malformations metabolic disease, chromosomal abnormalities, congenital infections

multiple gestation

Front 3

1) factors that affect maternal-to-fetus HIV transmission and those that play a role in the prevention of vertical HIV transmission

Back 3

- babies born to HIV+ mothers have about 25% change of HIV infection

To increase risk of vertical (mother-to-fetus) HIV transmission:
- frequent, unprotected sex during pregnancy
- amniocentesis
- advanced maternal HIV dz
- breastfeeding
- premature delivery

decreased risk of transmission:
- zidovudine
- C section prior to onset of labor and membrane rupture
- no breastfeeding

Front 4

1) Ballard and APGAR score

Back 4

Ballard: method is helpful if tehre is no early prenatal U/S to help confirm dates, or if the gestational age is in question because of uncertain maternal dates - based on specific neuromuscular signs and physical characteristics

APGAR: appearance, pulse, grimace, activity, respirations
- to detect transition from fetal life to outside of mother life

Front 5

1) What meds are routinely given to newborns?

Back 5

vitamin K, hep B vaccine, erythromycin for eye infection (Chlamydia and gonorrea)

Front 6

1) Common etiologies for SGA. definition of SGA

common problems

Back 6

SGA: less than 10th percentile

- TORCH, fetal alcohol syndrome, tobacco exposure, chromosomal abnormality, vertically acquired to HIV

- common problems: hypoglycemia, hypothermia, hypoxia, polycythemia (due to hypoxia and/or maternal fetal transfusion) --> should have temp and blood glucose monitored closely

Front 7

1) Congenital CMV infection + potential long term complications a/w this condition

Back 7

Infection:

long term complications:
- hearing loss
- microcephaly
- intracranial calcifications
- possible mental retardation and/or cerebral palsy (CP)

Front 8

1) HEEADSSS assessment

Back 8

Home
Education/Employment
Eating disorder screening
Activities/Affiliations/Aspirations
Drugs (and alcohol, tobacco, and steroids)
Sexuality
Suicidal behavior
Safety (abuse, fights, weapons, seatbelts, etc)

Front 9

1) Effect of teratogens: alcohol, tobacco, mj, cocaine

Back 9

- Alcohol: facial abnormalities, growth deficiencies, CNS dysfunction; no safe amt of alcohol that may be consumed

- Tobacco: increase risk for low birth weight. no characteristic facies

- MJ: more than 6x week often have withdrawal like syndrome (high pitched cry and tremulousness)

- Cocaine: vasoconstriction, leading to placental insufficiency and low birth weight; cognitive deficits, attention deficits

Front 10

2) Growth patterns in infants up to 9 mo of age using standard growth charts

Back 10

- Lose no more than 10% birth weight, but regain within 2 weeks of age
- avg weight gain for term infant is 20-30 grams/day
- weight: weight at 4 or 5 mo = double birth weight
- weight at 12 mo: triple birth weight
Length (approx) at 48mo = double birth weight

Front 11

2) nutritional requirements for appropriate growth for infants at ages 2, 6, and 9 mo, including caloric requirements, differences between formula and breast milk, and how and when to add solid foods to diet

Back 11

- until 4-6 mo, only breast milk or formula (no plain water until infant is eating solid foods)
- regular cow's milk not given until 12 mo age due to concern for colitis
- breastfeeding infants need vitamin D supplementation

- transition to solid foods: typically occurs at ages 4-6 mo
- signs child is ready for solid foods: able to sit up and keep head up on his/her own; can manipulate pureed foods like rice cereal in mouth; shows interest in solid foods (does not refuse spoon)
- at 9 mo, can eat toast, crackers, pasta, and banana, meats such as small pieces of chicken.

Front 12

2) developmental milestones

Back 12

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Front 13

2) differential for asymptomatic abdominal mass + evaluation

Back 13

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Front 14

3) Eczema and first line therapy

Back 14

Atopic dermatitis/eczema:
- thickening and inflammationo f skin
- tends to be familial, but with multifactorial inheritance
- often environemntal (allergic) triggers
- anything leading to itching can exacerbate eczema

treatment includes:
- extensive lubrication
- anti-inflammatories in short bursts: topical hydrocortisone adjusted to severity of flareup; newer topical anti-inflammatories such as calcineurin inhibitors are effective though safety concerns uncertain.
- antihistamines such as claritin, zyrtec, or diphenhydramine/hydroxyzine (atarax, vistaril)

Front 15

3) common causes and workup of anemia, first line therapy in iron deficiency anemia

Back 15

you know them already

- oral iron supplementation - many providers provide a trial rather than full workup - elemental iron 2-4 mg/kg dived once or twice daily. Normal Hgb for 6mo - 6yrs is 10.5-14 g/dL

Front 16

4) Factors contributing to childhood obesity

Back 16

- genetic: prader-willi, bardet-biedl, cohen syndrome
- birth hx: high birth wt, maternal diabetes
- family history of diabetes: if one is obese, odds ratio is about 3; if both, odds ratio is >10; before age 3, parental obesity is a strong predictor of obesity in adulthood than child's own weight status
- critical periods of excessive weight gain: infancy (duration and extent of BF); adolescence: normal tendency for insulin resistance; early menarche
- environmental: family/parental dynamics; lack of safe places for physical activity; inconsistent access to healthy food choices; low cognitive stimulation in home; low SES

Front 17

4) typical presentation of ADHD

Back 17

- core symptoms: inattention, hyperactivity, impulsivity

- meds: methylphenidate

Front 18

4) Conditions contributing to child's failure in school

Back 18

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Front 19

4) Initial evaluation of childhood hypertension

Back 19

- most bp elevation in children > 6 yrs of age and in adolescents is due to primary htn
- secondary causes, such as renal parenchymal dz and coarctation of the aorta, are important to consider in young pts who have substantial elevation of bp
-

Front 20

4) Dx of DM2

Back 20

symptoms of DM (polyuria, polydipsia, polyphagia, or weight loss), plus random BG > 200 mg/dL

or

fasting serum glucose > 126 mg/dL

or

2 hour serum glucose > 200 mg/dL during oral glucose tolerance test

Front 21

Creatine risks and benefits:

Back 21

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Front 22

Orthopedic exam:

Back 22

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Front 23

Tanner staging in male:

Back 23

staged 1-5

Stage 3: increased phallus length, testical volume 6-12mL, greater scrotal enlargement, and moderate amt of more curly, pigmented, coarser hair extending laterally

Front 24

differential dx and recognize common causes of benign fainting in healthy adolescent age group

Back 24

dehydration, cardiac causes, seizure, neurologic condition (stroke, AVM, etc)

Front 25

Key historical questions and PE findings that should prompt eval for serious causes of syncope in adolescent age group

Back 25

- ECG = r/o arrythmic causes of syncope (abnormal in greater than 90% of pts with HOCM)
- murmurs: HOCM

Front 26

differential dx for CP in healthy adolescent age group

Back 26

- Precordial catch: most common, sudden sporadic onset of sharp pain on left sternal bordre exacerbated by deep inspiration
- Costochondritis: due to inflammation and typically lasts hours or days
- asthma
- GERD
- cardiac: pain during exercise points to cardiac causes or exercise induced bronchospasm or asthma

Front 27

7) Differential dx of neonatal respiratory distress

Back 27

- transient tachypnea of the newborn (particularly in preterm infants or those who aspirated meconium)
- ARDS, particularly in preterms with underdeveloped lungs

Front 28

7) Effects of maternal diabetes on neonate

Back 28

- Incidence of major malformations is directly related to Hgb A1C level in the first trimester
- Infants born to women with A1C levels >12 have at least 12 fold increase in major malformations
- high levels of maternal serum glucose stimulate fetal pancreatic beta cells and the development of hyperinsulinemia
- high levels in third semester = increased growth of insulin-sensitive organ systems (heart, liver, muscle) and a general increase in fat synthesis and deposition --> produces a LGA infant
- insulin-insensitive organs, such as the brain and the kidneys, are not affected by the elevated insulin levels and have appropriate size for gestational age.

Front 29

7) Managing neonatal hypoglycemia

Back 29

goal: maintain glucose levels between 41-50 mg/dL
Thresholds:
asymptomatic and infants at risk for hypoglycemia: <35
symptomatic <45

milk feeding (formula or breast) raises glucose levels and maintains them at stable level, avoids rebound hypoglycemia associated with glucose water
- monitor glucose levels until levels are stable (>40mg/dL). If not stable after first enteral feeding, initiate IV dextrose
- frequency of monitoring depends on severity; may range from q30min to q3hr

Front 30

7) Factors determining neonate's readiness for discharge

Back 30

Confirm:
Physical examination without major defects
Minimal or no jaundice
No blood group incompatibility
Breastfeeding well every two to four hours
Six or more wet diapers daily
Transition from meconium to seedy, soft, tan-yellow stools
Weight loss < 10%
Car seat available
Good support for mother at home
Back-to-sleep program reviewed
Prescription for Vitamin D completed (for exclusively breastfeeding
infants, recommended 200 IU of vitamin D daily)
Follow-up visit arranged identified primary care physician
Risks of co-bedding (with parent or other children) reviewed:
Infant may be brought into bed for nursing or comforting but should be returned to their own bassinet or crib when parent is ready to return to sleep Infant should not be brought into bed when parent is excessively tired or using medications or substances that could impair his or her alertness.

Front 31

8) Metabolic causes of jaundice in neonate

Back 31

hypothyroidism, hypoglycemia, galactosemia

Front 32

8) Advantages of breastfeeding

Back 32

Infants:
- maternal-infant bonding
- protection against infections (OM, respiratory infections, diarrhea)
- reduced rates of SIDS
- reduced rates of some allergic reactions

Maternal:
- decreased postpartum bleeding and more rapid uterine involution
- lactational amenorrhea and delayed resumption of ovulation (increased child spacing)
- earlier return to pre-pregnant weight
0 improved bone remineralization postpartum with reduction in hip fractures in postmenopausal period
- decreased cost, relative to formula
- ready availability without preparation time

Front 33

8) Common difficulties of breastfeeding

Back 33

- enlarged, tender breasts (commonly caused by engorgement, mastitis, plugged ducts (galactocoele)
- improper latch, suckle
- prolonged feedings
- infants fall asleep before they finish feeding
- maternal inexperience/anxiety

Front 34

8) biliary atresia causing jaundice

Back 34

typically presents later, between 3-6 weeks of age, with progressive jaundice, dark urine, acholic stools. causes a direct hyperbilirubinemia.

Front 35

9) Differential dx of lethargy:

Back 35

V
- hypoxic-ischemic encephalopathy (usually presents shortly after birth; secondary to prenatal or perinatal central nervous system insult)
- polycythemia

I
- sepsis
- botulism

T
- shaken baby syndrome (especially with h/o seizures or irritability)

A
M
- congenital hypothyroidism
- hypoglycemia

I
- down syndrome
- CAH

N
D

Front 36

9) complications of home delivery

Back 36

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Front 37

9) clinical manifestations of congenital hypothyroidism

Back 37

- usually not evident until after 6 weeks of age due to placental transmission of maternal thyroid hormone.
- early signs include feeding problems, decreased activity, constipation, prolonged jaundice, skin mottling, large fontanels, hypotonia, hypothermia, and umbilical hernia
- later signs include large tongue, hoarse cry, and puffy myxedematous facies

Front 38

11) features needed to make dx of kawasaki dz

Back 38

fever and four of the following:
- changes in oral mucosa
- extremity changes (redness/swelling)
- unilateral cervical lymphadenopathy
- rash
- conjunctivitis

Front 39

11) acute management of kawasaki dz

Back 39

- hospitalization for treatment and evaluation of possible complications
- administration of IVIG, only therapy known to reduce risk of coronary artery sequelae
- high-dose aspirin until defervescence
- aspirin used as anti-inflammatory drug that helps shorten the febrile course of the illness (no effect on aneurysm development)
- echocardiography: during acute phase, both to look for presence of coronary aneurysms and to provide a baseline for future comparisons
- aneurysms may be present by the end of the first week, but usually present later, and almost always within four weeks of disease onset

Front 40

11) complications associated with Kawasaki dz

Back 40

coronary aneurysms
reye syndrome from long term aspirin therapy

Front 41

11) common viral exanthems

Back 41

- enterovirus: diffuse erythematous maculopapular rash that may involve palms and soles. In hand-foot-and-mouth dz there is a vesicular rash on hands and feet, and ulcers in the mouth
- measles: initial rash is Koplik spots. After prodrome of cough, coryza, and conjunctivitis, a maculopapular rash starts on neck, behind ears, and along hairline, then spreads downward and reaches feet in two to three days.
- fifth dz: parvovirus B19. frequently a low grade fevr followed by rash appearing 7-10 days later. Rash starts with slapped cheek appearance before traveling to the trunk and has an erythematous macular appearance.
- meningococcemia: initial rash may be urticarial, maculopapular, or petechial. In fulminant cases, can become purpuric, with large hemorrhages into skin
- roseola: macular or maculopapular rash starts on trunk and spreads to arms and neck. rash preceded by 3-4 days of high fevers, which end as rash appears.
- scarlet fever: very fine erythematous, blanching papular rash, often described as sandpaper-like. Starts in groin, axillae, and neck but spreads rapidly. Etiologic agent Group A strep. Treat!
- varicella: starts on trunk and spreads to extremities and head. Each lesion progresses from erythematous macule to papule to vesicle to pustule, and then crusts over. Lesions at various stages of development. self-limited lasting approx one week.

Front 42

11) differential dx for fever and rash

Back 42

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Front 43

11) differential dx for unilateral cervical lymphadenopathy

Back 43

- bacterial cervical adenitis (most commonly staph a and strep pyogenes
- cat scratch dz; axillae most commonly involved, but also cervical, submandibular, and inguinal regions
- reactive node from pharyngeal infection
- kawasaki dz
- mycobacterial infection

Front 44

11) diffuse adenopathy

Back 44

infectious mono, HIV, histoplasmosis, toxoplasmosis, lymphomas, leukemia, histiocytosis, metastatic neuroblastoma, and rhabdomyosarcoma
- measles also presents with generalized lymphadenopathy and splenomegaly that may last several weeks

Front 45

11) palmar rash

Back 45

Kawasaki, Cocksackie A, Rickettsia, Syphilis

Front 46

11) Strawberry tongue:

Back 46

streptococcal pharyngitis and Kawasaki

Front 47

12) differential for acute cough in 9-12 mo infant

Back 47

URI, asthma, bronchiolitis, pneumonia, foreign body aspiration, GERD?

Front 48

12) history needed in evaluating cough

Back 48

- pt drinking fluids? - assess degree of difficulty breathing and dysphagia
- fever?
- cough begin suddenly? appear to choke on anything? aspiration
- patient's voice or cry been hoarse? - distinguish whether upper or lower airway problem - problems isolated to lower airway typically do not affect voice or cry
- cough been barky? - would suggest dx of croup
- pt make any noises when she/he breathes? -wheezing typically expiratory; stridor more typically inspiratory (incdicating blockage in throat or larynx)

Front 49

12) 3 causes of cough considered in unimmunized/partially immunized

Back 49

pertussis, diphtheria, epiglottitis

Front 50

12) Signs of respiratory distress in infants

Back 50

- paradoxical breathing: indicates respiratory muscle fatigue, an ominous sign
- tachypnea
- grunting: forced epiration against partially closed epiglottis. suggests dz of air space such as atelectasis, PNA, or pulmonary edema
- nasal flaring
- head bobbing: best observed during sleep
- subcostal/intercostal retractions

Front 51

12) Findings on auscultation

Back 51

- stridor: due to airway narrowing above thoracic inlet, usually heard with inspiration, but may be biphasic if obstruction is severe
- wheezing: airway narrowing below thoracic inlet, usually heard only in expiration, but may become biphasic; polyphonic or monophonic
- rhonchi: due to secretions and airway narrowing, coarse, low-pitched rattling sounds, heard best in expiration
- crackles: due to fluid in alveoli or opening/closing of stiff alveoli, heard on inspiration, described as either coarse or fine
- bronchial breath sounds: lower in pitch and hollow sounding, caused by air moving through areas of consolidated lung

Front 52

13) differential dx for chronic cough

Back 52

asthma, bronchitis, SINUSITIS, allergies, habitual cough, atypical PNA, GERD

Front 53

13) atopic diathesis and relationship to allergies and asthma

Back 53

allergies, eczema, asthma

Front 54

13) relevant workup for patient suspected of having asthma

Back 54

spirometry: reversible obstruction
CXR: mild hyperinflation, interstitial streaks

Front 55

13) TST thresholds for positive TB identification

Back 55

>5mm for high risk (HIV, immunocompromised)
>10mm for moderate risk (immigrants, homeless, prison)
>15mm for low risk

Front 56

13) normal inspiratory ratio; meaning of increased or decreased ratio

Back 56

normally: 1:2
obstructive (asthma or CF): 1:3 or 1:4
restrictive (uncommon): 1:1

Front 57

14) Mnemonic for describing ear findings

Back 57

COMPT

Color (red, amber, blue, white, gray or yellow)
Other (bubbles, scarring, perforation)
Mobility (absent, reduced, normal or hypermobile)
Position (normal, retracted or bulging)
Transparency (opaque or translucent)

Front 58

14) Differential dx of congestion

Back 58

- URI
- AOM: typically develops 3-5d after onset of URI. sx include fever/otalgia
- OME: (otitis media with effusion) - fluid in middle ear without signs or sx of infection. May occur alone, secondary to URI or consequence of AOM
- Sinusitis: superinfection of pathogenic bacteria following viral URI. Persistent URI sx (>10d) with day and night cough are typical in pediatric cases.
- PNA: bacterial PNA (much less common than viral) signaled by abrupt onset high fever, productive cough, and chest pain. May see dyspnea and tachypnea. Viral PNA commonly with moderate fever, nonproductive cough.
- Allergic rhinitis: may be seasonal or perennial depending on type of environmental allergen. Not likely if fever is present.

Front 59

14) Management of cough and congestion in infant or young child

Back 59

OTC cough and cold products should NOT be used for infants and children under 2 yrs due to lack of demonstrated benefit and prevalence of reported adverse events, including fatal overdoses.

Front 60

14) Tx recommendation for AOM

Back 60

*note that AOM resolves spontaneously 50-80% of the time

take picture!

Front 61

14) Treatment for AOM

Back 61

high dose amoxicillin (first line)

augmentin (amox/clav) second line - greater efficacy in treating nontypeable H.influenzae, which is increasing in prevalence --> if dz is severe, may go straight to augmentin

Front 62

14) Tx for OME

Back 62

- if mild hearing loss but no language concern, "watchful waiting" for another 3-6mo with f/u hearing test is an option
- If persistent OME, especially with associated language delay, referral for tympanostomy tube placement would be optimal

Front 63

15) treatment for inpatient oral dehydration

Back 63

mild-moderate (5-9%)
- 50-100 mL/kg of oral rehydration solution (ORS) over 2-4 hours
- give 10ml/kg ORS for each additional diarrheal stool and 2 mL/kg ORS for each additional emesis

moderate-severe (10-15%)
- 20mL/kg IV fluid bolus
- repeat bolus after re-evaluation until patient is clinically improved (awake, alert, well-perfused, interested in and tolerating fluids, urine output present)
- often 60-100mL/kg total of bolus fluids are required with repeated evaluation
- depending on clinical situation, rehydration can be completed with ORS or with IV fluids at rapid rate

oral rehydration solutions: naturalyte, pediatric electrolyte, pedialyte, infalyte, rehydralyte

Front 64

15) differential dx of vomiting

Back 64

- viral gastroenteritis
- pyloric stenosis
- UTI
- malrotation with/without volvulus
- GERD
- inborn error of metabolism
- CNS disease (hydrocephalus, intracranial neoplasm, and trauma), particularly in absence of fever/diarrhea
- Intussusception: typicaly with bilious emesis and crampy/severe abdoinal pain. currant jely stools. "sausage-like" mass due to telescoped bowel may be palpated on abdominal exam.

Less likely
- milk allergy (with rash/loose stools)
- CF
- Overfeeding
- IBD
- Food poisoning - usually short lived

Front 65

16) Physical Exam dehydration correlations

Back 65

neurologic status, pulse, buccal mucosa/lips, eyes, tears if crying, urine output, fontanel if patent, skin touch and skin turgor, capillary refill

Front 66

16) 3 types of dehydration and appropriate rehydration method for each

Back 66

1) isotonic/isonatremic
2) hypotonic/hyponatremic
3) hypertonic/hypernatremic

Front 67

16) common signs/sx of DM1 and DKA

Back 67

polyuria, polydipsia, unexplained weight loss

Front 68

16) Differential dx of abdominal pain/vomiting

Back 68

- appendicitis
- increased ICP
- toxic ingestion
- DKA
- GI obstruction
- Gastroenteritis
- Pyelonephritis
- bacterial PNA

Front 69

17) Differential dx of painful limp in pediatric patient

Back 69

- transient synovitis of the hip: acute, self-limited inflammation of synovial lining of hip often following/coinciding with URI
- septic arthritis: infection of joint space, usually bacterial in origin. typically appear quite ill. emergency! can cause irreversible damage to cartilage; bacteria on gram stain
- reactive arthritis: inflammatory process that typically follows infection outside joint - most often GU or GI- presenting 2-4 weeks post-infection; classic a/w urethritis and conjunctivitis uncommon in children; clinically indistinguishable from septic joint other than negative cx (but with inflammatory cells)
- trauma
- osteomyelitis: infection of bone, usually bacterial in origin; usually indolent; high fever in half of patients
- leukemia: replacement of bone marrow by leukemic cells can cause bone pain

Front 70

17) Presentation, w/u, and tx of transient synovitis and septic arthritis of hip

Back 70

- treat with rest and ibuprofen
- pain resolves within 3-10d
- instruct parents to call if child develop high fever, becomes increasingly irritable or uncomfortable in spite of ibuprofen, or if develops redness, swelling, or warmth of the joint
- schedule close f/u

Front 71

17) differentiating septic arthritis from transient synovitis

Back 71

first four independent predictors of septic arthritis: fever, non-weightbearing, ESR >40, WBC >12

second five independent predictors:
above + elevated CRP

Front 72

18) Recognition of CHF in infant

Back 72

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Front 73

18) pathophys of VSD

Back 73

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Front 74

18) management of CHF in infant

Back 74

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Front 75

18) Differential dx of poor weight gain and difficulty with feedings

Back 75

- CHF
- Bronchiolitis
- PNA
- GERD
- metabolic disorder

cardiac, respiratory, GI, metabolic!

Front 76

20) Key features in h/o child with headaches

Back 76

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Front 77

20) Differential dx of HA in children

Back 77

First network:
- migraine
- tension headache
- stress reaction
- braintumor
- sinusitis

Second network:
- brain tumor
- toxin
- basilar artery migraine

Front 78

20) Differential dx of ataxia in children

Back 78

- post-infectious cerebellitis: (autoimmune response to viral illness such as varicella or cocksackie virus), causes cerebellar demyelination
- infectious cerebellitis: may be bacterial or viral in origin
- medication or toxin: alcohol, antihistamines, or anti-convulsants, may be accompanied by nystagmus and dysmetria
- intracranial mass: most often tumors in cerebellum or frontal lobe
- opsoclonus-myoclonus syndrome: paraneoplastic syndrome that occurs most often with neuroblastoma; ataxia accompanied by intermittent jerking movements and erratic, jerky, conjugate movements of the eyes
- migraine headache: particularly basilar artery or hemiplegic migraines (intermittent loss of vision, change in speech, HA, vomiting)
- hydrocephalus: increasing loss of coordination over weeks to months
- metabolic dz
- neurodegenerative dz: ataxia telangiectasia/Friedrich's ataxia (loss of developmental milestones and other neuro sx)
- psychiatric illness: conversion reaction can manifest as a hysterical involuntary gait disturbance

Front 79

20) signs and sx of increased ICP

Back 79

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Front 80

20) Sx of brain tumors: infratentorial, cerebellar, supratentorial

Back 80

- Infratentorial: usually present with cerebellar signs and
signs of increased ICP

- Cerebellar hemispheric lesions: may see changes in muscle tone and deep tendon reflexes; more often find hypotonia and hyporeflexia

- Supratentorial lesions: focal motor and sensory abnormalities on side opposite of lesions

- brain stem lesion: often associated with cranial nerve and gaze palsies

Front 81

20) Characteristics of tension vs migraine headache

Back 81

Tension: episodic, worsening throughout day, feels like band around head or involve occipital area with tenderness of posterior muscles of the neck
- occur in setting of emotional stress, fatigue, lack of sleep, and other stressors

Migraine headache: photophobia, phonophobia, abdominal pain, N/V
- precipitating factors: stress, bright lights, odors, and foods

types:
classic: accompanied by aura (visual sx, speech changes, or other sensory abnormalities)
- common: no aura, frequently unilateral (frontal or temporal)
- basilar artery: uncommon migraine variant a/w bilateral visual changes, paresthesias, and AMS
- migraine variants (seen exclusively in peds age group): cyclical vomiting, abdominal migraines, and benign paroxysmal vertigo

Front 82

21) Differential for petechiae and purpura in school-aged child

Back 82

- HSP
- ITP
- Leukemia
- Sepsis
- SLE
- Coagulation disorder

(CHILSS mnemonic)

mechanisms include: trauma, platelet deficiency or dysfunction, coag abnormalities, vascular fragility (immune mediated vasculitis)

Front 83

21) Typical clinical features of ITP, ALL, and intussusception

Back 83

ITP: asymptomatic petechiae and bruising, sometimes with severe epistaxis or other mucous memrane hemorrhage; rarely intracranial hemorrhage

Intussusception:

Front 84

21) normal and abnl findings on exam of lymph nodes, liver, and spleen

Back 84

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Front 85

21) Compare and contrast features of accidental vs. non-accidental bruising

Back 85

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Front 86

21) Compare and contrast typical CBC results in HSP, ITP, and ALL

Back 86

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Front 87

21) HSP typical signs and sx

Back 87

- nonthrombocytopenic petechiae and purpura
- hematuria
- arthritis, mainly of knees and ankles
- colicky abdominal pain

Front 88

26) Categorization of FTT

Back 88

Organic: chronic diarrhea, formula allergy, congenital heart defects, CF, developmental delay with poor suck and swallow, renal tubular acidosis, vomiting caused by GERD or bowel obstruction

Non-organic FTT (90% of cases): poverty, poor understanding of feeding techniques, improperly prepared formula, inadequate supply of breast milk, neglect of infant, psychological basis of non-organic FTT

Front 89

26) Formula allergy clinical manifestations

Back 89

intestinal blood loss (gross or occult). Infants are usually fussy and may vomit. Poor weight gain as an isolated finding is unusual

Front 90

26) Nutritional management of CF

Back 90

- more calories
- vitamins
- pancreatic enzymes