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staphylococcal scalded skin syndrome, usually children < 5y/o, high fever, rash, irritability, extraordinary tenderness, peeling of epidermis
caused by herpesvirus 6 & 7, usually <3y/o, high fever 3-5days, pink rash that BEGINS ON THE TRUNK and spreads outward. APPEARS WITHIN 24hrs OF FEVER RESOLUTION.
Criteria for physiologic jaundice
(1)bilirubin < 14 (2) bilirubin increases by <5mg/dL per day (3) 1st 3 days the bilirubin is <5mg/dL (4) jaundice resolved by 7d in term infant and 14d in pre-me. (5) conjugated bilirubin is always normal.
Cause of physiologic jaundice?
defective hepatic uptake coupled with decreased UDP-glucuronyl-transferase activity. (increased RBC load may also play a role)
What are some causes of pathologic jaundice?
ABO/Rh incompatibility, drug reactions, RBC defects (sickle cell, thal)
What are the two inborn disorders of bilirubin metabolism that lead to a CONJUGATED bilirubinemia?
Dubin-Johnson, Rotor syndrome, (Biliary atresia and alpha1 antitrypsin def. can present this way also)
What are the two inborn disorders of metabolism that lead to an UNCOJUGATED hyperbilirubinemia?
Gilbert's and Crigler-Najjar
The AAP mandates a formal developmental screen should occur when?
9mo 18mo and 30mo checkups, but it is recommended that surveillance occur at all well-child visits!
What is the PALMAR GRASP and when does it disappear?
anything placed in the palm the child tries to grasp. Disappears by 2-3 months
What is the MORO reflex and when does it disappear?
abrupt change in position causes symmetric arm abduction followed by adduction and sometimes a cry. Disappears by 4 MONTHS
What is the Asymmetric Tonic Neck Reflex, when does it disappear?
passively turning the child's head to one side causes the ipsilateral arm to extend and the contralateral arm to flex at the elbow (schwarzeneggar pose) think future hand eye coordination. Disappears by 6 months.
What is the PLANTAR GRASP reflex?
palpation of the ball of the foot causes flexion of the toes. Disappears by 8 months. (must disappear before walking possible.
What is the BABINSKI and when does it disappear?
Dorsiflexion of the great toe with fanning of the other digits in response to stroking the plantar surface of the foot. It persists up to 1-2 years.
How much VitD should children get?
Children should get 400units of VitD per day. Supplement if necessary.
Why should you introduce foods one at a time several days apart?
to identify possible allergic reactions.
What ages and weights correspond to what car seat positions?
rear seat/rear facing until 1YEAR AND 22lbs. 4 years and 40lbs = booster seat, 8 years back seat with seat belt, 12years front or back seat with seat belt.
What are some possibilities when you cannot elicit the red reflex on eye exam?
abnormalities such as cataracts, glaucoma, retinoblastoma and chorioretinitis
How do you assess pallor in children with darker complexions?
in the conjunctiva, nail beds and mucous membranes
What is the most frequently Dx neoplasm of infancy?
neuroblastoma, usually presenting before age to with fever, pallor, weight loss. Often asymptomatic abdominal mass.
What labs do you want to get if you suspect neuroblastoma? What is the Sn ?
Urine vanillylmandelic acid (VMA) and urine homovanillic acid (HVA). Sensitivity = 90-95% (small cell rosettes (homer-wright) on Bone marrow aspirate are highly suggestive)
What are the favorable prognostic factors of neuroblastoma?
non-amplification of the n-myc oncogene, DNA index greater than 1, favorable histology (Shimada classification), and age less than 1.
What are the teratogenic effects of maternal diabetes?
sacral agenesis (pathognomonic), cardiac defects, renal defects, anencephaly
What are the teratogenic effects of phenytoin?
fetal hydantoin syndrome: pre/postnatal growth retardation, hypoplasia of the distal phalanges, and defects alteration of CNS performance. Can also interfere with folate metabolism (give folate)
Describe fetal EtOH syndrome?
growth retardation, developmental delay, characteristic facies: microcephaly, microphthalmia, flattened philtrum. Also may have skeletal, joint, cardiac abnormalities
In testing for immunodeficiencies what test would you order to look for chronic granulomatous dz?
Nitroblue tetrazolium (NTB) a respiratory burst assay to look for phagocyte defects
In testing for immunodeficiencies what test would you order to look for wiscott-aldrich?
platelet count, if it is normal wiscott-aldrich is unlikely
In testing for immunodeficiencies what might intradermal skin testing with candida reveal?
no response in a patient with T-cell deficiency (DiGeorges)
In testing for immunodeficiencies what test might you check if a patient has repeated infections with encapsulated organisms?
peripheral smear (look for howell-jolly bodies as evidence of asplenia)
What are the Danger Signs in Jaundiced Infants?
(1) Family history of significant hemolytic disease, (2) Vomiting, (3) Lethargy, (4) Poor feeding, (5) Fever, (6) Onset of jaundice after the third day, (7) High-pitched cry
Physiologic jaundice of the newborn
bili <15, no other cause for jaundice, child healthy, transient unconjugated hyperbilirubinemia due to multiple factors (decreased liver enzymes (UDPGT), increased RBC, lack of intestinal flora
How often/day and for how long do babies typically nurse
Babies usually nurse 8-12 times in 24 hours, and the feedings may initially range from 20 to 60 minutes (although consistently lengthy feeds may indicate a problem)
When should stool switch from meconium and to what do they switch?
By the 3rd day of life, they should begin to appear yellow.
How many stools/day are normal by the 6th-7th day?
there are usually 3-4 stools per day (some have stools with every feeding).
How often should the baby void by the 3rd day?
The baby should void 3 to 4 times a day by the third day
how might Biliary atresia appear in a healthy-appearing infant?
with jaundice and gradually acholic (pale) stools at 3 to 6 weeks.
Why might G6PD cause jaundice even if there is no anemia?
G6PD deficiency may cause a gene interaction with the promoter variant of the gene for UDPGT causing a deficiency similar to Gilbert's disease
Maternal infection with toxoplasmosis produces what in the neonate?
microcephaly, hydrocephalus, chorioretinitis, seizures, intracranial calcifications.
Maternal infection with rubella causes what in the neonate?
cataracts, sensorineural hearing loss, and congenital heart disease (PDA, and pulm art stenosis)
Clinical features of CMV infection in neonates?
IUGR, low birth weight, petechiae and purpura, jaundice and hepatosplenomegaly, microcephaly, chorioretinitis, and intracranial calcifications.
What aer the characteristics of fetal hydantoin syndrome?
IUGR, Mental retardation, dysmorphic facies, hypoplasia of the nails and distal phalanges.
What does APGAR stand for?
Activity (none,arms/legs,active), Pulse (none, <100,>100), Grimace (none, grimace, sneeze/cough/pull away), Appearance (Blue, extremities blue, pink), Respirations (none, slow irregular, crying)
What is ERB's palsy?
congenital brachial plexus injury involving the 5th and 6th cervical roots: arm adducted, internally rotated, but grasp reflex intact
How can you differentiate caput succedaneum and cephalohematoma?
caput succedaneum occurs external to the periosteum and therefore crosses suture lines.
What might make you think meconium aspiration?
postdates, grunting respirations, meconium staining, signs of air trapping, RR>100.
What is the Barlow test?
adduct hips push back used w/ Ortolani's to check for Developmental dysplasia of the hip.
What is Ortolani's test?
abduction of the hip with upward pressure used with Barlow's to test for DDH
What is the cushings triad?
HTN, bradycardia, and respiratory depression (these are late findings of intracranial pressure)
How does lead poisoning manifest as neurological effects?
lead has an affinity for the SH amino groups and inhibits delta-aminolevulinic acid dehydratase which catalyzes the formation of the porphobilinogen ring. (needed for heme synthesis) Aminolevulinic acid (a neurotoxin) builds up because this dehydratase is inhibited
What are the treatment options for lead poisoning?
succimer (45-70mcg) or Dimercaprol followed by Calcium EDTA for higher levels. Laxative can help with removal of paint chips or large ingestions.
What are the Five F's of febrile seizure?
Fever, Five months to Five years, less than Fifteen minutes, non-Focal, and + Family history (if they don't fit this pattern, look for another cause!)