UWORLD PEDS WEEK 1
varicella exposure pathway
- if immunized: observe - if not immunized: give vaccine if immunocompetent, if IC give Ig
high risk items to ingest
1. Sharp object (eg, needle, safety pin) in the esophagus, stomach, or proximal duodenum 2. Symptoms of esophageal obstruction (eg, drooling, inability to swallow secretions) 3. Symptoms of respiratory compromise 4. Button battery in the esophagus (due to the risk of electrical and chemical injury) 5. Magnets in the esophagus or stomach (due to the potential for bowel entrapment as a result of magnetic attraction across intestinal segments)
signs of developmental dysplasia of the hip - 3 sxs
1. clicky hip 2. asymmetric hip/thigh/inguinal creases 3. limb length discrepancy
define delayed puberty in girls
15 or older in girls with secondary sex characteristics 13 or older in girls without
max amount of daily cows milk
16-24 oz too much can lead to decreased fiber intake/constipation
MCHAT screening when
18, 24 months
chiari malformation type 1 vs 2
1: herniation of cerebellar tonsils thru foramen magnum 2: herniation of cerebellar tonsils AND vermis thru foramen magnum
ADHD dx requires
2 separate settings so get parents AND teachers perspective
rotavirus vaccine given when
2-8 months
biliary atresia presents when
2-8 weeks
constitutional growth delay definition
2nd or less percentile for height but normal linear growth
UTI tx in children
3rd gen cephalosporin like cefixime
testicles usually descend when
4-6 months, 6 months at the latest
febrile seizures age
5 months to 5 yrs
simple febrile seizure 3 criteria
<15 mins generalized does not recur within 24 hrs
Juvenile idiopathic arthritis - list stuff
>2 weeks fever, rash that worsens with the fever, >6 weeks arthritis/joint pain can also have LAD, HSM labs might show elevated WBCs, elevated platelet count, elevated inflammatory markers, maybe some anemia
IRON POISONING SXS
AG metabolic acidosis hematemesis
Eustachian tube dysfunction is a RF for
AOM
AOM with TM perforation sxs
AOM sxs with otorrhea
CONGENITAL TORTICOLLIS CAN HAVE A MASS WHERE
AT THE SCM Congenital muscular torticollis is a postural neck deformity due to tightening of the sternocleidomastoid muscle and presents with ipsilateral head tilt and contralateral chin deviation. A fibrotic neck mass may be present on examination, and limited range of motion of the neck increases the risk of positional plagiocephaly.
bilateral pneumonia is, bugs
ATYPICAL - due to mycoplasma, chlamydia
Main heart problem in down syndrome
AV septal defect
down syndrome cardio complication
AV septal defect --> murmur, heart failure in infancy, ftt
lymphadenitis tx
Abx
main cause of pneumonia in adults with CF? how about kids with CF?
Adults: pseudomonas children: staph
CD19 =
B cell related
FX AT BASE OF THE SKLL =
BASILAR SKULL FX
Astrocytomas in kids or adults?
BOTH
breastfeeding and breast milk jaundice - 2 similarities
BOTH are more indirect BOTH work by increased enterohepatic circulation
bedwetting normal age
Bedwetting is normal before age 5. Mastery of nighttime continence can take months to years, and boys generally achieve this milestone later than girls.
biliary cyst presentation
Biliary cysts may be asymptomatic or present with abdominal pain, a right upper quadrant mass, and/or jaundice. All patients should undergo cyst resection to decrease the risk for malignancy (eg, cholangiocarcinoma, gallbladder cancer, pancreatic cancer).
MCC of sensorineural hearing loss in kids
CMV
NEURONAL FUNCTIONAL DISTURBANCE =
CONCUSSION
cavernous sinus thrombosis dx
CT venography
KERATOSIS PILARIS CAUSE, WORSE WHEN
Caused by retained keratin plugs in hair follicles keratosis pilaris is worse in cold, dry weather
cushing triad, cause
Cushing triad is caused by elevated ICP Triad - hypertension, bradycardia, respiratory rate abnormality Hypoxic-ischemic brain injury (eg, drowning) can lead to widespread neuronal cell death, cerebral edema, and increased intracranial pressure (ICP). Severely increased ICP can cause Cushing triad, characterized by hypertension, bradycardia, and irregular respirations.
DISRUPTION OF WHITE MATTER TRACTS =
DIFFUSE AXONAL INJURY
TELOGEN EFFLUVIUM
DIFFUSE HAIR LOSS WITHOUT INFLAMMATION, SCARRING DUE TO STRESS
walking on tip toes should remind of
DMD
COLIC DX HOW, CRITERIA
DOE crying for no other reason for at least 3 hours, 3 days a week in a kid <3 moa
BREATH HOLDING SPELLS PATHOGENESIS, PRESENTATION
EMOTIONAL TRIGGER --> APNEA, COLOR CHANGE --> LOC
HERPANGINA PRESENTS AS
FEVER ULCERS IN THE MOUTH DYSPHAGIA
most pts with laryngomalacia also have
GERD, spitting up
foodborne botulinism sxs are preceded by
GI sxs like n/v/d/abdominal pain
Penicillin is needed in patients with a history of ARF to prevent future episodes of GAS pharyngitis. Failure to provide antimicrobial prophylaxis may lead to progression of RHD.
GIVE EVEN IF NO ACUTE INXN
INNOCENT MURMURS GRADING
GRADE 1 OR 2 SYSTOLIC
target cells mneumonic
HALT HbC sickle cell Asplenia Liver dz Thalassemia
iron deficiency red blood cells are hypochromic. how is the width distribution
HIGH
FSGS is associated with
HIV
3 MCC of sinusitis
HSM
eczema herpeticum cause
HSV
LARYNGOMALACIA sxs - inspiratory or expiratory
INSPIRATORY stridor when crying, feeding, infection, etc also tends to have reflux
Thrombocytopenia after a viral infection
ITP
antibiotics used for osteomyelitis - children > 3 moa
IV 3rd gen cephalosporin PLUS staph coverage lke nafcillin/oxacillin OR vancomycin or clindamycin if MRSA is likely
CF staph with influenza - what to tx staph with
IV Vancomycin
antibiotics used for osteomyelitis - adults
IV Vancomycin PLUS anti pseudomonal cephalosporins or anti pseudomonal fluoroquinolones
antibiotics used for osteomyelitis - children < 3 moa
IV cefazolin PLUS staph coverage lke nafcillin/oxacillin OR vancomycin or clindamycin if MRSA is likely
splenic sequestration tx
IVF PRBCs
RAPIDLY INCREASING HEAD CIRCUMFERENCE IN A PREMIE- THINK
IVH
CVID tx
IVIG
kawasaki tx
IVIG, ASA
hsp aka
IgA vasculitis
neonatal resuscitation
Immediate routine neonatal resuscitation includes drying, stimulating, and warming. Healthy newborns should be placed on the mother's chest for skin-to-skin care, which provides warmth and allows early breastfeeding initiation.
joint pain OVER 6 WEEKS IN A KID
JIA
HODGKIN LYMPHOMA SXS
LAD PROLONGED FEVER Prolonged fever and lymphadenopathy (particularly supraclavicular) are common manifestations of Hodgkin lymphoma. Reed-Sternberg cells on lymph node biopsy are diagnostic.
INSIDIOUS HIP/KNEE pain think
Leg calve perthe/osteonecrosis if insidious
if adjustment disorder AND MDD criteria are met - pick what?
MDD
rheumatic fever arthritis is
MIGRATORY
think what when think of paroxysms of fever
Malaria should be suspected in any ill patients, especially those with a history of febrile paroxysms, who have traveled to an endemic-tropical region. Thick and thin blood smears should be ordered for parasite detection and quantification. Nonimmune children are at highest risk of death, but the sickle cell trait confers some protection from severe complications.
methemoglobinemia tx
Methylene blue, vitamin C
Most common nephrotic syndrome in children
Minimal change disease
minimal change disease biopsy findings, tx
Minimal change disease is the most common cause of nephrotic syndrome in preadolescent children. Renal biopsy shows normal kidney architecture but is not routinely obtained in patients age <10. Steroids are the treatment of choice.
congenital dermal melanocytosis aka
Mongolian spots
Does MEE have signs of inflammation like bulging, fever
NO
does Werdnig Hoffman affect the pupils?
NO
does candidal diaper rash involve the perianal area?
NO
does irritant diaper rash involve the perianal area?
NO
do physicians report vaccine refusal to authortity like local gov?
NO Physicians do not report cases of vaccination refusal. ONLY DOCUMENT IN THEIR NOTE THAT PT REFUSED, WE EXPLAINED
do premies have different brain development later on??
NO bc most have catch-up in brain development in the first 2 years of life
bloody infectious diarrhea - do you give ABX
NO if theyre mild bc risk of resistance to e coli
Does orchipexy after cyptochordism reduce risk of testicular germ cell tumor?
NO risk is the same
do you need imaging for congenital clubfoot?
NO the dx is clinical
Do u get imaging for ALL kids with head trauma? PECARN RULE
NO u should avoid for minor trauma Altered mental status Loss of consciousness Severe mechanism of injury (eg, fall >1.5 m [5 ft], high-impact hit, serious motor vehicle collision) Vomiting Severe Headache Signs of basilar skull fracture LAHHVB
greenstick fx long term complications
NONE
Juvenile idiopathic arthritis tx
NSAIDs
growing pains tx
OTC analgesics massaging reassurance
HSP clinical findings
PARA petichiae/purpura abdominal pain, intusussception renal stuff arthritis
idiopathic precocious puberty is central or peripheral
PERIPHERAL
Any event that can cause OLIGOHYDRAMNIOS can result in
POTTER sequence
if parents are divorced and one parent consents for tx and one doesnt - how to proceed
PROCEED WITH TX - All u need is consent from ONE legal guardia When caring for an unemancipated minor, informed consent from one parent or guardian is considered legally sufficient to justify proceeding with therapy. Physicians should also provide care in urgent situations without waiting for parental consent.
tumor lysis syndrome has high
PUP Potassium Uric acid Phosphate
CRANIOPHARYNGIOMA SXS
Presenting symptoms include bitemporal hemianopsia and signs of pituitary hormone deficiencies (eg, diabetes insipidus, growth failure).
Organophosphate poisoning tx steps
RAP remove clothing, irrigate pt atropine pralidoxime
FIRST STEP IN CHEMICAL POISONING
REMOVE THEIR CLOTHING
trendelenburg sign can be seen in
SCFE bc of the damage to the blood vessels, muscles
reyes mneumonic
SHINE steatosis hypoglycemia/hepatomegaly infection - vzv, influenza not awake encephalopathy
osteogenesis imperfecta height
SHORT STATURE
describe sxs of ankylosing spondylitis timing, worse with, better with
SI joint stiffness and pain worse at night, improves with activity
LARYNGOMALACIA PRESENTATION
STRIDOR WHEN SUPINE, CRYING, FEEDING, URI
splenic sequestration
Splenic sequestration crisis is a life-threatening complication of sickle cell disease in which red blood cells become entrapped within the spleen. Patients have anemia, splenomegaly, and hypovolemic shock.
CD 3 =
T cell related
Seizures are characterized by sudden loss of consciousness, loss of postural tone, and a postictal state with delayed return to baseline neurologic functioning. Tongue lacerations can occur with tonic-clonic movements.
TONGUE LACERATIONS
multiple dilated loops of small bowel with paucity of air in the large intestine and rectum
TRANSITION POINT IN CF
transfusion related circulatory overload description
Transfusion-associated circulatory overload can occur when a large volume of blood product is rapidly transfused, particularly in children age <3 with chronic anemia.
how to dx developmental dysplasia of the hip
US hip
photokeratitis cause
UV exposure prollonged like 6-12 hrs
MC cardiovascular complication with edwards syndrome
VSD
WHAT CAUSES BLUNTING OF THE CALYCES, PRENCHYMAL SCARRING
Vesiculoureteral reflux
WAGR stands
Wilms tumor Aniridia Genitourinary malformation mental/motor Retardation
Increasing head circumference and signs of increased intracranial pressure in children should be evaluated with an imaging study such as a CT scan of the brain.
`
testicular torsion sxs
abdominal pain nausea vomiting
noise exposure causing sensorineural hearing loss is more in
adults Constant exposure to loud noises over a prolonged period can damage the cochlea and lead to high-frequency SNHL. Older children and adults may be affected, but SNHL due to noise exposure is rare at age ≤5.
gamma tetramers -
alpha thalassemia
BPD CXR pattern
alveolar collapse --> ground glass opacities reticulogranular pattern
cyclopentolate is what, used for
an anticholinergic
CI for vaccines
anaphylaxis encephalopathy - prolonged seizures, coma, decreased consciousness
2 types of food alleergies and their pathogenesis
anaphylaxis - IgE diarrhea, n/v/abdominal pain - non IgE
serum sickness comes with which meds
antibiotics, chemo drugs
anticholingeric toxicity tx
anticholinesterases
malrotation of the gut presents when
anytime in first year of life
sunscreen regimen
apply 15-30 min before sun exposure reapply every 2 hours and after swimming
3 complications of myelomeningocele
arnold chiari 2 malformation hydrocephalus fnd below the lesion
Babies can sit by ____ age. is it normal for them to fall forward?
at 6 months normal if they fall forward
When do sickle cell crises start?
at 6 months as HgF begins to wane Sickle cell pain crises can present with severe bone pain due to vasoocclusion by sickled red blood cells. These episodes typically begin as early as age 6 months when the production of defective hemoglobin A increases. A 2-month-old's hemoglobin is primarily fetal hemoglobin, making a pain crisis unlikely.
vertebral metastases pain worse when
at night
pt with down syndrome is at risk for what joint problem
atlantoaxial instability
alopecia arreata pathogenesis
autoimmune attack on hair bulb
spondylolisthesis sxs, can cause what
back pain with palpable step off can cause radiculopathy if it impinges on the spinal cord
irritant dermatitis tx
barrier ointment
NSAIDs can cause prerenal azotemia how
bc prostaglandins cause dilation of afferent arteriole and NSAIDs block this which can lead to prerenal azotemia
prolonged QT tx
beta blockers
tracheal ring sxs
bisphasic stridor that improves with neck extesion
Osteogenesis imperfecta sxs, mneumonic and additional
bone fractures i- blue sclera teeth imperfections, gray/blue translucent teeth ear - hearing loss can also have hyperlaxity of joints
brain abscess next step
brain imaging
describe pubertal gynecomastia in males
breast tissue forms as glandular tissue - glandular enlarges, can be tender, can be unilateral OR bilateral
developmental dysplasia is associated with
breech presentation
pneumothorax and transillumination
brighter on side affected
congenital clubfoot causes
can be genetic or structural like oligohydramnios, breech position, uterine fibroids
Staphylococcus aureus, Serratia, Burkholderia, Aspergillus are ALL
catalase positive
cephalohematoma, caput succedaneum sxs, cause
cause - trauma with delivery, icnreased riskk with forceps or vacuum delivery sxs - swollen, edematous, nonfluctous(?) mass
infectious mononucelosis and penicillins
causes a rash
rental tubular acidosis effect in kids
causes normal anion gap acidosis --> renal issues --> ftt
cephalohematoma = collection of blood between skull and periosteum, does not cross suture lines Caput succedaneum = collectio of subcutaneous fluid, crosses suture lines
cephalohematoma = collection of blood between skull and periosteum, does not cross suture lines Caput succedaneum = collectio of subcutaneous fluid, crosses suture lines
Skeletal survey is used for
child abuse fractures
trachoma cause
chlamydia trachomatis
Pearly white mass in the ear
cholesteatoma
sydenham chorea sxs
chorea tics behavioral changes
a bunch of neutrophils but no effect
chronic granulomatous disease
decreased superoxide production is seen in
chronic granulomatous disease
chronic suppurative otitis media pathogenesis
chronic recurrent otitis media leading to TM perforation
Are vaccines given according to corrected gestational age or chronologic age in premies?
chronologic age
methemoglobinemia dx
clinical cynosis not corrected with O2
Tuberculosis Risk Factors
close/poor living conditions
A 5-day-old neonate is brought to the hospital due to poor feeding, sweating, pallor, and respiratory distress. The symptoms are exacerbated with feedings. There has been no loss of consciousness or cyanosis during these episodes. She has no fever or cough. The girl was born at 38 weeks gestation via an uncomplicated vaginal delivery. On examination, temperature is 36.7 C (98 F), pulse is 165/min, and respirations are 75/min. Oxygen saturation on room air is 97% in the right hand and 95% in the left foot. She has nasal flaring and retractions. Bilateral fine crackles are present. A gallop is heard over the precordium; there is no murmur. The liver edge is palpable 3 cm below the right costal margin. Extremities are pale and cold. Brachial pulses are strong and femoral pulses are weak. What is the most likely cause of her symptoms?
coarctation of the aorta answer was increased LV afterload
CHARGE syndrome components
coloboma heart defects atresia choanal retardation - motor and developmental genitourinary stuff ear/hearing stuff
clinical description of diaphragmatic hernia
concave abdomen barrel shaped chest with resp distress possibly n first few days, normal bowel sounds on the unaffected side, absent bowel sounds in the affected side since there is a hypoplastic lung
anticholinetgic toxicity sxs
confusion hallucinations dry membranes dilated pupils OPPOSITE OF DUMBELLS PLUS HALLUCINATION, CONFUSION
brain abscess RF
congenital heart dz
Delayed bone age indicates
constitutional growth delay
periorbital hematoma tx
cool compresses NSAIDs
Herpangina cause
coxsackie virus
methemoglobinemia sxs
cyanosis chocolate colored blood cyanosis not corrected with O2
lacrimal duct stenosis can progress to
dacrosystitis which has drainage plsu swelling, erythema, tenderness over nasolacrimal ducts
RFs for otitis media
daycare attendance lack of breastfeeding smoke exposure
DKA total body K is
decreased
TB findings
decreased breath sounds - consolidation chronic cough lymphadenopahy
optic gliomas sxs
decreased vision proptosis optic disc pallor
first-line pharmacotherapy for nocturnal enuresis
desmopressin
NECROTIZING OTITIS MEDIA population
diabetics
neonatal abstinence syndroms sxs
diarrhea poor feeding irritability sometimes seizures sneezing think alcohol, opioid withdrawal sxs
DMD has risk of what 2 thigns
dilated CM scoliosis
GIARDIA PATHOGENESIS
disrupts epithelial tight junctions
TACO tx
diuresis - furosemide
SPF level matter?
doesnt matter as long as 30 or more
GI things down syndrome increases risk of
duodenal atresia Hirschrpung disease
HSP dx, tx
dx clinically tx is supportive
laryngeal papilloma dx, tx
dx: flexible laryngoscopy tx: surgical debridement
kawasaki next step
echocardiogram
Androgen insensitivity syndrome tx
elective gonadectomy to reduce risk of malignancy Patients with androgen insensitivity syndrome are genotypically male (46,XY) but appear phenotypically female. These patients are at increased risk of testicular cancer due to their bilateral cryptorchid testes; therefore, management includes an elective gonadectomy.
alpha thalassemia has what erythrocyte count
elevated
keratosis pilaris tx
emollients to keep it moist keratolytics like saliylic acid, urea Treatment includes emollients and topical keratolytics (eg, salicylic acid, urea).
OSA can present how in kids
enuresis
scabies lesions
erythematous papules with intense itching, especially at night
Tinea capitis progression
erythematous, scaly patch --> inflammation, scarring, alopecia, itchy, lymphadenopathy
Moth-eaten appearance of long bone on an x-ray
ewing sarcoma
chylothorax is what type of pleural effusion
exudative
chylothorax fluid decription
exudative milky high triglycerides
atypical pneumonia presentation
fatigue, prolonged cough, low grade fever, crackles bilaterally on lung exam
Breath holding spells can present after
fear, minor trauma, emotional triggers
osteonecrosis of femoral head X Ray
femoral head looks flattened, fragmented
brain abscess sxs
fever fnd headache nausea/vomiting
Kawasaki disease sxs
fever mucositis rash conjunctivitis LAD edema
drug induced interstitial nephritis sxs
fever rash eosinophilia WBCs WBC casts
Marfan syndrome has problem with
fibrillin -1 Marfan syndrome is an autosomal dominant disorder that results from mutations of the fibrillin-1 gene. Affected patients have tall stature; long, thin extremities; arachnodactyly; joint hypermobility; upward lens dislocation; and aortic root dilation.
laryngeal papillaomas are ofte described as
finger shaped or grapelike
DMD dx
first - get genetic testing - next if genetic testing is not conclusive, get muscle biopsy creatine kinase is high
clubfoot tx
first casting/manipulation/bracing - basically serial manipulaiton if refractory, surgery
spondylisthesis tx
first conservative - PT, analgesics, limit activity if not resolving, getting more step off or neuro sxs like incontinence, weakness - get surgical eval
amenorrhea first and second steps
first get US then get FSH/LH if US confirms uterus to see if peripheral or central
port wine stains - flat or raised
flat
Laryngomalacia dx
flexible laryngoscopy
photokeratitis dx
fluorescin test shows punctate corneal staining
chronic suppurative otitis media tx
fluoroquinolone
trachoma sxs
follicular conjunctivitis, inflammation can --> inversion of the eyelashes, scarring of the cornea --> blindness
3 main causes of neonatal sepsis
gbs e coli listeria
trendelenburg sign can be a sign of
general gluteal muscle weakness
retinitis pigemntosa cause
genetics
management for drowning patients
get ABG, CXR even if all normal and they appear fine, they are at risk for delayed pulmonary complications so have them wait for a 8 hr prolonged observation periods - if still asx with normal vital signs like RR and oxygen saturation and CXR is normal, can dc them
Next step if microcephaly
get parents head measurements to evaluate for benign microcephaly
maternal chickenpox baby prophylaxis
give Ig if momhas it 5 days before to 2 days after delivery
pertussis prophylaxis
give macrolides for all those in contact REGARDLESS of vaccination status
alopecia arreata sxs
hair loss - well demarcated circular areas painless, no inflammation
hydrocephalus sxs
headache vomiting seizures
cavernous sinus thrombosis sxs
headache and eye findings (eg, periorbital swelling, proptosis, vision loss, cranial nerve palsy)
first next step in speech/language delay
hearing test
MC complication of sickle cell TRAIT
hematuria
HUS triad
hemolytic anemia thrombocytopenia acute kidney injury
membranous nephropathy is associated with
hep B
swelling without urticaria, rash, anaphylaxis - think
hereditary angioedema
elevated mean corpuscular hemoglobin concentration
hereditary spherocytosis
baterial meningitis CSF
high neutrophils high protein very low glucose
pathogenesis for physiologic jaundice of the newborn
higher RBC turnover - bc higher hematocrit levels, shorter lifespan of the RBCs
cmv spread
hits pregnancy women thru body fluids, then spread vertically thru placenta possibly
neuroblastoma presents as
horner's syndrome
cogenital toxoplasmosis sxs
hydrocephalus macrocephaly seziures intracranial calcificatins HSM
how to tx nursemaid's elbow
hyperpronation OR supination pus flexion
post streptococcal glomerulonephritis sxs
hypertension, hematuria, edema
pyloric stenosis electrolytes
hypochloremic hypokalemic metabolic acidosis
rickettsia 3 important lab values
hyponatremia thrombocytopenia elevated liver enzymes
large fontanelle is seen in babies with
hypothyroidism along with hypotonia
endocrinology things down syndrome increases risk of
hypothyroidism type 1 diabetes obesity
ITP tx
if just petechiae: observation if bleeding: DIG - anti D, Imunoglobin, or glucocorticoids
impetigo tx
if localized: mupirocin if spread: cephalosporin like cephalexin
When can doc get court order against parent for refusing tx
if parents are refusing life saving tx in a nonemergent time In a nonemergency situation in which a parent refuses potentially life-saving treatment for their child, the physician should seek a court order mandating treatment.
tx for hemangiomas - when, what
if there is risk of loss of functioning - like compressing on nerve or something OR if large and disfiguring give propranolol
Pimecrolimus works how
immunosupressive drug
Wilsons pathogenesis
impaired hepatocellular transport of copper
antlantoaxial instability sxs
incontinence gait problems UMN signs
2 causes of floppy baby syndrome
infant botulinism Werdnig-Hoffman
cavernous sinus thrombosis MCC
infection of the eye like orbital cellulitis, sinusitis
osteonecrosis of femoral head sxs
insidious hip pain proximal thigh muscle atrophy
what mediates refeeding syndrome
insulin Carbohydrate intake stimulates insulin activity, which in turn promotes cellular uptake of phosphorus, potassium, and magnesium, leading to electrolyte deficiency.
jejunal atresia aka
intestinal atresia
crying and flexes hips sounds like
intusussception flexes hips = bringing knees to chest
congenital torticollis description of rotation
ipsilateral head tilt contralateral chin deviation
cow's milk makes it harder for the body to absorb what
iron
SIGNS OF NEONATAL SEPSIS
irribaility poor feeding leukopenia
how does pediatric depression present?
irritability might be seen more than depression
bedbug lesion
itchy erythematous papules in a linear distribution
think transient synovitis when
joint pain after a viral infection
chronic hoarseness for weeks think
laryngeal papillomas due to HPV aka recurrent respiratory papillomatosis
port wine stain tx
laser therapy
hematology things down syndrome increases risk of
leukemia
Impaired neutrophil chemotaxis is seen in
leukocyte adhesion deficiency.
foreign bodies in vagina next step
local anesthetic and irrigate
Transient hypogammaglobulinemia of infancy description
low IgG - recurrent infections or atopic diseases
serum sickness sxs
low grade fevr joint pain urticaria
spondylisthesis pain is worse with STRAIGHT LEG RAISE = NORMAL
lumbar EXTENSION
lumbar disc herniation pain is worse with
lumbar flexion
pertussis tx
macrolides
lactose intolerance stools are
malodorous, bulky
What cause of biliary emesis is more likely with other congenital issues like omphalocele
malrotation
Tiny white round lesions are present on the buccal mucosa next to the first and second upper molars. SOUNDS LIEK
measles
Brudinski and Kernig indicate
meningitis
metatarsus adducts vs congenital clubfoot
metatarsus adductus is flexibe, congenital clubfoot is rigid
congenital zika sxs
microcephaly intracerebral calcifications
HUS pathogenesis starts with
microthrombi formation - which shears RBCs
Congenital hypothyroidism presentation
might appear normal at birth, but the they have sluggish, weak, constipation, hypotonia, umbilical hernia, macroglossia
JONES criteria, E
migratory arhtirits carditis nodules subQ Erythema marginatum sydenham chorea
sydenham chorea pathogenesis
molecular mimicry
Disseminated gonococcal infection sxs
monoarthritis OR DPT dermatitis tenosynovitis migratory polyarthritis
kawasaki presentation, may be preceded by
mucositis, extrem rash or edema, LAD, fever, conjunctival injection may have nonspecific GI or resp sxs before
Brudinski sign
neck flexes --> hip and knee flexes
gram negative diplococci in CSF - meningitis is due to what bug? what isolation precautions to use?
neisseria meningitidis droplet precautions
neurofibromas are a type of
nerve sheath tumors
optic gliomas are associated with
neurofibromatosis
Methemoglobinemia induced by
nitrates, sulfates, anesthetics
If the parent doesn't want the patient to know of their kid's dx, does the dr have to tell them?
no not unless it can harm the child - for example, a 10 yr old has HIV, the doc can not share but once he's a teen, the doctor should encourage parents to share Disclosure of an HIV diagnosis to a child with perinatally acquired infection should occur by adolescence to foster patient autonomy, increase medication compliance, and prevent transmission. The provider should respect the family's concerns and offer joint participation in establishing a timeline and plan for disclosure.
do u need renal bx for minimal change dz?
no just go straight to steroids since its highly responsive to steroids
should you recommend fluid restriction, alarm blankets/therapy for a kid less than 5?
no...it is normal behavior until 5 yoa
methemoglobinemia PaO2 is
normal
enterovirus meningitis CSF fluid
normal glucose aseptic (WBC low) elevated protein
how do kids present with kidney stones
normally or isolated hematuria without flank or abdominal pain
osteoid osteoma pain relieved by
nsaids
SCFE 2 main RFs
obesity hypothyroidism
Alport syndrome sxs
ocular disturbance sensorineural hearing loss hematuria
Greenstick fracture
one in which the bone is bent and only partially broken Because the periosteum surrounding the bone is thick and strong in children, the fracture may involve only one side of the bony cortex rather than extending through the width of the bone. This is known as a greenstick fracture, as seen on this patient's x-ray. The opposite side appears to have a deformation or bend without a break in the cortex.
retinitis pigementosa fundoscopic exam
optic disc pallor retinal pigment deposition
route of abx for otitis media
oral
Congenital clubfoot tx
ortho eval - possibly surgery
mullerian agenesis has NORMAL
ovarian development external genitalia secondary sex characteristics
breath holding spell tx
part of normal development tx is reassurance
Stranger anxiety peaks when, resolves when
peaks by 8-9 months resolves by 2 years
first step if delayed puberty in a female
pelvic ultrasound to visualize reproductive tract
what drugs can cause drug induced hemolytic anemia? aka hapten induced hemolysis
penicillins, cephalosporins
photokeratitis sxs
photophobia eye pain erythema
leg bowing can be, tx, height level
physiologic, genu varum tx is reasurance - resolves by age 2 NORMAL HEIGHT
skin infection and then renal stuff think
post streptococcal glomerulonephritis
myocarditis in a kid is usually
post viral - so viral URI sxs - then signs of myocarditis.....chest pain, respiratory distress, cardiomegaly, hepatomegaly.....bc it basically presents as HF in kids
LAD in mono location
posterior cervical lymphadenopathy
CHD screening uses
pre and post ductal pulse oximetry
intussception often associated with
preceeding gi infection bc peyers patch is a lead point
Mc-cune albright triad
precocious puberty fractures cafe au lait spots
pinealoma - 3 Ps
precocious puberty - beta hcg parinoud syndrome - vertical gaze palsy obstructive hydrocephalus
which babies require US head screening?
premies <32 weeks bc risk of IVH
MCC of sensorineural hearing loss in elderly/adults
presbycusis
mullerian agenesis presentation
primary amenorrhea with associated normal female external genitalia and secondary sexual characteristics
Jervell & Lange-Nielson syndrome
prologned QT - AR, with sensorineural deafness
Romano-Ward
prolonged QT - AD, no sensorineural deafness
sickle cell trait benefit
protection from malaria
POTTER stands for
pulmonary hypoplasia oligohydramnios - trigger twisted skin twisted face extremity defects renal failure
Lesch-Nyhan syndrome presentation
pyramidal sxs like spasticity, hyperreflexia extrapyramidal like dystonia, chorea self-mutilation intellectual disability
frequently spitting up saliva with a lesion think
rabies
whole blood used when
rarely required except in cases of massive blood loss.
palpable cervical lymph nodes are COMMON in young adults, children - if reassuring, next step
reassurace
metatarsis adductis tx
reassurance
campylobacter tx
reassurance - it is self resolving
2 types of palpable nodules in kids
reassuring - soft, mobile, <2cm, no systemic sxs worrisome - firm/hard, nonmobile, >2 cm, systemic signs
common variable immunodeficiency sxs
recurrent sinupulmonary and GI infections
kartagener syndrome triad
recurrent sinusitis recurrent bronchiectasis situs inversus
Radial head subluxation aka nursemaid's elbow tx
reduce by hyperPRONATING
Peutz-Jeghers syndrome DX
regular upper and lower endoscopy
Causes of oligohydramnios
renal agenesis, PUV (males), placental insufficiency, rtc
How to dx kidney stones in kids
renal, bladder US > CT
eczema herpeticum sxs
resembles chicken pox but with more systemic sxs in a pt with atopic dermatitis
leukocoria ONLY points to
retinoblastoma
colic tx
review soothing techniques reassurance
hepatomegaly, encephalopathy after viral infection
reyes
rachitic rosary can be seen in
rickets
widened wrist =
rickets
Tx for close contacts of pts with meningococcal meningitis
rifampin, ceftriaxone, or ciprofloxacin
tyampanocentesis and culture is done when for otitis media
same timeline as tympanoplasty tubes
candidal diaper rash descriptions
satellite rash involving the skin folds
hypothenuria is what, seen in who
seen in sickle cell pts inability to concentrate urine - polyuria, low specfic gravity, normal serum sodium
neonatal herpes sxs
seizure temporal lobe abnormalities
kid is verbal at home but does not speak/asocial in other situations
selective mutism
laryngomalacia tx
self-resolved by 18 months if not, surgical consultation
cephalohematoma, caput succedaneum tx
self-resolves, so give reassurance
congenita CMV sxs
sensorineural hearing loss seizures periventricular calcifications hsm jaundice thrombocytopenia - blueberry muffin rash
galactossemia has an increased risk of
sepsis due to e coli
recurrent and severe infections, failure to thrive, and lymphopenia - b and t
severe combined immunideficiency
high risk feautures of foreign body ingestion
sharp battery metal sxs of esophageal obstruction sxs of resp compromise
osteogenesis imperfecta height
short
rickets height level
short
lacrimal duct stenosis tx
shoudl resolve by 6 months if not, refer to optho
tick bites and spider bites are usually
single
DESCRIBE CONGENITAL MELANOCYTIC NEVUS
single area of hyperpigmentation with increasd hair follicles
newborn with copious rhinorrhea think what congenital infection
snuffles - syphillis Nonspecific signs of congenital infection include jaundice, hepatosplenomegaly, and symmetric growth restriction. Specific findings highly suggestive of congenital syphilis include snuffles (copious rhinorrhea) and a maculopapular or bullous rash that may desquamate.
selective mutism is like
social anxiety in kids
once guillain barre is suspected - next step
spirometry to make sure no resp failure
tx for refractor ITP in kids AND adults
splenectomy
spherocytosis key presentation
splenomegaly and signs of hemolysis like anemia, jaundice after upper respiratory illness
2 causes of chronic suppurative otitis media
staph aureus pseudomonas
MCC of lymphadenitis
staph, strep
depression screnning when
starting 12 yoa
retinitis pigementosa presentation
starts as night blindness --> progressive vision loss
Severe Combined Immunodeficiency (SCID) long term tx
stem cell transplant
diaper rash that involves the perianal area
streptococcal perianal dermatitis
orbital compartment syndrome sxs
sudden onset eye pain, vision loos periorbital swelling tight orbit proptosis
transientsynovitis tx
supportive
viral sinusitis tx
supportive
post streptococcal glomerulonephritis tx
supportive can give loop diuretics if the pt is volume overloaded
Infectious mononucleosis tx
supportive care and sporta avoidance
bloody diarrhea tx
suppotive care only
SCFE tx
surgery
biliary cyst next step after US finds it
surgery to prevent malingany
orbital compartment syndrome tx
surgical decompression
lymphadenitis sxs
tender, warm lymph nodes with signs of infection
tinea capitis tx
terbinafine or grisefulvin
cryptochordism has higher risk of
testicular torsion testicular cancer inguinalhernia
hypertonicity after neonatal stump infection
tetanus --> seizures, hypertonicity
gastrochisis looks how on US in mother
thickened intestinal loops floating free in abdominal sac
Have to get what if suspect strep with negative rapid test
throat culture Children with pharyngitis and no viral symptoms (eg, rhinorrhea, cough) should undergo group A Streptococcus (GAS) rapid antigen detection testing. Due to the risk of acute rheumatic fever with untreated GAS, a throat culture is performed to confirm a negative result.
candidal diaper rash tx
topical antifungals
prophylaxis for neonatal gonococcal conjunctivitis
topical erythromycin
toxoplasmosis vs cmv calcifications
toxoplasmosis = diffuse cmv = periventricular zika = intracerebral
PDA sounds like
train track
heart thing due to mom with gestational diabetes, tx
transient hypertrophic cardiomyopathy - presents with systolic murmur resolves by age 1, reassurance
orbital compartment syndrome pathogenesis
trauma --> increased intraorbital pressure
periorbital hematoma sxs
trauma --> pain, brusing around the eye no change in vision, no pupillary defect
how can leukemia lead to acute renal injury
tumor lysis sydrome --> tubular obstruction
Contact dermatitis pathogenesis
type 4 HS - T cell mediated
normal infant intake
up to 32 oz a day
mullerian agenesis is the failure of development of the mullerian duct which forms into
upper 1/3vagina uterus cervix
cystinuria dx
urinary cyanide nitroprusside test
hypospadias, dad wants circumcision - next step
urology eval
what does blind sweep for an object mean, is it recommended, why
using a finger to search for an object not recommended bc it can push it distally
Endometriosis pain is throughout whole period, might also have dyspareunia....how is the flow?
usually heavy
SCFE bilateral or unilateral
usually unilateral
JIA eye sxs
uveitis
sinusitis sxs without fever - dx
viral sinusitis
underdeveloped phallus equals
virilization
what reduces rates of morbidity and mortalitiy in patients with severe measles and should be given to hospitalized patients
vitamin A
vegan diet --> deficiency in what 4 minerals
vitamin B12 vitamin D Iron calcium
neonatal abstinence syndrome pathogenesis
when the mom is on susbtances, most commonly opioids,, durign pregnancy and then the baby has withdrawals once born
Kernig's sign
when the thigh/hip is flexed, extension of the knee is limited
JIA timings
worse in morning, improves throughout the day
growing pains timing
worst at night
JIA sxs timing
worst in morning
can lift weight before puberty? is there damage to growht plates?
yes no
