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1289 Cards in this Set
- Front
- Back
How long s/p birth:
-Colustrum available -Milk available |
Colustrum: immed
Milk: w/in 40h |
|
Infant WCC:
What s/sx is most sensitive indicator of NUTRITIONAL status? |
WEIGHT
|
|
S/p birth:
Neonate feeds how many times in first 24h? |
Immed --> 8-12x
|
|
What age:
Introduce free H2O? |
4-6mo
(once taking solid foods) |
|
First days of life: does colustrum meet nutritional reqs?
|
YES
|
|
0-6mo:
Does soy formula have enough protein? |
yes
|
|
Is it safe to combine formula concentrate with water in 1:1 ratio?
|
YES - if concentrate
Never safe to dilute non-concentrated formula to "stretch it out" |
|
Calorie reqs for infant that is:
-term -preterm -very low bw |
Term: 100-120 cal/kg/d
Preterm: 115-130 Very low bw: 150 |
|
Do breast-fed infants req vitamin D? Formula fed?
|
ALL infants req supp vitamin D
|
|
ALL infants (breast & formula) req what supplement?
|
Vitamin D
|
|
What age:
Introduce solid foods (rice cereal) |
4-6mos
(IRON-fortified solids) (many premies NOT ready for solids at 4mos) |
|
What age:
Eat STRAINED foods (pasta, toast, banana) |
9mos
|
|
9mo: req how many calories/day? What % from milk/formula?
|
100 cal/kg/d
75% breastmilk/formula |
|
What age:
Infant feeds themselves |
9mos
|
|
What age:
Introduce toast, pasta, banana |
9mo
|
|
What age:
Introduce MEAT |
9mo
|
|
Infant: how often introduce 1 new food?
|
q5-7 days start 1
(ID allergies) |
|
Infant:
when introduce hot dog? |
NEVER - choke
|
|
Term infant:
Gains how much wt per day? |
20-30 g/day
|
|
4mo: weights ____x birth weight
|
2x bw
|
|
What age:
Weigh 2x birth weight |
4mo
|
|
What age:
Weight 3x birth weight |
12mo
|
|
1yo: weighs ___x birth weight
|
3x
|
|
<1yo:
-# wet diapers per day -# stools per day |
6+ wet
6-8 stools |
|
What age:
2x birth LENGTH |
4mo
(same as 2x birth weight) |
|
4mo: ___x birth length
|
2x length
|
|
Red reflex: hold opthalmoscope how far from infant?
|
10 inches
|
|
Red reflex: what 1st see?
|
at BIRTH
|
|
Red reflex present or absent?:
Cataracts |
Absent
|
|
Red reflex present or absent?:
Glaucoma |
Absent
|
|
Red reflex present or absent?:
Retinoblastoma |
Absent
|
|
Red reflex present or absent?:
Chorioretinitis |
Absent
|
|
Rectal exam on infant:
-when perform? (what scenario) -what position hold infant? |
Only if abd mass; not part of routine
Pt SUPINE (on back) --> flex knees |
|
Enlarged thyroid common or rare in child?
|
RARE
|
|
Enlarged LNs:
-common or rare in toddler? -non/tender? -shotty located in what areas? |
Common
NT Shotty in ANT & POST cervical |
|
Murmur in toddler:
-most non/fxnl? |
FUNCTIONAL
|
|
NEW murmur: common due to congen HD?
|
No
--rarely 2/2 congen |
|
In-toeing in toddler: commonly due to what anatomic variant?
|
Tibial torsion
|
|
Tibial torsion in toddler: leads to what type of gait?
|
IN-TOEING
|
|
What is youngest age you administer INFLUENZA?
|
6mo
|
|
Immunization S/E: fussy + fever
-how long last? -need to see doc? |
Commonly last 24h
If >24 --> see doc |
|
What age:
Baby sleeps through night |
4-6mo
|
|
How position in car:
<1yo |
carseat, middle back seat, face back
|
|
How position in car:
<10kg |
carseat, middle back seat, face back
|
|
How position in car:
1-4yo |
Carseat, backseat, face forward
|
|
How position in car:
4-8yo |
Booster, back, forward
|
|
How position in car:
8-12yo |
Backseat, face forward
|
|
SURVEY or SCREEN?:
Bright futures |
Survey
|
|
SURVEY or SCREEN?:
PEDS test |
Screen
|
|
SURVEY or SCREEN?:
M-CHAT |
Screen
|
|
What is name for peds SURVEY most commonly used?
|
Bright Futures
|
|
What age:
Laughs, smiles |
2mo
|
|
What age:
Sits unsupported |
6mo
|
|
What age:
Look for dropped item |
6mo
|
|
What age:
Stranger RECOG |
6mo
(contrast anxiety- 9mo) |
|
What age:
Stand w/support |
9mo
|
|
What age:
mama, dada (nonspecific) |
9mo
|
|
What age:
Patty-cake |
9mo
|
|
What age:
STRANGER ANX |
9mo
|
|
What age:
Stands alone |
1yo
|
|
What age:
Mama, Dada - SPECIFIC |
1yo
(contrast non-specific - 9mo) |
|
Infant screening: do low measures of social/cog & language --> predict intellectual delays?
|
YES
|
|
What age:
Tricycle |
3yo
|
|
What age:
CIRCLE |
3yo
|
|
What age:
Cross |
3yo
|
|
What age:
Knows name, age, sex |
3yo
|
|
3yo: can draw what shape?
|
Circle, cross
|
|
What age:
Knows 2 actions, 1 color |
3yo
|
|
3yo: knows how many actions? colors?
|
2 actions
1 color |
|
What test:
Parents answer illustrated 30-item question at designated intervals |
Ages & Stages Questionarre (ASQ)
|
|
What test:
5 key areas (commun, gross & fine motor, prob-solv, personal/social) |
Ages & Stages (ASQ)
|
|
Ages & Stages Questionairre (ASQ):
-use what ages? -how many Qs? -how long to fill out? -tests what areas? |
0-5yo (contrast PEDS - 0-8)
30 Qs 10-15 min 5 areas: communication, gross motor, fine motor, prob-solving, social/personal |
|
Low or high sens & spec:
-ASQ -PEDS test |
Both high spec & sens
|
|
What test:
parent answers Y/N/sometimes --> color-coded score --> user guide to assess risk |
ASQ
|
|
PEDS test:
-useful what ages? -how many Qs? -what are 2 uses? |
0-8 yrs
10q (3 min) uses: 1. Develop screen test 2. Assess parent's concerns |
|
What test:
10 questions --> use to screen development OR assess parent's concerns |
Parent's Eval of Developmental Status (PEDS test)
|
|
What test: used in:
-0-5yo -0-6yo -0-8yo |
0-5: ASQ
0-6: Denver II 0-8: PEDS |
|
What test:
Reqs direct observation & parent report |
Denver II
|
|
Denver II:
-use what ages? -tests what areas? -low,mod or high sens & spec for development delay? |
0-6yo
Tests (4): gross, fine, language, social MODERATE sens & spec |
|
What test:
TEACHES developmental milestones |
Denver II
|
|
What test:
Reqs child cooperation --> time-consuming |
Denver II
|
|
Premature birth:
CORRECTED AGE = |
Chronologic age - days/mos prematurity
|
|
Neuroblastoma in abdomen <1yo:
-sympto? jaundice? -how affect G&D? |
Asympto, no jaundice
May see normal G&D |
|
What dz:
Abd CT: heterogeneous, cystic mass with calcifications |
Neuroblastoma
|
|
Neuroblastoma in abdomen <1yo:'
2 sites of mets |
Chest LNs
Posterior mediastinum |
|
What dz:
Small round BLUE CELLS |
Neuroblastoma
(e.g. abdominal) |
|
Neuroblastoma in abdomen <1yo:
How appear tumor cells (histo) |
small round blue cells
|
|
What dz:
Bone marrow ROSETTES |
Neuroblastoma
|
|
What dz:
Tumor cells w/dense, hyperchromic nuclei |
Neuroblastoma
|
|
Neuroblastoma in abdomen <1yo:
How affect CBC? |
BM infiltrate --> ANEMIA, other cytopenia
|
|
Neuroblastoma in abdomen <1yo:
In/decrease urine HVA:VMA? |
INCREASE
|
|
What dz:
Abdominal mass in infant + increased HVA/VMA |
Neuroblastoma
|
|
Wilms tumor: see LAD?
|
NO
|
|
Abdominal neuroblastoma:
CT appears homo/heterogeneous? cysts? |
HETERO
CYSTS (hemorrh, necrosis) |
|
Which has more hemorrhage & necrosis:
Wilms tumor or neuroblastoma? |
Neuroblastoma
(appears more cystic on CT) |
|
What dz:
Abd mass + heterogenous mass (CT) + PSEUDOCAPSULE |
Wilms tumor
|
|
Wilms tumor: CT shows demarcation b/w tumor & parenchyma?
|
YES
=pseudocapsule |
|
Wilms tumor:
where mets? |
PULM (see on CXR)
(contrast neuroblastoma - mets to chest LNs & post mediastinum) |
|
Wilms tumor: req BM aspiration?
|
NO - only if:
1. pain 2. unfavorable tumor histo |
|
Wilm's tumor: affect UA?
|
Yes - hematuria
|
|
Abdominal TERATOMA in infant: common or rare?
|
RARE
|
|
Abdominal teratoma:
see jaundice? pallor? |
No neither
|
|
Hepatic tumor in infant: common or rare? see jaundice? affect G&D?
|
RARE
jaundice decreased G&D |
|
Anemia in 3yo:
#1 etio |
Iron-deficiency 2/2 malnutrition
|
|
Anemia in 3yo:
Is anemia itself a good predictor of Fe2+ deficiency? |
NO -- poor predictor of iron def in diet
|
|
HIV in infant: expect anemia?
|
YES (ACD)
|
|
What dz:
Microcytic anemia with decreased RDW |
thalasemmia, sickle cell dz
|
|
Micro/normo/macro anemia:
-SCD -Thal |
Both MICRO
|
|
Mild (>9) or severe (<9) anemia:
Aplastic anemia |
severe
|
|
Mild (>9) or severe (<9) anemia:
Folate deficiency |
severe
|
|
Mild (>9) or severe (<9) anemia:
B6 deficiency |
Severe
|
|
What 3 nutritional defs can cause anemia?
|
Iron
Folate B6 |
|
3yo w/IDA: req iron supplement OR can just encourage iron-rich foods?
|
Give Fe2+
|
|
INITIAL labs in anemia w/u:
-retic? -smear? |
YES
|
|
INITIAL labs in anemia w/u:
-stool blood? -UA? |
YES
|
|
Iron-def anemia:
-micro/macro? -hypo/hyperchromic? -DEC/INCREASED retics? |
Micro, hypo
DECREASED RETICS |
|
Hemophilia A or B:
Decreased VIII |
A
|
|
Hemophilia A or B:
Decreased IX |
B
|
|
Hemophilia A: what def?
|
Decreased VIII (8)
|
|
Hemophilia B: what def?
|
Decreased IX (9)
|
|
Hemophilia: how affect:
-PTT -Bleed time |
PTT: prolonged
Bleed time: normal |
|
What dz:
Prolonged PTT, normal bleed time |
Hemophilia
|
|
How inherit:
Hemophilia |
X- RECESSIVE
|
|
How inherit:
vWD |
AD
|
|
What dz:
-prolonged PTT, normal bleed time -prolonged bleed time, normal PT |
HemoPhilia: prolonged PTT, normal bleed time
vWD: prolonged bleeD time, normal PT |
|
What dz:
Post-tonsillectomy bleed |
vWD
|
|
What dz:
Epistaxis |
vWD
|
|
What dz:
Gingival bleed |
vWD
|
|
vWD: how inherit
-Type I -II -III |
I&II: AD
III: AR |
|
vWD: what is defect in:
-type I -II -III |
I: decreased vWF (mild)
II: QUAL defect III: undetectable vWF (severe) |
|
vWD: which TYPE?
Decreased vWF; MILDEST |
I
|
|
vWD: which TYPE?
Most common (70%) |
I
|
|
vWD: which TYPE?
inherited AR |
III
|
|
vWD: which TYPE?
QUAL defect |
II
|
|
vWD: which TYPE?
Undetectable vWF |
III
|
|
vWD: which TYPE?
Most severe |
III (undetectable vWF)
|
|
vWD: how tx?
|
Intranasal OR IV desmo
|
|
What dz?:
Tx w/intranasal or IV desmopressin |
vWD
|
|
Atopic dermatitis: 2/2 what TWO immune mxns?
|
1. Increased IgE
2. Dysregulated Ab production (encoded by DIFFERENT gene sets) |
|
Atopic dermatitis:
-apply lubricant? -admin anti-inflamms? |
Yes- lube
ST anti-inflamms (alternate b/w low & high concens) |
|
What age:
Able to eat at table |
3yo
|
|
3yo nutrition: normal to prefer BLAND foods?
|
yes
|
|
What age:
1st dentist visit |
3yo
|
|
What age:
d/c bottle |
1yo
|
|
3yo: limit how many meals & how many snacks?
|
3 meals, 2 snacks
|
|
Can you give pre-schooler: H2O w/ice?
|
YES - prefer
|
|
How determine:
WEIGHT AGE |
Age at which wt plots @ 50%
|
|
Predispose to UNDER or OVERweight:
Bardet-Biedl syndrome |
Over
|
|
Predispose to UNDER or OVERweight:
Cohen syndrome |
Over
|
|
Does high birthweight correl w/childhood obesity?
|
YES
|
|
What % of 6-19yo are obest?
|
15%
|
|
Childhood obese: assoc w/SES?
|
Yes -- low SES
|
|
What % will become obese adults?:
-obese 4yo -obese adolescent |
4yo --> 20% obese adults
adol --> 80% obese adults |
|
What is increased risk that child will be obese:
-1 obese parent -2 obese parents |
1: 3x
2: 10x |
|
Normal 3yo: which is stronger predictor of obesity in adulthood:
Child's current wt OR parental obesity |
Parental obesity
|
|
Early adolescence: normal to see dec/increase insulin sensitivity?
|
Adol --> DECREASE insulin sensitivity (i.e. normal to see transient insulin resistance) --> increase wt gain
|
|
Menarche --> increase/decrease risk of obesity?
|
Increase
|
|
BMI =
|
Kg/m2
|
|
BMI: what # and %tile:
-overweight -obese |
Over: 25-30 (85-95%)
Obese: >30 (>95%) |
|
What fraction of obese children are hypertensive?
|
1/3
|
|
Obesity: assoc with restrictive lung disease? reactive?
|
Restrictive (inc OSA, pickwick)
NOT assoc w/reactive |
|
Obesity: assoc w/Blount disease?
|
YES
(outward bowing of tibia) |
|
What dz:
Wide physis (hip x-ray) |
SCFE
|
|
SCFE: wide or narrow physis?
|
WIDE
|
|
SCFE: displace what 2 components of femur?
|
HEAD & NECK (thru physeal plate)
|
|
What dz:
obese kid w/delayed sex maturation & antalsic gait |
SCFE
|
|
SCFE: see limited INT or EXT rotation of hip?
|
limited INTERNAL rotation
|
|
ADHD: sxs for how long? # settings?
|
6+ mos and before 7yo
2+ settings |
|
ADHD: req how many sxs (inattn or hyper)?
|
6+
(either type) |
|
How distinguish inattention ADHD from sleep disorder (e.g. OSA)?
|
Sleep: decreased sleep & tired
ADHD: poor sleep but NOT over-tired |
|
MDD in child: high rate of converting to what psych condition?
|
MANIA
|
|
ADHD: assoc w/oppositional defiance disorder? conduct disorder?
|
BOTH
|
|
ADHD: how tx? (1 drug; know dosing)
|
Sustained-release methylphenidate (concerta) 18mg po bid
BIDBIDBID |
|
T2DM: accounts what % total child DM?
|
10-50%
|
|
Childhood DM: inc/decrease appetite?
|
INCREASE (polyphagia)
|
|
What # to dx DM:
-Random BG -Fasting -2h OGT --Which method preferred to dx DM? |
Random: >200
Fast: >120 2h OGT: >200 FASTING PREFERRED |
|
DM: screen ALL overweight children? when start screen (2 options)? screen how often?
|
Screen if: overwt (85%) + 2 (Fhx, sxs, etc)
Start 10yo OR puberty onset Screen q2 years |
|
How define NORMAL BP in child?
|
Both SBP & DBP <90% (age/gender/ht/wt)
|
|
What age:
Start routine BP check |
3yo
|
|
Name for: SBP & DBP:
-90-95% -95-99% ->99% |
90-95%: pre-hypertension
95-99%: stage I HTN >99: stage II |
|
What % SBP & DBP:
Pre-hypertension |
90-95%
|
|
What % SBP & DBP:
Stage I HTN |
95-99%
|
|
What % SBP & DBP:
Stage II HTN |
>99%
|
|
Increased BP in >6yo: most due to 1' or 2' HTN?
|
PRIMARY
|
|
What dz:
Young child with HTN + no family hx HTN |
Ao coarctation
|
|
Childhood HTN: damages which heart chamber?
|
LVH
|
|
Order what labs: obese child with:
-85-95%, no risks -85-95%, risks ->95% |
Order what labs: obese child with:
-85-95%, no risks: fasting lipids -85-95%, risks: ALT, AST, BG ->95%: BUN, Cr |
|
Obese child: how tx:
-85-95% >95% in pre-teen, teen |
85-95: slow wt GAIN (until <85%)
95: active wt loss (gradual) Pre: <1lb/mo Teen: 1 lb/mo |
|
Obese child:
-limit TV hrs? -amt exercise |
TV <2h
Exercise: 60min every day |
|
Pedigree: try to get how many generations?
|
3rd
|
|
How inherit:
Marfan |
AD
(DOM!) |
|
How inherit:
neurofibromatosis |
AD
|
|
How inherit:
Duchenne's Musc Dys |
XR
|
|
How inherit:
MELAS |
mito
|
|
Is it EVER possible for male to transmit mito dz?
|
Rare; can see if nuclear gene mutation --> dysreg mito protein
|
|
How inherit:
CF |
AR
|
|
How inherit:
Tay-Sachs |
AR
|
|
Name for:
genetic test to determine the effects of a med |
Pharmacogenetics
|
|
All states req neonatal screen for what 2 dzs?
|
1. PKU
2. Hypothyroid |
|
What imaging:
Posterior fossa |
MRI
|
|
#1 SOLID childhood cancer
|
Brain tumor
|
|
Ped brain tumor:
Neuroectodermal tumor comprise what % ped brain tumors? |
25%
|
|
What is most common TYPE of brain tumor (histo)?
|
Neuroectodermal (medulloblastoma) - 25%
|
|
Astrocytoma: more common in cerebellum or brainstem?
|
Cerebellum
|
|
Ped brain tumor: which more common:
astrocytoma or glioma |
astrocytoma
|
|
How tx: unresectable brain tumor?
|
Surgical histo confirm --> XRT & chemo, possible BMT
|
|
Non- or Lateralizing ataxia:
Cerebellitis |
NON (affects entire cerebellum)
|
|
L cerebellar tumor:
-fall which direction? -nystagmus which direction? -past-pointing in which direction? |
ALL LEFT
|
|
If pt presents with LEFT-sided nystagmus --> suspect tumor on WHICH HEMI?
|
LEFT CEREBELLUM
|
|
Basilar migraine: see:
-vomit? -vision change? -increased ICP? |
Vomit & vision change
NO INCREASE ICP |
|
#1 etiology ataxia in child
|
CEREBELLITS
(No increase ICP) |
|
Can toxins/meds increase ICP? See non/lateralizing ataxia?
|
YES! Can increase ICP --> NON-lateralizing ataxia & nystagmus
|
|
Delivering bad news: is it OK to TOUCH pt?
|
YES
|
|
Teen interview: should you set up expectation for interview at beginning?
|
Yes
|
|
Teen: start with specific OR open-ended questions?
|
SPECIFIC
|
|
Teen interview: if parent refuses to leave --> should you advocate for adolescent privacy?
|
Yes
|
|
T/F offer HIV test to ALL sexually-active >13yo
|
TRUE
|
|
Normal range puberty:
-F -M |
F: 8-13yo
M: 10-15yo |
|
Tanner staging: assess what 2 features (M, F)?
|
M: pubes, testes
F: pubes, breasts |
|
Name for:
Measure of BODY COMPOSITION |
anthropometry
|
|
Which measure:
Most sensitive indicator of growth abnormalities |
growth VELOCITY
|
|
PTT: intrins or extrins?
|
Extrins
|
|
EBV: what % 35-40yo infected?
|
95%
|
|
EBV: infection in adol --> what % develop mononucleosis?
|
35-50%
|
|
EBV:
-fever? -LAD? -sore throat? -how long is incubation? |
fever + sore throat + swollen LNs
Incubates 4-6w |
|
HIV+ mother --> what % risk infection (if untreated)?
|
25-30%
|
|
Maternal HIV: increase risk transmission if:
-SVD or C/S? -ROM > ___h -what gestation? |
SVD
ROM >4h <37w |
|
Mother w/unknown HIV risk --> would you perform newborn screen?
|
YES
|
|
Neonatal HIV: see splenomeg?
|
possibly
|
|
TORCH: what stand for?
|
Toxo
Other: HIV, HBV, parvo, syph Rub CMV HSV-2 |
|
Congenital toxo: how screen:
-0-6mo ->1yo |
0-6mo: infant IgM or IgA
>1yo: IgG |
|
Does presence of maternal HBcAb predict risk transmit? HBsAg?
|
HBcAb: no (could indic past infnx)
HBsAg: yes |
|
Next step: presence of HBsAg in mother --> ?
|
Give mother AND neonate:
1. HBV vaccine 2. HBIg |
|
Detect via what test:
Maternal HIV |
PCR
|
|
Congenital rubella: how test:
-0-6mo ->1yo |
0-6mo: IgM
1yo: IgG |
|
Congenital CMV: how detect in neonate? next management step?
|
URINE CULTURE in weeks 0-3
(if pos --> routine hearing test) |
|
Which congenital infection:
if positive --> routine hearing test |
CMV
|
|
CMV:
-hearing loss abrupt or progressive? -occurs birth or 1yo? |
Progressive
Can occur birth OR up to 1yo (continuously monitor) |
|
What dz:
Infant w/microcephaly, intracranial Ca2+, lissencephaly, rash |
congenital CMV
|
|
CMV:
-what structure see Ca2+? -in/decrease # gyri? -assoc w/eye findings? |
Ca2+ esp in frontal horns of lat vents
Lissenceph: decrease gyri, increase cortex thickness Chorioretinitis |
|
congenital CMV: how tx neonate?
|
Antivirals ONLY IF BABY IS IMMUNOCOMPROMISED
|
|
Routine neonate meds:
-how admin vitamin K? -Erythro eye drops covers which STD? |
IM vitamin K
Gonococcus |
|
Another name for:
Pediculosis capitis |
Lice
|
|
Nits =
- firm or loose attach to hair shaft? |
egg CASES of lice
firm attach --> difficult to remove |
|
What dz:
5-10mm linear lesions |
Scabies
|
|
Scabies: related to cleanliness?
|
NO
|
|
What dz:
SARCOPTES |
Scabies
(Sarcoptes scabiei) |
|
Scabies: how acquire?
|
Close contact
|
|
Scabies: what causes itchiness? When is itching worst?
|
Laying of eggs (NOT mite bites)
Worse at night |
|
Scabies: common locations?
|
wrist
elbow finger toe |
|
Scabies: how dx?
|
Scrape MULTIPLE lesions (burrows or papules) --> mineral oil --> light micro --> see mite, egg or FECAL PELLET
|
|
What dz:
Diagnose by scraping lesion --> mineral oil --> see FECAL PELLETS |
Scabies
|
|
What dz:
Scaling, cracks & fissures b/w toes |
Tinea pedis
|
|
Tinea versicolor: infection with what form of fungus?
|
YEAST form
|
|
Tinea versicolor: predisposed by excess HUMIDITY or DRYNESS?
|
humidity
|
|
Tinea versicolor: do lesions have scale?
|
YES - fine scale
|
|
What dz:
Lesion turns pink --> brown --> white; fine scale |
Tinea versicolor
|
|
Tinea versicolor: how tx?
|
Selenium sulfide lotion
|
|
Selenium sulfide lotion:
tx what dz? |
Tinea versicolor
|
|
Tinea versicolor:
-recurrence common? -how long for pigment to normalize? |
Common
May take mos to return pigment to normal |
|
Tinea capitis:
-How tx? (drug, duration) -2 alt txs |
SYSTEMIC griseofulvin (6-8w)
Alts: terbinafine, itraconazole |
|
What is dz:
Skin lesions dx as eczema & treated w/steroids --> worse lesion |
TINEA
(misdx as eczema --> steroids worsen tinea) |
|
Name for:
Allergic response --> inflamed, weepy boggy lesion |
Kerion
|
|
Kerion: what is underlying mxn? HOW TX?
|
Allergic response --> inflammed, weepy boggy lesion
Tx: ORAL steroids |
|
Which is more predictive of LT neuro outcomes:
Umbilical artery blood sample OR APGAR |
Umb art
|
|
Perinatal asphyxia: detect via sampling which blood vessel in cord?
|
Umb ARTERY --> detect hypoxia, acidosis
(NOT vein) |
|
GDM: predispose neonate to:
-hypo or hypergly? -hypo or hyperCa? |
Hypogly (due increased insulin)
HypoCa2+ |
|
GDM: is neonate at increased risk of resp distress?
|
YES
|
|
Fetal glucose: normally what fraction of maternal glucose?
|
2/3 maternal glucose
(glucose crosses placenta) |
|
GOAL BLOOD GLUCOSE IN NEONATE
|
41-50
|
|
Persistent pulmonary HTN of newborn:
-underlying etio -where does blood divert? |
Due elevated pulm vasc R
Blood divers through ductus arteriosus & PFO (bypasses lungs) |
|
Persistent pulmonary HTN of neonate: presents with tachy/bradycardia?
|
Tachy
(also tachypnea) |
|
Cyanotic newborn: order an O2 challenge test?
|
YES
|
|
Acrocyanosis at birth:
-usu resolves after how long? -when start to suspect congenital HD? |
Usu resolves 4-5h
After 8h warming --> suspect congen HD |
|
#1 etio respiratory distress in preterm
|
Resp Distress Syndrome (RDS)
aka Hyalien Membrane Dz |
|
Respiratory Distress Syndrome in neonate:
underlying etio |
Surfactant deficiency
|
|
Name for:
Neonatal dz caused by surfactant deficiency |
Respiratory distress syndrome
|
|
Respiratory Distress Syndrome in neonate:
-genetic component? -M or F? -C/S or SVD? |
More common if siblings w/RDS
M > F C/S w/out labor > SVD |
|
Respiratory Distress Syndrome in neonate:
If mother has GDM --> may see RDS in infant up until how many weeks gest? |
37
|
|
Neonatal with resp distress: which is more common if healthy mother and gest >34w:
RDS or transient tachypnea of newborn |
TTN
|
|
How distinguish (what test):
RDS vs. TTN |
CXR
RDS: air bronchograms, ground glass |
|
What dz:
Newborn with resp distress & CXR w/bronchograms & ground glass |
RDS
|
|
Transient tachypnea of newborn:
More common term or preterm? |
TERM !!!!
|
|
Transient tachypnea of newborn:
Underlying etio |
Delayed fluid clearance
|
|
Transient tachypnea of newborn:
Early or late onset? Mild or severe distress? |
Early onset, mild distress
|
|
Transient tachypnea of newborn:
-M or F? -C/S or SVD? -micro or macrosomy |
M > F (same as RDS)
C/S (same as RDS) MACROSOMY (esp DM) |
|
What dz:
Neonate w/resp distress & CXR w/perihilar streaking, coarse densities and WET LOOKING lungs |
TTN
(contrast RDS: bronchograms, ground glass) |
|
TTN or RDS:
Male |
BOTH
|
|
TTN or RDS:
Perihilar streaking |
TTN
|
|
TTN or RDS:
Fluffy densities |
TTN
(contrast RDS: ground glass) |
|
TTN or RDS:
Lateral view shows fluid in pleural space, fissures |
TTN
|
|
TTN or RDS:
WET LOOKING LUNGS |
TTN
|
|
Pneumothorax:
More common in premie? |
YES
|
|
Neonatal sepsis/PNA: assoc w/PROM?
|
Yes - may have subtle early findings like poor feed, lethargy
|
|
Meconium aspiration: occurs when in birth process?
|
In utero
OR 1st breath |
|
TTN: expect to resolve after how long?
|
12h
|
|
APGAR:
-how many categories? -points? |
5 categories - appear, pulse, grimace, activity, resp
2pts each |
|
Are low 1- & 5-min Apgars markers of intrapartum hypoxia?
|
NO - not conclusive
|
|
Which is better predictor of neonatal death:
1- or 5-min apgar |
5-min
(although best is umb art sample) |
|
What birthweight #s:
Extremely low bw |
<1,000 g
(contrast very low: 1k - 1,499) |
|
What birthweight #s:
Very low bw |
1,000-1,499
|
|
What birthweight #s:
Low bw |
1,500 - 2,499
(contrast very low: 1,000-1,499) |
|
What birthweight #s:
NORMAL |
2,500 - 4,000
|
|
Ballard score: estimates what? includes what criteria?
|
Gestational age (s/p birth)
Criteria: neuromuscular & physical maturity |
|
Dubowitz exam: what 3 categories?
|
Estims gestational age (alternative to Ballard score; older tech)
1. Preterm (<37w) 2. Term 3. Post (>42) |
|
Cephalohematoma: 2/2 what device?
|
VACUUM
|
|
If baby is LGA --> risk hypo or hypergly?
|
HYPO
(same if baby is SGA --- inadeq glycogen stores) |
|
If baby is SGA --> risk hypo or hyper gly?
|
Hypo (2/2 low glycogen store)
Same if baby is LGA (2/2 overproduction of insulin) |
|
SGA neonate: expect pale or ruddy?
|
RUDDY --- due polycythemia --> increased viscosity
|
|
Premature infant: do you need to establish breast-feeding before discharge?
|
YES
(risk hypothermia, decreased glycogen stores) |
|
Newborn:
Is 1st phys exam (at birth) a good indication of successful transition to extrauterine? |
YES
|
|
Newborn:
1st breath --> where does fluid in lungs go? |
Squeezed out (cxns, air) --> absorbed by PULMONARY LYMPHOCYTES
|
|
0-1h life: normal V/S:
-pulse -rr |
p 160-180
rr 60-80 |
|
2h life: normal V/S:
-pulse -rr |
p 120-160
rr 40-60 |
|
2h neonate: suspect resp distress if RR > ____
|
rr > 60
|
|
Neonate:
Use glucometer to confirm hypogly? |
NO - use to SCREEN
(NOT confirm) |
|
Neonate glucometer read:
If neonate BG <40 ---> what is next step? |
Meas serum BG (to confirm neonatal hypogly)
START TX WHILE WAITING |
|
Neonate glucometer:
Start tx if neonatal BG < ___ |
<40
|
|
If neonate with RDS --> order what 3 tests?
|
1. CBC w/diff
2. Blood cx 3. LP |
|
Tx hypoglycemic neonate if:
-symptomatic and BG <___ -asympto and BG <___ |
sympto & <45
asympto & <35 |
|
Hypoglycemic neonate: how tx?
|
5% dextrose in WATER --> then feed breast/formula (prevent rebound hypogly) --> monitor until BG > 40 & stable
If no respond H2O --> IV dextrose |
|
How define:
Microcephaly (what %s) |
HC <10% for GA
|
|
Jaundice: accum bili in what skin layer?
|
Epiderm
|
|
Jaundice:
Occurs what % newborns? |
60%
|
|
How does bilirubin travel in blood?
|
Binds ALBUMIN
|
|
Bilirubin:
Transported by albumin to what site? |
LIVER
|
|
Bilirubin:
Conjugated in liver by WHAT ENZYME? |
UDPGT
|
|
UDPGT: fxn?
|
Conjugates bilirubin (transported from blood to liver) with glucoronide
|
|
Bilirubin:
Conjugated to WHAT MOLECULE in liver? |
glucoronide (via UDPGT)
|
|
Conjugated bilirubin is excreted into bile in WHAT FORM?
|
Stercobilirubin
|
|
Unconj (indirect) or Conj (direct):
Physiologic jaundice |
Unconj
|
|
Unconj (indirect) or Conj (direct):
Breast milk jaundice |
UNconj
|
|
Unconj (indirect) or Conj (direct):
Breast feed jaundice |
Unconj
|
|
Unconj (indirect) or Conj (direct):
Direct Coombs jaundice |
Unconj
|
|
Unconj (indirect) or Conj (direct):
Jaundice 2/2 spherocytosis |
Unconj
|
|
Unconj (indirect) or Conj (direct):
PK deficiency |
Unconj
|
|
Unconj (indirect) or Conj (direct):
Jaundice due G6PD |
Unconj
|
|
Unconj (indirect) or Conj (direct):
Jaundice 2/2 cephalohematoma |
Unconj
|
|
Unconj (indirect) or Conj (direct):
Jaundice 2/2 bruising |
Unconj
|
|
Unconj (indirect) or Conj (direct):
Jaundice 2/2 swallowed blood |
UNconj
|
|
Unconj (indirect) or Conj (direct):
Crigler-Naijjar |
Unconj
(decreased bili clearance) |
|
Unconj (indirect) or Conj (direct):
Galactosemia |
Unconj
(decreased bili clearance) |
|
Unconj (indirect) or Conj (direct):
Hypothyroid |
Unconj
(decreased bili clearance) |
|
Unconj (indirect) or Conj (direct):
Jaundice 2/2 neonatal asphyxia |
Conj
(due liver ischemia) |
|
Unconj (indirect) or Conj (direct):
Jaundice 2/2 sepsis |
Conj
(liver isch) |
|
Unconj (indirect) or Conj (direct):
Jaundice 2/2 congenital metabolic toxins |
Cong
(liver isch) |
|
Unconj (indirect) or Conj (direct):
Jaundice 2/2 biliary atresia, intestinal malrotation |
COng
|
|
Physiologic jaundice:
-occurs in bili <___ -peaks what day? resolves what day? |
Bili <15
Peaks d3-4 --> resolves d4-5 |
|
Physiologic jaundice: what 2 mxns?
|
Lack gut flora & increased activity beta-glucoronidase --> convert bili to unconj and reabsorb
|
|
Leads to what dz:
Neonate lacks gut flora & has increased beta-glucoronidase --> converts bili to unconj form --> reabsorbs |
Physiologic jaundice (normal, benign)
|
|
How disting:
Physiologic vs. breast milk/feed jaundice? |
Physio appears d0 --> peaks at d3 -- resolves d4
Breast: appears d4 |
|
Breast-milk/feed jaundice: underlying mxn?
|
INHIBITORY SUBSTANCE in milk --> increase enterohepatic circulation
|
|
Do RBC membrane defects (sphero) & enzyme defects (PK, G6PD) cause un/conj jaundice?
|
UNCONJ
|
|
3 etios of hepatobiliary dysfxn that can cause conjugated jaundice
|
Ischemia induced by: asphyxia, sepsis, congen metabolic toxins
|
|
Biliary atresia in neonate:
Absent INTRA or EXTRA hepatic bile ducts? |
EITHER
|
|
Biliary atresia in neonate:
Assoc with what 2 other conditions? |
Congenital HD
Intestinal malrotation |
|
Biliary atresia in neonate:
If no tx --> what complication --> how long until die? |
Develop cirrhosis --> die 2yo
|
|
Suspect what dz:
Neonate w/2 weeks of progressive jaundice |
Biliary atresia
|
|
What dz:
Acholic stools, hepatomegaly, dark urine, increased alk phos |
Biliary atresia (conj/direct jaundice)
|
|
Conj or Unconj jaundice:
See dark urine, acholic stools |
DIRECT/CONJ
|
|
Biliary atresia in neonate: assoc w/elevation of which LFT?
|
ALK PHOS
|
|
Biliary atresia of neonate: possible to see increase in INDIRECT BILIRUBIN?
|
NO -- ALWAYS SEE INCREASED DIRECT BILI
|
|
Affect risk of severe hyperbili in newborn?:
-jaundice at d0-1 |
Earlier jaundice --> higher risk of severe hyperbili
|
|
What GESTATIONAL AGE:
highest risk of severe hyperbilirubinemia |
35-38!!!
|
|
Jaundice: increased risk:
Breast or formula |
Breast
|
|
Jaundice: increased risk:
M or F? |
Male
|
|
Jaundice: increased risk:
White or Asian? |
Asian (esp East Asian)
|
|
Jaundice: increased risk:
young or old mom |
>25yo mom
|
|
Require further w/u?
Neonatal jaundice + VOMIT |
Yes
|
|
Require further w/u?
Neonatal jaundice + fever |
Yes
|
|
Require further w/u?
Neonatal jaundice + ONSET AFTER D3 |
YES
|
|
Require further w/u?
Neonatal jaundice + high-pitched cry |
YES
|
|
Require further w/u?
Neonatal jaundice + bili <15 |
NO - suspect physio
|
|
Jaundiced neonate:
Does normal CBC rule out hemolytic dz? |
NO ---- order retic to check for anemia
|
|
Breast milk:
Contain growth factors? |
Yes
|
|
#1 carbohydrate in breast milk
|
Lactose
|
|
See lactose intolerance in neonates?
|
Uncommon 0-1yo
|
|
Breast milk:
Fats comprise what % calories? Most fat at beginning or end of feed? |
50%
Most fat at end (encourage baby to drain boob) |
|
Breast milk:
Contains what 2 proteins? |
Whey
Casein |
|
Breast milk:
More or less protein than cowmilk? |
3x cow > breast
|
|
Do not give regular milk until what age?
|
>1yo
|
|
Colostrum: produced which days? slowly or rapidly replaced by milk?
|
d0-5
Slowly replaced by milk |
|
Which has more: colostrum or breastmilk:
-minerals -protein -fats -carbs -IgA |
Minerals: col
Protein: COLOSTRUM Fat: milk Carb: milk IgA: milk |
|
Breast-feeding: affect incidence of:
-SIDS? -Allergies? -DM? |
Breast --> decrease incidence all
|
|
Should mother expect menses while breastfeeding?
|
NO - no ovulate
|
|
Breast-feed: increase or decrease risk breast cancer in mother? ovarian cancer? osteoporosis?
|
Decrease all
(since suppresses estrogen) |
|
Breastfeed:
Is it common for infant to fall asleep before finish feed? |
YES
|
|
Breastfeed:
How many feeds per day? How frequently? How many minutes each breast? |
8-12 feeds/day
Every 2-3h 15mins/breast |
|
Breast milk contains all vitamins EXCEPT _____
|
Vitamin K
|
|
Do breast-fed babies req suppl Vitamin D?
|
Only if <15 min sun /week
|
|
Fluoride: supplement at what age? Under what conditions?
|
Suppl all infants >6mos if <0.3ppm
|
|
Kernicterus: stain what structures?
|
Basal ganglia & hippocampus
|
|
Kernicterus: highest risk if 1st or subsequent episode of jaundice?
|
Highest risk if FIRST episode of jaundice
|
|
Bilirubin encephalopathy:
see HYPO or HYPERtonia? |
TRICK
Hypotonia early --> hypertonia late |
|
What dz:
yellow baby with hypotonia, vomit --> hypertonia, szs, ataxia |
Bilirubin encephalopathy
|
|
Bilirubin encephalopathy: early OR late?:
Hypotonia |
Early
|
|
Bilirubin encephalopathy: early OR late?:
Hypertonia |
Late
|
|
Bilirubin encephalopathy: early OR late?:
Opisthotonous |
Late
|
|
Bilirubin encephalopathy: early OR late?:
Szs |
Late
|
|
Bilirubin encephalopathy: early OR late?:
Deafness |
Late
|
|
Bilirubin encephalopathy: increased risk in whites or Asians?
|
Asians
|
|
Bilirubin encephalopathy:
Assoc w/prematurity? |
Increased risk if premature
|
|
Bilirubin encephalopathy:
Assoc w/altitude? |
Increase risk at high alt
|
|
Bilirubin encephalopathy:
What other medical problem is a risk factor? |
Small bowel obstruction
|
|
How tx:
Breast + jaundice + bili 16-25 |
Cont breast + observe
OR Suppl formula 24-48h + phototx |
|
How tx:
Term + jaundice + hemolysis + bili 17.5-23 |
Exchange transfusion
|
|
Can you administer phototx while breast-feeding?
|
YES
|
|
Neonate w/hyperbili: can you lower via admin H2O/dextrose?
|
NO
|
|
Neonate:
What day stop meconium --> yellow BM |
day 3
|
|
Neonate: what day:
3-4 stools/day |
By d3-4
|
|
By d3-4 life: how many stools per day? how many wet diapers?
|
3-4 stools
3-4 wet diapers |
|
By d6 life: how many stools per day? how many wet diapers?
|
3-4 stools
6 diapers |
|
Return to birth weight at what age?
|
2w
|
|
At d5 life:
-at what % of birthweight? -require w/u at what %? |
At d5: 7-10% below birthweight
If >10% or no regain bw by w2 --> further w/u |
|
How obtain FONTANELLE SIZE?
|
Avg length & width
|
|
Anterior fontanelle:
-suspect what problem if barely open at birth? -what is avg diam? |
Over-riding sutures (benign; separates w/in few days)
Avg: 2.5 - 5.0 cm |
|
Name for:
Edema/serum over presenting part of scalp |
Caput succedaneum
|
|
Caput succedaneum: where located?
|
PRESENTING part of scalp (=edema)
|
|
Caput succedaneum:
Leads to hyperbili? |
NO -- overlies periosteum
|
|
Anatomic difference b/w:
Caput succedaneum & cephalohematoma |
Caput: edema overlies periosteum --> NOT increase bili
Cephalo: SUBperiosteal hemorr (not extend suture line) --> can cause hyperbili |
|
Cephalohematoma:
-where located in re: periosteum -cross suture lines? |
SUBperiosteal
NOT cross suture lines |
|
Can you approximate the bilirubin level based on the extent of jaundice?
|
YES
|
|
Normal amount of breast tissue (mm) in term infant
|
5-6mm
|
|
Suspect what problem:
Neonate 0-72h & anorexia/vomit/sz |
Inborn error of metab
|
|
What fraction of sick, full-term neonates without infection risks have an underlying metabolic dz?
|
20% !!! (1/5) --- that's a lot
|
|
Inborn error of metabolism: can appear insidiously?
|
Yes
|
|
Neonate screen: all states screen what 2 dzs? What method?
|
PKU
Hypothyroid via tandem mass spec |
|
Red reflux: see from how far away?
|
1 foot
|
|
Spleen: normally how far below L costal? Should you push to find tip?
|
1-2 CENTIMETER below L costal
Never push to find tip |
|
Ortolani & Barlow: 1st perform at what age?
|
BIRTH
|
|
Developmental Dysplasia of Hip:
More common L or R? |
3x L > R
|
|
Developmental Dysplasia of Hip:
F or M? White or black? |
F
White |
|
Developmental Dysplasia of Hip:
Assoc w/birth position? |
More common BREECH
|
|
Developmental Dysplasia of Hip:
Genetic component? |
Higher risk if FHx DDH
|
|
Neonate phys exam:
Perform hip exam at what ages? (to assess DDH) |
0-3mos
|
|
What test:
Thumb on lesser trochanter --> flex hip --> downward pressure |
Barlow Test
|
|
Barlow test:
-where is thumb? -flex or extend hip? what degree? -ab/duct? |
Thumb on LESSER trochanter --> flex to 90 --> ADDuct & down
|
|
What test:
Abduct hip & push femoral head anteriorly |
Ortolani
|
|
Ortolani maneuver:
-ab/duct hip? -push fem head ant or post? |
ABDUCT (contrast Barlow - adduct)
Push fem head ANTERIORLY over greater troch |
|
Barlow or Ortolani:
Feel CLUNK |
Ortolani
|
|
T/F Every IUGR infant is SGA
T/F Every SGA infant was IUGR |
T: every IUGR --> SGA
F: SGA may be 2/2 ethnicity, maternal ht, etc (not necessarily IUGR) |
|
IUGR: poor wt gain in which TM is a risk factor?
|
TM3
|
|
IUGR: due to fetal abns?
|
Possible; can see with chromo abns, metabolic dz, congen infxn
|
|
What is safe amt of EtOH in preg?
|
NO SAFE AMT
|
|
Smoking --> what facial abns?
|
none
just low bw |
|
How does cocaine/stimulant affect birth weight? (mxn)
|
Vasocon --> placental insuff --> low bw
|
|
What drug:
s/e fetal hydantoin syndrome |
Phenytoin
(see in 30% exposed infants) |
|
Phenytoin: safe in preg? safe in breastfeed?
|
S/E Fetal Hydantoin Synd (30% exposed fetuses)
SAFE IN BREAST FEED |
|
Suspect what etiology:
Neonate with: hypoplastic nails & distal phalanges, cardiac defects, cranio deforms, IUGR, M.R. |
Phenytoin --> fetal hydantoin syndrome
|
|
Higher risk in young or old moms:
-GHTN -Preeclampsia |
ADOLESCENT moms
--> low birth wt neonates |
|
What is most ominous finding of respiratory distress?
|
PARADOXICAL BREATHING
|
|
Paradoxical breathing: see what? indicates what condition?
|
Inspire --> chest draws inward
See in resp distress |
|
Name for sound:
Forced expiration against a closed glottis |
Grunting
|
|
Grunting: due to what action?
|
Forced EXPIRATION against closed glottis
|
|
Grunting: see in what 3 lung dzs?
|
1. Atelectasis
2. PNA 3. Pulm edema |
|
Head-bobbing in resp distress: synchronized with INSP or EXP?
|
INSP
|
|
Name for resp sound:
musical, CONSTANT PITCH, loudest at neck |
STRIDOR
|
|
Stridor:
-constant or variable pitch? -where ausc loudest? -lower or upper aw? |
Constant pitch (musical)
Loudest at neck Upper aw |
|
Stridor: see with insp, exp or both?
|
INSP ONLY
(according to CLIPP) |
|
Difference between:
Wheeze vs. rhonchi |
Basically same mxn
Wheeze: high pitch Rhonci: low |
|
Wheeze/rhonchi:
-due to RESONANCE? -see w/insp, exp or both? -where loudest? |
NOT due resonance; due to VIBRATION of narrowed aws
EXP (or exp+insp; never insp alone) loudest at chest |
|
What resp sound:
Only here during EXP or EXP+INSP (never insp alone) |
Wheeze/rhonchi
|
|
Wheeze/rhonchi: does longer & higher pitch indicate more severe dz?
|
YES
|
|
Crackles: dis/continuous?
|
DISCON
|
|
Crackles: sound differences b/w coarse & fine
|
Coarse: low pitch, loud, few
Fine: high pitch, quiet, many |
|
Lower or upper aw obstrution:
Wheeze |
Lower
|
|
Lower or upper aw obstrution:
Prolonged expiratory phase |
Lower
|
|
Lower or upper aw obstrution:
VIRAL URI |
LOWER!!!!
(see wet cough, no wheeze) |
|
Viral URI: common to see wheeze?
|
NO
|
|
Asthma: is wheeze severity correlated with asthma severity?
|
NO
If severe asthma with no air exchange --> no wheeze (BEWARE) |
|
Severe asthma --> what CV change?
|
Pulsus paradox
|
|
What dz: CXR shows:
Bilat hyperinflation, flat diaphs, atelectasis |
Asthma
|
|
Lower or upper aw obstrution:
Acute bronchiolitis |
LOWER
Edema/mucuus --> obstruct bronchioles |
|
Lower or upper aw obstrution:
Pertussis |
LOWER
|
|
Acute bronchiolitis:
What % due RSV? |
50%
|
|
Acute bronchiolitis:
In addition to RSV - what other viruses? |
para/influ
|
|
Acute bronchiolitis:
See what temps? (#) |
38.5 - 39
|
|
Acute bronchiolitis:
See wheezing? |
YES
(contrast VIRAL URI) |
|
Acute bronchiolitis:
How appear CXR? |
Bilat hyperinflat (sim asthma) w/scattered atelect
|
|
Asthma: due inflamm/edema of mucosa or parenchyma?
|
Mucosa
(contrast PNA - parenchyma) |
|
Pneumonia: what BACTERIAL pathogen:
-5-6yo (#1) -school age (#1-2) |
5-6yo: Strep pneumo
School: MYCOPLASMA #1, Strep pneumo #2 |
|
Viral pneumonia: what 4 viruses common?
|
RSV, para/influ, adeno
|
|
Indicates what dz:
Crackles |
PNA (bact or viral)
|
|
Chlamydia trachomatis PNA: presents how long after birth?
|
3-4w
|
|
Whooping cough: what pathogen?
|
Bordatella pertussis
|
|
Bordatella pertussis: vaccine is how effective? (%)
|
70-90%
|
|
What pathogen/dz:
3 stages (catarrhal, paroxysmal, convalescent) |
Bordatella pertussis
|
|
Bordatella pertussis: 3 stages & duration of each
|
1. Catarrhal: 1-2w (URI sxs)
2. Paroxysmal: 4-6w (staccato) 3. Convalescent: mos cough |
|
What dz:
Staccato cough |
Bordatella pertussis (whooping)
|
|
Bordatella pertussis: cough may persist how long?
|
Paroxysmal cough 4-6w --> regular cough for mos
|
|
Lower or upper aw obstruct:
Foreign body |
Upper
|
|
Lower or upper aw obstruct:
Epiglottitis |
Upper
|
|
What dz:
Assymetic wheeze in 5yo w/out hx aw dz |
foreign body
|
|
Foreign body asp: most common location
|
R mainstem bronchus
|
|
Epiglottitis: what age group?
|
2-5yo
|
|
Lower or upper aw obstruct:
Croup |
TRICK - both (subglottic)
|
|
Croup: caused by 6 pathogens
|
Para/influ
Adeno RSV MYCOPLASMA MEASLES!!!! |
|
Indicates what dz (general name):
Insp stridor + barking cough |
Croup
|
|
Cerebral palsy:
incidence |
2:1,000
|
|
Cerebral palsy:
Progressive? |
No
|
|
Cerebral palsy:
Defining feature |
Decreaesed motor control
|
|
Cerebral palsy: is spasticity dependent on velocity?
|
YES - greater resistance w/rapid movement
|
|
Cerebral palsy: is resistance greater with SLOW or RAPID movement?
|
RAPID
|
|
Cerebral palsy: in/decreased tendon jerks
|
INCREASED
|
|
What dz:
See spastic diplegia |
C.P.
|
|
Name for:
Increased tone, esp in lower extrems |
Spastic diplegia
|
|
Spastic diplegia: assoc w/prematurity?
|
Yes
|
|
Leads to what TYPE of cerebral palsy:
-birth asphyxia -kernicterus |
Both lead ot DYSKINETIC cerebral palsy
(NOT other types) |
|
Cerebral palsy: see pts with GLOBAL developmental delay?
|
No - just motor
GDD = cogn disabl/MR |
|
MR/cognitive disability: possible to see FHx?
|
Yes - if 2/2 inborn error metab
|
|
Abn development 2/2 neglect:
See improvement if stop abuse? |
YES
|
|
Do premature babies have increased risk of abuse?
|
Yes
|
|
Myopathy: p/w gross or fine motor abns?
|
BOTH
|
|
What class of dz:
abn tone, fasciculations, weakness |
Myopathy
(NOT CP - see spasticity, increased tendon jerks) |
|
Cerebral palsy: how dx?
|
MRI & assessment by developmental specialist (use Bayley scales of infant development)
(determines etio of abn neuro exam) |
|
Infant UTI: how obtain urine sample?
|
CATH
(NOT bag specimen) |
|
Fever: #
|
100.5 (38)
|
|
Name for:
Viable bacteria in circulation |
Bacteremia
(no necess systemic dz) |
|
Name for:
Systemic dz 2/2 microorgs in circ |
Septicemia
|
|
Difference b/w:
Fever w/out source AND fever unknown origin |
W/out source: no focus despite H&P
Unknown origin: 2weeks fever with 1w failed w/u |
|
Fever of unknown origin: present for how long?
|
2w
(with 1w of failed w/u) |
|
Occult bacteremia: definition (what tests)
|
Pos blood cx despite normal:
1. CXR 2. UA 3. LP |
|
Occult bacteremia: see in what age range?
|
0-3yo
|
|
Qualify as SERIOUS bacterial illness (SBI)?:
Enteritis |
Yes
|
|
Qualify as SERIOUS bacterial illness (SBI)?:
PNA |
Yes
|
|
Qualify as SERIOUS bacterial illness (SBI)?:
Cellulitis |
Yes
|
|
Qualify as SERIOUS bacterial illness (SBI)?:
Osteomyelitis |
Yes
|
|
Qualify as SERIOUS bacterial illness (SBI)?:
Otitis Media |
No
|
|
Meningismus: due to stretching of nerves in what SPACE?
|
Subarachnoid
|
|
Nuchal rigidity: in/vol?
|
INVOL
|
|
Name for:
Extreme nuchal rigidity --> hyperextend entire spine |
Opisthotonus
|
|
What is it?:
Opisthotonus |
Extreme nuchal rigidity --> hyperextend entire spine
|
|
Name for:
flex hip & extend knee --> pt resists knee extens |
Kernig
|
|
Name for:
flex neck --> pt flexes knee & hip |
Brudzinski
|
|
Difference b/w:
Kernig Brudzinski |
Kernig: flex hip --> resist knee EXTENSION
Brud: flex neck --> automatic flex knee & hip |
|
If you plan to tx infant w/IV abx for presumed bacterial infxn --> do you require a LP?
|
YES - RULE
If want to use IV abx --> get LP first |
|
LP contraindication: platelets <___ (#)
|
<50k
|
|
Must perform LP if fever <__ (what age)?
|
1yo
|
|
Does normal CSF definitively r/o meningitis?
|
YES
|
|
Febrile infant:
Suspect UTI in what ages? |
2mo - 2yo
|
|
Gastroenteritis: see low or high fever with:
-viral -bact |
HIGH FEVER with both
|
|
Upper resp infxn: see low or high fever?
|
Can see high fever
|
|
Work-up of BACTERIAL infxn: low or high predictive value:
>15,000 WBC w/left shit |
LOW predictive value
|
|
Viral infection: do most have ab/normal WBC?
|
Most have NORMAL
|
|
UA: nitrites have high or low:
-spec -sens |
HIGH SPEC (few FPs)
LOW SENS (many FNs) |
|
UA: is a positive LE enough to dx UTI?
|
No - only indicates that WBCs are in urine
|
|
Voiding cysturethrogram (VCUG): order in which infants?
|
ALL infants w/FIRST uti
|
|
VUR: is most mild/mod/severe? req tx?
|
Most mild --> spont resolve
|
|
UTI in <1yo:
what % have vesicourethral reflux? |
50%
|
|
VUR: affect risk of UTI? req ppx abx?
|
Increase risk of UTI --> GIVE PPX ABX (until VUR resolves or surg)
|
|
VUR: what is alt way to monitor (if not want VCUG)?
|
Periodic radionuclide cystograms
|
|
1st UTI --> order what imaging tests?
|
1. VCUG
2. Abdominal U/S (renal structure, dilation) |
|
UTI in infant:
-required in ALL cases? -duration? -route? -repeat urine cx? |
ALL pts w/1st UTI (even if asympto)
7-14d po --> IV if severe dehydr Repeat urine cx if no response after 2d |
|
Pyelo: 2 most common pathogens
|
E coli > enterococcus
|
|
Pyelo:
-2 best abx & route for INPATIENT -outpatient |
Gent + Amp INTRAVENOUS
--> TMP-SMZ bid (total 7-14d) |
|
Pyelo: what is disadvantage of:
-Ceftriaxone -Ciprofloxacin |
Ceftriax: no cover enterococci (#2), pseudomonas
Cipro: damages articular cartilage (esp knees) |
|
Nitrofurantoin: use in what type of UTI?
|
Lower UTI (cystitis)
NOT pyelo |
|
Sulfisoxazole: used to tx pyelo?
|
No - resistance
|
|
Always consider what dz:
HIGH fever x 5d.... |
Kawasaki
|
|
Always consider what dz:
HIGH fever x 5d.... |
Kawasaki
|
|
Kawasaki: usually <___yo
|
<4yo
|
|
Kawasaki: requires how many findings?
|
4 (in addition to fever)
|
|
Kawasaki: usually <___yo
|
<4yo
|
|
3 dzs with palmar rash
|
Kawasaki
Syphilis RMSF |
|
Kawasaki: requires how many findings?
|
4 (in addition to fever)
|
|
Kawasaki: where see rash (2)?
|
Groin
PALMS |
|
3 dzs with palmar rash
|
Kawasaki
Syphilis RMSF |
|
Kawasaki: what 2 eye findings?
|
1. Conjuncitivitis w/out discharge
2. ANTERIOR uveitis (slit lamp) |
|
Kawasaki: where see rash (2)?
|
Groin
PALMS |
|
Anterior uveitis 2/2 Kawasaki:
-how detect (what test)? -minority or majority of pts? |
Slit-lamp
80% pts in 1st week |
|
Kawasaki: what 2 eye findings?
|
1. Conjuncitivitis w/out discharge
2. ANTERIOR uveitis (slit lamp) |
|
Strawberry tongue: what 3 dz?
|
1. Kawasaki
2. Strep pharyngitis 3. Infectious mono |
|
Anterior uveitis 2/2 Kawasaki:
-how detect (what test)? -minority or majority of pts? |
Slit-lamp
80% pts in 1st week |
|
Strawberry tongue: what 3 dz?
|
1. Kawasaki
2. Strep pharyngitis 3. Infectious mono |
|
Kawasaki: see LAD?
|
YES
|
|
Kawasaki: see LAD?
|
YES
|
|
What dz:
HIGH FEVER x5d, groin rash, conjuncitivitis, strawberry tongue, puffy/peeling hands & feet |
Kawasaki
|
|
What dz:
HIGH FEVER x5d, groin rash, conjuncitivitis, strawberry tongue, puffy/peeling hands & feet |
Kawasaki
|
|
Kawasaki: low or high fever?
|
HIGH x 5d
|
|
4 causes of UNILATERAL cervical adenitis (non-cancerous)
|
1. Kawasaki
2. Cat Scratch 3. Pharyngeal infection --> reactive node 4. Mycobacteria |
|
Kawasaki: see uni/bilat LAD?
|
UNILAT
|
|
SJS:
-see conjuncitivitis? -what type of rash (name)? |
Conjunctivitis
Erythema multiform |
|
#1 fatal tick dz
|
RMSF
|
|
RMSF: how transmit?
|
Tick
|
|
RMSF: what type of rash? where located?
|
Petichial rash on palms
|
|
What dz:
Petechial rash, HEADACHE, fever, myalgia |
RMSF
|
|
Kawasaki: see change in CBC?
|
1. INCREASE WBC, esp PMNs
2. Normocytic, normochromic anemia 3. Increase platelets (week 2) |
|
Kawasaki: would you still suspect if negative ESR?
|
no
|
|
Kawasaki: see changes in LFTs?
|
INCREASE (nonspecific)
decrease albumin |
|
Suspect what dz:
Increased WBC (esp PMNs), normo normo anemia, increased platelets, increased LFTs, STERILE PYURIA |
Kawasaki
|
|
Kawasaki: what UA change? how collect UA?
|
STERILE PYURIA (2/2 sterile urethritis)
Collect via CLEAN CATCH (would not detect pyuria by cath) |
|
Kawasaki: order what imaging test?
|
Baseline ECHO --> repeat ECHO 4 weeks
|
|
Kawasaki: how tx? (2)
|
HIGH-dose ASA (other antipyretics not effective)
HIGH-dose intravenous Ig (only tx ot decrease coronary art sequel) |
|
Kawasaki: see CNS complications in what % pts?
|
90%: lethargy, aseptic meningitis
|
|
Kawasaki: see coronary art aneurysm in what % untx pts?
|
25%
|
|
Kawasaki: what GI complication? (2)
|
Liver dysfxn (40%)
Gallbladder hydrops (10%) |
|
Kawasaki: after discharge --> when RTC for repeat ECHO?
|
Echo at weeks 0 & 4
(usually RTC 2 weeks after discharge for repeat) |
|
What pathogen:
Vesicular rash on hands & feet; ulcers in mouth |
COXSACKIE (enterovirus) --> hand-foot-mouth dz
|
|
What pathogen:
Hand-foot-mouth dz |
Coxsackie (enterovirus)
|
|
What pathogen:
Prodrome fever >101 --> cough, runny nose, conjunctivitis --> maculopap rash behind ears --> reaches feet |
MEASLES
3Cs |
|
Measles: describe rash lesions & distrib
|
Maculopap
Starts behinds ears --> reaches feet w/in 2 days |
|
Meningococcal rash: itchy?
|
YES
|
|
What pathogen:
High fever 3d --> fever ends --> rash on trunk --> spreads arms, neck |
Rubeola
|
|
Rubeola: which see first:
Rash or fever |
Fever --> fever ends --> trunk rash
|
|
Rubeola: describe rash lesions & distrib
|
Maculopap on trunk --> spreads arms/neck
**Fever ends before rash appears |
|
Rubeola: usu <__yo
|
<2yo
|
|
Strep pharyngitis (GAS): 2 systemic comps
|
1. Scarlet fever (blanching sandpaper)
2. Rheum heart disease |
|
What pathogen:
Blanching sandpaper rash & high fever |
Strep pharyngitis --> Scarlet fever
|
|
Scarlet fever: low or high fever?
|
HIgh
|
|
Scarlet fever: describe rash
|
blanching sandpaper
starts groin/ax/neck --> spreads |
|
Scarlet fever: rash resolves how long?
|
<10d
|
|
Rheumatic fever: develops how long after strep infection?
|
18 days
|
|
What disease?:
Jones Criteria |
Rheumatic fever
|
|
Rheumatic fever: was diagnostic criteria (eponym)? req how many (#) criteria?
|
Jones criteria
1 major + 2 minor 2 major + 1 mintor |
|
What dz:
Migratory polyarthritis, peri/myocarditis, erythema marginatum, subQ nodules & chorea |
Rheumatic fever (2/2 strep pharyngitis)
|
|
Rheumatic Fever:
-what type of arthritis? -name for classic rash -what neuro disorder |
MIGRATORY polyarth
Erythema marginatum Sydenham's chorea |
|
Rheumatic Fever: what EKG finding?
|
Prolonged PR
|
|
What viral exanthem:
EKG - prolonged PR |
Rheumatic Fever
|
|
What dz:
Complication: peritonsilar abscess |
Strep pharyngitis
|
|
VZV: starts where on body?
|
Trunk
|
|
VZV: resolves after how long?
|
1 week
|
|
What dz:
Upslanted palpebral fissures |
Downs
|
|
What dz:
-small ears -low-set ears |
Small: Downs
Low: Turner's |
|
What dz:
Epicanthal folds |
Downs
|
|
What dz:
Redundant nuchal skin |
Downs
|
|
#1 M.R. involving genetic material
|
Downs (21)
|
|
Down's: 3 genetic mxns
|
Trisomy (#1, regardless mat age)
Unbalanced translocation Mosaic for 21 |
|
Down's: ABSOLUTE risk higher in young or old mothers?
|
YOUNG
(relative risk higher in old) |
|
Downs: how dx?
|
Leukocyte karyotype
|
|
What dz:
Micropthalmia, microceph, polydact, cleft lip & palate, umbilical hernia, CUTIS APLASIA |
Patau (13)
|
|
Patau (13): defects in what organs? (2)
|
Cardiac
Renal Also: microceph, polydact, clefts, umbilical hernia, cutis aplasia |
|
#1 FAMILIAL cause of M.R.
|
Fragile X
|
|
Fragile X: what repeat?
|
CGG outside FMR1 coding regions
|
|
What dz:
larges testes; large everted ears; long face w/large mandible |
Fragile X
|
|
Turner's syndrome: see physical differences at birth?
|
Yes
|
|
What dz:
See lymphedema in utero |
Turner XO
|
|
What dz:
web neck, low ears, hyperconvex nails, shield chest |
Turner XO
|
|
Turners:
What is feature of nails? |
Hyperconvex
|
|
Turners:
Ao coarctation in what %? |
20%
|
|
Turners:
How affect IQ? |
NORMAL IQ
|
|
How dx:
Benign Neonatal Hypotonia |
Dx of EXCLUSION
|
|
Benign Neonatal Hypotonia: px?
|
Good; gradual increase tone
|
|
Down's: what is most consistent finding at birth?
|
HYPOTONIA --> poor feeding
|
|
Down's: recommended imaging at birth?
|
ECHO
|
|
Down's: recommended blood test?
|
TSH
(6mo --> q 1 year) |
|
Down's: what skeletal abn?
|
Atlanto-axial instab
|
|
Down's: predisp what cancer?
|
Leukemia
|
|
Hypotonia in infant:
Tend to FLEX or EXTEND extrems? |
Extend (passive)
(noxious stim --> won't flex) |
|
Hypotonia in infant: see in/decreased primitive reflexes?
|
DECREASED
(since hypotonic) |
|
Hypoxic-ischemic encephalopathy 2/2 perinatal injury:
more commonly see HYPO or HYPERtonia? |
HYPER
(although can see hypo) |
|
Suspect what dz:
Normal neonate --> 2-4w later see lethargy, fever, HYPOTONIA |
SEPSIS 2/2 GBS
|
|
Congenital hypothyroidism: how affect ammonia level?
|
No change (normal NH4)
|
|
Newborn metabolic screen: uses what lab technique?
|
Mass spec
|
|
Screens for what dz:
Measure immunoreactive trypsinogen |
Cystic fibrosis
|
|
How define:
Lethargy |
1. Decreased eye movements
OR 2. fail to recog parents or interact w/environ |
|
Name for:
Decreased eye movements & fail to interact w/parents or environ |
LETHARGY
|
|
How define:
FTT |
Fail to regain bw by 3 WEEKS or continuous wt loss after 10d life
|
|
#1 sudden death adol athlete
|
Hypertrophic Obstructive Cardiomyopathy (HCOM)
|
|
Hypertrophic Obstructive Cardiomyopathy (HCOM):
-p/w what sx? -what % have abn EKG? |
SYNCOPE
90% abn EKG |
|
Child w/chest pain: higher suspicion of cardiac etio if:
present at rest OR exercise only? |
Exercise only
|
|
Chest pain due myocardial ischemia:
-sharp or dull? -how long last? |
Dull pressure
10-20 mins |
|
What dz:
Sharp/stabbing chest pain REPRODUCIBLE w/direct sternal pressure |
Costochondritis
|
|
Costochondritis: how long does pain last?
|
few seconds of stabbing over hrs-days
|
|
Costochondritis: chest pain assoc w/exercise?
|
NO - sporadic
|
|
What is dz:
Chest pain worse with deep inspiration |
Costochondritis
|
|
Costochondritis: worse with insp or exp?
|
Deep insp
|
|
Which more common:
Precordial catch OR costochondritis |
Precordial catch
|
|
#1 chest pain in child
|
Precordial catch
|
|
Precordial catch: assoc w/exercise?
|
No
(occurs equally at rest or exercise) |
|
Precordial catch:
-diffuse or well-localized? where most common? -sharp or dull? |
sharp, well-localized at LOWER STERNAL BORDER
|
|
Precordial catch: how long pain last?
|
secs-mins
|
|
Precordial catch: worse w/insp or exp?
|
Deep insp
(same as costochondritis) |
|
What dz:
Chest pain that pt can BREAK with forced deep insp |
Precordial catch
|
|
Name for:
Inadeq cerebral BF --> transient LOC & loss of postural tone |
Syncope
|
|
Syncope: underlying mxn?
|
Decreased cerebral BF
|
|
3 general etios of syncope in child
|
1. Neurocardiogenic (vasovagal; #1)
2. Neuropsych (szs, orthostatic, drugs) 3. Cardiac (arryth, structure defect) |
|
Syncope 2/2 orthostatic hypotension: classify as NEUROPSYCHIATRIC or CARDIOGENIC?
|
Neuropsychiatric
|
|
What drug class:
S/E prolonged QT --> neuropsychiatric syncope |
Antihistamines
|
|
Antihistamines: S/E what EKG change?
|
Prolonged QT
|
|
Difference b/w 1' and 2' cardiac syncope
|
1': structural defect --> obstruct ventricular outflow
2': ventricle DYSFXN or ARRYTH |
|
3 types of arryths that can cause syncope
|
1. SVT
2. VT 3. Heart block (2/2 Lyme) |
|
Syncope in child: EKG which pts?
|
ALL
|
|
Syncope in child: which is more serious:
Pallor OR warm/flushed skin |
WARM/FLUSHED
|
|
Syncope during exercise: mandatory refer to cardio?
|
YES
|
|
Are murmurs COMMON in healthy adols?
|
Yes
|
|
Teen physical:
Palp which 2 pulses? |
Femoral
Radial --> assess Ao coarct |
|
HCM: murmur louder supine OR standing?
|
STANDING
|
|
Murmur: evaluate if louder than ___ (what grade?)
|
III/IV
|
|
Teen physical:
How long should orthopedic exam take? |
2min
|
|
Teen physical:
Require chaperone for GU? |
always
|
|
What Tanner Stage:
Testes <1.5 mL |
1
|
|
What Tanner Stage:
No pubes |
1
|
|
What Tanner Stage:
Testes 1.6 - 6 mL |
2
|
|
What Tanner Stage:
Red, thin scrotum |
2
|
|
What Tanner Stage:
Thin pubes at base of penis |
2
|
|
What Tanner Stage:
Testes 6-12 mL |
3
|
|
What Tanner Stage:
Curly, coarse hair |
3
|
|
What Tanner Stage:
Testes 12-20 |
4
|
|
What Tanner Stage:
Darken & increase size of scrotum |
4
|
|
What Tanner Stage:
Adult pubes but absent on thighs |
4
|
|
What Tanner Stage:
>20 ml testes |
5
|
|
What Tanner Stage:
Pubes on medial thighs |
5
|
|
What is difference and which most common:
1' vs. 2' vs. 3' hypothyroidism |
1': thyroid dysfxn (95%)
2: pit 3: hypothal |
|
Congenital hypothyroidism: most common what ethnicities? (2)
|
Native Am
Hisp |
|
Mxns of congenital 1' hypothyroidism
|
Thyroid ectopy
A/hypoplasia Errors of thyroid hormogenesis |
|
1' hypothyroidism: low or high TSH?
|
HIGH
(HPA intact; prob is thyroid) |
|
1' or 2/3' hypothyroidism:
Low TSH |
2/3 (pit/hypothal not producing TSH --> low T4)
|
|
Does maternal thyroid hormone cross placenta?
|
YES
Infant with congenital hypothyroid appears normal at birth due maternal thyroid |
|
Congenital hypothyroidism: when do s/sx present?
|
6 WEEKS OF AGE
|
|
Congenital hypothyroidism:
Constip or diarrhea? |
Constip
|
|
Congenital hypothyroidism:
How does skin appear? |
JAUNDICED, mottling
|
|
Congenital hypothyroidism:
Small or large fontanelles |
LARGE
|
|
Congenital hypothyroidism:
Hypo or hypertonia |
HYPO
|
|
Congenital hypothyroidism:
Hypo or hyperthermia |
Hypo
|
|
Congenital hypothyroidism:
What abdominal defect? |
Umbilical hernia
|
|
Infant hypo or hyperthyroidism:
See umbilical hernia |
Hypo
|
|
What dz:
Normal neonate --> 6w age p/w feeding probs, jaundice, large fontanelle, hypotonia --> large tongue, puffy myxedematous face & M.R. |
congenital hypothyroid
|
|
What is next step:
Newborn screen shows low T4, high TSH --> ? |
START L-THYROXINE
then resend blood to confirm (do NOT wait to start tx) |
|
Congenital hypothyroid: initiate L-thyroxine --> what is goal TSH? T4?
|
TSH: 1 mU/ml
T4: upper 1/2 normal |
|
Congen hypothyroid: measure T4/TSH how often?
|
2w --> 4w --> q1-2 mos until 1yo --> q2-3mos until 3yo --> q3-12 mos until complete growth
|
|
#1 etio ambiguous female genitalia
|
Congen Adrenal Hyperplasia
|
|
Congen Adrenal Hyperplasia: how inherit (pattern)?
|
AR
|
|
Congen Adrenal Hyperplasia: defect what hormone?
|
Cortisol synth
|
|
Congen Adrenal Hyperplasia: #1 type
|
21-OH deficiency
Decrease cortisol, aldo Increase 17-OH progest --> increase androgens |
|
21-OH deficiency:
-decrease production which hormones? (2) -increase production which hormone? effect? |
Decrease cortisol, aldo
Increase 17-OH progest --> increase androgens --> verilize fems |
|
Difference b/w:
CLASSIC and NONCLASSIC congen adrenal hyperplasia |
Classic: complete enz def --> adrenal crisis --> hypoNa, hyperK --> shock at 1-2w
Nonclassic: NON-VIRILIZING; partial enz def --> manifests under stress |
|
Classic CAH: sxs appear what age?
|
1-2w
|
|
CAH: what lyte abns? (2)
|
HypoNa+
HyperK+ |
|
Non-classic CAH: virilizing?
|
NO
partial enz def --> manifests under stress |
|
See proteinuria with:
-acute glomerulonephritis? -intersitital nephritis? |
YES BOTH - but not as high as nephrotic syndrome
|
|
What dz:
1+/2+ protein during FEVER or EXERCISE |
Benign proteinuria
|
|
Benign proteinuria: how define?
|
1+/2+ protein during fever or s/p exercise
|
|
What dz:
Only excrete protein when standing (1,500mg/d) |
Orthostatic proteinuria
|
|
Orthostatic proteinuria: indicate renal dz?
|
NO - common in adols
|
|
Orthostatic proteinuria: see in AM?
|
NO - first AM urine should be negative since lying down --> not spillling protein
|
|
Common to see generalized tonic-clonic szs in newborn?
|
NO - contrast older infants
|
|
Neonatal sz: see horizontal or vertical deviation?
|
Horiz
|
|
Suspect what phenomenon:
Neonate w/eye jerking, lip-smacking, tonic limb posturing, APNEA |
SEIZURE
(subtle s/sx) |
|
Ankle clonus: what is normal # beats?
|
<10
|
|
Clonus: what is abn # beats in a 1-2mo old?
|
>3 beats is abnormal
|
|
Indicates what process:
-schistocytes -helmets |
Hemolysis (both)
|
|
If atopic parent --> what is risk to child? (%)
|
30% risk
|
|
Has rate of asthma increased in recent years?
|
2x increase in 15 years
|
|
#1 chronic dz in peds
|
asthma
|
|
Asthma: how long last & what cells involved:
-early rxn -late rxn |
Early (0-1h): masts & eosinos --> increase perm/mucus & bronchocon
Late (2-3h later): eosino, PMN, leuko --> epi destruct & remodel SM |
|
Asthma:
-how many hrs until late rxn peaks? resolves? -how long does aw hyperresponsiveness persist after late rxn? |
peaks 4-8h --> resolves 24h
aw hyperresponsive for days-wks |
|
Asthma: wheeze in what part of resp?
|
End-exp
|
|
How do allergies --> chronic cough?
|
Allergy --> nasal congest --> PND --> noct cough
|
|
What dz:
COBBLESTONE post pharyxn |
PND --> lymphoid hyperplasia
|
|
Allergic rhinitis: what TYPE of hypersens rxn?
|
Type 1 (immed)
|
|
Allergic rhinitis: how tx? (2)
|
Antihistamine
topical nasal steroids |
|
Sinusitis: req sxs how long?
|
1week purulent nasal discharge
|
|
Sinusitis: see fever?
|
YES
|
|
Sinusitis: nose & throat swabs useful?
|
No
|
|
Sinusitis: 4 most common bact
|
S pneumo
H flu M catar Strep PYOGENES |
|
Sinusitis: tx with what class?
|
B-LACTAMS
-cefuroxime -augmentin |
|
When develop:
-ethmoid sinuses -max sinuses -frontal |
Ethmoid & max: at birth
Frontal: 6-8yo |
|
Bronchitis: s/sx worse day or night?
|
EQUAL
(no change w/temp,exercise) |
|
Think what dz:
Rhonchi |
Bronchitis
|
|
Atypical/viral PNA: s/sx change w/temp, exercise?
|
MAY WORSEN
(contrast viral URI) |
|
Atypical/viral PNA: expect cough for how long?
|
8-12w
|
|
How does GERD --> nasal congestion?
|
NASAL reflux --> congest
|
|
Habitual cough: what is initial trigger?
|
Viral URI
|
|
What dz:
Brassy, short, dry spasmodic cough; no change w/exercise, cold; resolves w/sleep |
Habitual cough
|
|
Fungal pulm infxn: dry or wet?
|
DRY
|
|
Chlamydia PNA: intermittent or paroxysmal cough?
|
Parox!
|
|
Mycoplasma PNA: intermittent or paroxysmal cough?
|
Parox
|
|
Suspect what dz:
Chronic cough + palpitations |
CHF
|
|
Suspect what dz:
Chronic cough + abdominal pain |
PNA
|
|
Insp:Exp ratio:
-normal -restrictive lung dz -obstructive |
I:E
Norm: 1:2 Restrict: 1:1 Obstruct: 1:3 (due air-trapping) |
|
Due obstruction in small/med/large aw:
Wheeze |
Mod
|
|
Due obstruction in small/med/large aw:
Rhonchi |
Large
|
|
Due obstruction in small/med/large aw:
Rales |
Small
(contrast rhonchi: large) |
|
Difference between:
Variable & fixed obstruction |
Variable: insp or exp ONLY
Fixed: BOTH insp & exp |
|
If immunized child w/chronic cough --> suspect pertussis?
|
Unlikely
|
|
Fungal PNA:
-is cough productive? disturb sleep? -chest pain? |
Non-productive cough not disturb sleep
PLEURITIC chest pain |
|
What type of cancer can present with chronic cough?
|
Mediastinal lymphoma
|
|
Child with 1' TB:
See what changes on CXR? |
FEW/NO CHANGES
(little evidence of initial focus) May see focal hyperinflat, atelect |
|
Suspect what dz:
*Large regional lymphadenitis + non-productive cough + FTT + f/c |
1' TB
|
|
Pediatric Tb: see small or large regional lymphadenitis?
|
LARGE
|
|
Pediatric TB: which lobar segments at increased risk?
|
EQUAL RISK
2+ foci in 25% pts |
|
Pediatric TB: see local effusions on CXR?
|
YES
|
|
If suspect TB and pt is symptomatic --> how officially dx?
|
sputum cx OR 1st AM gastric asp
(positive PPD also useful in ped) |
|
What size:
Positive PPD in low-risk child |
>15mm
|
|
Asthma: how tx:
Mild intermittent |
B-agonist
|
|
Asthma: how tx:
Daily persistent asthma |
B-agon + inhaled cortico
|
|
Inhaled corticosteroid: how long until see improvement?
|
few weeks
|
|
Asthma: if LT inh corticosteroids --> monitor what 4 things?
|
1. BP (HTN)
2. BG 3. Growth 4. Cataracts |
|
Asthma: does administration of leuko-synth inhibitor affect the req dose of inh steroid?
|
allows lower dose steroid
|
|
Asthma: which more effective:
Inh steroid or leuko-inh |
STEROID
|
|
Asthma: can you use leuko-inh as monotherapy?
|
NO
|
|
If see CXR with mediastinal/hilar adenopathy --> think what 3 dzs?
|
1. TB
2. Fungal PNA 3. malig |
|
Cystic fibrosis: restrictive or obstructive
|
Obstructive (mucus plug traps air)
|
|
Obstructive or restrictive:
Decrease FEV1/FVC |
Obstruct
|
|
Asthma: decrease or normal FEV1/FVC
|
Decrease
|
|
Obstructive or restrictive:
SLE |
Restrictive
|
|
Obstructive or restrictive:
Normal FEV1/FVC |
Restrict
|
|
Nephrotic syndrome:
-what age? -M or F? |
1.5-8yo
M >F |
|
Nephrotic syndrome:
#1 etio |
MCD
|
|
Nephrotic syndrome:
Fluid moves from ___ to ____ |
Lose albumin in urine --->
Fluid moves from VASC to INTERSTITIUM --> hypovolemia |
|
Nephrotic syndrome:
How affect BP? |
NORMAL BP
Retain H2O but fluid moves out of vasc into interstitium |
|
How affect BP:
-Nephrotic syndrome -Acute glomerulonephritis |
Nephrotic: normal BP
Acute GN: HTN |
|
Acute glomerulonephritis: #1 presenting s/sx
|
Tea colored urine
|
|
Nephrotic synd and/or acute glomerulonephritis:
Gross hematuria |
acute nephritis
|
|
Nephrotic synd and/or acute glomerulonephritis:
preceded by URI |
acute nephritis
|
|
Nephrotic syndrome: what lyte change? 2 mxns for change
|
HYPONATREMIA
1. Lose vasc fluid to interstitium --> retain excess H2O & Na in kidney 2. HYPERLIPID --> pseudohyponatremia |
|
Nephrotic syndrome: how affect cholesterol?
|
Lose albumin in urine --> Liver increases lipid production --> HYPERCHOLESTEROL
(also see decreased lipid clearance from circ) |
|
Nephrotic synd:
Consider what imaging? |
Renal U/S
|
|
Nephrotic synd: order C3/C4?
|
Yes - r/o collagen vasc dz
|
|
Nephrotic synd:
Order what test to r/o post-strep glomerular dz |
Streptozyme
|
|
Nephrotic synd:
Tx w/albumin infusion in what 2 scenarios? |
1. Ascites/effusion -->resp problems
2. Scrotal edema |
|
Nephrotic synd:
Can you tx with diuretic monotherapy? How admin? |
Albumin infusion --> THEN intravenous furesomide
*Never diuretic alone --> hypovol |
|
Nephrotic synd:
Steroids useful? |
Yes
|
|
Nephrotic synd:
How much salt per day? |
restrict 1,500 - 2,000 mg daily
|
|
Nephrotic synd:
Admin what ppx vaccine |
PCV
|
|
Nephrotic synd: what 2 drugs prevent relapse?
|
cyclophosphamide x 8-12w
Calcineurin inhibitor (tacro, cyclospor) x 2 years |
|
Nephrotic synd:
See what complication (esp if tx with steroids) |
Spontaneous peritonitis
|
|
Nephrotic synd:
Most common pathogen in spont peritonitis (comp) |
Strep Pneumo
(also GNs) |
|
Nephrotic synd:
Do minority or majority kids outgrow? |
Majority
|
|
PID: what age?
|
15-19yo F
|
|
PID: G&C --> also infect uterus w/what 4 pathogens?
|
1. E coli
2. Bacteroids 3. Mycoplasma 4. Ureaplasa |
|
What dz:
16yo F with suprapubic pain --> RUQ pain radiating to R shoulder |
Fitz-Hugh-Curtis (2/2 PID)
|
|
PID: is pain most commonly uni/bilat?
|
BILAT
|
|
PID: order what tests?
|
Cervical cx
Urine PCR |
|
PID: req to tx partners?
|
Yes
|
|
Low or high fever?:
Appendicitis |
Low
|
|
Low or high fever?:
Acute cholecystitis |
Low
|
|
Low or high fever?:
Pneumonia |
HIgh
|
|
Low or high fever?:
UTI |
High
|
|
Low or high fever?:
Septic cholangitis |
HIgh
(contrast acute cholecystitis: low) |
|
Low or high fever?:
Gyn infxn (e.g. PID) |
High
|
|
Hypo-, normo- or hyperactive bowel sounds:
Ileus |
Hypo
|
|
Hypo-, normo- or hyperactive bowel sounds:
Gastroenteritis |
Hyper
|
|
Hypo-, normo- or hyperactive bowel sounds:
SBO |
Hypo <--> high-pitched hyper (peristalsis)
|
|
What dz:
Bowel sounds: quiet --> high-pitched and hyper --> quiet |
SBO w/peristalsis
|
|
Abd exam: what does hyperresonance indicate?
|
Gaseous distension
|
|
What dz:
Involuntary guarding |
Peritonitis
|
|
Hepatitis:
-see vomit? diarrhea? -fever? -mandatory finding? |
Vomit; no diarrhea
Fever Usu see JAUNDICE |
|
Hepatitis: well-localized or vague abd pain?
|
Vague (sometimes RUQ)
|
|
What dz:
Epigastric pain radiating to back |
Pancreatitis
|
|
Pancreatitis:
-vomit? -diarrhea? |
Vomit yes
Diarrhea no (same as hepatitis, appenditicits) |
|
Appendicitis:
-vomit? -diarrhea? |
Vomit yes, diarrhea no
(same as hepatitis, pancreatitis) |
|
Does sexual debut affect risk of UTI?
|
Yes - increased risk at debut
|
|
Low or high fever:
Ectopic pregnancy |
TRICK - no fever
|
|
What dz:
Acute INTERMITTENT sharp abdominal pain radiating down extremitin; n/v |
OVARIAN TORSION
|
|
Ovarian torsion: is pain intermittent or constant
|
INTERMITTENT
|
|
Ovarian torsion usually idiopathic or 2/2 cyst/neoplasm?
|
2/2 cyst/neoplasm
|
|
Ovarian torsion:
-vomit? -diarrhea? |
Vomit
no diarrhea |
|
Ovarian torsion: see bilateral torsion?
|
See bilat in INFANT
|
|
Testicular torsion: what finding on phys exam?
|
Lose cremasteric
|
|
Testic torsion: irrevers damage after how long?
|
4h
|
|
Crohn's: 1st line drug
|
Mesalamine (5-ASA)
|
|
Mesalamine (5-ASA): 1st line in what dz?
|
Crohn's
|
|
Infliximab: what dz?
|
IBD
|
|
What dz:
Chronic abd pain + bloody stools + failure to grow |
IBD
|
|
IBD: is pain localized?
|
YES (red flag)
|
|
IBD: does pt p/w urinary sxs?
|
DYSURIA
|
|
IBD: will pain awaken pt from sleep?
|
Yes
|
|
IBD: what % pts have positive FHx?
|
30%
|
|
IBD: what CBC abnormalities? (2)
|
Anemia
HIGH PLATELETS |
|
IBD: see hypo or hyperalb?
|
Hypo
|
|
IgA tissue transglutinase Ab (TTG): sens? spec?
|
Sens & spec for celiac
|
|
Tissue transglutinase: what CLASS of Ab? (Ig_)
|
IgA
|
|
Celiac: un/common?
|
Uncommon
|
|
What dz:
6mo-2yo with chronic abd pain + ABDOMINAL DISTENSION + vomit/diarrhea + NO GROSS BLOODY STOOLS |
Celiac dz
|
|
Celiac dz: what is youngest age you may see?
|
6mo!
|
|
Celiac: see gross blood loss? occult?
|
OCCULT --> anemia
(no gross BRBPR) |
|
Peptic ulcer dz: common in child?
|
NO
|
|
Peptic ulcer: see diarrhea? gross bloody stool?
|
NO - p/w pain & occult loss
|
|
#1 intestinal PARASITE in US
|
Giardia
|
|
Giardia: best dx test?
|
SPECIFIC ANTIGEN TEST
(NOT O&P) |
|
What dz:
Abdominal pain & palpable mass & bloody streaks on stool & guaic pos |
Constipation
|
|
HSP:
-diarrhea? |
NO
Although most pts p/w collicky pain & bloody stools |
|
What dz:
Collicky abdominal pain + bloody stools + RASH + no diarrhea |
HSP
|
|
HSP: abd pain is constant or intermittent?
|
COLLICKY
|
|
#1 etio chronic abdominal pain in child
|
Functional abd pain (dx of exclusion)
|
|
Functional abd pain: see bloody stool?
|
NO - if blood --> cannot be fxnl
|
|
Functional abd pain: how tx?
|
Reassurance
|
|
IBD: 1st imaging test to perform? 2nd? risks?
|
Colo --> THEN barium enema (delays colo)
UC: enema --> increase risk toxic megacolon |
|
#1 intestinal PARASITE in US
|
Giardia
|
|
Giardia: best dx test?
|
SPECIFIC ANTIGEN TEST
(NOT O&P) |
|
What dz:
Abdominal pain & palpable mass & bloody streaks on stool & guaic pos |
Constipation
|
|
HSP:
-diarrhea? |
NO
Although most pts p/w collicky pain & bloody stools |
|
What dz:
Collicky abdominal pain + bloody stools + RASH + no diarrhea |
HSP
|
|
HSP: abd pain is constant or intermittent?
|
COLLICKY
|
|
#1 etio chronic abdominal pain in child
|
Functional abd pain (dx of exclusion)
|
|
#1 intestinal PARASITE in US
|
Giardia
|
|
Functional abd pain: see bloody stool?
|
NO - if blood --> cannot be fxnl
|
|
Giardia: best dx test?
|
SPECIFIC ANTIGEN TEST
(NOT O&P) |
|
Functional abd pain: how tx?
|
Reassurance
|
|
What dz:
Abdominal pain & palpable mass & bloody streaks on stool & guaic pos |
Constipation
|
|
IBD: 1st imaging test to perform? 2nd? risks?
|
Colo --> THEN barium enema (delays colo)
UC: enema --> increase risk toxic megacolon |
|
HSP:
-diarrhea? |
NO
Although most pts p/w collicky pain & bloody stools |
|
What dz:
Collicky abdominal pain + bloody stools + RASH + no diarrhea |
HSP
|
|
HSP: abd pain is constant or intermittent?
|
COLLICKY
|
|
#1 etio chronic abdominal pain in child
|
Functional abd pain (dx of exclusion)
|
|
Functional abd pain: see bloody stool?
|
NO - if blood --> cannot be fxnl
|
|
Functional abd pain: how tx?
|
Reassurance
|
|
IBD: 1st imaging test to perform? 2nd? risks?
|
Colo --> THEN barium enema (delays colo)
UC: enema --> increase risk toxic megacolon |
|
#1 intestinal PARASITE in US
|
Giardia
|
|
Giardia: best dx test?
|
SPECIFIC ANTIGEN TEST
(NOT O&P) |
|
What dz:
Abdominal pain & palpable mass & bloody streaks on stool & guaic pos |
Constipation
|
|
HSP:
-diarrhea? |
NO
Although most pts p/w collicky pain & bloody stools |
|
What dz:
Collicky abdominal pain + bloody stools + RASH + no diarrhea |
HSP
|
|
HSP: abd pain is constant or intermittent?
|
COLLICKY
|
|
#1 etio chronic abdominal pain in child
|
Functional abd pain (dx of exclusion)
|
|
Functional abd pain: see bloody stool?
|
NO - if blood --> cannot be fxnl
|
|
Functional abd pain: how tx?
|
Reassurance
|
|
IBD: 1st imaging test to perform? 2nd? risks?
|
Colo --> THEN barium enema (delays colo)
UC: enema --> increase risk toxic megacolon |
|
What dz:
Cobblestone mucosa of GI tract |
Crohn's
|
|
What dz:
GI mucosa friable & erythematous |
UC
(contrast Crohn's - cobblestone) |
|
What dz:
GI PSEUDOPOLYPS |
Ulcerative Collitis
|
|
CD or UC:
ALWAYS involves rectum |
UC
|
|
Sickle cell:
-what AA substitution? -which Hgb chain? |
Switch VAL to GLUTAMIC ACID
Beta chain |
|
Sickle cell:
De/increase retic count? |
INCREASE retics
|
|
What electrophoresis pattern in:
-fetus --> normal adult -sickle TRAIT -SCD |
Normal: FF --> AF
Trait: FSC (mild sickling) Dz: FS |
|
What dz: electrophoresis shows:
FSC |
sickle TRAIT
(dz: FS) |
|
What dz: electrophoresis shows:
FS |
Sickle DISEASE
(trait: FSC) |
|
Sickle cell:
-what is baseline color of pt? -what does pallor indicate? |
Baseline jaundice (2/2 hemolysis)
Pallor due: spleen sequestor RBCs and/or aplastic crisis |
|
Sickle cell:
Murmur? |
Flow murmur 2/2 anemia
|
|
Sickle cell:
Is parental monitoring of spleen effective ppx? |
YES
|
|
Sickle cell:
How evaluate for stroke? (what test) |
Transcranial Doppler
|
|
Sickle cell:
What UA finding? |
Hematuria 2/2 papillary necrosis
|
|
#1 death in sickle pts
|
Acute chest synd
|
|
What dz:
Sickle pt with fever, cough, SOB, hypoxia |
Acute chest syndrome
|
|
Acute chest syndrome:
Single or multiple lobules affected? |
Multilobular
|
|
Acute chest syndrome:
How appear CXR? |
NEW INFILTRATES; effusion, atelectasis
|
|
Acute chest syndrome:
Specific etiology identified in what % pts? |
40%
Often develops in child hospitalized for painful vasooculsion crisis |
|
What complication:
-Sickle + chest pain + decreased breath sounds -Sickle + CP + normal bs |
Decreased bs: ACS
Normal bs: Rib infarct |
|
What complication:
Sickle + cardiomegaly + lower lobe infiltrates + tachypnea; no chest pain |
CHF (2/2 chronic anemia)
|
|
Aplastic crisis in sickle: may be due what infxn?
|
Parvo B19
|
|
Sickle: is EVERY fever an emergency?
|
YES - may be only sign of serious infxn
|
|
Sickle: susc to what 3 pathogens?
|
Strep pneumo
H flu N mening |
|
Sickle: what gallbladder complication?
|
Cholelithiasis
(often perform lap chole BEFORE develop gallstones) |
|
Sickle: see precocious puberty?
|
NO - see delayed sex maturation
|
|
Sickle: why do pts snore?
|
Fxnl asplenia --> hypertrophy WALDEYERS RING
|
|
Sickle: what eye dz?
|
Proliferative retinopathy
|
|
Sickle: ppx lap chole?
|
YES - remove GB before develop G-stones --> infxn
|
|
Sickle: cure?
|
BMT
|
|
Sickle: tx w/what drug?
|
Hydroxyurea
|
|
Hydroxyurea: tx what dz?
|
Sickle (decrease freq & severity)
|
|
Sickle: give what vaccines if:
-<2yo ->2yo |
Hib ALL pts
<2yo: PCV-23 >2yo: PCV-13 (polysacch) |
|
Sickle:
-if sepsis --> what abx? -what age initiate ppx? |
Penicillin
Start ppx at 5-6yo |
|
0-4mos: infant gains how much wt per day?
|
20-30 g/d
|
|
Malnutrition: decreased HC is early or late finding?
|
LATE
(brain usu spared) |
|
FTT: definition:
-wt <____% -wt for height <___% |
Wt <3%
Wt for ht <3% |
|
FTT: what % cases are NON-organic?
|
90%
|
|
How present: (what finding)
True milk-protein allergy w/FTT |
BLOODY STOOLS
|
|
Lead level:
-toxic -acute encephalopathy (#) |
Toxic >10
Encephalo >100-150 |
|
Lead: suspect in what 2 types houses
|
<1950
Renovatd 1978 |
|
Lead screen: screen CAP or VENOUS?
|
CAPILLARY lead level --> confirm w/venous
|
|
Lead: universal screen in what 2 scenarios (community scenarios)? Screen what ages?
|
1. Prevalence >11%
2. >25% houses older than 1950 Screen 9-12mo --> repeat 2yo |
|
What dz:
Microcytic anemia w/stippling |
Lead poison
|
|
Lead poison: micro/normo/macrocytic anemia?
|
Micro
|
|
Lead poison: how affect:
-BP -pulse -rr |
Increase ICP --> CUSHING
HTN bradycardia resp distress |
|
Lead: see hypo or hyperphosphatemia?
|
HYPO
|
|
What dz:
Hypophosphatemia + urine coproporphyrin + glycosuria |
Lead poison
|
|
Lead poison: see what molecule in urine?
|
Coproporphyrin
|
|
What dz:
CXR: hyperdense flecks |
Lead poison
|
|
Tx what dz:
Dimercaprol |
Lead poison
|
|
Tx what dz:
Calcium EDTA |
Lead poison
|
|
Tx what dz:
Succimer |
Lead poison
|
|
Tx what dz:
Penicillinamine |
Lead poison
|
|
Lead poison: admit to hosp if lead what level?
|
>100 + sxs
|
|
Lead poison: how tx (what drugs):
-inpt (2) -outpt (2) |
Inpt:
1. Dimercaprol 2. INTRAVENOUS Ca2+ EDTA Outpt: 1. Succimer 2. Penicillinamine |
|
What drug:
Stims vomit center in brain --> vomit w/in 20 minutes |
Ipecac
|
|
Ipecac:
-mxn -how long until vomit? -useful if poison w/in what time frame? |
Stims vomit center in brain --> vomit in 20 mins
Useful if poison <30min |
|
Ipecac: need to consult poison center first?
|
YES
|
|
Ipecac: contra-indicated in what age?
|
<6mo
|
|
Ipecac: contraindicated if infant ingests:
-LOW or HIGH viscosity hydrocarbon? |
LOW
|
|
Ipecac: safe to use in pt w/coagulation disorder?
|
No - contraindicated
|
|
Poisoning:
Perform gastric lavage? |
No clinical benefit
|
|
Activated charcoal:
Useful w/in how long from poison ingestion? |
<1hr
|
|
Toxin ingestion: see fever?
|
Usu not
|
|
Reye's syndrome: affect ICP?
|
Increase ICP --> papilledema, change mental status --> diffuse encephalopathy
|
|
Metabolic dzs: p/w fever? Focal neuro findings?
|
No fever or focal neuro
P/w diffuse encephalo |
|
ICH: focal or diffuse neuro?
|
FOCAL
|
|
Meningitis: see papilledema? focal neuro s/sx?
|
NO
|
|
Seizure disorder: see what lyte abns? (2)
|
Low Ca
Low Mg |
|
Infant with mental status change: if high suspicion of etiology --> is head CT mandatory?
|
YES - GET HEAD CT
|
|
Cystic fibrosis:
How inherit? How many mutations? |
AR
1,500 mutation |
|
Cystic fibrosis:
Deficiency in what enzyme responsible for malabsorption? |
Defic lipase
|
|
Cystic fibrosis:
Admin what % daily recommended cals? |
120-150%
|
|
Recommended daily calories (kcal/kg/d):
-9w normal -9w cystic fibrosis |
normal: 100 kcal/kg/d
CF: 130-160 |
|
Cystic fibrosis:
What % calories should be fat? |
40%
(contrast normal: 30%) |
|
Cystic fibrosis:
Do minority or majority of teens develop CHRONIC PNA? |
MAJORITY
|
|
Cystic fibrosis:
Replace what 3 enzymes? 4 vitamins? |
Lipase
Amylase Protease (Creon) vitamin ADEK |
|
Cystic fibrosis:
Sweat test --> how long until results? |
DAYS
|
|
Cystic fibrosis:
MAIN dx test |
Sweat test
(genotype is adjunctive) (>60 is diagnostic) |
|
Sweat chloride test:
-normal -CF |
Normal <60
>60 diagnostic |
|
Cystic fibrosis:
Is genetic test diagnostic? |
NO - req further testing (preferably sweat test)
|
|
Cystic fibrosis:
Vitamin E deficiency --> what complication? |
HEMOLYSIS
|
|
Cystic fibrosis:
Hemolysis due to what deficiency? |
Vitamin E deficiency
|
|
Cystic fibrosis:
In/decreased haptoglobin? |
DECREASE (due hemolysis 2/2 vit E def)
|
|
Cystic fibrosis:
-in/decrease plts? -retics? |
Hemolysis (2/2 vit E def)-->
-increase plts -increase retics |
|
#1 bowel obstruction in 6mo-6yo
|
Intusseption
|
|
Intussception: what ages?
80% <___yo? |
6mo - 6yo
80% <2yo |
|
Intussception: M or F?
|
M>F
|
|
Intussception: which invaginates into other - prox vs. distal
|
Prox ALWAYS invaginates into distal
|
|
Intussception: intermittent or constant pain?
|
PAROXYSMS of pain
|
|
What dz:
paroxysmal abd pain + inconsolable + sausage in R abd |
Intussception
|
|
Intussception: vomit? diarrhea?
|
Vomit: YES
Stool is CURRANT (blood & mucus) |
|
Intussception: most common location
|
Ileocecal jxn
|
|
Intussception: underlying mxn (what stimulates telescope)?
|
Hypertrophied lymph tissue
|
|
Intussception: what dx imaging (2)?
|
Air or contrast enema
|
|
Name for:
Mid ear fluid + s/sx ear infxn (bulg, drainage) |
ACUTE OM
(contrast OME - no s/sx) |
|
How different:
AOM vs. chronic OME |
AOM: fluid + s/sx
Chronic OME: fluid - s/sx |
|
AOM: 4 most common bact pathogens
|
Strep pneumo
H flu M cattarhalis STREP PYOGENES |
|
AOM: 3 common VIRAL pathogens
|
Influ
RSV Rhino |
|
AOM: higher bottle or breast? Assoc w/pacifier? genetic component?
|
Bottle
Increase risk if pacifier FHx |
|
AOM: M or F?
|
M > F
|
|
AOM: assoc w/SES?
|
Increased in LOW SES
|
|
AOM: highest what ethnicity?
|
Native American
|
|
What dz:
TMs retracted & amber & decreased mobility |
Chronic OME
|
|
Ear exam to r/o AOM: which is more reliable:
TM color OR position/mobility |
Position/mobility
|
|
Ear exam:
Is RED TM alone a good predictor of AOM? |
NO
|
|
What test:
Objective eval TM mobility |
Tympanogram
|
|
What test:
Audio thresholds via EARPHONES |
Conventional audiometry
|
|
What test:
Audio threshold via SPEAKERS |
Visual Reinforcement audiometry (VRA)
|
|
How different:
Conventional audiometry vs. Visual Reinforcement Audiometry |
Conventional: earphones; >4yo
Visual: speakers; 6mo - 2.5yo |
|
Conventional audiometry: can perform in what ages?
|
>4yo
|
|
Visual Reinforcement Audiometry: perform in what ages?
|
Speakers
6mo - 2.5yo |
|
What test:
PHYSIOLOGIC test of COCHLEAR response to stimulation |
Otoacoustic Emissions (OAE)
|
|
What test:
Use in newborn to assess hearing |
Otoacoustic Emissions (OAE)
-physio test of cochlear response |
|
AOM: what % resolve spontan?
|
50-80%
|
|
AOM: how tx DEFINITE dx in:
-0-2yo ->2yo |
0-2: abx
>2: abx if SEVERE (39', pain) |
|
UNCERTAIN AOM: must give abx if <___ (age)
|
<6mo
If 6mo -2yo --> you can observe (abx if 39', severe pain) |
|
Chronic OME: assoc w/hearing loss?
|
YES --> lang delay
|
|
Chronic OME: how tx? (2 options)
|
watch & wait
if hearing loss --> TUBES |
|
Name for:
Edges of optic disc blurred; narrow BVs |
Papilledema
|
|
TTH or Migraine:
LATE in day |
TTH
|
|
TTH: occur AM or PM?
|
PM
|
|
TTH or Migraine:
Triggered by stress |
BOTH
|
|
TTH or Migraine:
Occipital |
TTH
|
|
TTH or Migraine:
Tender neck muscles |
TTH
|
|
TTH or Migraine:
BILATERAL |
TTH
|
|
TTH or Migraine:
Any time of day |
Migraine
|
|
Migraine: AM or PM?
|
Any time of day
|
|
TTH or Migraine:
Unilateral |
Migraine
|
|
TTH or Migraine:
Can be triggered by foods |
Migraine
|
|
TTH or Migraine:
Relieved with sleep |
Migraine
|
|
What type of HA:
Bilateral vision changes + parasthesias + mental status changes |
BASILAR migraine
|
|
Basilar migraine: how present?
|
Bilateral vision loss
Parasthesias Mental status change |
|
Suspect what type of pathology:
HA + developmental delay |
Intracranial process
|
|
Febrile szs:
Occur EARLY or LATER in course of fever? |
EARLY (1st day)
|
|
Febrile szs:
See with temp >___ C |
>38C
|
|
Febrile szs:
Consider LP if <___ (age) |
1st sz <12yo
(OR atypical sz w/slow return to baseline) |
|
SIMPLE or COMPLEX febrile sz:
More common |
Simple
|
|
SIMPLE or COMPLEX febrile sz:
GENERALIZED |
SIMPLE!!!
(complex is focal) |
|
SIMPLE or COMPLEX febrile sz:
<15mins |
Simple
|
|
What is difference:
Simple vs. Complex febrile sz |
Simple: <15min x 1; generalized
Complex: >15min x multi; focal |
|
Febrile sz: what is % recurrence if 1st sz:
-<12mo ->12mo |
<12mo: 50% recurrence
>12mo: 30% recurrence |
|
Febrile sz:
increase risk epilepsy? |
SLIGHT increase (esp if early & recurrent)
|
|
Febrile sz:
FHx? |
Yes
|
|
True seizure: see PINTPOINT or DILATED pupils?
|
Pinpoint
|
|
What % infants w/meningitis p/w szs?
|
30%
|
|
Can a BENIGN VIRAL SYNDROME be responsible for fever without source?
|
YES
(may be indisting from occult bacteremia) |
|
#1 pathogen in OCCULT BACTEREMIA
|
Strep pneumo
|
|
Infant with fever of unknown source: catheterize if:
-M <__(age) -F <__(age) |
M<6mo (after 6mos start to think less about occult UTI)
F<12mo |
|
What % infants w/bacterial meningitis have fever?
|
95%
|
|
Infant w/bact meningitis: top 2 pathogens in IMMUNIZED:
-<2mo -2mo - 12yo |
<2mo: E coli & GBS
2mo-12yo: Strep pneumo + N mening |
|
Bact meningitis: suspect GBS if under what age?
|
<2mo
|
|
Bact meningitis: initiate what abx?
|
IV cephalo + vanco
|
|
Bacterial meningitis: may lead to what HORMONAL complication?
|
SIADH
|
|
Bact meningitis: is it RARE or COMMON for txed mening to be fatal?
|
RARE
|
|
#1 VIRAL meningitis
|
Enterovirus
|
|
Viral meningitis: what cells predom CSF:
-0-48h ->48h |
0-48h: PMNs
>48h: lymphocytes |
|
Viral meningitis: see predom LYMPHOS in CSF after how many hours?
|
>48h
|
|
Viral meningitis: what VIRUS --> RBCs in CSF?
|
HSV
|
|
HSV meningitis: what CSF feature?
|
See RBCs
|
|
Shock: initial bolus (size & fluid)
|
20 cc ISOTONIC NS
|
|
Shock:
When initiate INTRAOSSEOUS access? |
Fail periph: 90 seconds or 3 attempts
|
|
IV access in SHOCK:
What TYPE of central line is an approp alternative to periph line in older child |
FEMORAL
(NOT subclavian or arterial) |
|
Meningococcemia: 1st choice abx
|
IV PENICILLIN
|
|
Meningococcus: how prophylx:
-adult contacts -children |
Adult: cipro
Children: rifampin |
|
Meningococcemia: admin what abx at discharge to elim carrier state?
|
CEFTRIAX
|
|
MCV4: safe what ages?
|
11-18yo
|
|
Meningococcemia:
-what % adols die? total die? -what % have comps? |
Fatal 25% adols, 10% total
10-20% comps |
|
Hypernatremia: slow or rapid replace fluid?
|
SLOW!
Decrease Na 1 mEq / 2h (10 mEq/d) |
|
Leads to what lyte abn:
Drink boiled milk |
Hypernatremia
|
|
Leads to what lyte abn:
Drink free H2O |
Hyponatremia
|
|
How calculate:
Degree of dehydration (#) |
Previous wt - current wt
(assumes all wt loss is free H2O) |
|
Expect hypo/iso/hypernatremic loss:
Gastroenteritis |
ISOnatremia
(not req to meas lytes) |
|
Gastroenteritis: required to measure lytes?
|
No - only if mod/severe dehydr
(assume isonatremic loss) |
|
Dehyrdation: give what SIZE BOLUS over what AMT TIME? repeat boluses how often?
|
20 cc NS over 20-60min
Repeat until normal UOP & HR |
|
How calculate:
Fluid deficit (cc) = |
wt (g) x % dehydration
|
|
Dehydration: if replace fluids ORALLY --> how many CCs per how much TIME?
|
5-10cc q 1-5min
|
|
Give how much maintenance fluid?:
8kg |
8x100 = 800cc/d
|
|
Give how much maintenance fluid?:
14 kg |
10x100=1,000
4x50=200 1,200 |
|
Give how much maintenance fluid?:
25 kg |
10x100=1,000
10x50=500 5x20=100 1,600 |
|
Fluid balance:
Need to replace HOW MUCH fluid for stool loss? What type of fluid? |
>5g per 4h
Use 1/2NS + 20KCl (no dextrose) |
|
Normal saline: how much Na+? Cl?
|
154 each
|
|
Oral replacement therapy: able to use in MODERATE dehydration w/out vomit?
|
YES
|
|
Dehydration: when reintroduce breastmilk/full formula?
|
If no vomit & tolerates 1-2 ozs of ORT per feed
|
|
Give how much maintenance fluid?:
8kg |
8x100 = 800cc/d
|
|
Give how much maintenance fluid?:
14 kg |
10x100=1,000
4x50=200 1,200 |
|
Give how much maintenance fluid?:
25 kg |
10x100=1,000
10x50=500 5x20=100 1,600 |
|
Fluid balance:
Need to replace HOW MUCH fluid for stool loss? What type of fluid? |
>5g per 4h
Use 1/2NS + 20KCl (no dextrose) |
|
Normal saline: how much Na+? Cl?
|
154 each
|
|
Oral replacement therapy: able to use in MODERATE dehydration w/out vomit?
|
YES
|
|
Dehydration: when reintroduce breastmilk/full formula?
|
If no vomit & tolerates 1-2 ozs of ORT per feed
|
|
Where is pathology:
BILLIOUS vomit |
POST-AMPULLA
|
|
Where is pathology:
Bloody vomit |
Above ligament of Treitz
|
|
#1 etio gastroenteritis
|
Rotavirus
|
|
Pyloric stenosis:
When present? |
3w (1w - 5mo)
|
|
Pyloric stenosis:
Bilious? |
No - immed vomit
|
|
Pyloric stenosis:
Where palpate olive? |
Above & right umbilius
|
|
Pyloric stenosis:
See skin changes? |
Often see jaundice
|
|
Pyloric stenosis:
What lyte abn? |
Hypochloremic metabolic alkalosis
|
|
Pyloric stenosis:
What imaging? (2) |
Abd U/S --> (if not avail) --> upper GI WITH CONTRAST
|
|
What dz:
Upper GI: STRING SIGN |
Pyloric stenosis
|
|
Pyloric stenosis:
Does LACK of palpable olive --> affect suspicion? |
YES --- speaks strongly AGAINST P.S.
|
|
Pyloric stenosis:
See diarrhea? |
No
|
|
UTI:
see vomit? diarrhea? |
Vomit yes,
no diarrhea -- may see loose stools |
|
Gastroesoph reflux: see poor wt gain?
|
Baby can develop food aversion --> FTT
|
|
Baby w/normal growth --> acute vomit:
Suspect metabolic disorder? |
Not if previously normal growth
|
|
HSP:
-peaks what age? -M or F? |
4-6yo (range 2-17)
2x M > F |
|
HSP: underlying mxn?
|
viral/bact URI (50% pts )---> IgA-mediated
|
|
HSP: how affects platelts?
|
NORMAL PLATELETS!!!!
|
|
What dz:
URI --> IgA deposition --> leukocytic vasculitis |
HSP
|
|
What dz:
erythematous macules/wheals --> petechiae --> purpura |
HSP
|
|
HSP: where see purpura? (distrib)
|
Gravity-dependent & pressure-sensitive areas
ELBOWS, LOWER EXTREMS |
|
HSP: what % pts have skin s/sx?
|
100%
|
|
HSP: order what 2 labs?
|
UA: ALWAYS; assess renal involve
(if see blood/protein --> order BUN, CR) CBC: see NORMAL PLATELETS |
|
HSP: see splenomeg?
|
No
|
|
HSP: req PT? PTT? Blood cx?
|
NO
|
|
HSP:
-resolves how long? what % recur? -how tx? -risk what GI comp? |
4-6w; 30% recur
NSAIDs; STEROIDS FOR ABD PAIN risk GI bleed & ileoilial intuss |
|
ITP: more or less common than HSP?
|
LESS COMMON
(5:100k compared to 10:100k) |
|
ITP:
-age? -M or F? |
2-5yo (younger than HSP)
M=F |
|
What dz:
non-specific viral infxn --> anti-plt Abs that bind plt surface --> liver & spleen destroy plts |
ITP
|
|
HSP or ITP:
YOUNGER |
ITP (2-5yo)
(contrast HSP 4-6) |
|
HSP or ITP:
M > F |
HSP
|
|
HSP or ITP:
M = F |
ITP
|
|
HSP or ITP:
IgA deposits |
HSP
(contrast ITP: anti-plt Abs) |
|
HSP or ITP:
Anti-platelet Abs |
ITP
(contrast HSP: IgA deposits) |
|
HSP or ITP:
Usually preceded by viral infxn |
BOTH
HSP: viral/bact URI ITP: non-specific viral infxn |
|
ITP: presents with petech/bruising and what OTHER sxs?
|
NONE
(may see epistax, ICH) |
|
ITP:
-hepatosplenomeg? -arthralgia? |
NO
|
|
ITP is intracranial hemorrhage common?
|
NO - 0.5%
|
|
ITP: plts <___?
|
<20k
|
|
ITP: do most pts develop significant bleed?
|
NO
|
|
What dz:
viral infxn --> PETECHIA, BRUISING --> normal WBC, platelets <20k |
ITP
|
|
ITP: how tx? (3)
|
Steroid
IVIg Rhogham (anti-D) |
|
Leukemia: see change in platelets?
|
Decrease (<100k)
(BM infiltrate --> see other cytopenias) |
|
What dz:
Petech/purp + bone pain + hepatosplenomeg |
Leukemia
|
|
To percuss liver:
Child in what position? |
Supine w/knees bent
|
|
Normal liver size:
-neonate -child |
Neonate: 3.5cm
Child: 2.0cm |
|
Leukemia: see hepatomeg?
|
YES - due infiltration
|
|
Glycogen storage dz: see small or large liver?
|
Hepatomeg
|
|
Spleen palpable in what %:
-neonates -children -adols |
Neonate: 33%
Child: 10% Adol: 2% |
|
Spleen: what size is ABNORMAL?
|
>2cm
|
|
See splenomegaly?:
Endocarditis |
Yes
|
|
See splenomegaly?:
SLE |
Yes
|
|
Which storage disease:
See splenomegaly |
GAUCHER
|
|
LNs: abn if what size?
|
>2cm
|
|
Palpable LNs are considered NORMAL in what 3 areas?
|
Cervical
Ax Inguinal --> anywhere else is abn |
|
DKA: see OSMOTIC DIURESES once BG is above what #?
|
180
|
|
T1DM: comprises what % total DM?
|
5-10%
|
|
T2DM: insulin level is low, normal or high?
|
Normal-high
(tissues are insulin-resistant --> need higher levels of insulin) |
|
DM: screen if overweight (WHAT BMI %) and HOW MANY SXS?
|
BMI >85% and 2 s/sx
(FHx 1-2', race, HTN, dyslipid,etc) |
|
DM: screen beginning what age? how often?
|
puberty --> q3 yrs
|
|
Pediatric insulin: how many injections per day? how distribute doses?
|
3-4 injxns/day
2/3 total in AM (1/3 rapid + 2/3 intermed) --> 1/6 dinner (rapid) --> 1/6 bed (intermed) |
|
DKA: follow what LAB to monitor response to insulin?
|
SERUM ketones
|
|
What dz:
Increased beta-hydroxybutyrate |
DKA
|
|
DKA: monitor URINE KETONES how often?
|
Every void until no ketones
|
|
DKA: how decide when to switch from IV to SQ insulin?
|
Switch once NO KETONES In serum or urine
|
|
DKA: how affect BUN, CR?
|
Usually normal
Increase if severely dehydrated |
|
DKA: how affect:
-serum Na+? -K? |
HYPONATREMIA: due renal loss & osmotic movement of H2O into extracell
K+ low/normal/high (despite total body hypoK) --> provide K in IVF |
|
DKA: admin K+ in IVF?
|
YES - give K+
|
|
DKA: cont insulin drip until:
-pH > # -bicarb > # |
pH > 7.3
Bicarb > 15 |
|
DKA: add DEXTROSE to IVF if BG <___
|
<300
|
|
DKA: what is tx goal:
-RATE of BG drop -Target BG |
Decrease 80-100 mg/dl per HOUR
Goal: 120-250 |
|
DKA: #1 reason of death
|
Cerebral edema 2/2 overrapid glucose correction
|
|
What dz:
Child w/DKA --> give insulin drip --> HA & mental status change --> death |
Cerebral edema 2/2 overrapid correction
|
|
Cerebral edema 2/2 overrapid correct DKA:
-admin what drug to prevent? |
MANNITOL IV 0.25-1mg/kgDue
|
|
Do children have lower or higher % total body H2O?
|
HIGHER
(increases risk of dehydration) |
|
Dehydration: low or high sensitivity?:
Decreased UOP |
HIGH
|
|
Dehydration: low or high sensitivity?:
Dry mucus membranes |
HIGH
|
|
Dehydration: low or high sensitivity?:
Absent tearing |
HIGH
|
|
Hypo/iso/hypernatremic dehydration:
Gastroenteritis |
ISO
|
|
Dehydration: correct over how many hours?:
-hyponatremic -iso -hyper |
Hypo: 24h
Iso: 12h Hyper: 24h |
|
How define (what seurm Na+):
-hyponatremic -hyper |
Hypo: <130
Hyper: >150 |
|
If severe hyponatremia (<120): think what 3 etios?
|
1. Free H2O
2. Dilute formula 3. Adrenal insuff |
|
Hypo/iso/hypernatremic dehydration:
D.I. |
Hyper (>150)
|
|
Insensible losses account for what % daily H2O req?
|
40%
(other 60% is UOP) |
|
DKA: do you replace ongoing urine loss?
|
NO - mobilizing extracellular fluid
(you do replace stool losses) |
|
How distinguish:
Trans synovitis of hip VS septic hip |
DEGREE of inflamm (based WBC, ESR, CRP)
|
|
Transient synovitis of hip:
Common? |
YES
|
|
Transient synovitis of hip:
LT sequela? |
None
|
|
Transient synovitis of hip:
Low or high fever? |
Low
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Transient synovitis of hip:
Affect ROM? |
DECREASED ROM
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Transient synovitis of hip:
How long until resolve? |
3-4d
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Transient synovitis of hip:
How tx? |
rest + ibuprofen --> f/u 2d to recheck CBC (r/o leukemia)
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Can septic arthritis lead to avasc necrosis?
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Yes - accum pus --> pressure --> decrease BF fem head
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Septic arthritis: which pathogen common in neonate?
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GBS
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Septic arthritis: which pathogen in adol?
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N gonorr
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Septic arthritis: which species of strep?
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Strep pyogenes
Strep pneumo |
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Septic arthritis: see joint warmth? redness?
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Not always (since deep infxn)
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Septic arthritis: joint asp has DECREASED or INCREASED viscosity?
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DECREASED viscosity indicates infxn
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Septic arthritis: how tx?
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I & D! --> IV abx --> repeat asp
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JRA: difference between:
Pauci & polyarticular |
Pauci: <4 (usu large)
Poly >4 (usu small) |
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JRA: are all subtypes assoc w/fever?
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No, only some
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JRA: common to see rash?
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YEs
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JRA: dx requires s/sx to be present for how long?
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6+ weeks
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What dz:
Infxn --> Abs against joint |
REACTIVE (post-infectious) arthritis
(NOT transient syno: inflamm of lining - no actual Abs) |
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Reactive arthritis:
Presents how long after initial infxn? |
Few weeks
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Reactive arthritis: due to what PATHOGENS:
-GI infxn (2) -GU infxn -Pharyngitis |
GI: Yersinia, Shigella
GU: Chlam Strep |
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What dz:
Joint pain + asp w/inflammatory cells + NEGATIVE asp cx |
Reactive arthritis
(contrast septic: pos asp cx) |
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Reactive arthritis:
How tx? |
ABX IF INFXN STILL PRESENT
otherwise NSAIDs for few wekes |
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Reactive arthritis:
More common lower or upper extrems? small or large joints? |
Lower
Small |
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Sprain: what anatomic injury?
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Tear ligament
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See SPRAIN after fall?
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NO
Req tearing motion |
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Occult fx: see how long s/p injury?
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3-4w
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Osteomyelitis: #1 pathogen
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Staph aureus
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Osteomyelitis: ACUTE or INDOLENT pain?
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INDOLENT!!!
Delays abx 5-10d |
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Osteomyelitis: what % pts present with fever but no pain?
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50%
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Suspect what dz:
Limp + jaw pain |
Leukemia w/BM infil
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VSD: why not present in neonate?
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High pulm vasc R in neonate --> no reason for blood to shunt to pulm vasc rather than systemic
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VSD: how result in poor feeding?
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LV overload --> CHF --> increased RR --> difficult feeding
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What dz:
Sweat during feed; tire during feed |
CHF (e.g. 2/2 VSD)
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CHF: #1 phys finding
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TACHYPNEA
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What dz:
Tachycardia w/gallop rhythm |
CHF
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VSD: is murmur intensity correl with size of defect?
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NO
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What MURMUR:
Loud, blowing holosystolic at LLSB |
VSD
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VSD: when present?
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Few days s/p birth
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VSD: where best ausc?
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Lower left sternal border
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VSD: does magnitude of shunt affect the age of presentation?
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YES
larger defect --> earlier CHF |
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VSD: defect becomes smaller or larger with time?
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SMALLER
(75% small & 50% total will close) |
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VSD: what % total close?
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50%
(75% small VSDs) |
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VSD: expect abn EKG?
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YES - see RV dominance
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4 defects that cause murmur AND CHF
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1. VSD
2. Ao stenosis 3. Ao coarct 4. large PDA |
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Lead to CHF?:
PDA |
Yes (if large)
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Lead to CHF?:
ASD |
No
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Lead to CHF?:
TOF |
No
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Infant CHF: req inpatient tx?
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YES
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How tx:
-CHF due VSD -CHF due cardiomyopathy |
VSD: digoxin + furesomide
Cardiomyo: ACE-I |
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VSD: decide surgery at what age?
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6mo
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Shaken Baby Syndrome:
-what % die? what % poor neuro outcome? -account what % child abuse death? |
25% die, 40% poor neuro outcome
10% child abuse death |
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Shaken Baby Syndrome:
Pinpoint OR dilated pupils? |
DILATED
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Shaken Baby Syndrome:
Stiff or limp? |
STIFF
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Shaken Baby Syndrome:
Higher mortality if <1yo or >1yo? |
<1yo
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Shaken Baby Syndrome:
What TYPE of brain bleed? |
Subdural
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Subdural bleed in neonate: 2 main etios?
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1. Shaken baby
2. Vacuum NOT szs |
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Increased ICP in neonate: how affect breathing?
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See APNEA
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Bacterial mening in neonate: what % have hearing loss?
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20%
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Arrythmia: common to see apnea?
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NO
See: decreased feed, irritable, lethargic |
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Suspect increased ICP if:
SLOW or RAPID rr? |
SLOW
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R/o subdural bleed: what imaging 1st?
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CT --> serial CT to monitor
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Which brain imaging best for:
Shearing injury |
MRI
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Shaken Baby Syndrome:
-Administer what ppx meds? -what imaging (aside from brain)? |
Anti-epileptics
Skeletal survey |
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Apnea: definition (2)
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1. No breathe >20s
2. No breath (<20s) plus brady (<100) or pallor-cyanosis |
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#1 problem in prematures
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Apnea
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Gallop: common in peds?
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No
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What murmur:
Continuous diastolic murmur |
PDA
(PATHOLOGIC) |
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Common or rare?:
Endocarditis |
Rare
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Common or rare?:
Cardiomyopathy |
Rare
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Innocent murmurs: common what age? due to defect?
|
3-7yo
NOT defect (due vibration) |
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#1 innocent murmur
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Still's
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What murmur:
musical, vibratory murmur in LSB while supine |
Still's (innocent)
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Still's murmur: best heard standing or supine?
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SUPINE
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What murmur?:
Widely split, fixed S2 |
ASD
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ASD: presents what ages?
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3-5yo
(contrast VSD: few days s/p birth) |
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What murmur:
Presents 3-5yo |
ASD
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What murmur?:
Initially syst ejection murmur --> early diast murmur |
Ao stenosis
(leads to Ao insuff) |
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What murmur?:
S1 --> systolic ejection click --> harsh systolic murmur |
Pulmonic stenosis
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PDA: louder in dias or syst?
|
SYST loudest
(although continuous) |
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What murmur?:
Holosystolic, blowing |
VSD
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What murmur?:
PROGRESSIVE; detect any age; p/w HTN in upper extrems |
Ao coarct
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Detect what age:
Bicuspid Ao valve |
Adol/adult
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1st & most subtle sign of inadequate circulation
|
tachycardia
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Femoral pulse: represents periph or central pulse?
|
Central
(sim carotid) |
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What type of shock:
WARM EXTREMS |
Septic
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Can viral infection lead to septic shock?
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Yes (via toxin production)
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What type of shock:
ADEQUATE UOP |
Septic
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What type of shock:
Bounding pulse |
Septic
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Septic shock:
How tx? (2 immed management steps) |
Boluses --> Vasopressors (E/NE/DA)
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Leads to what type of shock?:
Cardiomyopathy |
Cardiogenic
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Leads to what type of shock?:
Tamponade |
Cardiogenic
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Cardiogenic shock:
Cool or warm extrems? |
Cool
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Cardiogenic shock: how affect UOP?
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Decrease UOP
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Leads to what type of shock?:
Anaphylaxis |
Distributive shock
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Leads to what type of shock?:
SIRS |
Distributive shock
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Hypoglycemia: see fever?
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No
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Encephalitis: how affect resp rate?
|
NORMAL --- tachypnea uncommon!
(contrast meningitis) |
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PNA in infant: expect mental status change?
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No
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Toxic shock syndrome: how does rash appear?
|
Sunburn-like sandpaper
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What dz:
Pastia's Sign |
Scarlet Fever
(linear petechia in body folds) |
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Scarlet Fever: see desquam?
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Yes (5d after rash)
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Name for:
Scarlet Fever --> linear petechia in body folds |
Pastia's sign
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