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74 Cards in this Set
- Front
- Back
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12 y/o w/high BMI and hip pain/limp, no other problems, no fever, no joint swelling
-tests -Dx |
Xray pelvis
slipped femoral capital epiphysis |
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Possible ADHD in patient who can't sit still in class - next step?
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Rating scales to parents and teachers
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Pain + anemia + thrombocytopenia + fever --> want to r/o
(why not toxic synovitis?) |
ALL
(TS has normal platelet count) |
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Test for Henoch-Schonlain purpura
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Labs will be normal
Use pressure cuff --> petechiae --> capillary fragility test |
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Jones Criteria
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MAJOR
J = joints (arthralgias) O = heart (carditis) N = nodules (osler's) E = erythema marginatum (pink rings on the trunk and inner surfaces of the limbs which come and go) S = syndhams chorea MINOR Fever Arthritis Acute phase reactants increased Prolonged PR interval (1st degree heart block) |
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olioarthritic vs poly" JIA - size of joint
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oligo = big
poly = small |
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2-5 y/o
URI, then limp low grade fever CBC, ESP, Xray normal -Dx? -Tx? |
transient synovitis of hip
(but r/o septic arthritis) resolves w/o Tx |
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SCFE (Slipped Capital Femoral Epiphysis)
vs Legg-Calve-Perthe disease = age ranges |
10-20 y/o
vs 5-10 y/o |
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Toddler
Fever Low Hct/Hb High WBC/Bands High EST -Dx? -next? |
septic arthritis
joint aspiration, xray, antibiotics |
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violaceous heliotropic rash
Gottron papules serum CK, ANA, AST, LDH elevated tirednesss, weakness, anorexia and low grade fever for few weeks |
juvenile dermatomyositis
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Gottron papules
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skin over prox phalangeal joints and metacarpals hypertrophic and pink (indicative of juvenile dermatomyositis)
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college student
swelling of metacarpal and interphalangeal jts for week red rash on face, lacy rash on trunk and extrem |
5th disease (parvovirus B19)
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child w/pain in R knee on and off for 2 mo
knee normal has limp CBC, EST, ANA, RF and lyme serology normal Dx? Tx? |
hip dysplasia
crutches |
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in infants, chlamydia trachomatis causes:
To Dx: to Tx: |
pneumonia
eosinophilia macrolides |
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herald patch
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cluster of small oval red spots --> first step of pityriasis rosea
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Fitz-Hugh-Curtis syndrome
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violen string adhesions to w/inflamed Glisson's (liver) capsule,
ascending from PID --> presents w/RUQ pain |
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best bedside test of testicular torsion
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lack of cremasteric reflex
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best bedside test of epididymus torsion
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blue dot sign
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Tx of bacterial vaginosis
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metronidazole, clindamycin
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Tx of trichomoniasis
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oral metronidazole, topical nystatin
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shock by age
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age systolic BP of shock
1 mo - 1 y/o <70 1y-10 y/o <70 + (2xage) >10 y/o <90 |
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Na+ = 120-130
Na+ <120 |
apathy, somnolence, irritability, hypotonia
seizure |
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serum osmolality
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2(Na+) + (BUN/3) + (Glu/18)
(Na has 2 letters, BUN has 3) |
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Reye syndrome preceded by
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varicella, influenza
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Reye-like syndromes
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FA oxidation defects, UC defects, organic acidemia
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cardiomyopathies
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Hypertrophic
Arrythmogenic Restricted Dilated |
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If an infant loses >10% of their weight, suspect
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lactation failure
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In hypertonic dehydration, skin feels
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doughy
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repeated emesis tinged w/birght red blood
-Dx -to test -intervention |
Mallory-Weis tear
Drop NG tube - if any doubt, endoscopy No intervention (suuportive) |
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Shigatoxin hits --- then ---
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GI, then GU (small blood vessels)
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3 warning signs of hemorrhagic disease
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-prolonged bleed after trauma or surgery
-spontaneous bleeding into skin (petechiae), mucous membranes (swollen gums), internal organs -bleeding from >1 site |
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Strep pneumo is the MCC of:
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1 - OM
2 - sinusitis 3 - meningitis in adults 4 - bacteremia 5 - pneumonia in adults |
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sudden onset of abd distension in infants
(where?) |
volvulus
(midgut) EMERGENCY |
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Increased reticulocytes from
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Hemolysis
Hemorrhage Hematinic (things that increase Hb, like FA/B12/Fe++) deficiency |
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Henoch-Schonlein Purpura effects:
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GI
GU Skin Joints |
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HSP vs ITP
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normal labs vs low platelet count
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If infant vomits blood, first check
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If mom's nipple is cracking
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Premie w/abd distension, single yellow emesis, occult blood in stool
-Dx -test -Tx |
necrotizing enterocolitis
Xray NPO, NG tube, IVF |
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mucosal pigmentation of lips and gums + new-onset rectal bleed
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Peutz-Jeghers syndrome
(intestinal polyps and pigmented macules) |
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patient who comes in unconscious/semiconscious/confused
S Stroke E Epilepsy/seizures M Meningitis/encephalitis/sepsis I Injury (head injury) ------------------------------------------------------------- M Metabolic/medications A Alcohol I Insulin D Diabetes ---------------------------------------------------------------- U Uremia P Poisons and drugs |
S Stroke
E Epilepsy/seizures M Meningitis/encephalitis/sepsis I Injury (head injury) ------------------------------------------------------------- M Metabolic/medications A Alcohol I Insulin D Diabetes ---------------------------------------------------------------- U Uremia P Poisons and drugs |
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Wheezing child
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asthma
if has CF - nasal polyps aspiration syndromes -GERD, TEF, foreign body bronchiolitis pneumonia CF CHF/HD bronchopulmonary dysplasia extrinsic AW compression defects in host defenses -immunodeficiency, bronchiectasis, immotile cilia syndrome |
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Blood in stool
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YESS-C!
Yesinia enterocolitica E.coli (EIEC) Shigella Salmonella Campylobacter jejuni |
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9 month old w/fever, vomiting and fever lethargy, irritable
No other findings on PE DD? tests? |
infectious processes like meningitis, sepsis, pneumonia, UTI
CBC w/diff and blood cultures |
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4 y/o w/several emesis in last 6h, then lethargy
dehydrated normal CBC ALT = 375 U/L DD? |
intrahepatic cholestasis, viral hepatitis, nonspecific granulomatous hepatitis, autoimmune hepatitis, acetaminophen poisoning, mononucleosis, Reye syndrome
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differential diagnosis of incessant crying
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would include GI problems (intussusception, appendicitis, pancreatitis, presenting sign of pneumonia, GERD, functional abdominal pain, acute diarrhea and excessive flatulence), sepsis, meningitis, trauma, respiratory problems (acute nasopharyngitis, acute pharyngitis, acute tonsillitis, acute otitis media, peritonsilar abscess), a UTI, bacteremia, roseola infantum, hair tourniquet syndrome, strangulated hernia, torsion of the testicle/ovary
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What does teething cause?
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More teeth
Drooling NOT fever NOT incessant crying |
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Sudden onset seizure
Irritable for several days No trauma Unsure if fever Failure of R lateral gaze on PE -suspect? why? -next? |
Be suspicious of an increased ICP, especially a space occupying lesion (tumor, abscess, hematoma) as indicated by the CN VI palsy demonstrated
-obtain a head CT with no contrast. |
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hierarchy of infant resuscitation
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If crying and pink --> wipe dry,
warm towels If crying/blue - hold O2 to baby’s face If not crying, blue and HR>100 - suction baby If not crying, blue and HR<100 - use mask and bag for positive pressure ventilation - intubate If not crying, blue and HR<60 (or NONE) -use crash cart medications like epinephrine 6 - CPR |
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Materials needed for infant resuscitation
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warmer, blankets, DeLee suction device, O2 source, tubing, bag w/at least 3 sizes of mask, straight laryngoscope, uncuffed ET tube, meconium aspirator, crash cart with medications
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MMR and Varivax are CI in pts who
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-have had a live vac in preceding 6 wks
-are preggers |
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Is rotavirus assoc w/intussesception?
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Nope! fixed it
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We now regularly use __ Ags to immunize against __ diseases
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130, 11
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Which live vac is okay for chemo pts?
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MMR
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why not vaccinate vs the common cold?
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>100 viruses cause it
too many Ag serotypes no cross-conferred immunity |
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MC deaths due to sequelae of Hep B
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cirrhosis
hepatocellular carcinoma |
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Hep B seronegative patient should get
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1 booster shot
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ZOSTER vac should be give to all adults > __ y/o
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65
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Get ZOSTER vac even if had shingles?
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YES
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DIDMOAD syndrome
(wolfram) |
DI
DM optic atrophy deafness |
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Delayed fontanelle closure can be caused by
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Cretonism
Hydrocephalus Acondroplasia Rickets Downs |
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Low Na+
High K+ Increased plasma renin -what syndrome? |
Addisons
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primary hyperPTism usually caused by
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gland hyperplasia
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hyperPTism - primary or secondary MC?
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secondary
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congenital hypothyroidism
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dry skin, large fontanelles
mostly asymp at birth --> DD if unTxed -test for it MCC = thyroid dysgensis |
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Soto syndrome
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cerebral gigantism
(increased growth in 1st 2-3 yrs w/mild MR, other DDs, hypotonia and speech problems) |
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SIADH signs and Sx
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HAs, impaired consciousness, hyponatremia, high urine osmolality (very concentrated), low plasma osmolality
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mucopolysaccharidoses stature
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normal to short w/hunchback
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type of tremor in hyperthyroid
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resting
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rickets - clinical signs
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craniotabes (abn thick skull), enlargement of bone at wrists/ankles, beading of rins, pectus carinatus, Harrison's sulci (diaphragm pulls bone down to cause horizontal line at thoracic region), hypotonia, deformed/delayed dentition
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Harrison's sulci
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diaphragm pulls bone down to cause horizontal line at thoracic region
-rickets -chronic asthmatics |
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MC thyroid carcinoma and Px
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papillary (75%), good
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Cushing's __ is caused by a pituitary tumor
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disease
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CAH HTN usually occurs w/the
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11 beta-hydroxylase deficiency form
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CAH MCC
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21 hydroxylase deficiency
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