UWORLD PEDS WEEK 1

varicella exposure pathway

- if immunized: observe - if not immunized: give vaccine if immunocompetent, if IC give Ig

high risk items to ingest

1. Sharp object (eg, needle, safety pin) in the esophagus, stomach, or proximal duodenum 2. Symptoms of esophageal obstruction (eg, drooling, inability to swallow secretions) 3. Symptoms of respiratory compromise 4. Button battery in the esophagus (due to the risk of electrical and chemical injury) 5. Magnets in the esophagus or stomach (due to the potential for bowel entrapment as a result of magnetic attraction across intestinal segments)

signs of developmental dysplasia of the hip - 3 sxs

1. clicky hip 2. asymmetric hip/thigh/inguinal creases 3. limb length discrepancy

define delayed puberty in girls

15 or older in girls with secondary sex characteristics 13 or older in girls without

max amount of daily cows milk

16-24 oz too much can lead to decreased fiber intake/constipation

MCHAT screening when

18, 24 months

chiari malformation type 1 vs 2

1: herniation of cerebellar tonsils thru foramen magnum 2: herniation of cerebellar tonsils AND vermis thru foramen magnum

ADHD dx requires

2 separate settings so get parents AND teachers perspective

rotavirus vaccine given when

2-8 months

biliary atresia presents when

2-8 weeks

constitutional growth delay definition

2nd or less percentile for height but normal linear growth

UTI tx in children

3rd gen cephalosporin like cefixime

testicles usually descend when

4-6 months, 6 months at the latest

febrile seizures age

5 months to 5 yrs

simple febrile seizure 3 criteria

<15 mins generalized does not recur within 24 hrs

Juvenile idiopathic arthritis - list stuff

>2 weeks fever, rash that worsens with the fever, >6 weeks arthritis/joint pain can also have LAD, HSM labs might show elevated WBCs, elevated platelet count, elevated inflammatory markers, maybe some anemia

IRON POISONING SXS

AG metabolic acidosis hematemesis

Eustachian tube dysfunction is a RF for

AOM

AOM with TM perforation sxs

AOM sxs with otorrhea

CONGENITAL TORTICOLLIS CAN HAVE A MASS WHERE

AT THE SCM Congenital muscular torticollis is a postural neck deformity due to tightening of the sternocleidomastoid muscle and presents with ipsilateral head tilt and contralateral chin deviation. A fibrotic neck mass may be present on examination, and limited range of motion of the neck increases the risk of positional plagiocephaly.

bilateral pneumonia is, bugs

ATYPICAL - due to mycoplasma, chlamydia

Main heart problem in down syndrome

AV septal defect

down syndrome cardio complication

AV septal defect --> murmur, heart failure in infancy, ftt

lymphadenitis tx

Abx

main cause of pneumonia in adults with CF? how about kids with CF?

Adults: pseudomonas children: staph

CD19 =

B cell related

FX AT BASE OF THE SKLL =

BASILAR SKULL FX

Astrocytomas in kids or adults?

BOTH

breastfeeding and breast milk jaundice - 2 similarities

BOTH are more indirect BOTH work by increased enterohepatic circulation

bedwetting normal age

Bedwetting is normal before age 5. Mastery of nighttime continence can take months to years, and boys generally achieve this milestone later than girls.

biliary cyst presentation

Biliary cysts may be asymptomatic or present with abdominal pain, a right upper quadrant mass, and/or jaundice. All patients should undergo cyst resection to decrease the risk for malignancy (eg, cholangiocarcinoma, gallbladder cancer, pancreatic cancer).

MCC of sensorineural hearing loss in kids

CMV

NEURONAL FUNCTIONAL DISTURBANCE =

CONCUSSION

cavernous sinus thrombosis dx

CT venography

KERATOSIS PILARIS CAUSE, WORSE WHEN

Caused by retained keratin plugs in hair follicles keratosis pilaris is worse in cold, dry weather

cushing triad, cause

Cushing triad is caused by elevated ICP Triad - hypertension, bradycardia, respiratory rate abnormality Hypoxic-ischemic brain injury (eg, drowning) can lead to widespread neuronal cell death, cerebral edema, and increased intracranial pressure (ICP). Severely increased ICP can cause Cushing triad, characterized by hypertension, bradycardia, and irregular respirations.

DISRUPTION OF WHITE MATTER TRACTS =

DIFFUSE AXONAL INJURY

TELOGEN EFFLUVIUM

DIFFUSE HAIR LOSS WITHOUT INFLAMMATION, SCARRING DUE TO STRESS

walking on tip toes should remind of

DMD

COLIC DX HOW, CRITERIA

DOE crying for no other reason for at least 3 hours, 3 days a week in a kid <3 moa

BREATH HOLDING SPELLS PATHOGENESIS, PRESENTATION

EMOTIONAL TRIGGER --> APNEA, COLOR CHANGE --> LOC

HERPANGINA PRESENTS AS

FEVER ULCERS IN THE MOUTH DYSPHAGIA

most pts with laryngomalacia also have

GERD, spitting up

foodborne botulinism sxs are preceded by

GI sxs like n/v/d/abdominal pain

Penicillin is needed in patients with a history of ARF to prevent future episodes of GAS pharyngitis. Failure to provide antimicrobial prophylaxis may lead to progression of RHD.

GIVE EVEN IF NO ACUTE INXN

INNOCENT MURMURS GRADING

GRADE 1 OR 2 SYSTOLIC

target cells mneumonic

HALT HbC sickle cell Asplenia Liver dz Thalassemia

iron deficiency red blood cells are hypochromic. how is the width distribution

HIGH

FSGS is associated with

HIV

3 MCC of sinusitis

HSM

eczema herpeticum cause

HSV

LARYNGOMALACIA sxs - inspiratory or expiratory

INSPIRATORY stridor when crying, feeding, infection, etc also tends to have reflux

Thrombocytopenia after a viral infection

ITP

antibiotics used for osteomyelitis - children > 3 moa

IV 3rd gen cephalosporin PLUS staph coverage lke nafcillin/oxacillin OR vancomycin or clindamycin if MRSA is likely

CF staph with influenza - what to tx staph with

IV Vancomycin

antibiotics used for osteomyelitis - adults

IV Vancomycin PLUS anti pseudomonal cephalosporins or anti pseudomonal fluoroquinolones

antibiotics used for osteomyelitis - children < 3 moa

IV cefazolin PLUS staph coverage lke nafcillin/oxacillin OR vancomycin or clindamycin if MRSA is likely

splenic sequestration tx

IVF PRBCs

RAPIDLY INCREASING HEAD CIRCUMFERENCE IN A PREMIE- THINK

IVH

CVID tx

IVIG

kawasaki tx

IVIG, ASA

hsp aka

IgA vasculitis

neonatal resuscitation

Immediate routine neonatal resuscitation includes drying, stimulating, and warming. Healthy newborns should be placed on the mother's chest for skin-to-skin care, which provides warmth and allows early breastfeeding initiation.

joint pain OVER 6 WEEKS IN A KID

JIA

HODGKIN LYMPHOMA SXS

LAD PROLONGED FEVER Prolonged fever and lymphadenopathy (particularly supraclavicular) are common manifestations of Hodgkin lymphoma. Reed-Sternberg cells on lymph node biopsy are diagnostic.

INSIDIOUS HIP/KNEE pain think

Leg calve perthe/osteonecrosis if insidious

if adjustment disorder AND MDD criteria are met - pick what?

MDD

rheumatic fever arthritis is

MIGRATORY

think what when think of paroxysms of fever

Malaria should be suspected in any ill patients, especially those with a history of febrile paroxysms, who have traveled to an endemic-tropical region. Thick and thin blood smears should be ordered for parasite detection and quantification. Nonimmune children are at highest risk of death, but the sickle cell trait confers some protection from severe complications.

methemoglobinemia tx

Methylene blue, vitamin C

Most common nephrotic syndrome in children

Minimal change disease

minimal change disease biopsy findings, tx

Minimal change disease is the most common cause of nephrotic syndrome in preadolescent children. Renal biopsy shows normal kidney architecture but is not routinely obtained in patients age <10. Steroids are the treatment of choice.

congenital dermal melanocytosis aka

Mongolian spots

Does MEE have signs of inflammation like bulging, fever

NO

does Werdnig Hoffman affect the pupils?

NO

does candidal diaper rash involve the perianal area?

NO

does irritant diaper rash involve the perianal area?

NO

do physicians report vaccine refusal to authortity like local gov?

NO Physicians do not report cases of vaccination refusal. ONLY DOCUMENT IN THEIR NOTE THAT PT REFUSED, WE EXPLAINED

do premies have different brain development later on??

NO bc most have catch-up in brain development in the first 2 years of life

bloody infectious diarrhea - do you give ABX

NO if theyre mild bc risk of resistance to e coli

Does orchipexy after cyptochordism reduce risk of testicular germ cell tumor?

NO risk is the same

do you need imaging for congenital clubfoot?

NO the dx is clinical

Do u get imaging for ALL kids with head trauma? PECARN RULE

NO u should avoid for minor trauma Altered mental status Loss of consciousness Severe mechanism of injury (eg, fall >1.5 m [5 ft], high-impact hit, serious motor vehicle collision) Vomiting Severe Headache Signs of basilar skull fracture LAHHVB

greenstick fx long term complications

NONE

Juvenile idiopathic arthritis tx

NSAIDs

growing pains tx

OTC analgesics massaging reassurance

HSP clinical findings

PARA petichiae/purpura abdominal pain, intusussception renal stuff arthritis

idiopathic precocious puberty is central or peripheral

PERIPHERAL

Any event that can cause OLIGOHYDRAMNIOS can result in

POTTER sequence

if parents are divorced and one parent consents for tx and one doesnt - how to proceed

PROCEED WITH TX - All u need is consent from ONE legal guardia When caring for an unemancipated minor, informed consent from one parent or guardian is considered legally sufficient to justify proceeding with therapy. Physicians should also provide care in urgent situations without waiting for parental consent.

tumor lysis syndrome has high

PUP Potassium Uric acid Phosphate

CRANIOPHARYNGIOMA SXS

Presenting symptoms include bitemporal hemianopsia and signs of pituitary hormone deficiencies (eg, diabetes insipidus, growth failure).

Organophosphate poisoning tx steps

RAP remove clothing, irrigate pt atropine pralidoxime

FIRST STEP IN CHEMICAL POISONING

REMOVE THEIR CLOTHING

trendelenburg sign can be seen in

SCFE bc of the damage to the blood vessels, muscles

reyes mneumonic

SHINE steatosis hypoglycemia/hepatomegaly infection - vzv, influenza not awake encephalopathy

osteogenesis imperfecta height

SHORT STATURE

describe sxs of ankylosing spondylitis timing, worse with, better with

SI joint stiffness and pain worse at night, improves with activity

LARYNGOMALACIA PRESENTATION

STRIDOR WHEN SUPINE, CRYING, FEEDING, URI

splenic sequestration

Splenic sequestration crisis is a life-threatening complication of sickle cell disease in which red blood cells become entrapped within the spleen. Patients have anemia, splenomegaly, and hypovolemic shock.

CD 3 =

T cell related

Seizures are characterized by sudden loss of consciousness, loss of postural tone, and a postictal state with delayed return to baseline neurologic functioning. Tongue lacerations can occur with tonic-clonic movements.

TONGUE LACERATIONS

multiple dilated loops of small bowel with paucity of air in the large intestine and rectum

TRANSITION POINT IN CF

transfusion related circulatory overload description

Transfusion-associated circulatory overload can occur when a large volume of blood product is rapidly transfused, particularly in children age <3 with chronic anemia.

how to dx developmental dysplasia of the hip

US hip

photokeratitis cause

UV exposure prollonged like 6-12 hrs

MC cardiovascular complication with edwards syndrome

VSD

WHAT CAUSES BLUNTING OF THE CALYCES, PRENCHYMAL SCARRING

Vesiculoureteral reflux

WAGR stands

Wilms tumor Aniridia Genitourinary malformation mental/motor Retardation

Increasing head circumference and signs of increased intracranial pressure in children should be evaluated with an imaging study such as a CT scan of the brain.

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testicular torsion sxs

abdominal pain nausea vomiting

noise exposure causing sensorineural hearing loss is more in

adults Constant exposure to loud noises over a prolonged period can damage the cochlea and lead to high-frequency SNHL. Older children and adults may be affected, but SNHL due to noise exposure is rare at age ≤5.

gamma tetramers -

alpha thalassemia

BPD CXR pattern

alveolar collapse --> ground glass opacities reticulogranular pattern

cyclopentolate is what, used for

an anticholinergic

CI for vaccines

anaphylaxis encephalopathy - prolonged seizures, coma, decreased consciousness

2 types of food alleergies and their pathogenesis

anaphylaxis - IgE diarrhea, n/v/abdominal pain - non IgE

serum sickness comes with which meds

antibiotics, chemo drugs

anticholingeric toxicity tx

anticholinesterases

malrotation of the gut presents when

anytime in first year of life

sunscreen regimen

apply 15-30 min before sun exposure reapply every 2 hours and after swimming

3 complications of myelomeningocele

arnold chiari 2 malformation hydrocephalus fnd below the lesion

Babies can sit by ____ age. is it normal for them to fall forward?

at 6 months normal if they fall forward

When do sickle cell crises start?

at 6 months as HgF begins to wane Sickle cell pain crises can present with severe bone pain due to vasoocclusion by sickled red blood cells. These episodes typically begin as early as age 6 months when the production of defective hemoglobin A increases. A 2-month-old's hemoglobin is primarily fetal hemoglobin, making a pain crisis unlikely.

vertebral metastases pain worse when

at night

pt with down syndrome is at risk for what joint problem

atlantoaxial instability

alopecia arreata pathogenesis

autoimmune attack on hair bulb

spondylolisthesis sxs, can cause what

back pain with palpable step off can cause radiculopathy if it impinges on the spinal cord

irritant dermatitis tx

barrier ointment

NSAIDs can cause prerenal azotemia how

bc prostaglandins cause dilation of afferent arteriole and NSAIDs block this which can lead to prerenal azotemia

prolonged QT tx

beta blockers

tracheal ring sxs

bisphasic stridor that improves with neck extesion

Osteogenesis imperfecta sxs, mneumonic and additional

bone fractures i- blue sclera teeth imperfections, gray/blue translucent teeth ear - hearing loss can also have hyperlaxity of joints

brain abscess next step

brain imaging

describe pubertal gynecomastia in males

breast tissue forms as glandular tissue - glandular enlarges, can be tender, can be unilateral OR bilateral

developmental dysplasia is associated with

breech presentation

pneumothorax and transillumination

brighter on side affected

congenital clubfoot causes

can be genetic or structural like oligohydramnios, breech position, uterine fibroids

Staphylococcus aureus, Serratia, Burkholderia, Aspergillus are ALL

catalase positive

cephalohematoma, caput succedaneum sxs, cause

cause - trauma with delivery, icnreased riskk with forceps or vacuum delivery sxs - swollen, edematous, nonfluctous(?) mass

infectious mononucelosis and penicillins

causes a rash

rental tubular acidosis effect in kids

causes normal anion gap acidosis --> renal issues --> ftt

cephalohematoma = collection of blood between skull and periosteum, does not cross suture lines Caput succedaneum = collectio of subcutaneous fluid, crosses suture lines

cephalohematoma = collection of blood between skull and periosteum, does not cross suture lines Caput succedaneum = collectio of subcutaneous fluid, crosses suture lines

Skeletal survey is used for

child abuse fractures

trachoma cause

chlamydia trachomatis

Pearly white mass in the ear

cholesteatoma

sydenham chorea sxs

chorea tics behavioral changes

a bunch of neutrophils but no effect

chronic granulomatous disease

decreased superoxide production is seen in

chronic granulomatous disease

chronic suppurative otitis media pathogenesis

chronic recurrent otitis media leading to TM perforation

Are vaccines given according to corrected gestational age or chronologic age in premies?

chronologic age

methemoglobinemia dx

clinical cynosis not corrected with O2

Tuberculosis Risk Factors

close/poor living conditions

A 5-day-old neonate is brought to the hospital due to poor feeding, sweating, pallor, and respiratory distress. The symptoms are exacerbated with feedings. There has been no loss of consciousness or cyanosis during these episodes. She has no fever or cough. The girl was born at 38 weeks gestation via an uncomplicated vaginal delivery. On examination, temperature is 36.7 C (98 F), pulse is 165/min, and respirations are 75/min. Oxygen saturation on room air is 97% in the right hand and 95% in the left foot. She has nasal flaring and retractions. Bilateral fine crackles are present. A gallop is heard over the precordium; there is no murmur. The liver edge is palpable 3 cm below the right costal margin. Extremities are pale and cold. Brachial pulses are strong and femoral pulses are weak. What is the most likely cause of her symptoms?

coarctation of the aorta answer was increased LV afterload

CHARGE syndrome components

coloboma heart defects atresia choanal retardation - motor and developmental genitourinary stuff ear/hearing stuff

clinical description of diaphragmatic hernia

concave abdomen barrel shaped chest with resp distress possibly n first few days, normal bowel sounds on the unaffected side, absent bowel sounds in the affected side since there is a hypoplastic lung

anticholinetgic toxicity sxs

confusion hallucinations dry membranes dilated pupils OPPOSITE OF DUMBELLS PLUS HALLUCINATION, CONFUSION

brain abscess RF

congenital heart dz

Delayed bone age indicates

constitutional growth delay

periorbital hematoma tx

cool compresses NSAIDs

Herpangina cause

coxsackie virus

methemoglobinemia sxs

cyanosis chocolate colored blood cyanosis not corrected with O2

lacrimal duct stenosis can progress to

dacrosystitis which has drainage plsu swelling, erythema, tenderness over nasolacrimal ducts

RFs for otitis media

daycare attendance lack of breastfeeding smoke exposure

DKA total body K is

decreased

TB findings

decreased breath sounds - consolidation chronic cough lymphadenopahy

optic gliomas sxs

decreased vision proptosis optic disc pallor

first-line pharmacotherapy for nocturnal enuresis

desmopressin

NECROTIZING OTITIS MEDIA population

diabetics

neonatal abstinence syndroms sxs

diarrhea poor feeding irritability sometimes seizures sneezing think alcohol, opioid withdrawal sxs

DMD has risk of what 2 thigns

dilated CM scoliosis

GIARDIA PATHOGENESIS

disrupts epithelial tight junctions

TACO tx

diuresis - furosemide

SPF level matter?

doesnt matter as long as 30 or more

GI things down syndrome increases risk of

duodenal atresia Hirschrpung disease

HSP dx, tx

dx clinically tx is supportive

laryngeal papilloma dx, tx

dx: flexible laryngoscopy tx: surgical debridement

kawasaki next step

echocardiogram

Androgen insensitivity syndrome tx

elective gonadectomy to reduce risk of malignancy Patients with androgen insensitivity syndrome are genotypically male (46,XY) but appear phenotypically female. These patients are at increased risk of testicular cancer due to their bilateral cryptorchid testes; therefore, management includes an elective gonadectomy.

alpha thalassemia has what erythrocyte count

elevated

keratosis pilaris tx

emollients to keep it moist keratolytics like saliylic acid, urea Treatment includes emollients and topical keratolytics (eg, salicylic acid, urea).

OSA can present how in kids

enuresis

scabies lesions

erythematous papules with intense itching, especially at night

Tinea capitis progression

erythematous, scaly patch --> inflammation, scarring, alopecia, itchy, lymphadenopathy

Moth-eaten appearance of long bone on an x-ray

ewing sarcoma

chylothorax is what type of pleural effusion

exudative

chylothorax fluid decription

exudative milky high triglycerides

atypical pneumonia presentation

fatigue, prolonged cough, low grade fever, crackles bilaterally on lung exam

Breath holding spells can present after

fear, minor trauma, emotional triggers

osteonecrosis of femoral head X Ray

femoral head looks flattened, fragmented

brain abscess sxs

fever fnd headache nausea/vomiting

Kawasaki disease sxs

fever mucositis rash conjunctivitis LAD edema

drug induced interstitial nephritis sxs

fever rash eosinophilia WBCs WBC casts

Marfan syndrome has problem with

fibrillin -1 Marfan syndrome is an autosomal dominant disorder that results from mutations of the fibrillin-1 gene. Affected patients have tall stature; long, thin extremities; arachnodactyly; joint hypermobility; upward lens dislocation; and aortic root dilation.

laryngeal papillaomas are ofte described as

finger shaped or grapelike

DMD dx

first - get genetic testing - next if genetic testing is not conclusive, get muscle biopsy creatine kinase is high

clubfoot tx

first casting/manipulation/bracing - basically serial manipulaiton if refractory, surgery

spondylisthesis tx

first conservative - PT, analgesics, limit activity if not resolving, getting more step off or neuro sxs like incontinence, weakness - get surgical eval

amenorrhea first and second steps

first get US then get FSH/LH if US confirms uterus to see if peripheral or central

port wine stains - flat or raised

flat

Laryngomalacia dx

flexible laryngoscopy

photokeratitis dx

fluorescin test shows punctate corneal staining

chronic suppurative otitis media tx

fluoroquinolone

trachoma sxs

follicular conjunctivitis, inflammation can --> inversion of the eyelashes, scarring of the cornea --> blindness

3 main causes of neonatal sepsis

gbs e coli listeria

trendelenburg sign can be a sign of

general gluteal muscle weakness

retinitis pigemntosa cause

genetics

management for drowning patients

get ABG, CXR even if all normal and they appear fine, they are at risk for delayed pulmonary complications so have them wait for a 8 hr prolonged observation periods - if still asx with normal vital signs like RR and oxygen saturation and CXR is normal, can dc them

Next step if microcephaly

get parents head measurements to evaluate for benign microcephaly

maternal chickenpox baby prophylaxis

give Ig if momhas it 5 days before to 2 days after delivery

pertussis prophylaxis

give macrolides for all those in contact REGARDLESS of vaccination status

alopecia arreata sxs

hair loss - well demarcated circular areas painless, no inflammation

hydrocephalus sxs

headache vomiting seizures

cavernous sinus thrombosis sxs

headache and eye findings (eg, periorbital swelling, proptosis, vision loss, cranial nerve palsy)

first next step in speech/language delay

hearing test

MC complication of sickle cell TRAIT

hematuria

HUS triad

hemolytic anemia thrombocytopenia acute kidney injury

membranous nephropathy is associated with

hep B

swelling without urticaria, rash, anaphylaxis - think

hereditary angioedema

elevated mean corpuscular hemoglobin concentration

hereditary spherocytosis

baterial meningitis CSF

high neutrophils high protein very low glucose

pathogenesis for physiologic jaundice of the newborn

higher RBC turnover - bc higher hematocrit levels, shorter lifespan of the RBCs

cmv spread

hits pregnancy women thru body fluids, then spread vertically thru placenta possibly

neuroblastoma presents as

horner's syndrome

cogenital toxoplasmosis sxs

hydrocephalus macrocephaly seziures intracranial calcificatins HSM

how to tx nursemaid's elbow

hyperpronation OR supination pus flexion

post streptococcal glomerulonephritis sxs

hypertension, hematuria, edema

pyloric stenosis electrolytes

hypochloremic hypokalemic metabolic acidosis

rickettsia 3 important lab values

hyponatremia thrombocytopenia elevated liver enzymes

large fontanelle is seen in babies with

hypothyroidism along with hypotonia

endocrinology things down syndrome increases risk of

hypothyroidism type 1 diabetes obesity

ITP tx

if just petechiae: observation if bleeding: DIG - anti D, Imunoglobin, or glucocorticoids

impetigo tx

if localized: mupirocin if spread: cephalosporin like cephalexin

When can doc get court order against parent for refusing tx

if parents are refusing life saving tx in a nonemergent time In a nonemergency situation in which a parent refuses potentially life-saving treatment for their child, the physician should seek a court order mandating treatment.

tx for hemangiomas - when, what

if there is risk of loss of functioning - like compressing on nerve or something OR if large and disfiguring give propranolol

Pimecrolimus works how

immunosupressive drug

Wilsons pathogenesis

impaired hepatocellular transport of copper

antlantoaxial instability sxs

incontinence gait problems UMN signs

2 causes of floppy baby syndrome

infant botulinism Werdnig-Hoffman

cavernous sinus thrombosis MCC

infection of the eye like orbital cellulitis, sinusitis

osteonecrosis of femoral head sxs

insidious hip pain proximal thigh muscle atrophy

what mediates refeeding syndrome

insulin Carbohydrate intake stimulates insulin activity, which in turn promotes cellular uptake of phosphorus, potassium, and magnesium, leading to electrolyte deficiency.

jejunal atresia aka

intestinal atresia

crying and flexes hips sounds like

intusussception flexes hips = bringing knees to chest

congenital torticollis description of rotation

ipsilateral head tilt contralateral chin deviation

cow's milk makes it harder for the body to absorb what

iron

SIGNS OF NEONATAL SEPSIS

irribaility poor feeding leukopenia

how does pediatric depression present?

irritability might be seen more than depression

bedbug lesion

itchy erythematous papules in a linear distribution

think transient synovitis when

joint pain after a viral infection

chronic hoarseness for weeks think

laryngeal papillomas due to HPV aka recurrent respiratory papillomatosis

port wine stain tx

laser therapy

hematology things down syndrome increases risk of

leukemia

Impaired neutrophil chemotaxis is seen in

leukocyte adhesion deficiency.

foreign bodies in vagina next step

local anesthetic and irrigate

Transient hypogammaglobulinemia of infancy description

low IgG - recurrent infections or atopic diseases

serum sickness sxs

low grade fevr joint pain urticaria

spondylisthesis pain is worse with STRAIGHT LEG RAISE = NORMAL

lumbar EXTENSION

lumbar disc herniation pain is worse with

lumbar flexion

pertussis tx

macrolides

lactose intolerance stools are

malodorous, bulky

What cause of biliary emesis is more likely with other congenital issues like omphalocele

malrotation

Tiny white round lesions are present on the buccal mucosa next to the first and second upper molars. SOUNDS LIEK

measles

Brudinski and Kernig indicate

meningitis

metatarsus adducts vs congenital clubfoot

metatarsus adductus is flexibe, congenital clubfoot is rigid

congenital zika sxs

microcephaly intracerebral calcifications

HUS pathogenesis starts with

microthrombi formation - which shears RBCs

Congenital hypothyroidism presentation

might appear normal at birth, but the they have sluggish, weak, constipation, hypotonia, umbilical hernia, macroglossia

JONES criteria, E

migratory arhtirits carditis nodules subQ Erythema marginatum sydenham chorea

sydenham chorea pathogenesis

molecular mimicry

Disseminated gonococcal infection sxs

monoarthritis OR DPT dermatitis tenosynovitis migratory polyarthritis

kawasaki presentation, may be preceded by

mucositis, extrem rash or edema, LAD, fever, conjunctival injection may have nonspecific GI or resp sxs before

Brudinski sign

neck flexes --> hip and knee flexes

gram negative diplococci in CSF - meningitis is due to what bug? what isolation precautions to use?

neisseria meningitidis droplet precautions

neurofibromas are a type of

nerve sheath tumors

optic gliomas are associated with

neurofibromatosis

Methemoglobinemia induced by

nitrates, sulfates, anesthetics

If the parent doesn't want the patient to know of their kid's dx, does the dr have to tell them?

no not unless it can harm the child - for example, a 10 yr old has HIV, the doc can not share but once he's a teen, the doctor should encourage parents to share Disclosure of an HIV diagnosis to a child with perinatally acquired infection should occur by adolescence to foster patient autonomy, increase medication compliance, and prevent transmission. The provider should respect the family's concerns and offer joint participation in establishing a timeline and plan for disclosure.

do u need renal bx for minimal change dz?

no just go straight to steroids since its highly responsive to steroids

should you recommend fluid restriction, alarm blankets/therapy for a kid less than 5?

no...it is normal behavior until 5 yoa

methemoglobinemia PaO2 is

normal

enterovirus meningitis CSF fluid

normal glucose aseptic (WBC low) elevated protein

how do kids present with kidney stones

normally or isolated hematuria without flank or abdominal pain

osteoid osteoma pain relieved by

nsaids

SCFE 2 main RFs

obesity hypothyroidism

Alport syndrome sxs

ocular disturbance sensorineural hearing loss hematuria

Greenstick fracture

one in which the bone is bent and only partially broken Because the periosteum surrounding the bone is thick and strong in children, the fracture may involve only one side of the bony cortex rather than extending through the width of the bone. This is known as a greenstick fracture, as seen on this patient's x-ray. The opposite side appears to have a deformation or bend without a break in the cortex.

retinitis pigementosa fundoscopic exam

optic disc pallor retinal pigment deposition

route of abx for otitis media

oral

Congenital clubfoot tx

ortho eval - possibly surgery

mullerian agenesis has NORMAL

ovarian development external genitalia secondary sex characteristics

breath holding spell tx

part of normal development tx is reassurance

Stranger anxiety peaks when, resolves when

peaks by 8-9 months resolves by 2 years

first step if delayed puberty in a female

pelvic ultrasound to visualize reproductive tract

what drugs can cause drug induced hemolytic anemia? aka hapten induced hemolysis

penicillins, cephalosporins

photokeratitis sxs

photophobia eye pain erythema

leg bowing can be, tx, height level

physiologic, genu varum tx is reasurance - resolves by age 2 NORMAL HEIGHT

skin infection and then renal stuff think

post streptococcal glomerulonephritis

myocarditis in a kid is usually

post viral - so viral URI sxs - then signs of myocarditis.....chest pain, respiratory distress, cardiomegaly, hepatomegaly.....bc it basically presents as HF in kids

LAD in mono location

posterior cervical lymphadenopathy

CHD screening uses

pre and post ductal pulse oximetry

intussception often associated with

preceeding gi infection bc peyers patch is a lead point

Mc-cune albright triad

precocious puberty fractures cafe au lait spots

pinealoma - 3 Ps

precocious puberty - beta hcg parinoud syndrome - vertical gaze palsy obstructive hydrocephalus

which babies require US head screening?

premies <32 weeks bc risk of IVH

MCC of sensorineural hearing loss in elderly/adults

presbycusis

mullerian agenesis presentation

primary amenorrhea with associated normal female external genitalia and secondary sexual characteristics

Jervell & Lange-Nielson syndrome

prologned QT - AR, with sensorineural deafness

Romano-Ward

prolonged QT - AD, no sensorineural deafness

sickle cell trait benefit

protection from malaria

POTTER stands for

pulmonary hypoplasia oligohydramnios - trigger twisted skin twisted face extremity defects renal failure

Lesch-Nyhan syndrome presentation

pyramidal sxs like spasticity, hyperreflexia extrapyramidal like dystonia, chorea self-mutilation intellectual disability

frequently spitting up saliva with a lesion think

rabies

whole blood used when

rarely required except in cases of massive blood loss.

palpable cervical lymph nodes are COMMON in young adults, children - if reassuring, next step

reassurace

metatarsis adductis tx

reassurance

campylobacter tx

reassurance - it is self resolving

2 types of palpable nodules in kids

reassuring - soft, mobile, <2cm, no systemic sxs worrisome - firm/hard, nonmobile, >2 cm, systemic signs

common variable immunodeficiency sxs

recurrent sinupulmonary and GI infections

kartagener syndrome triad

recurrent sinusitis recurrent bronchiectasis situs inversus

Radial head subluxation aka nursemaid's elbow tx

reduce by hyperPRONATING

Peutz-Jeghers syndrome DX

regular upper and lower endoscopy

Causes of oligohydramnios

renal agenesis, PUV (males), placental insufficiency, rtc

How to dx kidney stones in kids

renal, bladder US > CT

eczema herpeticum sxs

resembles chicken pox but with more systemic sxs in a pt with atopic dermatitis

leukocoria ONLY points to

retinoblastoma

colic tx

review soothing techniques reassurance

hepatomegaly, encephalopathy after viral infection

reyes

rachitic rosary can be seen in

rickets

widened wrist =

rickets

Tx for close contacts of pts with meningococcal meningitis

rifampin, ceftriaxone, or ciprofloxacin

tyampanocentesis and culture is done when for otitis media

same timeline as tympanoplasty tubes

candidal diaper rash descriptions

satellite rash involving the skin folds

hypothenuria is what, seen in who

seen in sickle cell pts inability to concentrate urine - polyuria, low specfic gravity, normal serum sodium

neonatal herpes sxs

seizure temporal lobe abnormalities

kid is verbal at home but does not speak/asocial in other situations

selective mutism

laryngomalacia tx

self-resolved by 18 months if not, surgical consultation

cephalohematoma, caput succedaneum tx

self-resolves, so give reassurance

congenita CMV sxs

sensorineural hearing loss seizures periventricular calcifications hsm jaundice thrombocytopenia - blueberry muffin rash

galactossemia has an increased risk of

sepsis due to e coli

recurrent and severe infections, failure to thrive, and lymphopenia - b and t

severe combined immunideficiency

high risk feautures of foreign body ingestion

sharp battery metal sxs of esophageal obstruction sxs of resp compromise

osteogenesis imperfecta height

short

rickets height level

short

lacrimal duct stenosis tx

shoudl resolve by 6 months if not, refer to optho

tick bites and spider bites are usually

single

DESCRIBE CONGENITAL MELANOCYTIC NEVUS

single area of hyperpigmentation with increasd hair follicles

newborn with copious rhinorrhea think what congenital infection

snuffles - syphillis Nonspecific signs of congenital infection include jaundice, hepatosplenomegaly, and symmetric growth restriction. Specific findings highly suggestive of congenital syphilis include snuffles (copious rhinorrhea) and a maculopapular or bullous rash that may desquamate.

selective mutism is like

social anxiety in kids

once guillain barre is suspected - next step

spirometry to make sure no resp failure

tx for refractor ITP in kids AND adults

splenectomy

spherocytosis key presentation

splenomegaly and signs of hemolysis like anemia, jaundice after upper respiratory illness

2 causes of chronic suppurative otitis media

staph aureus pseudomonas

MCC of lymphadenitis

staph, strep

depression screnning when

starting 12 yoa

retinitis pigementosa presentation

starts as night blindness --> progressive vision loss

Severe Combined Immunodeficiency (SCID) long term tx

stem cell transplant

diaper rash that involves the perianal area

streptococcal perianal dermatitis

orbital compartment syndrome sxs

sudden onset eye pain, vision loos periorbital swelling tight orbit proptosis

transientsynovitis tx

supportive

viral sinusitis tx

supportive

post streptococcal glomerulonephritis tx

supportive can give loop diuretics if the pt is volume overloaded

Infectious mononucleosis tx

supportive care and sporta avoidance

bloody diarrhea tx

suppotive care only

SCFE tx

surgery

biliary cyst next step after US finds it

surgery to prevent malingany

orbital compartment syndrome tx

surgical decompression

lymphadenitis sxs

tender, warm lymph nodes with signs of infection

tinea capitis tx

terbinafine or grisefulvin

cryptochordism has higher risk of

testicular torsion testicular cancer inguinalhernia

hypertonicity after neonatal stump infection

tetanus --> seizures, hypertonicity

gastrochisis looks how on US in mother

thickened intestinal loops floating free in abdominal sac

Have to get what if suspect strep with negative rapid test

throat culture Children with pharyngitis and no viral symptoms (eg, rhinorrhea, cough) should undergo group A Streptococcus (GAS) rapid antigen detection testing. Due to the risk of acute rheumatic fever with untreated GAS, a throat culture is performed to confirm a negative result.

candidal diaper rash tx

topical antifungals

prophylaxis for neonatal gonococcal conjunctivitis

topical erythromycin

toxoplasmosis vs cmv calcifications

toxoplasmosis = diffuse cmv = periventricular zika = intracerebral

PDA sounds like

train track

heart thing due to mom with gestational diabetes, tx

transient hypertrophic cardiomyopathy - presents with systolic murmur resolves by age 1, reassurance

orbital compartment syndrome pathogenesis

trauma --> increased intraorbital pressure

periorbital hematoma sxs

trauma --> pain, brusing around the eye no change in vision, no pupillary defect

how can leukemia lead to acute renal injury

tumor lysis sydrome --> tubular obstruction

Contact dermatitis pathogenesis

type 4 HS - T cell mediated

normal infant intake

up to 32 oz a day

mullerian agenesis is the failure of development of the mullerian duct which forms into

upper 1/3vagina uterus cervix

cystinuria dx

urinary cyanide nitroprusside test

hypospadias, dad wants circumcision - next step

urology eval

what does blind sweep for an object mean, is it recommended, why

using a finger to search for an object not recommended bc it can push it distally

Endometriosis pain is throughout whole period, might also have dyspareunia....how is the flow?

usually heavy

SCFE bilateral or unilateral

usually unilateral

JIA eye sxs

uveitis

sinusitis sxs without fever - dx

viral sinusitis

underdeveloped phallus equals

virilization

what reduces rates of morbidity and mortalitiy in patients with severe measles and should be given to hospitalized patients

vitamin A

vegan diet --> deficiency in what 4 minerals

vitamin B12 vitamin D Iron calcium

neonatal abstinence syndrome pathogenesis

when the mom is on susbtances, most commonly opioids,, durign pregnancy and then the baby has withdrawals once born

Kernig's sign

when the thigh/hip is flexed, extension of the knee is limited

JIA timings

worse in morning, improves throughout the day

growing pains timing

worst at night

JIA sxs timing

worst in morning

can lift weight before puberty? is there damage to growht plates?

yes no