Term
What could this be?
Purpuric cutaneous rash.
Migratory polyarthritis or polyarthralgias.
Intermittent abdominal pain.
Nephritis
|
|
Definition
Henoch-Schönlein Purpura (Anaphylactoid Purpura)
|
|
|
Term
Staphylococcal skin syndrome is thought to be a systemic effect of what?
Where does it occur? |
|
Definition
exfoliatin
can occur anywhere, but usually occurs in respiratory tract |
|
|
Term
| What is the prodromal phase of a staphylococcal skin syndrome? |
|
Definition
| prodromal phase of erythema, often beginning around the mouth, accompanied by fever and irritability. The involved skin becomes tender, and a sick infant will cry when picked up or touched. A day or so later, exfoliation begins, usually around the mouth. The inside of the mouth is red, and a peeling rash is present around the lips, often in a radial pattern. Generalized, painful peeling may follow, involving the limbs and trunk but often sparing the feet. More commonly, peeling is confined to areas around body orifices |
|
|
Term
What does this describe?
begins with papules that later develop a dark center and then evolve into lesions with central bluish discoloration or blisters and the characteristic target lesions (iris lesions) that have three concentric circles of color change
|
|
Definition
|
|
Term
| What's the tx for erythema multiforme? |
|
Definition
| Treatment is symptomatic in uncomplicated erythema multiforme. Removal of offending drugs is an obvious measure. Oral antihistamines such as hydroxyzine, 2 mg/kg/d orally, are useful. Cool compresses and wet dressings will relieve pruritus. Steroids have not been demonstrated to be effective. Chronic acyclovir therapy has been successful in decreasing attacks in patients with herpes-associated recurrent erythema multiforme. |
|
|
Term
| What causes erythema multiforme? |
|
Definition
Believed to be herpes simplex virus
drugs. especially sulfonamides and mycoplasma infections |
|
|
Term
| By what age do most infants develop CHF? |
|
Definition
|
|
Term
What causes CHF in an infant?
(6) |
|
Definition
| VSD, PDA, coarctation of the aorta, AV septal defect, large arteriovenous malformations, and chronic atrial tachyarrhythmias |
|
|
Term
Infant/child presents with irritability, diaphoresis with feeds, fatigue, exercise intolerance, or evidence of pulmonary congestion
what could it be?
|
|
Definition
|
|
Term
What could this be:
Holosystolic murmur at lower left sternal border with RV heave.
Clinical features are HF, failure to thrive, and diaphoresis with feeds.
Left-to-right shunt with normal pulmonary vascular resistance.
Large defects may cause Eisenmenger syndrome if not repaired early
|
|
Definition
|
|
Term
In VSD,
what closes sooner, muscular or membranous septum? |
|
Definition
|
|
Term
|
Definition
anticongestive measures
surgical repair can happen 3-6 months |
|
|
Term
| What diagnostic tool can pinpoint the location and exact size of the VSD? |
|
Definition
|
|
Term
What could this be?
Fixed, widely split S2, RV heave.
Grade I–III/VI ejection systolic murmur at the pulmonary area.
Large shunts cause a diastolic flow murmur at the lower left sternal border.
ECG shows rsR' in lead V1.
Frequently asymptomatic.
|
|
Definition
|
|
Term
What are the three types of ASD?
What is most common?
Who is more affected? males or females? |
|
Definition
ostium secundum, ostium primum, and sinus venosus
ostium secundum is the msot common; females more affected |
|
|
Term
| What are sxs of child with ASD? |
|
Definition
| usually no cardio sxs until older children or adults--may develop easy fatigure or rarely HF |
|
|
Term
| WHat would xray show of ASD? |
|
Definition
| Radiographs may show cardiac enlargement. The main pulmonary artery may be dilated and pulmonary vascular markings increased in large defects owing to the increased pulmonary blood flow. |
|
|
Term
| WHen does surgical closure of ASD usually occur for asymptomatic but large hemodynamically significant defect? |
|
Definition
|
|
Term
What could this be?
Hyperdynamic precordium.
Widened pulse pressure.
Hypotension.
Presence of a systolic heart murmur in many cases.
|
|
Definition
|
|
Term
| What is tx for patent ductus arteriosum? |
|
Definition
| A clinically significant ductus can be closed with indomethacin (0.1–0.2 mg/kg IV q12–24h for three doses) in about two thirds of cases. If the ductus reopens or fails to close completely, a second course of drug may be used. If indomethacin fails to close the ductus or if a ductus reopens a second time, surgical ligation is appropriate |
|
|
Term
| What is tx for pt's with Von Willebrand disease? |
|
Definition
| The treatment to prevent or halt bleeding for most patients with vWD types 1 and 2 is desmopressin acetate, which causes release of vWF from endothelial stores. |
|
|
Term
| What are lab findings in Von Willebrand? |
|
Definition
| PT is normal, and aPTT is sometimes prolonged. Prolongation of the PFA-100 or bleeding time is usually present since vWF plays a role in platelet adherence to endothelium. |
|
|
Term
What could this be?
A history of increased bruising and excessive epistaxis is often present. Prolonged bleeding also occurs with trauma or at surgery. Menorrhagia is often a presenting finding in females.
|
|
Definition
|
|
Term
What's this called:
failure of relaxation of lower esophageal sphincter
loss of peristalsis in distal esophagus |
|
Definition
|
|
Term
How do patients with achalasia usually present?
when? |
|
Definition
usually after 25 years of age
difficulty swallowing solids and liquids |
|
|
Term
| What may xray show in pt with achalasia? |
|
Definition
| beak-like narrowing caused by consistent contraction of LES |
|
|
Term
|
internal inflammation of a meibomian gland
what's most common organism to cause?
|
|
Definition
|
|
Term
eyelid swelling and erythema and then evolve into a painless, rubbery, nodular lesion
what's tx?
|
|
Definition
chalazion
tx: not antibiotic bcgranulomatous condition; hot compress or I&D |
|
|
Term
Pt presents with fever and H/A
CSF shows mononuclear cell pleocytosis, elevated protein level and normal flucose level.
What could it be? |
|
Definition
|
|
Term
Cerebral palsy: what is it?
how did insult or injury occur? |
|
Definition
nonspecific term used to describe a chronic, static impairment of muscle tone, strength, coordination, or movements
originated from somet ime of insult/injury before birth, during delivery or in the perinatal period |
|
|
Term
75% of cases of cerebral palsy involve what?
What about 15% of cases? |
|
Definition
75%" spasticity of limbs
15% ataxia |
|
|
Term
What are most common causes of death in cerebral palsy patients?
what is most common cause of cerebral palsy? |
|
Definition
aspiration, pneumonia, or ither intercurrent infection
common cause: intrauterine hypoxia |
|
|
Term
| The most common neural tube defect. |
|
Definition
|
|
Term
What is another name for spina bifida?
What causes it? patho? |
|
Definition
| Myelomeningocele is caused by a failure of primary neurulation, (ie, failure of the spinal neural tube to close normally by 28 days after conception |
|
|
Term
| Spina bifida is usually involved with what two major dysfunctions? |
|
Definition
| bladder and bowel abnormalities |
|
|
Term
An increased volume of CSF in association with progressive ventricular dilation.
What is this? |
|
Definition
|
|
Term
Pt presents with the following:
what are you thinking?
excessive head growth
irritabilty, vomiting
loss of appetite
impaired upward gaze, impaired EOM
hypertonia of lower extremities
generalized hyperreflexia |
|
Definition
|
|
Term
| What is usual tx for hydrocephalus? |
|
Definition
provide alt outlet for CSF
ventriculoperitoneal shunting |
|
|
Term
Pt presents at 10 weeks with constipation and severe hypotonia.
Pharyngeal paralysis, dry
What is on top of differntial? |
|
Definition
|
|
Term
| Is there a fever with botulism? |
|
Definition
|
|
Term
| What is classic triad of botulism? |
|
Definition
| (1) afebrile; (2) symmetrical, flaccid, descending paralysis with prominent bulbar palsies; and (3) clear sensorium |
|
|
Term
How do you diagnosis botulism?
How do you treat? |
|
Definition
The diagnosis is made by demonstration of C botulinum toxin in stool, gastric aspirate or vomitus, or serum
Tx:
intravenous human botulism immune globulin (Baby-BIG) is approved by the U.S. Food and Drug Administration (FDA) for use. Baby-BIG is a product containing high titers of neutralizing antibodies against type A and B toxin and is made from pooled plasma of adults who were immunized with a botulism toxoid vaccine.
bed rest, ventilatory support (if necessary), fluid therapy, enteral or parenteral nutrition, and administration of purgatives and high enemas. Aminoglycoside antimicrobials and clindamycin may exacerbate neuromuscular blockage and should be avoided. |
|
|
Term
Pt presents with inflammation of the lid margin. Crusty debris at the bases of the lashes, erythema.
If this pt came in with severe case: may also notice secondary corneal changes such as punctate erosions, vascularization and ulcers.
What is it? What causes? What is tx? |
|
Definition
Blepharitis
Staphylococcus infection
Tx: Lid scrubs with nonburning baby shampoo several times a week
Topical abx ointment: Erythromycin or bacitracin at bedtime |
|
|
Term
What is it called when there is conjunctivitis in the newborn. Usually during first month of life?
What causes it? |
|
Definition
opthalmia neonatorum
May be due to inflammation resulting from silver nitrate prophylaxis
OR bacterial infection or viral
Chlamydia most common cuase
Neisseries gonorrhoeae- can cause blindness |
|
|
Term
| What medicication/prevention can be done for opthalmia neonatorum? |
|
Definition
| povidone iodine offers broad spectrum |
|
|
Term
| WHat is difference btw how child presents with viral vs bacterial vs allergic conjunctivitis? |
|
Definition
bacterial: purulent discharge, neutrophils, bacteria
viral: watery discharge, lymphocytes, rash
allergic: severe itching
regional lymphadenopathy- uncommon in bacterial |
|
|
Term
| Whats tx for bacterial conjunctivitis? |
|
Definition
topic abx: erythromycin, polymixing-bacitracin, sulfacetamide, tobramycin, fluoroquinolones
if chlamydia, n. gonorrhea or n meningitis: need systemic tx |
|
|
Term
How long are kids with adenoviral keratoconjunctivitis contagious?
How do you tx herpes conjunctivitis? |
|
Definition
10-14 days from day of onset
should stay out of school as long as eye sare red and tearing
herpes conjunctivitis: topical trifluridine |
|
|
Term
How can you determine if child has strabismus?
What is strabismus? |
|
Definition
corneal light reflex will not be centered in both eyes
strabismus: misalignment of the visual axes of the two eyes |
|
|
Term
Define:
esotropia
exotropia
|
|
Definition
esotropia: eyes cross
exotropia: eyes diverge |
|
|
Term
What cause this be:
exudative tonsilitis
generalized cervical adenitis
fever
palpable spleen or axillary adenopathy
what supports diagnosis (ie what labs?) |
|
Definition
Infectious mononucleosis
more than 10% atypical lymphocytes on peripheral blood smear
positive mono spot tests |
|
|
Term
| What causes most causes of acute bacterial pharyngitis? |
|
Definition
group A strep
other:
mycoplasma pneumono
chlamydia pneumo
group B and G streptococci |
|
|
Term
What suggests strep throat?
How do you definitely diagnose? |
|
Definition
ant cercial nodes
palatal petechiae
beefy red uvula
tonsilar exudate
Definitive diagnosis: throat culture or rapid antigen test |
|
|
Term
| What type of skin condition is often associated with strep throat? |
|
Definition
scarlet fever
24-48 hours after onset of sxs
diffuse, finely papular, erythematous eruption producing a bright red discoloration of the skin (blances on pressure)
tongue strawberry appearance |
|
|
Term
strawberry appearing tongue
associated with what? |
|
Definition
| scarlet fever assoc with strep throat |
|
|
Term
How should you treat strep throat?
|
|
Definition
10 day course of Pen VK (three doses) OR Pen G benzathine (single dose)
if compliance issues: amox and azithromyciin are options (once daily) |
|
|
Term
If child fails tx for strep throat, what can you give?
|
|
Definition
| augmenten or azithromycin |
|
|
Term
Pt presents with the following, what could it be? What is tx?
Nasal congestion, decreased sense of smell, watery rhinorrhea, and sneezing accompanied by general malaise, throat discomfort and, occasionally, headache
|
|
Definition
viral rhintitis
tx: supportive, pseudoephedrine for decongestant |
|
|
Term
| You suspect pt has rhinosinusitis (aka sinusitis). What can you ask? |
|
Definition
| did you have URI before sxs began? |
|
|
Term
When do ethmoid and maxillary sinuses develop in a baby?
When do the sphenoid and frontal sinuses develop? |
|
Definition
third to fourth gestational age
sphenoid: by age 5
frontal: by 7-8 years |
|
|
Term
Sinusitis:
when do you start abx therapy?
what is first-line tx? |
|
Definition
For children who are not improving by 10 days, or who have more severe symptoms, with fever of at least 39°C and purulent nasal drainage for at least 3–4 consecutive days, antibiotic therapy is recommended
first line: amoxicilin
augmenten if child in day-care or was on some other abx and sxs worsening
macrolides reserved for allergies to PNC |
|
|
Term
how do you diagnose chronic sinusitis?
what is tx? |
|
Definition
Chronic rhinosinusitis is diagnosed when the child has not cleared the infection in the expected time but has not developed acute complications. Both symptoms and physical findings are required to support the diagnosis, and CT scan may be a useful adjuvant in making the diagnosis.
tx: same but longer duration (typically 3-4 weeks) |
|
|
Term
Pt presents with refusal to eat or swallow saliva and by drooling
High fever.
What could it be? What do you do immediately? what bug causes?
|
|
Definition
Epiglottitis
Intubate
bug: H.INflueza b |
|
|
Term
| What's classic sign for epiglottititis on lateral neck xray? |
|
Definition
|
|
Term
| What abx is best for epiglottis? |
|
Definition
cetriaxone sodium
or equivalent cephalosporin |
|
|
Term
Child presents with prodrome of upper respiratory tract symptoms is followed by a barking cough and stridor.
What could it be?
What bugs cause?
Tx?
|
|
Definition
Viral croup
Bugs:
parainfluenza
other: respiratory syncytial virus (RSV), human metapneumovirus, influenza virus, rubeola virus, adenovirus, and Mycoplasma pneumoniae.
Racemic epi
dexamethasone |
|
|
Term
| How do you differentiate viral croup from epiglottitis? |
|
Definition
| the presence of cough and the absence of drooling favor the diagnosis of viral croup over epiglottitis. |
|
|
Term
| What bugs cause peritonsilar abscess? |
|
Definition
| beta hemolytic streptococcal infection. Other pathogens are group D streptococci, -hemolytic streptococci, S pneumoniae, and anaerobes. |
|
|
Term
severe sore throat
high fever
oft palate and uvula on the involved side are edematous and displaced toward the uninvolved side. In cases of abscess formation, trismus, ear pain, dysphagia, and eventually drooling occur
what is it?
how do u treat?
|
|
Definition
peritonsilar abscess
PNC or clinda
consult for possible I&d |
|
|
Term
| how do you treat epistaxis? |
|
Definition
soft part of the nose below the nasal bones is pinched firmly enough to prevent arterial blood flow, with pressure over the bleeding site (anterior septum) being maintained for 5 minutes by the clock.
persistent bleeding, oxymetazoline (Afrin) into the nasal cavity may be helpful.
If bleeding continues, the bleeding site needs to be visualized. A small piece of gelatin sponge (Gelfoam) or collagen sponge (Surgicel) can be inserted over the bleeding site and held in place. |
|
|
Term
| What is tx for otitis externa? |
|
Definition
|
|
Term
otalgia, fever, irritability, anorexia, or vomiting
|
|
Definition
|
|
Term
| How do you distinguish AOM from OME? |
|
Definition
| To distinguish AOM from OME, signs of inflammation of the TM and symptoms of acute infection must be present. Otoscopic findings specific for AOM are a bulging TM, impaired visibility of the ossicular landmarks, a yellow or white color, opacification of the eardrum, and squamous exudate or bullae on the eardrum. OME is associated with a nonbulging TM, which may be retracted or neutral, but always has decreased mobility, may have opacification, and may have white or amber discoloration |
|
|
Term
|
Definition
amoxicillin first line (high dose 90 mg)
if that fails, augmenten(will help additionally cover h.influ
if child gets paular rash to amox- can try cefuroxime, cefpodoxime, and cefdini
tylenol or motrin for pain
auralgan drops |
|
|
Term
| What's major clinical sxs that differentiate secretory from osmotic diarrhea? |
|
Definition
Osmotic
Large volume watery
Excessive gas
Abdominal absent or mild cramping
Related to intake of milk products & drugs
Typically associated with food intake
Relieved with fasting
Not nocturnal, absence of blood & systemic features such as fever, weight loss or malaise
Secretory
Large volume
Watery
Independent of food intake
Often nocturnal
Unrelieved with fasting
May be associated with blood in stool, WBC, and systemic symptoms |
|
|
Term
What kind of diarrhea?
Large volume
Watery
Independent of food intake
Often nocturnal
Unrelieved with fasting
May be associated with blood in stool, WBC, and systemic symptoms
|
|
Definition
|
|
Term
What are causes of diarrhea?
6 |
|
Definition
1. interruption of normal cell transport processes for water, electrolytes or nutrients
2.decrease in surface area for absorption
3. increase in intestinal motility
4. increase in unabsorbale osmotically active molecules
5. increase in intestinal permability
6. increase in enterocyte secretion by toxins or cytokines |
|
|
Term
| Most abx assoc diarrhea is ____ and not associated with what? |
|
Definition
watery
not assoc with systemic sxs
stops when abx stopped |
|
|
Term
| What type of foods cause diarrhea in infant or child? |
|
Definition
fruit juices (osmotic)
citrus fruits, tomatoes, fermented cheeses
overfeeding- esp in young infants bc relative deficiency of pancreatic amylase causes osmotic diarrhea |
|
|
Term
Protein allergy most common in who?
what does it cause?
what are sxs? |
|
Definition
infants younger than 12 months
diarrhea
sxs: mild to severe colitis and rectal bleeding |
|
|
Term
Infant presents with diarrhea which shows mild lymphonodular hyperplasia, mucosal edema, and slight eosinophilia.
what could it be? |
|
Definition
| cow's milk protein allergy |
|
|
Term
fever
periumbilical abdominal pain
RLQ pain
anorexia
vomiting
diarrhea or constipation
what could it be?
how do u treat? |
|
Definition
acute appendicitis
US
CT can be diagnostic
expoloratory laparotomy or laparoscopy |
|
|
Term
| absence of ganglion cells in the mucosal and muscular layers of the colon is called |
|
Definition
|
|
Term
| What suggests the diagnosis of Hirschspring disease? |
|
Definition
| Failure of the newborn to pass meconium, followed by vomiting, abdominal distention, and reluctance to feed, suggest the diagnosis |
|
|
Term
What studies can you do for Hirscspring disease?
What is tx? |
|
Definition
plain abd radiograph: dilated proximal colon and absence of gas in pelvic colon
barium enema using catheter shows narrow distal segment with sharp transition to the proximal dilated colon
tx: diverting colostomy |
|
|
Term
|
Definition
| voluntary or involuntary passage of stools in a child who has been toilet trained |
|
|
Term
How do u treat constipation?
how do you treat encopresis? |
|
Definition
change diet: high fiber
increase fluid intake
meds: maltsupex
Miralax: stool softener
ex-lax
if encopresis- relieve fecal impaction (ie. mineral oil, nonabsorable osmotin agents such as Milk of magnesia) |
|
|
Term
What is the name:
a pustule at a follicular opening
What are common bugs?
Whats tx? |
|
Definition
folliculitis
bugs: staphylococcus and streptococcus
tx: warm compresses or keratolytics (same used for acne) |
|
|
Term
Occurs during hot months as erythematous, papular rash concentrated on the face, upper neck, and extremities
what could it be?
what causes?
whats tx? |
|
Definition
miliaria rubra
causes:obstruction of sweat glands
tx:loose fitting clothes, avoid oil-based topic lubricants |
|
|
Term
What's tx for molloscum contagiosum?
what are they? |
|
Definition
tx: Treatment for molluscum includes topical imiquimod, topical cantharidin, oral cimetidine, cryotherapy with liquid nitrogen, and curettage. Left untreated, the lesions resolve over months to years.
what is it? poxvirus that induces the epidermis to proliferate, forming a pale papule. Molluscum contagiosum consists of umbilicated, flesh-colored papules in groups on the genitalia or trunk. |
|
|
Term
healthy baby with periods of intense, unexplained fussing/crying lasting more than 3 hours a day, more than 3 days a week for more than 3 weeks
|
|
Definition
|
|
Term
When does primary teething usually begin?
what is tx? |
|
Definition
primary teething starts at 6 months
tx: topical anesthetics or teething gels, available over the counter. Most of these agents contain benzocaine or, less commonly, lidocaine. Systemic analgesics such as acetaminophen or ibuprofen are safer and more effective. Chewing on a teething object can be beneficial, if only for distraction purposes. |
|
|
Term
| What is the main bacteria causing dental caries? |
|
Definition
| The main bacteria implicated in the initiation of caries are Streptococcus mutans and S sobrinus; Lactobacillus acidophilus and L casei are linked to progression of caries. S mutans is most commonly transmitted from mother to child. |
|
|
Term
The rule of 3's is associated with what?
What is it? |
|
Definition
assoc with colic
An otherwise healthy infant aged 2–3 months seems to be in pain, cries for > 3 hours a day, for > 3 days a week, for > 3 weeks ("rule of threes") |
|
|
Term
What causes juvenile hypothyroidism?
What causes congenital hypothyroidism? |
|
Definition
juvenile: chronic lymphocytic (Hashimoto) thyroiditis
congenital:hypoplasia or aplasia of the thyroid gland or failure of the gland to migrate to its normal anatomic location/dyshormonogenesis |
|
|
Term
An infant presents with the following:
thick tongue, hypotonia, large fontanelles, constipation, umbilical hernia, hoarse cry, and dry skin
what could it be? |
|
Definition
| congenital hypothyroidism |
|
|
Term
Child presents with the following:
short stature and abnormal weight gain. Other findings include delayed epiphyseal development, delayed closure of fontanels, and retarded dental eruption. The skin may be dry, thick, scaly, coarse, pale, cool, or mottled, or have a yellowish tinge. The hair may be dry, coarse, or brittle. Lateral thinning of the eyebrows may occur. Musculoskeletal findings include hypotonia and a slow relaxation component of deep tendon reflexes (best appreciated in the ankles) |
|
Definition
|
|
Term
| Total T4 and FT4 levels are decreased. T3 resin uptake (T3RU) is low |
|
Definition
|
|
Term
| What is the drug of choice for acquired hypothyroidism? |
|
Definition
| Levothyroxine (75–100 mcg/m2/d) is the drug of choice for acquired hypothyroidism. |
|
|
