Peds EOR Pearls

flu

Annually ≥ 6 months of ageIntramuscular vaccine is an inactivated vaccine Intranasal vaccine is a live-attenuated vaccine

OE tx

Antibiotic drops ⇒ (aminoglycoside or fluoroquinolone +/- corticosteroids) + avoid moisture If perforated or chance of perforation: Ciprofloxacin 0.3% and dexamethasone 0.1% suspension: 4 drops BID × 7 days or ofloxacin: 0.3% solution 10 drops once a day × 7 days Diabetic/immunocompromised: malignant otitis externa ⇒ necrotizing infection ⇒ hospitalization with IV abx (caused by aspergillus)

dec clotting factors

Anticoagulant medications: heparin, warfarin Hemophilia Liver cirrhosis Vitamin K deficiency DIC

tx of contact dermatitis

Antihistamine (Hydroxyzine or Benadryl), animals Zinc oxide (diaper rash) Avoid agent, topical (triamcinolone cream 0.1%) or oral steroids, Burow's solution (aluminum acetate) PUVA Phototherapy

lichen planus

Appears as purplish, itchy, flat-topped bumps. On mucous membranes, such as in the mouth, it forms lacy white patches, sometimes with painful sores Clinically characterized by 5 Ps ⇒ purple, papule, polygonal, pruritus, planar Wickham striae: whitish lines visible in the papules of lichen planus and other dermatoses Treatment: Topical steroids

PTA tx

Aspiration, incision and drainage, and/or antibiotics IV antibiotics ⇒ amoxicillin, amoxicillin-sulbactam, and clindamycin In less severe cases, oral antibiotics can be used for 7 to 10 days (i.e., amoxicillin, amoxicillin-clavulanate, clindamycin) Tonsillectomy may also be considered in about 10% of patients

rheum fever tx

PCN and ASA

First dose at 2 months Second dose at 4 months Third dose at 6 months Fourth dose at 12-15 months

PCV13 inactivated

3-6-week infants can present with tachypnea, diaphoresis, inability or difficulty with feeding, and no weight gain. low birth weight premature infant Adults with PDA may present with signs and symptoms of heart failure

PDA

Rough "Machinery" murmur late in systole at the time of S2 making it loud

PDA

Nonbilious projectile vomiting after most or every feeding Physical exam - palpable epigastric olive-shaped mass (is pathognomonic for the disorder)

PS

NHL sx

Painless lymphadenopathy Release of cytokines causes fever, drenching night sweats, and weight loss Extranodal involvementGI tract ⇒ bowel obstructionBone marrow ⇒ fatigue, easy bruising, recurrent infectionsSpinal cord ⇒ loss of sensation

Everyone should receive an annual influenza vaccine

> 6 mo

2-hour plasma glucose of on an oral glucose tolerance test (3-hour GTT is the gold standard in GDM)

>200

Random blood glucose levels of

>200 w sx

rubella

"3-day rash" pink light-red spotted maculopapular rash first appears on the face, spreads caudally to the trunk and extremities, and becomes generalized within 24 hours (lasts 3 days) Cephalocaudal spread of maculopapular rash, lymphadenopathy (posterior cervical, posterior auricular) Although the distribution of the rubella rash is similar to that of rubeola, the spread is much more rapid, and the rash does not darken or coalesce Teratogenic in 1'st trimester - congenital syndrome - deafness, cataracts, TTP, mental retardation Treatment consists of supportive care. No specific therapy for rubella infection is available. MMR vaccine (12-15mo, 4-6yr)

tinea cruris

"Jock Itch" diffusely red rash in the groin or on the scrotum TX: Topical antifungals - azoles (1% clotrimazole, 2% ketoconazole), allylamines, butenafine, ciclopirox, and tolnaftate is effective. Nystatin is not effective for dermatophyte infections.

exanthem

(2-4 days after onset of fever): consists of a morbilliform, brick red erythematous, maculopapular, blanching rash, which classically begins on the face and spreads cephalocaudally and centrifugally to involve the neck, upper trunk, lower trunk, and extremities

crawls, pull-to-stand, pincer grasp, eats with fingers

9 mos

mama-dada(nonspecific) waves bye-bye, responds to name

9 mos

causes of OM

: S. pneumoniae 25%, H. influenzae 20%, M. catarrhalis 10%

constipation

< 2 bowel movements per week > 1 episode of encopresis per week (poop in the rectum, loose stool leaks)

tinea corporis

(ringworm): usually seen in younger children or in young adolescents with close physical contact with others (i.e. wrestlers) TX: Topical azole antifungals (1% clotrimazole, 2% ketoconazole) or 1% terbinafine cream applied twice daily for 2-4 weeks.

Moro and grasp reflex, visual tracking

0-1 month

stands

1 year

measles prodrome

1-3 days of a "the three C's" -cough, coryza, conjunctivitis, as well as fever

abstract reasoning, the formation of personality, may have friends of the opposite sex

11 years

TDAP

11-12 years of ageInactivated vaccine

rides a tricycle (3yrs), eats with utensils3-word sentencesknows first and last name

3 yrs

picture book

12 mos

Two separate fasting (8-hours) glucose levels of >

126

several words

15 mos

temper tantrums

15 mos

walks, uses cup

15 mos

names objects

18 mos

toilet-training begins

18 mos

walks up stairs, throws ball

18 mos

CoA dx

1st Echocardiogram EKG= LVH CXR=rib notching "figure of 3 sign"

ADHD tx

1st line meds - caution: wt. loss & ↓ growth with stimulants! Methylphenidate (Ritalin, Concerta, Daytrana) Dexmethylphenidate (Focalin) Amphetamine/dextroamphetamine (Adderall, Dexedrine) Atomoxetine (Strattera) selective norepinephrine atomoxetine (Strattera) selective norepinephrine reuptake inhibitor (non-stimulant) 2nd line/adjuncts Antidepressants (guanfacine, clonidine, imipramine, bupropion, venlafaxine) Behavior modification, family, educational managemen

holds head up, swipes at objects

2 mos

social smile

2 mos

Refer to surgery if an umbilical hernia persists >

2 years

levels less than micrograms/dL suggest A deficiency

20

2-word sentences, several hundred word vocabulary

24 mos

follows 2-step commands

24 mos

runs

24 mos

Skin is red and blistered, the skin is very tender

2nd deg

lifting head and chest, Moro reflex disappears

3 mos

Burned skin is tough and leathery, skin non-tender

3rd deg

orients to voice colic resolves in most babies by this age

4 mos

rolls from prone to supine, grasp objects

4 mos

All exclusively breastfed infants should receive international units (10 micrograms) daily of vitamin D supplements, beginning within a few days after birth

400

Into the bone and muscle

4th deg

MDD

5 or more SIEGECAPS for ≥ 2 weeks nearly every day and at least one of the symptoms is depressed mood or anhedonia SIGECAPS Sadness Interest/anhedonia Guilt Energy Concentration Appetite Psychomotor activity Suicidal

sits upright babbles

6 mos

stranger anxiety

6 mos

teething occurs

6 to 24 months of age

development of conscience (the super-ego), has same-sex friends

6-11

Glycated hemoglobin (A1C) ≥

6.5

children 1-18

600 international units (15 micrograms) daily

As a general goal for glycemic control, we suggest a target glycated hemoglobin (A1C) of <

7.5

impetigo

A highly contagious skin infection Areas of superficial skin trauma, most common on the face and extremities, most commonly caused by S. aureus The main symptom is red sores that form around the nose and mouth. The sores rupture, ooze for a few days, then form a yellow-brown crust Non-bullous: (MOST COMMON): vesicles, pustules, "honey-colored" and weeping

premenstrual dysphoric disorder

A disorder marked by repeated episodes of significant depression and related symptoms during the week before menstruation In the majority of menstrual cycles, at least five symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week post menses.

G6PD deficiency

A hereditary condition in which red blood cells break down when the body is exposed to certain drugs.

TEN

A rare, life-threatening skin condition that is usually caused by a reaction to drugs TEN is > 30% of body Very similar to Steven-Johnson syndrome - The difference is the age of the individuals (in toxic epidermal necrolysis older patients vs. SJS younger patient) and percentage of the body affected (in TEN > 30% of body surface area affected vs. SJS < 10% of body surface area affected)

contact dermatitis

A skin rash caused by contact with a certain substance Acute: erythema, vesicles, bullae burning, itching Chronic: scaling, lichenification, fissure *well-demarcated border

Most common childhood malignancy peak age 3-7 y/o Highly responsive to chemotherapy (remission > 90%) ANC < 1000

ALL

CHILD + Lymphadenopathy + bone pain + bleeding + fever in a CHILD, bone marrow > 20% blasts in bone marrow

ALL

Far more common in males than females Patients with AML may develop a soft-tissue tumor called a chloroma in the spinal cord or skin. The lesions have a greenish hue Smear Auer rods

AML

healthy 7-year-old girl who has reached all developmental milestones. On examination, the precordium is hyperdynamic with a prominent right ventricular heave. A grade III/VI systolic ejection murmur is present in the 2nd left intercostal space (pulmonic position) with an early to mid-systolic rumble and fixed splitting of the second heart sound (s2) during inspiration and expiration.

ASD

intuss

Affects children after viral infections or adults with cancer Previously healthy infants or children may present with sudden onset of crampy or colicky abdominal pain. The pain often occurs in intervals followed by periods of calm. Infants may cry and draw their legs toward the chest Vomiting and lethargy are common Stools may be normal or have a bloody, "currant jelly" appearance because of intestinal ischemia and mucosal sloughing Occasionally, a sausage-shaped mass may be palpated in the abdominal right upper quadrant, representing the intussusception

rubella

Although the distribution of the rubella rash is similar to that of rubeola, the spread is much more rapid, and the rash does not darken or coalesce Teratogenic in 1'st trimester - congenital syndrome - deafness, cataracts, TTP, mental retardation

leukemia dx

Anemia and thrombocytopenia are present at diagnosis in 90% of cases The anemia is normochromic and normocytic Decreased marrow production of red blood cells leads to a low reticulocyte count WBC count is low < 5,000/mm³ in one-third of patients, normal in one-third, and high > 20,000/mm³ in one-third Blast cells are frequently seen on peripheral smear especially if WBC is normal or high Bone marrow examination FNA and biopsy confirms DX

test torsion

Asymmetric high riding testicle "bell clapper deformity" negative Prehn's sign (lifting of testicle will not relieve pain). Teenage males. Sudden, severe pain and swelling in the testicle are symptoms. Associated with nausea and vomiting Very tender to palpation. Cremaster reflex absent Blue dot sign: Tender nodule 2 to 3 mm in diameter on the upper pole of the testicle

tinea pedis

Athlete's Foot: pruritic scaly eruptions between toes. Trichophyton rubrum is the most common dermatophyte causing athlete's foot TX: Topical antifungals - azoles (1% clotrimazole, 2% ketoconazole), allylamines, butenafine, ciclopirox, tolnaftate, and amorolfine

deficiency causes pellagra (meaning "raw skin), which is characterized by a photosensitive pigmented dermatitis (typically located in sun-exposed areas), diarrhea, and dementia, and may progress to death

B3 corn staple diets

intuss dx

Barium enema is both diagnostic and therapeutic in children

CHD tx

Below six months, congenital hip dysplasia is treated with a Pavlik harness and closed or open reduction for older kids, and in some cases, surgery might be necessary < 6 months old: Pavlik harness (abduction bracing) 6-15 months old: hip spica cast 15-24 months old: open reduction followed by hip spica cast

status epi tx

Benzodiazepines (lorazepam) are the preferred initial treatment after which typically phenytoin is given

HoCM tx

Beta-Blockers + Disopyramide (Norpace®) Calcium channel blockers Diuretics should be avoided

hodgkin lymphoma

Bimodal age distribution (15-35) and (>60) Painless cervical or supraclavicular lymphadenopathyUpper body lymph nodes: neck, axilla, shoulder, chest (mediastinum) Fatigue, wt loss, fever, chills, and drenching night sweats for > 1 monthB symptoms are common ⇒ weight loss > 10%, T >38 C, night sweats Associated with EBV (40% of patients) Spreads contiguously (nearby) ⇒ rarely extranodal

tx of cystitis

Cephalosporin x 14 days are the first-line oral agent in the treatment of UTI in children without genitourinary abnormalitiesFirst-generation cephalosporin (Keflex 50-100 mg/kg BID) for low risk of renal involvementSecond-generation (cefuroxime) or third-gen (cefixime, cefdinir, ceftibuten) for those with a high likelihood of renal involvement

kawasaki sx

Characterized by CRASH and burn (fever) Conjunctival injection (spares limbus) Rash (all body parts; flakes) Adenopathy (enlarged lymph nodes; cervical) Strawberry tongue Hand and foot rash fever (5 or more days that doesn't resolve with antipyretics)

a 3-year-old girl with growth retardation has a long history of recurrent pneumonia and chronic diarrhea. Her mother states that he has 6-8 foul smelling stools per day. Physical exam reveals a low-grade fever, scattered rhonchi over both lung fields, crepitant rales at the left lung base and dullness to percussion. Other findings include mild hepatomegaly and slight pitting edema of the lower extremities. CXR reveals hyperinflation, mucus plugging, and focal atelectasis. Labs reveal an elevated quantitative sweat chloride test.

CF

HMD dx

CXR will demonstrate diffuse bilateral atelectasis causing a "ground glass appearance" and air bronchograms

JONES criteria

Carditis Chorea Erythema marginatum Polyarthritis Subcutaneous nodules

pertussis stages

Catarrhal stage: cold-like symptoms, poor feeding, and sleeping Paroxysmal stage: high-pitched "inspiratory whoop" Convalescent stage: residual cough (100 days)

croup

Caused by the parainfluenza virus Common in children 6 mo-3 yrs, fall and early winter months (same time of year as bronchiolitis) Barking cough and stridor Steeple sign on PA CXR (narrowing trachea in the subglottic region)

ADHD

Characterized by problems paying attention, excessive activity, or difficulty controlling behavior which is not appropriate for a person's age. Hyperactivity, impulsivity, or inattentiveness manifesting prior to age 12 years. > 6 symptoms of inattention, hyperactivity-impulsivity, developmentally inappropriate and duration of symptoms > 6 months Symptoms must occur in more than one setting (example school and home)

ALL tx

Chemotherapy Highly responsive to combination chemotherapy with remission of > 90% Stem cell transplant if relapse

RDA B3

Children 9-13: 12mg

hand foot mouth

Children < 10 years old caused by coxsackievirus type A virus producing sores in the mouth and a rash on the hands, feet, mouth, and buttocks (watch video) The virus usually clears up on its own within 10 days Treatment is supportive, anti-inflammatories

fluid rep burns

Children with > 10% total body surface area and adults with > 15% total body surface area burns need formal fluid resuscitation IV Fluids: LR via 2 large boreAdults: LR 4 ml x wt (kg) x % BSAChildren: LR 3 ml x wt(kg) x % BSAHalf is given over the first 8 hours, then 16h

congenital hip dysplasia sx

Children with congenital hip dysplasia present with legs of unequal lengths and asymmetric skin folds around the groin, and they may develop limping and waddling gait when they start walking

PDD

Chronic depressions - depressive symptoms for > 2 years The individual has never been without the depressive symptoms in for more than 2 months at a time. There has never been a manic episode or a hypomanic episode

neutropenia tx

Cipro + Augmentin; Moxifloxacin

allergic rhinitis

Clear nasal drainage, rhinorrhea, itchy, watery eyes, sneezing nasal congestion, pale, bluish, boggy mucosa Allergic shiners (blue discoloration below eyes), transverse nasal crease IgE mediated mast cell histamine release TX: Avoid any known allergens and use antihistamines, cromolyn sodium, nasal or systemic corticosteroids, nasal saline drops or washes, and immunotherapy Intranasal decongestants not to be used more than 3-5 days may cause rhinitis medicamentosa

measles dx

Clinical diagnosis of measles requires a history of fever of at least three days, with at least one of the three C's (cough, coryza, conjunctivitis)

app dx and tx

Clinical diagnosis: Imaging if atypical presentation - appy ultrasound or abdominal CT scan CBC - neutrophilia supports the diagnosis TX: surgical appendectomy

Noncyanotic - Typically found just after the vessels are given off to the left arm. This is a cause of high blood pressure, as the kidneys do not "see" as high of a blood pressure as they would like.

CoA

an 8-year-old boy who is seen for the first time in your office. His parents report that he tires easily and often complains of weakness in his legs. Physical exam shows a healthy boy with a blood pressure of 141/91 mmHg. You notice that his lower extremities are slightly atrophic with a mottling appearance. Upon further examination, he is found to have very weak and delayed femoral pulses with a blood pressure of 96/60 in the lower extremities. He has a late systolic ejection murmur on cardiac auscultation. CXR is performed demonstrating a "figure of 3 sign"

CoA

AML tx

Combination chemotherapy + bone marrow transplant Tumor lysis syndrome - lethal side effect to chemotherapy initiation - treat with allopurinol and manage acute renal failure

astrocytoma tx

Combination of surgical resection, radiation therapy, and chemotherapy Have the best posterior fossa tumor prognosis, with a 90% five-year survival rate

Disseminated Intravascular Coagulation (DIC)

Complex, acquired disorder in which clotting and hemorrhage simultaneously occur

congenital hip dysplasia

Congenital hip dysplasia, or developmental dysplasia of the hip, is a problem where the socket or acetabulum - and the femoral head are misaligned, resulting in an unstable hip joint

failure of testes to descend (one or both)

Cryptorchildism

cystitis

Cystitis is when the infection is limited to the bladder Girls have a 10-fold risk over boys Escherichia coli is the most common bacterial pathogen in cases of urinary tract infection in children. The most significant risk factor is the presence of a urinary tract abnormality that causes stasis, obstruction or reflux In older children, S/S of cystitis are similar to those in adults and include fever, frequency, urgency, dysuria, incontinence, abdominal pain, and hematuria Newborns and infants with UTI have nonspecific signs, including fever, hypothermia, jaundice, poor feeding, irritability, vomiting, failure to thrive, and sepsis. Strong, foul-smelling or cloudy urine may be noted

overactivation of the coagulation system ⇒ ↑ PT and PTT, thrombocytopenia, peripheral blood smear showing microangiopathic hemolytic anemia, schistocytes

DIC

History of new-onset weight loss, polydipsia, polyphagia, and polyuria

DM

most common endocrine disease in childhood, occurring in 1 in 500 children and adolescents

DM

VUR dx and tx

DX: Diagnose by using VCUG and monitor by using serial ultrasonography and VCUGs TX: Mild to moderate VUR often resolves spontaneously, but the more serious disease may require surgical intervention Children with newly diagnosed VUR are given prophylactic antibiotics depending on their clinical course

TT dx and tx

DX: Diagnose with ultrasound and radionuclide study (gold standard) TX: Surgical emergency: Repair both testes within 4-6 hours A longer wait may cause infertility

VSD dx and tx

DX: Echocardiogram Treatment: Most close by age 6, surgery if large

cryptorchidism

DX: Ultrasound may be helpful in identifying undescended testicles in abdominal space TX: Treat with surgery (orchiopexy) by age 1 The current recommendation is to correct as soon as possible after 4 months of age

mod asthma tx

Daily symptoms or more than 1 nightly episode per week Step 3: Low-Dose ICS + Long-acting beta2 agonist (LABA) daily Step 4: Medium-Dose ICS +LABA daily

HL tx

Depends on stage, age, and general health Chemotherapy, radiation therapy - is highly curable compared to Non-Hodgkin Lymphoma Prognosis ⇒ excellent 5-year cure rate (60%)

meningitis tx

Dexamethasone + Empiric IV antibiotics (Cephalosporin, Vancomycin, Penicillins)

mono

Diagnosed with positive heterophile antibody screen (Monospot) - may not appear early in the illness (positive within 4 weeks) Atypical lymphocytes with enlarged nuclei and prominent nucleoli A maculopapular rash develops in 80% of patients treated with ampicillin Left upper quadrant pain secondary to splenomegaly and are at risk for splenic rupture - athletes should avoid vigorous sports for at least the first three to four weeks of the illness

asthma dx

Diagnosis and monitor with peak flow Spirometry with pre and post-therapy (albuterol inhalation) readingsDecreased FEV1/FVC (75-80%)> 10% increase of FEV1 with bronchodilator therapy FEV1 to FVC ratio < 80% (You would expect the amount of air exhaled during the first second (FEV1) to be the greatest amount. In asthma, since there is an obstruction (inflammation) you will have a decreased FEV1 and therefore a reduced FEV1 to FVC ratio

dx of hirschsprung

Diagnosis is by rectal suction biopsy, revealing the absence or paucity of ganglion cells

PS dx

Diagnosis is by ultrasound On ultrasound, you will see a "double-track" Barium studies will reveal a "string sign" or "shoulder sign" Labs: Hypochloremic, hypokalemic metabolic alkalosis (secondary to dehydration)

kawasaki dx

Diagnostic criteria ⇒ four of five CRASH symptoms + high fever lasting five days ↑ inflammatory markers↑ C-reactive protein↑ erythrocyte sedimentation rate↑ platelet count (often at weeks 2-3)↑ white blood cells with a shift to left ↑ liver transaminases Echocardiography for all patients with Kawasaki disease to assess for cardiac abnormalities

ToF

Difficult feeding, failure to thrive. "tet spells" ⇒ a baby with cyanosis and loss of consciousness with crying P ulmonary Stenosis R ight ventricular hypertrophy O verriding aorta V entricular septal defect Crescendo-decrescendo, holosystolic at LSB radiating to the back

RF of Febrile seizures

Elevated fever (≥ 38°C) Age - potentially due to developing nervous system being vulnerable to fever Viral infection (i.e., HHV-6, Influenza virus) Family history - potential genetic component Recent immunizations - the absolute risk is small

teething sx

Excessive drooling Chewing on objects Irritability or crankiness Sore or tender gums A slight increase in temperature — but no fever

meningococcal

First dose at 11-12 years of age Second dose at 16 years of age Inactivated vaccine

MMR

First dose at 12-15 months Second dose at 4-6 years of age Live-attenuated vaccine

varicella

First dose at 12-15 months Second dose at 4-6 years of age Live-attenuated vaccine

HepA

First dose at 12-24 months Second dose given at least 6 months after the first dose Inactivated vaccine

H flu

First dose at 2 months Second dose at 4 months Third dose at 12-15 months inactivated

RV vax

First dose at 2 months Second dose at 4 months Third dose at 6 months

DTaP

First dose at 2 months Second dose at 4 months Third dose at 6 months Fourth dose at 15-18 months Fifth dose at 4-6 years of age Booster doses are given starting at 11 years of age

hep B vaccine

First dose within the first 24 hours of life Second dose at 1-2 months of age Third dose at 6-18 months of age

macrocytic anemia

Folate deficiency B12 deficiency Copper deficiency Drug-induced

decreased serum haptoglobin

G6PD

involves persistent and excessive worry pertaining to multiple events or domains that continues for 6 months or more

GAD

Hematuria, overt or microscopic, is the hallmark of the disease

GN

HSV 2

Genital lesions (vulva, vagina, cervix, glans, prepuce, and penile shaft)

conj tx

Gentamicin/tobramycin (Tobrex): aminoglycoside antibiotic used for gram-negative bacterial coverage. Most cases of bacterial conjunctivitis will respond to this agent Erythromycin ointment (E-Mycin) Chlamydia for newborns Trimethoprim and polymyxin B (Polytrim) This combination is used for ocular infections, involving cornea or conjunctiva, resulting from strains of microorganisms susceptible to this antibiotic. Ciprofloxacin (Ciloxan)

HMD tx

Give antenatal steroid within 24-48 hours of birth - betamethasone IM x 2 Artificial surfactant can be given through the endotracheal tube Mechanical ventilation with positive pressure

strep

Group A B-hemolytic streptococci (GABHS) Centor criteria: 1. Absence of a cough, 2. exudates, 3. fever (> 100.4 F), 4. cervical lymphadenopathy Not suggestive of strep - coryza, hoarseness, and cough If 3 out of 4 Centor criteria are met get a rapid streptococcal test (sensitivity > 90%) If negative → throat culture is the gold standard

erythema mutiforme dx

Presents as raised (papular), target lesions with multiple rings and dusky center (as opposed to annular lesions in urticaria) Negative Nikolsky sign (as opposed to SJS/TEN)

Children < 10 years old caused by coxsackievirus type A virus

HFM

pityriasis rosea

Herald patch: Large oval plaque with central clearing and scaly border. 1st sign Pruritic erythematous plaque with central scale in Christmas tree pattern on the trunk The disease is self-limiting: topical or systemic steroids and antihistamines are often used to relieve itching. Asymptomatic lesions do not require treatment

hemolytic anemia

Hereditary spherocytosis G6DP deficiency Pyruvate kinase deficiency Sickle cell anemia HbC disease Extrinsic Autoimmune hemolytic anemia

roseola

Herpesvirus 6 or 7, only childhood exanthem that starts on the trunk and spreads to the face High fever 3-5 days then rose pink maculopapular blanchable rash on trunk/back and face Treatment is supportive and in most cases, roseola is a benign and self-limited diseaseFever can be controlled with antipyretics (eg, acetaminophen) if it is associated with discomfortThe rash resolves without treatment

urticaria tx

Hives usually go away without treatment, but antihistamine medications are often helpful in improving symptoms Second generation antihistamine blockers (H1) are first-line treatment (Allegra, Claritin, Clarinex, Zyrtec) First-generation antihistamine for sleep disturbances: hydroxyzine/diphenhydramine H2 antihistamines as adjuvants: cimetidine, ranitidine Steroids for exacerbations, avoid chronic use If anaphylaxis give epinephrine: 0.3-0.5 mg; use 1:1,000 dilution for IM route and 1:10,000 for IV route Peds: epinephrine 0.01 mg/kg SC/IV

25-year-old woman presents the ER after a syncopal episode. She had a loss of consciousness 3 times over the past 12 months. Each event occurred during or just after physical exercise. On PE: BP 110/70 mm Hg, HR 75/min, normal S1/S2, and an III/VI systolic ejection murmur is heard best at the left sternal border that decreases with squatting. The EKG shows a normal sinus rhythm with diffuse increased QRS voltage.

HoCM

The most common cause of sudden death in young athletes

HoCM

bronchiolitis tx

Hospitalization if O2 saturation < 95-96%, age <3 months, RR > 70, nasal flaring, retractions, or atelectasis on CXR Supportive ⇒ humidified O2, antipyretics, beta-agonist, nebulized racemic epinephrine, and steroids The only treatment demonstrated to improve bronchiolitis is oxygen Ribavirin is given if severe lung or heart disease and in immunocompromised patients

vit c def dx

However, plasma and leukocyte vitamin C levels are the mainstay for assessment and are reasonably well correlated with vitamin C intake

types of acne

I - Comedonal: comedones (+/- small amounts of papules and pustules) II - Papular: moderate number of lesions, little scarring III - Pustular: lesions > 25, moderate scarring IV - Nodulocystic: severe scarring

Often affects young males within days (24-48 hours) after URI or GI infection - caused by IgA immune complexes which are the first line of defense in respiratory and GI secretions so infections cause an overproduction which then damages the kidneys

IgA neph

Types of Atopic Dermatitis

IgE, type 1 hypersensitivity Infant- face, and scalp Adolescent- flexural surfaces

B12 def

Increased MCV, increased LDH, decreased haptoglobin

RSV hospitalization

Indications for hospitalization ⇒ tachypnea with feeding difficulties, visible retractions, oxygen desaturation < 95-96%

PDA tx

Indomethacin has been used to help close a PDA

vita A def tx

Infants 6 to 12 months of age: 100,000 international units orally (30 mg retinol equivalent) - One dose Children 12 to 59 months of age: 200,000 international units orally (60 mg retinol equivalent) - Dose repeated every four to six months

bronchiolitis sx

Infants and young children Tachypnea, respiratory distress, wheezing Diagnosed by nasal washing for RSV culture and antigen assay; CXR = normal

orbital cellultitis

Infection of orbital muscles and fat behind the eye (periorbital = infection only of skin) Decreased extraocular movement, pain with movement of the eye and proptosis, signs of infection Often associated with sinusitis. Occurs more often in children than adults - ages 7-12 y/o Decreased vision is a rare manifestation of orbital cellulitis DX: CT Scan of orbits (confirmatory) Focused assessment on extraocular muscles CBC and blood cultures in some settings Tx: Hospitalization and IV broad-spectrum antibiotics (vancomycin)

tinea ungium

Infection of the nail TX: Terbinafine is the first-line oral agent for mild to moderate dermatophyte onychomycosis.

ependyoma

Initial symptoms are typically related to increased intracranial pressure. Infants may present with developmental delay and irritability. Changes in mood, personality, or concentration may occur. Seizures, balance and gait disturbances, or symptoms of spinal cord compression (eg, back pain, loss of bladder and bowel control) may occur

sx of leukemia

Initial symptoms include lethargy, malaise, and anorexia 25% of children develop bone pain or arthralgia caused by leukemic infiltration of the perichondral bone or leukemic expansion of the marrow cavity Progressive bone marrow failure leads to pallor, ecchymoses or petechiae (50%) and fever (25%)

DM tx

Intensive insulin therapy combines the administration of a basal level of insulin together with premeal boluses of rapid-acting insulinMultiple daily injections (MDI) - consists of injections of a long-acting insulin analog once or twice daily, and rapid- or short-acting insulin before each meal and snackInsulin pump - This is a device that delivers a continuous subcutaneous infusion of a rapid- or short-acting insulin, which is supplemented by boluses before each meal or snack Options for blood glucose monitoring include fingersticks (at least four times daily) or one of several types of devices for continuous glucose monitoring (CGM)

normocytic anemia

Iron deficiency Anemia of chronic disease Chronic kidney disease Aplastic anemia

microcytic anemia

Iron deficiency Anemia of chronic disease Thalassemias Sideroblastic anemias Lead poisoning

duodenal atresia

It causes increased levels of amniotic fluid during pregnancy (polyhydramnios) and intestinal obstruction in newborn babies Early biliary vomiting in the newborn increased association of duodenal atresia with Down's syndrome

group of rheumatic diseases that begins at or before age 16

JIA

dx of diaper derm

KOH prep and fungal culture of skin scrapings for Candida Viral culture, mineral oil slide for scabies Culture of skin lesions for S. aureus or group A Streptococcus

tx of diaper derm

Keep area dry to allow airflow Barrier creams zinc oxide/petroleum jelly Candidiasis: Nystatin, Clotrimazole, Econazole x 2 wk Discuss proper diaper changes, disposable, avoid tight-fitting

enanthem

Koplik spots - irregularly-shaped, bright red spots often with a bluish-white central dot in the mouth

HoCM sx

LV Myocardium becomes hypertrophied leading to outflow obstruction SXS: SOB, chest pain, syncopal episode after exertion

burn classification

Rule of 9's children: Head 18%, each arm 9%, chest 18%, back 18%, each leg 14% Palmar method: Patient's palm equates to 1%; used for small burns

intermittent asthma tx

Less than 2 times per week or ≤ 2 night symptoms per month Step 1: Short-acting beta2 agonist (SABA) PRN

RV SE

Live-attenuated vaccine Can increase the risk for intussusception

Very common. Fever, diarrhea, weight loss, anemia.

MAC

live vaccines

MMR and varicella RV

AVN dx

MRI is the study of choice for early detection Hip x-rays demonstrate necrosis effusion and joint space widening with a negative aspirate

CF tx

Maintenance: Chest physiotherapy, high-fat diet, supplement fat-soluble vitamins (A, D, E, K) Acute exacerbations: Antibiotics

dx GN

Manifestations: proteinuria, HTN, azotemia, oliguria (< 400 ml urine/day), hematuria (RBC casts are hallmark) Edema is not as much as in nephrotic syndrome Urinalysis: proteinuria < 3.5 grams per day (24-hour urine), hematuria, RBC casts Biopsy: hypercellular, immune complex deposition

medulloblastoma

Metastasize through CSF It has a bimodal peak at age 3 to 4 yr and at age 8 to 10 yr but can occur throughout childhood Patients present most commonly with vomiting, headache, nausea, visual changes (eg, double vision), and unsteady walking or clumsiness

alopecia dx

Microscopic examination of cut or plucked hair fibers and scalp biopsies may provide additional information that is helpful for diagnosisBiopsy: telogen and atrophic folliclesTrichogramma: increased telogen hairs Hormones: testosterone, DHEA, Prolactin Treatable: thyroid (TSH), anemia (CBC), autoimmune (ANA)

burn tx

Mild: clean with soap & water; Drain & debride bullae; cover with 1% silver sulfadiazine Moderate/Severe: cover with a dry dressing, admit to hospital

measles

Morbilliform - maculopapular, brick red rash on face beginning at hairline then progressing to palms and soles last - rash lasts 7 days Koplik spots (small red spots in buccal mucosa with blue-white pale center) precedes rash by 24-48 hours. Treatment is supportive - anti-inflammatories, isolate for 1 week after onset of rash. MMR vaccine (12-15mo, 4-6yr)

mild asthma tx

More than 2 times per week or 3-4 night symptoms per month Step 2: Low-Dose inhaled corticosteroids (ICS) daily

acne treatment

Most acne- topical retinoids. Cystic acne- tetracyclines, then oral retinoids - isotretinoin (causes dry lips, liver damage, increased triglycerides/cholesterol, pregnancy category X). Must obtain 2 pregnancy tests prior to starting it and monthly while on it.

acute bronchiolitis most often caused by

Most often caused by RSV - commonly in fall and winter months

wart tx

Most resolve without treatment over 2 years Cryotherapy with liquid nitrogen may be applied with a cotton swab or with a cryotherapy gun (Cryogun) Self-administered topical therapy such as salicylic acid

febrile sz tx

Mostly counseling, reassurance, and educating the parent; antipyretics help alleviate symptoms of fever Further considerations for complex febrile seizures more commonly associated with infection or structural abnormalities Consider obtaining EEG though not required May treat with benzodiazepine if lasts >5 minutesTerminate status epilepticus with benzo or phenytoinInitiate status epilepticus protocol if continues Rarely develops into epilepsy Monitor complex febrile seizures as more likely to recur

HIV patients with CD4 < 50

Mycobacterium avium complex (MAC)

The child refuses to move the arm on presentation which is held in flexion and pronated, there is minimal swelling

NE

Look for an immunocompromised (HIV) patient with GI symptoms and painless peripheral lymphadenopathy

NHL

Spreads non-contiguously to extranodal sites ⇒ skin, GI tract, brain

NHL

tumor derived from lymphocytes - specifically from B-cells and T-cells

NHL

JIA tx

NSAIDs, intra-articular corticosteroids, and disease-modifying antirheumatic drugs - methotrexate

ASD

Noncyanotic Foramen ovale fails to close. Ostium Secundum is most commonPhysical Exam: Wide fixed, split, second heart sound (S2). Systolic ejection murmur at second left intercostals space with an early to mid-systolic rumble. Failure to thrive.

sessile (broad base) or pedunculated (narrow stalk) lesions found on the surface of bones

OC

A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling.

ODD Unlike children with conduct disorder (CD), children with oppositional defiant disorder are not aggressive towards people or animals, do not destroy property, and do not show a pattern of theft or deceit.

Ear pain (especially with movement of tragus or auricle), pain with eating, purulent cheesy white discharge, palpation of the tragus is painful Tuning fork ⇒ bone conduction > air conduction Pseudomonas aeruginosa (swimmer's ear), S. aureus (digital trauma)

OE

Classically present with tenderness over the tibial tubercle in a 9-14-year-old male who has undergone a rapid growth spurt and doing sports that involve running

OS

sun ray/burst or hair on end appearance followed by bone scan look for metastasis

OS

scoliosis dx

On Adams forward bending asymmetry in scapular height is noted Radiographs standing PA and lateralCobb angle > 10° defined as scoliosis - intra-interobserver error of 3-5° MRI - to rule out intraspinal anomalies. Should be performed if atypical curve pattern, rapid progression, neurologic symptoms of pain, reflex abnormalities, etc. Pulmonary function tests to determine whether the scoliosis is affecting breathing. Will demonstrate a restrictive airway pattern

lead poisoning dx

Once lead poisoning is suspected, whole blood lead levels need to be obtained. A level of 10 µg/dL is considered positive

HSV 1

Oral lesions (tongue, lips, etc.)

oral candidiasis

Oral thrush is an infection in which the fungus (candida albicans) accumulates in the mouth Mouth pain White plaques that bleed when scraped DX: KOH smear reveals budding yeast and pseudohyphae TX: with nystatin, oral fluconazole

Erythema infectiosum

Parvovirus B19 - "slapped cheek" rash on face - lacy reticular rash on extremities, spares palms, and soles Resolves in 2-3 weeks Treatment is supportive, anti-inflammatories

anorexia

Patient who refuses to eat due to fear of being overweight Intense fear of becoming fat, even though underweight. Frequent weight checks and denial of emaciated state. Weight < 85% of ideal body weight Anorexia nervosa can be distinguished from bulimia nervosa by body mass index < 17 or bodyweight < 85% of ideal body weight The highest suicide rate of eating disorders.

strep tx

Penicillin is first line, azithromycin if penicillin-allergic. Complications: Rheumatic fever and post-strep glomerulonephritis

pinworms

Perianal itching especially at night (eggs are laid at night) Eggs cling to the fingers while itching and are transmitted to other people either directly or through food or surfaces The eggs can thrive for 2-3 weeks on an inanimate object Diagnosis is with a "scotch tape test' done in the early morning. Can see the eggs under microscopy Treatment is with albendazole or mebendazole

GN Tx

Positive streptococcal cultures are treated with appropriate antibiotic therapy. Steroids and other immunosuppressive drugs may be used to control the inflammatory response Dietary management: salt and fluid restriction Hypertension when present can be severe, requiring vasodilators, diuretics, and fluid restriction Dialysis should be performed if symptomatic azotemia IgA nephropathy - glucocorticoids Rapidly progressive glomerulonephritis - immunosuppressive therapy Use medications to control hyperkalemia, pulmonary edema, peripheral edema, acidosis and hypertension May require renal transplant - most syndromes recur in the transplanted kidney

CF

Presentation: Recurrent respiratory infections (especially pseudomonas), steatorrhea Diagnosis: Quantitative sweat chloride test CXR may reveal hyperinflation, mucus plugging, and focal atelectasis

mumps

Prodrome of fever, malaise, and anorexia Parotid enlargement(usually bilateral but not always synchronous) 24 h later Swelling of submaxillary and submandibular glands Orchitis(usually unilateral) with testicular enlargement two to three times normal size Mumps is the most common cause of pancreatitis in children

CoA tx

Prostaglandins E1 Generally, require surgical repair with dilating the segment with balloons

atopic dermatitis

Pruritic, eczematous lesions, xerosis (dry skin), and lichenification (thickening of the skin and an increase in skin markings). Most common on flexor creases (ex. antecubital and popliteal folds)

9-year old girl is brought to the clinic by her mother on account of fever. She has red skin lesions on the trunk and proximal extremities, and also small, non-tender lumps located over the joints. On further enquiry, she reports a history of sore throat which occurred about 4 weeks ago. Antistreptolysin O titer is positive.

RF

develops in children and adolescents following pharyngitis with group A beta-hemolytic Streptococcus

RF

Antalgic or waddling gait with an externally rotated leg on the affected side

SCFE

MC cause of lower respiratory tract infection in children worldwide - virtually all children get it by age 3; the leading cause of pneumonia and bronchiolitis

RSV

a 5-month old infant with a three-day history of a mild respiratory tract infection with serous nasal discharge, fever of 38.5 C, and decreased appetite. Physical exam reveals a tachypneic infant with audible wheezing and a respiratory rate of 65. Nasal flaring, use of accessory muscles, subcostal and intercostal retractions are noted. Expiratory wheezes and a cough are present.

RSV

flu dx

RT-PCR or viral culture take 3-7 days to return

SCFE dx

Radiography for all patients to confirm diagnosis and grade severity AP and frog-leg lateral of right and left hip - lateral radiograph is the best way to identify a subtle slip Widening of joint space, decrease in epiphyseal height and Steel sign - double density from the superimposition of epiphysis and metaphysis MRI can help diagnose a pre-slip condition when radiographs are negative

diaper dermatitsi

Rash on buttocks region, common in infants 3wk ⇒ 2 yr Cause: wet, dark, friction, urine, feces, and microorganisms Fussiness, crying w/ diaper change, diarrhea, shiny erythema with dull margins Secondary infectionsSatellite lesions ⇒ candidiasisImpetigo (s. aureus)Herpes simplex virus (child sexual abuse)

ASD tx

Refer - Autism specialists, speech & language pathologist Audiology evaluation, +/- EEG Behavioral therapy Medications:Second-generation antipsychotics (risperidone, aripiprazole) for aggression/hyperactivity, mood lability; can also use haloperidol, carbamazepineSSRIs for stereotyped/repetitive behavior

PTA

Results from penetration of infection through tonsillar capsule and involvement of neighboring tissue Presents with a hot potato (muffled) voice, severe sore throat, lateral uvula displacement, bulging tonsillar pillar + Streptococcus pyogenes

atopic dermatitis tx

Review medications: OTX, RX, homeopathic, hot water, humidifier Antihistamine (Hydroxyzine or Benadryl), animals Topical or oral steroids PUVA Phototherapy

RSV

Rhinorrhea, wheezing/coughing that persists for months, low-grade fever, nasal flaring/retractions, nail bed cyanosis Diagnosed with nasal washing, RSV antigen test; CXR can show diffuse infiltrates

HHV6

Roseolovirus is more commonly known as the 6th disease or Roseola Infantum

Hip disorder common in adolescents in which the head of the femur slips off the neck of the femur inferiorly and posteriorly, often due to mechanical overload

SCFE

rare, serious hypersensitivity complex that affects the skin and the mucous membranes. It's usually a reaction to a medication or an infection commonly caused by anticonvulsants and sulfa drugs!

SJS

SJS

SJS is 3-10% of the body It begins with a prodrome of flu-like symptoms, followed by a painful red or purplish rash that spreads and blisters. Layers of skin peel away in sheets (+) Nikolsky's sign (pushing blister causes further separation from the dermis) Stevens-Johnson syndrome (SJS) is a milder form of toxic epidermal necrolysis (TEN) with LESS THAN 10% of body surface area detachment

PMDD tx

SSRIs are first-line treatment (fluoxetine, sertraline, paroxetine, escitalopram) and can be used continuously or instituted the week prior to menses Birth control, low-dose estrogen, and diuretics may also be beneficial SNRIs such as venlafaxine may also be effective in women with predominantly psychological symptoms Gonadotropin-releasing hormone (GnRH) - SEs include accelerated bone loss and vasomotor symptoms

MDD tx

SSRIs are the first-line treatment Continue to increase dosage q 3-4 wks until symptoms in remission The full medication effect is complete in 4-6 weeks Augmentation with 2nd medication may be necessary See within 2-4 weeks of starting medication and q2wk until improvement, then monthly to monitor medication changes

GAD tx

SSRIs: Paroxetine and escitalopram; SNRIs: Venlafaxine Buspirone is also effective; the starting dose is 5 mg PO bid or tid. However, buspirone can take at least 2 weeks before it begins to help Benzodiazepines (short-term use), beta-blockers Psychotherapy

constipation tx

Schedule time between classes, increase fiber to 11-24 g/day ⇒ wheat, fruits, veggies, fluids Decreased cows milk ⇒slows intestinal motility → < 24 oz/day (16oz preferably) Mineral oil 15 to 30 mL per year of age per day Polyethylene glycol 3350 (Miralax) 1.5 g per kg per day Lactulose 1 mL per kg per day once or twice per day, single dose or in two divided doses Fiber, decrease milk, increase fluids Enema, bathroom training Referral to a subspecialist is recommended only when there is a concern for organic disease or when constipation persists despite adequate therapy

hydrocele dx

Scrotal ultrasound can be used in the diagnosis of both hydrocele and varicocele The hydrocele can be visualized with transillumination Tumor or varicocele which both do not transilluminate

vit c def

Scurvy presents with swollen gums, bruising, petechiae, hemarthrosis, anemia, poor wound healing, perifollicular and subperiosteal hemorrhages, and corkscrew hair

DS comps

Septal defects between atria Duodenal atresia Increased risk for acute lymphoblastic leukemia Mental retardation and an increased risk for Alzheimer disease Sterility in males

GE sx

Signs and symptoms include some combination of diarrhea, anorexia, vomiting, and abdominal pain Fever, lack of energy, myalgia, and dehydration may also occur This typically lasts less than two weeks. It is unrelated to influenza though it has been called the stomach flu Exposures: foreign travel, playing in creek, daycare, poultry

autism

Social communication and social interaction deficit in many contexts such asLack of social-emotional reciprocityLack of nonverbal communicative behaviorsImpairment in developing, maintaining, and understanding relationships Restricted and repetitive patterns of behavior, interests, or activities such asMotor movements that are stereotyped or repetitive (e.g., flipping objects)Inflexibility to changeRestricted and fixated interests - these are typical with abnormal intensity or focusHyper- or hyporeactivity or unusual interest in a sensory stimulus (e.g., fascination with lights) These symptoms must be present in the patient's early developmental period in the absence of an organic etiology (e.g., hearing dysfunction) These symptoms cannot be better explained by other conditions (e.g., intellectual developmental disorder)

meningitis dx

Spinal tap: Increased opening pressure, decreased glucose, increased WBC (neutrophils), increased protein

strabismus

Strabismus is defined as any form of ocular misalignment Exotropia: out-turning of eyes Esotropia: in-turning of eyes

duodenal atresia tx

Suction/Drain secretions; respiratory Elevate head, IV glucose and fluid, ABX Definitive: SURGERY

croup tx

Supportive (air humidifier), antipyretics Severe: IV fluids and nebulized racemic epinephrine, steroids

2-week-old newborn brought to the ER by his mom who reports a sudden loss of consciousness during feeding and with crying. She also has noticed that the infant's lips have turned blue on three occasions during feeding. blood pressure is 75/45 mmHg, a pulse is 170/min, and respirations are 44/min. A grade 3/6 harsh systolic ejection murmur is heard at the left upper sternal border. A CXR shows a small boot-shaped heart and decreased pulmonary vascular markings.

TOF

erythema multiforme

Target (iris) lesions, dull "violet"red Macules, vesicles, central bullae with pale red rim and peripheral red halo Blanching and lack of itchiness help characterize this rash

RSV tx

Supportive measures include albuterol via nebulizer, antipyretics and humidified oxygen, steroids (controversial), resolves in 5-7 days Vaccine for children with lung issues or born premature/immunocompromised at birth should get Synagis prophylaxis (palivizumab) = once per month for five months beginning in November

tx of ependyoma

Surgical resection, usually followed by radiation therapy Sometimes chemotherapy The survival rate depends on age and on how much of the tumor can be removed:Total or near-total removal: 51 to 80% survivalLess than 90% removal: 0 to 26% survival

ASD tx

Symptomatic: Diuretics, ACE inhibitors, digoxin Definitive: Surgical closure

sx hypothyroid

Symptoms generally appear after the first year of life and includeCold intoleranceDiminished appetiteLethargyConstipation Physical findings include delayed puberty, immature body proportions, coarse puffy facies, dry thin hair, dry skin, and DTRs with delayed relaxation time

neonatal hep

Symptoms may range from transient jaundice and acholic stools to liver failure, cirrhosis, and portal hypertension. Presenting features in the first week of life include jaundice and hepatomegaly in 50% of patients. FTT and more significant liver disease occur later in infancy in 33% of patients. The course of disease is generally self-limited, with full recovery during infancy in as many as 70% of patients. tx is supportive

sx of lead poisoning

Symptoms of lead toxicity in children are non-specific and include behavioral changes, temperamental lability, irritability, hyper/hypoactivity, developmental delays, abdominal pain, vomiting, constipation, lethargy, headache, ataxia, and seizures

MAC

Symptoms rarely occur in immunocompetent patients (increased in bronchiectasis). HIV patients when CD4 < 50 Diagnose with AFB and culture Treat with clarithromycin + ethambutol for at least 12 months (+/- rifampin)

sev asthma tx

Symptoms several times per day and nightly Step 5: High-Dose ICS +LABA daily Step 6: High-Dose ICS +LABA +oral steroids daily

dx hyperthyroid

T4 levels are elevated T3 is elevated TSH is suppressed

teething tx

Teething rings and other chewing devices should be one piece These devices should not be dipped in sugary substances Teething necklaces, bracelets, or anklets that are made of beads should be avoided Avoid over-the-counter (including homeopathic remedies) or prescription-strength topical analgesics (eg, lidocaine, benzocaine) for teething pain Over-the-counter pain medications such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) if especially fussy

HbF increased, low MCV, hemolysis

Thalassemia

HoCM murmur

The cardiac murmur will sound similar to the murmur of aortic stenosis. However, a murmur due to HCM will increase in intensity with any maneuver that decreases the volume of blood in the left ventricle Increase with Standing Increase with Valsalva Decreases with squatting

otitis media

The clinical diagnosis of AOM requires 1) bulging of the tympanic membrane or 2) other signs of acute inflammation (eg, marked erythema of the tympanic membrane, fever, ear pain) and middle ear effusion

CHD dx

The diagnosis of congenital hip dysplasia is based on physical exam⇒ hip exam at every well-child visit until 2 years old

duodenal atresia dx

The diagnosis of duodenal atresia is commonly made prenatally, either as an isolated lesion or due to its association with other chromosomal abnormalities X-ray: double bubble Malrotation: corkscrew

CoA

The key finding is elevated blood pressure in the arms, with low blood pressure in the legs. Pulses in the leg may be decreased in intensity, or delayed compared with their occurrence in the arm. Ejection murmur is heard at the aortic area and left sternal border that radiates into the left axilla and left back

sx of turner syndrome

The most common features include streak ovaries, short stature, lymphedema, neck webbing, and congenital heart and renal defects

tinea capitis

The most common fungal infection in the pediatric population. This occurs mainly in prepubescent children (between ages 3 and 7 years). Asymptomatic carriers are common and contribute to spread TX: Systemic therapy warranted to penetrate the hair shaftOral griseofulvin (Drug of Choice): 20-25 mg/kg/24 h (max 1 g/24 h) once daily or divided b.i.d. of microsize griseofulvin for 6-8 weeks. In addition, topical therapy of 2.5% selenium sulfide or ketoconazole shampoo twice weekly suppresses viable spores. Laboratory monitoring is not needed.

ON tx

The supination-flexion technique is the classic method of reducing a subluxed radial head. It has a success rate of 80-92% Always ensure the child spontaneously uses the arm after reduction before discharging to confirm success

HFM tx

The virus usually clears up on its own within 10 days Treatment is supportive, anti-inflammatories

mumps tx

There is no available cure for mumps and treatment is supportive Symptoms usually last for 7-10 days and patients are contagious for up to 9 days after onset May need to provide scrotal support if painful or swollen testicle (as in case presentation) MMR vaccine is given at 12-15 months then again at 4-6 years of age

appendicitis

There is usually a marked reduction in or total absence of appetite, often associated with nausea, and occasionally, vomiting and low-grade fever As the inflammation increases, the abdominal pain tends to move downward - begins in epigastrium → umbilicus → RLQ Right lower quadrant= "McBurney's point." This "rebound tenderness" suggests inflammation has spread tothe peritoneum

vit d def tx

These doses are designed to maintain 25-hydroxyvitamin D (25OHD) levels >20 ng/mL (50 nmol/L) in most population

tx hypothyroid

Thyroid replacement with synthetic levothyroxine (Synthroid) is provided and adjusted to maintain normal serum free T4 levels, normal TSH levels, growth, and development Thyroid function tests should be monitored frequently

alopecia tx

Topical: Minoxidil/Rogaine 2%, %5; *hair loss first before regrowth Finasteride 1mg ⇒ inhibits T and DHT Spironolactone ⇒ blocks DHT

Gradual conversion of terminal hairs → indeterminate → vellus hair

androgenetic alopecia

paraphimosis tx

Treat by applying firm circumferential compression to the glans with the hand - may relieve edema sufficiently to allow the foreskin to be restored to its normal position. If this technique is ineffective, a dorsal slit using local anesthetic relieves the condition temporarilyCircumcision is then done when edema has resolved

SCFE tx

Treat with surgical fixation with screw for all patients Prophylactic screw fixation of the contralateral hip may be considered for patients, as there is a risk of the disease in the contralateral hip later in life - usually for patients < 10 or > 16 years of age

tx hyperthyroid

Treating with methimazole (MMI) rather than propylthiouracil (PTU) because MMI has fewer side effects Fifty percent of children with Graves' disease have a spontaneous remission and may be taken off antithyroid medications after 12-24 months of treatment All children with a history of hyperthyroidism should have lifelong monitoring of thyroid function, regardless of treatment choice and outcome Neonatal graves can be controlled with propranolol +/- methimazole. Most cases remit within 2-3 month

lead poisoning tx

Treatment includes preventing further exposure, chelation therapy, and dietary measures Dimercaprol, CaNaEDTA, penicillamine, and succimer are all agents that can be used to treat lead toxicity. Typically chelation therapy is only indicated if a patient has a blood lead level of ~45 μg/dL Patients are hospitalized when the levels are above 70 μg/dL

GE tx

Treatment involves getting enough fluids. For mild or moderate cases, this can typically be achieved by drinking oral rehydration solution (a combination of water, salts, and sugar).In those who are breastfed, continued breastfeeding is recommended. For more severe cases, intravenous fluids may be needed

scoliosis tx

Treatment is based on the degree of curvature Curves of 10-15 degrees are treated by 6-12 month follow-up with clinical evaluation and possible x-ray Curves of 15-20 degrees need serial AP radiographic follow-up every 3-4 months for larger curves and every 6-8 months for small curves or for patients near the end of growth Curves of 20 degrees or greater need a referral to an orthopaedist for continuous monitoring and management Moderate curves (20 to 40°) are treated conservatively (eg, physical therapy and bracing) to prevent further deformity. Surgery if > 40°

flu tx

Treatment is symptomatic (for most) or with antivirals ⇒ ideally< 48 hours - Tamiflu (oseltamivir), inhaled Relenza (zanamivir), IV Rapivab (peramivir), and oral baloxavir (Xofluza) Zanamivir and Oseltamivir both treat influenza A and B ⇒ (think Dr. "OZ" treats the flu)

AVN tx

Treatment may be conservative or may eventually need a joint replacement

tx of hemophilia

Treatment often involves the replacement of factor VIII or IX

hydrocele tx

Treatment usually involves watchful waiting. In rare circumstances, surgery is needed Most hydroceles will resolve within the first 12 months of life without treatment and do not need to be reassessed unless present after 1-year If elective repair is indicated treatment consists of needle aspiration or surgery Patients will require scrotal support after treatment, and they should be monitored for bleeding or infection at the site after intervention

weber test

Tuning fork is placed on the center of the head and see if sound lateralizes - Sound lateralizes to affected ear in conductive hearing loss, Sound lateralizes to unaffected ear in sensorineural hearing loss

rinne test

Tuning fork placed on mastoid and then up to the ear (should continue to hear) conductive hearing loss if bone > air, sensorineural hearing loss if air > bone

HPV

Two doses at 9-14 years of age in patients between the ages of 9-14, the 2 dose are administered 6-12 months after the first dose Three doses at ≥ 15 years of age given at 0, 1-2, and 6 months Subunit vaccine Three doses of this vaccine are also recommended in immunocompromised adolescent patients

down syndrome dx

Ultrasound Prenatal diagnosis ⇒ Nuchal translucency (weeks 11-14)Increased nuchal translucency and a hypoplastic nasal bone in a first-trimester ultrasound Amniocentesis An amniotic fluid sample is obtained with a fine needle through the abdomen and uterus Performed during 15th week of pregnancy or later Less risk to the child than chorionic villus sampling Usually indicated in mothers > 35 years old Chorionic villus sampling (CVS) Placental tissue sample is retrieved via vagina and cervix Usually performed between the 10th-12th week of pregnancy More risk to the child, but can be performed earlier Usually indicated in mothers > 35 years of age Quadruple screen (normally done some time between the 15th and 22nd): looks for four specific substances: AFP, hCG, Estriol, and Inhibin-A ↑ serum beta-human chorionic gonadotropin (β-hCG), inhibin A ↓ unconjugated estriol (uE3), alpha-fetoprotein (AFP) Postnatal diagnosis Fluorescence in situ hybridization (FISH), karyotyping Postnatal diagnosis ⇒ Clinical identification of dysmorphic features

cystitis dx

Urine culture is the gold standard for diagnosis. Susceptibility testing should be performed

AVN

Usually, just one hip is affected Think trauma, steroid use, or sickle cell In children AVN is known as Legg-Calve' Perthes disease - will present with persistent pain and a limp. Ages 2-11 years old with a peak incidence of 4-8 years of age

4-year-old boy who is brought to your office by his parents because he gets tired very easily and cannot keep up with the other children. On exam, you hear a loud, harsh, holosystolic murmur at the left lower sternal border without radiation to the axillae. An echocardiogram is performed with results seen here.

VSD

As in the case of ASD, the heart can dilate, the muscle can become weak, and the pressures in the pulmonary arteries can increase (pulmonary hypertension) due to the increase in blood flo

VSD

Loud, harsh, holosystolic murmur, left to right - heard best at the lower left sternal border

VSD

most common pathologic murmur in childhood

VSD

which urine flows retrograde, or backward, from the bladder into the ureters/kidneys In young female patients, any history that points to recurrent infection, especially cystitis or pyelonephritis, should trigger an evaluation for vesicoureteral reflux (VUR)

VUR

HHV 3

VZV (Varicella Zoster Virus commonly known as chickenpox or shingles)

Defined as low hematocrit and/or hemoglobin relative to normal values Symptoms: weakness, fatigue, dyspnea on exertion Physical exam: pallor, tachycardia, systolic flow murmur, jaundice, positive stool guaiac May present as angina

anemia

impetigo tc

Warm water soaks 15-20min then 1st line: topical Bactroban (mupirocin) x 5 days Widespread infection:Cephalexin or Erythromycin x 1 wkMRSA: DoxycyclineSick + MRSA: VancomycinBullous or severe: PO ABX

conductive loss

Weber: hear in bad ear Rhinne: bone > air

Sideroblastic anemia

anemia caused by inability to use available iron to manufacture hemoglobin

Neonatal jaundice appears when total bilirubin levels are

above 2 milligrams per decilitre

Characterized by a brief impairment of consciousness with an abrupt beginning and ending. At times involuntary movements may occur, but they are uncommon and the patient has no recollection and witnesses commonly miss them

absence sz

Characterized by areas of open comedones (blackheads) incomplete blockage, closed comedones (whiteheads) complete blockage, papules, pustules, nodules, or cysts. may result in scarring.

acne vulgaris

constitutes 97% of all childhood leukemias and is subdivided into acute lymphocytic leukemia (ALL) and acute nonlymphocytic anemia, also known as acute myelogenous leukemia (AML)

acute leukemia

warts

all warts are caused by the Human Papillomavirus (HPV). Most resolve without treatment over 2 years. Verruca vulgaris (common warts): skin-colored papillomatous papules Verruca plana (flat warts): Hands, face, arms, legs Verrucae plantaris (plantar warts): bottom of the foot. Rough surface. Dark spot (thrombosed capillaries) Condyloma acuminatum (venereal warts): flesh-colored, cauliflower appearance genital warts caused by HPV types 6 and 11 Epidermodysplasia verruciformis: a rare, lifelong hereditary disorder characterized by chronic infection with HPV

red eyes, itching and tearing, usually bilateral, cobblestone mucosa on the inner/upper eyelid TX: hand washing, avoid contamination

allergic conj

Presents as isolated persistent painless hematuria A genetic condition that occurs in children resulting in renal failure and hearing loss Ophthalmologic exam reveals anterior lenticonus - anterior part of the lens has a conical shape DX - C3 and C4 Levels

alports

a 5-year-old boy who is brought to the emergency department by his parents for a cough and shortness of breath. He has a past medical history of eczema and seasonal rhinitis. On physical exam, you note a young boy in respiratory distress taking deep slow breaths to try and catch his breath. He has diminished breath sounds in all lung fields with prolonged, expiratory wheezes.

asthma

chronic, reversible inflammatory airway disease with recurrent attacks of breathlessness and wheezing

asthma

5-year-old child presents with an occipital headache, an ataxic gait, nystagmus, and papilledema

astrocytoma

Most common PRIMARY childhood CNS tumors that develop from

astrocytoma

Most patients have symptoms consistent with increased intracranial pressure (eg, morning headaches, vomiting, lethargy)

astrocytoma

adducting the hip while holding the knee straight, and when this pops the femoral head out of the socket, this raises suspicion of hip dysplasia

barlow

Insidious onset of a dull ache or throbbing localized to the groin, lateral hip, or buttocks

avascular nec of hip

hirschsprung sx

baby's inability to pass meconium, 48 hours postpartum Other clinical features include constipation, vomiting, and abdominal distension

will present with purulent (yellow) discharge from both eyes ("glued shut"), crusting, usually worse in the morning; May be unilateral S. pneumonia, S. aureus (common) - acute mucopurulent M. catarrhalis, Gonococcal - copious purulent discharge, in a patient who is not responding to conventional treatment Chlamydia- newborn, Giemsa stain - inclusion body, scant mucopurulent discharge

bac conj

fever, dyspnea, tachycardia, tachypnea, cough, +/- sputum

bac pna

If the stool is bloody, the cause is

bacterial

haptoglobin

binds free hemoglobin

Von Willebrand disease

bleeding disorder caused by a deficiency of von Willebrand factor, a "sticky" protein that lines blood vessels and reacts with platelets to form a plug that leads to clot formation bleed more

9-month old infant presents with a three-day history of a mild respiratory tract infection with serous nasal discharge, fever of 38.5 C (101.4 F), and decreased appetite. Physical exam reveals a tachypneic infant with audible wheezing and a respiratory rate of 65. Flaring of the alae nasi, use of accessory muscles, and subcostal and intercostal retractions are noted. Expiratory wheezes are present.

bronchiolitis

NHL tx

chemotherapy and radiation therapy Depends on subtype, aggressiveness and spreading Worse prognosis than Hodgkin lymphoma

dx of HL

chest radiograph should be obtained to search for mediastinal adenopathy. Diagnose with excisional biopsy of lymph node, may need bone marrow CBC normal, elevated ESR CXR - mediastinal mass (adenopathy) CT scan to establish the stage Excisional biopsy of the lymph node shows Reed-Sternberg cellsReed-Sternberg Cells are pathognomonic - B cells fused together forming a large cell with two nuclei "owl eye"

whiteheads) complete blockage

closed comedones

A genetic chromosome 21 disorder causing developmental and intellectual delays

down syndrome

Rule of 3's ⇒ cry > 3 hrs/day, 3 d/wk, for 3 weeks

colic

Severe and paroxysmal crying in the late afternoon to evening Unexplained paroxysms of irritability, fussing, crying that may develop into agonized screaming, an infant may draw up knees against the abdomen Peaks 2-3 months, ends around 4 months Very common, cause unknown

colic

A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated

conduct disorde

Osgood-Schlatter disease tx

consists of reducing physical activity, applying ice to the tuberosity to reduce swelling, physical therapy, as well as short term NSAIDs Surgery (ossicle resection, excision of tibial tuberosity) is indicated if everything fails, for individuals with closed growth platesMight be necessary for persisting pain, especially if fragmented bones have avulsed off, and get trapped within the patella ligament

rubella tx

consists of supportive care. No specific therapy for rubella infection is available. MMR vaccine (12-15mo, 4-6yr)

Most common chromosomal disorder and cause of mental retardation

down syndrome

a 2-year-old boy who is brought to you by his father who is concerned about a "barking cough," mild fever, and a hoarse voice. He reports that he had a runny nose last week that has since resolved. Physical exam reveals inspiratory stridor. AP neck film is shown here.

croup

infection of the upper airway, which obstructs breathing and causes a characteristic barking cough

croup

Passage of intestine through the external inguinal ring at Hesselbach triangle, rarely enters the scrotum

direct hernia

ortolani

done and this consists of flexing the baby's hip at 90° and then gently abducting it. This causes a reduction of the hip dislocation (CLICK auscultated)

Microcephaly, flat occiput, flattened face; epicanthal folds; flat nasal bridge; upward-slanting palpebral fissures; small nose/mouth; protuberant tongue; low-set/small ears; short neck, excessive nuchal skin; Brushfield spots (small white/grayish spots on periphery of iris); shortened extremities; big gap between first toe (hallux)

down sydrome

congenital absence or complete closure of a portion of the lumen of the duodenum.

duodenal atresia

The 3rd most common CNS tumor in children (after astrocytomas and medulloblastomas), representing 10% of pediatric brain tumors

ependyoma

Supraglottic inflammation and obstruction of airway due to infection with Haemophilus influenzae type B (Hib) This is a medical emergency Caused by Hib - usually unvaccinated children (Hib vaccine at 2, 4, 6, 12-15 mo) or underserved areas Stridor, restlessness, cough, dyspnea, fever, dysphagia, drooling, respiratory distress (tripod / "sniffing dog" posture - neck extended)

epiglottitis

Parvovirus B19 - "slapped cheek" rash on face - lacy reticular rash on extremities, spares palms and soles

erythema infectiosum

a 12-year-old boy who presents with some non-itchy maculopapular rash that looks like targets. He stated that a week ago, he was treated for an HSV infection. On PE, you note a symmetrical red rash with 3 areas of concentricity which are red, white & purplish in color respectively.

erythema multiforme

acute, self-limited, and sometimes recurring skin condition that is considered to be a type IV hypersensitivity reaction affecting the skin and mucous membranes

erythema multiforme

Pain often accompanied by fever, often mimics an infection. May have palpable mass, swelling, and local tenderness

ewings

appears as a lytic lesion with an onion-skin appearance of the periosteum

ewings

Convulsion associated with an elevated temperature greater than 38° (100.4 F)

febrile sz

Erythema of involved tissue, skin blanches with pressure, the skin may be tender

first deg burn

OM tx

first-line amoxicillin, augmentin = 2nd line (PCN allergy = azithromycin, erythromycin, Bactrim) Treat < 2 y for 10 days and > 2 y for 5-7 days Recurrent: tympanostomy, tympanocentesis, myringotomy Complications: Mastoiditis and bullous myringitis

viral respiratory infection caused by orthomyxovirus resulting in fever, coryza, cough, headache, and malaise

flu

This type of focal seizure was previously known as a simple partial seizure No alteration in consciousness. Abnormal movements or sensations

focal sz w retained awareness

This type of focal seizure may also be called a focal dyscognitive seizure (previously known as complex partial seizures) Altered consciousness, automatisms (ie. Lip-smacking) Present with a postictal state (confusion and loss of memory) which differentiate them from absence seizures

focal sz with loss of awareness

infectious diarrhea, is inflammation of the gastrointestinal tract that involves the stomach and small intestine

gastroenteritis

inflammation of the glomerular basement membrane

glomerularnephritis

(+) anti-GBM antibodies, dx linear IgG deposits, treat with high dose steroids, plasmapheresis + cyclophosphamide

goodpastures

Most cases of hyperthyroidism in children are caused by

graves

turner syndrome tx

growth hormone therapy and sex hormone replacement therapy

The most common cause of juvenile or acquired hypothyroidism is

hashimotos

Children can also develop a hemarthrosis once they start walking and falling

hemophilia

The bleeding patterns and consequences of these two types of hemophilia are similar ⇒ hemarthrosis, bruising, and bleeding

hemophilia

Identified via tzanck smear with visualization of multinucleated giant cells

herpes zoster

congenital aganglionic bowel disease, is caused by a lack of caudal migration of the ganglion cells from the neural crest. It produces contraction of a distal segment of colon, causing obstruction with proximal dilatation.

hirschsprung

tumor derived from lymphocytes - specifically B-cells which mainly reside in lymph nodes

hodgkin lymphoma

a premature infant who is born at 30 weeks and after several hours develops rapid shallow respirations at 60/ min, grunting retractions, and duskiness of the skin. The chest X-ray reveals diffuse bilateral atelectasis, ground glass appearance, and air bronchograms

hyaline membrane disease

affects premature infants. It occurs when infants are born before the lungs are producing adequate amounts of surfactant. Surfactant helps to prevent the lungs from collapsing. As the airways collapse, infants will struggle more and more to breathe until they become acidotic and multisystem organ failure begins

hyaline membrane disease

most common cause of respiratory disease in the preterm infant

hyaline membrane disease

collection of fluid around the testicle or along the spermatic cord leading to a non-tender fluid-filled (cystic) mass

hydrocele

voracious appetite (without weight gain or with weight loss), heat intolerance, emotional lability, restlessness, excessive sweating, frequent loose stools, and poor sleep

hyperthyroid

(more common than epispadias) is when the urethra opens onto the bottom (underside) of the penile shaft

hypospadias

phimosis

inability to retract the foreskin Usually resolves by age five Unable to retract the foreskin More chronic than paraphimosis Treat with betamethasone topically, if no improvement circumcision

DTaP type

inactivated

kawasaki tx

includes both intravenous immunoglobulin (IVIG) and aspirin

(Most Common): Passage of intestine through the internal inguinal ring down the inguinal canal, may pass into the scrotum. Often congenital and will present before age one Remember: Indirect goes through the Internal Inguinal

indirect hernia

MCC erythema multiforme

infection, herpes simplex, mycoplasma pneumonia, upper respiratory infections.

epi tx

intubating if necessary, supportive care, ceftriaxone, may treat as an outpatient if stable

telescoping or invagination of a more proximal portion of the intestine into a more distal portion

intussusception

low ferritin, low serum Fe, high TIBC

iron def

tinea versicolor

is caused by Malassezia furfur, a yeast found on the skin of humans. Lesions consist of hypo or hyperpigmented macules that do not tanTX: selenium sulfide 2.5% applied to the affected skin for 10 minutesWash off thoroughly. Apply daily for 7-10 days. Monthly applications may help prevent recurrences *Nystatin is not effective for dermatophyte infections

Lasting fever usually is the first sign. The condition most often affects kids younger than 5 years old and boys

kawasaki

vasculitis mostly affecting children where the immune system attacks arteries, damaging endothelial cells of blood vessels

kawasaki

viral pna

kids ⇒ RSV; comes on fast; adults ⇒ flu = MC cause Dx: CXR = bilateral interstitial infiltratesRapid antigen testing for flu, RSV nasal swab, cold agglutinin titer negative Tx: flu with Tamiflu (A and B) if sx's began < 48 hrs; symptomatic tx = beta 2 agonists, fluids, rest

low MCV, basophilic stippling, increased free erythrocyte porphyrins

lead

most common environmental illness of children in the United States.

lead poisoning

accounts for the greatest percentage of cases of childhood malignancies

leukemia

chronic papulosquamous inflammatory dermatosis of unknown etiology, probably autoimmune in origin

lichen planus

OS tx

limb-sparing resection or radical amputation - 76% long-term survival with modern treatment

pertussis tx

macrolide (clarithromycin/azithromycin); supportive care with steroids / beta2 agonists Vaccination: 5 doses - 2, 4, 6, 15-18 mo, 4-6yrs (DTap) 11-18 yo = 1 dose Tdap Expectant mothers should get Tdap during each pregnancy, usually at 27-36 weeks

Suppurative infection of mastoid air cell ⇒ usually a complication of acute otitis media Organisms: S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus, S. pyogenes Fever, otalgia, pain, erythema posterior to ear and forward displacement of the external ear

mastoiditis

The 4 C's - cough, coryza, conjunctivitis, and cephalocaudal spread

measles

paramyxovirus and is transmitted by respiratory droplets, it has a 10-12 day incubation period. It progresses in three phases characterized by a prodrome, enanthem, and exanthem.

measles

Most common MALIGNANT posterior fossa tumor in children and represents about 20% of all pediatric CNS cancers

medulloblastoma

Kernig sign (watch video) - knee extension causes pain in the neck Brudzinski sign (watch video) - leg raise when bend neck

meningitis

Unlike encephalitis no mental status changes

meningitis

classic triad of headache, fever and a stiff neck (nuchal rigidity)

meningitis

inflammation of the membranes (meninges) surrounding the brain and spinal cord

meningitis

classic triad of fever + lymphadenopathy + pharyngitis

mono

21-year-old male with a 2-day history of malaise and low-grade fever; develops swelling in the lower face bilaterally with the right side more pronounced. He now has a red, swollen duct on the inside of his right lateral mouth.

mumps

viral disease that is part of the paramyxovirus family. It presents with parotitis (painful parotid gland swelling), orchitis, or aseptic meningitis. It is transmitted through respiratory droplets and has an incubation period of 12-14 days

mumps

pertussis dx

nasopharyngeal swab

tx hernia

ndirect inguinal hernia: Management includes referral for elective repairOptimal timing is debatable: a waiting time less than 14 days is advisable for asymptomatic inguinal hernias in this pediatric age groupAn emergent referral is necessary if evidence of bowel incarceration is noted (erythema of overlying skin, pain, and tenderness) Direct inguinal hernia (asymptomatic) monitor, surgical repair if preferred

4-week old baby boy brought in by mother with c/o of a red rash on the sides of his face. She states that the rash has been present for a week now. It does not appear to itch at this time. On PE, you note comedones, papules on the lateral aspect of his face.

neonatal acne

idiopathic hepatic inflammation during the neonatal period. It is a diagnosis of exclusion and is the most common cause of cholestasis in the newborn.

neonatal hepatitis

ANC < 1000 Fever is the earliest and only sign Hx of chemotherapy treatment

neutropenia

The "4 Ds" serves as a mnemonic for the manifestations of Dermatitis ⇒ Photosensitive, pigmented Diarrhea ⇒ Potentially also vomiting Dementia ⇒ Potentially also anxiety, disorientation Death ⇒ Untreated pellagra potentially fatal

niacin deficiency

dislocation of the elbow joint caused by a sudden pull on the extended pronated forearm, such as by an adult tugging on an uncooperative child or by swinging the child by the arms during play. The technical term for the injury is radial head subluxation.

nursemaid elbow

most common form and usually affects young girls. It is characterized by the involvement of ≤ 4 joints during the first 6 mo of disease.

oligoarticular

(blackheads) incomplete blockage,

open comedones

inflammation of the patellar ligament, right at the point where it inserts on the tibial tuberosity, resulting in painful swelling just below the knee

osgood schlatter

Benign chondrogenic lesion derived from aberrant cartilage - the most common benign bone tumor mostly in males ages 10-20 years old

osteochondroma

Progressively worsening night pain, bone pain/joint swelling - may look similar to growing pains and can be easily missed

osteosarcoma

dx of OM

otoscopic ⇒ bulging, loss of landmarks, redness, TM injection A key finding is limited mobility of the TM with pneumotoscopy

pna tx

outpatient = doxy, macrolides; inpatient = ceftriaxone + azithromycin/respiratory FQs

One of the most common causes of GERD is

overfeeding

characterized by recurrent, unexpected panic attacks with at least a month or more of worry or avoidant behavior. Panic disorder can occur with or without agoraphobia. Symptoms develop abruptly and reach a peak within 10 minutes.

panic disorder

tinea barbae

papules pustules, around hair follicles TX: Oral antifungal therapy is necessary - two- to four-week course of griseofulvin microsize (500 mg per day) or oral terbinafine (250 mg per day). Itraconazole and fluconazole are also effective for dermatophyte folliculitis.

inability to return the foreskin to normal position

paraphimosis

pna dx

patchy, segmental lobar, multilobar consolidation Blood cultures x 2, sputum gram stain

shows symptoms or signs of a serious illness, or if total bilirubin rises faster than 0.2 mg/dL per hour or 5 mg/dl per day or becomes greater than 18/mg/dl or lasts more than 1 week in term infants or 2 weeks in preterm infants

path jaundice

highly contagious respiratory tract infection marked by a severe hacking cough followed by a high-pitched intake of breath that sounds like a whoop. Gram-negative bacteria Bordetella pertussis - high contagious

pertussis

symptoms begin 10-15 minutes prior to stress event except in this case it is a specific stress event (i.e flying, blood, social situations, spiders etc. etc.)

phobia

no symptoms or signs of a serious illness and the total bilirubin rises slower than 0.2 mg/dL per hour or 5 mg/dl per day, remains lower than 18/mg/dl, and resolves within 1 week in full-term infants or 2 weeks in preterm infants

physiologic jaundice

enterobiasis vermicularis, is a human parasitic disease caused by the pinworm (a type of roundworm). The most common symptom is itching in the anal area. This can make sleeping difficult.

pinworm

occurs in children and young adults. It is characterized by an initial herald patch, followed by the development of a diffuse papulosquamous rash. Pityriasis rosea is easier to identify when the general eruption appears with smaller secondary lesions that follow Langer's lines (cleavage lines) in a Christmas tree-like pattern.

pityriasis rosea

a 15 year-old male was seen last week with complaints of sore throat, headache, and mild cough. A diagnosis of URI was made and supportive treatment was initiated. He returns today with complaints of worsening cough and increasing fatigue. At this time, chest x-ray reveals bilateral hilar infiltrates. A WBC count is normal and a cold hemagglutinin titer is elevated. (mycoplasma pneumonia)

pna

First dose at 2 months Second dose at 4 months Third dose at 6-18 months Fourth dose at 4-6 years

polio inactivated

the second most common form. It affects ≥ 5 joints at onset and is divided into 2 types: RF negative and RF positive. Typically, young girls are RF negative and have a better prognosis. The RF-positive type typically occurs in adolescent girls and is often similar to adult RA. In both types, arthritis tends to be symmetric and frequently involves the small joints.

polyarticular

pain > 3 months, paresthesias or decreased sensation. Treat with gabapentin or TCA, topical lidocaine gel, and capsaicin

postherpetic neuralgia

Group A strep (skin or throat) - 10-14 days after infection - diagnosed with ASO titers and low serum complement - treatment is supportive + antibiotics Group A streptococcal skin infection 3-6 weeks prior Throat infection 1-3 weeks prior Serum C3 and C4 can be ↓ Kidney biopsy not usually necessary

postinfectious GN

formation of a weak platelet plug and causes mucocutaneous bleeding

primary hemostasis

contact wearers

pseudomonas tx=fluoroquinolone (ciprofloxacin / Ciloxan drops)

pylorus undergoes hyperplasia and hypertrophy, leading to obstruction of the pyloric valve which causes vomiting (that might be projectile), as well as dehydration and metabolic alkalosis

pyloric stenosis

PS tx

pyloromyotomy (Ramstedt's procedure)

tx EM

remove the offending agent Mucocutaneous lesionsIV fluids if neededoral compound solution (throat soothie/magic swizzle)systemic steroids for severe (Prednisone 40-60mg) Ocular: immediate referral/consult Recurrent: antiviral QD

tx hirschsprung

resection of the affected segment or colostomy

Patient will present as → a 3-year-old child presents strabismus. His mother notes that sometimes of family photographs it appears that one eye is white while the other is red. Malignancy of the retina of the eye Often presents in children less than 3 years of age Physical exam - leukocoria (absence of red-light reflex)

retinoblastoma

Leading cause of mitral valve stenosis and valve replacement in adults in the United States

rheumatic fever

Typically the disease affects a child between six months and two years of age and begins with a sudden high fever (102-104°). This can cause, in rare cases, febrile convulsions due to the sudden rise in body temperature, but in many cases, the child appears normal

roseola

In children, is the most common cause of severe disease. Norovirus (#1 in adults), adenovirus, enterovirus

rotavirus

"3-day rash" pink light-red spotted maculopapular rash first appears on the face, spreads caudally to the trunk and extremities and becomes generalized within 24 hours (lasts 3 days) Cephalocaudal spread of maculopapular rash, lymphadenopathy (posterior cervical, posterior auricular)

rubella

lateral spinal curvature with a Cobb angle of 10° or more

scoliosis

problems with coagulation factors and causes deep tissue bleeding

secondary hemostasis

epi dx

secure airway then culture for H.flu The classic finding is thumbprint sign on x-ray lateral neck film from swelling

vit d def dx

serum 25OHD levels recommended in certain high-risk populations <12 ng/mL

vit a def dx

serum retinol levels

high ferritin, high serum Fe, low TIBC

sideroblastic

mastoiditis tx

simple = oral antibiotics; IV antibiotics (ceftriaxone) ENT referral in more serious cases or pt with unreliable follow up Drainage of middle ear fluid

urticaria

skin rash triggered by a reaction to certain foods, medications, stress, or other irritants Symptoms include blanchable, pruritic, raised, red, or skin-colored papules, wheels, or plaques on the skin's surface; usually, disappear within 24 hours (+) Darier's sign: localized urticaria appearing where the skin is rubbed (histamine release) Angioedema: painless, deeper form of urticaria affecting the lips, tongue, eyelids hand, and genital

8th leading cause of death in the United States and the second leading cause of death in ages 15-19 years

suicide

Atypical Mycobacterial infections in children are most frequently located in

superior anterior cervical or in submandibular nodes

Superficial fungal infections (not candidal) of the skin, hair, and nails are characterized by erythema, scaling, changes in color, and pruritus. Risk factors include increased skin moisture, immunodeficiency (HIV, DM) peripheral vascular disease.

tinea

single epileptic seizure lasting more than five minutes or two or more seizures within a five-minute period without the person returning to normal between them

status epilepticus

SJS tx

stop all offending medications, early admission to burn unit, manage fluid/electrolytes/nutrition, airway stability, eye care IVIG Steroids used to be tx of choice but now thought to increase risk of sepsis

ferritin

storage form of iron

measles tx

supportive with anti-inflammatories Patients must be isolated for 1 week after onset of rash Otitis media, pneumonia, diarrhea and encephalitis are known complications of rubeola. Vaccination is highly effective: Administer a 2-dose series of MMR vaccine at ages 12 through 15 months and 4 through 6 years. The second dose may be administered before age 4 years, provided at least 4 weeks have elapsed since the first dose

is recommended for all children with primary hyperparathyroidism

surgery

Caused by a twisting of the testicle around the cord supplying blood to the scrotum

test torsion

Bilaterally symmetric and without focal onset Begins with a sudden loss of consciousness—a fall to the ground Tonic phase: very stiff and rigid 10-60 seconds. Clonic phase: generalized convulsions and limb jerking Postictal phase: a confused state

tonic clonic sz

Extreme rigidity then immediate LOC, but not followed by a clonic phase

tonic sz

The most common cause of primary amenorrhea (uterus present)

turner

genetic disorder caused by a missing X chromosome in females (45XO)

turner

B3 def dx

urinary N-methylnicotinamide or by measuring the erythrocyte NAD: NADP (ratio).

NHL dx

usually NO Reed-Sternberg cells Imagin studies ⇒ CT scan to help establish the stage based on extent of nodal and extranodal involvement Lymph node biopsy

Dewdrops on a rose petal in different stages It starts on the face and spreads down Acutely causes chickenpox - becomes latent in the dorsal root ganglion Symptomatic treatment may use acyclovir in special populations

varicella

clusters of vesicles on an erythematous base.

varicella

acute onset unilateral or bilateral erythema of conjunctiva, copious watery discharge, tender preauricular lymphadenopathy, scant mucoid discharge MC caused by adenovirus; highly contagious, transmission via direct contact/swimming pools

viral conj

Deficiency impairs immunity and hematopoiesis and causes rashes (dry skin) and typical ocular effects (eg, xerophthalmia (dry eyes), night blindness)

vit a

deficiency is responsible for scurvy

vit c

causes rickets in infants and children, and osteomalacia in all age groups

vit d def

common in dark skin pigmentation and those who are exclusively breastfed beyond three to six months of age

vit d def

vit c def tx

vitamin C supplementation and reversal of the conditions that led to the deficiency For children, recommended doses are 100 mg ascorbic acid given three times daily (orally, intramuscularly or intravenously) for one week, then once daily for several weeks until the patient is fully recovered

varicella reactivation causing a maculopapular rash along one dermatome

zoster

shingles involving CCN V, dendritic lesions on slit lamp exam if keratoconjunctivitis is present

zoster opthalmicus

hemophilia dx

↑ PTT, normal PT, and platelets, with ↓ Factor VIII or IX on assay ↑ PTT and normal platelet count and functionCorrected with mixing studies ⇒ indicates a factor deficiencyIf PTT does not correct with mixing studies indicates lupus anticoagulant or factor inhibitor Normal PT Normal bleeding time Most specific test: Functional assay for factor VIII (Hemophilia A) or IX (Hemophilia B) to confirm the diagnosis of hemophilia and determine its type and severity

bacterial LP

↑ Protein ↓ Glucose (bacteria love to eat glucose)

dx hypothyroid

↓ T4 and ↓ T3 ↑ TSH in primary hypothyroidism If secondary hypothyroidism is present, the TSH level may be depressed, normal, or elevated Palpation of thyroid nodule should prompt evaluation with a thyroid scan