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Pediatric Pance

Acute otitis media MC infx in peds S pneumoniae --> #1, H influenzae, Moraxella catarrhalis -also viruses: influenza A, RSV, parainfluenza RF: straight eustachian tube, day-care, smoking Ssx: dull bulging immobile TM, poor feeding, irritable
Treatment of Otitis Media, and complications -high dose amoixicillin x 10 d empiric -complications: TM perforation, mastoiditis (Hflu), meningitis, cholesteatomas, chronic otitis media
Serous OM associated with allergic rhinitis FLUID in middle ear w/o acute infix decreased mobility of TM Tx: observation and decongestants x3mo NO ABX consider drainage >3mo to avoid hearing/speech delay
MCC bronchiolitis RSV
MCC Croup Parainfluenza
Bronchiolitis features -child<2 yo, fall winter -inflammation small airways upper and lower resp tract -tachypnea, wheezing, crackles, -inc respiratory rate
Bronchiolitis treatment -supportive: nebulizer, hydration -high risk pt: maybe Ribavirin, RSV prophylaxis w/ Respi-Gam or Synagis
Croup pathophys -aka laryngotracheitis/ layrngotracheobronchitis -inflammation of the larynx w/in the sub-glottic space
Croup symptom/diagnosis -barky cough at night, inspiratory *stridor* -prodrome 1-7 days, URI symp -stridor improves with racemic epinephrine -Neck XR: subglottis narrowing (steeple sign)
Treatment of Croup based on severity -mild: cool mist tx, fluids -moderate: supp O2, IM corticosteriods, nebulized racemic epinephrine -severe: inpt, nubulized racemic epinephrine
epiglottitis features, CXR, pathogens -Streptococcus spp (H influenza type b, now immunization) -*acute onset high fever*,*Respiratory distress*: drooling, dysphagia, inspiratory retractions, neck hyperextension, sniffing dog position -XR: swollen epiglottis, "thumbprint sign"
epiglottitis diagnosis and treatment -emergency! Secure the airway! -evaluate with ENT or anesthesiologist -definitive diag with fiberoptic visualization of cherry red epiglottis -intubate, IV ceftriaxone/cefuroxime
MCC meningitis in neonates (<1 month) GBS, Listeria, Ecoli Tx: ampicillin + gentamycin Ampicillin is for LISTERIA Gentamycin will cover GBS and Ecoli
MCC meningitis infants/children S pneumoniae, N meningitidis, H influenza
Meningitis associated with petechial rash N meningitidis
Treatment of meningitis in neonate (<1 month) -ampicillin and ceftaxime or gentamicin (no ceftriaxone for neonates) -bugs: GBS, Listeria, Ecoli
Treatment of meningitis in infant/child -ceftriaxone and vancomycin -bugs: S pneumo, H influenza, N meningitidis
Treatment of pertussis -hospitalize infant< 6 m macrolides (erythromycin / azithromycin)
Daignosis pertussis CULTURE it! suspect if WHOOPING inspiration
Diagnosis, Treatment of hemophilia -prolonged PTT, normal prothrombin, bleeding time, fibrinogen level, low factor VIII -tx: replace factor VIII; mild disease: desmopressin (DDAVP) releases factor VIII from endothelial cells
Enuresis treatment 1. reassurance, resolves spontan, normal 4-5 yo 2. *desmopressin* (DDVAP) 3. imipramine
Ewings sarcoma pathophys, genetics -sarcoma (neuroectoderm) -chrom 11:22 translocation -Caucasian males
Ewings sarcoma features, XR -*systemic symptoms* (none in osteosarcoma) + local pain, swelling -midshaft of long bone = middle of FEMUR -*inc ESR* -XR: onion skin, periosteal reaction
Osteosarcoma pathophys -osteoblasts (mesenchyme) -male adolescents
Osteosarcoma symptoms, features, XR -*local symp only* (v Ewings: sysemic sx) -metaphysis long bones = distal femur -metastasis lungs 20%--> get CXR!! -*inc alk phos* -"sunburst lytic lesion
Management of unilateral gynecomastia in adolescent male -Pubertal gynecomastia: seen in 50% adolescent boy ~14 yo -usually asymmetrical, tender, regresses in 6-18 months -ass w/ inc adrenal androgens, more can convert to estradiol -tersticle size usually 2cm lngth, 3mL volume
MCC of stridor in children traceomalacia/laryngomalacia: -floppy epiglottis, disproportionately small soft larynx -noisy breathing, worse with lying on back (gravity) -larygoscopy: collapse of laryngeal structures during inspriation -no treatment needed, resolves by 18 months
vitamin supplement fr measles vitamin A -reduces morb/mort; immune enhancement, allows GI and respiratory epithelium to regenerate
complications with varicella -skin lesions 2/2 infection w/ Strep pyogenes or Staph aureus -pneumonia, encephalitis -Reyes syndrome (w/ aspirin use)
Treeatment for varicella in normal child, or VZV pneumoniae -normal child: antihistamines, lotions -immunocompomised child or VZV pneumoniae: acyclovir
Treatment for immunocompromised child/newborn exposed to varicella -Varicella zoster immune globulin (VZIG)
Measles (Rubeola) cause, prodrome, rash features -paramyxovirus -Prodrome: Cough, coryza, Conjunctivitis -*koplik spots* -rash: maculopapular rash head-->toe
Rubella cause, prodrome, rash -rubella virus "3-day measles" -Prodrome: low grade fever (v measles) LAD behind ears -rash: maculopapular head-->toe (but clears on its way down)
2 yo boy w/ 3 days of very high fever. Fever resolves, child breaks out into diffuse rash on trunk--> extremities Roseola infantum -HHV-6, HHV-7 -cx febrile seizures
Erythema infectiosum (fifth disease) cause, rash, complications -Parvovirus B19 -"slapped cheeks", itchy erythematous rash arms-->trunk; *worse* with sun and fever -cx: aplastic crisis in sicklers Once have rash on body = no longer infectious, but very contagious prior to that during slapped cheeks phase
MCC nephrotic syndrome in children -Minimal change disease--> give empiric steroids -child with edema, proteinuria>3.5, hyperlipidemia
Minimal change disease diagnosis, treatment -diagnosis made clinically -give empiric steroids -no biopsy needed
Contraindications to DTaP -immediate anaphylactic reaction, encephalopathy, CNS complication w/in 7 d --> give DT instead of DTaP -adverse reactioins attributed to *pertussis* component of vaccine
newborn chokes, coughs regurgitates with first feeding; +- atelectasis esophageal atresia w/ or w/o tracheoesophageal fistula (air in esophagus and stomach; food in lungs)
3 weeks-5 month old infant with 5 days of non-bilious vomiting after feeds; olive shaped mass in midepigastrum; peristalstic waves in epigastrum hypertrophic pyloric stenosis -idiopathic, not present at birth
Newborn with bilious vomiting w/o abdominal distention duodenal atresia -ass w/ down syndrome -XR: double bubble sign -tx: NG decompression and fluids; duodenoduodenostomy
Fetal alcohol syndrome defects -midfacial hypoplasia, hypoplastic maxilla, long philtrum, thin upper lip border, microcephaly -irritable, MR
Lithium birth defects congential heart dz (Ebstein's anomaly)
Warfarin birth defects nasal hypoplasia, stippled bone epiphyses, developmental delay, ophtho anomalies
Valproic acid birth defects neural tube defects (spina bifida)
Down syndrome features, associations -meitotic nondisjunction (95%) -upslaneted eyes, simean crease, hypotonia -duodenal atresia, Hirschprungs, congenital heart dz (ASD, endocardial cushion defect>VSD) -inc risk ALL, hypothyroidism, early onset Alzheimers
Klinefelter's syndrome (male) features 47XXY hypogonadism testicular atrophy, tall stature, long extremities, gynecomastia, female hair distribution
Turner's syndrome (female) -45XO MCC primary amenorrhea due to ovarian dysgenesis (dec estrogen) webbed neck, coarc aorta, lymphedema hands feet as neonate -horshoe kidney
Fragile X syndrome X-Dominant --> MALES -MC inherited form of MR -large jaw, large testes, laarge ears -autistic behavior
Palpable purpura Henoch-Schonlein purpura
Henoch-Schonlein Purpura is associated with what complciation? Intussusception: due to intestinal wall purpura -abd pain and large amount of blood in stool
Most comon cause of bowel obstruction in first years of life intussusception
Risk factors for Intussusception -Meckel's diverticulum -intestinal lymphoma -Henoch-Schonlein purpura -celiac dz, CF, infxnx, polyps
Intussusception features, diag, tx -abrupt onset colicky abd pain, comiting, bloody mucus in stool (currant jelly stool) -"suasage shaped" RUQ abd mass -no bowels in RLQ -diag: US: target sign -emergency: air-contrast barium enema
acid base in pyloric stenosis -hypocholremic, hypokalemic, metabloic alkalosis (vomiting HCl)
Meckel's diverticulum sx, diag, tx -child <2 yo -sudden intermittent painles rectal bleeding -cx: intestinal obstruction, diverticulitis, volvulus, intussusception -diag: Meckel scintigraphy scan -tx: surgical excision of the diverticulum with adj ileal segment
Hirschsprung's disease path -no ganglion cells in distal colon, uncoordinated perstalsis -ass w/ Down syn, MEN type 2, Waardenburg
MC GI emergency in neonates, esp premature infants Necrotizing Enterocolitis
XR: pneumatosis intestinalis (intramural air bubbles, gas produced by bacteria w/in bowel wall) Necrotizing Entercolitis
Gastroschisis -bowel protrudes through defect on R side umbilical cord -no cover on membrane -bowel angry and matted -no ass w/ other abnormalities
Omphalocele -intraabd contents protrude through umbilical ring -bowel covered by amnioperitoneal membrane -ass w/ other congential abnormalities
Management of Gastroschisis and Omphaocele -delivery at tertiary care center -C-sec only for usual indications -wrap bowel with sterile dressing (gastro and omphalo) preserve heat and dec fluid loss -insert orogastric tube to decompress tomach -stabilize airway, IV access
disease association with ASD and endocardial cushion defects Down syndrome
congenital infection ass w/ PDA congential rubella triad of congenital rubella - PDA - hearing defect - cataracts Blueberry muffin baby
dz ass w/ coarctation of aorta Turner's syndrome -can also have biscuspid valve
Disease associated with coronary artery aneurysms Kawasaki disease
Disese ass w/ congenital heart block neonatal lupus
dz ass w/ supravalvular aortic stenosis Williams syndrome - elfin face, neurodevelopmental do
dz ass w/ conotruncal abnomalities (truncus arteriosus, tetrology of fallot, interrupted aortica arch) CATCH-22 syndromes, Gi-George, velcardiofacial syndromes
Ebstein's anomaly Maternal lithium use during pregnancy
dz as w/ asymmetric septal hypertrophy and transposition of the gerat vessels maternal diabetes
Neisseria v Chlamydia and sexual abuse -Neisseria in vaginal culture is defnitive evidence of abuse -Chlamydia is not bc can be from mother during delivery and can persist for up to 3 yrs
acyanotic heart defects and their murmurs -rarely present at birth; L-R shunt VSD - harsh holosystolic murmur ASD- fixed wide split S2, sys ej murmur PDA - machinery, wide pulse P, bounding pulses
Eisenmenger syndrome -left to righ shunt leads to pulmonary hypertension and shunt reversal
Most common cyanotic heart disease in new born v child -newborn: transpositsion of great vessels -child: tetrology of Fallot
congential heart disease nitially tereated with PGE1 PGE1 keeps ductus arteriosus from fetal circulation OPEN until neonate stable enough for surgery -severe coarctation of aorta -transposition of great vessels -tetrology of fallot
Anomalies in Tetrology of Fallot PROVe Pulmonary stenosis RVH Overriding Aorta VSD
treatment of VSD, ASD, PDA -VSD: tx CHF w/ diuretics, inotropes, ACEI; small VSD close spon; large VSD, surgery -ASD: 90% close spon -PDA: indomethacin unless needed for survival (transposition, tetrology)
Milestones 2 months: gross motor, fine motor, language, social -*lift head/chest when prone* -track pst midline -coos -*social smile*
Milestones 4-5 months: gross motor, fine motor, language, social ROLLS OVER grasp - can hold rattle laughts
Milestones 6 months: gross motor, fine motor, language, social -*sit unassisted* palmer grasp, transfer objects -*babbles* -*stranger anxiety* Transfer across midline
Milestones 9-10 months: gross motor, fine motor, language, social -crawl, pull to stand -pincer grasp -nonspecific "mama/dada" -waves bye bye, pat-acake
Milestones 12 months: gross motor, fine motor, language, social -*walks alone* -2 finger pincer grasp -*1-3 words*; follow *1 step commands* -*separation anxiety* imitates
Milestones 2 years: gross motor, fine motor, language, social -*walks up/down stairs*, jumps -tower of 6 cubes -*2-word phrases* -follow *2step commands*
Milestones 3 years: gross motor, fine motor, language, social -*tricycle*; climb stairs with alternating feet -*copies a circle* -*3 word sentences* -brush teeth, wash/dry hands
Milestones 4 years: gross motor, fine motor, language, social -hop -*copies a cross* -knows colors, some numbers -cooperative play, board games
Milestones 5 years: gross motor, fine motor, language, social -skips, walk backwards -*copies triangle* -*5 word sentences* -domestic role playing, dress up
Cerebral palsy management -no cure -treat spasticity with diazepam, dantrolene, baclofen
Febrile seizure diagnosis, tx -focus on finding source of infection -LP is CNS infection suspected -no w/u if >18 m and its obviously febrile seizure -<6 m need sepsis w/up -tx: acetominophen; no aspirin (Reyes)
Signs of autism in development milestones -no babbling, gesturing by 12 months -no single words by 16 months -no 2 wordphrases by 24 m -failure to make eye contact -other signs of language or social skills
Umbilical hernia management -imperfect closure, weakness of the umbilical ring -most disappear apon by 1 yo -surgery if hernia persists to 3-4 yo, exceeds 2 cm diameter, symptomatic, becomes strangulated, or progressively enlargens after 1-2 yo
meconium ileus -manisfestaion of CF -failure to pass meconium w/in first 24 hours of birth -bilious vomiting -h/o polyhydramnios -family history of CF -cx: intestinal perforation--> pneumoperitoneum (after birth) or intrabdominal calification (before birth)
Meconium plug syndrome -similar presentation to meconium ileus: bilious vomit, failure to pass meconium w/in first 24 h -BUT non-cystic fibrosis babies -no cx with intestinal perforation
child with anemia, thrombocytopenia, renal failure Hemolytic uremic syndrome
Most common cause of acute renal failure in toddlers HUS 2/2 E coli 0157:H7 -tx: supportive with plasmapheresis, maybe dialysis and steroids
*infant cyanotic when feeding, sucking; relieved by crying* Choanal atresia -separation of the nose and pharynx by a membrane or bone -unable to pass catheter through one or both nostrils -confirm diag with CT scan with intranasal contrast -tx: place oral airway and lavage feeding; surgery
Laryngomalacia --month olg infant, noisy breathing, stridor, hoarseness, symptoms worse when lying on back -floppy epiglottis and supraglottic aperture; small and soft larynx -tx: reassurance, rsolves spont in 18 m
Wiskott-Aldrich syndrome -Xrec, males -*low IgM*, high IgE, IgA, *thrombocytopenia* -*bleeding, eczema, recurrent otitis media* -present at birth with bleeding from circumcision, petechiae, bruises, bloody stool -infxnx encapsulated organism
Dactylitis -hand foot syndrome -6m-2 yo acute onset symmetric swelling of hands and feet, due to vascular necrosis of metacarpals and metatarsals -earliest sign of vaso-occlusion insickle cell anemia -give child complete w/up
recurrent hemarthroses (bleeding into joint) Hemophilia
Tay-Sachs disease -lysoomal storage disease; abscence hexoaminidase leads to GM2 ganglioside -normal until 3-6 months old -cherry red spot but *NO hepatosplenomegaly* -Tay-SAX lacks heXosaminidase
Legg-Calve-parthes disease AVASCULAR necrosis of femoral head 2-8yo Ssx: painful limp Tx: rest and NSAIDS then hip surgery
Slipped capital femoral epiphysis displacement of femoral epiphysis OBESE adolescent Ssx: painful limp and externally rotated leg
Osgood-Schlatter disease overuse apophysitis of tibial turbercle -loaclized pain, esp quadriceps contraction -in acitve young boys -tx: dec activity 3 months, maybe a brace
complications of duchennes muscular dystrophy -mortality from pulmonary congestion caused by high output cardiac failure stemming from cardiac fibrosis
Neonatal conjunctivitis -present w/in 24 hrs of life: chemical conjunctivitis due to silver nitrate; resolves spont -presents on 2nd day of life: gonococcal; most destructive; ceftriaxone -presents day 5-14: chlamydia; oral erythromycin
daignosis of ALL -CBC, blood smear: 90% lymphoblasts, WBC count low, norm or high -bone marrow aspirate for hypercellularity and blasts -*CXR to r/o mediastinal mass*
Tumor lysis syndrome -hyperK, hyperphosphatemia, hyperuricemia -comon prior to and during chemo tx -tx with fluids, allopurinol, urine alkalinization -corticosterios CI bc can pricipaitate tumor lysis syndrome
Neuroblastoma -neural crest tumor -<2 yo ass w/ neurofibromatosis, Hirschsprungs disease, M-myc oncogene -sx: nontender abdominal mass *crosses the midline*, Horners syn, *myoclonus* -*elevated VMA and HMA*
Freidrich's ataxia gait disturbances, pes cavus, ataxia, absent ankle reflexes
Peutz-Jeghers syndrome GI tract polyposis, mucocutaneous pigmentation -estrogen secreting tumor: precocious puberty
Sturge Weber port-wine stain over trigeminal nerve eye / vision involvement MR SEIZURES
Atlantoaxial instability -1-2% Down syndrome pts with upper motor neuron findings -increased laxity C1 and C2--> compressionof spinal cord
dermatitis herpetiformis and chronic non-bloody diarrhea in child 12-15 months celiac disease
young child with recurrent upper respiratory infections and bilateral nasal polyps cystic fibrosis
Sickle cel disease patients are susceptible to infection from what bugs? -functional asplenia by 2-3 yo, can't remove encapsulated organisms -Pneumococcus (Strep pneumo) -H. influenza -osteomyelitis: Salmonella
*Marfans syndrome* -Aut dom -mutation fibrilin-1 gene (v collagen Ehlers-Danlos) -tall stature, emaciated extremities, arachnodactyly, hypermobility of joints, *upward lens dislocation* (v downward in homocyst), *aortic root dilation*
Ehlers Danlos -defective *collagen* production (v Marfans- fibrillin) -hypermobile joints -easy bruising, poor wound healing, velvety hyperelastic skin -cx: organ rupture, hemorrhage
Treatment of Kawasaki disease aspirin and IVIG -only time it is ok to give child aspirin
PKU -aut rec -def phenyalanine hydroxylase - breaks down phenyalanine into tyrosine -screening: check blood phenyalanine test -Guthrie test in urine- qualitative test
Heinz bodies -aggregates of denatured Hb seen in G6PD def, thalassemia -bite cells also seen
Physiologic jaundice -not present until 72 hrs after birth, lasts 1 week -moderate unconj bili<12-14 -more common in preterm, diabetic mom, Asian pts
Breast milk jaundice -appears in 2nd week of life -unconj bili ~10-30 -levels drop rapidly when breastfeedig stops; give formula 1-2 d, and return to breastfeeding
Pathologic jaundice -appears in first 24-36 hrs of life, lasts longer than a week -direct/conj bili >12; inc >5/day
Henoch-Schonlein Purpura -IgA vasculitis of small vessels -follows strep or viral URI -sx: palpable purpura, arthritis, abd pain -cx: intussusception, renal dysfunction (IgA deposition) -tx: usually benign, self limited; severe: steriods
Downs Syndrome child with loud P2. What heart defect? Endocardial cushion defect of AV canal - left to right shunt leads to pulmonary hypertension (v ASD - low flow to lung)
Benign mumur features = still's murmur -most murmurs in children are benign: asx pt, intensity grade 2 or less, normal S2, no clicks, normal pulses - LSB systolic low grade - diminishes with standing, sitting, or valsalva - loudest when laying down
Pathologic murmur features -most murmurs in children are benign -Pathologic need echo: symptomatic, intensity 3 higher, abnormal S2, pansystolic, no femoral pulses, murmur quality unchanged with position
Calculate Apgar -Color:0 blue; 1 body pink, ext blue; 2 pink -HR: 0 no act; 1 <100; 2 >100 -Reaction: 0 no reaction; 1 grimace; 2 active cough -Tone: 0 limp; 1 some flexion; 2 active flexion -Respirations: 0 none; 1 slow; 2 good effort
premature infant with normocytic, normochromic anemia; no other RBC abnormalities on peripheral blood smear (no schistocytes); reticulocyte count low -Anemia of prematurity - commo in premature infants and low birth weight infants -diminished RBc prod, short RBC life span and blood loss -tx: iron supplementation although anemia unrelated to iron def
strawberry tongue and sandpaper rash scarlet fever
Scarlet fever path, sx, tx -toxin mediated dz by Group A Strep -fever, 12 hrs later punctate pink exanthem on trunk --> extremities -fades in 4 days followed by desquamation -pharynx is beefy red, tongue initially white, then bright red -tx: pencillin V> erythromycin, clinda
Stevens Johnson Syndrome sx, tx -severe variant of erythema multiforme -erythema multiforme lesions (traget lesions) covering *<10% body*--> bullae -fever malaise, *mucous membranes involvement*, uveitis -due to virus (herpes) or drugs -supportive tx
Toxic Epidermal Necrolysis -severe erythema multiforme with widespread involvement -due to drug hypersensitivity -target lesion--> widespread full thickness necrosiss of skin >30% body -prodrome fever, flue sx -mucous membranes affected
Hand Foot Mouth disease -coxsackie A virus -vesicles open rapidly to painful ulcers, even in soft palate -gray blisters on hands, feet, on background erythema -high fever, severe sore throat, may be unable to swallow -ulcerative lesions on palate, tonsils, pharynx
MC presentation of sickle cell trait painless hematuria -sickle cell DISEASE: acute painful episodes, splenic infarction, dactylitis, etc
Congenital Toxoplasmosis sx -chorioretinitis -hydrocephlus -intracranial Calcifications -ring enhancing lesions on MRI -tx pyrimethamine and sulfadiazine
Congenital Rubella sx -"blueberry muffin rash" -cataracts -MR -Hearing loss -PDA
Congenital CMV -*periventricular* calcifications -petechial rash
Congential HSV -skin eye mouth infections -CNS/systemic infection -acyclovir
Congenital HIV sx -often asx -failure to thrive -bacterial infexns -inc incidence of upper and lower resp diseases
Congenital Syphlis sx -snuffles -maculopapular skin rash -LAD, hepatomegaly osteitis -late congential syphilis: saber shins, saddle nose, CNS, Hutchinsons triad (peg shaped incisors, deafness, interstitial keratitis)
nocturnal vulvar itching, anal pruritis pinworm infection -scotch tape test -mebendazole
Lyme Disease treatment in children -<9 yo, preg women: amoxicillin ->9 yo: doxycycline -if cannot take amox or doxy, give cefuroxime or erythromycin
social smile 2 months
6 months babble start teething Transfer objects across midline Sits up unsupported
2-3 words phrases, obey 2 step commands 2 yo over 50 word vocal
hold head up 3 month
roll back to front and fron to back 4 months
walk up and down stairs without help 24 months
9 months bangs 2 objects together
12 months FINE pincher starts walking 2-3 words and can obey 1 step commands
15 mo build tower of 2 blocks walks independently 3-5 words
24 months builds tower of 6 cubes turns page of books jumps in place
imitates action/comes when called 12 months
play with other children 18 months old
Supracondylar humeus fracture -most comon pediatric elbow fracture -danger of brachial artery entrapment - *do radial pulse test* -inc risk Volmann's contracture: compartment syndrome of the forearm
*TCA intoxication treatment* -sodium bicarbonate for QRS prolongation -diazepam or lorazepam for seizures -cardiac monitoring for arrhythmias
Todd's paralysis hemiparalysis right after a seizure -postictal paralysis -restoration of function in 24 hrs
Iron poisoning sx -nausea, vomiting, diarrhea, abd pain, GI bleeding, metabolic acidosis -iron pills radio-opaque, CAN be seen on abd XR -tx: asymptomatic pt: ipecac syrup symptomatic: deferoxamine, an iron chelator
MCC of death by poisoning multivitamin pills - iron toxicity
*aseptic necrosis of the femoral head* -common coplication of sickle cell disease -sx: pain in the hip that gradually progresses -involves occlusion of end arteries supplying the femoral head, bone necrosis and eventual collapse of the periarticular bone and cartilage
Waterhouse-Friderichsen syndrome -sudden vasomotor collapse and skin rash (large purpuric lesions on flanks) due to adrenal hemorrhage -esp after infant with meningococcemia RF: meningococcal meningitis
IgA type B cell deficiency predisposes to what infxnx? Giardia!!! -cannot kill encapsulated prgaisms, so also H influenza and S pneumo
Erythema toxicum -benign self limited condition in *newborns* -evanescent rash with red halos and *eosinophils* on skin lesions
Hirschsprung v Intestinal atresia BOTH: bilious vomit, no BM hirsch: *48 hrs* eval - no meconium atresia: duodenal atresia (double bubble), jejunal stresia (triple bubble); immediate eval of newborn
Bronchopulmonary displasia (BPD) chronic lung disease from infants that needed MECHANICAL vent and supplemental O2 for RDS (resp distress synd) Defined as need for supplemental O2 after 36 wks PE: tachypnea, increased AP diameter, air trapping
TORCH infections Prenatal infex that lead to severe abnormalities = most common HEARING IMPAIRMENT & MR Toxoplasmosis Other = syphillis, varicella, HIV Rubella Cytomegalovirus Herpes Simplex
Live vaccines Influenza live in NASAL SPRAY ROTAVIRUS VARICELLA / zoster RUBELLA MMR
DTaP vs. Tdap Diphtheria + Tetanus + acellular Pertussis = DTaP given in 5 doses: 2, 4, 6, 15mo, 4 yrs Tdap is the BOOSTER given to children ~10yo who did not complete DTaP series Td BOOSTER given q 10 years - can give to adults
Vaccines at 12mo MMR Varicella Hep A (hep B can give at birth)
Vaccines that cannot be given in prego MMR Rubella Varicella / zoster
infant growth head circumference increases 1cm/mo 1st year 2cm total 2nd year birth wt triples by year 1
female sexual development onset of secondary sexual characteristics 8-13yo Breast budding is the first sign Menarche w/in 2 years of budding
mom of neonate is HBsAg+ give HepB IgG to neonate
Meningitis in the neonate Vertical transmission from GU/GI tract of mom MCC = Grp B strep - prophylax mom @ delivery with AMOXICILLIN
Respiratory distress syndrome (RDS) Due to insufficient surfactant RF: premature, meconium aspiration Prevent: steroids to preterm Ssx: tachypnea, tachycardia, retractions, grunting, cyanosis, nasal flaring Dx clues: HYALINE mb in alveoli/ground glass appearance on CXR
Meconium aspiration Normal fetus does not release meconium until after birth If meconium is released in amnionic fluid, the fetus can aspirate --> meconium inactivates surfactant and leads to RDS Clinical PE: infant is stained with meconium @ delivery CXR: ground glass
SIDS sudden unexplained death highest in winter / males 2-6mo RF: teen mom, preterm / low birth wt / smoking exposure Prevention: breastfeeding, BACK to SLEEP
Neonatal physiologic jaundice Increased in indirect / unconjugate bilirubin COOMBs negative appears on 2-3d, peaks by 5d, gone by 7-10d Due to liver immaturity (not conjugating) Tx: PHOTOTHERAPY
Pathologic jaundice w/in 24 hours of life Coombs POSITIVE = suspect hemolytic disease of newborn due to ABO incompatibility
Breast-milk jaundice Associated with breast-feeding Peaks by 14d Increase in INDIRECT bilirubin Diagnosis of exclusion when other causes of jaundice r/o
Herpangina Coxsachie A virus = hand, foot, mouth disease Ssx: multiple small ulcers/vesicles on posterior pharynx and on fingers + FVR, dysphagia RF: fecal-oral transmission from swimming pools / water parks self-limiting. no complications
Reye's syndrome caused by use of ASA for VIRAL illness Ssx: rash, vomiting, lethargy, encephalitis, coma BUT ASPIRIN is ok for KAWASAKI d/o
Septic arthritis in peds MCC < 15yo = staph aureus MCC >15yo = nisseria gonorrhea FVR, pain, swelling, limited joint motion Tx: MUST TAP = arthrocentesis + IV abx
Roseola infantum acute viral disease = HHV6 + HHV7 Ssx: starts with FUO 3-5d with no other clinical signs. When FVR drops get significant rash spreading from trunk outward Key: if rash and FVR at same time = not roseola Ddx: Rubella Rubeola (measels)
abrupt onset of FVR in peds with no other signs, followed by rash Roseola Very high FVRs in roseola = febrile seizure risk
Congenital rubella TRIAD: cataracts, deafness, heart defects PE: blueberry muffin baby
peds rashes 1. FVR then rash = roseola 2. head cold/photophibia + FVR, then rash + FVR = meseals 3. Sandpaper rash, finely papular = scarlet fvr 4. slapped cheeks then rash = erythema infectious 5. dew drop on a rose petal = varicella
Scarlet FVR clues 1. Sandpaper papular rash 2. Strawberry tongue 3. Pastia's lines = rash in flexor creases does not blanch esp axilla and groin Ssx: acute onset FVR, sore throat, chills, hypermic tonsils, exudates Tx: penicillin, amoxicillin
Salicylate poisoning causes anion-gap metabolic acidosis Tx: maintain hyperventilation to compensate (pt on vent) Activated charcoal if <2hrs Correct fluid deficits to get urine output 1-1.5ml/kg/hr ALKALINIZE URINE (bicarb bolus) - prevents salicylate reabsorption
neonatal septic workup Get LP on any febrile neonate <28d Otherwise LP any infant with CNS signs (irritability, lethargy) MCC: GBS, E/coli from maternal GU tract Dx: LP, blood culture, urine culture, CXR Tx: ampicillin and gentamycin
6mo infant brought in by mom for seizure, FVR 103 x 3d. On PE irritable, shallow breathing, delayed cap refill, BP 80/20 most likely dx = FEBRILE SEIZURE 2/2 SEPSIS must order septic eval: CBC + D CSF analysis blood / urine cultures CXR
Varicella HIGH pruritic rash that is vesicular best initial test = TZANCK smear showing multinucleated giant cells Tx: supportive, antihistamines to decrease itching Cx: staph aureus super-infection Prevention: vaccine at 12 mo
peritonsilar abscess UVULA is not midline - deviates away from abscess Hot potato voice MCC = GABHS Tx: ceftriaxone + drainage (always drain abscess) Cx: can cause obstruction around carotids
Vaccines given at 2, 4, 6, & 15mo schedule CHID conjugated pneumo H flu Inactivated polio DTaP
Muscular dystrophy X-linked Progressive degeneration of skeletal muscle GOWLER maneuver to stand dead by 25 from respiratory failure
Absence seizure School age 5-12 peak incidence NO POST ICTAL PERIOD Amnesia after each seizure Ssx: sudden stare, stop verbal/motor activity "day dreaming" "impairment of consciousness" Tx: ethosuximide
Tonic-clonic seizure Grand mal = associated with Epilepsy MC type of seizure d/o Ssx: frequently aura, HA, amnesia Jacksonian march = seizure is generalized Todd's paralysis = weakness in post-ictal period Tx: anticonvulsants
Status epilepticus Prolonged seizure > 30 min w/o regaining CNS funx risk of brain damage from hypoxia Tx: intubate / airway support 2 IV O2 mask Lorazepam (1st choice) Fosphenytoin Send labs for TOX screen, metabolites, sepsis workup
Infectious diarrhea in peds Bloody stools and + cultures (E.coli / shigella) = do not use ABX - will cause the bacteria to release toxins In peds tx all diarrhea with aggressive fluid rehydration and caloric support No opiates (loperamide) for infx diarrhea ever
Tinia capitis Peak = school age kids Superficial fungal infx of the scalp = scalp ringworm Ssx: scaling, erythema, partial alopecia, itching, red raised patches Tx: ORAL GRISEOFULVIN unlike other tinia this one does not respond to topicals, must give PO
Head lice due to direct contact / sharing hats Ssx: Nits are firmly attached white lesions (vs. dandruff) Tx: Permethrin Must re-treat 1 week later
Hemophilia A vs. B A = factor VIII defect Tx: cryoprecipitate B = factor IX defect Tx: FFP - there is no factor IX in cryoprecipitate Both types give hemearthrosis and increased PTT
Hemorrhagic disease of the newborn gut is not colonized so bacteria are not making VitK Give VitK IM shot immediately after birth
Hemolytic uremic syndrome follows acute gastroenteritis E.Coli infection releases toxins Ssx: TRIAD follows episode of diarrhea - hemolytic anemia - jaundice - thrombocytopenia - petechiae - acute renal failure - oliguria, edema, HTN Tx: SUPPORTIVE No abx for HUS
ALL #1 childhood malignant neoplasm Ssx: initially non-specific - generalized weakness, fatigue, wt loss - pallor, bruising, petechiae - FVR - increased infx - SWOLLEN lymph nodes, spleen enlargement - bone pain 2/2 marrow hypertrophy
Hemangioma MC BENIGN childhood neoplasm
GI foreign body remove if in the esophagus = endoscopy Ssx: may be asymptomatic - can swallow liquids but difficulty with solids - copious DROOLING in toddlers
retinopathy of prematurity disorganized retinal vessels in premeeis that had NICU stays likely due to overexposure to supplemental O2 RF: - premature - O2
7yo presents with NO IMMUNIZATIONS, which are the most appropriate to start with Tdap, polio (OPV), measles-mumps-rubella (MMR) children not immunized in the 1st year of life and you are >7yo = give Tdap (not DTap)
Created by: duanea00