Pediatric Pance
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| 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
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| Treatment of Otitis Media, and complications | -high dose amoixicillin x 10 d empiric
-complications: TM perforation, mastoiditis (Hflu), meningitis, cholesteatomas, chronic otitis media
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| 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
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| MCC bronchiolitis | RSV
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| MCC Croup | Parainfluenza
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| Bronchiolitis features | -child<2 yo, fall winter
-inflammation small airways upper and lower resp tract
-tachypnea, wheezing, crackles,
-inc respiratory rate
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| Bronchiolitis treatment | -supportive: nebulizer, hydration
-high risk pt: maybe Ribavirin, RSV prophylaxis w/ Respi-Gam or Synagis
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| Croup pathophys | -aka laryngotracheitis/ layrngotracheobronchitis
-inflammation of the larynx w/in the sub-glottic space
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| 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)
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| Treatment of Croup based on severity | -mild: cool mist tx, fluids
-moderate: supp O2, IM corticosteriods, nebulized racemic epinephrine
-severe: inpt, nubulized racemic epinephrine
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| 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"
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| 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
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| MCC meningitis in neonates (<1 month) | GBS, Listeria, Ecoli
Tx: ampicillin + gentamycin
Ampicillin is for LISTERIA
Gentamycin will cover GBS and Ecoli
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| MCC meningitis infants/children | S pneumoniae, N meningitidis, H influenza
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| Meningitis associated with petechial rash | N meningitidis
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| Treatment of meningitis in neonate (<1 month) | -ampicillin and ceftaxime or gentamicin
(no ceftriaxone for neonates)
-bugs: GBS, Listeria, Ecoli
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| Treatment of meningitis in infant/child | -ceftriaxone and vancomycin
-bugs: S pneumo, H influenza, N meningitidis
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| Treatment of pertussis | -hospitalize infant< 6 m
macrolides (erythromycin / azithromycin)
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| Daignosis pertussis | CULTURE it!
suspect if WHOOPING inspiration
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| 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
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| Enuresis treatment | 1. reassurance, resolves spontan, normal 4-5 yo
2. *desmopressin* (DDVAP)
3. imipramine
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| Ewings sarcoma pathophys, genetics | -sarcoma (neuroectoderm)
-chrom 11:22 translocation
-Caucasian males
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| 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
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| Osteosarcoma pathophys | -osteoblasts (mesenchyme)
-male adolescents
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| 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
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| 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
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| 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
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| vitamin supplement fr measles | vitamin A
-reduces morb/mort; immune enhancement, allows GI and respiratory epithelium to regenerate
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| complications with varicella | -skin lesions 2/2 infection w/ Strep pyogenes or Staph aureus
-pneumonia, encephalitis
-Reyes syndrome (w/ aspirin use)
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| Treeatment for varicella in normal child, or VZV pneumoniae | -normal child: antihistamines, lotions
-immunocompomised child or VZV pneumoniae: acyclovir
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| Treatment for immunocompromised child/newborn exposed to varicella | -Varicella zoster immune globulin (VZIG)
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| Measles (Rubeola) cause, prodrome, rash features | -paramyxovirus
-Prodrome: Cough, coryza, Conjunctivitis
-*koplik spots*
-rash: maculopapular rash head-->toe
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| 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)
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| 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
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| 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
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| MCC nephrotic syndrome in children | -Minimal change disease--> give empiric steroids
-child with edema, proteinuria>3.5, hyperlipidemia
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| Minimal change disease diagnosis, treatment | -diagnosis made clinically
-give empiric steroids
-no biopsy needed
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| 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
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| newborn chokes, coughs regurgitates with first feeding; +- atelectasis | esophageal atresia w/ or w/o tracheoesophageal fistula (air in esophagus and stomach; food in lungs)
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| 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
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| Newborn with bilious vomiting w/o abdominal distention | duodenal atresia
-ass w/ down syndrome
-XR: double bubble sign
-tx: NG decompression and fluids; duodenoduodenostomy
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| Fetal alcohol syndrome defects | -midfacial hypoplasia, hypoplastic maxilla, long philtrum, thin upper lip border, microcephaly
-irritable, MR
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| Lithium birth defects | congential heart dz (Ebstein's anomaly)
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| Warfarin birth defects | nasal hypoplasia, stippled bone epiphyses, developmental delay, ophtho anomalies
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| Valproic acid birth defects | neural tube defects (spina bifida)
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| 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
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| Klinefelter's syndrome (male) features | 47XXY
hypogonadism
testicular atrophy, tall stature, long extremities, gynecomastia, female hair distribution
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| 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
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| Fragile X syndrome | X-Dominant --> MALES
-MC inherited form of MR
-large jaw, large testes, laarge ears
-autistic behavior
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| Palpable purpura | Henoch-Schonlein purpura
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| Henoch-Schonlein Purpura is associated with what complciation? | Intussusception: due to intestinal wall purpura
-abd pain and large amount of blood in stool
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| Most comon cause of bowel obstruction in first years of life | intussusception
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| Risk factors for Intussusception | -Meckel's diverticulum
-intestinal lymphoma
-Henoch-Schonlein purpura
-celiac dz, CF, infxnx, polyps
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| 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
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| acid base in pyloric stenosis | -hypocholremic, hypokalemic, metabloic alkalosis (vomiting HCl)
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| 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
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| Hirschsprung's disease path | -no ganglion cells in distal colon, uncoordinated perstalsis
-ass w/ Down syn, MEN type 2, Waardenburg
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| MC GI emergency in neonates, esp premature infants | Necrotizing Enterocolitis
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| XR: pneumatosis intestinalis (intramural air bubbles, gas produced by bacteria w/in bowel wall) | Necrotizing Entercolitis
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| Gastroschisis | -bowel protrudes through defect on R side umbilical cord
-no cover on membrane
-bowel angry and matted
-no ass w/ other abnormalities
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| Omphalocele | -intraabd contents protrude through umbilical ring
-bowel covered by amnioperitoneal membrane
-ass w/ other congential abnormalities
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| 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
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| disease association with ASD and endocardial cushion defects | Down syndrome
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| congenital infection ass w/ PDA | congential rubella
triad of congenital rubella
- PDA
- hearing defect
- cataracts
Blueberry muffin baby
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| dz ass w/ coarctation of aorta | Turner's syndrome
-can also have biscuspid valve
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| Disease associated with coronary artery aneurysms | Kawasaki disease
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| Disese ass w/ congenital heart block | neonatal lupus
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| dz ass w/ supravalvular aortic stenosis | Williams syndrome - elfin face, neurodevelopmental do
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| dz ass w/ conotruncal abnomalities (truncus arteriosus, tetrology of fallot, interrupted aortica arch) | CATCH-22 syndromes, Gi-George, velcardiofacial syndromes
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| Ebstein's anomaly | Maternal lithium use during pregnancy
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| dz as w/ asymmetric septal hypertrophy and transposition of the gerat vessels | maternal diabetes
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| 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
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| 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
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| Eisenmenger syndrome | -left to righ shunt leads to pulmonary hypertension and shunt reversal
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| Most common cyanotic heart disease in new born v child | -newborn: transpositsion of great vessels
-child: tetrology of Fallot
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| 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
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| Anomalies in Tetrology of Fallot | PROVe
Pulmonary stenosis
RVH
Overriding Aorta
VSD
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| 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)
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| Milestones 2 months: gross motor, fine motor, language, social | -*lift head/chest when prone*
-track pst midline
-coos
-*social smile*
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| Milestones 4-5 months: gross motor, fine motor, language, social | ROLLS OVER
grasp - can hold rattle
laughts
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| Milestones 6 months: gross motor, fine motor, language, social | -*sit unassisted*
palmer grasp, transfer objects
-*babbles*
-*stranger anxiety*
Transfer across midline
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| Milestones 9-10 months: gross motor, fine motor, language, social | -crawl, pull to stand
-pincer grasp
-nonspecific "mama/dada"
-waves bye bye, pat-acake
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| 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
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| Milestones 2 years: gross motor, fine motor, language, social | -*walks up/down stairs*, jumps
-tower of 6 cubes
-*2-word phrases*
-follow *2step commands*
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| 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
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| Milestones 4 years: gross motor, fine motor, language, social | -hop
-*copies a cross*
-knows colors, some numbers
-cooperative play, board games
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| Milestones 5 years: gross motor, fine motor, language, social | -skips, walk backwards
-*copies triangle*
-*5 word sentences*
-domestic role playing, dress up
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| Cerebral palsy management | -no cure
-treat spasticity with diazepam, dantrolene, baclofen
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| 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)
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| 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
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| 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
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| 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)
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| 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
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| child with anemia, thrombocytopenia, renal failure | Hemolytic uremic syndrome
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| Most common cause of acute renal failure in toddlers | HUS 2/2 E coli 0157:H7
-tx: supportive with plasmapheresis, maybe dialysis and steroids
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| *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
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| 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
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| 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
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| 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
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| recurrent hemarthroses (bleeding into joint) | Hemophilia
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| 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
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| Legg-Calve-parthes disease | AVASCULAR necrosis of femoral head
2-8yo
Ssx: painful limp
Tx: rest and NSAIDS then hip surgery
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| Slipped capital femoral epiphysis | displacement of femoral epiphysis
OBESE adolescent
Ssx: painful limp and externally rotated leg
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| 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
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| complications of duchennes muscular dystrophy | -mortality from pulmonary congestion caused by high output cardiac failure stemming from cardiac fibrosis
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| 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
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| 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*
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| 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
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| 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*
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| Freidrich's ataxia | gait disturbances, pes cavus, ataxia, absent ankle reflexes
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| Peutz-Jeghers syndrome | GI tract polyposis, mucocutaneous pigmentation
-estrogen secreting tumor: precocious puberty
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| Sturge Weber | port-wine stain over trigeminal nerve
eye / vision involvement
MR
SEIZURES
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| Atlantoaxial instability | -1-2% Down syndrome pts with upper motor neuron findings
-increased laxity C1 and C2--> compressionof spinal cord
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| dermatitis herpetiformis and chronic non-bloody diarrhea in child 12-15 months | celiac disease
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| young child with recurrent upper respiratory infections and bilateral nasal polyps | cystic fibrosis
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| 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
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| *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*
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| Ehlers Danlos | -defective *collagen* production (v Marfans- fibrillin)
-hypermobile joints
-easy bruising, poor wound healing, velvety hyperelastic skin
-cx: organ rupture, hemorrhage
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| Treatment of Kawasaki disease | aspirin and IVIG
-only time it is ok to give child aspirin
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| PKU | -aut rec
-def phenyalanine hydroxylase - breaks down phenyalanine into tyrosine
-screening: check blood phenyalanine test
-Guthrie test in urine- qualitative test
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| Heinz bodies | -aggregates of denatured Hb seen in G6PD def, thalassemia
-bite cells also seen
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| 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
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| 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
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| Pathologic jaundice | -appears in first 24-36 hrs of life, lasts longer than a week
-direct/conj bili >12; inc >5/day
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| 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
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| 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)
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| 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
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| 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
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| 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
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| 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
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| strawberry tongue and sandpaper rash | scarlet fever
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| 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
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| 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
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| 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
🗑
|
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| 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
🗑
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| MC presentation of sickle cell trait | painless hematuria
-sickle cell DISEASE: acute painful episodes, splenic infarction, dactylitis, etc
🗑
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| Congenital Toxoplasmosis sx | -chorioretinitis
-hydrocephlus
-intracranial Calcifications
-ring enhancing lesions on MRI
-tx pyrimethamine and sulfadiazine
🗑
|
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| Congenital Rubella sx | -"blueberry muffin rash"
-cataracts
-MR
-Hearing loss
-PDA
🗑
|
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| Congenital CMV | -*periventricular* calcifications
-petechial rash
🗑
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| Congential HSV | -skin eye mouth infections
-CNS/systemic infection
-acyclovir
🗑
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| Congenital HIV sx | -often asx
-failure to thrive
-bacterial infexns
-inc incidence of upper and lower resp diseases
🗑
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| 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)
🗑
|
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| nocturnal vulvar itching, anal pruritis | pinworm infection
-scotch tape test
-mebendazole
🗑
|
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| Lyme Disease treatment in children | -<9 yo, preg women: amoxicillin
->9 yo: doxycycline
-if cannot take amox or doxy, give cefuroxime or erythromycin
🗑
|
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| social smile | 2 months
🗑
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| 6 months | babble
start teething
Transfer objects across midline
Sits up unsupported
🗑
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| 2-3 words phrases, obey 2 step commands | 2 yo
over 50 word vocal
🗑
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| hold head up | 3 month
🗑
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| roll back to front and fron to back | 4 months
🗑
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| walk up and down stairs without help | 24 months
🗑
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| 9 months | bangs 2 objects together
🗑
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| 12 months | FINE pincher
starts walking
2-3 words and can obey 1 step commands
🗑
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| 15 mo | build tower of 2 blocks
walks independently
3-5 words
🗑
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| 24 months | builds tower of 6 cubes
turns page of books
jumps in place
🗑
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| imitates action/comes when called | 12 months
🗑
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| play with other children | 18 months old
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|
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| 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
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|
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| *TCA intoxication treatment* | -sodium bicarbonate for QRS prolongation
-diazepam or lorazepam for seizures
-cardiac monitoring for arrhythmias
🗑
|
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| Todd's paralysis | hemiparalysis right after a seizure
-postictal paralysis
-restoration of function in 24 hrs
🗑
|
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| 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
🗑
|
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| MCC of death by poisoning | multivitamin pills - iron toxicity
🗑
|
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| *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
🗑
|
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| 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
🗑
|
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| 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
🗑
|
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| 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
🗑
|
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| 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)
🗑
|
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