Pediatric Board Review 2011

staph epi, staph aureus

lowest serum levels of any Ab, factor in allergic conditions (atopy, asthma, allergic rhinitis, food allergies)

0.5 cm ender noduls on the palms, fingertips and soles (OUCHlers nodes)

fried rice

frozen foods (esp chicken), milk, eggs, baby chicks and reptiles

progressive psych sxs x6 mo --> neuro sxs (ataxia) --> death, look for exposure in England

remove before puberty 2/2 malignant transformation (basal cell carcinoma)

stepping on a nail, esp if through a tennis shoe

Klippel-Trenaunay - progressive soft tissue and/or limb overgrowth

anion gap, met acidosis, also: low BG, K, ferric chloride + salicylate turns urine purple or brown

recurrent GN inf, esp neisseria meningitis, bec C5-9 make an attach complex that drills a hole in bacterial cell walls

check for eye and skin lesions, HSM, signs of thrombophlebitis

plaques - topical steroids and creams (vit D, tar, retinoid) + UVB light, acitretin if severe, TNA-alpha inh in severe (black box warning for cancer)

intralesional/topical steroids, *methotrexate, occasionally antimalarials

rickets, anemia, iodine def, malnutrition

CSF Ag test, or India ink test (large halo - looks like a bubble)

baby has a 99% chance of surviving 1 wk

38

protease inhibitors

50%, 1/3 AV canal (often no murmur), 1/3 VSD, 1/3 ASDs + Tet

structural birth defect or congenital malformation

15 mo

MC hereditary

abnl exam, 4-fold greater VDRL/RPR than Mom or + treponemal (FTA-AB, dark field microscopy)

leptospirosis

klebsiella granulomatis

htn and proteinuria

subluxation of the radial head

none for most (levels normalize by 3-4 yo.), but some may need IVIG

toxo, CMV

Asperger's - nl lang and IQ

2 yrs

bulls eye or central clearing; lyme dz

bili dec by 4-5

full thickness

DOL1 - contact from the ppx; DOL2-7 gonorrhea, DOL7-14 chlamydia

molluscum, seborrheic dermatitis, tinea, psoriasis, folliculitis, hairy leukoplakia, herpes, oral or vaginal candidiasis

Tdap, HPV, meningococcal

schizonts in the blood, no banana gametes (p. falciparum)

invasive-type bacterial etio (shigella, salmonella, campylobacter, yersinia, amebic) or IBD

LE, urine micro with >10 WBC/HPF, gram stain, if negative --> specific test for GC and CT

flucon x1, tons of intravaginal agents (only use topical agents for pregnant women)

mitochondrial

DTap/Tdap

acute strep pharyngitis + fine, diffuse, sandpapery red rash - 1-2D after sore throat, starts in the neck and upper chest and spreads, esp in elbow - Pastia lines (red lines), pallor around the mouth, rash fades with desquamation in 1 wk

when some cells in F have an active X from Mom and some cells have an active X from Dad

hand (except if superficial), extensive inf, bites involving deeper tissue (tendon, bone…), ones causing extensive disfigurment, bites on the head in young kids (easy to underestimate the severity of the injury)

<6 y.o., fever at onset of dz, descending (proximal --> distal) flaccid paralysis without reflexes that reaches full extent within 4D

extramedullary hematopoiesis

strep pneumo sepsis bc of splenectomy

Common causes of asplenia are splenectomy following trauma to the spleen, and autosplenectomy caused by sickle cell anemia. Ten percent of patients with Coeliac disease also present with splenic atrophy with subsequent Howell-Jolly bodies. Other causes are radiation therapy involving the spleen, such as that used to treat Hodgkin lymphoma. Howell-Jolly bodies are also seen in: severe hemolytic anemia, megaloblastic anemia, hereditary spherocytosis, and myelodysplastic syndrome (

X-linked recessive

4 mo

Tzank - multinucleated giant cells, Ab-testing, PCR

phagocyte killing defect

pre-discharge bili in a high-risk zone, jaundice in 1st 24h, immune-mediated hemolysis, 35-36 wks, sib who required phototx, cephalohematoma, sign bruising, exclusively breastfed, East Asian or Greek

vibrios, noro (clams, oysters)

>2 accelerations of fetal HR in 20 min

linear fx of the parietal

bacteria, fungi, parasites, mycobacteria - mostly extracellular organisms

depends on location: travels from duodenum --> muscle (pain --> calcifications) --> heart (myocarditis), eye (irritation, periorbital edema)

5-7 days

persistent inconsolable crying for >3 hrs within 48h

grafting or healing from the edges if small

p. malariae (m and n are next to each other in the alphabet)

is not

2/7 of; >5 café-au-lait spots >0.5 cm pre-pubertal or >1.5 post-pubertal; 1 plexiform or >1 neurofibroma; axillary or inguinal freckling; optic glioma; >1 Lisch nodules (iris hamartomas), sphenoid abnl, 1st degree relative

repetitive stress injury to the patellar tendon as it inserts in the tibial tubercle

migratory red patches, asymptomatic and benign

Wisconsin and Arkansas (kids at UWis Madison had a blast in college); hunters and loggers (beavers are the Wisconsin mascot)

*deep palmar and sole creases, long face, high forehead, thick everted long lip, bone, joint and renal malformations

BCG, MMR, varicella, nasal flu, oral polio, smallpox

cooing (random --> interactive)

CO concentration bec pulse ox may be falsely nl

PCN

abrupt onset of fever, dysphasia, drooling, look like they're trying to die, 2-7 y.o.

something present at birth

10% Ca gluconate at 2 cc/kg over 5 min, need cardiac monitoring during the infusion

low K, Mg and renal tubular acidosis; hypotension with 1st dose (2/2 peripheral vasodilation)

aut dom, aut rec

either congenital heart block OR skin findings - raccoon eyes (periorbital erythema), round or annular red plaques MC on head

1 (1x8=8)

13 yrs

sensorineural

petechial or pustular rash, asymmetric arthralgias, tenosynovitis, frank septic arthritis, fevers/chills, + blood cx, + synovial cx, perihepatitis (Fitz-Hugh-Curtis) - RUQ pain, meningitis, endocarditis

swimming in a brackish water (salinity bet salt and fresh water)

CT, HBsAg, hep C, HIV, GC, pap smear (if not done within the last yr), rubella, syphilis (not trich)

cx or serology

cryptosporidium, from contaminated water

she has RFs and she's unlikely to return for her test results

CT, GC, E. coli (if young or engaging in anal sex)

macrocephaly, LGA, prominent forehead, hypertelorism, MR, large hands/feet

white macule with central telangiectasia or red macule --> few days later it rapidly elevates and enlarges, can be red and superficial or blue and deep

not

4 yrs

inc risk of neural tube defects, if exposure is between 14-30D

phagocyte killing defect

1, 2

IgG-mediated, cytotoxic

Ab testing (99% sensitive, 90% specific), if +, confirm with Western blot (confirms viral proteins)

tall, gynectomastia, delayed puberty, azoospermia, small testes, infertility

5 lbs/yr

absence of anterior abd wall musculature

usually need surgery

*periventricular calcifications, LBW, MR, microcephaly, hearing loss that can develop during the neonatal period

testing for G6PD

local asymptomatic pleural effusion (low glu, high prot) - AFB is usually neg but get a pleural bx to inc yield

mild - loperamide + cipro x1 dose; severe - use cipro BID x3D

middle to lateral portion

IUGR, placental insufficiency, placental abruption or previa, if <20 wks - inc risk of miscarriage

the area of induration (not erythema)

pen G; ceftriaxone

wide range, can include meningitis, renal or hepatic failure (with disproportionately high bili) with hemorrhage (Weil syndrome)

0.2-0.4 kg/day to avoid refeeding syndrome and heart failure

chorio, x48h until cx neg

winter and spring

early childhood refractive errors, strabismus, cataracts, corneal opacities

6 mo

bacterial vaginosis

4, 6

observed expression of a genotype

antifreeze, radiator fluids, and it tastes sweet

myoclonus and severe dementia, die within 5 mo

cannot

von Hippel Lindau

33-37

2.5, 3, 3.5

99

usually induce if >34 wks, 32-33 wks - amnio to test for pulm maturity or bed rest with steroids and abx, <28 wks - tocolysis and steroids

MRSE

does not cover serotype B which causes 30% of dz (B for Bad)

5 yrs (nl before then)

strep pneumo

summer; year-round if warm, not during winter if there's snow; spring; fall

abd distention, bilious vomiting, no mec >24h, *abd feels doughy (bec loops are filled with mec and not air)

total absence of thymus, so they act like SCIDS (bec T cells activate B cells)

ASA for Reyes syndrome, and motrin bec it inc the risk of strep pyogenes inf

functional asplenics (hemoglobinopathies), HIV, nephrotics, bad heart/lung dz

drunk --> resp prob --> cardiac failure, szs, cerebral edema, renal failure, death

likely extension from OM - strep pneumo, H flu, staph aureus, GN

trichomonas vaginalis

DTaP, hep B, HIB, IPV, pneumococcal, rota

partial albinism, white forelock, cochlear deafness, premature graying, hypertelorism, heterochromia of the iris, cleft lip/palate, +/- absent vagina, Hirschsprung

von Hippel Lindau

<4 cm (equivalent to tanner 1 female)

*prenatal care after 1st trimester, teenager moms, >40 with no high school education, underlying chronic dz, smokers

*delayed umbilical cord separation, necrotizing inf at sites where the body interacts with the envi (skin, lungs, GI) --> leaves cigarette paper scarring

1 hypersensitivity and involve IgE

Appearance (color) - blue / acrocyanosis / pink; Pulse - <60 / 60-100 / >100; Grimace (when catheter placed in nose) - nothing / grimace / cough sneeze cry; Activity - limp / some flexion / active; Respiration - absent / slow, irregular / good cry

more, the protein means in breastmilk is more quickly digested

Tdap, a smaller amt of pertussis Ag

aut rec

community-acquired PNA in >5 y.o., causes a lot bronchospasms

chloroquine + primaquine (adjuvant to eradicate hypnozoites in the liver which are responsible for relapse, after r/u G6PD)

child wakes up in a room with a bat, bite or mucous membrane contamination

7 mo

acute bacterial endocarditis, rare in kids

teens or 20s with recurrent sinopulm inf with encapsulated bacteria, noncaseating granulomas (spleen, liver, lungs, skin), giardia

conditions that can be transmitted from parent to child

exclusively breastfed M <38 wks who was discharge <72h

blood that doesn't cross sutures lines

zinc or tar shampoo, low-potency topical steroid + concurrent topical antifungal cream

3 y.o., annually

aut dom, aut rec (not X-linked and mito)

Ig Abs bind to tissue Ag or cell receptors (auto-Abs) --> cell destruction (via opsonization, MAC)

32

soap and water daily, leave blisters intact, abx ointment, change dressings qDay, Td if needed, re-eval q2-3D bec burn may progress

IVF (LR) - 4 mg/kg/% total burned surface area (50% in first 8h, 50% in next 16h) + maintenance, add dextrose if <5 y.o. to prevent hypoglycemia, consider referring to burn center

14 mo

benign mass that comes out of the floor of the mouth

12 mo

persistence or enlargement over 3 menstrual cycles --> aspirated

Carolinas, Georgia, Virginia (Missouri, Oklahoma and TX)

high fevers, hot tube users

when the placenta penetrates the scars in placental accreta

2 y.o., 15-19 y.o.

flagyl oral x7D, intravaginal x5D, clinda intravaginal x7D, if pregnant - only oral

AGE sxs (N/V, abd pain, diarrhea) --> 1 wk later coughing, SOB, ARDS; suspect with severe hemorrhagic PNA, low plts, high H&H

EBV can tirgger an accelerated phase --> organ infiltration and pancytopenia

occur whenever, acute rapid fall in fetal HR and a variable recovery

2/2 occipital bone separation --> brain damage and hemorrhage, bad prognosis

3-word sentences, talks in short paragraphs, 75% intelligible, ues plurals, pronouns and prepositions

acrodermatitis enteropathic

larger (2x)

fall onto an outstretched hand

azithro 1g x1

high risk of liquid tumors (ATM gene affected repairs DNA/causes apoptosis)

1 yrs, 8 yrs, early adulthood

slapped cheeks, lacy pruritic rash (comes out more after the sun or a warm bath), most aren't ill

Mom (babies doesn't synthesize their own BG)

1 - 20 min after injury, 2 - after 1 wk of no sxs (so min 1 wk), 3 - min 1 mo, after 1 wk of no sxs

congenital malformations (25%)

benadryl

cannot

*renal dysgenesis, oligo, skull ossification defects, when exposure is in the 2nd and 3rd trimesters

most systemic fungal inf

should

windshield washer fluid, anti-freeze, picnic stove fuel, canned heat

pasturella, staph aureus, DF-2

kids with symptoms or visible burns in the mouth

viral load bec shortly after inf each person's HIV equilibrates to a certain set-point (viremia of 100-1,000,000)

anemia --> inc erythropoiesis --> depletes the hematopoietic stem cells --> low plts, WBCs and RBCs

doxy (for all ricketssial inf)

IUGR, microcephaly, hirsuitism, heart dz, synophrys, long eyelashes, thin upper lip, downturned mouth, , syndactyly, micromelia (small hands/feet), thalidomide-looking arms/legs

thumb/great toe

uses past tense, 4-5 word sentences, short paragraphs, able to tell a story

sublingual dilation of a salivary gland

all asymptomatic sexually active girls for chlamydia +/- gonorrhea, +/- UA for LE in both girls and boys

3 yrs

DTap/Tdap + TIG (tetanus immunoglobulin)

3 yrs

tummy time when awake, helmet x22h/day (start <6 mo)

SSRIs are more effective than TCAs

chronic liver dz, IC

parents are concerned, speech delay, h/o bacterial meningitis, neonatal TORCH inf, h/o sign head trauma (esp temporal bone), syndrome ass with hearing loss, neurodegenerative dz, head and neck anatomic malformations, +FHx, confirmed measles or mumps, ototoxic meds (ex. amnioglycosides)

not starting ppx early enough before leaving or stopping it too quickly after returning

many small, scaly papules and plaques on the face, trunk and proximal extremities

trich

bradycardia, U-waves (b4 T wave) 2/2 hypoK, low-voltage, ST depression with exercise and prolonged T intervals are ass with inc risk of vtach

basal cell carcinoma early in childhood, *develop other ca - ovarian, medulloblastoma, dysmorphic facies, skeletal defects, MR, jaw cysts (gory with all the scars from their cancers)

3 yrs

1-2D prior to rash until all lesions are crusted over

if displaced - eval for damage to the brachial artery, median and radial nerves (high risk of compl)

cutaneous - painless papule --> vesicles --> ulcer --> black eschar, with painless non-pitting edema and induration; GI; pulm ("wool sorter's dz")

3-5 days

ODD <6 mo, conduct >6 mo

REM

type 4 hypersensitivity rnx (T cells)

either spontaneous mutation or germline mosacism

<33

culture, IgG (use for presumed false neg), PCR only for CNS inf, Tzanck preparation (only on the boards - low sens & spec) - multi-nucleated giant cells

PPHN

ataxia (by 5 yo) --> oculocutaneous telangiectasia (by 5 yo), high A1AT, sinopulm dz (B/T cell dysfunc)

2nd gen cephalosporin (cefoxitin, cefotetan) IV + doxy, for 24h after pt has improved and then 14D of doxy

18 mo

babies, bad eczema, CLD, diarrhea, FTT, no thymic shadow on CXR, lymphopenic

adenopathy (starts post-auricular), rash (egg over your head, macular), low-grade fever, red spots on the palate (Forchheimer spots)

augmentin, if PCN-allergic - clinda + bactrim

a recognizable pattern of structural defects, often with a predictable natural hx, that can be identified amongst several pts

>40 wks, AA, exclusive bottle feeding

hearing loss

sweat glands are blocked --> sweat escapes just under the skin surface

appear bet 3-4 mo of life, papules, pustule, and open and closed comodomes, lasts for 6-12 mo

methemoglobinemia (it’s idiosyncratic and not dose related)

material hyperglycemia --> fetal hyperglycemia --> inc B-cell stimulation --> hyperinsulinemia

bag of worms, L-sided (L renal vein has a more torturous course), inc with valsalva

diphtheroids (GPR)

neurotoxin

3 yrs

peak is absent (straight line), low max compliance, negative middle ear pressure

10%, <0.5%, because it's MC X-linked

refer to a hand surgeon 2/2 high risk of inf

Mississippi and Ohio River valleys

birth trauma

18 mo (double nl)

nl, and can persist into adulthood

GI (0-6h) - N/V, diarrhea, abd pain, hematemesis and bloody diarrhea --> stability (6-24h) --> systemic shock (24-48h) - anion gap ---> hepatoxicity (2-3D) - hepatic failure, coagulopathy --> GI/pyloric scarring (2-6 wks)

infected blood, resp droplets, urine, and transplancentally

fetal HR, fetal movement, uterine activity

rashes, HSM, OM, FTT, abd pain, recurrent pharyngitis

all chromosomes except X and Y

not wake the pt which prolongs the episode, or pre-emptively wake the pt up if they always happen at the same time of night

exchange transfusion, phototherapy 12h/day, liver tx

germline mosaicism

when the placenta burrows into the uterine endometrium 2/2 previous trauma (ex. curettage, myomectomy, C-section)

5 yrs

>60 mg/kg

chloroquine + primaquine (adjuvant to eradicate hypnozoites in the liver which are responsible for relapse, after r/u G6PD)

giant pronormoblasts in the BM

is not, and may indicate a viral PNA

RICE - rest, ice (20 min 2h x48h), compression, elevation

<30 wks, BW <1200, high O2 use

type 3 hypersensitivity rxn - Ag-Ab deposition --> activates the complement system

listeria

staph aureus

DTaP, IPV, MMR, varicella

high plasma hgb interferes with insulin func --> hyperinsulinemic

inc risk of spontaneous abortion, stillbirth, prematurity, congenital heart block

budding yeast and pseudoyphae on KOH, pH <4.5

diffuse, scaling papules on the palms and soles, penis and mucosa

lower (bec nl airflow goes to the lower lungs)

oto and nephrotoxicity

all 11-12 y.o., also: asplenics (including Hgb SS), terminal complement def, properdin def at 2 y.o.

cardiac (aoritis), ophthalmic (iritis), auditory (deafness), gumma (necrotic center)

midline gap between abd rectus muscles most noticeable with crying, usually closes after the 1st year of life

well-defined round or oval or target lesions, often involves palms and soles and can involve mucous membranes, individual lesions don’t move around and are often on the extensor surfaces

>2 y.o. and no asthma, allergy to eggs, dz that ↑ risk of flu

conditions that give them a high exposure to latex, ex. spina bifida, congenital urologic problems

coarse facies, macroglossia, ear lobe creases, posterior auricular pits, oomphalocele, Wilms tumor cryptorchidism, hemihypertrophy

domed first molars, congenital syphilis

high A1AT, abnl QUIGs

rectal prolapse (5%), szs

1-1.5

18 mo

cidal

<5 mo old, pearly white plaques that have pinpoint bleeding when removed

3 yrs

ingesting infected cat eggs - so by changing litter boxes, eating raw/undercooked meat, wear gloves when gardening (cats poop in soil)

when a T cell interacts with an Ag causing an infl rxn

NTD (don't dec fertility)

superficial - red skin

pt-applied: podofilox, imiquimod, MD-applied - cryotherapy, podophyllin, TCA, BCA surgical removal, pregnancy - can only use cryo, TCA or BCA

1-2 wks of life – before levels are high enough to damage to cause damage

2 yrs

small risk of melanoma with small and medium ones, post-pubertal; 10% lifetime risk with large ones and it's usually in the first few yrs of life

is safe

acidic

3-4, 3-4

hyperextensible, dystrophic scarring (shiny), feels like "fine sponge," fragile - splits & looks like a gaping "fish mouth," extra skin on hands, feet and stomach, wrinkled palms/soles

3-4 mo

Down syndrome

brachycephaly, proptosis, syndactyly, broad thumbs, fused digits

acidic

café-au-lait spots, precocious puberty, bony fibrous dysplasia

10% have Y chromosomal material in all or some cells (inc risk for gonadoblastoma)

M>F

HIV DNA PCR, 3 tests over 4 mo

(+) cover/uncover test (strabismus), or acuity <20/40 in either eye, >1 line difference between R and L eyes

no abx because it increases the risk for HUS

fat redistribution, lipid abnl (inc TG and chol - don't treat with statins), new-onset DM

eczema, scoliosis, hyperextensibility, teeth prob, fxs, recurrent abscesses, facies - broad nose, prominent forehead, triangular jaw, IgE 2-10K

is for a test, probability of dz in a pt with a + test, =TP /(TP + FP)

BMT, splenectomy if no match for BMT

high

1 kg - 7 cm, 2 kg - 8 cm, 3 kg - 9 cm, 4 kg - 10 cm

HIV DNR by PCR

aut dom

of an genetic abnl and neurologic involvement

vanc (only choice for the boards although linezolid works)

teatracycline, aminoglycosides, chloramphenical, sulfa

irritant dermatitis caused by maceration and friction

15 mo

*most severe form, lethal during neonatal period 2/2 resp insufficiency, bones are soft, limbs are short and bowed

ass with GI malignancy

28

acidic

CXR can be nl for 24h after exposure

PCN G + aminoglycoside until susc come back, 10D for bacteremia and PNA, 14D for meningitis, 3 wks for arthritis, 4 wks for osteo

dark-staining Donovan bodies (intracytoplasmic inclusions bodies) on tissue-crush prep or bx

2%, ass with low SES, M>F, hereditary, 48%

post-hepatic neuralgia (MC in >60 y.o.)

fever, rashes (red, pruritic, urticaria, angioedema), joint pain, LAD, myalgias, proteinuria, N/V x7-10D

2 yrs

3, 6 and 12 mo, and then qyr

cradle cap - patches of greasy yellow scales, can spread to the forehead and cheeks, resolves within months

distal rdial metaphysis (wrist)

candida albicans

IVIG qmonth, avoid oral polio

HHV-8

stool assay for cytotoxin (not cx because can be nl gut flora)

infl limited to the rectum (last 12 cm)

neg; ricketssial infection

red --> blue --> green --> yellow --> nl, red x1D, and then each x3D

multi-sys dz (causes legions of problems) - PNA (CXR looks worse than the pt), CNS (HA, delirium)

hearing, MR, dysphasia, dysarthria, structural abnl of the mouth/resp tract, child abuse/neglect

aut dom

pen G or cipro x1-2 mo

port-wine stain in the LE, AVMs, progressive soft tissue and/or limb overgrowth (similar but worse than Klippel-Trenaunay)

irrespective of the BCG vaccine

if nl, corresponds to a pH of >7.25

Na bicarb, IV ethanol or fomepizole, thiamine and pyridoxine (shunt metabolism to less toxic metabolits), dialysis, Ca

trigoncephaly, discrete exophthalmos, arched eyebrows, short neck with webbing

pasturella, staph aureus; consider x-ray bec punctures wounds are often more extensive than they appear

3, 4

bright red, sharp borders, satellite lesions, usually 2-4 mo old

Na bicarb to alkalinize serum, lidocaine

household, daycare, close intimate contacts and passengers seated directly next to a case on flights >8h, health care providers who had close intimate contact (ex. intubation)

1 hr; max 7D

dystonic rxn (neck spasms, tongue thrusting, oculogyric crisis)

turricepahly (~long and thin), proptosis, hypertelorism, strabismus, maxillary hypoplasia

year-round

0 (-150 to +50), x

7 days of life

2.5 yrs

they're requiring FiO2 >50% to maintain PaO2 >50

*high-arched palate, *dislocated lens (ectopic lentis - dislocates up), *pectus carinatum/excavatum, *mitral valve prolapse, tall, wrist sign (thumb and pinkie overlap when encircling the wrist), thumb sign (thumb past ulnar surface of the hand), scoliosis (>20%), dec elbow extension, dilation and dissection of ascending aorta

everyone should get zanamivir and everyone should get vaccinated

GP, GN (E. coli, klebsiella, proteus), anaerobes

cefoxitin, cefotetan, cefuroxime

gonadoblastoma (if Y chr present), auto-immune (Hashimoto's, alopecia, vitiligo), GI prob (incl carb intolerance)

subacute bacterial endocarditis

fever, pharyngitis, conjunctivitis, rhinorrhea, cervical adenitis, diarrhea, hemorrhagic cystitis

immigrants, gay men, institutionalized pts

unpasteurized milk or cheese, inhalation, handling carcasses

bulimia

99

usually by 2-3 mo, but can take up to 6 mo

expanding vocab, more fluency - less stuttering, 25% intelligible, 2-syllable word

11 mo

anterolateral thigh --> deltoid (never the butt)

bacteremia > meningitis > osteo > cellulitis-adenitis

4 hypersensitivity and involve cytotoxic T cells

Dad

immune-complex (Ab-Ag)-mediated

teratogenicity, pseudotumor cerebri (esp when used with tetracyclines), depression, psychosis, pancreatitis, hyperTG, hearing loss, loss of night vision

2 mo

low AFP and estriol, high hCG and inhibin

2 yrs

DTaP, hep B, HIB, IPV, pneumococcal, rota

baby is <2 kg

PPHN

50

non-healing skin ulcers in people working around fish tanks, usually over lymphatic channels

if baby has 3 copies of chr 21 and Mom is <35 yo - 1%, if Mom is >35 y.o. - similar to age-specific risk, if unbalanced translocation - depends on type

dry, leathery, waxy, not painful

only if contacts with TB or who have been to prison within 5 yrs, x-ray findings c/w TB, immigration from high-risk countries, significant travel to endemic countries, areas with a lot of TB, HIV+, in jail

scaly hyperkaratotoic palmar skin rash, mucocutaneous lesions, LAD, condylomata lata (hypertrophic granulomas in warm, moist areas)

infected ticks after 2 days of feeding (so don't worry if someone finds a tic immediately), also (rarely) transplacentally

kerosine, gasoline, lamp oil, mineral spirits

vets and cave explorers (not for hunters or mailmen)

rest, NSAIDs

5 yrs

absent clavicles, brachycephaly, frontal bossing, delayed teeth, fused teeth, wormian bones (extra skull sutures)

24h of life because you need the buildup of metabolites

excision

3-5D

hair loss most apparent at the scalp margin, esp over the temporal area

short stature, short limbs, microcephaly, beaked nose, broad thumbs and big toes, heart dz, MR

not helpful because it's + before sxs start and it stays + for life

racoon eyes, battle sign (mastoid bruising), hemotypanum; CSF leak, CN damage

midline over the neck and move vertically with swallowing and tongue protrusion

carbon monoxide, boric acid

all cells (except RBCs)

obsessions: involuntary persisent, recurrent ideas that intrude on nl activities; compulsions: repeitive beh done to stop the obsession, not pleasurable

likely vasomotor instability, benign

rib - esp posterior and near the spine (NOT due to CPR), bucket handle and metaphyseal chip fxs (avulsion 2/2 shearing with shaking)

must be given on the same day or 1 mo apart

DTaP, hep B, HIB, IPV, pneumococcal, rota

undescended testes with underdeveloped penis and scrotum

1 yr

probability that someone w/out a dz will have a – test =TN/(TN+FP)

parent carries gene mutation only in their gonadal tissues and germline cells, but not in their somatic cells (so they're asymptomatic)

2 yrs

bone age is delayed (c/w age at which the kid’s ht is 50%)

not , so it's always the wrong answer (D/C that med)

common cold, SARS - recent travel to Asia, flu-like sxs that rapidly progress to severe resp distress

SEM (skin, eye, mucosa) > CNS > disseminated

testes growth and thinning of the scrotum --> penis lengthening --> pubic hair

banana gametes in the blood, no schizonts

atypical squamous cells of undetermined significance; HPV testing - if (+), refer for colposcopy and bx, if (-) repeat pap in 1 yr

9 mo

>18 y.o. with the exception of anthrax and UTI

chlamydia trachamotis L1, L2, L3

10-21 days

idiopathic avascular necrosis; 4-8 y.o. boy, painless limp; ratty appearance of femoral head

2 yrs

black necrotic spot on the nose or paranasal sinuses --> extends intracranially, poor prognosis

none

38

50%, autosomal recessive (80%)

everyone 13-64 y.o., unless your practice has a HIV prevalence of less than 0.1% (1/1000), everyone seeking STI testing, high-risk beh

red, wet, v. painful, blisters

abd contents pass through a periumbilical defect, covered with a membrane, ass with genetic abnl

10 mo (10 letters)

West Nile

triphalangeal thumb, radial hypoplasia, hypoplastic anemia, heart dz

2 cm/mo 0-3 mo, 1 cm/mo 3-6 mo, 0.5 cm/mo 6-12 mo

(MERRF) mitochondrial

psoriatic pustulare lakes of pus (small pustules that often coalesce), localized (+DIP involvement) or generalized

too short an interval, given at too young an age, missing doses; re-IMZ kids <1 yo with any questionable shots, get titers if >1 yo

progressive multifocal leukoencephalopathy (progressive demyelination) - multiple pres bec it's multifocal

bladder inf --> hematuria

blood in the anterior chamber

sensitive, few FN

4 ys

spinal agenesis with caudal regression syndrome, small L colon syndrome

augmentin (all produce B-lactamase)

GN - neisseria gonorrhea, H. flu, E. coli, klebsiella, proteus, enterobacter and serratia, poor GP coverage; ceftaz kills pseudomonas

Lyme disease

specific, few FP

12 mo

flagyl x1-2 wks, if recurs, tx with flagyl again, if it recurs again, then po vanc

10% are ass with Sturge Weber syndrome - ipsiL cerebral vascular malformation

painful, pruritic, ulcerate, change in size, color or shape, or they are bothersome (like when nicked while shaving)

streptomycin

hypothyroidism, nutritional deficiency, chornic inf (mono, HIV), chronic systemic illness (SLE), substance abuse

inc risk for squamous cell carcinoma in adolescence

12 mo (double nl)

terror, insomnia, fever --> restlessness, severe laryngeal spasms esp when seeds food/ water (hydrophobia), szs --> paralysis, coma death

binds to Hgb and displaces O2, impairs O2 release from Hgb

none

first Ig produced in an infection, so useful in distinguishing between a recent and chronic inf

new-onset sz in a teenager from Central/S. America

tropical latitudes - Central and S. America, Caribbean

types 6 and 11 (>90% of genital warts) and 16 and 18 (>70% of cervical cancer)

EBV --> polyclonal expansion of B and T cells ---> invade organs --> BM failure, fulminant hepatitis, B-cell lymphoma, acquired hypogammaglobulinemia

no recommendation to terminate, bec there have been no cases of vaccineass congenital rubella syndrome

3 yrs

95%

coloboma, heart dz, atresia (choanal), retardation (growth, MR), GU abnl (hypogonadism), ear abnl

HEPA filter, get rid of animal (although dander will be detectable for 5 mo for dogs and even longer for cats)

acute onset of severe pain, N/V, diffusely swollen and tender testicle, horizontal lie, absent cremasteric reflex

FTT, anemia, weakness, fatigue, larva migrans in the skin (serpinginous, red)

symptomatic irrespective of CD4; no sxs with CD4 <350 for kids >5 y.o. or <25% of nl for kids <5 y.o.; all kids <1 yr known to be HIV+

hemangioma in the CN V distribution, glaucoma, szs, meningeal hemangiomata

none – they don’t cause neurological damage or epilepsy

azithro to decrease spreading, if allergic - bactrim

staph aureus, GBS, GN

rota > adeno

does not (could be a fistula)

sudden or gradual pain at the upper pole of the testis, tender pea-sized swelling, "blue dot" sign

SALTR: (think of an ankle fx) I slipped - physis, II above - metaphysis, III lower - epiphysis, IV through - metaphysis, physis, epiphysis, V rammed - crush injury

0, 2, 6 mo

partial thickness

Stage 1 - erythema migrans (bulls-eye or central clearing), HA, mylagias, arthralgias, fever, LAD --> 2 - neuro (meningitis, CN palsy, foot drop), myocarditis (alternating 1st, 2nd and 3rd degree heart block) --> 3 - disseminated - oligoarthritis, neuro changes

increased bone density along the suture

*mec aspiration, *PNA, *HMD/RSD, *sepsis, *pulm hypoplasia, hypoglycemia, hypothermia, polycythemia

SI, HI, psychosis, substance use, failed out-pt management

opiods, benzos, antivenom if severe

clean wound with >3 IMZ >10 yrs ago or <3 IMZ or h/o unknown; dirty wound with >3 IMZ but >5 yrs ago

3 mo (in anticipation of rolling at 4 mo)

brain abscess (get MRI/CT to look)

periorbital (ocular prob), beard lesions (subglottic hemangioma), midline lumbosacral (spinal dysraphism), nose, lip and perineum (inc risk of ulceration)

TDap, HPV, meningococcal

shallow - nl peak but low compliance (<0.2)

when the parents is aware the child is home; 2-3x/wk x2 wk; somatic complains (HA, stomachache)

not

Pen G IV q4 x14D or Pen IM qD + probenecid x14D, if pen-allergic ceftriaxone qD x14D but there is some cross-reactivity, so probably just de-sensitize

cat's cry 2/2 larynx abnl, hypertelorism, down-slanting palpebral fissures, hyptotonia, short stature, microcephaly, high-arched palate, flat nasal bridge, MR

is not

cefepime

36-37

rule of palm - child's palm (not including pictures), is 1% of BSA, useful in smaller burns

a lot more (thousands vs ~25)

systemic type 3 hypersensitivity rxn - inject a large amt of Ag --> necrotic vasculitis

short stature, pulm valve stenosis, pectus,, webbed neck, hypertelorism lymphedema, bleeding diathesis

anemia --> inc flow to the organs --> inc fluid load --> ascites, pleural effusion, hydrops

6 mo, 6

should not

bacterial vaginosis (MC), trich, candidiasis

anomalies of different structures that lied together during embryonic development

exfoliative rxn, the entire body surface becomes red, warm and scaly

has been eliminated from the US

vocal cord paralysis, hypothyroidism, trauma to the hypopharynx

night (they worsen as the day goes on)

4, 4

cidal

3, 3

catarrhal (common cold) --> paroxysmal (whooping cough) ---> convalescent (sxs slowly improve)

kids exposed at high risk for severe dz - IC, pregnant women, newborns who's mom had inf <5D before <2D after delivery, premies

400 IU, breastfed and partially breastfed babies, and all older children who drink less than 1 quart (32 oz) of milk/day

anergy, too recent of an exposure (takes 2.5 mo to become +)

HR starts decreasing at the peak of the uterine contraction and returns to nl only after the contraction has ended, slow gentle dec

outbreak of psoriasis in the area of an abrasion, linear

1 million, TP (+test, + dz)

birth, 2 yo., 3 y.o, 4 y.o. and q2-3 yr until adolescence

consistent clinical picture (painful ulcer with inguinal LAD), neg syphilis and HSV testing

lactic acidosis in pregnant women

blister in the lowest level of the epidermis

cocci

toxo (see multiple lesions)

*mild form, fxs are present at birth, *tibial bowing, dentiogenesis imperfecta (translucent, discolored)

when all the maternal mito DNA in 1 cell are identical

9-12 mo

pulsed dye laser

autoimmune dz, Celiac-like, diarrhea/PLE, inc risk of lymphoma

localized blistered on knees, elbows, dorsum of hands --> scarring --> mitten-like deformities, esophageal strictures, *severe chronic anemia

rupture of blood vessels that run between the skull and the priosteum --> collection of blood under the periosteum

chest compressions, epi q3-5 min, atropine, consider pacing

95

head compression --> vagal stimulation --> dec HR

6 mo

observe - 50% will resolve in 2-3 mo, use US if PEx can't distinguish bet cystic and solid

after neisseria meningitidis inf, bec 20% will have this defect

ppx for meningococcal inf

2nd generation anti-histamines (don’t cross the blood-brain barrier), ex. loraditine, leukotriene receptor antagonists, nasal corticosteroids, ocular agents

18 mo

bactrim; if PaO2 < 70 - bactrim + steroids

infants <1 mo, IC - AIDS, leukemia/lymphoma

bloody or green discharge 2-7 days after delivery

all babies <1 yo; CD4 <500 if 1-5 yo; CD4 <200 if >5 yo

suspect immunodeficiency

pale retinal lesions, surrounded by hemorrhage

strep pneumo

RhoGAM during 3rd trimester and at the time of birth

*IUGR, *rocker bottom feet, *clubfoot, *clenched fist, *heart dz (90% - MC VSD), high forehead, microcephaly, small face and mouth, short sternum, overlapping fingers, hypoplastic nails

none

IM Pen G qwk x3 wks, if PCN-allergic doxy or tetracycline x28D, if pregnant must use PCN so if allergic desensitize first

linear group of small, purple or flesh-colored papules, asymptomatic, self-limited, MC on extremities, resolve within 1 yr

staph

ZDV bec it decrease rate of infection by 30%

activated charcoal and whole bowel irrigation for a child who swallowed a patch

34-35

ability of genes to product many effects (ex. Marfans affects the eyes, heart…)

complement fixation titer >1:64

3, 4

main Ig in secretions

szs, cardiac arrhythmias

babies born at >3000 feet

first 8 wks - deafness (85%), 9-12 wks - cataracts (52%), 12-30 wks - heart dz (16%)

tetra/doxycycline, quinolones, bactrim

12 mo, there’s no dentist who will see a child and then 3 yo, or medically complex/high risk of caries and then 6 mo

40

tender grouped vesicles (painful, itchy) that spontaneously rupture for form shallow painful ulcers

likely extension from paranasal sinus - strep pneumo, H. flu, anaerobes

continuous murmur, resp distress, bounding pulses, wide pulse pressure

FHx of sensorineural hearing loss, congenital inf, craniofacial abnl, BW <1500 g, exchange transfusion 2/2 jaundice, ototoxic meds, bacterial meningitis, APGAR <3 at 5 min, syndrome ass with deafneess

1-2 wks after birth, macules --> vesicle, esp at sites of trauma (*scalp monitor, presenting part)

asymptomatic inf dx by serology, early - infected within 1 yr, late infected >1 yr ago

3.5 yrs

pseudomonas (MC in the pelvis or vertebrae)

>7.25; 7.20-7.25; <7.20

posterior fat pad

ptosis, miosis (small pupils), exophthalmos, delayed pigmentation of the iris

babies < 3 mo, pregnant women

daycare centers, 1-4 y.o

39

18 mo

INH x9 mo; rifampin x4 mo

ampicillin

1 - sxs <15 min, 2 - sxs >15 min, 3 - loss of consciousness

a PTX with >20% remaining after needle decompression or if the baby is still hypoxic or in distress

aut dom, aut rec, X-linked dominant

pork, usually a GM who is handling pork and then feeds the baby without washing his hands

9 yo, 28 days

protective Ag, edema factor and lethal factor

small grouped freckle-like café-au-lait spots 1-4 mm in the axilla or groin ass with NF1

rash (maculopapular --> petechial, in distal extremities), HA, arthralgias (but not arthritis), fever, recent h/o tick exposure

3 yrs

microcephaly, +FHx of MR, +FHx of fetal loss, IQ <50, skin pigment abnl, suspected genetic syndrome

danazol to reduce # of attacks, E-aminocaproic acid to terminate acute attacks but takes 48h to work

staph brain abscess

breastmilk, sepsis, galactosemia, hypothyroidism, CF, biliary atresia, hepatitis, spherocytosis

vaginal adenocarcinoma, when exposure is before 12 wks

rifampin x4D to close contacts

the different forms of a gene (alleles) at a given locus

mitochondrial

never

girls smoke more than boys, but boys drink 2x as much alcohol

gonococal (GN intracellular diplococci), non-gonococcal (MC CT, but also ureaplasma, mycoplasma, trich)

excise the node (don't I&D because it will create a sinus tract)

SOAP - sympathomimetics (speed, cocaine, LSD), organophosphages, aspirin, PCP

5 yrs

non-immune hydrops, jaundice, HSM, rhinitis (highly contagious), pseuoparalysis of an extremity, skin rash (vesicular), uveitis, choreioretininitis

foxglove*, lily of the valley, oleander

scotch tape over the butt to look for eggs, or see worms in the poop

PNA

Wood's lamp and florescein

4 yrs

does not (will go on to cause meningitis and other bad stuff)

chancre

BMI 85-95%; >95%

1, 2

ceftriaxone x1, but give x2-3 while waiting for blood and CSF cxs

pox virus

dustmite allergy in toddlers, seasonal allergies >5 yo (bec you need repeated exposures to become allergic)

newborn

dec hepatic uptake of bili

MR, craniofacial abnl, hypoplastic nails, growth def in 10% (during 1st trimester), vit K def in 30% (--> bleeding prob )

recurrence risk inc if the affected individual has a more severe pres

18 mo

using corrected gestational age rather than chornocoligc age

loosening of a secure tooth, gingival lac, bleeding around a tooth

can have dzs usually ass with genomic imprinting (ex. Prader Willi with maternal disomy because you have no copy from Dad)

36-39

immobilization for 2-3 wks in a young kid or 3-4 wks in an older kid

0.2-1.8, y

dec

red, very painful, warm nodules, usually on the shins

for a test, probabability of no dzin a pt with a test, =TN/(TN+FN)

an announced intention to go on a diet

no live attenuated IMZs (could be fatal)

acuity <20/30 or >1 line difference between R and L eyes

careful exam for abnl, +/- renal US

34-35

>2 wks of depressed mood/irritability + 4/9 of SIGECAPS - sleep, interest, guilt, energy, concentration, appetite, psychomotor, SI

convalescent or post-EBV (EBV as a dx is N/A because the kid already had it)

6-12 mo

can cause anal prolapse, blood-streaked stool, diarrhea, wt loss, abd pain, fever

it's in the mouth (from an electrical cord bite) because it can cause labial artery bleeding in 1-3 wks

points, shakes head, "Mama" and "Dada"

microdeletion

bitter; superficial coagulation necrosis; severe gastritis, met acidosis, acute renal failure, perforation, late stricture

1 yr

different phenotypes with the same genotype (ex. +/- cleft palate with Treacher-Collins)

CN abnl, hypoplastic tongue or digits, limb abnl, Poland anomaly (no pect major/minor muscles), ipsiL breast hypoplasia (absence of 2-4 rib segments)

spinal dysraphism

likely extension from OM - strep pneumo, H flu, staph aureus, GN

any baby with jaundice on DOL1, any baby sent home before DOL4 (so everyone)

occipital encephalocele, microcephaly, polycystic kidney, polydactyly, *lethal

IDM, SGA, LGA, premies, LWB (<2.5k), hypothermia, resp distress, sepsis, polycythemia (hct >70), low APGARs (<5 at 1 min)

12 mo

hep A

persistent late or variable decels with loss of beat-to-beat variability, prolonged severe bradycardia, sinusoidal pattern, loss of beat-to-beat variability

6th CN palsy (lateral rectus --> defect in abduction), basilar enhancement on the head CT

white babies <500 g

diphtheria anti-toxin, erythro - to make less contagious; IMZ with DTap after recovery

IgE-mediated, immediate (anaphylactic, atopic)

amp

extramedullary hematopoiesis in the spleen

keratitis --> blindness (MC inf cause of acquired blindness in the developed world)

schizonts in the blood, no banana gametes (p. falciparum)

early (10-13) - impulsive, concrete; middle (14-16) - peers are most imp, cognition begins to mature; late (17-21) - individual relationships are most imp, idealistic, focus on life goals, cognitive development is complete

*mod form, *many fxs in the newborn period, severe short stature, progressively deforming, initial blue sclera, *hydrocephalus, *basilar skull invagination

much higher risk of IDDM (20x greater), progressive rubella pancencaphlitis (starts in the 10s, die within yrs)

no tx uless appear infected - augmentin, if PCN-allergic - clinda + bactrim

breast development (thelarche)

clinical, don't I&D the LN bec it will create a persistent sinus tract

edema, b/l painless parotid gland swelling (above angle of the mandible), calluses on dorsum of the fingers (Russell sign), loss of tooth enamel

4 yrs

hearing screen

eczematous plaque where a zipper has been

LWB infants bec they’ve been found to have ↑ amts of aluminum

band-like, get worse later in the day

strep pneumo

*ash leaf hypopigmented macules (90%, enhance with Woods lamp), *shagreen patches (oval leathery-thick plaques on trunk), facial angioma, ungual and gingival fibromas, polycystic kidney dz, cardiac rhabdomyomas (50%, regress with time), +/- infantile spasms

well-defined erythematous skin lesions with silvery scales, usually symmetric and over the knees, elbows, sacrum and scalp, nail pitting with "oil-slick" deposition, thickened nails with oncholysis (separation of the distal nail from the nail bed)

ceftriaxone IM x1, plus always tx for chlamydia unless it's been r/u (so also azithro 1g x1), if allergic doxy, if pregnant - no doxy, spectinomycin

*steroids, immunosuppressives if needed for skin changes

babbles, has diferent cries

+FHx of dyslipidemia or premature CVD (<55 in M, <65 in F), unknown FHx, overweight, htn, smoking, DM

clinical

minor - only 1 mucous membrane is involved, resolves before 24h

eye discharge DOL7-14; PNA (AF, staccato couch)

excess brain tissue 2/2 ↑ size or # of brain cells

*atretetic or narrowed ear canals, also: frog-like legs, depressed midface, protruding mandible, deep-set eyes, carp-like mouth, MR

M - mostly asymptomatic, F - frothy, smelly, yellow-green discharge, dysuria, pruritis, vulvar irritation, cervicitis (strawberry cervix)

sudden fetal death in 3rd trimester, macrosomia --> birth trauma, inc rate of c-sections, IUGR, hypoglycemia/Ca/Mg/phos, polycythemia, cardiomyopathy, congenital heart dz, lumbosacral dysgenesis/caudal regression, unconjugated hyperbili, small L colon syndrome, renal abnl, inc risk of DM/obesity

male, APGARs <4 at 5 min, bradycardia at 5 min, lack of antenatal steroids, hypothermia, IUGR

pain or refusal to walk, usually <3 y.o., M>F, single large joint (knee, or hip)

pen G or a quinolone (floxacin)

cervical vertebral abnl (33%), heart dz, renal abnl (15%)

1%, 14.5 and 18 (ass with transitions from middle to high school, and high school to college)

4 yrs

temp is >39 without localizing signs of inf and with a WBC >15

HIB; ill (always bactermic)

observe for other badness (ex. congenital agaglionic megacolon)

permanent (never primary/baby teeth)

new TB pt, <4% primary resistant to INH in the community, no known exposure to pt with drug-resistant inf, not from a high prevalence country

girl with patterned blistered along the lines of Blaschko (routes of embryonic cell migration) within wks of birth --> verrucous papules x mo --> hyperpigmented linear swirls along the lines of Blaschko for yrs --> hypopigmented macules, also delayed teeth eruption (67%), cone-shaped teeth and/or missing teeth, cicatricial (scarring) alopecia (33%), strabismus, blindness, sz

M (4x) > F

smelly water diarrhea and gas, in campers, travelers, kids in day care, gay men, pts with IgA def

CSF for VDRL, cell count and prot, CBC, long-bone x-rays, CXR, LFTs, cranial US, eye and hearing screen

trypansoma cruzi (Chagas dz)

Pen G x10D (if you miss >1D, must start over)

sacral agenesis, situs abnl, holoprosencephaly, congenital heart dz

25%, 10%

clean wound and IMZ are UTD (>3, w/in 10 yrs), dirty wound and IMZ are UTD (>3, w/in 5 yrs)

main Ig in the immune response

subacute bacterial endocarditis

no B-cells (arrested at pre-B cell stage)

males, except for Rett syndrome

painful

50