pealing of the epidermis in response to shearing forces
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.
When is jaundice always pathologic?
during the first day of life.
Cause of physiologic jaundice?
defective hepatic uptake coupled with decreased UDP-glucuronyl-transferase activity. (increased RBC load may also play a role)
Bilirubin over what level is always pathologic?
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
What are the signs of biliary atresia?
lack of gallbladder and triangular cord sign on ultrasound.
When should children be screened for autism
18 months and 2 years
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!
Newborns lose weight right after birth, when do they regain their birth weight?
by 2 wks of age.
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.
What is the most sensitive test for detecting developmental dysplasia of the hip?
What age groups are covered by the DENVER II developmental screen?
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 age do most children start sleeping through the night?
4 to 6 MONTHS
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.
How many HepB shots does a child need on the regular schedule?
3 (usually birth, 2mo, 6-18mo)
How many DTaP shots does a child need on the regular schedule?
5 (2mo,4mo,6mo, 15-18mo, 4-6yrs)
How many IPV (inactivated polio) shots does a child need?
4 (2mo,4mo,6-16mo, 4-6yrs)
What shots are not required until 1 yr?
MMR, Varicella, HepA ...happy birthday ;- (
When do kids get immunized to ROTAVIRUS?
2mo, 4mo, 6mo
By what ages do children double and triple their birthweight?
double at 5mo, triple at 12mo.
When do most children reach double their birth length?
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?
"salt and pepper" speckling (white spots) on the iris seen in downs
How many blood vessels are in a normal umbilical cord? What are they?
2 arteries, 1 vein
What is considered Small for Gestational Age (SGA)?
birth weight < 10th percentile
Infants above how many Kg are considered Macrosomic?
Most common cause of abdominal mass in a newborn?
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 are the 3 bacteria causing neonatal infections?
GBS, E coli, Listeria
What is the main cause of Gram (-) sepsis and meningitis in the newborn?
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!)
Classic characteristics of roseola?
xanthum subitum, caused by HHV-6: 3-5 days of hi fever followed by maculopapular rash.