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Pediatrics EOR Exam
Terms in this set (279)
Impetigo can be bullous or non-bullous. 70% of cases have "honey-colored crust" and are ___caused by what bacteria? The other 30% are __ and caused by ___.
70% - non-bullous, S Aureus or GAS
30% - bullous, S Aureus
A deeper form of impetigo is ___ with classic lesion with a rim of erythematous induration surrounding an eschar.
Diaper dermatitis is often caused by ___ with tx being topical NystatiA n, Lotrimin, or Diflucan po for 2 weeks. DR. DUPUY says mosts cases are contact dermatitis.
Perianal dermatitis is caused by GAS and treatment wiith __ or __.
PCN or erythromycin
Perioral dermatitis presents as discrete erythematous micropapules & micropapulovesicles with "sparing of the vermillion border". Cause unknown but can be aggravated by what? Tx: metronidazole or erythromycin gel or minocycline po qd.
topical steroid use
Drug Reactions: a ___ reaction is the most frequent and similar to viral xanthems. Macpap eruption that often spare the face -- itching common. Ampilcillin, isoniazid, phenytoin, quinidine, sulfonamides, thiazides
Drug reactions: a ____ reaction is due to anaphylactic IgE dependent reaction that occurs wi minutes to hours of administration. Epi needed in severe reactions. Aspirin, PCN, blood products.
Drug reactions: A ___ drug eruption is single or multiple, round demarcated red plaques that appear soon after the drug exposure and reappear in the same site each time the drug is taken HALLMARK. Tetracycline, cotrimoxazole
Drug reactions: ___ present w tingling of palms and soles followed in a few days by painful, well-defined symmetric swelling and erythema. Cytosine arabinoside, fluorouracil, doxorubicin.
chemotherapy induced acral erythema
Lichen planus or thickened skin is an uncommon, inflammatory papulosquamous disorder of unknown cause. Noted w gold salts, beta blockers, antimalarials, thiazide, furosemide. What are the 5 P's? What is the treatment?
pruritic, planar, polygonal, papules, purple; treatment is antihistamines and topical steroids
What can pityriasis rosea's herald patch be confused with? What treatment may hasten resolution of lesions?
tinea; UVB light
In SJS, a severe mucocutaneous syndrome, involving at least 2 mucous membranes, involves a disruption in what?
a disruption of the dermis/epidermis junction
SJS is associated with mycoplasma PNA and what drugs?
phenytoin, phenobarbitol, sulfonamides, aminopenicillin
TENS is full thickness involvement. ___ sign is sheet like peeling of the epidermis with slight pressure.
____ is different from SJS/TENS, milder targetoid "iris" lesions, dusky red and round --- frequent recurrences.
Comedones: use ___.
Papules & Pustules: use ____.
Nodules & Cysts: use ____.
Hormonal treatment with ____.
comedones - benzoyl peroxide, topical retinoids
papules & pustules - add topical and oral abx
nodules & cysts - accutane
hormonal treatment - OCPs
What PE finding other than pruritis can be found in lice infestation?
posterior cervical adenopathy
Scabies is caused by ___. When is itching worse?
Sarcoptes Scabieie; worse at night
What is the oral treatment that can be used for lice and scabies?
____is a physiologic reaction to androgens in the genetically predisposed men. Begins after puberty & usually is expressed by the time the patient is in his or her 40s.
___takes 8-12 months for regrowth. Rare side effects are increased cardiac output, left ventricular mass, tachycardia, dizziness.
___blocks 5-alpha-reductase. SE: decreased libido and erectile dysfunction, TERATOGENIC.
____-HPV 3,10, 28.41 - or flat warts are most evident under oblique illumination. Smooth, slightly raised 1-3mm lesions.
___ - HPV 1, 2, 4, 7 - range from small pinhead sized to irregularly surfaced domed lesions.
Verruca vulgaris - common warts
___ - are "ant hill like lesions" - pain at heel or metatarsal heads - HPV 1.
Verruca Plantaris - plantar warts
What is the rule of 9s in burns for children and adults?
Adults - 9% head arms; 18 anterior and posterior trunk, 1 genitals, 18 legs
Children - 18% head, 14 anterior and posterior trunk, 1 genitals, 9 arms, 14 legs
What's the Parkland formula for fluid resuscitation in burn patients?
4mL/kg/% of BSA burned of LR, 1/2 in 1st 8 hours and 1/2 in next 16 hours
The ___ formula is used in children ie. 5000mL/m of BSA burned + 2000mL/m of BSA in 1st 24 hours. Half of solution given in 1st 8 hours and half in next 16 hours. What solution is used?
Galveston formula; lactated ringers + 5% dextrose
Refer burns to a ___ when:
--second degree >15% BSA or third degree > 5% BSA
--face, hands, feet, genitals, major joints
--electrical, chemical, pulmonary, inhalation
Urticaria -- wheal and flare.
Acute is <6 weeks and common in ___.
Chronic is >6 weeks and you must look for 5 Is ie. ____.
Tx: antihistamines, prednisone, epi if severe
atopic individual due to IgE/histamine; inhalants, injectants, ingestants, infections, internal disease
Contact dermatitis is caused by either a ___ or ___.
irritant or allergen
What is the allergic triad of atopic dermatitis?
allergic rhinitis, atopic dermatitis, and asthma
In infants, it's important to distinguish atopic & seborrheic dermatitis. How?
atopic is itchy and has a positive family history; atopic is often on face and extensor surfaces and seborrheic is often on axilla and diaper area
In Tinea captius, a ___ or boggy mass may develop.
___ is tinea with sharply demarcated erythema lesions in inguinal folds.
___ are scaly, annular red papules w raised border and central clearing.
Diagnosis of tinea with ___.
___ on KOH shows spaghetti and meatballs pattern.
Rocky Mountain spotted fever is caused by ___ (tx:Doxy x __days. Lyme disease is caused by ___ (tx: Doxy x __days).
1. Rickettsia Rickettsia, doxy x 7-14 days
2. Borrelia burgdorferi, doxy x 21 days
Viral conjunctivitis cause MC is ____.
adenovirus 3, 8, 19
Bacterial conjunctivitis cause MC is ___. Tx: erythromycin drops, Polytrim drops, ofloxacin drops
S Aureus, Strep pneumo, M Cat, H Flu
What illness is orbital cellulitis associated with? Most common cause is __ or __. Why admit?
sinusitis; S Pneumo or H Flu; admit for IV abx (nafcillin, vanc for MRSA, metro or clinda or ceftriaxone)
Complications of orbital cellulitis?
meningitis, loss of vision, brain abscess
____ is misalignment of the visual axis due to ocular muscle weakness or imbalance. No binocular fixation. What age should stable alignment be present?
Strabismus; 2 months
___ = convergent strabismus/crossed eyes MC
___ = divergent strabismus.
If strabismus is left untreated after age 2, what can result?
MC cause of AOM?
H Flu then S pneumo and M Cat
What are the indications for tympanostomy?
3 episodes of AOM in last 6 months; 4 in last year with 1 being in preceding month
DOC for AOM: ____.
PCN allergy then ____.
PCN/Ceph allergy then ___.
Amox 90mg/kg/day; Cephalosporin; consider tympanocentesis, clinda, macrolide
Type I allergic hypersensitivity reaction
Early: Due to degranulation of mast cells causing inflammatory response and release of histamine, leukotrienes, cytokines, and prostaglandins. Occurs when? What sx?
occurs 10-15 min after exposure; sx: sneezing, rhinorrhea, itching, increased vascular permeability
Type I allergic hypersensitivity reaction
Late: release of cytokines and leukotrienes - cause influx of inflammatory cells or eosinophils. Occurs when? What sx?
4-6 hours after exposure; nasal congestion & post nasal drip
Whats the most effective allergy treatment for overall control?
With conductive hearing loss ie. from obstruction of external auditory canal due to cerumen, foreign body, etc. what are the results of the Weber and Rinne test?
Weber -- sound in affected ear
Rinne -- BC>AC
With sensorineural hearing loss, ie. from lesion in the inner ear or 8th cranial nerve, what are the results of the Weber and Rinne?
Weber - sound in unaffected ear
Rinne -- AC>BC
___ is a rare complication of AOM that is caused by the same microorganisms. Treatment?
Mastoiditis; same as AOM but for 3-4 weeks
Otitis externa can be acute localized, diffuse, chronic, or malignant. Malignant is a severe necrotizing infection caused by ____.
Where do tympanic membrane perforations usually occur?
pars tensa, anterior and inferior
90% of epistaxis occurs where?
anterior Kiesselbach plexus
Posterior epistaxis is common in what age group?
elderly due to arterioschlerosis
What should be considered with chronic nose bleeds?
ALL or Von Willebrands disease
What are the complications of strep pyrogenes (pharyngitis) infection?
rheumatic fever, scarlet fever, glomerulonephritis, abscess formation
What are the tonsillectomy indications after recurrent strep infections?
past year - 7
past 2 years - 5/year
past 3 years - 3/year
The incidence of epiglottitis has decreased because of what vaccine?
Epiglottitis is a respiratory emergency. What are the PE/XR findings?
drooling, leaning forward to breath, thumb sign on neck xray
How can candida be differentiated from leukoplakia? Peak incidence at what age of life?
leukoplakia can be scraped off; peak incidence at age 4 weeks
In peritonsillar abscess, infection forms between the palatine capsule wall and the ____.
The maxillary sinuses aerate at age ___. Frontal sinuses aerate at age ___. Ethmoid sinuses aerate at birth.
maxillary - 4; frontal - 7
What is the Jones criteria for diagnosis of rheumatic fever? Diagnosis with 2 major or 1 major and 2 minor
Major - carditis, subcutaneous nodules, polyarthritis, chorea, erythema marginatum
Minor - fever, increased ESR, increased CRP, polyarthralgia, reversible prolonged PR
What's the most common valvular residual of acute rheumatic fever?
mitral insufficiency or aortic insufficiency
____ is a disease of inflammation of medium and small sized vessels, MC vasculitude in children. Likely viral etiology.
Diagnostic criteria for ______ disease:
--acute fever - up to 105F
--4/5 of bilateral conjunctivitis, cervical lymphadenopathy, truncal polymorphous rash, strawberry tongue, injected lips, dry lips, peripheral erythema, edema, desquamation.
Kawasaki disease is MC in ___ descent.
The most important manifestation of Kawasaki disease is ___.
Treatment of Kawasaki with ___. ___ are contraindicated.
The murmur of hypertrophic cardiomyopathy ___ w squat, hand grip, leg elevation and ___ w valsalva.
What's the treatment for HCM?
BB or CCB (nondihydropyridine)
What's the MC cause of syncope?
Prolonged standing or stressful event can cause ___ syncope. Immediate syncope on standing can cause ___. Syncope w exertion often is ___ in nature.
vasovagal; orthostatic; cardiac
____ lesions cause some of the systemic venous return to cross from the right to the left heart and return to the body without going through the lungs.
What are the 4 defects of tetrology of fallot?
VSD, overriding aorta, RVH, pulmonary stenosis
What's the acute treatment options of TOF?
BB, vasoconstrictors, oxygen, vagal maneuvers, morphine
What are the PE findings in TOF?
holosystolic crescendo-decresendo murmur radiating to back; loud S2; increased RV impulse
What are the PE findings in complete transposition of the great arteries?
quiet tachypnea, single S2, "egg on a string" heart
Treatment of complete transposition of great arteries?
Prostaglandin E to maintain ductal patency and surgery within 2 weeks of life
___ is when a single arterial trunk arises from the heart with a large VSD immediately below the truncal valve. Single S2 heard.
___ is the congenital absence or agenesis of the tricuspid valve. RV and PA is hypoplastic. Essentially single ventricle physiology.
___ lesions are a left to right shunt. Left is going in a normal process. Enough oxygen in systemic circulation.
What is the most common atrial septal defect?
Ostium secundum from a patent foramen ovale
What is the CP of an ASD?
systolic ejection murmur at 2nd LICS; early-middle systolic rumble, wide fixed split S2
What is the tx of an ASD?
often closes spontaneously; otherwise elective closure between ages 2 & 4
The MC form of congenital heart disease is ___.
ventricular septal defect
What are the PE findings of a VSD?
holosystolic murmur at LLSB
___is a large VSD. Refers to any untreated congenital cardiac defect with intracardiac communications that leads to pulmonary HTN, reversal of flow, and cyanosis.
Atrioventricular septal defect is MC in infants with ___.
What are the s/s of AVSD?
CHF babies, breathing fast, hard, sweat, and tire while feeding
What is the PE of an infant with a patent ductus arteriosus?
bounding pulses & macine like murmur
What medication decreases prostaglandin synthesis and is effective in closing a PDA?
___ is narrowing of the aorta at varying points anywhere from the transverse arch to the illiac bifurcation.
coarctation of the aorta
What are the PE findings of coarctation of the aorta?
CXR - enlarged aortic knob, rib notching, decreased femoral pulses; RVH in neonate & LVH in older children
What is the essential tx in coarctation? What is the procedure of choice?
maintaining the ductus with prostaglandin E; procedure of choice is a balloon angioplasty
___ is the MC cause of death from heart defects in the 1st month of life. Faliure of development of the mitral or aortic valve of the aortic arch. Tx: prostaglandin infusion to maintain ductus until surgery.
Hypoplastic left heart syndrome
Acute bronchiolitis or ___ is infection or inflammation of the smaller airways. Increased risk with exposure to ___ or ___.
RSV; smoking or daycares
What is the CP of RSV? Dx?
CP: diffuse "happy" wheezing, tachypnea
Dx: RSV nasal swab; PCR rapid antigen
Croup which presents with a barking cough is due to ___ inflammation. ___ sign is seen on lateral neck film.
subglottic; steeple sign
What is the active intervention of patients with stridor and croup?
oxygen, racemic epi, glucocorticoids, artificial airway in extreme cases
What is the MC bacteria causing PNA in infants? children/adolescents?
infants - Strep pneumo
Children/adolescents - Mycoplasma pneumo
1st line abx tx for PNA?
atypical tx for PNA?
1 - amoxicillin, augmentin
2 - cephalosporin, macrolide
What are the three forms of asthma?
intrinsic, extrinsic, exercise induced
Diagnosis of asthma via ___ or ___.
FEV1/FEV < 75% or methacholine challenge
What is the stepwise asthma tx?
SABA ---- + ICS ---- + LABA or increase ICS dose ---- + systemic steroids
Asthma severity classification:
SABA use <2days/week - ___.
SABA use >2 days/week - ___.
SABA use daily - ___.
SABA use several times per day - ___.
intermittent, mild persistent, moderate persisiant, severe persistent
What is the single MC cause of death via foreign body aspiration?
hot dog aspiration
In foreign body aspiration, what technique is both diagnostic and therapeutic? When would endoscopy need to be performed?
bronchoscopy; endoscopy if the material is beyond the oropharynx
Hyaline membrane disease or RDS is a respiratory disease of the newborn in which a membrane composed of proteins and dead cells lines the alveoli. Deficiency in what?
What are some predisposing factors of RDS?
1. prematurity 2. diabetic mom 3. positive FH
What are the CXR findings in RDS?
ground glass appearance, air bronchograms, doming of the diaphragm
What is the treatment of RDS?
assist ventilation, restrict fluids to avoid pulmonary edema, surfactant replacement
Diagnostic criteria for cystic fibrosis must show:
a. clinical sx of CF in at least 1 organ system
b. evidence of CFTR dysfunction.
What is the evidence of CFTR dysfunction?
a. sweat Cl > 60 two times
b. 2 disease causing mutations in CFTR from parent
c. abnormal nasal potential difference
What is the main risk of gastroenteritis?
What is the MC form of gastroenteritis?
What is the Holliday-Segar method for estimating water needs in infants, toddlers, and children? What about replacement for diarrhea/vomiting?
infants - 1oz/hour
toddlers - 2oz/hour
children - 3oz/hour
replacement: 10ml/kg for every loose stool, 2ml/kg for every emesis
Appendicitis PE signs:
___=pain localized to RLQ.
___=pain with flexion & IR of hip.
___=pain on extension of the leg.
McBurney's point, Obturator sign; Psoas sign
An appendix >___mm is diagnostic of obstruction -- usually by a fecalith.
____ is crying for no apparent reason that lasts for greater or equal to 3 hours/day and occurs at least 3 days/week in an otherwise healthy baby < 3 months of age.
What is the physical exam done to rule out in colic?
intussusception, strangulated hernia, tongue tied, thrush, ears, diaper rash
What sex and race has the highest incidence of GERD due to increased frequency of transient LES relaxations?
If alarm sx for GERD are present ie. dysphagia, GI bleeding, weight loss -- think what?
adenocarcinoma or stricture
What's the gold standard for identifying reflux?
esophageal pH monitoring
Tx of constipation:
a. osmotic laxatives ie. polyethylene glycol, glycerin, lactulose, or sorbitol allows what as MOA?
b. emollient laxatives ie. docusate sodium or mineral oil works to promote softening -- useful in ___.
c. saline agents ie. Mg, PO4, SO4, citrate salts, useful in ___.
d. stimulants ie. Senna & bisacodyl are for ___.
a. allows water to enter lumen of colon
c. acute evacuation
d. acute constipation
Pyloric stenosis or hypertrophic pyloric sphincter is most common in what sex and age?
male predominance; 2 weeks - 2 months
In pyloric stenosis, what kind of vomiting do you see? Physical exam finding? Sign on barium upper GI?
projectile vomiting; olive shaped mass on PE; string sign on upper GI
What abnormal lab finding is unique to pyloric stenosis?
hypocholoremic alkalosis with hypokalemia -- from regurgitation of stomach acid also (Dr. Dupay)
What is the most common location in the intestine is intussusception found?
Intussusception: ____ stool; abdominal film shows lack of ____; u/s shows ___ sign; ___ is diagnostic & therpeutic; ___ mass; associated with ___ vaccine. Dr. Dupay's PE finding/alarm sx?
Current jelly stool; lack of bowel gas; target/donut sign; Barium enema; sausage shaped mass; rotavirus vaccine; waxing and waning mental status and no fever
__ is congenital absence of Meissner & Aurebach autonomic plexuses enervating the bowel wall. Failure of meconium; presents in 1st 24-48 hours.
Foreign body: removal via __ if caustic, sharp, or lodged objects.
Hepatitis __ & __ are spread via the fecal-oral route.
Hep A & E
Hepatitis __ & __ are spread via the parenteral or sexual route.
Hep B & D
Hepatitis __ is spread via the parenteral route.
3 phases of Hepatitis:
___ -- lab tests normal and patient is asymptomatic.
___ -- sx are malaise, nausea, decreased appetite, vague abdominal pain, viral antibodies appear, transaminases increase
___ -- serum transaminases reach peak, urine darkens, stool lightens, bili > 3.0mg/dL, JAUNDICE
incubation, pre-icteric, icteric
Hep __ & __ are treated with immunoglobulin (IG).
Hep A & B
Kernicterus results from toxic bili levels ____and is associated with encephalopathy.
bili levels > 20-25 mg/dL
Jaundice within the 1st 24 hours of life must be evaluated immediately and is associated with __ & __.
sepsis & erythroblastosis fetalis
___ occurs in a baby with an Rh positive father and previously sensitized Rh negative mother. Tx: exchange transfusion. Prevent with Rhogam.
___ -- increased bilirubin that is most commonly from hemolytic anemia. Pre-hepatic.
___ -- increased bilirubin that is most commonly from physiologic or breast milk jaundice.
What is present in some breast milk that can cause jaundice?
inhibitor of bilirubin conjugation
___ benefits all jaundice.
___ is the complete congenital obstruction of the lumen of a hollow viscus. Most frequent cause of bowel obstruction in newborn. Bilious vomiting without distension. Double bubble appearance. Tx: nasogastric tube, duodenostomy.
___ is the most common surgical procedure in children. ___ is the most common type. ___ is acquired as a result of weakness of the transversalis fascia in Hesselbach's triangle (inferior epigastric vessels, inguinal ligament, and rectus sheath).
Inguinal hernia; Indirect hernia; Direct hernia
___ hernias are trapped in a weak part of the abdominal wall. This can lead to ___ or a lack of blood flow.
Most children with umbilical hernias spontaneously close by what age? They rarely become incarcerated, strangulated, or rupture.
5 years of age
What are the four D's of niacin deficiency?
dementia, dermatitis, diarrhea, death
The MC sx of Vit A deficiency is ___ or nyctalopia. What disorders can lead to this disorder?
night blindness; disorders of fat absorption
Vit C deficiency or scurvy causes __, __, & __.
bleeding bums, petichae, and poor wound healing
____ individuals may require up to 6-10x of exposure to sunlight as light skinned individuals.
Vit D deficiency can lead to ___ in children or failure of mineralization of growing bone and cartilage.
Vit D deficiency can lead to ___ in adults ie. softening of bones -- can cause muscle or bone pain.
Deficiency of ___ can lead to beriberi --- sensory nerve damage, muscle wasting, paralysis (dry), or edema and heart damage.
____, involved in clotting, can cause hemorrhage if there is a deficiency.
___ deficiency which often occurs with other B deficiences causes cheilosis, glossitis, and angular stomatitis.
Lactose intolerance can be caused by ___ deficiency --- an enzyme that digests lactose. What is the tx?
___ or undescended testes increases malignancy 5x in 20-30 year olds. The testes most commonly descend by age ___. Sx that fixes this?
Cryptorchidism; 3rd month; orchidopexy
A ___ is caused by a patent processus vaginalis ie. accumulation of fluid in the scrotum around the testes. Non-communicating vs. communicating? What age do they resolved by?
hydrocele; non-communicating ie obliteration of processis vaginalis -- communicating may develop into a inguinal hernia; usually resolve by age 2
A ___ is inability of retracted foreskin to reduce -- causes painful swelling.
___ is inability to retract foreskin. Physiologic vs. Pathologic. Tx: circumcision
What deformity is associated with testicular torsion which is the MC cause of testicular pain in boys > 12. What reflex may be absent?
bell clapper deformity; cremasteric reflex
Testicular torsion -- may be acute or gradual onset -- w gradual: palpation of testes reveals a 3-5mm indurated mass visible through the scrotum and is call the ___.
blue dot sign
____ is urinary incontinence (>5 yo) -- Primary is in kids that never achieved night dryness. Secondary is often related to stool retention and suboptimal daytime voiding habits or life stressors. Brain maturation.
___ is when the uretral meatal opening is on the anterior shaft of the penis. Refer to pediatric urologist -- do not circumcise bc prepuce can be used for surgical repair.
___ is an often congenital condition in which the normal valve mechanism of the ureterovesicular junction is impaired, leading to reflux of bladder urine into the ureter of the kidneys.
Which children should be imagined for VCUG?
first UTI in all children <5 yo -- febrile UTI -- and boys with UTI -- children w prenatally identified hydronephrosis
What imaging is used with VCUG? What treatment is used?
renal/bladder u/s and/or voiding cystourethrogaphy; long term abx prophylaxis and surgery is highly successful
Glomerulonephritis is characterized by glomerular injury, is accompanied by inflammation and presents with what three symptoms?
hematuria, edema, and hypertension
What color is urine in glomerulonephritis? What titer is increased?
tea or color colored; antistreptolysin-O
Primary GN is isolated to the ___ ie. IgA nephropathy, antiglomerular basement membrane, idiopathic crescentic GN
Secondary GN is a ____ disorder ie. poststrep GN (MC!), HSP, lupus, Wegeners granulomatosis
90% of UTI's in children are caused by ___ and can be treated with Cefdinir. Enterococcus is a more complicated cystitis and can be treated with Amox or Nitrofurantoin
Anemia: In infants, RBC production is at a minimum during the ___ week an drise to max values at ___ months.
2nd week; 3 months
The American Academy of Pediatrics recommends screening for anemia when?
between 9 and 12 months
Microcytic anemia (TICS) causes?
Normocytic anemia causes?
Macrocytic anemia causes?
Microcytic causes are TICS = thalassemia, iron deficiency, chronic disease, sideroblastic anemia (lead poisoning)
Normocytic causes are anemia of chronic disease
Macrocytic causes are Vit B12 or folate deficiency
Suspect ____ with an adolescent girl with excessive menstrual bleeding, recurrent nosebleeds, and pallor.
Von Willebrands Disease
In vWF disease, bleeding is exacerbated by ___ and decreases with use of ____.
increases with aspirin or NSAIDs and decreases with use of estrogen or pregnancy
Types of VonWillebrand disease:
____is quantitative deficiency of vWF.
____is qualitative defective vWF.
____is autosomal recessive absence of vWF.
Type I, Type II, Type III
___is one of the most common and potentially life threatening causes of non-immune peripheral platelet destruction. Patient will present w both bleeding and clotting.
DIC - disseminated intravascular coagulation
____ is a small vessel vasculitis (MC vasculitis syndrome in children) mediated by IgA immune complex deposition with tetrad of palpable purpura, arthralgia, abdominal pain, and renal disease.
Henoch Schonlein Purpura
Hemophilia A is a low amount of factor ___ and Hemophilia B is a low amount of factor ___.
___is an autoimmune bleeding disorder in which patients develop antibodies against their own platelets. NO SPLENOMEGALLY. Abrupt onset of petechiae, purpura, and epistaxis. Often follow viral infection.
ITP -- idiopathic throbmocytopenic purpura
What drugs may worsen ITP?
bactrim, quinine, penicillins, furosemide, phenytoin, cimetidine
___ is the most common pediatric malignancy. Dani's type. Immature lymphoblasts are produced with no furthur differentiation. >80% are cured.
ALL - acute lymphoblastic leukemia
___is less common - AUER RODS ON SMEAR - incidence high in neonatal period -- uncontrolled proliferation of primitive hematopoietic cells. Bone Marrow Transplant
AML - acute myelogenous leukemia
___ leukemia is rare in children -- the Philadelphia chromosome is seen. Stem cell transplant is best option for survival
CML - chronic myelogenous leukemia
Leukocytosis causes of elevations:
Neutrophils segs - _____.
Neutrophils bands - ____.
Lymphocytes - _____.
Eosinophils/Basophils - _____.
Monocytes - _____.
Atypical lymphocytes - _____.
bacterial infections, acute bacterial infections/sepsis, viral infections, allergies, chronic infections/TB/subacute bacterial endocarditis, EBV
____is a malignant d/o of the lymphatic system that mainly affects the lymph nodes. Bimodal distribuation of disease onset. REED-STERNBERG CELLS. May be linked to what virus?
Hodgkin's lymphoma, EBV
____ has MC presentation of lymphadenopathy - noted in cervical, axillary, or inguinal region. Nodes are firm and nontender w size >1cm.
Neutropenia is a low number of circulating neutrophils in the blood stream. The risk of infection begins to increase at an ANC below ____.
ANC < 1000
How do you calculate the ANC?
WBC x total neutrophils (segmented + bands)
Which brain tumors in children are highly curable?
cerebellar astrocytomas and meduloblastomas
Which brain tumors in children have extremely poor prognosis?
brainstem gliomas and glioblastoma multiforme
Symptoms of ___ are anorexia, headache, abdominal pain, n/v, and constipation. Antidote is calcium disodium edetate.
___ is defined as less than 5th percentil on the growth chart. Further testing is required to rule out other causes including CBC, ESR, U/A, BUN and creatinine, serum electrolytes, including calcium and phosphorus, stool fat content, karyotpe , and intrinsic growth factor. What radiography is taken?
Short Stature, radiograph of distal radius
____ is due to hypoplasia/aplasia of the thyroid gland. Bloated, puffy eyes; dry skin; little perspiration; muscle weakness; constipatoin; sluggish mental and physical processes; bradycardia. What laboratory findings?
Congenital hypothyroidism; cretinism....lab findings are elevated TSH and low T4
The most common cause of hyperthyroidism is ___. What is the treatment?
Grave's disease; propanolol, thiourea drugs, methimazole, propylthiouracil, radioactive iodine (not in pregnancy), thyroid surgery in pregnancy
Calcium levels have an inverse relationship with ____.
____ causes constipation and polyuria and in severe -- stupor, coma, and azotemia (elevated BUN and SCr).
What does EKG show in hypercalcemia?
What is treatment of hypercalcemia?
treat underlying cause, NORMAL SALINE WITH FUROSEMIDE in emergency, bisphosphonates in malignancy, calcitonin
In children, BMI screenings should start at what age?
What are the diagnostic criteria for diabetes?
Sx + Glucose >200; fasting glucose > 126; 2 hr GTT > 200
What are the diagnostic criteria for impaired fasting glucose?
glucose between 110 and 126
What are the diagnostic criteria for impaired GTT?
glucose between 140 and 200
What are the Salter Harris classification for fractures?
S - straight through physis
A - above - into metaphysis
L - lower - through epiphysis
T - through - epiphysis, metaphysis, and physis
R - ram
___ is subluxation of the radial head. Happens from pulling on the forearm and the ___ slips proximally and becomes trapped between the radius and ulna.
Nursemaid's elbow; annular ligament
How is nursemaid's elbow fixed?
by putting hand over the radial head and supinating the elbow
___ is displacement of the femoral head through the physis. Typical displacement is medially and posteriorly relative to femoral neck. Blacks overweight boys. What ROM is limited?
Slipped capital femoral epiphysis - "ice cream cone deformity"
___ is a microfracture at the location of the patellar tendon insertion into the tibia tubercle. Happens during a period of rapid growth. Self-limiting disease and usually heals when epiphysis closes. XR to rule out other dx like avulsion fracture.
Osgood Schlatter's disease
____ is lateral curvature of the spine that may be structural or functional in nature. What is the PE test used to screen for this?
Scoliosis; Adam's forward bend test
Scoliosis varies with degree of curvature.
<25 degree means ____.
>45 means ____.
25-45 degrees mean ____.
observation, surgery, bracing
Congenital hip dysplasia - PE tests:
___attempts ot dislocate the hip via posterior pressure.
___attempts to identify the hip that is dislocated or subluxed.
Positive Barlow and Ortolani should be evaluated with what?
Barlow; Ortolani; ultrasound most accurate
Neoplasia of MSK system: Alk phos and lactate dehydrogenase are elevated. biopsy essential. What symptom is often associated with malignancy?
___ is the #1 bone tumor in children.
__ is one of the MC primary malignant tumors of bone. Typically noted in ages 10-30 yrs and more common in males.
Other neoplasias of MSK system are ___ w onion-skin appearance and ___.
Ewing Sarcoma; osteoid osteoma.
___ is the MC cause of arthritis under the age of 16. Characterized by chronic synovitis. 3 types: systemic or Stills disease, pauciarticular, or polyarticular.
Juvenile Rheumatoid Arthritis
JRA Types: ___ presents with minimal articular findings but spiking fevers, myalgias, polyarthralgia, and a salmon-pink macpap rash appearing in the evening.
Still disease/Systemic JRA
JRA Types: ___ is characterized by involvement of </= 4 medium to large joints. If positive ANA, may have asymptomatic uveitis -- possibly leading to blindness.
JRA Types: ___ resembles adult RA with symmetric involvement and >/=5 small and large joints. Sx: low grade fever, fatigue, rheumatoid nodules, anemia.
Dx of ___ based on the following specific criteria:
--age of onset </=16
--arthritis 1+ joints -- no swelling or effusion
--duration 6 weeks or longer
--exclusion of other d/o
___fx is a ulna shaft fractures with a proximal radial dislocation.
___fx is a radial fx with a distal ulna dislocation.
A ___ fx is a spiral tibial shaft fracture. 1-3 yo, long leg cast for 3 weeks.
Mycobacterium avium-intracellulare is a pulmonary infection that typically occurs in patients with underlying __. In a child, present with unilateral ___.
lung disease; lymphadenopathy
___ is caused by enterobius vermicularis is that most prevalent helminthis infection in the US. MC presentation? Dx test?
Pinworms; noctural anal pruritis; cellophane tape test
___ is caused by human parvovirus B19. Spread via respiratory transmission and is moderately infectious. Nonspecific prodrom, febrile illness with __, __, and __. Noncontagious when __ erupts.
Erythema infectiousum/5th disease; headache, diarrhea, and coryza; rash
What virus causes cold sores? ___ is an infection involving the finger or nail area.
HSV1; Herpes whitlow
What's the incubation period for HSV2/genital herpes?
With HSV, a Tzanck smear shows ___. ___ is the test of choice for dx of HSV encephalitis.
multinucleated giant cells; PCR
What is used to prevent transmission of HSV from mom to infant?
Think ____ with sudden onset of fever, myalgia, headache, chills, rhinitis, and abdominal pain.
What's the incubation period of influenza?
___ is rapidly progressive with a 30% fatality rate -- fatty liver with encephalopathy - may develop 2-3 weeks after influenza A/varicella especially after aspirin use. RASH, VOMITING, LIVER DAMAGE.
Tamiflu should not be given to kids <____ & Relenza <____. It should be given within ___ hours of symptom onset.
Tamiflu - <2 weeks; Relenza - < 7 yo; 48 hours
___ is the cause of most influenza fatalities.
EBV - presence of ___ shows a positive monospot. Presence of what type of lymphadenopathy?
heterophile antibodies; posterior lymphadenopathy
Mumps is caused by the ___. What is the hallmark of the disease? Tx?
paramyxovirus; parotid pain and swelling; symptomatic
What vaccine prevents mumps? When administered?
MMR and Varicella; 12 months and 5 years
What is 1st disease and the main CP?
1st disease is measles, "cough, coryza, and conjunctivitis"
2nd disease is scarlet fever and what is the CP?
circumoral pallor, sandpaper rash, and white/strawberry tongue
3rd disease is german measles or ___ and CP? Complications are congenital rubella syndrome and arthralgia or juvenile RA.
3rd disease or rubella - postauricular and occipital adenopathy
4th disease or Filatov-Dukes disease is now not considered a separate disease -- thought to be a mild, variant form of ___.
5th disease or __ is caused by human parvovirus B19. Lacey rash @ 10-17 days of mild flu-like illness.
6th disease or ___ caused by HHV6, abrupt fever, 3-7 days, macpap rash. Tx: supportive.
Varicella, a ___ virus, presents with "dew drops on a rose petal."
human herpes virus
How can you tell the difference between varicella and small pox?
small pox has lesions all at the same stage. Varicella has lesions at different stages.
Hand, foot, and mouth disease is caused by __ & __ which causes small vesicles on anterior part of the mouth, palms, and soles. Tx: supportive.
Herpangina -- oral manifestation
What are the 3 stages of pertussis? Catarrhal, paroxysmal, and convalescent?
Catarrhal -- 1-2 weeks -- sx of URI
Paroxysmal - 2-4 weeks -- whoop
Convalescent -- > 4 weeks -- no cough
Tx for whooping cough?
Why no erythromycin in infants < 1 month?
hypertrophic pyloric stenosis
With diphteria, must give ___ within 48 hours.
____ can occur in unimmunized communities. Headache, sore throat, fever, muscle weakness/tenderness, and asymmetric flaccid paralysis.
Giardiasis or ___ is from water contaminated with cysts. Diarrhea, greasy stools.
Prepubertal BMI - ____
Pubertal BMI - ____
1st year inches and pounds?
2nd year inches and pounds?
3rd year-puberty inches and pounds?
prepubertal BMI - 14-18
Pubertal BMI - 16-22
1st year - 8-10 inches and 10-15 lbs
2nd year - 3-4 inches and 4-6 lbs
3rd year - puberty - 2.5 inches/year and 3-5 lbs/year
What does APGAR stand for? What times are the scores measured?
A - activity
P - pulse
G - grimace
A - appearance
R - respirations
scores are measured at 1 and 5 minutes
A simple febrile seizure (65-90%) is a generalized seizure lasting __ minutes once in a 24 hour period.
A complex febrile seizure lasts ___ min & occurs more than once in a 24 hour period.
What labs should be drawn to evaluate a febrile seizure?
u/a, serum electrolytes, blood glucose
Meningitis etiologies by age group:
___=group B strep, gram negative/E Coli, Listeria Monocytogenes
___=S pneumo, N meningitides, H Flu
___=S pneumo, Listeria monocytogenes, S Aureus, N Meningi, gram negative
neonates; children <15, children>15
____ is a single seizure lasting > 90 minutes or multiple seizures that occur without regaining consciousness between episodes. What diagnostic tool makes the diagnosis?
How do you distinguish bacterial vs. viral meningitis?
bacterial has high WBC>100 with lots of neutrophils and low glucose<40 and viral has not quite as high WBC>50 and glucose>50
Dx of ____ via any 6 of the following:
b. poor Moro reflex
c. hypermobility of joints
d. flattened facies and occiput
e. excess skin on posterior neck
f. anomalous auricle, upward slanting palpebral fissure, pelvic dysplasia, dysplasia of middle phalanx of 5th finger, and single transverse palmer crease (simian crease)
___ is partial or complete absence of one X chromosome. CP: short stature, webbed neck, low posterior hairline, lymphadema of hands and feet at birth, shield shaped chest, horseshoe kidney, coarctation of the aorta. 45X
What congenital heart disease is common in Downs?
atrial septal defect
What are Down's patients at an increased risk of developing in life?
leukemia, early onset Alzheimer's type dementia, hypothyroidism, GI anomalies like duodenal atresia and Hirshsprung's disease, sleep apnea
With ADHD, sx must be present before what age and in how many settings?
before age 7 and in 2 or more settings
Kids with ___ are unlikely to function independently as adults.
autism spectrum disorder
____ is considered a "high-functioning" autism spectrum disorder. Social deficits, narrow interests, and clumsiness.
What autism screening is used in toddlers?
MCHAT -- modified checklist for autism in toddlers
____ is defined as a child </=2 with weight plotting below the 5th percentile for age on more than one occasion or whose weight crosses two major percentiles downward on a standardized growth grid.
Failure to thrive.
Screenings for Depression in children:
Age 7-17: children's depression inventory
Age 8-12: reynolds child depression inventory
Age 13-18: reynolds adolescent depression inventory
Age 13+: Patient health questionnaire - PHQ-9
Age 14+: Beck Depression Inventory for primary care
Depression - watch for suicidal ideation!!!
With ____, patient shows signs of aggression, property destruction, lying/theft, or rule violation 3 or more times in the last 12 months. Criteria for antisocial personality disorder only applies to patients over the age of ___.
Conduct disorder; 18
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