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275 Cards in this Set
- Front
- Back
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2 diseases with strawberry tongue? |
Strep pharyngitis
Kawasaki disease |
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Time to development of coronary artery aneurysms in Kawasaki disease?
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4 weeks
(follow up with Cardiology within 2 weeks) |
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Risk of long term aspirin treatment for Kawasaki disease?
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Reye syndrome if you get the flu
(make sure they get flu shots!) |
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Risk of coronary artery aneurysm after Kawasaki disease and change in risk with IVIG?
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20%
down to 2-4% |
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Aspirin vs IVIG treatment in Kawasaki?
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Aspirin reduces febrile course of illness (DON'T use Ibuprofen)
IVIG reduces risk of coronary artery aneurysm |
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What happens to the ESR after the fever in Kawasaki disappears?
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Stays elevated!
(Platelets are also elevated) |
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Complications of Kawasaki's?
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CNS (90%)
Coronary artery aneurysm (20-25%) Liver dysfunction (40%) Arthritis (30%) Hydrops gallbladder (10%) |
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Diseases associated with diffuse adenopathy?
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EBV, CMV, HIV, Histo, Toxo, Mycobacteria, Measles, Lymphoma, Leukemia, Neuroblastoma, Rhabdomyosarcoma, Histiocytosis
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Palm/sole rash?
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Enterovirus (coxsackie)
Syphilis RMSF Kawasaki |
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Rashes that start on trunk?
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Varicella (mild fever after)
Roseola (fever first) (in kids < 2) |
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Fever in Erythema infectiosum (B19) vs Measles?
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B19: temp of 100-101
Measles: T > 101 |
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Rashes that follow fever?
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B19: rash follows fever 7-10d later
Roseola: rash 3-4d after fever |
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Triad of RMSF?
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Fever
Headache Rash |
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Rash of SJS?
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Blistering, purpuric macules on face/trunk, erythema multiforme, severe mucosal changes (stomatitis)
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Diagnosis criteria of Kawasaki?
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High fever > 5 d
Changes in oral mucosa Extremity changes (red/swell) Rash Conjunctivitis Cervical adenopathy |
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Who to suspect bacterial cervical adenitis in?
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1-5 yo with recurrent URI, strep, or staph
Pt has high fever, toxic appearance, sometimes cellulitis or fluctuance |
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Appearance of someone with mycobacterial lymphadenitis?
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Often appear well
Nodes can rupture through skin though --> tx with surgical excision |
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Coughs that are worse at night?
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Asthma
Sinusitis |
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Dry coughs?
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Environmental irritant
Fungal infection Asthma |
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Barking cough?
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Croup
Subglottic disease Foreign body |
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Paroxysmal coughs?
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Pertussis
Chlamydia Mycoplasma Foreign body |
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Brassy/honking cough?
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Habitual cough
Tracheitis |
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Change in voice implies what?
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Laryngeal irritation (can be from rhinitis, GERD, etc)
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Radiology findings in TB?
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Primary complex (large hilar adenopathy with initial lung focus)
Focal hyperinflation Atelectasis Small local pleural effusions |
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Who uses inhaled steroids?
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All pts with persistent asthma
Need to monitor BP, glucose, growth delay, cataracts |
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Who gets methacholine, histamine, or exercise challenge?
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When asthma is suspected but spirometry is normal
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Abx to treat sinusitis?
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Cefuroxime
Amoxicillin-clavulanate |
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Timing of sinus development?
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Ethmoid and maxillary at birth
Frontal start around 6-8 yr |
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Complications of sinusitis?
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Orbital sinusitis
Cavernous sinus thrombosis Meningitis Epidural abscess |
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Cause of rhonchi?
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Mucus/secretions in airways
Continuous, low pitched, polyphonic |
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Cause of cobblestoning of posterior pharynx?
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Lymphoid hyperplasia
- from chronic post nasal drip and with chronic nasal allergies |
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Stages of asthma exacerbation?
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Early asthmatic reaction: 1 hr, PGs/LTs, permeability, hypersecretion, bronchoconstriction
Late: 2-3 hrs later, epithelial destruction, fibrotic remodeling, hyperplasia of bronchial smooth muscle Airway hyperresponsiveness can persist for days to weeks |
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Cerebellar hemispheric vs deep cerebellar nuclei lesions?
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Hemispheric: limb abnormalities, nystagmus, tremor, dysmetria (spares speech)
Deep nuclei: resting tremor, myoclonus, opsoclonus (neuroblastoma) |
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Most common childhood brain tumors?
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Medulloblastoma (20%)
Juvenile pilocytic astrocytoma (20%) |
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Classic vs common migraine?
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Classic has aura
Common: no aura, more common |
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Triad of ICP signs?
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HTN
Bradycardia Irregular respiration |
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Complication of pseudutumor cerebri?
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Blindness from elevated pressure around optic nerve sheath
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Causes of pseudotumor cerebri?
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Obesity
Meds (Vit A, tetracycline, OCPs, steroids) Metabolic disorders (galactosemia, hypo-PTH) Infection (sinusitis, OM) |
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Location of germ cell tumors in brain?
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Pineal gland or suprasellar region
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Presentation of supratentorial vs infratentorial tumor?
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Infratentorial: cerebellar signs, signs of raised ICP
Supratentorial: focal motor and sensory abnl on opposite side of lesion |
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Male predominance of what types of brain tumors?
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Medulloblastoma
Ependymoma |
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Two peaks of incidence of brain tumors?
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First decade
8th decade |
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Ages where supra or infratentorial tumors are more common?
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Supra < 2yo
Infa in kids Supra in adolescents/adults |
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Who does post-infectious cerebellitis appear in?
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1-3 yo
Several wks after viral infection (varicella, coxsackie) CSF w/ pleocytosis, high prot |
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Infectious cerebellitis can be caused by what?
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Mumps
Enterovirus EBV Bacterial meningitis pathogens |
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Examples of toxins that can cause sudden ataxia?
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Alcohol
Anti-convulsants Often get dysmetria and nystagmus also |
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Age of neuroblastoma/opsoclonus-myoclonus?
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6mo to 3yo
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Initial workup for CHF?
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CXR
EKG (save echo for later) |
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Murmurs associated with CHF?
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Aortic stenosis
Coarctation PDA VSD |
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When is a VSD first heard?
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Days to weeks of age
- occurs as pulmonary resistance decreases |
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EKG changes with VSD?
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Large: RVH and upright T wave in V1
Moderate: LVH Small: nl |
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When are ASD and Coarctation detected?
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Preschool age
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Most common murmur in kids?
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Innocent murmur
3-7 yo |
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What does Still's murmur sound like?
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Musical/vibratory
Best heard LLSB, supine 3-7 yo |
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Digoxin and Lasix treat what?
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Symptoms of CHF
- Digoxin: not good for VSD |
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Most common hip disorder in adolescents?
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SCFE
- posterior displacement of capital femoral epiphysis from femoral neck through cartilage growth plate |
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Complications of Legg-Calve-Perthes disease?
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Femoral head deformity
Degenerative arthritis often in boys 4-10 yo |
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How long after and after what types of infections does reactive arthritis occur?
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2-4 wks after GI or GU infection
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What action is impaired with a SCFE?
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Internal rotation
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How is pain from transient synovitis and septic arthritis relieved?
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By opening the hip capsule (hold hip in flexion and external rotation)
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Key way to distinguish transient synovitis vs septic arthritis?
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Elevated ESR, CRP in septic arthritis (can wait for lab values before doing joint tap if low suspicion)
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What worsens pain with osteomyelitis?
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Weight bearing
Pain is NOT position dependent (like in septic arthritis or transient synovitis) |
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Time of ESR vs CRP elevation?
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ESR: remains elevated for weeks after improvement
CRP: elevated 4-6 hrs after initial insult, peaks at 36-50 hrs, and returns to normal after 3-7 days |
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3 reasons kids are at higher risk of dehydration?
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1. Higher SA to body mass ratio
2. Higher basal metabolic rate 3. Higher percentage of body weight that's water |
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Diagnosis of DKA?
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1. Random BS > 200
2. pH < 7.3 or HCO3 < 15 3. Mod-lg ketonuria or ketonemia |
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Dx of diabetes?
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1. Sx and random glucose > 200
2. Fasting > 126 3. 2-hr GTT > 200 4. HbA1c > 6.5 |
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Most common cause of diabetes-associated death in children?
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Cerebral edema
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Replacement complications of hyponatremia and hypernatremia?
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Hyponatremia: replacement can cause central pontine myelinolysis
Hypernatremia: replacement can cause cerebral edema |
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Cause of iso/hypo/hyper tonic/natremic dehydration?
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Iso: AGE, diarrhea
Hypo: adrenal insufficiency Hyper: breastfeeding failure, DI, inappropriate rehydration solutions |
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Risk factors for cerebral edema?
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High BUN
Acidosis with hypocapnia Attenuated rise in Na+ with treatment Admin of bicarb |
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Other Abs to check in DM workup?
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Anti-pancreatic (Anti insulin, GAD, IA2)
Autoimmune thyroiditis and celiac DON'T check TFTs (can be elevated due to non-thyroidal illness) |
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Sodium concentration in oral rehydration solution?
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45-50 mEq/L
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Where's the blood in malrotation (+/- volvulus)?
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Blood in stool but not in vomit
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Current jelly stools?
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Intussusception
- also bilious emesis, crampy abd pain, and sausage mass on exam |
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Electrolyte changes in vomiting from pyloric stenosis?
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Hypochloremic, hypokalemic metabolic alkalosis
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Time of presentation of pyloric stenosis?
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3-12 weeks
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Order of exam in child?
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1. General obs
2. Eyes 3. CV/Lungs/Abd 4. Ears/oral cavity |
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Most important characteristics of ear exam?
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Mobility and Position
- Also color, translucency, and other |
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Appearance of TM in AOM?
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Bulging, yellow, poorly mobile
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Bacterial causes of AOM?
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1/2. S. pneumo/Non-typeable H. inf
3. M. catarrhalis 4. S. pyogenes |
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Who do we treat AOM with amoxicillin-clavulanate with (as opposed to just amoxicillin)?
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Kid with fever > 39C or moderate to severe otalgia
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Alternative treatments for AOM?
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Azithromycin
Erythromycin Clindamycin |
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Use of conventional vs visual reinforcement audiometry (VRA)?
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VRA: good 6 mo to 2.5 yo, not ear specific
Conventional: > 4yo, frequency-specific |
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Which hearing test is used in newborn assessments?
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Otoacoustic emissions (OAE)
- measure cochlear fxn in response to presentation of stimulus |
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Findings associated with otitis external?
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Bullous myringitis
Radial vascular dilation (bicycle-spoke distribution) Marked erythema with "cobblestone" appearance of TM |
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Who to use abx vs no abx for AOM?
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Abx: < 6mo, 6mo to 2 yr: if certain dx or severe disease, >2 yo with severe illness
No abx: 6mo to 2yr with uncertain dx, > 2yo without severe illness |
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Who should get a hearing test?
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Effusion > 3mo
If nl, follow q3-6mo If not, consider bilateral myringotomy with tube placement |
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Test for 0-6yo that reports percent of children who successfully perform each task?
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Denver II
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Complications of untreated chronic OME?
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Permanent sensory neural hearing loss (SNHL)
Tympanosclerosis Adhesive otitis media Cholesteatoma TM perforation Mastoiditis, Labyrinthitis, Meningitis Epidural/brain abscess |
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Cause of RUQ pain in PID?
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Fitz-Hugh-Curtis
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What should you ask the child to do during a rectal exam?
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Bear down as you enter the rectum to relax the external sphincter
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Presentation of hernia?
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<1 yo, more F
- Pain, irritability, vomiting, abd distention (if intestinal obstruction) |
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Use of CT for abd pain?
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Abscesses and Appendicitis
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Use of US in abd pain?
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PID, tubo-ovarian abscess (TOA)
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Use of barium study in abd pain?
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Chronic abd pain (IBD)
Dx intussusception |
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Use of KUB in abd pain?
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Ileus
Fluid levels Fecaliths (appy) Free air (perforated viscus) Malrotation Gallstones |
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What causes Fitz-Hugh-Curtis?
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Bacteria spills from uterus, tracks along paracolic gutter, and causes inflammation of the hepatic capsule and diaphragm
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Immediate treatment of hypoglycemia?
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20 cc/kg NS bolus
D25 bolus Maintenance D10 drip |
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What can be given to inhibit insulin release with sulfonylurea overdose?
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Octreotide
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EKG findings with TCA overdose?
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Wide complex tachycardia
- inc PR interval - QRS widening - QT interval prolongation |
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2 causes of hypotension with TCA overdose?
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Myocardial depression of Na+ channels
Alpha-1 block |
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2 types of breath holding spells?
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Pallid (acyanotic): associated with fall
Cyanotic: associated with anger - occurs 6mo to 6yr |
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Time period of colic?
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Several hours > 5 nights/week
Age: > 2 wks, peaks at 6 wks, lessens by 3-4 mo |
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Time of SIDS vs ALTE (apparent life threatening event)?
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SIDS: most are midnight to 6am
ALTE: most are 8am-8pm |
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Other names for Mongolian spots?
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Congenital dermal melanocytoses
Slate gray patches |
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Fracture that can be confused for abuse?
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Toddler's fracture: fracture of tibia in walking children
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Posterior rib fractures can result from what?
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Squeezing baby's thorax (shaken baby syndrome)
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What's the "fattest baby" age?
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4mo: 25% of weight is fat
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When is the physiologic nadir for Hgb?
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Around 7-9 weeks
Hgb 11 Then starts to rise after |
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What can cause false positive sweat test results?
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Adrenal insufficiency
Hypothyroidism |
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Screening vs confirmatory test for CF?
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Screening (newborn): detects immunoreactive trypsinogen in blood
Confirmatory = genotyping for specific mutations |
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What percent of CF pts present with pancreatic insufficiency?
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85-90%
aka 10-15% don't have it (they have normal weight gain, normal stools) |
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Pain scales by age?
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FLACC (face, legs, activity, cry, consolability) for non-verbal kids
FACES: for 3-8 yo 0-10 scale: > 8 yo |
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Most common cause of abd pain in kids?
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Functional abdominal pain
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First signs of chronic GI illness?
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Slowing of weight gain (or especially weight loss)
Change in height velocity suggests more long standing illness |
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What percent of pts with HSP have guiac positive stool?
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50% are guiac positive
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2 problems with barium enema?
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1. Contrast delays potential colonoscopy
2. Increased risk of toxic megacolon with UC |
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Are crypt abscesses are more common with UC or CD?
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UC
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2 studies to distinguish UC vs CD?
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Upper GI study
Colonoscopy |
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2 characteristics of Crohn's on barium enema?
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1. Cobblestoning
2. Separation from nearby loops (bowel wall thickening) |
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Does UC or CD have a stronger inheritable component?
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CD
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Treatments for IBD?
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1st line: aminosalicylates (mesalamine)
--> Corticosteroids, abx (cipro, metro), immunomodulators (6-MP, MTX), anti-TNF |
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When do you stop using prematurity corrected charts?
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age 2
premature infants should catch up by then |
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Most variable component of development?
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Language
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When does the AAP recommend developmental screening?
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9, 18, and 30 months
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What causes pigeon-toe-ing?
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Internal tibial torsion
- common in childhood, resolves with growth |
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How long does it take the pedal arch to develop?
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8 yrs
- can have flat feet until then |
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When does child gait look like an adult?
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3 yo
- heel strike present |
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When do you screen for autism?
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18 and 24 months
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3 realms of changes in autism?
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1. Social interaction
2. Communication 3. Restricted repetitive and stereotyped patterns |
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Which types of diseases will cause regression of milestones?
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Neurodegenerative disease
Psychosocial |
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Description of cerebral palsy?
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Heterogeneous group of non-progressive disorders
- motor and postural dysfunction |
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Risk factors for cerebral palsy?
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Perinatal asphyxia (10%)
Intrauterine infection (28%) Prematurity (78%) IUGR (34%) |
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Sequence of events in retinopathy of prematurity?
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Extraretinal fibrovascular proliferation
Detachment Blindness/visual impairment - risk: BW < 1500g |
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Complication associated with IVH?
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Periventricular Leukomalacia (PVL)
- damage from hypoxia, ischemia, inflammation |
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Complications of kernicterus?
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Abnl motor development (choreoathetoid cerebral palsy)
Sensorineural hearing loss |
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2 surgeries common in sickle cell patients?
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Tonsillectomy
Cholecystectomy |
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Cause of gallstones in sickle cell?
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Hemolytic anemia --> bilirubin gallstones --> cholelithiasis --> cholecystitis
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Which sickle cell pts get abx prophylaxis?
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Age 2 mo to 5-6 yrs
- oral penicillin BID |
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PCV23 is given to who and when?
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Pts with sickle cell get PCV23
- 2yo and then repeat 3-5 yr later - same schedule for meningococcal |
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2 things that can worsen anemia with sickle cell pts?
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1. Myelosuppression by viruses (parvovirus)
2. Hypersplenism (spleen enlarges and traps RBCs) |
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Who gets transcranial doppler (TCD) and why?
|
Sickle cell pts between 2-15 yo
- determine risk of stroke (10% risk by 15 yo) |
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Causes of impaired height and weight in sickle cell?
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Chronic anemia
Poor nutrition Painful crises Endocrine dysfunction Poor pulmonary function |
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What happens to the spleen of sickle cell pts?
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Becomes progressively fibrotic and no longer palpable by age 4-6
Hgb SC or S-beta-thal can have splenic enlargement into adolescence |
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Baseline Hgb in sickle cell?
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6-9
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Treatment of painful crises in sickle cell?
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IVF and IV narcotics
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Peak time of lymphoid tissue growth?
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Age 4-6 yo
- tonsils can be mildly enlarged during this time |
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Most common infection with steroid use for nephrotic syndrome?
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Spontaneous peritonitis
- often S. pneumo or GNRs |
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Management of nephrotic syndrome?
|
1. Albumin infusion
2. IV furosemide 3. Corticosteroids (taper over wks) 4. Sodium restriction (1500-2000 mg/d) |
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What are pts with nephrotic syndrome predisposed to?
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Venous thrombosis
- urinary loss of anti-coagulants, lipids destabilize platelets, inc fibrinogen, inc blood viscosity (high Hct) |
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4 categories of MCD?
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Steroid responsive
Relapsing Steroid-dependent Resistant (--> bx) |
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PID and TOA are best detected with which type of imaging?
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Ultrasound
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Chronic abd pain is best assessed with which type of imaging?
|
Barium study
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Who needs to be seen immediately for a fever?
|
Kids younger than 6-8 wks
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What is the worst measure of circulatory status?
|
Cold extremities
(pt can be cold with adequate circulation) |
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What do the D and E stand for in the ABCDEs of assessment?
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D: disability (quick neuro assessment - ICP, toxidromes, etc) and dextrose (check for hypoglycemia)
E: exposure/environment (expose all parts of pt, keep pt warm) |
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What's a practical problem with vasoconstriction in shock?
|
Vasoconstriction can make it difficult to get a good pulse ox measurement
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Next line of management if you can't get a peripheral IV in for a pt in shock?
|
Intraosseus line
- if peripheral IV can't be placed in 90 seconds - central line also acceptable in older kid or adult |
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Prophylaxis for meningococcus?
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Rifampin, cipro, or ceftriaxone
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Complications of meningococcal meningitis?
|
11-19% get complications:
- hearing loss - neuro disability - digit/limb amputations - skin scar |
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Problem with penicillin treatment of meningococcus?
|
Doesn't eliminate carrier state.
- Need rifampin (kids, young adults) or cipro (adults) or 5-7 d ceftriaxone to eliminate carrier state |
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Contraindications to IO line?
|
Osteogenesis imperfecta
Fracture Recently used site Infection |
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Complications of IO line?
|
Fracture
Fluid into subQ (--> compartment syndrome) Osteomyelitis Microscopic fat, BM emboli |
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Actions of TCAs?
|
Inhibit reuptake of NE
Antagonize ACh (--> hypotension), Na+ channels (--> dysrhythmias), and GABA (--> seizure) |
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Sympathomimetic toxidrome?
|
Mydriasis
Fever Diaphoresis Tachycardia Agitation SZ |
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Opioid toxidrome?
|
Miosis
Resp depression Hypotension Bradycardia Hypothermia AMS |
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Sedative-hypnotic toxidrome?
|
Miosis OR mydriasis
Hypotension Bradycardia Hypothermia Sedation |
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Anticholinergic toxidrome?
|
Mydriasis
Dry skin Flushing Tachycardia Ileus Urinary retention Fever Delirium, SZ |
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Cholinergic toxidrome?
|
Miosis
n/v/d Tears Sweating Urinating Bronchorrhea Bronchospasm Muscle twitch Bradycardia SZ, coma |
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What is given with activated charcoal in poisoning cases?
|
Cathartics
- charcoal helps absorb the toxins and cathartics accelerate defecation |
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Series of events in anorexia?
|
Amenorrhea
Bradycardia Postural hypotension Electrolyte abnormalities Continued deficiency of Ca, Mg Neuro changes, increased reflex tone, compromised cardiac function |
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Best tests for dx of von Willebrand's disease?
|
Platelet function tests
Factor VIII activity vWf antigen and activity (Ristocetin) aPTT (but can be normal, other tests are better) |
|
|
Genetics of vWD?
|
Autosomal dominant with variable penetrance: Type 1 and 2
Autosomal recessive: Type 3 |
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Meds to treat vWD?
|
Intranasal or IV desmopressin
vWF OCPs/levonorgestrel IUD (for menorrhagia) |
|
|
Most common hereditary bleeding disorder?
|
von Willebrand's disease
- 1% of population |
|
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When does fever after a vaccine usually present?
|
Usually 24-72 hours after
MMR and Varicella: can be 7-10d after |
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3 clinical tests/findings in meningitis?
|
1. Kernig's: resist knee extension
2. Brudzinski's: flex hip/knee in response to neck flexion 3. Opisthotonos: hyperextension of neck and spine - often NOT positive in infants <12mo |
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Most common organism in occult bacteremia?
|
S. pneumo
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How common is occult bacteremia in kids with fever?
|
present in 3-5% of 3-36mo with fever
|
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Indications for LP?
|
<3 or <12 mo (depends on clinician)
toxic appearing WBC > 15,000 with left shift T > 40 |
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Who doesn't needed to be cultured for strep throat?
|
Kids <2yo
Strep throat uncommon in young kids and ARF very rare in kids < 3yo |
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Treatment options for UTI?
|
Ampicillin (E coli often resistant)
Ceftriaxone (careful of ppts with Ca) Piperacillin/tazobactam (expensive) Ciprofloxacin (kids > 1 yo) TMP-SMX: good |
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Who should get a VCUG?
|
After second febrile UTI or with concerning findings on renal/bladder ultrasound
|
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Who should get a renal technetium scan?
|
Pts who don't respond to tx
|
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How prevalent is VUR?
|
Present in 25-50% of infants following first UTI
|
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Management of grade 1-2 VUR?
|
Most common type
- most often resolves spontaneously in 2-5 yrs - PCP can follow (whereas grade 3-5 needs to be referred to urology) |
|
|
Benefit of radionuclide cystogram?
|
Exposes pt to smaller doses of radiation than VCUG
- preferred imaging study to follow pts with VUR |
|
|
What percent of pts with HSV gingivostomatitis are symptomatic?
|
Only 10-30%
- some just have fever and irritability - most common in 10 mo - 3 yr |
|
|
Sequelae of bronchopulmonary dysplasia?
|
Increased caloric requirement
Illness Neuro disease |
|
|
What is grunting a sign of?
|
Respiratory distress
- closure of glottis with expiration |
|
|
Signs and cause of paradoxical breathing?
|
Chest drawn in with inspiration, abd rises
- Force of contraction from diaphragm >> ability of chest wall muscles to expand |
|
|
Sounds with narrowing of airways above vs below thoracic inlet?
|
Above: stridor
Below: wheezing |
|
|
Sounds from secretions causing airway narrowing?
|
Rhonchi
|
|
|
Cause of fine vs coarse crackles?
|
Coarse: purulent secretions in alveoli
Fine: pulmonary edema, interstitial disease |
|
|
What should you get before getting a bronchoscopy?
|
Obtain imaging (x-ray or fluoroscopy) first
|
|
|
Dynamic eval over several breaths to see foreign body?
|
Chest fluoroscopy
|
|
|
Two manifestations of foreign body and findings on imaging?
|
Partial obstruction: get air trapping/hyperinflation
Complete obstruction: get atelectasis, signs of volume loss of x-ray (mediastinal shift) |
|
|
Most consistent finding with Down syndrome?
|
#1 finding = Hypotonia
- small ears are also common |
|
|
Findings on US with Down syndrome?
|
Nuchal skin thickness
Nasal bone ossification Growth parameters |
|
|
Standard karyotype test?
|
Lymphocyte karyotype
- easier than skin fibroblasts |
|
|
Purpose of annual CBC in pts with Down syndrome?
|
Infancy: leukemoid rxn, transient myeloproliferative disorders (TMD)
> 1 yo: iron deficiency anemia |
|
|
Which vaccines are first given at adolescence?
|
Tdap
Meningococcal |
|
|
Methods of calculating BMI?
|
Total body water
Total body potassium Bioelectrical impedance Dual-energy x-ray absorptiometry |
|
|
Characterization of chest pain in precordial catch syndrome?
|
Sudden, sporadic onset, sharp
Location: LSB Exacerbated by deep inspiration Lasts sec to min Resolves spontaneously |
|
|
Tanner stage with increased penis length AND circumference?
|
Stage 4
|
|
|
Tanner stage with small amount of pubic hair but still childlike phallus?
|
Stage 2
|
|
|
Tanner stage with moderate curly pubic hair and phallus of increased length?
|
Stage 3
|
|
|
Differentiation of costochondritis pain with precordial catch syndrome?
|
Costochondritis: lasts hrs to days (compared to seconds to minutes)
|
|
|
Symptoms of hypoglycemic syncope?
|
Diaphoresis
Anxiety Tremulousness Hunger |
|
|
Erythema multiforme progression?
|
Dusky red macules --> wheals --> target lesions --> fixed for 1-3 wks
Most common with HSV, meds |
|
|
Common time of onset and treatment of candidal rash?
|
Diaper dermatitis, 7-10 mo (can also have satellite lesions)
Tx: nystatin or imidazole antifungals |
|
|
Selenium sulfide is used to treat what?
|
Tinea versicolor
|
|
|
Treatment of tinea capitis?
|
PO griseofulvin, 6-8 wks
|
|
|
Zinc oxide is used to treat what? What can help distinguish it from other rashes?
|
Irritant dermatitis
- spares intertriginous creases |
|
|
Strength of steroids?
|
Clobetasol > Betamethasone > triamcinolone > hydrocortisone
|
|
|
Location of staph folliculitis vs nodular/cystic acne?
|
Folliculitis often below waste/groin
|
|
|
Pseudofolliculitis appearance?
|
Papules NOT pustules
- distinguish from acne by presence of inflammation |
|
|
Radiographic appearance of intussusception?
|
Mass with central ring of hypoattenuation (mesenteric fat in intussusceptum)
|
|
|
Most common manifestations of HSP?
|
75% - arthritis
65% - colicky abd pain 25% - renal involvement 5-10% - intussusception |
|
|
What is small for gestational age (SGA) most often due to?
|
Constitutional factors - maternal ethnicity, parity, weight, height
|
|
|
3 risks for babies with SGA?
|
Hypoglycemia
Hypothermia Polycythemia |
|
|
Presentation of polycythemia in infants?
|
"Ruddy"/red color to skin
Respiratory distress Poor feeding Hypoglycemia Sluggish blood flow |
|
|
Symmetric vs asymmetric IUGR?
|
Symmetric: both head and abd circumference decreased proportionately
Asymmetric: greater decrease in abd than head ("head sparing phenomenon") |
|
|
5 basics of newborn resuscitation?
|
Dry
Warm (large SA/V) Position Suction Stimulate (vigorous cry) |
|
|
What percent of newborn and 12mo olds have palpable spleens?
|
30% of newborns
10% of 12 mo Often palpable 1-2cm below L costal margin |
|
|
Most common presentation of congenital CMV?
|
> 90% have no clinical evidence of disease as newborns
But 40% are SGA, 30% preterm, 25% of males have inguinal hernias |
|
|
5 types of treatments for eczema?
|
Lubrication
Anti-inflammatories Topical hydrocortisone Antihistamines (sedating and non) Calcineurin inhibitors |
|
|
2 things to prevent dental caries?
|
Stop bottle feeding by 12-15 mo
Fluoride (promotes re-mineralization of Ca into enamel) |
|
|
2 metabolic causes of hyperbili?
|
Galactosemia
Hypothyroidism |
|
|
Severe manifestations of kernicterus?
|
Lose suck reflex
Lethargy Irritability Seizures Death |
|
|
Signs of kernicterus in those who survive?
|
Opisthotonus, rigidity, oculomotor paralysis, tremor, hearing loss, ataxia
|
|
|
When and how does biliary atresia usually present?
|
> 2 wks
Direct hyperbili (progressive) Acholic stools |
|
|
How does jaundice progress?
|
Cephalocaudal direction
- 4-5 at face, 10-15 below knees - dermal zones often underestimate true level though |
|
|
Optimal time for newborn exam?
|
>/= 24 hrs after birth
- earlier: might miss PKU and other metabolic disorders that require accumulation |
|
|
Time of breast feeding vs breast milk jaundice?
|
Breast feeding: early 1st week
Breast milk: first 4-7d, peaks 10-14d, can last up to 12 wks |
|
|
Is PE common in neonates?
|
NO. Often only occurs with underlying clotting disorder or placement of central venous catheter
|
|
|
Is prematurity a risk factor for TTN?
|
NO
TTN: more common in term babies - risks: mother with DM, C/S delivery |
|
|
Are APGAR scores predictive of neurologic outcome?
|
NO
- Documented asphyxia is correlated with neuro outcome. Check cord arterial blood gas for acidosis. |
|
|
Small, appropriate, and large for gestational age percentiles?
|
SGA: < 10th %
AGA: 10-90th % LGA: > 90th % |
|
|
Complications of LGA?
|
Fractured clavicle
Brachial plexus injury Facial nerve palsy Complications of C/S, forceps, and vacuum Hypoglycemia |
|
|
What is Transient Tachypnea of the Newborn (TTN) due to and what is it also known as?
|
Delayed absorption of pulmonary fluid
- aka persistent postnatal pulmonary edema. |
|
|
Causes of persistent pulmonary HTN of the newborn (PPHN)?
|
Meconium aspiration syndrome
Diaphragmatic hernia Hypoplastic lungs In utero asphyxia |
|
|
Which cardiac anomaly is associated with maternal diabetes?
|
Transposition of the great arteries (TGA)
|
|
|
Best indicator of fetal malformations in moms with diabetes?
|
Major malformations are directly related to the First-Trimester HbA1C level
- HbA1C levels >12: 12x risk |
|
|
Relationship of respiratory rate and feedings?
|
Babies with RR > 80 often can't tolerate oral or NG feeds and need IV nutrition
|
|
|
Hypoglycemic glucose values that require intervention?
|
< 35 if asymptomatic
< 45 if symptomatic |
|
|
What can happen after giving a hyperinsulinemic infant glucose water?
|
Rebound hypoglycemia 1-2 hrs after
|
|
|
When are electrolyte values indicative of the infant's status?
|
After 12-24 hours
- sooner: indicative of mother's status and any medications administered |
|
|
What are the risk factors for DDH?
|
- Breech position: 30-50% of DDH cases occur in infants born in the breech position.
- Gender: 9:1 female predominance. - Family history. |
|
|
What is an MSK concern for pts with Down syndrome?
|
Myelopathic signs/sx for atlantoaxial instability
- importance of cervical spine positioning during procedures |
|
|
Distinguish neonatal seizures from jitteriness?
|
Jitteriness: stimulus-sensitive movements, generalized symmetric
|
|
|
Risks of home deliveries?
|
Neonatal tetanus
Omphalitis Hemorrhagic disease of the newborn (with no Vitamin K) |
|
|
Definition of polycythemia in term newborn?
|
> 65%
|
|
|
When does OTC deficiency present?
|
1-2 days
- sx due to protein in breast milk or formula --> poor feeding, lethargy, and vomiting |
|
|
Causes of large anterior fontanelle?
|
Skeletal disorders (rickets, osteogenesis imperfecta)
Chromosomal abnl (Down) Hypothyroid Malnutrition ICP |
|
|
Causes of premature closure of anterior fontanelle?
|
Microcephaly
Craniosynostosis Hyperthyroidism Nl variant |
|
|
Later symptoms of congenital hypothyroidism?
|
Large tongue
Hoarse cry Puffy myxedematous facies |
|
|
Most common time and presentation of botulism?
|
3-4 mo
poor suck and weak cry |
|
|
Risk of adulthood obesity with childhood obesity?
|
20% of obese 4 yo
80% of obese adolescents |
|
|
Psychiatric condition with the highest comorbidity with ADHD?
|
ODD/CD
|
|
|
When to start vision and hearing screening?
|
Vision: start 3 yr
Hearing: newborns, then resume at 4 mo |
|
|
Sequelae of obesity?
|
Sleep apnea (7% of overweight)
Dyslipidemia HTN (33% of obese) Nonalcoholic fatty liver |
|
|
When to suspect secondary causes of HTN?
|
In young kids
> 6 yo: most is primary |
|
|
Who and how to screen for type 2 DM?
|
> 10 yo or puberty onset
q2 yr with fasting serum glucose - overweight, FH, race/ethnicity, insulin resistance (AN, PCOS, HTN, dyslipid) |
|
|
Car seat rules?
|
< 2 yo: rear facing car seat
2-4 yo: forward facing car seat 4-8 yo: belt booster seat |
|
|
Causes of absent red reflex?
|
Cataracts
Glaucoma Retinoblastoma Chorioretinitis |
|
|
Times of administration of Hep B?
|
0, 1, 6 mo
3 times |
|
|
Times of administration of Rotavirus?
|
2, 4, 6 mo
3 times |
|
|
Times of administration of Hep A?
|
12 mo, second dose 6 months after and before 2nd birthday
|
|
|
Times of administration of Varicella?
|
1 yr and 4-6 yr
2 times - same as MMR |
|
|
Times of administration of MMR?
|
1 yr and 4-6 yr
2 times - same as Varicella |
|
|
Times of administration of IPV?
|
2, 4, 6 mo, 4-6 yr
4 times |
|
|
Times of administration of PCV?
|
2, 4, 6, 12 mo
4 times - same as Hib |
|
|
Times of administration of Hib?
|
2, 4, 6, 12 mo
4 times - same as PCV |
|
|
Times of administration of DTaP?
|
2, 4, 6, 15mo, 4-6 yr
5 times - start getting Tdap 11-12 yo |
