Pediatric Cases

Front 1

von Willebrand disease

Back 1

fatigue, heavy periods, h/o frequent nose bleeds, otherwise negative ROS, blood oozing from wound, pale, ecchymoses, epistaxis, menorrhagia, bleeding
post-tonsillectomy/post-dental extractions, gingival bleeds, bruising in non-exposed areas

Front 2

Girl puberty

Back 2

Starts at 8-13 years:
Breast buds appear at 10-11 years
Pubic hair appears at 10-11 years
Growth spurt at 12 years (2 years after BBs)
Periods begin (menarche) at 12-13
Adult height at 15 years

Front 3

Boy puberty

Back 3

start puberty at 10-15 years:
Growth of testicles at 12 years
Pubic hair appears at 12 years
Growth of penis, scrotum at 13-14 years
First ejaculations at 13-14 years
Growth spurt at 14 years
Adult height at 17 years

Front 4

Mononucleosis

Back 4

fever, sore throat, and swollen lymph glands. Sometimes, a
swollen spleen or liver problems may develop.

Front 5

Fetal Alcohol Syndrome

Back 5

smooth philtrum (divot or groove between the nose and upper lip), thin vermilion (upper lip), small palpebral fissures, growth deficiencies, facial abnormalities, growth deficiencies, CNS dysfunction (mental retardation, poor motor skills and hand-eye coordination, learning problems)

Front 6

Congenital CMV

Back 6

Hearing loss (may be after the newborn period, may be progressive), microcephaly and intracranial calcifications, chorioretinitis, hepatosplenomegaly and rash (resolve in few weeks)

Front 7

Neuroblastoma

Back 7

infant <1 year old, asymptomatic UQ abdominal mass, pallor but not jaundiced, lymphadenopathy, fatigue, loss of appetite, fever, failure to thrive and joint pain

Front 8

Wilms Tumor

Back 8

UQ abdominal swelling/mass/pain, 3-4 y/o, Fever, hematuria, Reduced appetite, HTN, Constipation, Nausea, and normal growth and development

Front 9

6-month-old

Back 9

Gross motor: Sitting unsupported; no head lag when pulled to sit from
supine.
Fine motor: Immature raking grasp; transfers from one hand to the other.
Language: Babbling (use of repetitive consonants e.g., ba-ba-ba or
da-da-da).
Social/Adaptive: Stranger recognition, which is the prelude to stranger
anxiety.

Front 10

9-month-old

Back 10

Gross motor: Sits unsupported, crawls, pulls self to a stand.
Fine motor: Has between a raking grasp and a fine pincer grasp. This grasp is referred to as a thumb-finger grasp. Bangs objects held in each hand.
Language: Combines syllables and can usually say "mama" and "dada," but nonspecifically.
Social/Adaptive: Plays pat-a-cake and waves bye-bye, indicates wants, shows stranger anxiety.

Front 11

12-month-old

Back 11

Gross motor: Stands alone (many can walk well).
Fine motor: Has fine pincer grasp.
Language: Says "mama" and "dada" (specific) and 1 or 2 other words.
Social/adaptive: Drinks from cup, imitates activities and plays ball with
examiner.

Front 12

3 y/o

Back 12

Gross Motor: Jumps in place, kicks ball, rides tricycle.
Fine Motor: Copies circle, wiggles thumb, Social/cognitive: Knows name, age and sex. Has self-care skill, shows early
imaginative behavior.
Language: Knows 2 actions, names 1 color, speech at least
half-understandable.

Front 13

Costochondritis

Back 13

pain with direct sternal pressure (Reproducibility by direct pressure over costochondritis joints), sporadic, unassociated with exertion, brief (a few seconds or a minute), stabbing or sharp and well localized, exacerbated by deep inspiration, last for hours or days, usually follows a recent viral infection/muscle strain/trauma/overuse

Front 14

Neurocardiogenic syncope

Back 14

Starts with prodrome (lightheadedness, dizziness, nausea, SOB, pallor,
diaphoresis and visual changes), lasts several seconds to minutes,
progresses to brief LOC, and ends with arousal to a previous level of
alertness.
Precipitators:
Emotional stress: fear, anxiety, pain, phlebotomy.
Physical states: anemia, dehydration, hunger, recent illness, physical
exhaustion, motionless standing in crowded poorly ventilated confines.

Front 15

Precordial catch

Back 15

sporadic, unassoc w/exertion, very intense, sharp pain, typically at the left side of the chest, which is worse when taking breaths, lasts from 30 seconds to a few minutes then pain is resolved quickly and completely, pain can often be "broken" with a
forced deep inspiration

Front 16

Asthma

Back 16

chest pain during exercise, coughing,
respiratory distress, wheezing, coughing at night

Front 17

GERD

Back 17

retrosternal/burning/non-radiating chest pain, repeated vomiting, effortless spitting up, coughing, other respiratory problems. Inconsolable crying, failure to gain adequate weight, refusing food, bad breath, belching/burping, arching back/not breathing

Front 18

RDS

Back 18

MC = cyanosis, cold skin, tachypnea apnea, retracting, use of accessory muscles, tachycardia (may go into bradycardia), grunting, nares flaring, ground glass on CXR, wheezing, stridor

oligo/anuria, edema of arms or legs, Shallow breathing

Front 19

TTN

Back 19

tachypnea, retractions, nasal flaring, grunting, cyanosis..
(Chest x-ray = fluid in the interlobar fissures and perihilar streaking, which sometimes obscures the heart borders. Hyperaeration of the lungs and mild cardiomegaly may be seen; alveolar edema may appear as coarse, fluffy densities)

Front 20

pneumothorax

Back 20

increasing respiratory distress (including tachypnea, grunting, nostril flaring, and chest wall retractions), difficulty auscultating breath sounds unilat
-if tension pneumothorax= change in the location of heart or lung sounds when the organs are moved by the presence of air
(CXR = One half of the lung may seem blacker—that is, more radiolucent—than the other, which will be more radio-opaque or whiter. In particular, the area beyond the collapsed lung will be very radiolucent, can identify the
edge of the collapsed lung)

Front 21

CHF

Back 21

Big 4 = Tachycardia, Tachypnea, Hepatomegaly, cardiomegaly
Also: Ascites, Pleural effusion, edema, Jugular venous distension, Retractions, Nasal flaring or grunting, Rales, Pulmonary edema, Fatigue or low energy, Pallor, Sweating, Cool extremities, failure to thrive, Dizziness, Altered consciousness, Syncope
-in infants, when feed, sweat and dusky blue color

Front 22

Meconium Aspiration Syndrome

Back 22

greenish or yellowish appearance of the amniotic fluid (infant's skin, umbilical cord, or nailbeds may be stained green), rapid or labored breathing, cyanosis, bradycardia, a barrel-shaped chest or low Apgar score, diffuse crackles and rhonchi (chest X-rays = patchy or streaked areas on the lungs)

Front 23

hypothermia of the newborn

Back 23

Acrocyanosis (blue hands&feet), Cool extremities, Lethargy, Bradycardia, Apnea, Poor feeding, respiratory Distress (grunting, nasal flaring, and retractions), Tachypnea

Front 24

pneumonia in neonate

Back 24

tachypnea; signs of respiratory distress (grunting, nasal flaring, and retractions); lethargy; poor feeding; irritability. Fever may not be present in newborns; however, hypothermia and temperature instability may be observed.
* Cyanosis may be present in severe cases.
* Nonspecific complaints, such as irritability or poor feeding, may be the presenting symptoms.
* Cough may be absent in the newborn period.

Front 25

pneumonia in infant

Back 25

After the first month of life, cough is the most common presenting symptom.
Also tachypnea, grunting, retractions, Vomiting, poor feeding, irritability, can be febrile (if bacterial), wheezing or has noisy breathing.

Front 26

pneumonia in toddlers

Back 26

* Cough is the most common presenting symptom
*Wheezing, dullness to percussion over affected area, rales over affected area, fever, upper airway/bronchial sounds
*Can be asymp or have only abd pain
* Vomiting (particularly post-tussive emesis), Chest pain

Front 27

pneumonia in Older children and adolescents

Back 27

Cough, Vomiting, Abdominal pain or tenderness, fever constitutional symptoms, such as headache, pleuritic chest pain, and vague abdominal pain, diarrhea, pharyngitis, and otalgia/otitis

Front 28

Croup

Back 28

MC = "barking"/"seal" cough, stridor (high pitched breathing), subepiglottic narrowing on CXR, fever

hoarseness, difficult breathing (usually worsens at night), coryza (inflammation of the mucous membranes lining the nasal cavity)

Front 29

epiglottitis

Back 29

fever, difficulty in swallowing, drooling, hoarseness of voice, stridor, acutely ill/toxic, anxious, very quiet shallow breathing with the head held forward, insisting on sitting up in bed, symptoms are insidious
-severe = cyanosis and choking
(lat CXR = thumb sign)

Front 30

Pyloric Stenosis

Back 30

Feed lustily then projectile vomit, substernal olive mass, metabolic acidosis

Front 31

neonatal seizure

Back 31

apnea, pedaling of legs, abn mouth/tongue mvmt, staring, tonic limb posturing, may be conscious

Front 32

Hyaline Membrane Disease

Back 32

shortly after birth, tachypnea, grunting, chest retrations, nasal flaring, cyanosis, apneic spells, breath sounds decreased on ausc

Front 33

Pneumothorax

Back 33

may be resp distress/cyanosis, may be asymp

Front 34

TTN (transient tachypnea of the newborn)

Back 34

tachpynea
(if any cyanosis/grunting/retracting, is minimal)

Front 35

Meconium aspiration

Back 35

tachypnea, increased chest diameter, cyanosis, staining of umb cord and under fingernail tips

Front 36

Amniotic Fluid aspiration

Back 36

achypnea, cyanosis,

Front 37

Necrotizing enterocolitis

Back 37

abd distension, emesis, gastric retention, hematochezia (frank or occult)

(lethargy, apnea, bradycardia, hypothermia, diarrhea)

Front 38

herpetic gingivo stomatitis

Back 38

fever, submandibular LAD, anorectic, oral vesicles all over/rupture early

Front 39

herpes labialis

Back 39

ulcers in mucocutaneous jcn w/red bases

Front 40

chicken pox (VZV)

Back 40

-fever
-malaise
-rash = papules-->vesicles-->pustules-->scabs-->scars
(in crops, central to periph)

Front 41

Shingles (VZV)

Back 41

fever, malaise, rash (same as chicken pox) along dermatome then post-herpetic neuraligia

Front 42

Infectious mono (EBV)

Back 42

fever, sore throat, cervical LAD (esp post chain), severe malaise and fatigue, splenomegaly
(maculopapular rash, Alice-in-Wonderland syndrome, periorbital edema)

Front 43

Roseola Infantum (exanthum subitum)

Back 43

fever --> 3-4days later, drops and truncal rash appears --> rash for 24h
FEVER CRASH + ROSIE RASH

Front 44

mnemonic for exanthms and fever

Back 44

EXANTHEM DAYS FEVER
Children Chicken Pix 1
Scratch Scarlet Fever 2
Small Small Pox 3
Masses Measles 4
Terribly Typhus 5
Terribly

Front 45

Scarlet Fever

Back 45

2 day fever, sandpaper truncal rash (desquam at end of week 1), circumoral pallor, rash in deep creases (Pastia's sign), phayngotonsillirtis, strawberry tongue

Front 46

Measles (rubeola)

Back 46

Catarrhal stage (fever-Chills, Coryza, Conjunctivits, Koplik spots (grains of salt on red base on buccal mucosa)
-4 day fever
Maculopapular rash

("tweechule's measles)

Front 47

Rubella (german measles)

Back 47

mild uri Sx, LAD (esp retroauricular), rash

Front 48

Rocky Mt Spotted Fever

Back 48

fever, prostration, HA, vomiting
-rash on 2nd-4th day (starts periph to central, papular-->petechial)

Front 49

Lyme disease

Back 49

Stage I = RASH (red papular)
Stage II = NEURO (facial weakness) or cardiac abnormalities
Stage 3 = ARTHRITIS (esp knees)

Front 50

5th Disease (erythema infectiosum)

Back 50

slapped cheek rash, then maculopapular rash on trunk that fades w/central clearing, then lacy/reticulated rash

Front 51

Meningococcal disease

Back 51

fever (none to high), HAs, stiff neck (less likely in younger), N&V, lethargy, irritability, rash (purpuric or petechial), altered sensorium
-neonate esp may present w/only lethargy, irritability and poor feeding
-viral meningitis is similar but milder

Front 52

Kawasaki disease

Back 52

fever of 5 or more days PLUS at least 4 of:
-bilat nonexudative conjunctivitis
-mucosal changes
-periph extrem changes
-rash
-cervical LAD

Front 53

Acute Otitis Media

Back 53

Pain (in infants, incessant crying), fever, irritability, hearing loss
-can be asymp
-if exudate, get hearing loss
-chronic = inflamm of middle ear, can have discharge, may get cholesteatoma

Front 54

UTI

Back 54

in infants/young --> fever, vomiting

in older --> dysuria, abd pain, incontinence, frequency, urgency

Front 55

Reye syndrome

Back 55

persistent vomiting develops over 1-2 weeks, lethargy-->drowsiness-->coma, seizures

Front 56

acute nasopharyngitis (rhinovirus)

Back 56

rhinorrhea, fever, irritability

Front 57

pharyngitis/tonsilitis

Back 57

fever, sore throat, cervial LAD

Front 58

sinusitis

Back 58

fever, HA, facial pain, congestion (nasal), periorbital edema, cough, rhinorrhea

Front 59

dphtheria

Back 59

fever, grey-white membrane in pharynx, stridor

Front 60

acute bronchitis

Back 60

persistent cough, wheeze, substernal chest pain, rhonchi

Front 61

acute bronchiolitis (rsv)

Back 61

apnea, rhonchi, rales, tachypnea, chest retractions, wheezing, fever

Front 62

mycoplasma pneumonia

Back 62

cough, fever, HA, sore throat
-sever illness unusual

Front 63

Chlamydial pneumonia

Back 63

rhinorrhea, congestion, fussiness, fever, conjunctivits, dry cough, tachypnea

Front 64

laryngomalacia

Back 64

congenital inspiratory stridor from birth, altered by position, no retractions

Front 65

asthma

Back 65

wheezing (sudden or insidious) on expiration, cough, chest tightness, Sx worse at night, hyperinflated chest

Front 66

acute diarrhea

Back 66

viruses/V.cholera = vomiting, watery diarrhea, low grade fever, abd pan
YESS C (and entamoeba) = bloody/mucousy diarrhea, fever, abd pain
Giardia = smelly stools, abd pain, anorexia

Front 67

Intusussception

Back 67

bouts of abd pain w/screaming and vomting, red currant jelly stool, susage shaped mass in RUQ, mass felt per rectum

Front 68

acute appendicitis

Back 68

pain (epigastric/periumbilical), anorexia/nausea/vomiting (after pain), local abd tenderness, fever

Front 69

pancreatitis

Back 69

anorexia, fever, vomiting, nausea, worsening pain (epigastric) that's worse w/meals, abd distension/tenderness

Front 70

ulcerative colitis

Back 70

bloody diarrhea, colicky abd pain w/defecation, tenesmus, anorexia, nausea, vomiting, wt loss

Front 71

crohn's disease

Back 71

(possibly bloody) diarrhea, colicky abd pain w/defecation(periumbilical or RLQ, unrelated to meals), oral mucosal ulcers, epigastric pain,anorexia, nausea, vomiting, wt loss, perirectal fissures/fistulae, growth failure

Front 72

IBS

Back 72

abd pain relieved by BM, change in steel freq/appearance, abd distension, no wt loss, better at night

Front 73

celiac sprue

Back 73

diarrhea, abd distension, irritability, FTT, anorexia
-assoc w/dermatitis herpetiformis

Front 74

PUD

Back 74

bloody (occult) stools, recurrent abd pain (epigastric) w/meals or nocturnal, tenesmua, nausea, vomiting, wt loss

Front 75

Esophageal atresia

Back 75

chough, choke, cyanosis after 1st feed

Front 76

GERD

Back 76

excessive but nonprojectile vomiting, irritability, excessive crying, arching of neck, apnea, stridor, FTT

Front 77

duodenal obstruction

Back 77

bilious vomiting right after born

Front 78

malrotation

Back 78

bilious vomiting right after born

Front 79

Meconium ileus

Back 79

vomiting, abd distention and no stools right after born

Front 80

Hirschsprung disease

Back 80

constipation (may alternate w/diarrhea)

Front 81

neonatal hypoplastic left colon

Back 81

abd distension, failure of passage of meconium in 1st 48h, bilious vomiting

Front 82

imperforate anus

Back 82

dimple instead

Front 83

transposition of great vessels

Back 83

severe cyanosis in first few post-birth hrs, tachypnea, dyspnea

Front 84

hypoplastic L heart syndrome

Back 84

severe cyanosis in first few post-birth hrs, dyspnea, all pulses weak/absent

Front 85

truncus ateriosus

Back 85

dyspnea, FTT, ejection click and systolic murmur

Front 86

total anomalous pulm venous drainage

Back 86

cyanosis, dyspnea, S2 fixed and wise split

Front 87

ASD

Back 87

S2 fixed and wise split with NO cyanosis

Front 88

Tetralogy of Fallor

Back 88

mild cyanosis at birth gradually increases, systolic thrill at L sternal border, "tet" (blue) spells (dyspnea, cyanosis, restlessness, syncope), squatting after exercise

Front 89

VSD

Back 89

small defects asymp, large = dyspnea, FTT, pansystolic murmur on L sternal border

Front 90

PDA

Back 90

may be asymp
tachycardia, bounding pulses, continuous machinelike murmur of 2nd IC space (pulm)

Front 91

Coarctation of Aorta

Back 91

infant ---> dyspnea on feed, sudden CHF signs or can be asymp
femoral pulses decreased/absent but brachial fine/high

Front 92

CHF

Back 92

tachycardia, tachypnea, cardiomegaly, hepatomegaly

Front 93

hypertrophic cardiomyopathy

Back 93

heart murmur may be only sign
may get dyspnea, syncope w/activity, fatigue, palpitations, chest pain
MCC sudden death in young adults

Front 94

ALL

Back 94

fever, malaise, irritability, pallor, fatigue, gingival swelling/parotitis, LAD, arthralgias, hemorrhage (petechiae, etc)

Front 95

raised ICP

Back 95

HA, vomit, papilledema, 6th CN palsy (can't abduct)

Front 96

transient synovitis of hip

Back 96

painful, self-limited

Front 97

Legg-Calve-Perthes disease

Back 97

painful limp, abduction/int rotation limited
5-10 y/o

Front 98

slipped capital femoral epiphysis

Back 98

painful limp, abduction/int rotation limited
10-20 y/o
acute or gradual

Front 99

septic arthritis

Back 99

<5 y/o
sudden onset
painful jt mvmts
systemic sx (fever, etc)
Kept flexed to avoid pain

Front 100

acute post-strep glomerulonephritis

Back 100

proteinuria
hematuria
oligouria
edema (periorbital esp)
HTN

Front 101

membranous glomerulonephritis

Back 101

microscopic hematuria

Front 102

membranoproliferative glomerulonephritis

Back 102

proteinuria
hematuria
HTN

Front 103

HUS (hemolytic uremic syndrome)

Back 103

prodrome = diarrhea (bloody)
anemia, acute renal failure

Front 104

auto rec PKD

Back 104

flank masses bilat, oligohydramnios, Potter sequence, severe HTn

Front 105

auto dom PKD

Back 105

enlarged kidneys, hematuria, abd pain, HTN