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527 Cards in this Set
- Front
- Back
What should you do if birth screening test is positive
|
order a confirmatory test
|
|
Most states screen for what at birth?
|
- hypothyroidism
- phenylketonuria - galactosemia - sickle cell disease |
|
Cow's milk should not be given before age
|
1 year
|
|
Hot water should be less than
|
110-120F
|
|
Start introducing solid foods at age
|
6 months
|
|
Head circumference should be measured routinely until what age
|
2 years
|
|
2 major causes of increased head circumference
|
- hydrocephalus
- brain tumor |
|
TORCH infections =
|
Toxoplasmosis
"other": syphilis and viruses Rubella CMV HSV |
|
What percentage of childhood obesity is due to organic causes like cushings?
|
5%
|
|
Define failure to thrive
|
growth below 5th percentile for age
|
|
Most common case of failure to thrive
|
psychosocial reasons
|
|
Hearing screening should be done
|
- at birth
- every 2 years from 4 years old to adolescence |
|
Vision should be screened
|
every few years starting at age 3
|
|
Absent red reflex may be sign of
|
CATARACTS
- congenital rubella - other TORCH infections - galactosemia RETINOBLASTOMA |
|
When is lazy eye normal
|
never, if persistant; may be occational until 3 months of age
|
|
2 infections classically associated with hearing loss
|
- meningitis
- recurrent otitis media |
|
Who should always get iron supplements?
|
pre-term breastfed babies
|
|
First step in lead poisoning
|
stop the exposure
|
|
Classic behaviors/situations for lead poisoning
|
- eating paint chips
- living by battery recycling |
|
Concerning lead level
|
if >10 ug/dl need close f/u
|
|
Treatment of severe lead poisoning
|
succimer or DMSA (chelation therapy)
|
|
First dentist appointment by age
|
3 years
|
|
Do you need to supplement fluoride?
|
no, almost always in the water
|
|
When should you start Vit D supplements?
|
6 months
|
|
High risk for INFANTS for Vit D defeciency
|
- inadequate maternal intake
- little sun - exclusive breast feeding after 6 months |
|
Screening for TB
|
only in high risk area or immigrant
- at 4-6 years AND - at 11-16 years |
|
Timing of Hep B vaccine
|
3 doses:
- 0-1 month - 1-4 months - 6-18 months |
|
Timing of DTP vaccine
|
5 doses:
- 2 months - 4 months - 6 months - 15-18 months - 4-6 years AND Td booster every 10 years |
|
Timing of HiB vaccine
|
4 doses:
- 2 months - 4 month - 6 month - 12-15 months |
|
Timing of polio vaccine
|
4 doses:
- 2 months - 4 months - 6 months - 4-6 years |
|
Timing of MMR vaccine
|
2 doses:
- 12-15 months - 4-6 years |
|
Timing of pneumococcus vaccine
|
4 doses:
- 2 months - r months - 6 months - 12-15 months |
|
Timing of varicella vaccine
|
1 dose:
- 12-18 months |
|
Avoid MMR vaccine in
|
- egg allergy
- neomycin allergy - immunodeficiency (HIV ok) |
|
If mom has Hep B, at birth give
|
both Hep B vaccince and immune globulin
|
|
Avoid polio vaccine in
|
- neomycin or streptomycin allergy
|
|
Avoid varicella vaccine in
|
- neomycin allergy
- immunodeficiency |
|
What peds populations should (especially) get influenza vaccine?
|
- 6+ mo old with immunodefeciency
- severe heart/lung disease - chronic ASA therapy |
|
What peds populations should get pneumococcus vaccine?
|
If older than 2 years give if:
- immunodefeciency - asplenic - sickle cell disease |
|
Screening test for sexually active female teens
|
- PAP smear
- GC/Chlamydia |
|
Peds screening for urinary malformations is indicated when? What is test of choice?
|
- boys: 1st UTI if less than 6 years
- girls: 2nd UTI if less than 6 years * use voiding cystourethrogram or renal US |
|
When are Apgars done?
|
1 and 5 min (1 minute meaning immediately)
|
|
General categories of for Apgar
|
each with 2 points:
- HR - Respiratory effort - Muscle tone - Color - Reflex irritability |
|
Apgar for HR
|
0- absent
1- less than 100 2- more than 100 |
|
Apgar for respiratory effort
|
0- no cry
1- weak cry 2- strong cry |
|
Apgar for muscle tone
|
0- limp
1- some flexion 2- active motion |
|
Apgar for color
|
0- blue all over
1- pink body, blue extrem 2- pink all over |
|
Apgar for reflex irritabilty
|
0- none
1- grimace 2- grimace and strong cry/cough/sneeze |
|
Important number on Apgar
|
resustitate/monitoring or to ICU until Apgar above 7
|
|
If only one umbilical artery is present, look for
|
renal malformations
|
|
At birth check the umbilical cord for
|
- 2 arteries
- 1 vien - absence of urachus |
|
swelling of scap at birth that crosses the midline =
|
caput succedaneum, benign
|
|
True or false: cephalohematomas from birth trauma do not cross the midline
|
true
|
|
What eval needs to occur with cepahlhematomas
|
- usually benign but may indicate underlying skull fracture, consider x-ray
|
|
Time course of cavernous hemangioma
|
- noticed a few days after birth
- increases in size then rapidly resolves within few years |
|
Treatment of cavernous hemangioma
|
nothing, just wathc
|
|
Anterior fontanelle closes by
|
18 month
|
|
4 causes of delayed anterior fontanelle closure
|
- hypothyroidism
- hydrocephalus - rickets - IUGR |
|
Moro reflex disapears at
|
6 months
|
|
Palmar grasp reflex disappears by
|
6 months
|
|
In premature infants, subtract the time for developmental milestone up until what age?
|
2 years
|
|
Age for social smile
|
1-2 months
|
|
Age for cooing
|
2-4 months
|
|
Age for lifts head to 90 degrees when prone
|
3-4 months
|
|
Age for rolls front to back
|
4-5 months
|
|
Age for voluntary grasp (no release)
|
5 months
|
|
Age for stranger anxiety
|
6-9 months
|
|
Age for sitting no support
|
7 months
|
|
Age for pulls to stand
|
9 months
|
|
Age for pat-a-cake
|
9-10 months
|
|
Age for first words
|
9-12 months
|
|
Age for imitates others' sounds
|
9-12 months
|
|
Age for voluntary grasp and voluntary release
|
10 months
|
|
Age for waves bye'bye
|
10 months
|
|
Age for separation anxiety
|
12-15 months
|
|
Age for walking
|
13 months
|
|
Age for build tower of 2 cubes
|
13-15 months
|
|
Age for understands 1 step command
|
15 months
|
|
Age for good use of cup and spoon
|
15-18 months
|
|
Age for runs well
|
2 years
|
|
Age for build tower of 6 cubes
|
2 years
|
|
Age for ties shoe laces
|
5 years
|
|
Average age of puberty for girls
|
10.5
|
|
Average age of puberty for boys
|
11.5
|
|
First event for male puberty
|
testicular enlargement
|
|
First event for female puberty
|
breast development
|
|
Tanner stage is based on what?
|
* pubic hair for both
- boys: testicular and penile growth - girls: breast growth |
|
Definition of delayed puberty in boys
|
No testicular enlargement by 14 years old
|
|
Definition of delayed puberty in girls
|
No breast or pubic hair by 13 years old
|
|
Most common cause of delayed puberty
|
constitutional delay (normal variant)
|
|
Most common cause of precocious puberty
|
idiopathic
|
|
McCune-Albright syndrome =
|
girls with:
- cafe'au'lait spots - fibrous dysplasia - precocious puberty |
|
girls with:
- cafe'au'lait spots - fibrous dysplasia - precocious puberty |
McCune-Albright syndrome
|
|
Causes of precocious puberty
|
- McCune-Albright syndrome
- ovarian tumors - testicular tumors - CNS disease/trauma - adrenal neoplasm - congenital adrenal hyperplasia |
|
Congenital adrenal hyperplasia in boys is usually
|
21-hydroxylase deficiency
|
|
Congenital adrenal hyperplasia in girls usually causes
|
ambiguous genitalia
|
|
Risk of precocious puberty
|
premature closure of epiphyseal plate
|
|
Treatment of otherwise untreatable precocious puberty
|
GnRH agonists
|
|
Boys with recurrent nose bleeds and blood dyscrasia =
|
nasopharyngeal angiofibromas
|
|
Most common cause of nosebleeds
|
trauma
|
|
Fever, anemia and nosebleed =
|
leukemia
|
|
Rate of African Americans heterozygous for sickle cell in US
|
8%
|
|
Diagnosis of sickle cell disease
|
blood smear with sickles, high retic count; Hb electrophoresis
|
|
Aplastic crisis in sickle cell, look for
|
parvovirus B19
|
|
Look for this site problem in sickle cell with bone pain
|
osteonecrosis of femoral head
|
|
Renal complication of acute sickle cell crisis
|
papillary necrosis
|
|
When do symptoms of sickle cell start?
|
around 6 months (this is when adult Hb production starts)
|
|
When are antibiotics given in sickle cell prophylactically
|
From diagnosis until age 5 years
|
|
Classic presentation of sickle cell anemia in children
|
dactylitis (hand-foot syndrome)
|
|
Biggest key points for HUS
|
- children
- diarrhea |
|
Biggest key points for Henoch-Schonlein purpura
|
- rash
- abdominal pain - arthritis - melena |
|
Biggest key points for TTP in peds
|
- CNS changes
- young adults |
|
Biggest key points for ITP
|
- antiplatelet antibodies
|
|
Most common age for HUS
|
children
|
|
Most common age for HSP
|
children
|
|
Most common age for TTP
|
young adults
|
|
Most common age for ITP
|
children or adults
|
|
Common previous infection for HUS
|
E. coli diarrhea
|
|
Common previous infection for HSP
|
URI
|
|
Common previous infection for TTP
|
none
|
|
Common previous infection for ITP
|
viral, esp in children
|
|
RBC count in HUS
|
Low
|
|
RBC count in HSP
|
Normal
|
|
RBC count in TTP
|
Low
|
|
RBC count in ITP
|
Normal
|
|
Platelet count in HUS
|
low
|
|
Platelet count in HSP
|
Normal
|
|
Platelet count in TTP
|
low
|
|
Platelet count in ITP
|
low
|
|
Features of peripheral smear in HUS
|
Hemolysis
|
|
Features of peripheral smear in HSP
|
Normal
|
|
Features of peripheral smear in TTP
|
Hemolysis
|
|
Features of peripheral smear in ITP
|
Normal
|
|
Kidney manifestations in HUS
|
- ARF
- hematuria |
|
Kidney manifestations in HSP
|
- hematuria
|
|
Kidney manifestations in TTP
|
- ARF
- proteinuria |
|
Kidney manifestations in ITP
|
none
|
|
Treatment of HUS
|
supportive (may need transfusion or dialysis)
|
|
Treatment of HSP
|
supportive (may need transfusion or dialysis)
|
|
Treatment of TTP
|
- Plasmaphoresis
- NSAIDs * DO NOT give platelets |
|
Treatment of ITP
|
- steroids
- splenectomy if meds fails |
|
When do you give steroids in ITP?
|
- bleeding
- counts below 20-40 |
|
What do you NOT do for TTP
|
- do not give plts, they are likely to form clots
|
|
Constant machine like murmur in upper left sternal border
|
PDA
|
|
How do you close a PDA?
|
indomethacin, surgery
|
|
How do you keep a PDA open?
|
PGE 1
|
|
PDA is associated with
|
- Rubella
- high altitudes |
|
Associated symptoms with PDA
|
- dyspnea
- possible CHF |
|
Holostyolic murmur next to sternum
|
VSD
|
|
True or false: most VSDs resolve on their own?
|
true
|
|
What is the most common congenital heart defect?
|
VSD
|
|
What heart defect is asymptomatic until adulthood?
|
ASD
|
|
What heart defect often presents with palpitations?
|
ASD
|
|
What heart defect has a fixed split s2
|
ASD
|
|
Treatment of ASDs
|
No treatment unless very large
|
|
The 4 anomalies of tetrology of fallot
|
1. VSD
2. Right ventricular hypertrophy 3. pulmonary stenosis 4. overriding aorta |
|
Most common cyanotic congenital heart defect
|
tetrology of fallot
|
|
Kids who squart after exertion likely have
|
tetrology of fallow
|
|
Upper extremity HTN =
|
coarctation or aorta
|
|
Radiofemoral delay =
|
coarctation or aorta
|
|
Systolic murmur heard over mid-upper back
|
coarctation or aorta
|
|
Heart defect with rib notching on x-ray
|
coarctation or aorta
|
|
Heart defect associated with Turner syndrome
|
coarctation or aorta
|
|
What heart defects need endocarditis prophylaxis?
|
All except asymptomatic secundum-type ASDs
|
|
What % of ASDs are asymptatic secundum-type?
|
80%
|
|
3 syndromes to think about in patient with VSD
|
- fetal alcohol syndrome
- TORCH infections - Down syndrome |
|
Teenager with sudden cardiac death =
|
hypertrophic obstructive cardiomyopathy
|
|
Treatment of hypertrophic obstructive cardiomyopathy
|
- B-blockers
- consider pacemaker placement |
|
Where is fetal circulation O2 highest?
|
Umbilical vein
|
|
Where is fetal circulation O2 lowest?
|
Umbilical artery
|
|
In fetus, which has highest O2 content, blood to arms or legs?
|
Blood to arms
|
|
Resting HR over 100 is normal up to age
|
10 years
|
|
Medications that are contraindicated in obstructive hypertrophic cardiomyopathy
|
- positive ionotropes
- diuretics - vasodilators |
|
How does the foramen ovale close?
|
Increase in left-side heart pressures
|
|
Heart pressure changes at time of birth
|
- 1st breaths cause lung inflation and decreased pulmonary vascular resistance
--> increased arterial flow --> increase left sided pressures |
|
What triggers closure of the ductus arteriosis?
|
increased O2 shuts off prostaglandin production
|
|
EKG finding of Wolff-Parkinson-White syndrome
|
delta wave
|
|
Delta wave on EKG =
|
Wolff-Parkinson-White syndrome
|
|
What causes symptoms in Wolff-Parkinson-White syndrome?
|
Transient arrhythmias conducted on accessory pathways
|
|
Treatment of pyloric stenosis
|
surgical
|
|
Treatment of duodenal atresia
|
surgical
|
|
Treatment of tracheoesophageal fistula
|
surgical
|
|
Treatment of Hirschsprung disease
|
surgical
|
|
Treatment of anal atresia
|
surgical
|
|
Treatment of choanal atresia
|
surgical
|
|
Presenating age of pyloric stenosis
|
0-2 months
|
|
2 month old with nonbilious projectile emesis likely has
|
pyloric stenosis
|
|
Gender predominance of pyloric stenosis
|
males MUCH more than females
|
|
"double-bubble" sign =
|
duodenal atresia
|
|
duodenal atresia is associated with this syndrom
|
Down syndrome
|
|
palpable olive shaped mass in epigastrium
|
pyloric stenosis
|
|
electrolyte findings in pyloric stenosis
|
- low chloride
- low potassium - metabolic alkalosis |
|
Presenting age of duodenal atresia
|
0-1 week
|
|
newborn with down syndrome and bilious emesis may have
|
duodenal atresia
|
|
Presenting age for tracheoesophageal fistula
|
0-2 weeks
|
|
1 week old with food regurgitation = concern for
|
tracheoesophageal fistula
|
|
Describe the most common variant of tracheoesophageal fistula
|
85% of cases have a fistula from bronchus to distal esophagus
|
|
CXR with NG tube coiled in esophagus and large air filled stomach is classic for
|
esophageal atresia
|
|
Age of presentation of Hirschsprung disease
|
0-2 years
|
|
2 year old with feculent emesis =
|
Hirschsprung disease
|
|
No ganglia seen on rectal biopsy =
|
Hirschsprung disease
|
|
Classic clinical features of Hirschsprung disease
|
- feculent emesis
- abdominal distention - obstipation |
|
Gender distribution of Hirschsprung disease
|
boys much more than girls
|
|
Presnting age of anal atresia
|
0-1 week; usually detected on exam in nursery
|
|
Gender distribution of anal atresia
|
boys much more than girls
|
|
Cyanosis with feeding that is relieved by crying =
|
choanal atresia; cannot pass NG tube
|
|
Presentation age of choanal atresia
|
0-1 week
|
|
Presenting age for intussusception
|
4 mo to 2 years
|
|
Presenting age for necrotizing enterocolitis
|
0-2 months
|
|
Presenting age for meconium ileus
|
0-2 weeks
|
|
Presenting age for midgut volvulus
|
0-2 years
|
|
Presenting age for meckel diverticulum
|
0-2 years
|
|
Presenting age for strangulated hernia
|
any age
|
|
2 GI manifestations of cystic fibrosis
|
- meconium ileus
- rectal prolapse |
|
Current jelly stools (blood and mucus) is likely
|
intussusception
|
|
5month old with palpable sausage like mass
|
intussusception
|
|
Treatment of intussusception
|
air or barium enema (both diagnostic and therapeutic)
|
|
In what population does necrotizing enterocolitis occus?
|
premature infants
|
|
1 month old premie with fever, rectal bleeding, air in bowel wall
|
necrotizing enterocolitis
|
|
Treatment of necrotizing enterocolitis
|
- make NPO
- OG tube - IV fluids - antibiotics |
|
Difference in radiographic findings in volvulus in peds vs. adults
|
- finding is "bird's beak" in both but..
- small bowel in peds, large bowel in adults |
|
2 year old with bilious emesis, sudden onset abd pain, distention and rectal bleeding
|
midgut volvulus
|
|
Treatment of midgut volvulus
|
surgery
|
|
What is the rule of 2s for meckel diverticulum
|
- 2% of population
- 2 inches long - within 2 feet of ileocolic junction - presents in first 2 years of life |
|
Meckels diverticulum usually presents with
|
bleeding, GI ulceration
|
|
Treatment of Meckels diverticulum
|
surgery
|
|
Character of emesis with strangulated hernia
|
bilious
|
|
Gender predominance of diaphragmatic heria
|
boys more than girls
|
|
Diaphragmatic hernia is more common on what side?
|
the left (this is Bochdalek type)
|
|
Bochalek is a type of
|
diaphragmatic hernia
|
|
Why is diaphragmatic hernia a problem in peds?
|
Can cause pulmonary hypoplasia
|
|
Patient presents with respiratory distress and bowel sounds in chest
|
diaphragmatic hernia
|
|
Treatment of diaphragmatic hernia
|
surgery
|
|
Prognosis in diaphragmatic hernia is based on
|
lung development (not on the hernia)
|
|
Meckel diverticulum is a remnant of
|
the omphalomesenteric duct
|
|
Features of omphalocele
|
- midline location
- sac with multiple abdominal organs - no umbilical ring - other anomolies are common |
|
Features of gastroschisis
|
- on right side
- only small bowel exposed (no sac) - umbilical ring is present - other anomalies rare |
|
Which process, omphalocele or gastroschisis, has the location midline
|
omphalocele
|
|
Which process, omphalocele or gastroschisis, has the location on right side
|
gastroschisis
|
|
Which process, omphalocele or gastroschisis, has the sac containing multiple abdominal organs
|
omphalocele
|
|
Which process, omphalocele or gastroschisis, has no sac and has small gowel exposed
|
gastroschisis
|
|
Which process, omphalocele or gastroschisis, has no umbilical ring
|
omphalocele
|
|
Which process, omphalocele or gastroschisis, has the umbilical ring
|
gastroschisis
|
|
Which process, omphalocele or gastroschisis, has associated anomolies
|
omphalocele
|
|
Which process, omphalocele or gastroschisis, has no associated anomolies
|
gastroschisis
|
|
Treatment of Henoch-Schoenlein purpura is
|
supportive
|
|
GI manifestations of Henoch-Schoenlein purpura
|
- GI bleed
- abdominal pain - possible GI infection |
|
Rash of Henoch-Schoenlein purpura is classically
|
on lower extremities and buttocks
|
|
Classic features of Henoch-Schoenlein purpura
|
- GI bleed/pain
- antecetent infection (URI or GI) - swelling hands and feet - rash on LE and buttocks - arthritis - hematuria/proteinuria |
|
True or false: GI upset, nausea and vomiting with systemic illness is more common in kids vs. adults
|
true
|
|
Two categories of neonatal jaundice
|
- physiologic
- pathologic |
|
First diagnostic step in neonatal jaundice
|
measure bilirubin (total, direct and indirect)
|
|
Main concern in neonatal jaundice
|
Kernicterus
|
|
What is Kernicterus
|
deposit of unconjugated bilirubin in the basal ganglia
|
|
5 classic symptoms that go with neonatal jaundice
|
- poor feeding
- seizures - flaccidity - opisthotonos - apnea |
|
Jaundice present at birth is
|
pathologic
|
|
Describe bilirubin findings in physiologic jaundice in term infant
|
- mostly unconjugated
- less than 12 mg/dl - peak at day 2-5 - normal by 2 weeks |
|
Describe bilirubin findings in physiologic jaundice in premature infant
|
- mostly unconjugated
- less than 15 mg/dl - normal by 3 weeks |
|
How common is physiologic jaundice?
|
- 50% of newborns
- higher in premature infants |
|
6 general categories of pathologic jaundice in newborn
|
- breast milk
- illness - hemolysis (Rh incompatibility) - metabolic - biliary atresia - medications |
|
Features and treatment of neonatal jaundice from breast milk
|
- bilirubin peaks 10-20 at 2-3 weeks of age
- hold breast milk until resolved |
|
How does illness effect neonatal jaundice?
|
- prolong the jaundice
- lower threshold of kernicturis * the youngest sickest infants are the most at risk |
|
4 classic illnesses associated with higher risk of kernicteris in neonatal jaundice
|
- sepsis
- hypothyroidism - liver disease - cytic fibrosis |
|
List 4 examples of metabolic causes of neonatal jaundice
|
- high uncojugated bili:
* Criggler-Najjar (very high) * Gilbert (mildly high) - high conjugated bili: * Rotor disease * Dubin-Johnson disease |
|
Newborn presents with jaundice and clay colored stools
|
biliary atresia
|
|
Treatment of biliary atresia
|
surgery
|
|
Risk of sulfa drugs in newborns
|
- kernicterus
(sulfa drugs displace bilirubin from albumin) |
|
Treatment of unconjugated hyperbilirubinemia in the neonate
|
- phototherapy
- last resort is exchange transfusion (bili over 20 or phototherapy failed) |
|
Babies with ambiguous genitailia are usually _____ and 90% have _____
|
- girls
- 21-hydroxylase deficiency |
|
Ambiguous genitalia often also has
|
adrenal insuffeciency
|
|
Female child with "bunch of grapes" from vagina
|
- sarcoma botryoides (malignant)
|
|
Newborn with ambiguous genitalia, hyponatremia, kyperkalemia and hypertension
|
adrenogenital syndrome
|
|
This hormone is elevated in adrenogenital syndrome
|
17-hydroxyprogesterone
|
|
Treatment of adrenogenital syndrome
|
steroids and IV fluids to prevent death
|
|
Boys with 21-hydroxylase deficiency experience
|
perecocious sexual development
|
|
Most vaginitis in peds is
|
nospecific/physiologic
|
|
Causes of pediatric vaginitis to look for on boards
|
- foreign body
- sexual abuse - candida as presentation of diabetes |
|
Vaginal bleeding in the neonate
|
- usually from withdrawl from maternal estrogen
- resolves in a few days |
|
Most common primary immunodeficiency
|
IgA deficiency
|
|
What should you look for in patient with frequent respiratory and GI infections?
|
IgA deficiency
|
|
What should you look for if patient has anaphylaxis with immunoglobulin exposure?
|
IgA deficinecy
|
|
What therapy should be avoided in patients with IgA deficiency?
|
immunoglobulins
|
|
X-linked agammaglobulinemia is also known as
|
Bruton agammaglobulinemia
|
|
6 month old boy with Strep infections, low B-cells
|
Bruton agammaglobulinemia (x-linked)
|
|
Features of X-linked agammaglobulinemia
|
- X-linked recessive, so seen in boys
- low or absent B cells - infections begin at 6 months (maternal antibodies dissapear) - recurrent lung or sinus infections - usually strep or HiB |
|
Hypocalcemia and heart defect 24 hours after birth =
|
DiGeorge syndrome
|
|
Features of DiGeorge syndrome
|
- 3rd and 4th pharyngeal pouches don't form
- hypocalcemia - tetany - heart defects - immunodeficiency from absent/small thymus |
|
Inheritance of severe combined immunodefiency
|
- autosomal recessive or
- X-linked |
|
Common cause of severe combined immunodefiency
|
adenosine deaminase deficiency (autosomal recessive)
|
|
Patient with severe recurrent infections early in life with both B and T cells low =
|
severe combined immunodefiency
|
|
Skin finding in patients with severe combined immunodefiency
|
usually have cutaneous anergy
|
|
Lymph nodes and thymus in severe combined immunodefiency are usually
|
hypoplastic or absent
|
|
Inheritance of Wiskott-Aldrich deficiency
|
- x-linked recessive
|
|
Triad of eczema, thrombocytopenia and reccurent infections =
|
Wiskott-Aldrich deficiency
|
|
Wiskott-Aldrich deficiency classic tria
|
eczema, thrombocytopenia and reccurent infections
|
|
Inheritance of chronic granulomatous disease
|
- usually x-linked recessive
|
|
Give 2 examples of catalase-positive organisms
|
- Staph aureus
- Pseudomonas |
|
Test for chronic granulmoatous disease
|
deficient nitroblue tetrazolium dye reduction by granulocytes
|
|
nitroblue tetrazolium dye reduction test measures
|
respiratroy burst
|
|
2 organisms common in infections with chronic granulomatous disease
|
- Staph aureus
- Pseudomonas |
|
Inheritance of Chediak-Higashi syndrome
|
- usually autosomal recessive
|
|
Oculocutaneous albinism with giant granules in neutrophils =
|
Chediak-Higashi syndrome
|
|
Chediak-Higashi syndrome findings
|
- Oculocutaneous albinism
- giant granules in neutrophils |
|
Pathology of Chediak-Higashi syndrome
|
defect in microtubule polymerization
|
|
Recurrent neisserial infections likely have
|
complement deficiencies (C5 through C9)
|
|
complement deficiencies (C5 through C9) usually have
|
Recurrent neisserial infections
|
|
Cadidiasis with hypothyroidism may be
|
chronic mucocutaneous candidiasis
|
|
chronic mucocutaneous candidiasis is often associated with
|
hypothyroidism
|
|
Hyper-IgE syndrome is called
|
Job-Buckley syndrome
|
|
Job-Buckley syndrome is called
|
Hyper-IgE syndrome
|
|
Look for ______ in recurrent staph infections of the skin
|
Hyper-Ig E (Job-Buckley) syndrome
|
|
Features of hyper-Ig E (Job-Buckley) syndrome
|
- reccurent staph infections (usually skin)
- Very high IgE - red hair - fair skin - eczema |
|
3 most common organisms in otitis media
|
- Strep pneumoniae
- H. influenzae - Moraxella ctarrhalis |
|
8 classic complications of otitis media
|
- tympanic membrane perforation
- mastoiditis - labyrinthitis - CN VII and VIII palsies - meningitis - cerebral abscess - venous thrombosis - chronic otitis media |
|
In what time frame does mastoiditis usually occur after otitis media
|
2 weeks
|
|
Treatment of cholesteatomas with marginal perforations
|
surgical excision
|
|
Antibiotics to use in otitis media
|
- amoxicillin
- 2nd gen cephalosporin - TMP/SMX |
|
Prolonged secretory otitis is from
|
an unresolved otitis
|
|
2 malformations to look for in kids under 5 with UTI
|
- vesicoureteral reflux (boys and girls)
- posterior urethral valves (boys) |
|
Highest incidence of meningitis in kids is in what age group?
|
neonates
|
|
10 classic findings in neonatal meningitis
|
- lethargy
- fever or hypothermia - poor muscle tone - bulging fontanelle - emesis - photophobia - altered consciousness - hypotension - jaundice - respiratory distress |
|
3 classic associated features of sepsis in neonates
|
- hypotension
- jaundice - respiratory distress |
|
What if you can't get a lumbar puncture in a kid you suspect of meningitis
|
treat with IVF and antibiotics (here treatemnt trumps diagnosis)
|
|
Herpes encephalitis in neonates is due to
|
HSV II
|
|
Herpes encephalitis in older kids and adults is due to
|
HSV I
|
|
Treatment of HSV encepalitis
|
acyclovir
|
|
Imaging findings in HSV encephalitis
|
temporal lobe abnormalities on CT or MRI
|
|
What do you need to do if a kid has Neisseria meningitis?
|
treat contacts prophylactically
|
|
Choices of antibiotics for Neiserria meningitis prophylaxis
|
- rifampin
- ceftriaone - cipro (in adults) |
|
Fever followed 3 days later by white spots on buccal mucosa
|
Measles
|
|
Measles is also known as
|
rubeola
|
|
rubeola is also known as
|
measles
|
|
Koplik spots are found in
|
Measles
|
|
Head to toe progression of rash with fever, conjunctivitis =
|
Measles
|
|
Progresion of rash in measles is
|
head to toe
|
|
4 classic complications of measles
|
- penumonia (giant cell)
- otitis media - encephalitis (acute) - subacute sclerosing panencephalitis |
|
Classic finding in rubella
|
suboccipital and postauricular lymphadenopathy
|
|
What do you do if a pregnant woman has not had rubella immunization?
|
- DON'T give immunization during pregnancy
- follow and do titers if she has a febrile illness |
|
Rash in rubella
|
milder than measles, but same progression of head to toe
|
|
High fever for 4 days, return to normal, rash on chest and abdomen =
|
Roseola infantum
|
|
Roseola infantum
|
HHV 6 (DNA virus)
|
|
Age group of roseola infantum
|
less than 3 years old
|
|
Roseola infantum aka
|
Exanthem subitum
|
|
Exanthem subitum aka
|
Roseola infantum
|
|
Erythema infectiousum aka
|
Fifth disease
|
|
Fifth disease aka
|
Erythema infectiousum
|
|
Erythema infectiousum caused by
|
parvovirus B19
|
|
2 things that parvovirus B19 causes
|
- Erythema infectiousum
- aplastic crisis in sickle cell disease |
|
low fever and aches with red checks, next day rash on arms, legs and trunk =
|
Erythema infectiousum
|
|
Pathological findings in varicella
|
- do Tzanck smear from base
- shows multinucleated giant cells |
|
Discrete macules on trunk that occur in crops and crust over =
|
varicella
|
|
When can you use varicella-zoster immunoglobulin?
|
- very debilitated patient (AIDS, leukemia, etc) within 4 days
- exposure of newborn if mom has chickenpox |
|
Can a person with zoster causes chickenpox?
|
Yes in an uninfected/unimmunized person
|
|
How long are you contagious with chicken pox?
|
Until the last lesion crusts over
|
|
Organisms for scarlet fever
|
streptococcus (pharyngitis)
|
|
Sandpaper rash with circumoral pollar
|
scarlet fever
|
|
Strawberry tongue with rash on abdomen and trunk
|
scarlet fever
|
|
Erythrogenic toxin is from ____ and can cause ____
|
- streptococcus
- scarlet fever |
|
Treatment of scarlet fever
|
PCN
|
|
Complication of scarlet fever
|
rheumatic heart disease
|
|
Mucocutaneous lymph node syndrome is aka
|
Kawasaki syndrome
|
|
Typical age for Kawasaki syndrome
|
under 5 years
|
|
Treatment of Kawasaki disease
|
* ASA
- immunoglobulin - follow with ECHO for cardiac abnormalities |
|
Diagnosis of Kawasaki disease
|
** fever for 5+ days
- trunk rash 1 day after fever (polymorphous) - conjuctival injection - changes in oral mucosal - changes in extremities - cervical lymphadenopathy - arthritis - cardiac issues |
|
Infectious mononucleosis is causes by
|
EBV
|
|
Tests for EBV
|
* heterophile antibodies (monospot)
- EBV vial capsid antigen - EBV nuclear antigen |
|
EBV is associated with these neoplasms:
|
- nasopharyngeal carcinoma
- African Burkitt lymphoma |
|
How do you differentiate mononucleosis from step pharyngitis?
|
Mono has:
- splenomegaly - hepatomegaligy - atypical lymphocytes - anemia/thrombocytopenia - heterophile anitbodies |
|
Rocky mountain spotted fever is caused by
|
Rickettsia rickettsii
|
|
Rickettsia rickettsii causes
|
Rocky mountain spotted fever
|
|
Tick bite, fever, chills, rash
|
Rocky mountain spotted fever
|
|
Rash for Rocky mountain spotted fever
|
palms/wrist and soles/ankles and rapidly spreads to trunk and face (often pechitial)
|
|
Treatment of Rocky mountain spotted fever
|
** doxycycline
- chloramphenicol |
|
Weeping skin lesion with yellow crust
|
impetigo
|
|
Most common organisms for impetigo
|
Staph and step
|
|
Treatment of impetigo
|
antistaph PCN
|
|
Acute laryngotracheitis is aka
|
croup
|
|
Typical age for croup
|
1-2 years old
|
|
Main organism causing croup
|
50-75% are parainfluenza virus, rest are influenza
|
|
Season typical for croup
|
fall/winter
|
|
Steeple sign =
|
croup
|
|
Radiologic finding for croup
|
steeple sign (subglottic edema)
|
|
Treatment of croup
|
- humidified O2
- racemic epinephrine |
|
Typical age for epiglottitis
|
2-7 years old
|
|
3 major organisms for epiglottitis
|
- HiB (less w/ immunization)
- Strep pneumo - Staph aurues |
|
Sick kid with no prodrome, high fever, drooling =
|
epiglottitis
|
|
Is there cough with epiglottitis?
|
no
|
|
Thumb sign on x-ray
|
epiglottitis
|
|
X-ray finding for epiglottitis
|
thumb sign on lateral neck x-ray
|
|
Treatment of epiglottitis
|
- establish airway if needed
- 3rd generation cephalosporin |
|
Bronchiolitis is usually caused by
|
RSV causes 75% of causes; rest by parainfluenza and influenza
|
|
Typical age for RSV
|
less than 18 months
|
|
Season for RSV infections
|
fall/winter
|
|
Viral URI follow 1-2 days later by rapid respirations, intercostal retraction and expiratory wheezing in 15 month old
|
RSV bronchiolitis
|
|
Classic x-ray findings in bronchiolitis
|
hyperinflation with flattening of diaphragms
|
|
General treatment for RSV
|
- supportive
- use Ribavarin only in severe cases or high risk |
|
Prophylaxis for RSV
|
Palivizumab (use in premature or chonic lung disease during RSV season)
|
|
Diphtheria is caused by
|
Corynebacterium diphtheriae
|
|
Whooping cough is caused by
|
bordetella pertussis
|
|
oropharynx with gray pseudomembrances
|
diptheria
|
|
Diptheria is associated with
|
myocarditis
|
|
Treatment of diphtheria needs to include an
|
anti-toxin
|
|
Classic complications of strep pharyngitis
|
- rheumatic fever
- scarlet fever - glomerulonephritis |
|
Diagnosis of Rheumatic fever
|
history of Streptococcal pharyngitis and Jones criteria
- migratory polyarthritis - carditis - chorea - erythema marginatum - subcutaneous nodules - minor criteria |
|
List the minor Jones criteria
|
(rheumatic fever)
- elevated ESR - elevated CRP - elevated WBC - elevated strep anitbody titer - prolonger PR on EKG - arthralgia |
|
Treatment of rheumatic fever
|
- anti-inflammatories
- if carditis: steroids |
|
Flat erythematous annulur rash, consider
|
rheumatic fever
|
|
Time course of strep infection to glomerulonephritis
|
- usually 1-3 weeks after strep skin infection or pharyngitis
|
|
Features of poststreptococcal glomerulonephritis
|
- abrupts hematuria
- mild proteinuria - RBC casts - smoke colored urine - HTN - edema (periorbital) - elevated VUN/Cr |
|
Treatent of post-strep glomerulonephritis
|
supportive; control BP, can use diuretics for severe edema
|
|
Smoke colored urine =
|
post-strep glomerulonephritis
|
|
Can glomerulonehpritis after strep by prevented by antibitotic therapy?
|
no
|
|
Most common cause of neonatal meningitis and sepsis
|
Group B strep (strep agalactiae)
|
|
Treatment of mom's with group B strep
|
amoxicillin
|
|
7 classic effects from TORCH infections
|
- mental retardation
- microcephaly - hydrocephalus - hepatosplenomegaly - jaundice - anemia - IUGR |
|
Defects specific to toxoplasmosis prenatal infection
|
- intracranial calcifications
- chorioretinitis |
|
Maternal exposure to cats is a risk for
|
toxoplasmosis
|
|
Prenatal infection with varicella-zoster is associated with
|
- limb hypoplasia
- scarring of the sin |
|
Prental infection with syphilis is associated with
|
- rhinitis
- saber shins - Hutchinson teeth - interstitial keratitits - skin lesion |
|
Newborn with Hutchingson teeth and interstitial keratitis likely had perinatal infection with
|
syphilis
|
|
4 defects specific to congenital rubella
|
- cardiovascular (PDA, VSD)
- deafness - cataracts - microphthalmia |
|
Most common TORCH infection
|
CMV
|
|
3 defect specific to congenital CMV infections
|
- deafness
- cerebral calcifications - microphthalmia |
|
inheritance of Werdnig-Hoffman disease
|
autosomal recessive
|
|
Describe Wednig-Hoffman disease
|
- heritable
- degeneration of anterior horn cells - slow and progressive - all affected by 6 months - treatment is supportive |
|
Typical age of presentation of muscular dystrophy
|
3-7 years old
|
|
5 year old boy with weakness, elevated CPK and large calves
|
duchenne muscular dystrophy
|
|
inheritance of duchenne muscular dystrophy
|
X-linked recessive
|
|
What is the Gower sign?
|
Muscular dystrophy - walk hands up body in order to stand up
|
|
Life span of duchenne muscular dystrophy
|
most die by age 20
|
|
Inheritance of Becker muscular dystrophy
|
X-linked recessive
|
|
Myopathy with ragged red fibers on biopsy
|
mitochondrial myopathies
|
|
Mitochondrial myopathies classically have what feature on physical exam
|
ophthalmoplegia
|
|
inheritance of myotonic dystrophy
|
autosomal dominant
|
|
Age of onset of myotonic dystrophy
|
20-30
|
|
Define myotonia
|
inability of muscle to relax
|
|
3 classic co-features of myotonic dystrophy
|
- mental retardation
- baldness - testicular or ovarian atrophy |
|
Young patient with weakness and cramping after exercise should be considered for
|
McArdle disease
|
|
Triangular patch of hair over the lumbar spine
|
spina bifida occulta
|
|
Difference between meningocele and myelomenigocele
|
myeleomenigocele includes both meninges and CNS tissues outside the spinal canal
|
|
5 classic signs of hydrocephalus in peds
|
- increasing head circumference
- increased ICP - bulging fontanelle - scalp vein engorgement - paralysis of upward gaze |
|
3 most common causes of hydrocephalus in peds
|
- congenital malformations
- tumore - inflammation/infection |
|
Most common malignancy in children
|
ALL
|
|
Child with pancytopenia must be evaluated for
|
ALL
|
|
Syndrome risk factor for ALL
|
Down syndrome
|
|
Most common brain tumors in children
|
- crebellar astrocytoma
- medulloblastoma - ependymoma |
|
Most brain tumors in children are located where?
|
posterior fossa
|
|
Major differential diagnosis of flank tumor in a child
|
- Wilms tumor (kidney)
- neuroblastoma (usually adrenal) |
|
Peak incidence of Wilms tumor in peds
|
2 years
|
|
Peak incidence of neuroblastoma in peds
|
2 years
|
|
True or false, neuroblastomas may regress spontaneously
|
true
|
|
Most common primary liver malignancy in children
|
hepatoblastoma
|
|
Most common kidney malignancy in children
|
Wilms tumor
|
|
Most common adrenal malignancy in children
|
neuroblatoma
|
|
Feature of inherited retinoblastoma
|
can be bilateral
|
|
Simple bone cyst is aka
|
unicameral bone cyst
|
|
10 year old wtih well-demarcated lesion in the proximal humerous likely has a
|
unicameral bone cyst
|
|
Typical age for osteosarcoma
|
10-20 year olds
|
|
Usual location of osteosarcoma
|
about the knee (distal femur, proximal tibia)
|
|
15 year old with leg pain with sunburst appearance on x-ray =
|
osteosarcoma
|
|
3 major causes of neonatal conjunctivitis
|
- chemical reaction
- gonorrhea - chlamydial infection |
|
Neonate with conjuantivitis within 24 hours after birth has
|
chemical reaction (often from drops for preventing gonorrhea)
|
|
Infant with extremely purulent conjunctivits 2-5 days after birth =
|
gonorrhea
|
|
Treatment of infant gonorrhea conjunctivitis
|
- erythromycin ointment
- IV or IM ceftriaxone |
|
Mild to severe conjunctivitis that begins 5-14 days after birth, consider
|
Chlamydial infection (mom often asymptomatic)
|
|
Infant chlamydial conjunctivitis is aka
|
inclusion conjunctivtis
|
|
Common complication of infant chlamydial conjunctivitis is
|
chlamydial pneumonia
|
|
Treatment of infant chlamydial conjunctivitis
|
oral erythromycin
|
|
For the 3 most common forms of infant conjunctivitis, give the causes based on time of presentation after birth
|
- under 24 hours = chemical
- 2-5 days = gonococcal - 5-14 days = chlamydial |
|
Cataracts in infant =
|
- TORCH infections
- inherited metabolic disorder like glactosemia |
|
Features of orbital cellulitis
|
- ophthalmoplegia
- proptosis - severe eye pain - decrased visual acuity |
|
Most common causes of orbital and pre-orbital cellulitis
|
- Step pneumo
- Staph - Strep |
|
Complications of orbital cellulitis
|
- extension into the skull
- dural sinus thrombosis - blindness |
|
Treatment of preorbial or orbital cellulitis
|
- IV antibiotics
- blood cultures to direct therapy - surgery if abscess |
|
Age of presentation for congenital hip dysplasia
|
birth
|
|
Epidemiology of congenital hip dysplasia
|
- female
- first born - breech delivery |
|
Signs for congenital hip dysplasia
|
- Barlow's
- Ortolani's |
|
Treatment of congenital hip dysplasia
|
harness
|
|
Age of presentation for Legg-Calve'-Perthes disease
|
4-10 years
|
|
Epidemiology of Legg-Calve'-Perthes disease
|
- male
- short stature - delayed bone age |
|
Symptoms of Legg-Calve'-Perthes disease
|
knee, thigh and groin pain
limb |
|
Treatment of Legg-Calve'-Perthes disease
|
orthoses
|
|
Age of presentation of slipped capital femoral epiphysis
|
9-13 years old
|
|
Epidemiology of slipped capital femoral epiphysis
|
- overweight
- male - adolescent |
|
s/s of slipped capital femoral epiphysis
|
- knee, thigh groin pain
- limb |
|
Treatment of slipped capital femoral epiphysis
|
surgical pinning
|
|
Pediatric hip problems present in adults as
|
arthritis
|
|
Age of presentation of Osgood-Schlatter disease
|
10-15 years
|
|
Describe Osgood-Schlatter disease
|
- osteochondritis of tibial tubercle
- often bilateral |
|
13 year old boy with pain, swelling and tenderness to palpation of the knee should be considered for
|
Osgood-Schlatter disease
|
|
Treatment of Osgood-Schlatter disease
|
- rest/activity restriction
- NSAIDs |
|
In juvenile rheumatoid arthritis, RF is often
|
negative
|
|
Most cases of mental retardation are
|
idiopathic
|
|
IQ range for mild mental retardation
|
55-70
|
|
Number one preventable cause of mental retardation
|
fetal alcohol syndrome
|
|
TORCH cause of autism
|
congenital rubella
|
|
Antisocial personality disorder must have what diagnosis as child
|
conduct disorder
|
|
Classic conduct disorder
|
- fire starting
- cruelty to animals - lying - stealing - fighting |
|
Child that is hostile towards adults but normal with peers may have
|
oppositional-defiant disorder
|
|
3 criteria for anorexia
|
-15% below weight
- intense fear of gaining weight - amenorrhea |
|
Death rate in anorexia
|
10-15%
|
|
Incidence of bulemia in anorexia
|
about 50% of people with anorexia also have bulemia
|
|
List 4 purging behaviors of bulemia
|
- vomiting
- laxatives - exercising - fasting |
|
A teenage girl with eroded skin over knuckles should be considered for
|
bulemia
|
|
What do tics do in Tourettes during sleep
|
go away
|
|
A hyperactive kid who develops tics after starting stimulant for ADHD may actually have
|
Tourette disorder
|
|
When is encopresis considered abnormal?
|
4 years old
|
|
When in enuresis considered abnormal?
|
5 years old
|
|
Treat refractory cases of enuresis with
|
imipramine
|
|
Top 3 causes of death in adolescents
|
- accidents
- homicide - suicide |
|
Infant ARDS is due to
|
atelectasis from defiency of surfactant
|
|
Risk factors for infant ARDS
|
- diabetic mom
- premature |
|
Complications of infant ARDS
|
- intraventricular hemorrhage
- pneumothorax (from vent) - bronchopulmnary dysplasia (from vent) |
|
inheritance of cystic fibrosis
|
autosomal recessive
|
|
Most common lethal genetic disease in whites is
|
cystic fibrosis
|
|
In a child with rectal prolapse _______ must be considered
|
cystic fibrosis
|
|
In a child with meconium ielus _______ must be considered
|
cystic fibrosis
|
|
In a child with esophageal varices _______ must be considered
|
cystic fibrosis
|
|
Diagnosis of cystic fibrosis
|
- salt test
- DNA probe |
|
3 classic non-pulmnary complications of cystic fibrosis
|
- infertility
- pancreatic insufficiency - cor pulmonale |
|
How do you treat pancreatic insuffeciency
|
- pancreatic enzyme replacement
- supplement fat soluble vitamins |
|
Major risk factor for cryptorchidism
|
prematurity
|
|
Relation of cryptorchidism and testicular cancer
|
The higher up the testes is (closer to kidney) the high risk of cancer
|
|
Treatment of cryptorchidism
|
surgical trestment if not descended by 1 year
|
|
Epispadias is associated with
|
exstrophy of the bladder
|
|
Where do the right and left gonadal veins drain?
|
- right into IVC
- left into left renal vein |
|
Findings in bilateral renal agenesis
|
- ligohydramnios
- limb deformities - abnormal facies - lung hypoplasia |