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105 Cards in this Set

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von Willebrand disease
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
Girl puberty
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
Boy puberty
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
Mononucleosis
fever, sore throat, and swollen lymph glands. Sometimes, a
swollen spleen or liver problems may develop.
Fetal Alcohol Syndrome
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)
Congenital CMV
Hearing loss (may be after the newborn period, may be progressive), microcephaly and intracranial calcifications, chorioretinitis, hepatosplenomegaly and rash (resolve in few weeks)
Neuroblastoma
infant <1 year old, asymptomatic UQ abdominal mass, pallor but not jaundiced, lymphadenopathy, fatigue, loss of appetite, fever, failure to thrive and joint pain
Wilms Tumor
UQ abdominal swelling/mass/pain, 3-4 y/o, Fever, hematuria, Reduced appetite, HTN, Constipation, Nausea, and normal growth and development
6-month-old
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.
9-month-old
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.
12-month-old
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.
3 y/o
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.
Costochondritis
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
Neurocardiogenic syncope
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.
Precordial catch
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
Asthma
chest pain during exercise, coughing,
respiratory distress, wheezing, coughing at night
GERD
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
RDS
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
TTN
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)
pneumothorax
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)
CHF
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
Meconium Aspiration Syndrome
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)
hypothermia of the newborn
Acrocyanosis (blue hands&feet), Cool extremities, Lethargy, Bradycardia, Apnea, Poor feeding, respiratory Distress (grunting, nasal flaring, and retractions), Tachypnea
pneumonia in neonate
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.
pneumonia in infant
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.
pneumonia in toddlers
* 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
pneumonia in Older children and adolescents
Cough, Vomiting, Abdominal pain or tenderness, fever constitutional symptoms, such as headache, pleuritic chest pain, and vague abdominal pain, diarrhea, pharyngitis, and otalgia/otitis
Croup
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)
epiglottitis
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)
Pyloric Stenosis
Feed lustily then projectile vomit, substernal olive mass, metabolic acidosis
neonatal seizure
apnea, pedaling of legs, abn mouth/tongue mvmt, staring, tonic limb posturing, may be conscious
Hyaline Membrane Disease
shortly after birth, tachypnea, grunting, chest retrations, nasal flaring, cyanosis, apneic spells, breath sounds decreased on ausc
Pneumothorax
may be resp distress/cyanosis, may be asymp
TTN (transient tachypnea of the newborn)
tachpynea
(if any cyanosis/grunting/retracting, is minimal)
Meconium aspiration
tachypnea, increased chest diameter, cyanosis, staining of umb cord and under fingernail tips
Amniotic Fluid aspiration
achypnea, cyanosis,
Necrotizing enterocolitis
abd distension, emesis, gastric retention, hematochezia (frank or occult)

(lethargy, apnea, bradycardia, hypothermia, diarrhea)
herpetic gingivo stomatitis
fever, submandibular LAD, anorectic, oral vesicles all over/rupture early
herpes labialis
ulcers in mucocutaneous jcn w/red bases
chicken pox (VZV)
-fever
-malaise
-rash = papules-->vesicles-->pustules-->scabs-->scars
(in crops, central to periph)
Shingles (VZV)
fever, malaise, rash (same as chicken pox) along dermatome then post-herpetic neuraligia
Infectious mono (EBV)
fever, sore throat, cervical LAD (esp post chain), severe malaise and fatigue, splenomegaly
(maculopapular rash, Alice-in-Wonderland syndrome, periorbital edema)
Roseola Infantum (exanthum subitum)
fever --> 3-4days later, drops and truncal rash appears --> rash for 24h
FEVER CRASH + ROSIE RASH
mnemonic for exanthms and fever
EXANTHEM DAYS FEVER
Children Chicken Pix 1
Scratch Scarlet Fever 2
Small Small Pox 3
Masses Measles 4
Terribly Typhus 5
Terribly
Scarlet Fever
2 day fever, sandpaper truncal rash (desquam at end of week 1), circumoral pallor, rash in deep creases (Pastia's sign), phayngotonsillirtis, strawberry tongue
Measles (rubeola)
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)
Rubella (german measles)
mild uri Sx, LAD (esp retroauricular), rash
Rocky Mt Spotted Fever
fever, prostration, HA, vomiting
-rash on 2nd-4th day (starts periph to central, papular-->petechial)
Lyme disease
Stage I = RASH (red papular)
Stage II = NEURO (facial weakness) or cardiac abnormalities
Stage 3 = ARTHRITIS (esp knees)
5th Disease (erythema infectiosum)
slapped cheek rash, then maculopapular rash on trunk that fades w/central clearing, then lacy/reticulated rash
Meningococcal disease
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
Kawasaki disease
fever of 5 or more days PLUS at least 4 of:
-bilat nonexudative conjunctivitis
-mucosal changes
-periph extrem changes
-rash
-cervical LAD
Acute Otitis Media
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
UTI
in infants/young --> fever, vomiting

in older --> dysuria, abd pain, incontinence, frequency, urgency
Reye syndrome
persistent vomiting develops over 1-2 weeks, lethargy-->drowsiness-->coma, seizures
acute nasopharyngitis (rhinovirus)
rhinorrhea, fever, irritability
pharyngitis/tonsilitis
fever, sore throat, cervial LAD
sinusitis
fever, HA, facial pain, congestion (nasal), periorbital edema, cough, rhinorrhea
dphtheria
fever, grey-white membrane in pharynx, stridor
acute bronchitis
persistent cough, wheeze, substernal chest pain, rhonchi
acute bronchiolitis (rsv)
apnea, rhonchi, rales, tachypnea, chest retractions, wheezing, fever
mycoplasma pneumonia
cough, fever, HA, sore throat
-sever illness unusual
Chlamydial pneumonia
rhinorrhea, congestion, fussiness, fever, conjunctivits, dry cough, tachypnea
laryngomalacia
congenital inspiratory stridor from birth, altered by position, no retractions
asthma
wheezing (sudden or insidious) on expiration, cough, chest tightness, Sx worse at night, hyperinflated chest
acute diarrhea
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
Intusussception
bouts of abd pain w/screaming and vomting, red currant jelly stool, susage shaped mass in RUQ, mass felt per rectum
acute appendicitis
pain (epigastric/periumbilical), anorexia/nausea/vomiting (after pain), local abd tenderness, fever
pancreatitis
anorexia, fever, vomiting, nausea, worsening pain (epigastric) that's worse w/meals, abd distension/tenderness
ulcerative colitis
bloody diarrhea, colicky abd pain w/defecation, tenesmus, anorexia, nausea, vomiting, wt loss
crohn's disease
(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
IBS
abd pain relieved by BM, change in steel freq/appearance, abd distension, no wt loss, better at night
celiac sprue
diarrhea, abd distension, irritability, FTT, anorexia
-assoc w/dermatitis herpetiformis
PUD
bloody (occult) stools, recurrent abd pain (epigastric) w/meals or nocturnal, tenesmua, nausea, vomiting, wt loss
Esophageal atresia
chough, choke, cyanosis after 1st feed
GERD
excessive but nonprojectile vomiting, irritability, excessive crying, arching of neck, apnea, stridor, FTT
duodenal obstruction
bilious vomiting right after born
malrotation
bilious vomiting right after born
Meconium ileus
vomiting, abd distention and no stools right after born
Hirschsprung disease
constipation (may alternate w/diarrhea)
neonatal hypoplastic left colon
abd distension, failure of passage of meconium in 1st 48h, bilious vomiting
imperforate anus
dimple instead
transposition of great vessels
severe cyanosis in first few post-birth hrs, tachypnea, dyspnea
hypoplastic L heart syndrome
severe cyanosis in first few post-birth hrs, dyspnea, all pulses weak/absent
truncus ateriosus
dyspnea, FTT, ejection click and systolic murmur
total anomalous pulm venous drainage
cyanosis, dyspnea, S2 fixed and wise split
ASD
S2 fixed and wise split with NO cyanosis
Tetralogy of Fallor
mild cyanosis at birth gradually increases, systolic thrill at L sternal border, "tet" (blue) spells (dyspnea, cyanosis, restlessness, syncope), squatting after exercise
VSD
small defects asymp, large = dyspnea, FTT, pansystolic murmur on L sternal border
PDA
may be asymp
tachycardia, bounding pulses, continuous machinelike murmur of 2nd IC space (pulm)
Coarctation of Aorta
infant ---> dyspnea on feed, sudden CHF signs or can be asymp
femoral pulses decreased/absent but brachial fine/high
CHF
tachycardia, tachypnea, cardiomegaly, hepatomegaly
hypertrophic cardiomyopathy
heart murmur may be only sign
may get dyspnea, syncope w/activity, fatigue, palpitations, chest pain
MCC sudden death in young adults
ALL
fever, malaise, irritability, pallor, fatigue, gingival swelling/parotitis, LAD, arthralgias, hemorrhage (petechiae, etc)
raised ICP
HA, vomit, papilledema, 6th CN palsy (can't abduct)
transient synovitis of hip
painful, self-limited
Legg-Calve-Perthes disease
painful limp, abduction/int rotation limited
5-10 y/o
slipped capital femoral epiphysis
painful limp, abduction/int rotation limited
10-20 y/o
acute or gradual
septic arthritis
<5 y/o
sudden onset
painful jt mvmts
systemic sx (fever, etc)
Kept flexed to avoid pain
acute post-strep glomerulonephritis
proteinuria
hematuria
oligouria
edema (periorbital esp)
HTN
membranous glomerulonephritis
microscopic hematuria
membranoproliferative glomerulonephritis
proteinuria
hematuria
HTN
HUS (hemolytic uremic syndrome)
prodrome = diarrhea (bloody)
anemia, acute renal failure
auto rec PKD
flank masses bilat, oligohydramnios, Potter sequence, severe HTn
auto dom PKD
enlarged kidneys, hematuria, abd pain, HTN