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Peds Final (New)

Pediatrics: Exam 3: Final: Cardio, Oncology, Hemotology, Adolescence, Ortho etc.

Blue discoloration of the skin, mucus membranes and nails due to desaturated hemoglobin Cyanosis
T/F: S1 closure of mitral and tricuspid valves. S2 closure of aortic and pulmonic valves. Normal to have split S2 with inspiration All true
Continuous machinery-like murmur PDA (Patent ductus arteriosus)
T/F: Diastolic murmurs are ALWAYS abnormal True (one of the few "ALWAYS" questions that is actually correct)
VSD, MR, TR Holosytolic murmurs
One continuous murmur that isn't abnormal? Venous hum
3 characteristics of a pathological murmur; what should you do? 1) Grade 3 or higher 2) Diastolic 3) Increase in intensity w/ standing; REFER these
Quality of sound, lack of significant radiation, and change with positions, no thrill with normal history and exam Physiological innocent murmurs
T/F: 99% of childhood murmurs are innocent True
I-II/IV soft, short, high-pitched SEM (systolic ejection murmur), LUSB (left upper sternal border), radiates to back or axilla. Tx? Peripheral Pulmonary Artery Stenosis (PPS): due to normal branching of pulmonary arteries; Resolves by 6 mo +
SEM, grade 1-3, vibratory musical quality louder when lying down, decreases w/ standing/sitting, louder w/ fever/tachycardia, LLSB; Physiologic or pathological Still's/Vibratory (Innocent/physiologic)
Continuous, infraclavicular area, louder when upright, disappears with turning head/jugular compression. Innocent of pathologic? Venous hum; Innocent
SEM, heard over carotid artery in neck. Innocent or pathologic? Carotid bruit; Innocent
Common in older children/adolescents, doesn't radiate, softer when standing, louder when lying down, LUSB. Innocent or pathologic? Pulmonary (adolescent) Ejection Murmur; Innocent
Fixed, split S2 ASD (atrial septal defect)
Tachypnea while feeding, wheezing, rales, rhonchi, hepatomegaly, fatigue, weak pulses, condition may worsen w/ fluid administration; Evaluation? Congestive Heart Failure; E: Echo
Most common diagnosable cause of chest pain in children? Other common causes? When would you consider cardiac sources of chest pain? Musculoskeletal (overuse/muscle strain/trauma); Other common: asthma, pneumonia, GERD, sickle cell crisis; Cardiac: pain w/ exertion, syncope, palpitataions, acute onset w/ fever
What causes sinus arrhythmia in children? Innocent or pathological? Variation in rate w/ breathing; innocent
Rate > 200; rapid regular rate w/ narrow QRS complex and p waves associated w/ every QRS, abrupt onset and termination. Can lead to heart failure. Tx? Supraventricular Tachycardia (SVT); Tx: increase vagal tone, IV adenosine, electrocardioversion if acutely unstable
What is the easy way to remember cyanotic vs acyantotic congenital heart diseases? Almost all of the cyanotics start with T. None of the acyanotics start with T.
What chromosomal abnormalities increase congenital heart disease and which ones? (2) 1) Down's: endocardial cushion defect, VSD, ASD, PDA; 2) Turner's Syndrome, coarctation of the aorta or aortic stenosis
What environmental factors can increase/cause congenital heart disease? (3) 1) Infections: Rubella- PDA; 2) Drugs-phenytoin, alcohol 3) Maternal disease: DM and SLE
2 subcategories of acyanotic congenital heart disease (Ex of each?) 1) Left to right shunts (ASD, VSD, PDA) 2) Obstructive lesions (PS, AS, Coarctation)
Most common congenital heart defect, left to right shunt increases as pulmonary vascular resistance normalizes. Excess pulmonary flow, CHF, holosystolic murmur. cyanotic vs acyantotic? Management? VSD, Ventricular Septal Defect. Acyanotic. 35% close spontaneously
Many close spontaneously by 4 yo, rarely symptomatic, even if large. Widely split fixed S2. cyanotic vs acyantotic? Atrial Septal Defect (ASD). Acyanotic.
Left to right shunting will occur as pulmonary vascular resistance decreases after birth. CHF or ASx, continuous machine-like murmur. Normal fetal adaptation that allows flow from pulmonary artery to aorta that fails to close. cyanotic vs acyantotic? PDA, Patent ductus arteriosus. Acyanotic
Poor feeding, respiratory distress in neonates. Leg discomfort w/ exercise. Absent fem pulses and BP in lower extremities lower than upper. Imaging abnormalities? cyanotic vs acyantotic? Tx? Coarctation of aorta: narrowing of aorta almost always near ductus arteriosis. CXR: Rib notching. Acyanotic. Tx: Prostaglandin to keep ductus arteriosum open.
Characteristics of cyanotic heart disease (2) Right to left shunt causing cyanosis 1) communication such as septal defect 2) reason for blood to be shunted from lungs (ex: pulmonic stenosis)
1) Transposition of the great arteries 2) Tricuspid atresia 3) Truncus arteriosus 4) Total anomalous pulmonary venous return 5) Hypoplastic left heart syndrome Tetralogy of Fallot/Cyanotic Heart Disease
4 structural defects of Tetralogy of Fallot; EKG? CXR? 1) VSD 2) Pulmonary stenosis 3) overriding aorta 4) RVH; EKG: RVH w/ RAD. CXR: boot shaped heart
Restlessness, agitation, crying, rapid and deep breathing, sudden increasing cyanosis, LOC -> death; Tx? (4) Sx of hypoxic "Tet" spells (sudden tightening of the narrowed area below the pulmonary valve causing increased right to left shunt); Tx: O2, knee to chest position, morphine, phenylephrine
Cyanosis ESPECIALLY in newborn, quiet tachypnea, single S2. CXR? Tx? Transposition of Great Arteries (TGA); Egg on a string due to narrow superior mediastinum. Tx: Prostaglandins to keep ductus open until STAT surgery
Cardiac disease caused by group A hemolytic strep infx. Dx? (2) Rheumatic Fever; Dx: ASO titers confirm recent strep infx and Jones criteria (2 majors or 1 major, 2 minors)
What is the Jones criteria? Major: J: Joints/polyarthritis <3: carditis N: subcutaneous Nodules E: Erythema marginatum S: Sydenham chorea; Minor: Fever, arthralgia, Prior RF, Leukocytosis, Elevated ESR/CRP, Prolonged PR
Acquired heart disease; Fever + 4 of the following: 1) Conjunctivitis 2) oral cavity changes 3) cervical lymph nodes 4) Rash 5) Extremity changes; Management? (2) Kawasaki Disease; IV immunoglobulin, HIGH dose aspirin (one of the few exceptions to the rule)
Phases w/ some characteristics of Kawasaki (3) Acute 1-2 weeks: coronary artery aneurysms, carditis; Subacute 2-4 weeks: increased platelet count, desquamation, risk of sudden death. Convalescent 6-8 weeks: Sx resolve
Caused by Viridans group strep and staph w/ constitutional Sx, petechial hemorrhages, splinter hemorrhages, osler nodes, janeway lesions, retinal hemorrhages, heart murmurs. Dx? (2) Tx? Infective endocarditis. Dx: Blood Cx, echo. Tx: 4-8 weeks of IV Vanc
3 presentations suggesting hematologic disorders 1) Anemia (palor, fatigue) 2) Neutropenia (infxs) 3) Thrombocytopenia (petechiae, ecchymosis)
Decreased oxygen carrying capacity due to 1) decrease in the number of RBC or low or 2) abnormal hemoglobin (Hb). Anemia
XLinked, regional, and drug (antimalarials, nitrofurantoin) cause of anemia? G6PD
Cows milk causes ____ anemia, vegetarian/goat's milk can cause _____? Iron, B12 and iron
EBV, CMV, Parvovirus cause? What drug type causes the same anemia? Bone marrow suppression. Chemo also causes marrow suppression
irritability, pallor, glossitis, systolic murmur, growth delay and nail bed changes Chronic anemia presentation
Microcytic anemias? (3) Normocytic anemias? (1) Macrocytic anemias? (3) Mirco: Iron, lead toxicity, thalassemia. Normo: Chronic illness. Macro: B12 or folate deficiency , aplastic.
Anemia Sx, apathy, irritability, poor concentration; Increased RDW and TIBC, low iron and ferritin. Iron deficiency
Basophilic stippling, hypochromic microcytic, associated w/ pica Lead poisoning/toxicity
A group of inherited anemias characterized by impaired or absent synthesis of either the alpha or beta chains that make up adult Hb leading to premature RBC death. RBC indicies? Thalassemias; hypochromic, microcytic.
How can you distinguish between iron deficiency and thalassemia? Get an iron panel!
Disorder than only affects RBC line. Low retic count. What other physical anomolies is it associated with? (5) Diamond-Blackfan syndrome; short stature, web neck, cleft lip, thumb defects (very long thumb), increased risk of leukemia
Suppression of RBC synthesis w/ gradual onset and spontaneous recovery w/in 4-8 weeks Transient Erythroblastopenia of Childhood
Progressive pancytopenia due to autosomal recessive genetic disorder. Microcephaly, absent thumbs, cafe au lait spots, short stature. What is high initially? Fanconi Anemia; HIGH MCV and HbF
Jaundice, pallor, splenomegaly w/ retic count, bili and LDH all increased. What are 2 inherited diseases that can cause it? Tx? Hemolytic anemia; Spherocytosis and elliptocytosis (seen on smear). Autosomal dominant; Tx: Splenectomy can be curative.
Difference between aplastic crisis and aplastic anemia? Anemia: Caused by Fanconi, idiopathic, or viral or drug induced presenting w/ bleeding, infx or anemia. Crisis: Parvovirus B19 induced complication of chronic hemolytic anemia?
Predisposed to oxidant stressors by triggers that are most common in African, Mediterranean, Middle Eastern people. Heinz bodies. What are the conditions specifically (drugs (3), infx, food (1), genetics (1))? G6PD deficiency; Drugs: sulfas, nitrofuantoin, anti-malarials), Fava Beans, infxs, X linked disease
African, Mediterranean, Middle Eastern, Indian, Caribbean ancestry w/ ASx until 4 months,then FTT, fever, infx, irritability -> pain crisis, acute chest syndrome, aplastic crisis. Tx? Complications? Sickle Cell Disease; Tx: O2 and fluids, daily HYDROXYUREA to decrease sickling, penicillin prophylaxis, bone marrow transplant curative. Complications: Splenic sequestration (massive pooling) and embolic stroke
Autoimmune disorder that may follow 1-4 weeks after a viral infection. Antibody binds to platelets leading to removal of platelets by the spleen. Sx: abrupt onset of petechiae, purpura, epistaxis in an otherwise healthy child (usually age 1-10yrs). Tx? Idiopathic (Immune) Thrombocytopenic Purpura; Tx: 80% spontaneously resolve in 6 months. Prednisone or IV immunoglobulins can help
Lymph node or lump that doesn't resolve, persistent limp, persistent HA, fever, night sweats, wt loss, petechiae Sx of pediatric cancer
fever, pallor, bruising, petechiae or bleeding, bone or joint pain/limp, malaise, lethargy, Lymphadenopathy and organomegaly w/ infiltrations throughout the body. Most common type? Dx? Leukemia. 75% of leukemia in children is ALL (Acute Lymphoblastic Leukemia). Dx: immature blast cells on peripheral smeer
Painless, firm/rubbery lymphadenopathy, beta symptoms. Dx? (2) Hodgkin Lymphoma; Dx: CT, Bx: Reed-Sternberg Cells pathognomonic
lethargy headache and vomiting, increased head circumference, irritability, anorexia, poor school performance, loss of developmental milestones, seizures, CNS Tumors
Presents with bone or abdominal pain, weight loss, fatigue, fever, irritability, periorbitral ecchymosis (raccoon eyes), proptosis, spinal cord compression, abdominal pain or mass that is hard, irregular, may extend past midline. Complications? Cause? Neuroblastoma; Paraneoplastic syndromes: secretory diarrhea, profuse sweating, opsomyoclonus-dancing eyes and feet. Cause: neural crest cells of adrenal medulla or sympathetic ganglia
asymptomatic smooth, firm abdominal mass (rarely crosses midline), most commonly as a toddler/preschool age. May have abdominal pain, fever, HTN 25% and hematuria 25%. Associated congenital anomalies? Wilms Tumor/Nephroblastoma; Anomalies: WAGR: Wilm’s tumor, Aniridia (don’t form the colored part of the iris), GU anormalities, Mental Retardation
Masses that arise from connective tissue such as muscle, fibrous or adipose tissue. Most common subtype? Sarcoma; Rhabodomyosarcoma
Mass that is of primitive bone stem cell origin. most common in adolescents Osteosarcoma
symptoms depend on site of tumor; enlarging mass or chronic drainage: GU, head, neck, extremities, trunk. Ex: proptosis, nasal mass, urethral or paratesticular swelling Rhabdomyosarcoma
pain and swelling, usually located at the distal femur, proximal tibia or proximal humerus. Lytic or sclerotic lesion seen on X-ray Osteosarcoma
pain in pelvis or femur, may also have fever, weight loss. 95% have chromosomal translocation t(11;22). Dx w/ Bx Ewing sarcoma
Highest prevalence of cancer in children? (5) (at least know the top 3) Leukemia, Wilms, neuroblastoma, retinoblastoma, hepatoblastoma
Highest prevalence of cancer in adolescents? (3) Hodkins, bone cancers, gonadal malignancies
Most common causes of mortality in adolescence accidental/injuries usually w/ psychosocial issues prevalent (including MVC, homicide, suicide, malignancy)
HEADDSSS. What does this pneumonic for? Home Education Alcohol Drugs Diet Sex Suicide Safety; Psychosocial history
Adolescent immunizations (5) Tdap, HPV, Influenza, Hep A and B, meningococcal vaccine
Psychological development: (3) 1) Early teens (10-14) "Am I normal?" 2) Middle Teens (15-17) "Risk taking increased" 3) Late teens (18-21) "Future planning"
3 things that cannot be kept confidential 1) SI 2) HIV+ status 3) Sexual/physical abuse
Thelarche: Age and Appearance 8-13; breast budding
Adrenarche: Appearance Straight pubic hair over mons pubis, axillary hair, body odor, acne OR Testicular enlargement
Menarche: Average age and Occurence 12.6 yrs and onset of menses
Sequence of growth and development TAM
Tanner Staging 1) prepubertal 2) initial hair staight and fine 3) hair becomes coarse and darkens 4) Hair looks adult but limited in area 5) Full development
breast asymmetry, physiologic leukorrhea, gynecomastia and menstrual irregularity. All normal variants of puberty
Cause of primary ammenorrhea (2) Turner syndrome, outflow tract obstruction
Cause of secondary ammenorrhea (2) Pregnancy, hyperthyroidism
Pelvic pain during early days of menstrual cycle. Tx? Dysmenorrhea; Tx: 1st line: NSAIDs; 2nd line: hormonal contraceptives
T/F: coagulopathy can have menorrhagia as its initial presentation in adolescence True
Decreased BMI, layered clothing, lanugo, bradycardia, hypothermia. Aspects for Dx? (3) Anorexia nervosa; Dx: Severe wt loss, distorted image, intense fear of wt gain
Binge/vomit cycle. Dx? Bulimia Nervosa; Dx: Reccurent episodes of binge eating, compensatory behavior, once a week+ for 3 months, unduly influenced by body shape
CRAFFT. What is the pneumonic for ? Car Relax Alone Forget Friends Trouble; screening for adolescence substance abuse
Obese, tall and thin following growth spurt. Melted ice-cream cone appearance Slipped capital femoral epiphysis (SCFE)
Anterior knee pain on tibial tubercle after repetitive microtrauma and activity related pain. Tx? Osgood Schlatter; Tx: Rest, restriction, PT, NSAIDs
Repetitive microtrauma or overuse of heel common in young athletes w/ pain in posterior aspect of calcaneus. Tx? Sever Disease; Tx: Rest, ice, NSAIDs
Why do we screen for Idiopathic Adolescent Scoliosis and how do we do it? Determine Cobb angle on XR. We use Tanner stage to assess how much growth is left. (<25 degrees: observe, 25-40 degrees: orthosis in skeletally immature because curve progressive, >40 degrees: may need surgery)
Young child pulled by hand and is now holding flexed arm against body with palm down. Tx? Nursemaid's Elbow: subluxation of radial head; Tx: supination -> flexion or hyperpronation
Blackheads and whiteheads. Tx? Noninflammatory/Comedonal acne; Tx: Retinoids, benzoyl peroxide, salicylic acid
Erythematous papules, pustules, cysts, nodules, abscesses. Tx? Inflammatory Acne; Tx: topical abx (tetra or a mycin), short term oral abx: same, oral isotretinoin (accutane) for severe (liver abnormalities and teratogenecity)
Irritant contact dermatitis due to exposure to moisture, urine/feces, chemicals in topical preparations/wipes. Tx? (2) Preventions? Diaper dermatitis; Tx: allow exposure to air and frequent diaper changes are main things. Prevention: ABCDE (air, barrier, cleansing, diaper, education)
Honey-colored crusted lesions weeping that began as single red papulovesicle. Tx? Impetigo; Tx: Bactroban/mupirocin oinement or oral abx (cephalexin)
Pruritic annular papule that expands outward with a raised ring of erythema and scale with central area of clearing. Tx? Tinea corporis; Tx: topical anti-fungal (clotrimazole)
Causes scale, fissuring, cracking of skin between toes, and on foot. Tx? Tinea pedis; Tx: topical antifungal
"black dot" alopecia. Dx? Tx? Tinea capitus; Dx: +KOH prep. Tx: oral griseofulvin 6-8 weeks
intense inflammatory reaction with perifollicular pustules on a boggy, nontender, scalp mass. Tx? Kerion; Tx: oral prednisone
Causes scaly oval hyper or hypo pigmented macules 1-2 cm in diameter on upper chest, back, arms. Hypopigmentation may persist for months. Dx? Tx? Tinea Versicolor; Dx: KOH prep confirms "spaghetti and meatballs" hyphae and round spores. Tx: antifungal cream (clotrimazole) or SELENIUM SULFIDE SHAMPOO
Severe pruritis, eczematous eruption of red excoriated papules and nodules, may see linear burrows in web spaces of digits and foot, axilla, umbilicus, groin, penis. Tx? (2 options but which is first line?) Scabies; Tx: Permethrin 5% cream (Elmite) from neck down first line or oral ivarmectin
Live in the hair and periodically feeds on the skin which causes small papules and itching. Tx? Head lice; Tx: Permethrin 1% OTC
Poxvirus causes 2-4 mm pearly flesh or pink colored non-tender dome-shaped papules with central umbilication. Tx? Molluscum contagiousm; Tx: may resolve on own or liquid nitrogen or imiquimod cream
Pain, stiffness, refusal to move joint, erythema, effusion, fever, rash, uveitis, anemia, fatigue. Most common? Tx? Juvenile Idiopathic Arthritis; Common: Oligoarticular; Tx: NSAIDs DOC, systemic corticos for systemic JIA
Less than 5 joints w/ no systemic Sx. Prognosis? Oligoarticular JIA; 90% remission w/ excellent prognosis
5+ joints involved and may present w/ systemic Sx Polyarticular JIA
recurring spiking fever once or twice per day for weeks to months w/ salmon colored rash only evident while febrile Systemic JIA
Created by: crward88



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