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527 Cards in this Set

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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