Pediatrics EORE

major depressive disorder def

5 or more SIEGECAPS for ≥ 2 weeks nearly every day and at least one of the symptoms is depressed mood or anhedonia

1) prone sleeping position 2) maternal smoking 3) overheating 4) late or no prenatal care 5) young maternal age 6) preterm birth 7) male gender 8) sleeping on a soft surface

8 major risk factors for SIDS

normocytic non-hemolytic anemia causes

-iron deficiency -anemia of chronic disease -chronic kidney disease -aplastic anemia

Ortolani test

1. hips and knees flexed to 90º 2. adduction 3. push thigh anterior to place back in acetabulum 4. clunk sound = postive B comes before O once we have been out, we come back home

Oppositional defiant disorder

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. -Frequent temper tantrums -Arguments with adults and authority figures. -Does not conform to rules and regulation -Intentional exasperation of others -Easily annoyed by others. -Revenge-seeking & vindictiveness -Angry attitude -Harsh and unkind. 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.

9 months to 5 years

AAP recommends A.G regarding discipline at every visit between?

drowning, burns, poisonings

After MVA as leading cause of injury death what is next?

diabetes mellitus tx

As a general goal for glycemic control, we suggest a target glycated hemoglobin (A1C) of <7.5 percent for children and adolescents • Intensive insulin therapy combines the administration of a basal level of insulin together with premeal boluses of rapid-acting insulin --Multiple 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 snack --Insulin 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)

benign, recurring condition of childhood in which anger/pain produce crying that culminates in noiseless expiration and apnea

Breath-holding spells

Neutropenia dx

CBC, CMP, blood culture, UA CXR, CT/US, LP

niacin RDA

Children 9-13: 12mg 19+ male: 16mg; 19+ female: 14mg Pregnancy: 18mg Lactation: 14mg

diarrhea in poorly canned home foods

Clostridium perfringens

if normocytic follow with

Coombs test, iron studies, bilirubin

fungal meningitis etiologies

Cryptococcus neoformans is a common fungal form of the disease that affects people with immune deficiencies, such as AIDS (Diagnosis: India ink stain)

Tetrology of Fallot sx

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

testicular torsion dx

Diagnose with ultrasound and radionuclide study (gold standard)

androgenic alopecia def

Gradual conversion of terminal hairs → indeterminate → vellus hair • Genetic predisposition (androgen) • M 20-40 y/o, W: MC after 50 • Men > Women (MC in white men)

acne vulgaris dx

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 Differentiate by the presence of comedones: --Open comedones (blackheads) incomplete blockage, closed comedones (whiteheads) complete blockage

if foreign body is distal to esophagus (stomach most commonly)

If symptomatic remove immediately with endoscopy • Asymptomatic --Small blunt object - follow with serial radiographs; remove endoscopically if does not advance past pylorus in 3-4 weeks --Large object (> 3 cm) - beyond pylorus then monitor with serial imaging; in the stomach then remove endoscopically --Sharp object - before pylorus then remove endoscopically; beyond pylorus monitor with serial imaging and remove if no progress for 3 days

2-3x the national average

Incidence of SIDS in AA and Am Indian children?

Kawasaki Disease tx

Intravenous Immunoglobulin (IVIG) and aspirin • self-limitied and resolves in 6-8 weeks with or without tx but 25% risk of heart complications if left untreated

8-12 years old

Lap and shoulder safety belt in back seat

indirect inguinal hernia

MC passage of intesting through the internal inguinal ring down to the inguinal canal, may pass into the scrotum. often congenital and will present before age one

respiratory syncytial virus

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 • 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

diabetes mellitus def

MC endocrine disease in childhood, occuring in 1 in 500 children and adolescents • The main risk factor is family history - first-degree relative, presence of DR3 and DR4 major histocompatibility antigens • History of new-onset weight loss, polydipsia, polyphagia, and polyuria • The physical exam is generally normal in type 1 DM unless DKA is present • The child with DKA appears acutely ill and suffers from moderate to profound dehydration. Symptoms include polyuria, polydipsia, fatigue, headache, nausea, emesis, and abdominal pain. On PE, tachycardia, and hyperpnea (Kussmaul respirations), fruity odor to the breath due to ketosis

retinoblastoma def

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)

Bacterial meningitis etiologies

Neonate: E. coli (gram-negative rods) and S. agalactiae (Group B Streptococcus) Most people: S. pneumoniae (gram-positive diplococci), N. meningitidis (gram-negative diplococci):

niacin deficiency tx

Niacin replacement RDA for niacin is 6 to 12 mg daily in children, 16 mg for adult males, and 14 mg daily for nonpregnant adult females

11-14 hours per day

Optimal sleep time for 1-2 years

20-30 minutes

Parents who co-sleep often need to lay with child ________ to get them to fall asleep

direct inguinal hernia

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

Anticoagulant medications

Patients bleeding from warfarin have a prolonged PT and normal aPTT (Warfarin typically prolongs the PT alone, but at high levels warfarin can prolong both tests) Patients bleeding from heparin have a prolonged aPTT and normal PT

Down's syndrome tx

Prenatal genetic counseling; Supportive management of affected body systems

if macrocytic follow with

RBC folate serum B12

panic disorder tx

SSRIs: Paroxetine, Sertraline, Fluoxetine Benzodiazepines: for acute attacks (watch for abuse) CBT (relaxation, desensitization, examining behavior consequences)

false

T/F: it's okay to do bed sharing with young infants

Conduct disorder tx

The most effective treatment for an individual with conduct disorder is one that seeks to integrate individual, school, and family settings. Additionally, treatment should also seek to address familial conflicts such as marital discord or maternal depression

tinea cruris tx

Topical antifungals - azoles (1% clotrimazole, 2% ketoconazole), allylamines, butenafine, ciclopirox, and tolnaftate is effective. Nystatin is not effective for dermatophyte infections.

tinea pedis tx

Topical antifungals - azoles (1% clotrimazole, 2% ketoconazole), allylamines, butenafine, ciclopirox, tolnaftate, and amorolfine

tinea corporis tx

Topical azole antifungals (1% clotrimazole, 2% ketoconazole) or 1% terbinafine cream applied twice daily for 2-4 weeks.

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 Conductive loss: hear in BAD ear senorineural loss: hear in GOOD ear

cryptorchidism dx

US may be helpful in identifying undecended testicles in abdominal space

Once your baby is strong enough to roll from back to front and front to back by himself, you don't need to worry about him rolling onto his stomach during sleep. But you should still put him down to sleep on his back until he is a year old.

Up to what age must an infant be placed on his/her back to sleep?

Kawasaki disease def

a vasculitis mostly affecting children where the immune system attacks arteries, damaging endothelial cells of blood vessels Lasting fever usually is the first sign. The condition most often affects kids younger than 5 years old and boys

encopresis sx and dx

abdominal pain, fecal mass dilated rectum packed with stool urinary frequency rectal exam, KUB xray

encopresis tx

acute • peg/miralax • glycerin suppository for infants up to 3d chronic • elimination of all cow's milk 1-2 wk trial • maintenance laxatives for 6 mo-1 yr • high fiber diet and increase fluids • toilet sitting same times 5-10 min after meals

phimosis def

an inability to retract the foreskin Usually resolves by age five Unable to retract the foreskin More chronic than paraphimosis

influenze vaccine dosing

annually ≥6 months of age intramuscular vaccine is inactivated, intranasal is live-attenuated

strabismus def

any form of ocular misalignment exotropia--outturning of eyes esotropia--in-turning of eyes

cardiac syncope

arrhythmias (i.e. AV blcok, sick sinus syndrome), obstruction of blood flow (i.e. aortic stenosis, hypertrophic cardiomyopathy, massive MI

mycobacteria kansasii

causes tuberculosis-like disease tx with rifampin + ethambutol

verruca vulgaris

common warts skin colored papillomatous papules

hemophilia

deficiencies of coagulation factors • Hemophilia A and B are X-linked recessive disorders, so they almost exclusively affect males, and lead to deficiencies in factors 8 and factor 9, respectively • Typically there's a prolonged aPTT, with a normal PT and platelet count • Infant males often develop excessive bleeding from circumcision or can develop a cephalohematoma which is bleeding under the scalp due to trauma from the delivery • Children can also develop a hemarthrosis once they start walking and falling • Repeated episodes of hemarthrosis can cause the joint to deform, severely restricting the range of motion and causing chronic pain

four Ds of niacin deficience

dermatitis-->photosensitive, pigmented diarrhea--> potentially also vomiting dementia--> potentially anxiety, disorientation death--> untreated pellagra potentially fatal

if microcytic follow with

ferritin, iron, TIBC

syncope tx

fix the underlying cause

verruca plana

flat warts hands, face, arms, legs

viral pneumonia tx

flu with Tamiflu (A and B) if sx's began < 48 hrs; symptomatic tx = beta 2 agonists, fluids, rest

atonic seizures

formerly known as drop attackes • looks like syncope, sudden loss of muscle tone

Tinea unguium (dermatophyte onychomycosis) def

fungal infection of the nail

hypertrophic cardiomyopathy def

general condition is autosomal dominant • most common cause of sudden death in young athletes • 2.8 times more common in athletes vs. non athletes • Marfan's syndrome

impetigo dx

gram stain and culture, (-) Nikolsky

Turner Syndrome tx

growth hormone therapy and sex hormone replacement therapy

siderblastic anemia labs

high ferritin, high serum Fe, low TIBC

measles vaccination

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

patent ductus arteriosus tx

indomethacin

ventricular septal defect tx

most close by age 6, surgery if large

erythema multiforme major and minor forms

now regarded as distinct from Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) Major: causes widespread skin lesions and affects 2 + mucosal sites Minor: affects a limited region of the skin and 1 type of mucosa (usually oral)

diarrhea breakout at daycare center

rotavirus

diarrhea from poultry or pork

salmonella

croup tx

supportive (air humifier), antipyretics severe:IV fluids and nebulized racemic epinephrine, steroids

strabismus dx

the cover/uncover test • cover: cover one, observe other--(+) uncovered eye shifts to re-fixate • cover/uncover: (+) deviated affected eye

rotavirus vaccine dosing

three doses 1. 2 months 2. 4 months 3. 6 months

rubella (German measles)

• "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)

causes of decreased clotting factors

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

febrile seizure 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 minutes --Terminate status epilepticus with benzo or phenytoin --Initiate status epilepticus protocol if continues • Rarely develops into epilepsy • Monitor complex febrile seizures as more likely to recur

focal seizures with retained awareness (consciousness maintained)

• previously known as simple partial seizure • no alteration in consciousness. abnormal movements or sensations

rubella def

"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

1) Acute illness 2) Seperation anxiety (9-18 months) 3) Nightmares 4) Night Terrors

"He was sleeping through the night, now he wakes-up screaming" ddx

tinea cruris def

"jock itch" diffusely red rash in the groin or on the scrotum

pinworm dx

"scotch tape test' done in the early morning. Can see the eggs under microscopy

bacterial otitis externa def

"swimmers ear" • ear pain (especially with movement of the tragus or auricle), pain with eating, purulent cheesy white discharge, palpation of the tragus is painful • tuning fork --> bone>air conduction • pseudomonas aeruginosa (swimmers ear), s. aureus (digital trauma) • malignant otitis externa is commonly seen in diabetics

osteosarcoma

(kids 10-14 years) Progressively worsening night pain, bone pain/joint swelling - may look similar to growing pains and can be easily missed • X-ray: sun ray/burst or hair on end appearance followed by bone scan look for metastasis • 90% occur in metaphysis (distal femur MC) • Lung is the most common site of metastasis, followed by bone • Treat with limb-sparing resection or radical amputation - 76% long-term survival with modern treatment

hypospadias def

(more common than epispadias) is when the urethra opens onto the bottom (underside) of the penile shaft • The position of the urethral meatus defines the type of hypospadias • Glandular - head of the penis (lease severe) • Midshaft - middle of the penis • Penile/scrotal - where the penis and scrotum come together (most severe)

contact dermatitis dx

*History and physical, conduct patch testing to verify Allergy referral Skin prick tests NOT used for contact dermatitis

suicide risk factor

--Mental disorders (e.g. major depression, substance use disorders, or psychotic disorders) --Previous suicide attempt --Gay, lesbian, or bisexual orientation, or transgender or gender non-conforming identity --History of physical or sexual abuse --Family history of suicidal behavior

constipation tx

-Schedule time between classes, increase fiber to 11-24 g/day ⇒ wheat, fruits, veggies, fluids -Decreased cow's 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

osteochondroma

10-20 years • Benign chondrogenic lesion derived from aberrant cartilage - the most common benign bone tumor mostly in males ages 10-20 years old • X-ray: sessile (broad base) or pedunculated (narrow stalk) lesions found on the surface of bones • Treat with observation, resection if it becomes painful

Attention deficit/hyperactivity disorder (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 reuptake inhibitor (non-stimulant) 2nd line/adjuncts • Antidepressants (guanfacine, clonidine, imipramine, bupropion, venlafaxine) • Behavior modification, family, educational management

measles exanthem

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

1) Normal 2) Excessive dt distress/disease 3) Excessive w/o apparant cause

3 categories of crying

all exclusively breastfed infants should receive ___ IU daily of vitamin D supplements, beginning within a few days after birth

400 IU vit D

measles enanthem

48 hours prior to exanthem--koplik spots-irregularly shaped, bright red spots often with a bluish-white central dot in the mouth

1) problems of daily routine 2) aggressive resistance behavior 3) Overdependent or withdrawal behavior 4) hyperactivity or excessive restlessness 5) Undesirable habits

5 Categories of problem behaviors

Major depressive disorder

5 or more SIGECAPS for ≥2 weeks nearly every day and at least one symptom is depressed mood or anhedonia

children 1-18 should have ___ IU of vitamin D daily

600

suicide def

8th leading cause of death in the US and seconds leading cause of death ages 15-19 year --in all age groups, male deaths by suicide outnumber female deaths 4 to 1 --Women attempt suicide 2 to 3 times more often than men; among girls aged 15 to 19 yr, there may be 100 attempts to every 1 attempt among boys of the same age --3 percent of adolescents in the United States planned a suicide attempt in the previous year and 8 percent attempted suicide --On average, primary care physicians encounter ≥ 6 potentially suicidal people in their practice each year. --About 77% of people who die by suicide were seen by a medical practitioner within 1 yr before killing themselves, and about 32% had been under the care of a mental health care practitioner during the preceding year.

congenital hip dysplasia tx

< 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

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. One (or more) of the following symptoms must be present: • Marked affective lability (e.g., mood swings; feeling suddenly sad or tearful, or increased sensitivity to rejection). • Marked irritability or anger or increased interpersonal conflicts. • Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts. • Marked anxiety, tension, and/or feelings of being keyed up or on edge. One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from above. • Decreased interest in usual activities (e.g., work, school, friends, hobbies). • Subjective difficulty in concentration. • Lethargy, easy fatigability, or marked lack of energy. • Marked change in appetite; overeating; or specific food cravings. • Hypersomnia or insomnia. • A sense of being overwhelmed or out of control. • Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of "bloating," or weight gain.

autism spectrum disorder def

A range of conditions classified as neurodevelopmental disorders Individuals diagnosed with autism spectrum disorder present a developmental delay in socialization, language, and cognition Autism spectrum disorders (ASD) encompasses Autistic disorder ⇒ Disruption of social interaction and language at age 3 or earlier Childhood disintegrative disorder Pervasive developmental disorder-not otherwise specified Asperger disorder ⇒ a child has normal cognitive development, poor relationships and does not spontaneously seek activities with others

toxic epidermal necrolysis (TEN) def

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)

conduct disorder def

A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated Manifested by the presence of at least three of the following 15 criteria in the past 12 months. From any of the categories below with at least one criterion present in the past 6 months. It is often seen as the precursor to antisocial personality disorder, which is per definition not diagnosed until the individual is 18 years old.

contact dermatitis def

A skin rash caused by contact with a certain substance --Acute: erythema, vesicles, bullae burning, itching --Chronic: scaling, lichenification, fissure *well-demarcated border Allergic or irritant etiology --Allergic: Nickel, poison ivy, etc. Type 4 hypersensitivity --Irritant: a direct toxic effect of an offending agent on the skin (cleaners, solvents, detergents, urine, feces)

gastroesophageal reflux disease (GERD) def

A small degree of reflux is common in all infants • Complications include failure to thrive, aspiration pneumonia, esophagitis, choking or apneic episodes, hematemesis, anemia, and fussiness • Incompetence of the esophageal sphincter may be the result of prematurity, esophageal disease, obstructive lung disease, medications, or overeating • One of the most common causes of GERD is overfeeding ⇒ careful history of formula, how it is mixed, how much the infant eats during each feeding, and how often the child is fed • If emesis is independent of meals, it is probably not reflux

leukemia tx

ALL: Chemotherapy Highly responsive to combination chemotherapy with remission of > 90% Stem cell transplant if relapse AML: Combination chemotherapy + bone marrow transplant Tumor lysis syndrome - lethal side effect to chemotherapy initiation - treat with allopurinol and manage acute renal failure

Neutropenia def

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

general principles for managing suicidal children and adolescents with psychotherapy include:

Address family interactions or increase nonfamilial support Provide a sufficient number of treatment sessions Target alcohol and substance abuse when clinically indicated Discuss motivation for treatment Initiate treatment quickly and at a greater intensity when suicidal crises recur Coordinate treatment administered by multiple clinicia

Non-hodgkins T-cell lymphoma

Adult T-cell lymphoma ⇒ sometimes referred to as a leukemia Mycosis fungoides ⇒ T-cell lymphoma of the skin

3 months

After _________ they do not need to eat during the night

obesity dx

All children older than two years should have their BMI calculated at least annually from measured height and weight • The results should be plotted on an appropriate growth curve to determine the BMI percentile and trend • The following definitions are used to categorize weight status for children between 2 and 20 years of age --Underweight - BMI <5th percentile for age and sex. --Normal weight - BMI between the 5th and <85th percentile for age and sex. --Overweight - BMI ≥85th to <95th percentile for age and sex. --Obese - BMI ≥95th percentile for age and sex. --Severe obesity - BMI ≥ 120 percent of the 95th percentile values or a BMI ≥35 kg/m2 (whichever is lower) Labs: lipids, BP, A1C and fasting glucose, ALT between ages 9 and 11 to evaluate for fatty liver disease • Additional testing based on clinical findings may be warranted - PCOS, OSA, Cushings, hypothyroidism

drug eruption def

An adverse cutaneous reaction in response to the administration of a drug; usually within the past 6 weeks • Skin reactions are the most common adverse drug reactions • Severity can range from mild eruptions that resolve after the removal of the inciting agent to severe skin damage with multiorgan involvement • Several drugs have been implicated as causes of drug eruptions. Examples include penicillin such as amoxicillin, ampicillin, Bactrim, allopurinol, NSAIDs, calcium channel blockers, sulfonamides, anticonvulsants, and so on

cystic fibrosis def

An autosomal recessive mutation in the CFTR gene Abnormally thick mucus, difficulty clearing mucus Presentation: Recurrent respiratory infections (especially pseudomonas), steatorrhea

9,143

Annually, about ______ children under 19 die from unintentional injury

6,178,000

Annually, about ________ children under 14 sustained unintentional nonfatal injuries treated in ERs

child abuse and neglect may also manifest with..

Anxiety Aggressive/violent behavior PTSD Depression or suicide Substance abuse Poor self-esteem Dissociative disorders Paranoid ideation Failure to thrive

Child abuse/neglect may also manifest as...

Anxiety, aggressive/violent behavior, PTSD, depression/suicide, substance abuse, poor self esteem, dissociative disorders, paranoid ideation, failure to thrive

No honey until 1 y/o

At what age can a child be given honey

Introduction of solid foods at age 4-months and water and baby food at 6-months

At what age can children be given solid foods

tinea pedis def

Athlete's Foot: pruritic scaly eruptions between toes. Trichophyton rubrum is the most common dermatophyte causing athlete's foot

cystitis def

Bacterial UTIs are a frequent cause of pediatric morbidity • 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

intussusception dx/tx

Barium enema is both diagnostic and therapeutic in children An abdominal x-ray will reveal a "Crescent sign" or a "Bull's eye/target sign/coiled spring lesion" representing layers of the intestine within the abdomen • If the contrast enema fails to reduce the intussusception, or if the child has signs of peritonitis or pneumoperitoneum, an operative reduction is indicated • The risk of recurrence is 5% after contrast reduction and 1% after surgical repair

inguinal hernia dx

Based on history and physical exam • An ultrasound examination may be helpful when the etiology of an acute groin swelling cannot be determined on clinical examination

short stature dx

Because most cases of short stature result from either familial short stature or constitutional delay, diagnosis studies are generally not necessary unless abnormalities are found on the exam • Bone age (AP x-ray of the left wrist) helps delineate familial short stature from constitutional delay --An advanced bone age ⇒ precocious puberty --A normal bone age ⇒ familial short stature --Delayed bone age ⇒ constitutional delay • Thyroid function tests ⇒ rule out hypothyroidism • Urinalysis and renal function tests ⇒ rule out chronic renal disease • CBC and SED rate ⇒ chronic systemic infection • Albumin and total protein to determine the child's nutritional status • IGF-1 and IGF-BP3 to look for GH deficiency • Karyotype ⇒ chromosomal anomaly • MRI of the head ⇒ hypothalamic or pituitary process that is resulting in decreased GH secretion from the pituitary

Start once they've outgrown harness Continue until 4'9" and b/t 8-12 years old

Belt positioned booster seat

status epilepticus tx

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

burn dx

Body percentage: 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

stoves, can't reach handles, electrical outlets, water heater dial chan change to 120 or lower, smoke detectors

Burn prevention for infants and preschoolers

Fall asleep on their own

By 4-6 months, infants should be able to

diarrhea in a patient post abx

C. difficile

HHV 5

CMV (Cytomegalovirus is the most common virus transmitted to a pregnant woman's unborn child) infectious mononucleosis, hepatitis, congenital cytomegalic inclusion disease, hepatitis*, retinitis*, pneumonia*, colitis*

Kawasaki Disease diagnostic criteria

CRASH and burn Conjunctival injection (spares limbus) Rash (all body parts;flakes) Adenopathy (enlarged lymphnodes; cervical) Strawberry tongue Hand and foot rash Burn: fever (5 or more days that doesnt resolve with antipyretics) 25% of patients have cardiac sequelae • coronary artery aneurysm in 25% of patients and may lead to death • myocarditis • myocardial infarction dx with four out of five CRASH sx + high fever lasting 5 days --vasculitis in coronary arteries is a definitice sign --it is possible to have cases that do not meet all clinical dx requirments

orbital cellulitis dx

CT scan of orbits (confirmatory) • focused assessment and extraocular muscles • CBC and blood cultures in some settings

foreign body aspiration dx

CXR (expiratory radiograph) may reveal regional hyperinflation of the affected side if the object if facing you->esophagus if object on side-> trachea --ABG: necessary for appropriately evaluating the ventilation, may be useful for following progression of respiratory failyre when it is of concern

hyaline membrane disease dx

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

car seats: all kids under 4 are in restrained car seat when they fly in an airplane, not to leave kid in a car unattended

Car safety for infants and preschoolers

cystitis tx

Cephalosporin x 14 days are the first-line oral agent in the treatment of UTI in children without genitourinary abnormalities • First-generation cephalosporin (Keflex 50-100 mg/kg BID) for low risk of renal involvement • Second-generation (cefuroxime) or third-gen (cefixime, cefdinir, ceftibuten) for those with a high likelihood of renal involvement • Amoxicillin and ampicillin are not routinely recommended for empiric therapy because of the high rate of resistance of E. coli

conductive hearing loss

Cerumen impaction, otitis externa, exostoses (bony outgrowths of external auditory canal related to exposure to cold water) Tympanic membrane perforation Otitis media, otosclerosis, neoplasms

Attention Deficit/Hyperactivity Disorder (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)

fluid replacement with burn victims

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 bore • Adults: LR 4 ml x wt (kg) x % BSA • Children: LR 3 ml x wt(kg) x % BSA Half is given over the first 8 hours, then 16h

Look for chokable items on the floor, cut their food up really small, no coined hotdogs, hard candies or grapes. Eat only while they are sitting and secure, strings on blinds need to be up, take strings out of hoodies, make plastic bags out of reach, encourage CPR classses

Choking prevention

persistent depressive disorder (dysthymia) def

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

important food sources of vitamin C

Citrus fruits, tomatoes, potatoes, brussels sprouts, cauliflower, broccoli, strawberries, cabbage, and spinach In children, breast milk provides an adequate source of ascorbic acid for newborns and infants.

apnea color change marked change in muscle tone choking/gagging

Clincal presentation of an ALTE

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) • Observation of Koplik's spots is also diagnostic of measles • Laboratory diagnosis of measles can be done with confirmation of positive measles IgM antibodies or isolation of measles virus RNA from respiratory specimens

1) cry/scream-noiseless expiration-turn blue-LOC 2) followed by rhythmic jerking of extremities 3) Total of one minute 4) Usually no post-episode drowsiness 5) Usually several/week

Clinical presentation of breath-holding spells

2-3x more likely

Co-sleeping infants are __________ to wake up at night vs sleeping alone

Unexplained crying/fussiness in infants that usually occurs in the late afternoon/evening

Colic

-change formula -elimination diet -gas drops -tummy massage -regular burping -5 S's

Colic Management

-skin for bruises -palpate long bones -inspect digits and penis for hair tourniquet -retina for hemorrhages -evert eyelides -fluorescein stain -U/A septic work up

Colic work up

suicide tx

Consider referral to emergency services • Crisis service, emergency department • Psychotherapy ⇒ effective options include cognitive-behavioral therapy, dialectical behavior therapy, family therapy, and mentalization-based therapy • The emergent administration of antidepressants has no role in the acute management of the suicidal adolescent or child

febrile seizure

Convulsion associated with an elevated temperature greater than 38° (100.4 F) • Most common seizure in infants and young children ⇒ occurs between 6 months and 5 years of age, with a slight male predominance • Associated with fever (≥ 38°C ) without evidence of CNS infection, afebrile seizure history, or metabolic disturbance

Child abuse and neglect

Deliberate action that is harmful to a child's physical, emotional, or sexual well-being -injury not adequately explained or inconsistent with the history given —bruises/lacerations/soft tissue swelling, dislocations/fractures, spiral fractures —burns (doughnut-shaped, stocking-glove, symmetrically round) —bruises or injuries with regular patterns on the face, back, buttocks, thighs —internal hemorrhages, abd injuries, bite marks, injury with shape of instrument used

child abuse and neglect def

Deliberate action that is harmful to a child's physical, emotional, or sexual well-being Injury not adequately explained or inconsistent with the history given: Bruises/lacerations/soft-tissue swelling, dislocations/fractures, spiral fractures, Burns (doughnut-shaped, stocking-glove, symmetrically round), Bruises or injuries with regular patterns on face, back, buttocks, thighs, Internal hemorrhages, abdominal injuries, bite marks, injury with shape of instrument used

Hodgkin's Lymphoma 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%)

asthma dx

Diagnosis and monitor with peak flow • Spirometry with pre and post-therapy (albuterol inhalation) readings • Decreased 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

CBC to check for anemia Consider EEG/EKG work up

Diagnostics for breath holding spells

atopic dermatitis dx

Diagnostics: History and physical • Conduct patch testing to verify • Allergy referral

syncope dx

ECG, glucose, pulse ox, echo, tilt table, CNS imaging = rare

HHV 4

Ebstein Barr virus commonly known as infectious mononucleosis [mono or grandular fever] Infectious mononucleosis, hepatitis, encephalitis, nasopharyngeal carcinoma, Hodgkin lymphoma, Burkitt lymphoma, lymphoproliferative syndromes*, oral hairy leukoplakia*

5% of all children Most common b/t 12-18 months

Epidemiology of breath-holding spells

Affects 10-20% of infants <3 months/old

Epidemiology of colic

aseptic meningitis tx

Etiology: Enterovirus, HSV, TB, fungus Spinal tap - normal pressure, increased WBC (lymphocytes) Treatment: symptomatic or IV acyclovir for HSV

phobias tx

Exposure therapy (first line), teach to relax and try to understand/overcome the fear SSRI + CBT Benzodiazepines (i.e prior to flying) Treat agoraphobia just as GAD with SSRIs and CBT

tonic seizures

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

prolonged prothrombin time (PT)

Extrinsic and common coagulation pathways Seen in bleeding from warfarin

gates, padding the corner of sharp furniature, not leaving them unattended starting at 4 months, crib railing all the way up, no infant walkers, strap them in cart, tampolines should be enclosed

Fall prevention for infants and preschoolers

make sure they are locked up and ammunition is seperate

Firearm safety

Child abuse and neglect tx

First thing: care for any immediate injuries (i.e. burns, fractures) —it is also the healthcare provider's responsibility to report any suspicion of child abuse to CPS —social worker should be involved to help decide next steps

bulimia nervosa tx

First, you must restore the nutritional state. Fluoxetine 60 mg PO once/day is recommended (this dose is higher than that typically used for depression). SSRIs used alone often reduce the frequency of binge eating and vomiting. Second-line medications: TCAs, MAOIs Behavioral/family/group therapy

Start at 2 or once they've grown out of rear-facing. Continue until they've outgrown it (at least 40-80 lbs)

Forward-facing car seat with harness

gastroenteritis dx

Gastroenteritis is typically diagnosed clinically, based on a person's signs and symptoms ⇒ Determining the exact cause is usually not needed as it does not alter the management of the condition • Stool cultures should be performed in those with blood in the stool, those who might have been exposed to food poisoning, and those who have recently traveled to the developing world • It may also be appropriate in children younger than 5, old people, and those with poor immune function Labs: Electrolytes and kidney function should also be checked when there is a concern about severe dehydration --CBC: WBC, bands --BMP/CMP: CO2, BUN/Cr --Stool: Culture, O&P, virus (GE panel) --UA: dehydration

hyaline membrane disease 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

pneumococcal (PPSV23) vaccine schedule

Given at least 1 year after PCV13 administration in adults ≥ 65 years of age PPSV23 is indicated in patients 19-64 years of age with the following: chronic heart disease (excluding hypertension), chronic liver disease, chronic lung disease, diabetes mellitus, cigarette, smoking, patients ≥ 19 with immunodeficiency disorders, HIV, anatomical or functional asplenia, chronic renal failure or nephrotic syndrome, cerebral spinal fluid leak, cochlear implant PPSV23 is given after PCV13 PPSV23 is not conjugated and does not stimulate a helper T-cell response

diabetes mellitus dx labs

Glucose + A1C Insulin and C-peptide levels - low or inappropriately normal fasting C-peptide and insulin levels with concomitant hyperglycemia • High fasting insulin and C-peptide levels suggest T2DM Insulin, GAD65, and IA-2 antibodies - If one or more of the antibodies is present, and especially if two or more are positive, the patient should be presumed to have type 1 diabetes and should be treated with insulin replacement therapy

acute pharyngotonsillitis tx

Group A Strep: Penicillin is the first line, azithromycin if penicillin-allergic. Complications: Rheumatic fever and post-strep glomerulonephritis Viral: supportive Mononucleosis: Symptomatic and avoid contact sports, antibiotics such as amoxicillin or ampicillin may cause a rashFor athletes planning to resume non-contact sports three weeks from symptom onsetFor strenuous contact sports four weeks after illness onset Fungal: clotrimazole, miconazole, or nystatin Gonorrhea pharyngitis: follows the same principles for the approach to therapy of uncomplicated urogenital gonococcal infections, with a preferred regimen of intramuscular ceftriaxone and azithromycin as a second agent

mycobacterium avium complex (MAC)

HIV patients with CD4 <50 • very common. fever, diarrhea, weight loss, anemia • present in soil and water (not person to person • sx rarely occur in immunocompetent patients (increased in bronchiectasis). • dx with AFB and culture • tx with clarithromycin + ethambutol for at least 12 months (+/-) rifampin • prophylaxis for HIV patients with (azithromycin or clarithromycin) if CD4 < 50

thalassemia labs

HbF increased, low MCV, hemolysis

acute otitis media tx

High dose amoxicillin or Augmentin or cephalosporin (penicillin-allergic) <6 mos and 6 mos or greater in children with high fever, bilateral disease, and severe pain. 6 mos or greater with none of the three symptoms can get analgesia and observation • Azithromycin or clarithromycin in children who have had an immediate hypersensitivity reaction or serious delayed reaction to amoxicillin or other beta-lactam antimicrobial agents • Treat < 2 y for 10 days and > 2 y for 5-7 days • Recurrent: tympanostomy, tympanocentesis, myringotomy • Complications: Mastoiditis and bullous myringitis

Slipped capital femoral epiphysis def

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 • Pain in the groin, hip, thigh, or ipsilateral knee without inciting trauma and painful limp in an obese adolescent with painful limp • Antalgic or waddling gait with an externally rotated leg on the affected side • Drehmann sign: while in the supine position, hip externally rotates and abducts with passive hip flexion • Most common in 7-16y obese male during a growth spurt, jumping activities

umbilical hernia dx

History and physical exam, including an attempt to reduce the mass • detected during the newborn abdominal examination, particularly when there is increased intraabdominal pressure from crying

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

Tummy time: 5-10 min 2-3 times per day Place infant in crib in alternating directions Change position of bouncy/car seat Keep baby upright

How do you prevent positional plagiocephaly

hyaline membrane disease def

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 is the most common cause of respiratory disease in the preterm infant • It is caused by a deficiency in surfactant resulting in poor lung compliance and atelectasis • Infants less than 30 weeks gestation at birth

ocular foreign body tx

If a corneal foreign body is detected, an attempt can be made to remove it by irrigation after the instillation of topical anesthetic. This is particularly helpful in the case of multiple superficial foreign bodies (eg, sand) • An attempt can then be made to remove the foreign body with a swab, using direct visualization • Intraocular foreign bodies require immediate surgical removal by an ophthalmologist --Systemic and topical antimicrobials (effective against Bacillus cereus if the injury involved contamination with soil or vegetation) are indicated • Rust ring — After removal of a foreign body containing iron, there is often a residual rust ring and reactive infiltrate. Patients with rust ring should be treated as patients with corneal abrasions. The rust ring itself is not harmful and will usually resorb gradually

Hodgkin's Lymphoma dx

If the diagnosis is suspected, a 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 cells --Reed-Sternberg Cells are pathognomonic - B cells fused together forming a large cell with two nuclei "owl eye"

Chronic Glomerulonephritis

IgA Nephropathy (Berger disease) • 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 • Slowly progresses to renal failure in 25% of cases • Renal biopsy alone makes the diagnosis demonstrating mesangial deposits of IgA in the glomeruli Alport's Syndrome • 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 Membranoproliferative glomerulonephritis - due to SLE, viral hepatitis

dehydration sx

In children, the most accurate signs of moderate or severe dehydration are prolonged capillary refill, poor skin turgor, and abnormal breathing --Other useful findings (when used in combination) include sunken eyes, decreased activity, a lack of tears, and a dry mouth. normal urinary output and oral fluid intake is reassuring • lab testing is of little clinical benefit in determining the degree of dehydration. Thus the use of urine testing our ultrasounds is generally not needed

viral hepatitis def

Incidence varies with the specific virus. Most infections in children and adolescents are caused by hepatitis A and B • Prenatally infected infants are usually asymptomatic • Clinical signs of acute hepatitis include anorexia, nausea, malaise, vomiting, jaundice, dark urine, abdominal pain, and low-grade fever • Children with Hepatitis A virus and Hepatitis E virus may have diarrhea • A wide range of severity exists and as many as 30 to 50% of infected children are asymptomatic • Hepatitis B and Hepatitis C infection are usually silent in that the patient complains of no symptoms unless chronic infection has caused significant hepatic damage scleral icterus and jaundice are noted in some children with HAV, 50% of children with hepatitis B virus, and 20% to 30% of children with hepatitis C. Hepatomegaly and right upper quadrant tenderness may be present • A benign-appearing rash may be present early in the course

B12 and folate deficiency

Increased MCV, increased LDH, decreased haptoglobin

Respiratory Syncytial Virus (RSV) tx

Indications for hospitalization ⇒ tachypnea with feeding difficulties, visible retractions, oxygen desaturation < 95-96% • Supportive measures include albuterol via nebulizer, antipyretics and humidified oxygen, and steroids (controversial) - resolves in 5-7 days Synagis prophylaxis (palivizumab) for children with lung issues or born premature/immunocompromised at birth. It is given (via injection) once per month for five months beginning in November

inguinal hernia tx

Indirect inguinal hernia: Management includes referral for elective repair --Optimal timing is debatable: a waiting time less than 14 days is advisable for asymptomatic inguinal hernias in this pediatric age group --An 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

avascular necrosis of the proximal femur sx

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

indirect hernias goes through the...

Internal inguinal ring (an I for an I)

prolonged partial thromboplastin time (PTT)

Intrinsic and common coagulation pathways Seen in bleeding from heparin

12 month's

Introduction of whole cow's milk

Tinea dx

KOH Dermatophytes: long, branching fungal hyphae with septations Candidiasis: budding yeast, pseudohyphae Tinea versicolor: short hyphae and clusters of spores ("spaghetti and meatballs") *Nystatin is not effective for dermatophyte infections

oral candidiasis (thrush) dx

KOH smear reveals budding yeast and pseudohyphae

HHV 8

Kaposi sarcoma associated herpesvirus Not a known cause of acute illness but has a causative role in Kaposi sarcoma* and AIDS-related non-Hodgkin lymphomas that grow primarily in the pleural, pericardial, or abdominal cavities as lymphomatous effusions Also linked with multicentric Castleman disease

rubella dx

Laboratory diagnosis of rubella is warranted when congenital rubella syndrome is suspected or when the diagnosis is sought for a condition compatible with the known complications of postnatal rubella, such as arthritis • Serologic assays, primarily enzyme immunoassays (EIA), are used most frequently • Rubella virus-specific IgM antibodies are present in people recently infected with the Rubella virus but these antibodies can persist for over a year and a positive test result needs to be interpreted with caution • The presence of these antibodies along with, or a short time after, the characteristic rash confirms the diagnosis

acute rheumatic fever

Leading cause of mitral valve stenosis and valve replacement in adults in the United States • 1st Mitral valve, 2nd Aortic Valve, 3rd Tricuspid Valve • Rheumatic fever develops in children and adolescents following pharyngitis with group A beta-hemolytic Streptococcus • The presence of the M protein is the most important virulence factor for group A streptococcal infection in humans and anti-M antibodies against the streptococcal infection may cross-react with heart tissue. • Peak incidence ages 5-15 years

ventricular septal defect dx

Loud, harsh, holosystolic murmur, left to right - heard best at the lower left sternal border • Like ASD's, the size and therefore the clinical course of these defects is quite variable. • Some remain large, while others become smaller over time. • It is not unusual for small-to-medium-sized VSDs to eventually close spontaneously. DX by echocardiogram

9 mo. Motor language Social

M: crawls, pull-to-stand, pincer grasp, eats with fingers L: mama-dada (nonspecific) S: waves bye-bye, responds to name

2 mo. Motor language Social

M: holds head up, swipes at objects L: cooing S: social smile

3 mo. Motor language Social

M: lifting head and chest, moro reflex disappears

0-1 mo. Motor language Social

M: moro and grasp reflex, visual tracking L: crying S: minimal

36 mo. Motor language Social

M: rides a tricycle, eats with utensils L: 3 word sentences S: knows first and last name

4 mo. Motor language Social

M: rolls from prone to supine, grasp objects L: orients to voice, colic resolves in most babies by this age S: laughs

24 mo. Motor language Social

M: runs L: 2 word sentences, several hundred word vocabulary S: follows 2-step commands

6 mo. Motor language Social

M: sits up right L: babbles S: stranger anxiety

12 mo. Motor language Social

M: stands L: mama-dada (specific) S: picture book

18 mo. Motor language Social

M: walks up stairs, throws ball L: names objects S: toilet training

15 mo. Motor language Social

M: walks, uses cup L: several words S: temper tantrums

Hyperthyroidism def

MCC in children is Grave's Disease • Other causes include hyperfunctioning "hot" thyroid nodule or acute suppurative thyroiditis • Symptoms include voracious appetite (without weight gain or with weight loss), heat intolerance, emotional lability, restlessness, excessive sweating, frequent loose stools, and poor sleep • Exophthalmos is uncommon in children • Older children may complain of palpitations • There is often a change in behavior and school performance • The thyroid gland is generally enlarged, smooth, firm, and nontender • Neonatal Graves disease occurs in about 2% of infants born to women with Graves disease, due to the passage of TSH receptor-stimulating antibodies across the placenta. --Neonates will have typical hyperthyroid symptoms, including goiter

hypothyroidism def

MCC is Hashimoto's thyroiditis • Other causes include panhypopituitarism, ectopic thyroid dysgenesis, administration of antithyroid medications, and surgical or radioactive iodine ablation for treatment of hyperthyroidism • Congenital hypothyroidism (also known as cretinism) often presents with hypotonia, lethargy, macroglossia, large fontanelles, and dry skin --It is one of the leading causes of intellectual disability in the world • Girls 4 x > than boys, family history • Most children present at adolescence; it is unusual to develop thyroiditis before 5 years of age • Symptoms generally appear after the first year of life and include --Cold intolerance,Diminished appetite, Lethargy, Constipation • Physical findings include delayed puberty, immature body proportions, coarse puffy facies, dry thin hair, dry skin, and DTRs with delayed relaxation time

burns def

MCC: scalding, direct thermal and flame burns • depth: superficial partial thickness, deep partial thickness, full thickness • chemical: exposure to strong acids/alkalis --acid: coagulation, necrosis, eschar; irrigate --alkaline: liquefaction necrosis, deep damage

normocytic hemolytic anemia causes

MCV 80-100 fl intrinsic: -hereditary spherocytosis -G6DP deficiency -pyruvate kinase deficiency -sickle cell anemia -HbC disease extrinsix -autoimmune hemolytic anemia

macrocytic non-megaloblastic anemia

MCV >100 fl -alcohol use disorder -liver disease

macrocytic megaloblatic anemia

MCV >100, immature cells -folate deficiency -B12 deficiency -copper deficiency -drug-induced

ependymoma dx

MRI and histologic biopsy

astrocytoma dx

MRI and histologic evaluation of biopsy

medulloblastoma dx

MRI and histologic evaluation of biopsy

avascular necrosis of the proximal femur dx

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

microcytic anemia causes

MVC <80 fl -iron deficiency -anemia of chronic disease -thalassemias -sideroblastic anemia -lead poisoning

Acute Rheumatic Fever JONES criteria dx

Major Carditis Chorea Erythema marginatum Polyarthritis Subcutaneous nodules Minor Arthralgia Elevated ESR or C-reactive protein Fever Prolonged PR interval (on ECG) Leukocytosis ASO Titer test patients with rheumatic heart may develop afib

tinea versicolor def

Malassezia furfur, a yeast found on the skin of humans. Lesions consist of hypo or hyperpigmented macules that do not tan

Reassurance Iron therapy if iron-deficiency

Management of breath holding spells

glomerulonephritis dx

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

Many by 3 months Most by 4 months

Many infants sleep through the night (5 uninterrupted hours) by ____? Most by ______

umbilical hernia tx

Many umbilical hernias resolve on their own and rarely require intervention • Refer to surgery if an umbilical hernia persists >2 years of life • Children with large, trunk-like hernias without any decrease in the size of the umbilical ring defect over the first two years of life, generally require surgery, because their hernias are unlikely to close spontaneous

1 hour

Median crying time at 12 weeks

1 3/4 hours

Median crying time at 2 weeks

2 3/4 hours

Median crying time at 6 weeks

ocular foreign body dx

Metallic foreign bodies may leave a rust ring (see media) If you can't remove the foreign body easily then refer to the ophthalmologist DX: Full inspection of lids, conjunctiva, and cornea - Slit-lamp examination will assist in identification and removal --X-ray or CT of may be necessary if there is evidence of penetration of the globe

dysmorphic features of down syndrome

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) Others ⇒ single transverse palmar crease; short fifth finger with clinodactyly

vesicoureteral reflux 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

Neglect can be considered if...

Minor allowed to engage in potentially harmful behavior (i.e. ETOH consumption) Child is unattended; in some states, leaving child < age 13 home alone

burn tx

Monitor ABCs, fluid replacement, sulfadiazine --Mild: clean with soap & water; Drain & debride bullae; cover with 1% silver sulfadiazine --Moderate/Severe: cover with a dry dressing, admit to hospital Labs: ABG, CBC, CK, CMP, UA, carboxyhemoglobin

acne vulgaris tx

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.

viral meningitis etiologies

Most cases in the United States are caused by a group of viruses known as enteroviruses, which are most common in late summer and early fall Viruses such as herpes simplex virus, HIV, mumps, West Nile virus and others also can cause viral meningitis

medulloblastoma def

Most common MALIGNANT posterior fossa tumor in children and represents about 20% of all pediatric CNS cancers • Metastasize through CSF--drep metastatis • Homer-Wright Rossettes • 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.

astrocytoma def

Most common PRIMARY childhood CNS tumors that develop from astrocytes • Most patients have symptoms consistent with increased intracranial pressure (eg, morning headaches, vomiting, lethargy) •Often benign • Location of the tumor determines other symptoms and signs, for example --Cerebellum: Weakness, tremor, and ataxia --Visual pathway: Visual loss, proptosis, or nystagmus --Spinal cord: Pain, weakness, and gait disturbance

epistaxis (anterior) tx

Most nosebleeds are anterior and stop with direct pressure • Apply direct pressure at least 10-15 minutes, seated leaning forward • Short-acting topical decongestants (Afrin, phenylephrine, cocaine) • Anterior nasal packing Patients with nasal packing must be treated with antibiotics (cephalosporin) to prevent toxic shock syndrome and the patient has to return to take the packing out • If there is no packing in the nose, place a small amount of petroleum jelly or antibiotic ointment inside the nostril 2 times a day for 4-5 days • Cauterize if able to visualize bleeding source

acute bronchiolitis def

Most often caused by RSV - commonly in the fall and winter months • Infants and young children • Tachypnea, respiratory distress, wheezing

verrucae 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

atypical mycobacterial disease def

Mycobacteria other than the tubercle bacillus sometimes infect humans • Atypical Mycobacterial infections in children are most frequently located in superior anterior cervical or in submandibular nodes (91%) • Children usually lack constitutional symptoms and present in 95% of cases with unilateral, subacute, progressive lymphadenopathy • The swelling is painless, firm and not erythematous • The majority of cases are reported in 1-5 year olds because there is increased tendency of these children to put objects contaminated by soil or stagnant water into their mouths. It may also be due to the relative poor immunity to Mycobacteria found in this age group

Child sits-up in bed screaming for 15 min; tachycardia, tachypnea, sweating Usually during first 4 hours

Night Terros

usually during last 1/3 of night Child is scared but consolable Can recall dream and afraid to go back to sleep

Nightmares

Non-Hodgkin's Lymphoma def

Non-Hodgkin lymphoma is a tumor derived from lymphocytes - specifically from B-cells and T-cells • Painless lymphadenopathy • Release of cytokines causes fever, drenching night sweats, and weight loss • Extranodal involvement --GI tract ⇒ bowel obstruction --Bone marrow ⇒ fatigue, easy bruising, recurrent infections --Spinal cord ⇒ loss of sensation Two types: B and T Cell Look for an immunocompromised (HIV) patient with GI symptoms and painless peripheral lymphadenopathy Spreads non-contiguously to extranodal sites ⇒ skin, GI tract, brain

coarctation of the aorta def

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. • leads kidneys to release substances to raise the pressure/renin • patient in teens, twenties need to r/o in a young adult with HTN • key finding: 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 A bicuspid valve is seen in 50% of the cases - also increase incidence of cerebral berry aneurysm

constipation dx

Often, medical history, and physical examination are sufficient to diagnose functional constipation • Further evaluation for Hirschsprung disease, a spinal cord abnormality, or a metabolic disorder may be warranted in a child with red flags, such as onset before one month of age, delayed passage of meconium after birth, failure to thrive, explosive stools, and severe abdominal distension • Pain with defecation, bleeding, fissures, hard stool • Abdominal x-ray

Scoliosis dx

On Adams forward bending asymmetry in scapular height is noted • Radiographs standing PA and lateral --Cobb 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 • ↑ serum blood lead level (BLL) • Basophilic stippling • ↓ or normal MCV • ↓ mean MCH • Hemolysis --↑ indirect bilirubin, LDH --↓ haptoglobin

1 in 5

One in every ____ kids in the US seeks medication attention for injury each year

10-13 hours per day

Optimal sleep time for 3-5 years

12-16 hours/day

Optimal sleep time for 4-12 months

9-12 hours per day

Optimal sleep time for 6-12 years of age

8-10 hours per day

Optimal sleep time for teenagers 13-18 years

tinea barbae 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.

Neutropenia tx

Outpatient (low risk): Cipro + Augmentin; Moxifloxacin Monotherapy *pseudomonas: Cefepime, Imipenem, Augmentin Dual therapy: *unstable Monotherapy + Vanc or Flagyl (abd)

obesity tx

Overweight and obese children and adolescents with comorbidities should be referred to a pediatric obesity specialist for weight control • Referral for severely obese children at any age, particularly those who are younger than two years • One of the first things that can be done is limiting sugar intake, particularly sweet beverages. --Children between ages 2 to 18 years old should consume less than 25g, or roughly 6 teaspoons, of added sugar each day --One can of soda contains about 39 grams, or 9 teaspoons of sugar --One apple juice carton contains about 28 grams, or 7 teaspoons of sugar • Ideally, plates should be about 1/2 fruits and vegetables, 1/4 whole grains (like rice or pasta), and 1/4 protein

Acute Rheumatic fever tx

PCN and aspirin

Pneumococcal (PPSV23)

PPSV23 is given after PCV13 PPSV23 is not conjugated and does not stimulate a helper T-cell response

hyperthyroidism tx

PTU, methimazole or radioiodine may be used to treat Graves' disease and must be titrated carefully because too high a dose can result in hypothyroidism • 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 months

colic tx

Parent education and reassurance • DON'T SHAKE YOUR BABY • Assure them their baby is healthy & crying can increase and likely stop by ~ 3-4mo • Assure them they are not to blame • Make sure the baby is not hungry, soiled, or tired • Swaddle, gentle motions, pacifier • Get help from family to get a break! • Possible formula switch or GERD tx

bulimia nervosa

Patient who has episodes of mass eating followed by self-induced vomiting or intense exercise Frequent binge eating with or without purging • Purging commonly performed by self-induced vomiting resulting in - metabolic alkalosis, urinary chloride < 20mEq, and volume depletion --May abuse laxatives/diuretics --May exercise excessively Patients are disturbed by their behavior Binging and compensatory behaviors occur at least once a week for 3 months. On the exam look for these classic physical findings: scars on knuckles, swollen parotid glands + dental erosions + normal weight +hypokalemia

enuresis tx

Patients younger than 5 years of age do not require investigation or treatment; patients and family should be informed that bed-wetting is normal at their age and will likely resolve with time. • Behavioral modification: Nighttime audio alarm that sounds as soon as the child starts to urinate, eventually conditioning controlled bladder emptying before enuresis • Medications: Desmopressin acetate (DDAVP) acts to concentrate the urine. If given in the evening, less urine is produced overnight, decreasing the likelihood of wetting • With all therapies, the cure rate is 15% per year after the age of 5 --Children who remain enuretic past age 8 have a 10% risk of never resolving their symptoms

nasal foreign body sx

Persistent foul-smelling purulent unilateral nasal discharge in a young child without other respiratory symptoms should raise suspicion for a retained nasal foreign body, even without a history of witnessed foreign body insertion

atrial septal defect dx

Physical exam--> passing a catheter through the defect in cath lab BEST

move it high out of reach, proper labeling, call poison control, dosing on medcations

Poison prevention for infants and preschoolers

glomerulonephritis 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

acute glomerulonephritis

Postinfectious - 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 Rapidly progressive glomerulonephritis - crescent formation on biopsy due to fibrin and plasma protein deposition • Goodpasture's syndrome: (+) anti-GBM antibodies, dx linear IgG deposits, treat with high dose steroids, plasmapheresis + cyclophosphamide • Vasculitis - lack of immune deposits (+) ANCA antibodies --Microscopic polyangiitis (+) P-ANCA --Granulomatosis with polyangiitis (Wegener's) (+) C-ANCA

sensorineural hearing loss

Presbycusis (most common cause): Gradual, symmetric hearing loss associated with aging— the most common cause of diminished hearing in elderly patients - degeneration of sensory cells and nerve fibers at the base of the cochlea Noise-induced, infection, drug-induced, congenital, Meniere disease, CNS lesions

nasal foreign body tx

Prior to removal consider using oxymetazoline drops to shrink the mucous membrane

-persistent or worsen beyond 5 years old -more than 5/day -persistent negative mood b/w tantrums -destruction of property -harm to self or others -recurrent tantrums at school -other behavioral problems

Problem tantrums

excellent usually resoled by age 5

Prognosis of breath holding spells

scabies def

Pruritic papules - S-shaped or linear burrows on the skin. Often located in web spaces of hands, wrists, waist with severe itching (worse at night) • Diagnose with the microscopic observation of mite, egg or feces after skin scrape

lice def

Pruritic scalp, body, or groin. Nits are observed as small white specs on the hair shaft Body (corporis); Pubic (pubis)

atopic dermatitis def

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

Oppositional defiant disorder tx

Psychotherapy: is aimed at helping the child learn to express and control anger in more appropriate ways. -Cognitive-behavioral therapy aims to reshape the child's thinking (cognition) to improve problem-solving skills, anger management, moral reasoning skills, and impulse control. -Family therapy may be used to help improve family interactions and communication among family members. Peer group therapy might also be helpful Pharmacotherapy to control ODD include mood stabilizers, antipsychotics, and stimulants. -Other drugs seen in studies include haloperidol, thioridazine, and methylphenidate which also is effective in treating ADHD, as it is a common comorbidity.

psoas sign

RLQ pain with hip extension

obturator sign

RLQ pain with internal rotation of the hip

Rovsing sign

RLQ pain with palpation of LLQ

Slipped Capital Femoral Epiphysis 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

1) Redirection 2) Spanking 3) Scolding/reasoning 4) Ignoring 5) Time-out 6) Removal of privileges

Reactive Discipline techniques

Start at birth and continue until at least 2 years or exceeds wt and ht restrictions for the seat

Rear facing car seat

autism 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, carbamazepine --SSRIs for stereotyped/repetitive behavior

Autism tx

Refer—specialists, speech & language pathologies Audiology evaluation,+/- EEG Behavioral therapy Medications: -second generation antipsychotics (risperidone, aripiprazole) for aggression/hyperactivity, mood lability; can also use haloperidol, carbamazepine -SSRI fro stereotyped/repetitive behavior

drug eruptions tx

Remove the offending drug once identified is the first treatment measure. • anaphylaxis can be treated with epinephrine 1:1000 0.5-1 mL given IM or subQ • DIHS can be treated with systemic corticosteroids (1-1.5 mg/kg/day) with a slow taper over at least 6 weeks • children with SJS or TEN should be hospitalized to the burn unit and managed appropriately with fluids and symptomatically • acute and chronic urticarial can be treated with 2nd generation antihistamines

anorexia nervosa tx

Restore nutritional state Hospitalization - if weight is < 75% expected body weight Psychotherapy - behavioral therapy Pharmacologic - SSRIs;Have added benefit of causing weight gainHave not been proven to be effective in anorexia nervosaHave some efficacy in bulimia nervosa

contact dermatitis tx

Review medications: OTX, RX, homeopathic, hot water, humidifier • Avoid aggravating agents • Antihistamine (Hydroxyzine or Benadryl) • Zinc oxide (diaper rash) • Topical (triamcinolone cream 0.1%) or oral steroids, Burow's solution (aluminum acetate) • PUVA Phototherapy

down syndrome risk factors

Risk factors include advanced maternal age • 1:1500 in women under 20 • 1:25 in women over 45 Associated with the development of multiple comorbidities including: • Acute lymphocytic leukemia (ALL) • Early-onset Alzheimer's disease • Atlantoaxial instability (C1-C2)

HHV 6

Roseolovirus is more commonly known as the 6th disease or Roseola Infantum Roseola infantum, otitis media with fever; encephalitis

colic dx

Rule of 3's ⇒ cry > 3 hrs/day, 3 d/wk, for 3 weeks Complete history Physical Exam: r/o pathology

-cry at least 3hrs/day -at least 3 days/week -for more than 3 weeks -arount 3 pm

Rule of three with Colic

persistent depressive disorder (dysthymia) tx

SSRIs and other antidepressants psychotherapy physical exercise

Major depressive disorder tx

SSRIs are first line tx —continue to increase dosage q3-4 weeks until symptoms in remission —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 2wk until improvement, then monthly to monitory medication changes

premenstrual dysphoric disorder 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

major depressive disorder tx

SSRIs are the first-line treatment + cognitive behavioral therapy • 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

Generalized anxiety disorder 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

SIGECAPS

Sadness Interest/anhedonia Guilt Energy Concentration Appetite Psychomotor activity Suicidal

phobias def

Same as panic disorder - 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.)

cystitis dx

Screening urinalysis indicates pyuria (> 5 WBCs/HPF) in most children with UTI, but some children can have sterile pyuria with ut UTI • Urine culture is the gold standard for diagnosis. Susceptibility testing should be performed • In toilet-trained older children a midstream, a clean-catch method is usually satisfactory • In infants and younger children, bladder catheterization or suprapubic collection is necessary in most cases to avoid contaminated samples • Bagged urine specimens are helpful only if negative • Asymptomatic bacteriuria is detected in 0.5-1% of children screened with urine culture Renal and bladder ultrasonography (RBUS) • Vesicoureteral reflux (VUR) is detected in 30-50% of children presenting with a UTI at < 1 y/o --The American Academy of Pediatrics (AAP) recommends RBUS for all infants and children 2 to 24 months following their first febrile UTI --Children of any age with recurrent febrile UTIs --Children of any age with a UTI who have a family history of renal or urologic disease, poor growth, or hypertension --Children who do not respond as expected to appropriate antimicrobial 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

hypercalcemia dx

Serum calcium concentrations are greater in children than in adults, therefore the diagnosis of hypercalcemia in younger patients requires the use of age-appropriate normal ranges Evaluation of the child with hypercalcemia: Laboratory values in the differential diagnosis of hypercalcemia EKG: shortened QT interval, prolonged PR interval & QRS widening

colic def

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

no blankets, or stuffed animals in the crib; sleep on their backs and not their stomachs

Sleep safety

Autism DSM V criteria

Social communication and interaction deficit in many contexts such as: • lack of social-emotional reciprocity • lack of nonverbal communicative behaviors • impairment in developing, maintaining, and understanding relationships Restricted and repetitive patterns of behavior, interests or activities such as: • motor movements that are stereotyped or repetitive • inflexibility to change • restricted and fixated interested—there are • sx present in the early developmental period in the absence of an organic etiology • cannot be better explained by other conditions

autism DSM V criteria

Social communication and social interaction deficit such as --Lack of social-emotional reciprocity --Lack of nonverbal communicative behaviors --Impairment in developing, maintaining, and understanding relationships Restricted and repetitive patterns of behavior, interests, or activities such as --Motor movements that are stereotyped or repetitive (e.g., flipping objects) --Inflexibility to change --Restricted and fixated interests - these are typical with abnormal intensity or focus --Hyper- 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 CSF Finding on Lumbar Puncture Bacterial: ↑ Protein ↓ Glucose (bacteria love to eat glucose) Viral: No specific characteristics but may have lymphocytes Make sure the patient does not have increased intracranial pressure prior to LP check for papilledema. Get a CT scan if you are unsure if there is swelling in the brain (risks include age > 60, immunocompromised, AMS, focal neuro finding or papilledema)

diarrhea after a picnic and egg salad

Staphylococcus aureus

tinea def

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. *Nystatin is not effective for dermatophyte infections

testicular torsion tx

Surgical emergency: Repair both testes within 4-6 hours • A longer wait may cause infertility

1) Cyanotic (60%) 2) Positive family history (25%) 3) Both (20%)

Symptoms of breath-holding spells

tinea capitis tx

Systemic therapy warranted to penetrate the hair shaft Oral 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.

True

T/F: prone sleeping in a child who is not used to prone sleeping is even worse

False: positive family history 25% of the time

T/F: there is no genetic connection to breath holding spells

at 2-3 years old

Temper tantrums are most common?

Tinea unguium (dermatophyte onychomycosis) tx

Terbinafine is the first-line oral agent for mild to moderate dermatophyte onychomycosis.

ependymoma def

The 3rd most common CNS tumor in children (after astrocytomas and medulloblastomas), representing 10% of pediatric brain tumors • Mean age at diagnosis is 6 yrs however, about 30% of ependymomas occur in children < 3 yr • 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

acute otitis media def

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 • Bugs: S. pneumoniae 25%, H. influenzae 20%, M. catarrhalis 10% • Acute: <3 weeks, chronic: >3 mo, recurrent: 3 episodes in 6 mo or 4 in 12 with clearing between • Chronic >3 mo: clear serous fluid in the middle ear without s/sx of ear infection (may have hearing loss / asymptomatic) - no abx

nursemaid's elbow dx

The diagnosis is made clinically and radiography is unnecessary unless is needed to exclude fractures or other dislocation.

appendicitis sx

The first symptom is crampy or "colicky" pain around the navel (periumbilical) 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 Rovsing, Obturator, Psoas signs

hypercalcemia tx

The initial approach to the medical treatment of severe or symptomatic hypercalcemia is to increase the urinary excretion of calcium--IV FLUIDS OR DIURETICS • In most cases, hypercalcemia is due to osteoclastic bone resorption, and agents that inhibit or destroy osteoclasts are therefore effective treatments (calcitonin, bisphosphonates, zoledronic acid) • Parathyroid surgery, the conventional treatment for adults with symptomatic primary hyperparathyroidism, is recommended for all children with primary hyperparathyroidism

teething tx

The management of teething symptoms is palliative (eg, chewing on a chilled [not frozen] teething ring or other teething devices, systemic analgesia) • Teething rings and other chewing devices should be one piece and 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

tinea capitis def

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

vitamin D deficiency tx

The primary natural (unfortified) dietary sources of vitamin D are oily fish (salmon, mackerel, sardines), cod liver oil, liver and organ meats, and egg yolk • These natural dietary sources are rarely consumed by children in sufficient amounts to maintain target 25OHD concentrations in the absence of other sources • Vitamin D is fortified in many foods, particularly milk and milk products, orange juice, bread, and cereals --Infant formulas in the United States are required to contain vitamin D

nursemaid's elbow 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

vitamin C deficiency dx

There are no reliable determinants of functional vitamin C status. However, plasma and leukocyte vitamin C levels are the mainstay for assessment and are reasonably well correlated with vitamin C intake • MRI: Sclerotic, lucent metaphyseal bands, soft-tissue edema The most specific symptoms (occurring as early as three months after deficient intake) are follicular hyperkeratosis and perifollicular hemorrhage, with petechiae and coiled hairs Other common symptoms include ecchymoses and gingivitis (with bleeding and receding gums and dental caries)

Male sex Low income Family stressors

Things associated with higher rates of unintentional injury

hypothyroidism tx

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

Usually begins at 2-3 weeks, peaks at 6-8 weeks; resolves by 3-4 months

Time line of colic

-be a role model -set limits -define expectations and consequences -be consistent -ignore trivial problems -avoid power struggles -complement desirable behavior -take time-out when angry

Tips for discipline

lack of control over the world, inability to communication, or limitations of their congitive and motor abilities

Toddlers become frustrated/angry due to

1) can they stay dry for 2 hours 2) can they get on the potty and remove clothes 3) do they understand the task at hand

Toilet training 3 things to consider

perioral dermatitis tx

Topical metronidazole, avoid steroids Mild: topical ALONE 1st line --Topical Pimecrolimus 0.1% --Erythromycin solution q12h --Metronidazole 0.75% gel q12h --Clindamycin lotion q12 hours --Oral ABX: Doxycycline if necessary - no gels, solutions, or lotions on eye Moderate: topical + oral ABX

hearing loss tx

Treat the underlying cause, hearing aids, surgery, cochlear implants

cryptorchidism tx

Treat with surgery (orchiopexy) by age 1 The current recommendation is to correct as soon as possible after 4 months of age

lactose intolerance tx

Treatment focuses on avoidance of dairy products, use of lactose-free products, or the use of lactase supplements

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 • Contact with the local health department is only necessary when patients have a blood level of greater than 20 μg/dL, or if after 3 months the levels remain elevated • Siblings and other children who live in the household or attend the same school or daycare should be tested

gastroenteritis tx

Treatment involves getting enough fluids. For mild or moderate cases, this can typically be achieved by drinking an 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 • Viral: symptomatic, fluids --Children infected with rotavirus usually make a full recovery within three to eight days • Bacteria: antibiotics are recommended for young children with a fever and bloody diarrhea --Cipro, Doxy, Azithromycin, Bactrim • The rotavirus vaccine is recommended as a prevention for children

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°

hemophilia tx

Treatment often involves the replacement of factor VIII or IX • People who have hemophilia should avoid situations that might provoke bleeding and should avoid drugs (for example, aspirin and probably also nonsteroidal anti-inflammatory drugs) that interfere with the function of platelets • They should be conscientious about dental care so that they will not need to have teeth extracted

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 conductive: bone>air sensorineural: air>bone

pyloric stenosis dx

U/S (will see a double track) barium studies (string sign or shoulder sign) labs: hypochloremic, hypokalemic metabolic acidosis (secondary to dehydration)

Down's Syndrome dx

Ultrasound • Prenatal diagnosis ⇒ Nuchal translucency (weeks 11-14) • Increased nuchal translucency and a hypoplastic nasal bone in a first-trimester ultrasound Lab results ⇒ Prenatal diagnosis • Chorionic villus sampling/amniocentesis 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

vitamin A deficiency tx

Universal periodic distribution — Periodic supplementation is recommended for populations endemic for vitamin A deficiency, at the following doses (where 1 microgram retinol = 3.3 international units) • 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 • Routine supplementation is no longer recommended for neonates, infants one to five months of age, or to mothers during the postpartum period living in endemic areas

androgenic alopecia dx

Usually made clinically Microscopic examination of cut or plucked hair fibers and scalp biopsies may provide additional information that is helpful for diagnosis • Biopsy => telogen and atrophic follicles Hormones: testosterone, DHEA, Prolactin Treatable: thyroid (TSH), anemia (CBC), autoimmune (ANA)

acute pharyngotonsillitis def

Usually viral - adenovirus most common • Mononucleosis: Epstein Barr virus, fever, sore throat, lymphadenopathy, splenomegaly, atypical lymphocytes, + heterophile agglutination test (monospot) • Consider gonorrhea pharyngitis in patients with recent sexual encounters, or with non-resolving pharyngitis • Fungal in patients using inhaled steroids Strep pharyngitis • 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

tympanic membrane tx

Usually, resolve on own; surgical repair may be necessary with persistent hearing loss • Keep dry ⇒ water/moisture to the ear should be avoided to prevent secondary infection that impedes closure • The only class of antibiotics that are non-ototoxic are the Floxin drops and should be used if you are going to be prescribing drops with a perforated TM • Surgery if persists past 2 months

Children must be in a car seat until they reach age 4 and in a booster seat until they reach age 8

WI law

impetigo tx

Warm water soaks 15-20min then • 1st line: topical Bactroban (mupirocin) x 5 days • Widespread infection: --Cephalexin or Erythromycin x 1 wk --MRSA: Doxycycline ---Sick + MRSA: Vancomycin --Bullous or severe: PO ABX Complications: poststreptococcal glomerulonephritis

Never leave unattended anywhere at all, pool enclosed by a fence

Water safety for infants and preschoolers

Swaddling Side or stomach position Shushing Swinging Sucking

What are the 5 S's for Colic management

Autonomy and independence

What is common both among adolescents and 2-3 year olds as reasons for throwing tantrums

Injury

What is the leading cause of death in people ages 1-19 in the US (40% of deaths)

MVA

What is the leading cause of injury death?

Apparent Life-threatening Event

What's an ALTE?

A disorder in which the back or one side of an infant's head is flattened, often with little hair growing in that area Often related to positioning

What's positional plagiocephaly

13 years old

When can a child start sitting in the front seat

between 8 am and 8 pm

When does ALTE typically occur?

when tired, ill or hungry

When is frustration worse in toddlers?

pertussis def

Whooping cough (pertussis) is a 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 - highly contagious • Consider in adults with cough >2 weeks, patients < 2 years old --Catarrhal stage: cold-like symptoms, poor feeding, and sleeping --Paroxysmal stage: high-pitched "inspiratory whoop" --Convalescent stage: residual cough (100 days)

hydrocele def

a collection of fluid around the testicle or along the spermatic cord leading to a non-tender fluid-filled (cystic) mass • This occurs when lymphatic drainage from the scrotum is impaired, leading to swelling and enlargement • Hydrocele is common in newborns and typically disappears without treatment during the first year of life. However, treatment is indicated if the mass becomes large and uncomfortable

vesicoureteral reflux def

a condition in 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)

down syndrome

a genetic chromosome 21 disorder causing developmental and intellecutal delays • MC chromosomal disorder and cause of mental retardation • characterized by trisomy 21 (most often) or chromosomal translocation

turner syndrome def

a genetic disorder caused by a missing X chromosome in females (45XO) • MCC of primary amenorrhea (uterus present) • Most patients are infertile The most common features include streak ovaries, short stature, lymphedema, neck webbing, and congenital heart and renal defects

epidermodysplasia verruciformis

a rare, lifelong hereditary disorder characterized by chronic infection with HPV

status epilepticus

a 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 Two forms: convulsive and nonconvulsive --Convulsive status epilepticus presents with a regular pattern of contraction and extension of the arms and legs --Nonconvulsive status epilepticus includes complex partial status epilepticus and absence status epilepticus

Hodgkin Lymphoma def

a tumor derived from lymphocytes - specifically B-cells which mainly reside in lymph nodes • Bimodal age distribution (15-35) and (>60) • Painless cervical or supraclavicular lymphadenopathy --Upper body lymph nodes: neck, axilla, shoulder, chest (mediastinum) • Fatigue, wt loss, fever, chills, and drenching night sweats for > 1 month --B symptoms are common ⇒ weight loss > 10%, T >38 C, night sweats • Associated with EBV (40% of patients) • Spreads contiguously (nearby) ⇒ rarely extranodal • Two types: Classical (4 types) and nodular lymphocytic --Classical: nodular sclerosis, mixed cellularity, lymphocyte-rich, lymphocyte depleted

testicular torsion def

a twisting of the testicle around the cord supplying blood to the scrotum • 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

adolescence (girls 11, boys 13) normal development

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

leukemia def

accounts for the greatest percentage of cases of childhood malignancies. There are 3,000 new cases each year in the US Acute leukemia 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) Chronic leukemias make up just 3% of childhood leukemias

viral conjunctivitis def

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

Erythema multiforme def

acute, self-limited, and sometimes recurring skin condition that is considered to be a type IV hypersensitivity reaction affecting the skin and mucous membranes • Extremities (hands, feet, and mucosa) • Most common cause = infection, herpes simplex, mycoplasma pneumonia, upper respiratory infections. • Less common = drugs (e.g., sulfonamides, β-lactams, phenytoin). Often idiopathic. • 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

Barlow maneuver

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 --flex hips and knees to 90º -- push legs back posteriorly --positive if hip dislocates (palpable) B comes before the O bar (we are going out tonight--hip popped out of acetabulum)

toxic epidermal necrolysis (TEN) tx

admit to burn unit with supportive care; consult ophthalmology if eyes affected; cyclosporine and possibly plasma exchange for severe cases

pinworm tx

albendazole or mebendazole

pinworms def

also known as 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. • 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

roseola

also known as exanthema subitum, roseola infantum, rose rash of infants, sixth disease, baby measles. Caused by HHV 6 and 7 • 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 • After a few days, the fever subsides, and just as the child appears to be recovering, a red rash appears --A blanching macular or maculopapular rash starting on the neck and trunk and spreading to the face and extremities. Occasionally the rash is vesicular. It is generally nonpruritic. The rash typically persists for one to two days --Only childhood viral exanthem that starts on the trunk - spreading to the legs and neck dx is clinical tx is supportive (bed rest, fluids, fever reducing meds)

focal seizures with loss of awareness (consciousness impaired)

also known as focal dyscognitive seizure or complex partial seizure • altered consciousness, automatisms (lip-smacking) • present with posticatal state (confusion and loss of memory) which differentiate them from absense seizures

gastroenteritis def

also known as infectious diarrhea, is inflammation of the gastrointestinal tract that involves the stomach and small intestine • 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

turner syndrome signs and sx

amenorrhea short stature webbed neck Physical exam amenorrhea with a present uterus, coarctation of the aorta may be evident on auscultation, low hairline in backlow-set ears, extremity edema, hypertension, signs of thyroid dysfunction, stool guaiac may identify GI bleeding

coarctation of the aorta presentation

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"

paraphimosis def

an inability to return the foreskin to normal position Entrapment of the foreskin behind glans Causes a tourniquet effect and is a medical emergency More acute than phimosis

Osgood-Schlatter Disease def

an inflammation of the patellar ligament, right at the point where it inserts on the tibial tuberosity, resulting in painful swelling just below the knee • 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 • Repetitive traction of the apophysis of the tibial tuberosity results in microtrauma and micro-avulsion - the proximal patellar tendon insertion separates from the tibial tubercle • Pain and swelling over the tibial tubercle at the point of insertion of the patellar tendon • Pain on resisted knee extension with a lump below the knee and prominent tibial tuberosity

bacterial otitis externa tx

antibiotics drops--> (aminoglycoside or fluroquinolone +/- corticosteroids)+ avoid moisture • if perforated or chance of perforation: ciprofloxacin 0.3% and dexamethasone 0.1% suspension: 4 drops BID x7 days or ofloxaxcin: 0.3% solution 10 drops once a day x7 days • diabetic/immunocompromised: malignant otitis externa-> necrotizing infection-> hospitalization with IV abx (caused by aspergillus)

neonatal jaundice def

appears when the total bilirubin levels are above 2 miligrams per decilitre • If there's isolated unconjugated hyperbilirubinemia appearing 24 hours after birth in an infant with 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, then jaundice is usually physiologic. • But If unconjugated hyperbilirubinemia appears within the first 24 hours after birth or the infant 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 - then the jaundice is considered pathologic- and it is most likely due to a prehepatic cause.

paraphimosis tx

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 temporarily • Circumcision is then done when edema has resolved

peritonsillar abscess tx

aspiration, incision and drainage, and/or antibiotics • IV antibiotics-> amoxicillin, amoxicillin-sulbactam, and clindamycin • in less severe cases, oral abx can be used for 7 to 10 days • tonsillectomy may also be considered in about 10% of patients

niacin deficiency dx

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

Rome III Diagnostic criterial for diagnosing functional constipation in children---> age ≥4 years

atleast 2 or more of the following: -Two or fewer bowel movements in the toilet per week -At least one episode of fecal incontinence per week -History of retentive posturing or excessive voluntary stool retention -History of painful or hard bowel movements -Presence of a large fecal mass in the rectum -History of large diameter stools that may obstruct the toilet

allergic rhinitis tx

avoid allergens and use antihistamines, cromolyn sodium, nasal or systemic corticosteriods, nasal saline drops or washes, and immunotherapy • intranasal decongestants not to be used more than 3-5 days may cause rhinitis medicamentosa

neonatal hepatitis dx

based on clinical presentation, results of liver biopsy, and exclusion of other causes of cholestasis

congenital hip dysplasia dx

based on physical exam⇒ hip exam at every well-child visit until 2 years old • barlow and ortholani maneuvers • US can be used to asses the position of the femoral head and structure of acetabulum • radiographs are unreliable until pt is atleast 4 months old because of radiolucency of femoral head

Turner Syndrome dx

based primarily on physical exam and patient history • Labs ⇒ low anti-Mullerian hormone • Karyotype analysis is the diagnostic test of choice ⇒ may identify 45XO, confirming the diagnosis • Fertility testing may identify 45XO, confirming the diagnosis • Endoscopy may identify GI telangiectasias causing lower GI bleeding

hypertrophic cardiomyopathy tx

beta-blockers + disopyramide (norpace) calcium channel blockers diuretics should be avoided

phimosis tx

betamethasone topically, if no improvement circumcision

Toxic Epidermal Necrolysis (TEN) dx

biopsy (necrotic epithelium)

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 complete blood count or CBC, might show anemia due to the loss of red blood cells, and a normal platelet count • ↓von Willebrand's factor (vWF) and ↓ Factor VIII • The PTT may be normal or elevated in patients with decreased factor 8 activity

measles def

caused by paramyxovirus and is transmitted by respiratory droplets, it has a 10-12 day incubation period. it progresses in 3 phases characterized by prodrome, enanthem, and exanthem • prodrome: 1-3 days of the "three C's" cough, coryza, conjunctivitis, as well as fever

Niacin deficiency def

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 Causes include diets low in tryptophan or niacin ⇒ corn staple diets Niacin is widely distributed in plant and animal foods. Good sources include yeast, meats (especially liver), grains, legumes, corn treated with alkali (as in corn used in tortillas), and seeds Dietary supplement; enriched grain, cereal, milk

panic disorder def

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. Palpitations, chest pain, sweating, SOB, etc. etc.

Non-Hodgkin's Lymphoma tx

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

lichen planus def/dx

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

asthma def

chronic, reversible inflammatory airway disease with recurrent attacks of breathlessness and wheezing categorized: intermittent, mild persistent, moderate persistent, severe persistent

allergic rhinitis def

clear nasal drainage, rhinorrhea, itchy, watery eyes, sneezing, nasal congestion, pale, blueish, boggy mucosa • allergic shiners (blue discoloration below eyes), transverse nasal crease • IgE mediated mast cell histamine release

Osgood-Schlatter disease dx

clinical and based on inflammation of the tibial tuberosity, which worsens with activity • Diagnostic imaging is used only for atypical presentation (pain not related to activity, fever, rash, etc.) to exclude other conditions (e.g. osteomyelitis) --Ultrasound can show soft tissue swelling around the tuberosity --An x-ray might show fragmentation of the tibial tuberosity in severe cases

febrile seizure dx

clinical diagnosis • Consider lumbar puncture if suspicious of meningitis --i.e., lack of Haemophilus influenza type B or Streptococcus pneumoniae vaccination • Physical exam suggesting meningitis or some CNS infection • Lab may be used for seizure evaluation in the setting of complex febrile seizure --Do if useful to identify fever source

Hyperthyroidism dx

clinical history and PE + T3 and T4 elevated TSH is suppressed Graves: T3 elevated and (+) anti-thyrothropin antibodies

erythema multiforme dx

clinical hx and PE • 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)

perioral dermatitis dx

clinical, a biopsy may help

mastioditis dx

clinical; CT scan temporal bone with contrast for complicated/toxic appearing

medulloblastoma tx

combination of surgery, radiation, and chemotherapy --long term survival with tx is 70%

astrocytoma tx

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

constipation def

common and almost always functional without an organic etiology. Stool retention can lead to fecal incontinence in some patients. • < 2 bowel movements per week • > 1 episode of encopresis per week (poop in the rectum, loose stool leaks) • MC triggers: transitioning to solid foods from breastmilk and formula, potty training, and starting school --Starting solid foods can lead to reduced fiber and fluid intake causing harder stools --Children may start to withhold stools when they start potty training or going to school. They may be scared to use the toilet itself or scared to use the toilet at school

duodenal atresia dx

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

duodenal atresia def

congenital absence or complete closure of a portion of the lumen of the duodenum • 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 syndrome

Hirschsprung disease def

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. • Absent plexuses (regulate bowel function) → intestine muscles permanently constricted → passing stool difficult, impossible • Incidence is approximately 1:5,000 live births. Hirschsprung disease is five times more frequent in male infants, and in 80% of cases, there is a family history • At birth infants are asymptomatic • First sign: baby's inability to pass meconium, 48 hours postpartum • Other clinical features include constipation, vomiting, and abdominal distension

pyloric stenosis def

congenital condition where a newborn's 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 • Projectile vomiting occurs shortly after feeding in an infant < 3 mo old with a palpable "olive-like" mass at the lateral edge of the right upper quadrant • Pediatric patients < 3 months old • Nonbilious projectile vomiting after most or every feeding • Physical exam - palpable epigastric olive-shaped mass (is pathognomonic for the disorder)

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 plates --Might 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)

moderate persistent asthma

daily symptoms of more than 1 nightly episode per week --step 3: low dose ICS + LABA daily --step 4: medium-dose ICS + LABA daily

orthostatic hypotension

defect in vasomotor reflexes, common in elderly, diabetics, patients taking certain medications (i.e. diuretics, vasodilators)

Scoliosis def

defined as a lateral spinal curvature with a Cobb angle of 10° or more • MC at 8-10 years of age At routine screening, a patient is asked to flex forward and the scapula height is observed (known as Adam's test) if scoliosis is present, asymmetry in scapular height is noted • Boys and girls are equally affected; however, it is 10 times more likely to progress and require treatment in girls

hemophilia severity of bleeding

depends on how a particular gene abnormality affects the blood clotting activity of factor VIII or IX • Mild: People whose clotting activity is 5 to 25% of normal have mild hemophilia that may go undiagnosed --These people may bleed more than expected after surgery, dental extractions, or a severe injury. • Moderate: People whose blood clotting activity is 1 to 5% of normal have moderate hemophilia --They have few unprovoked bleeding episodes, but surgery or injury may cause uncontrolled and fatal bleeding • Severe: When the clotting activity is less than 1% of normal, hemophilia is severe --Serious episodes of bleeding occur and recur after a minor injury or for no apparent reasonIn severe hemophilia, the first bleeding episode often occurs during or immediately after delivery --The infant may develop a collection of blood under the scalp (cephalhematoma) or may bleed excessively during circumcision. --In severe or moderate hemophilia, a bleeding episode generally occurs before 18 months of age and may follow a minor injury A child who has hemophilia bruises easily --Even an injection into a muscle can cause bleeding that results in a large bruise and hematoma

school age (6-11 years) normal development

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

bacterial meningitis tx

dexamethasone + empiric IV antibiotics (cephalosporin, vancomycin, penicillins) --household contacts: treat with rifampin, Cipro, levaquin, azithromycin, ceftriaxone

nursemaid elbow

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. • Common pediatric presentation, generally occurring between the ages of 1 and 3 years old • Generally, occurs with a pulling upward type of motion while the child has an outstretched arm • The child refuses to move the arm on presentation which is held in flexion and pronated, there is minimal swelling • Characterized by significant pain, partial limitation of flexion/extension of the elbow, or total loss of pronation/supination in the affected arm

patent ductus arteriousus def

ductus arteriosus is a normal fetal structure • if it remains open if is called "PDA" • 3-6 week infants can present with tachypnea, diaphoresis, inability or difficulty with feeding, and no weight gain • adults that were low birth weight premature infants with PDA may present with sx of heart failure • rough 'machinery' murmur late in systole at the time of S2 making it loud • murmur is best heard at the pulmonic area 2nd ICS left sternal border and inferior to the clavicle bounding pulses and a widened pulse pressure • because prostaglandin E-2 is responsible for keeping the ductus patent--inhibitors of prostaglandin will close it --this is why NSAIDs are the tx and contraindicated in pregnancy

traveler's diarrhea

e coli

anorexia nervosa--restrictive type

eat very little exercise to excess

patent ductus arteriosus dx

echocardiogram

coarctation of aorta dx

echocardiogram EKG=LVH CXR=rib notching "figure 3 sign"

hypertrophic cardiomyopathy dx

echocardiogram + MRI

foreign body aspiration

enters the airway and causes choking. Objects can enter the esophagus through the mouth, or enter the trachea through the mouth or nose • Most often food and can be life-threatening. 80% in mainstem or lobar bronchus right > left • Risk factors include institutionalization, advanced age, poor dentition, alcohol, sedative use • Presentation (depends on the location of obstruction) --Inspiratory stridor (if high in the airway) or wheezing and decreased breath sounds (if low in the airway)

Vitamin D deficiency def

essential nutrient that plays an important role in calcium homeostasis and bone health Severe deficiency of vitamin D causes rickets in infants and children, and osteomalacia in all age groups • Softening bones (Rickets) ⇒ bowed legs, fractures, costochondral thickening ("rachitic rosary"), dental • Prevalence in the United States in the pediatric age range is approximately 15 percent • common in infants who have dark skin pigmentation and those who are exclusively breastfed beyond three to six months of age --For individuals with light skin pigmentation, during most seasons, 10 to 15 minutes of sun exposure near midday is sufficient for adequate vitamin D synthesis --Direct sunlight exposure should be avoided for infants younger than six months ** • Vitamin D is transferred from the mother to the fetus across the placenta, and reduced vitamin D stores in the mother are associated with lower vitamin D levels in the infant • Vitamin D deficiency is particularly common in dark-skinned pregnant mothers, especially those living at higher latitudes and in the winter months • Vitamin D levels are particularly low in premature infants because they have less time to accumulate vitamin D from the mother through transplacental transfer

hemophilia sx

excessive bleeding • may be into a joint or muscle, inside the abdomen or head, or from cuts, dental procedures, or surgery • Recurring bleeding into the joints and muscles can lead to crippling deformities • Bleeding can swell the base of the tongue until it blocks the airway, making breathing difficult • A slight bump on the head can trigger substantial bleeding in the brain or between the brain and the skull, causing brain damage and death.

urticaria dx

extensive lab testing not indicated; skin or IgE testing limited to the specific history of provoking allergen

Cryptochidism def

failure of testes to descend (one or both) • An undescended testicle is generally rare in full-term babies but common in baby boys born prematurely (30%) • If not repaired risks infertility and malignancy

short stature normal causes

familial (genetic short) stature and constitutional delay. Eighty percent of cases of short stature are attributable to these two causes • Familial short stature: Children with familial short stature establish growth curves at or below the fifth percentile by the age of 2 • They are otherwise completely healthy, with a normal physical exam • These children have normal bone age, and puberty occurs at the expected time Constitutional delay: Children grow and develop at or below the fifth percentile at normal growth velocities • This results in a curve parallel to the fifth percentile • Puberty is delayed which results in a delay in the bone age

Encopresis

fecal incontinence, also known as encopresis or soiling, refers to the repetitive, voluntary or involuntary, passage of stool in inappropriate places by children four years of age and older, at which time a child may be reasonably expected to have completed toilet training and exercise bowel control • almost always associated with severe constipation: liquid stool leaks around a hard, retained stool mass and is involuntarily released through the distended anorectal canal • encopresis is seen predominantly in males

gastroesophageal reflux disease (GERD) tx

fifty percent of infants will have a clinically significant improvement or resolution of symptoms with conservative measures alone • infants with GERD should receive small infrequent feedings in the upright position and be maintained for at least 20 min after a feeding • feeds should be thickened with cereal • Avoidance of exposure to tobacco smoke • Elimination of cow's milk proteins from the diet If esophagitis is suspected a PPI or H2RA may be helpful • Surgery ⇒ Nissen fundoplication In older children and adolescents ⇒ small frequent meals, eat slowly, maintain upright position after meals, and avoid meals after 7 PM --Pharmacologic treatment with PPIs (preferred) or H2RAs

diptheria, tetanus, and/or pertussis (DTap) dosing

five doses followed by boosters 1. 2 months 2. 4 months 3. 6 months 4. 15-18 months 5. 4-6 years inactivated vaccine

primary hemostasis

formation of a weak platelet plug and causes mucocutaneous bleeding • Primary hemostatic problems usually cause petechiae (pinpoint superficial skin bleeds), anterior epistaxis (mild nosebleeds), immediate bleeding after surgical procedures, like tooth extraction, or bleeding from mucosal surfaces, like gingival, gastrointestinal, or vaginal bleeding commonly have a prolonged bleeding time

tonic-clonic seizures

formerly known as convulsive of grand mal 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 sec clonic phase: generalized convulsions and limb jerking postictal phase: a confused state

absence seizures

formerly known as petit mal • characterized by a brief impariment of consciousness with and 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

pneumococcal conjugate (PCV 13) vaccine dosing

four doses 1. 2 months 2. 4 months 3. 6 months 4. 12-15 months inactivated vaccine

poliovirus vaccine dosing

four doses 1. 2 months 2. 4 months 3. 6-18 months 4. 4-6 years inactivated vaccine

third degree burn

full thickness burn Burned skin is tough and leathery, skin non-tender

encopresis cause

functional: chronic constipation emotional: school, divorce, ect.

diarrhea after drinking (not so) fresh mountain stream water

giardia lamblia--incubates for 1-3 weeks, causes foul smelling bulky stool, and may wax and wane over weeks before resolving

Juvenile Rheumatoid Arthritis (JRA) def

group of rheumatic diseases that begins at or before age 16 There are three types 1. Oligoarticular JIA (40-60%) is the most common form and usually affects young girls. It is characterized by the involvement of ≤ 4 joints during the first 6 mo of disease. 2. Polyarticular JIA is 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. 3. Systemic JIA (Still disease) is the least common form and involves fever and systemic manifestations.

viral conjunctivitis tx

hand washing, avoid contamination eye lavage with normal saline BID 7-14 days; antihistamine drops, warm to cool compresses

bacterial conjunctivitis tx

hand washing, avoid contamination tx in order of suggested use--the dose is 0.5 inch (1.25 cm) of ointment (preferable in children) depositied inside the lower lid 1 to 2 drops instilled four times daily for 5 to 7 days 1. gentamycin/tobramycin (tobrex): aminoglycoside abx used for gram negative bacterial coverage. most cases of bacterial conjunctivitis will respond to this agent 2. erythromycin ointment (e-mycin) chlamydia for newborns 3. trimethoprim and polymyxin B (polytrim) this combination is used for occular infections, involving cornea or conjunctiva, resulting from strains of mircoorganisms susceptible to this abx 4. ciprofloxacin (ciloxan) contact lenses use = pseudomonas tx = fluroquinolone (ciprofloxacin) Neisseria conjunctivitis warrants prompt referral and topical + systemic antibiotics Chlamydial conjunctivitis systemic tetracycline or erythromycin x 3 weeks, topical ointments as well, assess for STD or child abuse

obesity def

has become one of the most important public health problems in the United States • The history should include the age of onset of overweight and information about the child's eating and exercise habits, along with medication history, medical history, family history, and psychosocial history • Calculation of body mass index (BMI) is a clinically practical tool for the assessment of overweight and obesity in children

hemophilia def

hereditary bleeding disorder caused by a deficiency in one of two blood clotting factors: factor VIII or factor IX There are two forms: • Factor VIII in Hemophilia A which accounts for about 80% of all cases • Factor IX in Hemophilia B (Christmas Disease) --**Remember: Hemophilia A = "Aight" and B comes after A which is factor NINE • caused by several different X-linked recessive gene abnormalities ⇒ the gene abnormalities are inherited through the mother and that nearly everyone with hemophilia is male The bleeding patterns and consequences of these two types are similar ⇒ hemarthrosis, bruising, and bleeding

chronic disease/renal failure

high ferritin, low serum FE, low TIBC

impetigo

highly contagious bacterial infection of the skin • areas of superficial skin trauma, most common on the face and extremetities, most commonly caused by S. aureus • the main symptom is red sores that form around the nose and mouth. sores ruptures, ooze for a few days, then form a yellow, brown crust Non-bullous: (MOST COMMON): vesicles, pustules, "honey-colored" and weeping --MCC: S. aureus; GABHS Bullous: vesicles ⇒ bullae, varnish-like crust --fever, diarrhea --MCC: S. aureus

drug exposure

history of phenytoin, phenobarbital, or MTX

urticaria def

hives 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

orbital cellulitis tx

hospitalization and IV broad spectrum antibiotics (vancomycin)

neonatal hepatitis

idiopathic hepatic inflammation during the neonatal period. It is a diagnosis of exclusion and is the most common cause of cholestasis in the newborn. • Incidence is 1 in 5,000-10,000 live births, with a male predisposition. Clinical features • 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.

human papillomavirus (HPV) vaccine doses

if 9-14 years of age, two doses are given 6-12 months apart 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

appendicitis dx

imagine if atypical presentation --appy U/S or abdominal CT scan CBC-neutrophiia supports the dx

other noncardiogenic causes

include metabolic causes (e.g., hypoglycemia, hyperventilation), hypovolemia (e.g., hemorrhage), hypersensitivity (syncope precipitated by wearing a tight collar or turning the head), mechanical reduction of venous return (e.g., Valsalva maneuver, post micturition), and various medications (e.g., β-blockers, nitrates, antiarrhythmic agents)

kawasaki disease labs

increased inflammatory markers: CRP, ESR, platelet count (at 2-3 weeks), WBC with left shift increased liver transaminases ECHO for all patients to assess for cardiac abnormalities --obtained at time of dx and again at 2 and 6-8 weeks after

oral candidiasis (thrush) def

infection of fungus (candida albicans) accumulates in the mouth • mouth pain • white plaques that bleed when scraped

orbital cellulitis def

infection of orbital muscles and fat behind the eye (periorbital=infection of only the skin) • decreased ocular 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 yo

croup def

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

glomerulonephritis def

inflammation of the glomerular basement membrane Antigen-antibody complexes are formed or deposited in the subepithelial or subendothelial areas; immune mediators follow, resulting in inflammatory injury Hematuria, overt or microscopic, is the hallmark of the disease

meningitis def

inflammation of the membranes (meninges) surrounding the brain and spinal cord • swelling from meningitis typically triggers the classic triad of headache, fever and a stiff neck (nuchal rigidity) • Most cases of meningitis in the United States are caused by a viral infection, but bacterial, parasitic and fungal infections are other causes • Unlike encephalitis no mental status changes • N. meningitidis (most likely if pt. has a rash) ⇒ petechiae

lactose intolerance def

insufficient levels of lactase, an enzyme that catalyzes the hydrolysis of lactose into glucose and galactose, in their digestive system. • In most cases, this causes symptoms that may include abdominal bloating and cramps, flatulence, diarrhea, nausea, borborygmi (rumbling stomach), or vomiting after consuming significant amounts of lactose • Clinical symptoms typically appear within 30 minutes but may take up to two hours, depending on other foods and activities • Patients may need calcium supplementation

fourth degree burn

into the bone and muscle

epiglottitis tx

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

Juvenile Rheumatoid Arthritis (JRA) tx

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

Ewing's Sarcoma

kids 5-25 • Pain often accompanied by fever, often mimics an infection. May have palpable mass, swelling, and local tenderness • X-Ray: appears as a lytic lesion with an onion-skin appearance of the periosteum • found in diaphysis of long bones (femur MC) • Treat with chemotherapy, surgery and radiation therapy

Kernig's Sign

knee extension causes pain in the neck Meningitis indication

diaper dermatitis dx

laboratory tests are not necessary but may help confirm the diagnosis in recalcitrant cases • 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

herald patch

large oval plaque with central clearing and scaly border. 1st sign of pityriasis rosea

lice tx

launder potential fomites such as sheets in hot water (> 131 F or 55 C) • Permethrin topical is the drug of choice: Capitis: permethrin shampoo x 10 minutes; Pubis: permethrin lotion x 8 hours

anorexia nervosa--binging/puring type

laxatives/diuretics abuse excessive exercise

Brudzinski Sign

leg raise when bend neck Meningitis indication

hypercalcemia def

less common in children than in adults but is more likely to be clinically significant in younger patients • Clinical features of hypercalcemia may be nonspecific in neonates and infants, and hypercalcemia is often discovered when a chemistry panel is obtained to evaluate failure-to-thrive • Primary hyperparathyroidism is far less common in children and adolescents than in adults --Nearly all patients (79%) are symptomatic at presentation and end-organ damage (nephrocalcinosis, nephrolithiasis, acute pancreatitis, or bone involvement) is common (44%) STONES, BONES, GROANS, MOANS

intermittent asthma

less than 2 times per week with ≤2 night sx per month --step 1: short acting beta2 agonist (SABA) PRN

bone marrow disease labs

leukemia, lymphoma, or myelodysplasia

rotavirus vaccine

live attenuated vaccine can increase the risk for intussusception high risk infants

lead exposure labs

low MCV, basophilic stippling, increased free erythrocyte porphyrins

iron deficiency labs

low ferritin, low serum Fe, high TIBC

anemia def

low hematocrit and/or hemoglobin relative to normal values • sx: weakness, fatigue, dyspnea on exertion • physical exam: pallor, tachycardia, systolic flow murmur, jaundice, positive stool guiac • may present as angina

pertussis tx

macrolide (erythromycin/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

diabetes mellitis dx criteria

made by one of the following: Random blood glucose levels of > 200 mg/dL + diabetic symptoms Two separate fasting (8-hours) glucose levels of > 126 mg/dL 2-hour plasma glucose of > 200 on an oral glucose tolerance test (3-hour GTT is the gold standard in GDM) Glycated hemoglobin (A1C) ≥ 6.5 percent

cystic fibrosis tx

maintenance: chest physiotherapy, high-fat diet, supplement fat soluble vitamins (A, D, E, K) acute exacerbations: abx

Hirschsprung disease tx

management includes resection of affected segment or colostomy

mycobacteria marinum

marinum=aquarium • found in fresh and saltwater--infection occurs after inoculation of the skin via abrasion or puncture in a patient with contact of an aquarium, saltwater, or marine animals • occupational hazard of aquarium handlers, marine workers, fishermen, and seafood handlers • diagnose by culture

avascular necrosis of proximal femur tx

may be conservative or may eventually need a joint replacement

HBV polymerase chain reaction (PCR)

may be used for both diagnosis and assessing the response to therapy

short stature pathologic causes

may result in either disproportionate or proportionate short stature • Disproportionate short stature is characterized by short limbs but an average-sized trunk --Rickets and achondroplasia (dwarfism) • Proportionate short stature (PSS) is when the person is small, but all the parts are in the usual proportions: --Prenatal etiologies include intrauterine growth retardation, placental dysfunction, intrauterine infections, teratogens, and chromosomal abnormalities (trisomy 21 and Turner's syndrome) --Postnatal causes include malnutrition, chronic systemic disease, psychosocial deprivation, drugs and endocrine disorders (hypothyroidism), GH deficiency, glucocorticoid excess, and precocious puberty

gastroesophageal reflux disease (GERD) dx

mild reflux can be diagnosed with a careful history • In moderate to severe reflux diagnosis can be confirmed with: --Upper GI examination --PH probe placement --If severe reflux or projectile emesis obstructions should be considered ⇒ abdominal US and barium swallow --CBC usually normal --CMP may demonstrate hypochloremic, hypokalemic metabolic alkalosis --CXR if abnormal chest examination ⇒ aspiration pneumonia

ebstein-barr disease

mononucleosis is a viral illness characterized by a classic triad of fever + lymphadenopathy + pharyngitis • 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 of splenic rupture--athletes hsould avoid vigorous sports for at least the first three to four weeks of illness Tx: supportive

mild persistent asthma

more than 2 times per week or 3-4 night sx per month --step 2: low dose ICS daily

lead poisoning def

most common environmental illness of children in the United States. • In children, most organs are susceptible, especially the brain. Therefore, must remain high on the differential list for pediatric patients • Environmental exposure is the most significant source in children, including exposure to lead-based paint, food, water, and soil --Classic case scenarios of lead poisoning involve children inside an old house with paint chips • 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 --can also cause anemia

myoclonic seizures

muscle jerking, but not the tonic phase, occurs in the morning

Conduct disorder criteria

must have at least 3 of the following 15 criteria in last 12 months: aggression towards people/animals -often bullies, threatens, or intimidates others -often initates physical fights -Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun). -Has been physically cruel to people. -Has been physically cruel to animals. -Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery). -Has forced someone into sexual activity. destruction of property -has deliberately engaged in fire setting with the intention of causing serious damage -has deliberately destroyed other' property (other than by fire setting) deceitfulness or theft -Has broken into someone else's house, building, or car. -Often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others). -Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery). serious violations of rules -Often stays out at night despite parental prohibitions, beginning before age 13 years. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period. Is often truant from school, beginning before age 13 years.

epistaxis def

nasal trauma, dryness, HTN, nasal cocaine, alcohol Kiesselbach's Plexus or Little's Area is the most common site for anterior bleeds Posterior bleed = less frequent (woodruff plexus) Recurrent epistaxis: Must rule out hypertension of hypercoagulable disorder

acute bronchiolitis dx

nasal washing for RSV culture and antigen assay; CXR=normal

pertussis dx

nasopharyngeal swab of secretions-->culture

ventricular septal defect def

non-cyanotic MC pathological murmur in childhood --in this case, the hole or defect in the heart muscle is between the ventricles (interventricular septum) --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 of blood flow

diarrhea on a cruise ship

norovirus - vomiting and horrible muscle cramps

enuresis def

nvoluntary loss of urine in a child older than 5 years • Successful bladder control is usually achieved between the ages of 24 and 36 months, although many developmentally normal children take significantly longer • Clinically significant: occurs > two times per week for > three consecutive months or affects day-to-day life • Age: > five years old • Not caused by other substance It may be nocturnal or daytime, or both and primary or secondary • Primary enuretics: patients who have never successfully maintained a dry period --Primary nocturnal enuresis is thought to be due to delayed maturational control or inadequate levels of ADH secretion during sleep • Secondary enuretics: dry for several months before regular wetting occurs

oral candidiasis (thrush) tx

nystatin, oral fluconazole

generalized seizures def

occur when there is widespread seizure activity in the left and right hemispheres of the brain. Start midbrain or brainstem and spreads to both cortices types: absence seizures tonic-clonic atonic seizures clonic seizures tonic seizures myoclonic seizures

teething def

occurs between 6 to 24 months of age • The two bottom front teeth (lower central incisors) are usually the first to appear, followed by the two top front teeth (upper central incisors). Classic signs and symptoms of teething include: Excessive drooling Chewing on objects Irritability or crankiness Sore or tender gums A slight increase in temperature — but no fever

tetanus, diphtheria, acellular pertussis (Tdap) vaccine doses

one dose 1. 11-12 years inactivated vaccine

Tetanus, diphtheria, acellular pertussis (Tdap) or tetanus and diphtheria (Td) vaccine dosage

one dose Tdap and then a Td booster every 10 years in pregnant women, 1 dose of Tdap should be given during each pregnancy between 27-36 weeks gestation

infection related anemia labs

osteomyelitis, HIV, mycoplasma, or EBV

acute otitis media dx

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

bacterial pneumonia tx

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

acute asthma exacerbation tx

oxygen, nebulized SABA, ipratropium bromide, and oral corticosteroids

tinea barbae def

papules pustules, around hair follicles

second degree burn

partial thickness Skin is red and blistered, the skin is very tender

HBV surface antigen (HBsAG)

pathognomonic for active disease. It is the antigen used in the hepatitis B vaccine.

anorexia nervosa

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.

Generalized anxiety disorder (GAD) def

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

clonic seizures

person may lose control of bodily functions and begin jerking in various parts of the body. He/She may temporarily lose consciousness, followed by confusion.

focal seizure tx

phenytoin, and carbamazepine are drugs of choice

tetrology of fallot dx

physical exam and boot shaped heart on CXR

verruca plantaris

plantar warts bottom of the foot. rough surface. dark spot (thrombosed capillaries

epistaxis (posterior) tx

posterior balloon packing • high-risk for complications-specialist eval and inpatient monitoring; nasal arterial supply ligation via surgery in some cases

atrial septal defect def

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. Noncyanotic Foramen ovale fails to close. Ostium Secundum is most common • Physical 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.

tympanic membrane perforation def

presents with pain, otorrhea, and hearing loss/reduction • can occur from infection (AOM) or trauma (barotrauma, direct impact, explosions)

influenza dx

primarily on patient hx. a rapid antigen test can be performed in the clinic--the virus can be isolated from the throat or nasal mucosa • rapid serology test are often available and accurate during the first few days of illness • gold standard=RT-PCR or viral culture take 3-7 days to return • CXR for primary influenza pneumonia will show bilateral diffuse infiltrates

varicella (chickenpox) infection def

primary infections - clusters of vesicles on an erythematous base. • 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

secondary hemostasis

problems with coagulation factors and causes deep tissue bleeding Patients with secondary hemostatic problems can develop large bruises (ecchymoses), deep tissue hematomas or hemarthrosis (bleeding inside the joint space), posterior epistasis (severe nosebleeds), persistent bleeding after surgical procedures, as well as intracerebral hemorrhage

liver cirrhosis labs

prolonged PT an PTT ↓ albumin, ↑ bilirubin, and ↑ AST and ALT (early) or ↓ AST and ALT (late)

vitamin K deficiency labs

prolonged PT and PTT all infants get an injection of vitamin K

DIC

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

coarctation of the aorta tx

prostaglandins E1 generally require surgical repair with dilating segment with balloons

HBV surface antibody (HBsAb)

protective and can result from vaccination or natural infection.

fungal otitis externa def

pruritis, weeping, pain, hearing loss swollen, moist, wet appearance aspergillus niger (black), a. flavus (yellow) or a. fumigatus (gray), candidia albicans

bacterial conjunctivitis def

purulent discharge from both eyes ('glued shut') crusting, usually worse in the morning; may be unilateral • s. pneumonia, s. aureus (common)-acute mucopurulent • m. matarrhalis, gonococcal-copious purulent discharge in a patient who is not responding to conventional tx • chlamydia-newborn, giemsa stain-inclusion body, scant mucopurulent discharge

cystic fibrosis dx

quatitiative sweat chloride test CXR may reveal hyperinflation, mucus plugging and focal atelectasis

Stevens-Johnson Syndrome def

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 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) • milder form of toxic epidermal necrolysis (TEN) with LESS THAN 10% of body surface area detachment

Hirschsprung disease dx

rectal suction biopsy, revealing the absence of paucity of ganglion cells • barium assisted radiography • digital rectal exam

allergic conjunctivitis def

red eyes, itching and tearing usually bilateral, cobblestone mucosa on th einner/upper eyelid

strabismus tx

referral if constant anytime or intermittent >6 mo • patch exercises, if untreated after age 2, amblyopia results

foreign body aspiration tx

remove foreign bod with bronchoscope • rigid bronchoscopy preferred in children while flexible is diagnostic and therapeutic in adults • complications include pneumonia, acute respiratory distress syndrome, asphyxia treat acutely with the heimlich maneuver

erythema multiforme tx

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

Vitamin C deficiency

responsible for scurvy • Scurvy presents with swollen gums, bruising, petechiae, hemarthrosis, anemia, poor wound healing, perifollicular and subperiosteal hemorrhages, and corkscrew hair • The body cannot synthesize, must obtain from the diet • Risk factors include food insecurity, feeding infants evaporated/boiled cow's milk

vitamin A deficiency def

results form inadequate intake, fat malabsorption, or liver disorders • deficiency impairs immunity and hematopoiesis and causes rashes (dry skin) and typical ocular effects (xerophthalmia (dry eyes), night blindness) • The common food sources of preformed vitamin A (retinols) are liver, kidney, egg yolk, and butter • Provitamin A (beta-carotene) is mostly found in green leafy vegetables, sweet potatoes, and carrots --These are metabolized by mammals into vitamin A, with varying efficiencies • Rarely seen in the United States and other resource-rich countries. --The prevalence of vitamin A deficiency is approximately 30 percent among children under age five worldwide and nearly 50 percent in young children in South Asia and sub-Saharan Africa --Approximately 500,000 preschool children become blind each year and many die

HBV core antibody (HBcAb)

results from natural infection (not vaccination) and persists lifelong.

peritonisillar abscess def

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

tinea corporis def

ringworm usually seen in younger children or in young adolescents with close physical contact with others (i.e. wrestlers)

HBV e antibody (HBeAb)

rises late in infection

HBV e antigen (HBeAg)

rises very early in active infection and is therefore useful in diagnosing acute infection.

SIEGECAPS

sadness interest/anhedonia guild energy concentration appetite psychomotor activity suicidal

epiglottitis dx

secure airway then culture for Hib • the classic finding is thumbprint sign on x-ray lateral neck film from swelling

tinea versicolor tx

selenium sulfide 2.5% applied to the affected skin for 10 minutes Wash off thoroughly. Apply daily for 7-10 days. Monthly applications may help prevent recurrences

Pityriasis Rosea tx

self-limiting: topical or systemic steroids and antihistamines are often used to relieve itching. Asymptomatic lesions do not require treatment

vitamin D deficiency dx

serum 25OHD levels recommended in certain high-risk populations Serum concentrations of 25OHD: • Vitamin D sufficiency- 20 to 100 ng/mL (50 to 250 nmol/L) • Vitamin D insufficiency- 12 to 20 ng/mL (30 to 50 nmol/L) • Vitamin D deficiency- <12 ng/mL (<30 nmol/L)

dehydration def

significant depletion of body water and, to varying degrees, electrolytes • divided into mild (3-5%), moderate (6-9%), and severe (≥10%)

HHV 7

similar to HHV 6 ( not yet classified)

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

Stevens-Johnson Syndrome dx

skin biopsy shows necrotic epithelium ddx: erythema multiforme, viral exanthems, drug rash

asthma tx

step 1: SABA PRN step 2: low-dose ICS step 3: low dose ICS + either LABA or LTRA or theophylline OR Medium dose ICS step 4: medium dose ICS + LABA step 5: high dose ICS + LABA step 6: high dose ICS + LABA + oral systemic corticosteroids

Stevens-Johnson Syndrome 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

hepatitis B vaccine

subunit vaccine In HBsAg-positive mothers, the infant should recieve the hepatitis B immune globulin

duodenal atresia tx

suction/drain secretions; respiratory elevate head, IV glucose and fluid, ABX Definitive: SURGERY

first degree burn

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

vitamin C deficiency tx

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 • Adults are usually treated with 300 to 1000 mg daily for one month • Many of the constitutional symptoms improve within 24 hours of treatment; bruising and gingival bleeding resolve within a few weeks

neonatal hepatitis tx

supportive management • decreased fat absorption may lead to growth failure and vitamin deficiencies. Increased nutritional support with concentrated calories, use of medium-chain triglyceride-containing formulas, and provision of fat-soluble vitamins A, D, E, and K are indicated. TPN may be needed if growth remains problematic. • Ursodeoxycholic acid, a bile acid, is used to enhance bile flow and to reduce bile viscosity. Ursodeoxycholic acid is not used until biliary obstruction has been excluded as a possibility. • liver transplantation may be necessary in cases of severe liver failure

measles tx

supportive with anti-inflammatories • patients must be isolated for 1 week after onset of rash • otitis media, pneumonia, diarrhea adn encephalitits are known complications of rubeola

mastioditis def

suppurative infection of the 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 the ear and forward displacement of the external ear

Epiglottitis def

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 or underserved areas 3 Ds of epiglottitis: dysphagia, drooling, respiratory distress

appendicitis tx

surgical appendectomy

pyloric stenosis tx

surgical correction - pyloromyotomy (Ramstedt's procedure)

retinoblastoma tx

surgical enucleation of the eye, chemotherapy

Slipped Capital Femoral Epiphysis tx

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

hypospadias tx

surgical repair, usually performed before 1-2 years of age Do not circumcise - foreskin may be used to reconstruct the urethra

ependymoma tx

surgical resection, usually followed by radiation therapy --sometimes chemo survival rate depends on age and how much of the tumor can be removed -total or near-total removal: 51 to 80% survival -less than 90% removal: 0-26% survival

Juvenile Rheumatoid Arthritis (JRA) dx

suspected in children with symptoms of arthritis, signs of iridocyclitis, generalized adenopathy, splenomegaly, or unexplained rash or prolonged fever The diagnosis is primarily clinical. • should be tested for RF, ANA, and HLA-B27 because these tests may be helpful in distinguishing between forms.

influenza tx

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) • Indications for antiviral treatment: hospitalized, outpatient with severe/progressive illness, an outpatient at high risk for complications (immunocompromised, pt with chronic medical conditions, >65 yo, pregnant women / 2 weeks postpartum)

atrial septal defect tx

symptomatic: diuretics, ACE inhibitors, digoxin definitive: surgical closure

severe persistent asthma

symptoms several times per day and nightly --step 5: high dose ICS +LABA daily --step 6: high dose ICS + LABA + oral steroids daily

allergic conjunctivitis tx

systemic and topical antihistamines or mast cell stabilizers (naphcon-a, ocuhist, generics) • epinastine (elestat) • azelastine (optivar) • emedastine difumarate (emadine) • levocabastine (livostin)

intussusception def

telescoping or invagination of a more proximal portion of the intestine into a more distal portion • The incidence is 1.5-4 in 1,000 live births, with a slight male predominance • Peak incidence occurs at 5-9 months of age. It is the most common cause of bowel obstruction after the neonatal period in infants less than 2 years of age • 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

child abuse and neglect treatment

the first thing to do is to care for any immediate injuries - like burns and fractures --healthcare provider's responsibility to report any suspicion of child abuse to child protective services --Oftentimes a social worker should be involved to help decide on the best next steps to ensure the child's safety, like separating the child from the abuser and helping the family cope

congenital hip dysplasia def

the socket or acetabulum - and the femoral head are misaligned, resulting in an unstable hip joint • typically present at birth, but sometimes appears later as the bones develop over time • 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

always remvoe button/disc batteries as soon as possible because...

their risk of causing corrosive burns or tissue damage to the GI tract (unless it has already passed the pylorus and is making swift progress through GI tract)

herpes virus

there are 8 different types of herpes known to infect humans called herpes human viruses (HHV) there are two types of herpes simplex viruses (HSV): HSV 1 (oral lesions), HSV 2 (genital lesions)

H. influenzae type B conjugate vaccine dosing

three doses 1. 2. months 2. 4 months 3. 12-15 months inactivated vaccine

hepatitis B vaccine dosing

three doses 1. birth 2. 1-2 months 3. 6-18 months

causes of decreased platelet number

thrombocytopenia which may be caused by decreased production, increased destruction, or sequestration.

scabies tx

topical permethrin 5% - apply to the entire body and wash after 8-14 hours ⇒ repeat in one week (> 2 months old) • Sulfur 5%-10% ointment (< 2 months old) • All clothing bedding, towels washed and dried using heat and have no contact with the body for at least 72 hours • Oral ivermectin if extensive involvement or immunocompromised individual --(0.2 mg/kg) → Often 3 mg tabs take four now and repeat in two weeks --Do not use in pregnant/breastfeeding women or in children < 15 kg Pruritus may persist for 2-4 weeks after treatment

lichen planus tx

topical steriods

syncope def

transient loss of consciousness/postural tone secondary to an acute decreased in cerebral blood flow • characterized by a rapid recovery of consciousness without resuscitation • MCC: vasovagal, idiopathic • red flags: syncope during exertion, multiple recurrences in short time, heart murmur/structural heart disease, old age, significatn injury during syncope, family hx of unexpected death/exertional/unexplained recurrent syncope • less common=cardiac arrhythmia

meningococcal vaccine dosage

two doses 1. 11-12 years 2. 16 years inactivated vaccine

measles, mumps, rubella vaccine dosing

two doses 1. 12-15 months 2. 4-6 years live attenuated

varicella vaccine dosing

two doses 1. 12-15 months 2. 4-6 years live attenuated

hepatitis A vaccine dosing

two doses 1. 12-24 months 2. 6 months after first dose inactivated vaccine

zoster vaccine schedule

two doses given 2-6 months apart at ≥50 year

Rome III Diagnostic criterial for diagnosing functional constipation in children---> age <4 years

two or more of the following: -Two or fewer bowel movements per week -At least one episode of incontinence per week after the acquisition of toileting skills -History of excessive stool retention -History of painful or hard bowel movements -Presence of a large fecal mass in the rectum -History of large diameter stools that may obstruct the toilet

drug eruption dx

typically clinical • Any new medications (vitamins, topical creams, herbs, prescriptions, OTC medications) taken in the past 6 weeks should be appropriately documented. • Complex drug eruption should be worked up. • CBC, CMP should be ordered to evaluate liver & kidney functions.

pityriasis rosea

typically 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.

enuresis dx

urinalysis and urine culture to rule out infection • Then, a thorough history and physical with fluid intake, stool, and voiding diary should be compiled in order to investigate abnormal patterns seen in conditions like constipation or diabetes insipidus

Non-Hodgkin's Lymphoma dx

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

causes of gastroenteritis

usually caused by viruses. However, bacteria, parasites, and fungus can also cause gastroenteritis • If the stool is bloody, the cause is less likely to be viral and more likely to be bacterial • Viral: In children, rotavirus is the most common cause of severe disease. Norovirus (#1 in adults), adenovirus, enterovirus • Parasitic: cryptosporidium, giardia • Bacterial: campylobacter, e. coli, clostridium, salmonella (reptiles) • Some foods commonly associated with illness include raw or undercooked meat, poultry, seafood, and eggs; raw sprouts; unpasteurized milk and soft cheeses; and fruit and vegetable juices.

hypospadias dx

usually made during the newborn exam but imaging studies (excretory urogram) can aid in the diagnosis

vitamin A deficiency dx

uually made by clinical findings, but can be supported by measurement of serum retinol levels levels less than 20 micrograms/dL [0.7 micromol/L] suggest deficiency

herpes zoster (shingles) def

varicella reactivation causing a maculopapular rash along one dermatome • Identified via tzanck smear with visualization of multinucleated giant cells • Zoster Ophthalmicus: shingles involving CCN V, dendritic lesions on slit lamp exam if keratoconjunctivitis is present • Zoster Oticus (Ramsay-Hunt Syndrome): facial nerve (CN VII) otalgia, lesions on the ear, auditory canal and TM, facial palsy auditory symptoms • Treat shingles with acyclovir, valacyclovir, and famciclovir - given within 72 hours to prevent post-herpetic neuralgia • Postherpetic Neuralgia: pain > 3 months, paresthesias or decreased sensation. Treat with gabapentin or TCA, topical lidocaine gel, and capsaicin • Herpes zoster vaccine is a live, attenuated virus vaccine - vaccination is recommended for immunocompetent adults > 60 years of age

HHV 3

varicella zoster virus (VZV) commonly known at chickenpox or shingles

condyloma acuminatum

venereal warts flesh colored, califlower appearance gential warts caused by HPV 6 and 11

umbilical hernia def

very common, generally is congenital and appears at birth • due to a persistent opening of the umbilical ring, which normally spontaneously closes • Closure of the umbilical ring is complete in almost all children by five years of age • Although closure is complete in most children by five years of age, this is not true for all children, as closure continues well into the teenage years for some children --4 to 5 years of age - 14 percent --6 to 7 years of age - 4 percent --8 to 9 years of age - 3 percent --10 to 11 years of age - 2 percent The majority of pediatric patients with umbilical hernias are asymptomatic, in rare cases, the hernia can interfere with feeding, especially in young infants with hernias that contain bowel

diarrhea from shellfish

vibrio cholerae

mumps def

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 Patient will present as → a 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. • 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

influenza

viral respiratory infection caused by orthomyxovirus resulting in fever, coryza, cough, headache, and malaise --three strains A, B, C everyone >6 months should receive an annular influenze vaccine --Avoid vaccination: severe egg allergy, previous reaction, Guillain-Barré syndrome (GBS) within 6 weeks of previous vaccination, GBS in the past 6 weeks, <6 mo old. Avoid FluMist in pt with asthma

vesicoureteral reflux dx

voiding cystourethrogram (VCUG) and monitor by using serial ultrasonography and VCUGs

verrucae def

warts all warts are caused by human papillomavirus (HPV). most resolve without treatment over 2 years

hemorrhage labs

watch Central Venous Pressure, not the Hct

hydrocele tx

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

Drehmann Sign

while in the supine position, hip externally rotates and abducts with passive hip flexion

atypical mycobacteria tx

with tetracyclines, fluoroquinolones, macrolides, sulfonamides for 4-6 weeks.

hypertrophic cardiomyopathy on physical exam

• 12 Lead EKG practical screening test (LVH on EKG) • LV Myocardium becomes hypertrophied leading to outflow obstruction SXS: --SOB, chest pain, syncopal episode after exertion • Systolic murmur left sternal border/loud S4 (outflow obstruction) --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 In contrast, standing up results in decreased venous return and thus decreased preload --With less preload there is less blood to separate the anterior leaflet from the hypertrophied septum, resulting in more obstruction and hence increased intensity of the murmur

neonatal jaundice dx

• A Coombs test is done --Positive ⇒ Rh or ABO incompatibility --Negative ⇒ check the levels of hemoglobin low ⇒ hematomas high ⇒ diabetic mother, twin- twin, maternal- fetal transfusion or delayed cord clamping. normal ⇒ look for increased reticulocytes and LDH and decreased haptoglobin which point to hemolysis ⇒ obtain a blood smear, for spherocytosis or elliptocytosis, enzyme levels, for G6PD or Pyruvate Kinase deficiency and hemoglobin electrophoresis for thalassemia and sickle cell. --If reticulocytes, LDH and haptoglobin come back normal, it's usually breastfeeding or milk jaundice, but it may also be caused by Gilbert or Crigler- Najjar syndromes. • Unconjugated hyperbilirubinemia is usually benign, but if severe, may need phototherapy or exchange transfusion. • If total bilirubin and conjugated bilirubin levels are high, then jaundice can be hepatocellular and caused by genetic syndromes, like Dubin-Johnson and Rotor syndrome. • If AST and ALT are high, then a large spectrum of liver conditions that lead to cirrhosis can be the cause and additional workup includes hepatitis B serology, anti-HCV antibody for hepatitis C, antibodies, PCR or culture for TORCH infections, serum iron, transferrin and ferritin for hemochromatosis, ceruloplasmin for Wilson disease, alpha-1 antitrypsin for alpha-1 antitrypsin deficiency, galactose-1-phosphate and GALT enzyme activity for galactosemia. • If alkaline phosphatase levels are high, then jaundice is post hepatic and caused by an obstruction of the biliary tree. • Obstructions are caused by biliary atresia, choledochal cysts, or the Alagille syndrome TX dependent on cause

lactose intolerance dx

• A presumptive diagnosis of lactose intolerance can be made in patients with mild symptoms that occur with significant lactose ingestion (e.g., >2 servings of dairy/day or >1 serving in a single dose that is not associated with a meal) and resolve after five to seven days of avoidance of lactose-containing foods, with recurrence on rechallenge • Lactose hydrogen breath test - definitive diagnosisT --he hydrogen breath test is positive for lactose malabsorption if the post lactose breath hydrogen value rises greater than 20 ppm over the baseline measurement • Stool acidity test (Fecal PH Test)

Acute Myelogenous Leukemia (AML)

• AML accounts for 20% of all cases of childhood leukemia • 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

foreign body in ear

• Aggressive flushing can cause perforation of the tympanic membrane, so caution is advised while irrigating • After each flush, it is prudent to recheck the external canal for retained foreign body (FB) fragments, which can occur with an insect • Irrigation of the external ear can be uncomfortable for the child consider treating with topical pain agents such as benzocaine-anti-pyrene • Insects must be immobilized prior to removal. Drown insects with mineral oil or viscous lidocaine before attempting removal • Removal of foreign body which requires direct visualization prior to removal either via warm irrigation with a syringe, or instruments like an alligator forceps

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

viral hepatitis tx

• Both active and passive forms of immunization are available, depending on the source of infection • HAV immunization is recommended for all children • HAV immunoglobulin will prevent clinical disease when administered within 14 days of exposure • The HBV vaccine series is recommended for all infants in the United States • Infants of infected mothers should receive both the vaccine and HBV immunoglobulin at delivery to prevent the disease and the development of a carrier state • Children with chronic hepatitis B who develop persistently abnormal ALT values should be referred for consideration of treatment to clinicians with expertise in managing pediatric hepatitis • The development of direct-acting antiviral agents (DAAs) and combination drug regimens represents a major milestone in the treatment of HCV

Acute Lymphocytic Leukemia (ALL) def

• CHILD + Lymphadenopathy + bone pain + bleeding + fever in a CHILD, bone marrow > 20% blasts in bone marrow • The most common pediatric neoplasm accounts for 80% of all cases of childhood acute leukemia • Most common childhood malignancy peak age 3-7 y/o • Highly responsive to chemotherapy (remission > 90%) • Absolute Neutrophil Count < 1000

hand-foot-and-mouth disease

• 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

Non-Hodgkins B-cell lymphoma

• Diffuse large B cell lymphoma ⇒ most common and aggressive • Follicular lymphoma ⇒ indolent, from chromosomal translocation • Burkitt lymphoma ⇒ highly aggressive, starry sky appearance on microscopy • Mantle cell lymphoma ⇒ aggressive • Marginal zone lymphoma ⇒ indolent • Nodal marginal zone • Splenic marginal zone • Lymphoplasmacytic lymphoma ⇒ indolent

mumps dx

• During an outbreak, a diagnosis can be made by determining recent exposure and parotitis. Usually, the disease is diagnosed on clinical grounds, and no confirmatory laboratory testing is needed • If there is uncertainty about the diagnosis, a test of saliva or blood may be carried out; a newer diagnostic confirmation, using real-time nested (PCR) technology, has also been developed • As with any inflammation of the salivary glands, the serum level of the enzyme amylase is often elevated • CSF demonstrates increased lymphocytes and decreased glucose

febrile seizure risk factors

• 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

Roseola (sixth disease)

• 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 disease --Fever can be controlled with antipyretics (eg, acetaminophen) if it is associated with discomfort --rash resolves without treatment

epinephrine dosing

• Infants weighing <7.5 kg (16 lbs) should be given an exact weight-based dose (not estimated), whenever possible. However, if drawing up an exact dose is likely to cause a significant delay in a rapidly deteriorating patient, the 0.15 mg dose can be given by autoinjector (Epi-Pen Jr.) or by drawing up 0.15 mL of the 1 mg/mL solution. • Infants and children weighing from 7.5 kg to 25 kg (16 - 55 lbs) can be given 0.15 mg by autoinjector (Epi-Pen Jr.) or by drawing up 0.15 mL of the 1 mg/mL solution. • Patients weighing 25 to 50 kg (55 - 110) can be given 0.3 mg by autoinjector (EpiPen) or by drawing up 0.3 mL of the 1 mg/mL solution. • Patients who weigh >50 kg (110 lbs) can be given 0.5 mg (0.5 mL of the 1 mg/mL solution). If the patient is obese, this can be administered using a 1.5-inch needle to penetrate the subcutaneous fat. However, if drawing up an exact dose is likely to cause a significant delay in a rapidly deteriorating patient, the 0.3 mg dose can be given by autoinjector.

diaper dermatitis tx

• Keep area dry to allow airflow • Barrier creams zinc oxide/petroleum jelly • Candidiasis: Nystatin, Clotrimazole, Econazole x 2 wks. • Discuss proper diaper changes, disposable, avoid tight-fitting Make sure to do a good oral exam as children with a diaper rash often have concurrent thrush. Another good question is to ask a breastfeeding mother if she has burning or redness on her breasts which can also be transmitted between the infant and the mom.

viral hepatitis dx

• Liver enzymes are uniformly elevated in hepatitis. Because the clinical manifestations are so similar, specific serologic tests are indispensable for securing an accurate diagnosis • The presence of anti-HAV IgM antibody confirms Hepatitis A infection • HCV antibody is present in both acute and chronic infection • HCV RNA can be detected by PCR within 1 week of infection, whereas the "window period" from infection to antibody response for HCV may be as long as 12 weeks

hemolytic anemia labs

• Mechanical ⇒ increased reticulocyte count • Immunologic ⇒ Positive Coombs test • Intrinsic hemolysis --G6PD/Hereditary spherocytosis ⇒ decreased serum haptoglobin • Extrinsic hemolysis --Cold agglutinins ⇒ osteomyelitis, HIV, mycoplasma, or EBV --Autoimmune ⇒ increased LDH, K + and bilirubin, decreased haptoglobin --Mechanical destruction ⇒ microangiopathic hemolytic (TTP, HUS, or DIC)

if the foreign body is thought to be in the esophagus (based on imaging and clinical presentation

• Observe for 24 hours with serial radiographs and remove endoscopically if the object does not pass distally within that timeframe • If the object causes symptoms or the time-point of ingestion is unknown attempt immediate endoscopic removal • If the ingested item appears relatively benign and has already progressed inferior to the diaphragm on imaging, observe and wait for spontaneous passage • If the ingested object is sharp, then remove it immediately with endoscopy • Batteries in the esophagus have the potential to cause severe tissue damage and should be removed immediately with endoscopy • Consider using a Foley catheter to remove retrograde from the esophagus or bougienage to pass the object distally into the stomach

erythema infectiosum (fifth disease)

• 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

diaper dermatitis def

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

atopic dermatitis tx

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

routine dental care

• Run a soft, clean cloth over baby's gums twice a day — after the morning feeding and before bed. The cleansing can keep food debris and bacteria from building up in the baby's mouth • When a baby's first teeth appear, use a small, soft-bristled toothbrush to clean his or her teeth twice a day. Until children learn to spit — at about age 3 — use a smear of fluoride toothpaste no bigger than the size of a grain of rice. Then switch to a pea-sized dollop as children approach 2 to 3 years of age • The American Dental Association and the American Academy of Pediatric Dentistry recommend scheduling a child's first dental visit at or near his or her first birthday

most common issues for those affected with Down's syndrome

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

leukemia sx

• Symptoms usually develop less than 4 weeks before diagnosis • 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%) • DDX includes aplastic anemia, ITP, Epstein-Barr, and other malignancies,

measles (Rubeola)

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

acute bronchiolitis tx

• The only treatment demonstrated to improve bronchiolitis is oxygen • Hospitalization if O2 saturation < 95-96%, age <3 months, RR > 70, nasal flaring, retractions, or atelectasis on CXR • Treatment is supportive; bronchodilators sometimes relieve symptoms but probably do not shorten hospitalization, and systemic corticosteroids are not indicated in previously well infants with bronchiolitis • Ribavirin if severe lung or heart disease and in immunocompromised patients • There is no vaccine. Monoclonal antibodies to RSV (palivizumab) prophylaxis (once per month for five months beginning in November) for special populations (immunocompromised, premature infants, neuromuscular disorders)

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)

androgenic alopecia tx

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

causes of decreased platelet function

• Von Willebrand disease --Type 1: ↓ quantity of VwF --Type 2: ↓ function of VwF • Bernard-Soulier disease • Glanzmann thrombasthenia • Uremic platelet dysfunction (CKD) • Result of medications like aspirin, non-steroidal anti-inflammatory drugs or NSAIDs, and clopidogrel

acne vulgaris def

• characterized by areas of open comedones (blackheads) incomplete blockage, closed comedones (whiteheads) complete blockage, papulaes, pustules, nodules, or cysts. may result in scaring

if acid/alkali is ingested..

• do NOT induce emesis • monitor ABCs • endoscopy 2-3 weeks later to assess damage

bacterial pneumonia dx

• fever, dyspnea, tachycardia, tachypnea, cough, +/- sputum • Dx: patchy, segmental lobar, multilobar consolidation • Blood cultures x 2, sputum gram stain

viral pneumonia dx

• kids ⇒ RSV; comes on fast; adults ⇒ flu = MC cause • Dx: CXR = bilateral interstitial infiltrates • Rapid antigen testing for flu, RSV nasal swab, cold agglutinin titer negative

neglect can be considered if...

• minor allowed to engage in potentially harmful behavior (i.e. EtOH consumption) • child is unattended; in some states, leaving child < age 13 home alone

gastroenteritis concerns

• presence of blood or mucus • weight loss • low BP, sunken fontanelle, dry mucous membrane--> want to know if crying, peeing • decreased urine output • reactive arthritis occurs in 1% of people following infections with campylobacter species

fungal otitis externa tx

• topical therapy, anti-yeast for candida or yeast: 2% acetic acid 3-4 drops QID, clotrimazole 1% solution; itraconazole oral

perioral dermatitis def

• yound women. papulopustular, plauques, and scales around the mouth • lip margin (vermillion border) is spared

hemophilia dx

↑ PTT, normal PT, and platelets, with ↓ Factor VIII or IX on assay • ↑ PTT and normal platelet count and function --Corrected with mixing studies ⇒ indicates a factor deficiency --If 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

hypothyroidism dx

↓ 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