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39 Cards in this Set

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FTT - ↓wt,N ht, N HC
caloric insufficiency
↓ intake
hypermetabolic state
↑ losses
FTT - ↓Wt, ↓Ht, N HC
structural dystrophies
endocrine disorder
familiar short stature
constitutional growth delay
FTT - ↓Ht, ↓Wt, ↓HC
intrauterine insult
genetic abnormality
Organic FTT causes (broad categories)
inability to feed
inadequate absorption
inappropriate use of nutrients
↑ energy requirements
↓ growth potential
Inability to feed causes
insufficient milk production
poor retention - GERD, V
anorexia (e.g. d/t chronic disease)
Inadequate absorption
malabsorption
- celiac
- CF
- pancreatic insufficiency
Loss from GIT
chronic D, V
inappropriate utilization of nutrients
renal loss (tubular disorders)
inborn errors of metabolism
endocrine
- DM
- DI
- hypopituitism
- congenital hypothyroidism
Increased energy requirements causing FTT
pulmonary disease - CF
cardiac disease
endocrine - hyperthyroidism, hypopituitism, DI
malignancies
chronic infection
inflammatory - SLE
Decreased growth potential causing FTT
specific syndromes
chromosomal abnormalities
GH deficiency
intrauterine insults:
- FAS
- TORCH infections
heart murmurs
50-80% of kids at some point
have audible murmurs
most functional
audible/accentuated during high output states (fever, anemia)
Characteristics of an 'innocent' murmur
nothing on Hx/PE
SEM (except venous hum - continuous)
grade <3/6
physiologically split S2
No extra sounds or clicking
murmur varies with change in position
Characteristics of pathological murmur
S/S of cardic dz
- FTT, exercise intolerance
diastolic, pansystolic or continuous
>3/6
fixed split or single S2
presence of extra sounds/clicks
no change in murmur with position change
Name 5 innocent heart murmurs
Still's
pulmonary ejection
venous hum
supraclavicular arterial bruit
peripheral pulmonic stenosis
Still's murmur (description and DDx)
vibratory, LLSB or apex, SEM
DDx
subaortic stenosis
small VSD
Pulmonary ejection murmur (description and DDx)
soft, blowing, ULSB, SEM
DDx
ASD
pulmonary stenosis
Venous hum (description and DDx)
infraclavicular hum, continuous, R>L
DDx
PDA
Supraclavicular arterial bruit (description and DDx)
low intensity, above clavicles
DDx
AS
bicuspid AV
Peripheral Pulmonic stenosis (description and DDx)
neonates, low pitched, radiates to axilla and back
DDx
PDA
pulmonary stenosis
cutis marmorata/acrocyanosis
= vasomotor response
- usually N (especially in premies)
vernix caseosa
soft, creamy white layer
- common in premies
- disappears by term
- peeling of extremities in post-term babies
slate grey nevus of childhood
= mongolian spots
- bluish-black macules over lower back and buttocks
- common in black, asian, aboriginal infants
capillary hemangioma
raised red lesion that increase in size after birth and often involute b/t 1-4yrs
erythema toxicum
erythematous vesico-papular rash
- comes in crops
- self-limited to 1st 24-48hrs (gone within 1wk)
pustular melanosis
defined by brown macular base with dry vesicles
more common in black infants
diaper dermatitis DDx
irritant contact dermatitis
seborrheic dermatitis
candidiasis
psoriasis
Name 4 common pediatric infections that feature "diffuse erythematous macular eruptions"
coxsackie
EBV - mononucleosis
enteroviruses
roseola
measles exanthum
erythematous macular eruption beginning on head and spreading downward
rubella exanthum
erythematous macular eruption beginning on face and spreading to rest of body
scarlet fever exanthum
erythematous, finely papular eruption first appearing in axilla, groin and neck
varicella exanthum
diffuse vesicular pustular eruption beginning on thorax and spreading to extremities
Itchy eruptions in childhood
UC-SCAB
Urticaria
Contact dermatitis
Scabies
Chicken pox
Atopic dermatitis
Bites
Causes of Vomiting in the newborn
TEF
Duodenal atresia
pyloric stenosis
malrotation of the intestine
clinical presentation of TEF
+/- hx maternal polyhydramnios
vomiting, coughing, gagging (after several mnths if no assoc esophageal atresia)
cyanosis with feeds
resp distress, recurrent pneumonia
frothy bubbles of mucus in mouth and nose that return after suctioning
VACTERL associations in 50%
clinical presentation of duodenal atresia
50% premies
assoc w down's
+/-hx maternal polyhydramnios
bile stained vomiting (of distal to CBD)
no abd distension
dehydration
double bubble sign
DDx duodenal atresia
annular pancreas
aberrant mesenteric vessels
pyloric stenosis
3 "P's" of pyloric stenosis
palpable mass
peristalis visible
projectile vomiting (age 2-4wks)
clinical features of pyloric stenosis
non-bilious projectile vomiting after feeding
infant hungry & alert - will refeed
constipation, FTT
dehydration
prolonged physiological jaundice
gastric peristalsis - LUQ → epigastrium
"olive sign" at margin of right rectus abd
hypochloremic metabolic alkalosis
Malrotation of the intestine clinical features
80% have symp in first 2 months
3 presentations:
1. recurrent vomiting
2. FTT w vomiting
3. sudden onset abd P then shock
- if vomiting bilious = malrotation w volvulus until proven otherwise
distended abd
Dx of intestinal malrotation
UGI studies
- duodenum not fixed
- spiral jejunum
- mobile cecum