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153 Cards in this Set

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causes of child with limp
trauma (MC)
neoplasia
infection
arthritis
synovitis
Child with limp:
0-3 yrs old
4-12 yrs old
>12 yrs old
developmental dysplasia
Legg Calve Perthes
Slipped capital femoral epiphysis
Developmental dysplasia:
physical examination
Dx
Tx
Complications
physical exam -Barlow is most important exam: will dislocate an unstable hip
Dx-U/S best test
Tx- Pavilk harness for 1-2 mths old, surgery, casting
Complications: acetabular dysplasia
where does hip pathology refer pain
too the knee
cause of capital femoral epiphysis
avascular necrosis
who has capital femoral epiphysis
growing child
Legg Calve Perthes presentation
mild intermittent pain in anterior thigh with painless limp, decreased restriction of motion
Legg Calve Perthes Dx
x ray shows compression, collapse and deformity of femoral head
Most common adolescent hip disorder
slipped capital femoral epiphysis
Clinical presentation of slipped capital femoral epiphysis
sudden onset extremem pain; cannot stand or walk
complications of SLipped capital femoral epiphysis
osteonecrosis (avascular necrosis) and chrondrolysis (degeneration of cartilage)
Clinical presentation of transient synovitis
acute pain with limp
pain in groin, anterior thigh and knee
Cause of transient synovitis
viral; 7-14 days after URI
Dx transient synovitis
small effusion
slight increase in ESR
Normal x-rays
What is talipes equinovarus
clubfoot
what is the difference between talipes equinovarous and metatarsus adductus
in talipes equinovarus the patients hell cant go flat on the exam surface as opposed to metatarsus adductus in which the heel can
child cant get heel flat on exam table
talipes equinovarus (clubfoot)
most common cause of intoeing >2 yrs of age
internal femoral torsion
most common of intoeing <2 yrs of age
internal tibial torsion
What is Genu varum
bowleg
What is genu valgum
knock knees
WHat is popliteal cyst (Baker cyst)
distension of bursa by synovial fluid behind knee
Dx of Popliteal cyst
U/S for aspiration
Presentation of Osgood Schlatter Disease
swelling, tenderness, increased prominence of tubercle
Cause of Osgood Schlatter
overuse injury
Dx scoliosis
Adams test: > 20 degree curvature
x-ray
Presentation of Torticollis
twisted neck
head tipped to one side
chin rotates to other side
Cause of Torticollis
in utero positioning
labor trauma
Nursemaid elbow presentation
child refusing to bend his arm at the elbow
What is nursemaid elbow
longitudinal traction causes radial head subluxation
history of pulling on arm
describe x-ray for osteomyelitis
initially normally
changes are not seen until 10-14 days
Causes of osteomyelitis
S. aureus-MC
Neonate-GBS
Pseudomonas-puncture wound
Salmonella-sickle cell
Test for osteomyelitis Dx
blood culture
CBC
ESR
C-reactive protein (CRP)
Organism for septic arthritis
almost all are S aureus
Presentation of osteomyelitis
pain with movement in infants
Dx for osteomyelitis and septic arthritis
1. initial plain film to exclude other causes
2. U/S
3. MRI (best test)
Osteogenesis imperfecta triad
fragile bones
blue sclera
early deafness
most common genetic cause of osteoporosis
osteogenesis imperfecta
osteogenesis imperfecta inheritance
AD
cause of osteogenesis imperfecta
structural defect in type I collagen
Most common malignant bone tumor
osteogenic sarcoma (Ewing sarcoma if younger than 10 yrs old)
compare x ray of osteogenic sarcoma and Ewing sarcoma
osteogenic sarcoma-sunburst
Ewing sarcoma-onion skin
Metastases of Bone tumor
go to bone and lung
Clinical presentation of congenital hypopituitarism
normal size and weight at birth then severe growth failure in first year
Clinical presentation of acquired hypopituitarism
no progression of sexual maturation, amenorrhea
Laboratory evaluation for hypopituitarism
-screen for low serum IGF-1 and IGF binding protein 3
-definitive test: GH stimulation test
Most common type of hyperpituitarism
adenomas secreting corticotropin
Laboratory evaluation for hyperpituitarism
-screen IGF-1 and IGF-BP3 for growth hormone excess; confirm with glucose suppression test
- Need MRI of pituitary
Define precocious puberty
girls sexual development <8
boys sexual development <9
Evaluation of Precocious puberty
-screen- significant increase in LH
-definitive- GnRH stimulation test; if positive order MRI
Clinical presentation of hypothyroidism
-prolonged jaundice
-large tongue
-umbilical hernia
-edema
Most common cause of congenital hypothyroidism
thyroid dysgenesis
Test for osteomyelitis Dx
blood culture
CBC
ESR
C-reactive protein (CRP)
Organism for septic arthritis
almost all are S aureus
Presentation of osteomyelitis
pain with movement in infants
Dx for osteomyelitis and septic arthritis
1. initial plain film to exclude other causes
2. U/S
3. MRI (best test)
Osteogenesis imperfecta triad
fragile bones
blue sclera
early deafness
most common genetic cause of osteoporosis
osteogenesis imperfecta
osteogenesis imperfecta inheritance
AD
cause of osteogenesis imperfecta
structural defect in type I collagen
Most common malignant bone tumor
osteogenic sarcoma (Ewing sarcoma if younger than 10 yrs old)
compare x ray of osteogenic sarcoma and Ewing sarcoma
osteogenic sarcoma-sunburst
Ewing sarcoma-onion skin
Metastases of Bone tumor
go to bone and lung
Clinical presentation of congenital hypopituitarism
normal size and weight at birth then severe growth failure in first year
Clinical presentation of acquired hypopituitarism
no progression of sexual maturation, amenorrhea
Laboratory evaluation for hypopituitarism
-screen for low serum IGF-1 and IGF binding protein 3
-definitive test: GH stimulation test
Most common type of hyperpituitarism
adenomas secreting corticotropin
Laboratory evaluation for hyperpituitarism
-screen IGF-1 and IGF-BP3 for growth hormone excess; confirm with glucose suppression test
- Need MRI of pituitary
Define precocious puberty
girls sexual development <8
boys sexual development <9
Evaluation of Precocious puberty
-screen- significant increase in LH
-definitive- GnRH stimulation test; if positive order MRI
Clinical presentation of hypothyroidism
-prolonged jaundice
-large tongue
-umbilical hernia
-edema
-mental retardation
-anterior and posterior fontanels wide
-mouth open
-hypotonia
Most common cause of congenital hypothyroidism
thyroid dysgenesis
Lab evaluation of hypothyroidism
low T4
increased TSH
First sign of hypothyroidism
deceleration of growth
Most common cause of acquired hypothyroidism
Hashimoto
Which conditions have an increased risk of hypothyroidism
Down
Turner
Klinefelter
Rubella
Describe thyroid in Hashimoto
diffusely increased firm nontender thyroid
describe exopthalmos in Graves disease
infiltration of thyroid and retro orbital tissue with lymphocytes and plasma cells
what is thyroid storm
acute onset of hyperthermia, severe tachycardia, restlessness-> rapid progression to delirium, coma, and death
Lab evaluation of hyperthyroidism
increased T4, T3
decreased TSH
Tx for hyperthyroidism
PTU, methimazole
Beta blockers for acute symptoms
Clinical presentation of hypoparathyroidism
-laryngeal and carpopeal spasm
-seizures (hypocalcemic seizures in newborn think DiGeorge)
Lab evaluation for hypoparathyroidism
decreased serum calcium
increased serum phosphorus
normal or low alk phosp
low 1,25 D3 (calcitriol)
normal Mg
Low PTH
EKG prolongation of QT
Causes of hypoparathyroidism
1. aplasia/hypoplasia- DiGeorge
2. X linked recessive-embryogenesis defect
3. AD- Ca sensing receptor mutation
4. postsurgical
5. autoimmune- polyglandular dz
Tx for hypoparathyroidism
calcium gluconate
calcitriol (1,25 D3)
Tx for Congenital adrenal hyperplasia
hydrocortisone
fludrocortisone (if salt losing)
increased doses of both hydrocortisone and fludrocortisone in times of stress
Most common type of CAH
21- hydroxylase def
Clinical presentation of 21 hydroxylase deficiency
hypoglycemia, hyponatremia, hyperkalemia
-affected females masculinized external genitalia (internal organs normal)
Lab evaluation for CAH
-increased 17 OH progesterone
-low serum sodium and glucose, high potassium, acidosis
-low cortisol, increased androstenedione and testosterone in affected males
-increased renin and decreased aldosterone
-Definitive test: measure 17-OH progesterone before and after IV bolus of ACTH
Most common cause of Cushing syndrome
prolonged exogenous glucocorticoid administration
what is Cushing disease
excess ACTH from pituitary adenoma
Lab evaluation Cushing syndrome
-Dexamethasone-suppression test (single best test)
-Determine cause - CT scan or MRI
Clinical presentation of Cushing syndrome
moon facies, truncal obesity, impaired growth, striae, delayed puberty and amenorrhea, hyperglycemia, osteoporosis

SOAP 'n GO HOME
Causes of type I DM
T cell mediated autoimmune destruction of islet cell, insulin autoantibodies, and glutamic acid decarboxylase
Clinical presentation of Type I DM
polyuria
polydipsia
polyphagia
wt loss
DKA
Tx for DKA in Type I DM
-insulin must be started at beginning of Tx
-rehydration lowers glucose
-sodium is falsely low
Diabetes Diagnostic criteria
1.Symptoms + random glucose >200
2. fasting sugar>126
3. 2 hr oral glucose tolerance test > 200
Most important initial approach for Type II DM
nutritional education-wt loss and increased physical activity
Symptoms for Type II DM
_-excessive wt gain
-fatigue
-glycosuria
-ACANTHOSIS NIGRANs
Clinical presentation for Juvenile rheumatoid arthritis
morning stiffness
easy fatigability
joint pain, joint swelling, warm joints with decreased motion
no redness
Pathophysiology of Juvenile rheumatoid arthritis
vascular endothelial hyperplasia and progressive erosion of articular cartilage
Tx for Juvenile rheumatoid arthritis
NSAIDS (1st line)
methotrexate
sulfasalazine
azathioprine
cyclophosphamide
Types of Juvenile rheumatoid arthritis
-Pauciarticular (fewer than 5 joints)- joints of lower extremity (hip never presenting joint; almost never upper extremities)
-Polyarticular (five or more joints)- rheumatoid nodules on extensor surfaces of elbows and achilles tendon
-systemic onset- arthritis and visceral involvement - hepatosplenomegaly, lymphadenopathy, serositis, iridocyclitis, salmon colored rash
Clinical presentation of SLE
-females
-fever, fatigue, arthralgia, arthritis, rash
Causes of SLE
-autoantibodies against self antigens
-drug induced- especially with anticonvulsants, sulfonamides, antiarrhythmics
Best screen and test for SLE
screen-ANA
test-anti dsDNA
Tx for SLE
NSAIDS if no renal disease
hydroxychloroquine for mild dz
steroids for kidney dz
cyclophosphamide for severe dz
Dx of SLE
"MD Soap 'n Hair"
Malar rash
discoid rash
serositis
oral ulcers
ANA-positive
photosensitivity
neurological d/o
hematologic d/o
arthritis
immune d/o
renal d/o
what should be done to any child suspected of having Kawasaki dz
echo
Platelet lab values with kawasaki
platelets high/normal in week 1, then significant increase in weeks 2-3 to more than a million
Most important Dx for kawasaki
2D echo; repeat at 2-3 wks and if normal at 6-8 wks. Also get ECG, follow platelets
Tx for Kawasaki
acute- IV immunoglobulin
high dose aspirin
what is HSP
IgA mediated vasculitis, usually follows URI
abnormal Labs for HSP
increased IgA, IgM
complications of croup
hypoxia only when obstruction is complete
Dx of Croup
clinical, x-ray not needed (steeple sign)
Tx for Croup
cool and warm mist
nebulized epinephrine
corticosteroids
Signs and symptoms of Croup
URI 1-3 days, then barking cough, hoarseness, inspiratory stridor, worse at night, gradual resolution over one week
cause of croup
parainfluenza
cause of epiglottis
H influ type B
Strep pyogenes
strep pneumonia
Staph aureus
mycoplasma
Tx for Epiglottis
1. intubate (establish patent airway)
2. Antibiotics to cover staph, HiB, and resistant strep (antistaph plus third generation cephalosporin)
Dx of Epiglottis
1. clinical first
2. cherry red swollen epiglottis
3. x-ray not needed (thumb sign)
cause of Bacterial tracheitis
staph aureus
Tx for bacterial tracheitis
antistaph antibiotics; may require intubation if severe
signs and symptoms of bacterial tracheitis
brassy cough, high fever, respiratory distress, but no drooling or dysphagia
cause of acute infectious laryngitis
viruses
signs and symptoms of acute infectious laryngitis
URI with sore throat, cough, hoarseness
Differential dx for acute infectious laryngitis
-diphtheritic croup
-foreign body aspiration
-retropharyngeal abscess
-angioedema
most common foreign body
peanuts
Dx of Airway foreign body
chest x-ray reveal airtrapping
bronchoscopy for definite dx
Tx of airway foreign body
removal by rigid bronchoscopy
signs of acute bronchitis
URI symptoms
dry, hacking cough is persistent, then may be purulent
coarse and fine crackles
Dx of Bronchiolitis
-chest x-ray- hyperinflation with patchy atelectasis
-immunofluorescence of nasopharyngeal swab
Tx for bronchiolitis
-give trial of beta2 agonist nebulization
-no steroids
-ribavirin still controversial
Bronchiolitis prevention
hyperimmune RSV IVIG or monoclonal antibody to RSV F protein in high risk patients only
definition of pneumonia
inflammation of the lung parenchyma
causes of pneumonia
-viruses are predominant cause in infants and children younger than 5 yrs of age (RSV, parainfluenza, influenza, adenovirus)
-nonviral causes are more common in children older than 5 yrs of age (Strep pneumo, M pneumo, C. pneumo)
Tx for inpatient and outpatient pneumonia
inpatient: cefuroxime (if suspect S. aureus, add vancomycin or clindamycin)
outpatient: amoxicillin (best) alternative: cefuroxime
Chlamydia or mycoplasma: erythromycin or other macrolide
MCC of exocrine pancreatic deficiency in children
Cystic fibrosis
pathophysiology of Cystic fibrosis
membranes of CF epithelial cells unable to secrete Cl- in response to cyclic adenosine monophosphate
How does cystic fibrosis manifest
bronchiectasis
large nasal polyps
Clinical presentation of cystic fibrosis
meconium ileus
frequent, bulky, greasy stools, and failure to thrive
acute pancreatitis
fat soluble vitamin def (ADEK)
rectal prolapse
cough, purulent mucus
salty taste of skin
Dx of cystic fibrosis
Sweat test (best)
X-ray- hyperinflation of chest
Tx for cystic fibrosis
1. clear airway secretions and control infections: albuterol/saline, daily dose of human recombinant DNAse (mucolytic)
2. chest physical therapy with postural drainage
3. Antibioitics: most frequent is Pseudomonas (less common H inflluenza, S. aureus, B. cepacis)
Aerosolized antibioitcs -tobramycin
5. Hospitalization: pseudomonas-pipercillin plus tobramycin or ceftazidime
6. Nutrition: pancreatic enzyme replacement and fat soluble vitamins
What is sudden infant death syndrome (SIDS)
sudden death of an infant unexplained by history
Differential diagnosis of SIDS
infections
congenital anomaly
unintentional injury
traumatic child abuse
Pathology findings for SIDS
petechial hemorrhages
pulmonary edema
risk factors for SIDS
low socioeconomic status
AA or native americans
highest at 2-4 mths ; most by 6 mths
more in winter
more in males
Reduce SIDS risk
supine sleeping
no soft surfaces
no bed sharing
Differential Dx of allergic rhinitis
nonallergic inflammatory rhinitis (no IgE antibodies)
vasomotor rhinitis
nasal polyps (think CF)
septal deviation
overuse of topical vasoconstrictors
Differential Dx of eosinophilia
neoplasms
asthma/allergy
addison dz
collagen vascular d/o
parasites
Allergic rhinitis physical exam
-allergic shiners
-transverse nasal crease
-pale nasal mucosa, turbinate hypertrophy
-postnasal drip
Pharm Tx
1st line: Antihistamines
2nd line but most effective -intranasal corticosteroids