Term
Definition: most common neuromuscular d/o characterized by progressive weakness, intellectual impairment, hypertrophy of calves, and proliferation of connective tissue
- more common in boys
- x-linked recessive
Sx:
- perinatal: none
- Infancy: poor head control
- Toddlers: poor hip girdle = lordosis. Gower's sign: have to walk up from hands and knees to standing. Trendelenberg gait
- Childhood: lose ability to walk around 12 y/o. loss of DTR. scoliosis is major issue
- Teenage: progression of weakness from larger to smaller muscle groups, resp issues, muscle contractures, enlargment of calves/tongue/forearm, wasting of thighs, cardiomyopathy, smooth muscle GI dysfunciton
dx?
referral?
tx?
prognosis? |
|
Definition
Duchenne's Muscular Dystrophy
dx: via PCR for gene mutation or by muscle bx with endomysial connective tissue proliferation
Referral: ped cardiology
Tx: symptomatic - digoxin, up to date immunizations, good nutrition, therapy
Prognosis: death by age 18-20 due to resp failure, heart failure, pneumonia, aspiration
referal: |
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Term
Short Stature DDX:
1. most = ?
2. Disproportion btwn upper and lower body, short stature, webbed neck, low IQ, wide spaced nipples, short 4th metacarpal
3. Disproportion btwn upper and lower body, low muscle tone, incomplete sexual development, cognitive disability, behavior probs, obesity, always hungry
4. 2 other Disproportion btwn upper and lower body
5. Decreased bone mineral density, impaired cardiac fxn, central obesity, increased insulin sensitivity, reduced exercise capacity, emotional disturbance, decreased quality of life, elevated cholesterol. test for insulin=like growth factor (IGF-1)
6. decreased weight for height
7. decrased height for weight |
|
Definition
1. most commonly - nothing
2. turner syndrome
3. prader willi syndrome
4. skeletal dysplasias and down's
5. growth hormone deficiency
6. suggests nutritional problem
7. suggests endocrine problem (growth hormone def, hypothyroid, glucocorticoid excess)
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Term
Estimated height
Boys
Girls |
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Definition
Boys:[(Mom + 13 cm) + Dad]/2 = Kid +/- 5 cm
a. Girls: [(Dad – 13 cm) + Mom]/2 = Kid +/- 5 cm
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Term
Acute Strep pharyngitis
1. Epidemiology: uncommon before age __. Most common in what age?
2. Incubation
3. Sx?
4. tx?
5. complications |
|
Definition
1. uncommon before 2, most common in early school age
2. incubation 2-5 days
3. sx: prominent sore throat, ha, GI sx, fever, no cough
4. tx: penicillin/amoxicillin - hastens recovery by 12-24 hr, prevents sequelae
5. Complications: otitis media, parapharyngeal abscess, rheumatic fever, glomerulonephritis |
|
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Term
Chronic strep pharyngitis
1. most common cuase? tx?
2. when to do tonsillectomy? |
|
Definition
1. most commonly, inadequate tx. tx with IM penicillin
2. tonsillectomy in >7 times in the past year or >5 x in each of 2 consecutive years. lowers incidence in kids for 1-2 years
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Term
Scarlet Fever:
1. Cause?
2. sx |
|
Definition
1. GAS in pts who do not have antitoxin abs
2. URI + rash due to pyrogenic exotoxin. strawberry tongue
- rash: 24-48 hrs after sx onset. begins around neck and spreads over trunk and extremities. diffuse, finely papular, erythematous, blacnhes, usually spares face. may desquamate when rash fades
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Term
Mono
1. cause
2. transmission, incubation
3. sx
4. pe
5. cbc
6. dx?
7. complications
8. tx |
|
Definition
1. epstein barr virus
2. spread via sexual intercourse and in oral secretions. cannot be spread via non-intimate contact. virus is shed >6 mos after infction. incubation 30-50 days
3. classic triad: fatigue, pharyngitis, lymphadenopathy
- also, malaise, fever, ha, nausea, abd pain, myalgia, splenic enlargment
4. PE: lymphadenopathy, splenomegaly (50%), hepatomegaly (10%), petechiae in soft palate, rash and edema of eyelid,
- Rash: giannoti-crosti syndrome. symmetrical erythematous papular rash on cheeks, extremities, and buttocks.
5. CBC: atypical lymphocytosis, posibly liver enzymes elevated
6. dx: monospot
7. complicaitons: EBV associated wtih lymphoid malignancies, splenic rupture, ampicillin rash, alice in wonderland syndrome, guillain barre, reye
6. tx: supportive, no participation in contact sports for 2-3 weeks
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Term
S/S: sudden onset clear or mucoid rhinorrhea, nasal congestion, sneezing, sore throat, cough, fever. duration = 1 week.
PE: TMs, nose, and throat appear red and inflamed
Tx?
Consider ___ if sx persist beyond 10-14 days |
|
Definition
viral rhinitis (common cold)
tx: tylenol or ibuprofen, humidification, nasal saline rinse, nasal suction, topical decongestant
consider sinusitis if sx persist >10-14 days |
|
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Term
S/S: nasal drainage, congestions, facial pressure/pain, postnasal drainages, hyposmia/anosmia, fever, cough, fatigue, maxillary dental pain, ear pressure/fullness
common presentation: child with a cold doesn't improve after 10-14 days or worsens after 5-7 days
common etiologies?
tx? |
|
Definition
bacterial rhinosinusitis
strep pneumo, H. flu, M. catrrhalis, GABHS
complications: orbital cellulitis, oseitis of frontal bone (Pott's puffy tumor), meningitis, cheek cellulitis
tx:
mild-mod: amoxicillin
severe or in day care: augmentin
PCN allergy: cephs or macrolides
|
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Term
causes of viral pharyngitis/tonsillitis
1. exudative tonsils, generalized adenitis, fever, palpable spleen, >10% atypical lymphs on cbc.
2. 3 mm ulcers with a halo on anterior tonsillar pillars, soft palate, and uvula. anterior mouth and tonsils spared. caused by coxsackie
3. ulcers anywhere in mouth, vesicles/papules/pustuls on palms, soles, interdigital, buttocks. caused by coxsackie or enterovirus
4. caued by adenovirus. is epidemic. exudative tonsilitis, conjunctivitis, lymphadenopathy, fever |
|
Definition
1. mono
2. herpangina
3. hand foot mouth
4. pharyngoconjunctival fever
** 90% of sore throats and fever in kids are due to viral infections |
|
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Term
acute inflammatory disease of the larynx. affects younger kids in fall and winter. most often parainfluenza, rsv, influenza, rubeola, adenovirus, and mycoplasma pneumonia
s/s: URI sx wtih barking cough and stridor. absent or low grade fever. severe disease: stridor at rest, retractions, air hunger, cyanosis
neck xray: Steeple sign (subglottic narrowing)
tx? |
|
Definition
croup - viral
tx:
- mild: supprotive
- severe: nebulized racemic epinephrine, dexamethasone injection |
|
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Term
pseudomembranous croup, severe life threatening form of laryngotracheobronchitis.
caused by staph aureas, h flu, group a strep, neisseria, and m. catarrhalis
s/s: similar to croup but instead of improvement pts develop high fever, toxicity, and progressive intermittent airway obstruction that is unresponsive to croup tx
bronchoscopy: normal epiglottis + purulent tracheal secretions and membranes
tx? |
|
Definition
bacterial tracheitis
tx: intubation, debridement, humidification, suctioning, iv abx |
|
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Term
Major cause of bronchiolitis and pneumonia in <1 y/o
- same family as parainfluenza and measles
- 4 day incubation
- outbreaks in winter mos
- very contagious - most kids get it by their 2nd bday
sx (in order of appearance): rhinitis, pharyngitis, cough, sneezing, low grade fever, audible wheeze, tachypnea, intercostal/subcostal retractions, hyperexpansion of chest, restlessness, peripheral cyanosis
Hypoxemia is more marked than anticipated based on clinical picture
PE: wheezes, crackles, rales, rhonchi
CXR: normal, hyperexpansion, peribronchial thickening, central pneumonia
dx?
tx? |
|
Definition
RSV
dx: usually clinical, nasopharyngeal wash is optimal test
tx: sympomatic (humidified oxyen, fluids, head of bed to 10-30 deg), epi and b-agonists are controversial |
|
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Term
Sx: fever, sore throat, trismus (inability to open mouth), dysphagia
PE: asymmetrical tonsillar bulge wtih displacement of uvula- may be poorly visualized due to trismus
tests?
tx? |
|
Definition
peritonsillar abscess
tests: CT
tx: surgical drainage, abx against GABHS and anaerobes
Tonsillectomy if failure to resolve after 24 hrs |
|
|
Term
inherited multisystem d/o of kids and adults, characterized by obstruction and inflammation of airways and maldigestion. most common life-limiting recessive trait in whites. responsible for most exocrine pancreatic dysfxn, severe chronic lung disease, salt depletion.
Sx: bronchiolitis --> bronchitis --> broncholar obliteration --> bronchiolectasis --> bronchiectasis
- cough is most constant sx.
- as disease progresses: wheezing, exercise intolerance, SOB, failure to gain wiehgt, cor pulmonale, resp failure, atelectasis, hemoptysis, pneumo
- meconium ileus in 15-20% of newborns
- maldigestion
- pancreatic dysfunction
- delayed sexual development
- excessive loss of salt in sweat -- "frosting of skin" or "salty babies"
Tests:
- Sweat test + if Cl> 60 meq/L
- DNA testing on newborn screening exam
tx? |
|
Definition
cystic fibrosis
tx:
- pulmonary: bronchodilators and corticostroids, chest PT
- treat complicatiosn as they develop
- kids with CF should NOT have restricted acitivities
prognosis: median survival 35 yrs
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Term
common secondary mitochondrial hepatopathy due to the combo of viral infx and salicylate use in geneticaly susceptible individuals
sx: characteristic: resolving viral syndrome with acute onset of vomiting and encephalopathy. rapid progression to seizure, coma, and death
labs: elevated liver enzymes
prognosis? |
|
Definition
Reye Syndrome
prognosis: death from increased ICp and brain herniation
Pts that survivae have full recovery of liver function
>40% mortality rate |
|
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Term
Acute asthma exacerbation:
1. home managment
2. ER management |
|
Definition
Home management:
- all kids should have written action plan - can reduce asthma death by 70%
- Immediate tx wtih SABA (up to 3/hr)
- Resolution if no sx over next 4 hrs, improvement in PEF to 80% personal best
- Follow up with child's PCP
- incomplete response: 4 days of oral corticosteroids
- Epipen and portable O2 should be at home wtih kids with severe asthma
ER managment:
- correct hypoxemia, improve airway obstruction, prevent progression or recurrence
- Supplemental o2, inhaled SABA every 20 min for 1 hr, systemic corticosteroids, may add ipratroprium if no significant improvement
- Add ICS to child's asthma regimen upon discharge
- Overnight observation for pts that do not adequately improve in 1-2 hrs
Complications:
- atelectasis, pneumo
- status asthmaticus: severe exacerbation that does not resolve wtih standar therapy - needs frequent bronchodilators and oral steroids
- ventilation-perfusion mismatch from too much SABA - needs constant oximetry |
|
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Term
a dramatic, potentially life-threatening condition characterized by acute potentially fulminating course of high fever, sore throat, dyspnea, and rapidly progressing respiratory obstruction
Sx: sudden development of sore throat and fever. within hours, appears toxic, swallowing is difficult, breathing is labored, drooling, neck hyperextended to maintain airway
- Tripod position: sitting upright and leaning forward wtih chin up and mouth open
- air hunger and restlessness followed by cyanosis and coma
- Stridor is late finding and suggests near complete airway obstruction
- laryngoscopy?
- xray?
- what not to do?
- tx?
- prognosis? |
|
Definition
epiglottitis (supraglottitis)
laryngoscopy: large, cherry red epiglottis and possibly ariepiglottic folds
xray: "thumb sign"
do not do: PE, phlebotomy, IV insertion, place child supine, or any other anxiety-produing procedures until child is stable
tx: intubation, regardless of degree of resp distress + abx
prognosis:
- unintubated: 6% mortality
- intubated: 1%
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Term
Foreign Body Aspiration
- 73% are kids <__ y/o
- which bronchus is more commonly obstructed?
sx?
workup? |
|
Definition
< 3 y/o
- R bronchus
sx:
- complete obstruction: sudden resp distress and inability to talk or cough
- choking/coughing spasms accompanied by wheezing
- stages:child will at first be coughing/choking, then may have an asymptomatic interval as object gets lodged
workup:
- XR: pt is asymptomatic with normal xray in 15-30%
- good hx from parents about common offending agents
- emergent bronchoscopy if hx of eating nuts |
|
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Term
Lactose intolerance
1. all ethnic groups are lactate sufficient at birth
2. Gnetic/familial lactase deficience appears after __ y/o
3. Eventually develops in almost 100% of __, __, and ___
4. Develops in 70% of___ and 30-60% of ___
sx?
tests?
tx? |
|
Definition
2. 5 y/o
3. alaskans, asians, native americans
3. blacks, whites
sx: diarrhea, abd distention, flatus, abd pain, stools are liquid/frothy with pH <5.5
tests: lactose breath test, lactose load test
tx: avoid lactose, add lactase |
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Term
1. __% of kids are overweight and ___% are at risk for becoming overweight
2. What 2 ethnic groups are at highest rates?
3. ___ is the strongest predictor of chidhood obesity
4. Diseases associated with childhood obesity represent <_% of cases
5. Workup?
6. tx
7. dietary modifications
8. lifestyle modifications |
|
Definition
1. 16% are overweight, 31% at risk for becoming overweight
2. african american girls and hispanic boys
3. parental obesity - doubles risk of obesity in kids
4. <5%
5. labs: glucose, insulin, A1c, Ast/Alt, cholesterol, trig
6. tx: in still growing kids: focus on weight maintenance instead of loss
- weight loss in severe or skeletally mature: 1 lb per week or 10% initial wt loss
7. dietary modifications:
- juice: limit to 4-6 oz in <6 y/o and 8-12 oz in >6 y/o
- milk: change to skim
- limit btwn meal snacking
- increase fam meal times and decrease fast food
- eat breakfast
- decerased sweetened beverages
8. lifestyle modifications:
- avoid tv and computers in <2 y/o
- < 2 hrs screen time per day in kids 2-18 y/o
- increase exercise
bariatric surgery may only be considered in adolescents |
|
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Term
BMI percentile for age vs. Weight Status
Underweight =
Normal =
At risk for overweight
Overweight |
|
Definition
Underweight: <5th percentile
normal: 5th-84th
At risk: 84th-94th
Overweight: >95th |
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Term
| ___ defects are the most common congenital heart defects |
|
Definition
|
|
Term
AKA Ostium secundum
creates L-->R shunt
- enlarged r heart and pulmonary artery
- s/s: slow to gain weight, lower resp infx, or asymptomatic
PE: SEM with wide split S2 ad LUSB, RV heave
surgery if >3mm |
|
Definition
|
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Term
Most common congenital heart defect - makes up 25-30% of cases
< 1 y/o - most are in muscular septum
>1 y/o - most are in membranous septum
creates L --> R shunt
sx: volume overload and heart failure -- chf, dyspnea, slow growth, cardiomeglay, increased lung markings
PE: harsh or high pitched holosystolic murmur
Typical presentation: 3-4 week old infant presents with difficulty breathing and new murmur
tx? |
|
Definition
VSD
tx: refer to cardio for surgery at 6-12 mos |
|
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Term
R--> L shunt
normal in newborns
functional closure shortly after birth
anatomic closure by a few years old
Present in 10-20% of adults
S/s: usually not
Potential complications: stroke |
|
Definition
|
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Term
a vessel in the developing fetus that connects the pulmonary artery to the aortic arch so most of the blood from the RV bypasses the non-functioning lungs. Should close after birth due to lack of prostaglandins
if it remains open, creates a L-->R shunt
associated wtih prematurity and rubella
murmur = "machinery murmur"
PE: wide pulse pressure, bounding peripheral pulse, enlarged LV, failure to thrive, tachycardia
Tx? |
|
Definition
patent ductus arteriosis
tx: fluid restriction and indomethacin (inhibits prostaglandin)
- surgery if persistent
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Term
| Most common defect in down's |
|
Definition
AV canal defect
- low ASD + high VSD = missing center of heart |
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Term
narrowing of the aorta at the level of the ductus arteriosis just distal to the left subclavian.
more common in males
if present in females, consider Turner syndrome
PE: LE hypotension + UE hypertension. pain/weakness in legs with exercise
CXR: enlarged aortic knob
tx? |
|
Definition
coarctation of aorta
tx: surgery in young, stent in older |
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Term
Most common cyanotic heart lesion in kids with CHD who survive infancy
Causes R-->L shunt
Decreased O2 sat during periods of exertion
S/S: cyanosis, clubbing, PS murmur, S2 at LLSB
Tet spells: restless, agitation, crying --> causes increase in RV outflow resistance, which leads to R-->L shunt which causes increased cyanosis
Classic example: cyanotic child who squats after exertion
CXR: boot shaped heart, RVH, "couer en sabot"
tx? |
|
Definition
Tetrology of Fallot
Tx: Surgery to close VSD and open PS |
|
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Term
| 4 defects in tetrology of fallot |
|
Definition
Pulomary stenosis (RV outflow obstruction)
RVH
Overriding aorta
VSD
PROV |
|
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Term
Most common CHD in neonates
Causes desaturated blood to go out through the aorta and oxygenated blood to be sent to the lungs through the pulmonary artery
Need VSD/ASD/PDA to mix the 2 sides for the child to survive
PE: single, loud S2 bc aorta is right under sternum
S/S: cyanosis at birth, RB heave, single loud S2
CXR: egg on a string or oval shaped heart
diagnosis made via?
Tx? |
|
Definition
transposition of great arteries
dx via echo
tx: prostaglandin E to keep PDA open
arterial switch in first week of life |
|
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Term
Single arterial trunk from the base of the heart that includes both the aorta and the pulmonary artery + large VSD
associated wtih microdeletion of chromosome 22
L --> R shunt
s/s: wide pulse pressure, bounding arterial pulse, heart failure
"Washing machine" murmur
tx? |
|
Definition
Truncus arteriosus
tx: surgery |
|
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Term
Pulmonary vein connects SVC to RA instead of LV. Oxygenated blood goes back to the lungs instead of the body
L --> R shunt
S/S: in infancy - HF, tachypnea, failure to thrive, rapid onset pulmonary edema
EKG: RAD, RVH
CXR: classic "Snowman" or "figure 8" silhouette
tx? |
|
Definition
Total anomalous pulmonary venous return
tx: treat HF then surgery |
|
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Term
CHD in which leaflets of the tricuspid are pushed downward to creat a large right atrium and small RV so not enough blood gets to lungs.
usually ASD or PFO
associated wtih WPW
DUE TO MATERNAL LITHIUM USE IN PREGNANCY |
|
Definition
|
|
Term
autosomal dominant d/o
murmur: grade 3-4 crescendo-decrescendo systolic murmur. louder with valsalva
most common cause of sudden death in athletes |
|
Definition
idiopathic hypertrophic subaprtic stenosis
also, HCM |
|
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Term
Child presents with known aortic stenosis and has syncope and CP
what do you do? |
|
Definition
|
|
Term
High-pitched, blowing holosystolic murmur heard best at the apex, often preceded by a click
more common in pts with Marfan's, Ehler's Danlos, or mucopolysaccharidoses |
|
Definition
| Mitral regurg (MVP or rheumatic fever) |
|
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Term
| example of a continuous murmur? |
|
Definition
|
|
Term
| Murmur pneumonic: PASS PAID |
|
Definition
Pulmonary Aortic Stenosis = Systolic
Pulmonary Aortic Insuff = Diastolic
Mitral and Tricuspid are opposite |
|
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Term
Innocent Murmurs:
1. heard in neck or anterior upper chest. heard both in systole and diastole. due to blood draining down collapsed jugular into dilated intrathoracic veins. absent when supine, valsalva, turning head, or compressing jugular
2. SEM with musical or vibratory quality, similar to kazoo. Decreased with inspiration and standing
3. Which extra sound is normal in kids? |
|
Definition
1. venous hum
2. Still's murmur
3. S3 |
|
|
Term
Neonatal Jaundice:
1. Def: serum bilirubin > __
2. ___: increased unconjugated bili causess yellow staning on basal ganglia and hippocampus. sx?
3. normal in first week of life. apepars within 24 hrs of birth, peaks at day 3, resolves in 1 week. progresses in cephlopedal manner
4. what is bilirubin conjugated with in the liver?
5. why are infants predisposed to jaundice?
6. risk factors? |
|
Definition
1. >5 mg/d
2. kernicterus. sx: lethargy, irritability, hypotonia, opsithonos (rigid arched back, head back_), seizures, MR, CP, hearing loss
3. physiologic jaundice
4. albumin
5. due to increased RBC volume and decreased RBC survival + immature liver
6. risk factors: east asian, known hemolytic disease, prematurity, siblings needed phototherapy, signifiant bruising, difficulty nursing, wt loss, coomb's +
7. Tx:
- phototherapy: converts unconjugated bili into water soluble isomer that can be excreted
- Exchange transfusion: removes bili directly |
|
|
Term
|
Definition
direct coombs: tests baby for autoimmune hemolytic
anemia
indirect coombs: prenatal test of some sort |
|
|
Term
TM perforation:
1. Causes
2. Tx?
3. Cause of chronic perf?
4. Complications of chronic perf |
|
Definition
1. causes: AOM, OME, trauma, chronic suppurative OM, cholesteatoma
2. should heal spontaneously within 2 weeks
3. CSOM usually, could be from AOM or failure of closure after extrusion of tympanostomy tube
4. conductive hearing loss |
|
|
Term
Evaluation of infant with tender abdomen:
Key findings:
1. child lies still, won't move
2. child can't sit still
3. bilious emesis
4. bloody emesis
5. bloody/mucoid diarrhea
6. sore throat + HA + abd pain
XRAY:
7. strange bowel gas pattern
8. air fluid levels
9. Rotation
10. Penumatosis or free air
11. US: cinnamon roll sign
12. PE: bowel loops |
|
Definition
1. inflammatory pain - usually infection or perf
2. colicky pain - usually from obstruction
3. obstruction
4. UGI bleed
5. entercolitis
6. pharyngitis
7. constipation
8. obstruction
9. volvulus
10. necrotizing entercolitis
11. intussusception
12. necrotizing entercolitis |
|
|
Term
Vaccines at each age:
Birth
2 mo
4 mo
6 mo
(any time 6 mo-18 mo)
(any time 12-15 mo)
(any time 15-18 mo)
4-6 yr
11-12 yr
13-18 yr
yearly at 6 mos? |
|
Definition
Birth: Hep B
2 mo: Hep B, Rotavirus, DTaP, Hib, pneumococcal, polio
4 mo: rotavirus, DTap, Hib, pneumococcal, polio
6 mo: rotavirus, dtap, hib
6-18 mo: hep b, pneumococcal, polio
12-15 mo: hib, MMR, Varicella, dose 1 Hep A
15-18 mos: DTaP, Hep A
4-6 yr: DTaP, Polio, MMR, Varicella
11-12 yr: Tdap, HPV (3x), Meningicoccal
13-18 yr: Mening booster
yearly: flu
|
|
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Term
Gynecomastia:
1. True vs. pseudo
2. neonatal
3. pubertal
4. due to genetic mutations causing increased aromatization
5. due to drugs causing increased estrogens or decreased androgens (spironolactone, alkylating agents, anabolic steroids, hcg, ketoconazole, cimetidine, flutamide)
6. includes klinefelter's, sertoli cell tumors, peutz-jegher syndrome, hyperthyroidism
7. gynecomastia associated wtih galactorrhea |
|
Definition
1. true: prsence of glandular breast tissue in male. palpable fibroglandular mass located beneath nipple
pseudo: accumulation of adipose tissue in area of breast. overweight boys
2. neonatal: normal in 60-90% of newborn males. result of normal stimulation by maternal estrogen. 5% have galactorrhea. most disappear wtihin 4-8 weeks but can persist for a year
3. pubertal: in 65% of males. incidence peaks at tanner stage 3-4 or 14 y/o. Due to imbalance btwn androgens and estrogens
4. familial
5. exogenous estrogens
6. hypergonadotropic hypogonadism
7. prolactinoma |
|
|
Term
Childhood Poisoning:
1. Peak incidence?
2. poison prevention education should begin when?
3. highest risk ingestions? |
|
Definition
1. peak incidence: 2 y/o
2. 6 mo WCC
3. caustic solutions, Hydrogen fluoride, drugs, CCBs, opioids, hypoglycemics, antidepressants |
|
|
Term
Child abuse:
1. an act of commission. any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which present an imminent risk of serious harm.
2. acts of omission. Resulting in actual or potential harm. Inadequate health care, education, supervision, protection from hazards and environmental, physical needs, and/or emotional support.
3. spanking is ok when?
4. 4 levels of risk factors |
|
Definition
1. abuse
2. neglect
3. spanking is ok when limited to buttocks, over clothing and NEVER on head or neck
4. individual (MR), familial (mom's bf or domestic violence), community (dangerous neighborhood), society (low SES) |
|
|
Term
Clinical manifestations of child abuse
1. critical factor in recognizing abuse?
2. most common manifestation?
3. How can you tell if a bit is by a kid or adult?
4. Suspicious burns?
5. suspicious fx
6. signs suspicious of head trauma
7. signs suspicious of abd trauma |
|
Definition
1. Critical factor: lack of plausible explanation
2. most common: bruises. suspicious bruises: in pre-ambulatory infant, in padded/less exposed areas (buttocks, cheeks, under chin, genitalia), patterned bruises, ligature bruises, multiple bruises at diff ages
3. bites by kids <8 y/o have a distance of <2.5 cm between canines
4. burns: sock and glove distribution, symmetric, those of buttocks and perineum, cigarette burns 7-10 mm, delay in seeking medical attn
5. fx: matephyseal lesions, posterior rib, scapula, sternum, spinous process, femoral, humeral
6. head: lethargy, vomiting w/o diarrhea, seizure, coma, subdural/retinal hemorrhage, raccoon eyes
7. abd: bilious vomiting w/o fever or peritoneal inflammation, acute abd
|
|
|
Term
| Principles for assessing abuse/neglect |
|
Definition
thorough PE and hx
verbal children interviewed separately from parents
careful documentation w/ direct quotes
assess child's immediate danger
assess other kids in home
screen parents for risk factors
|
|
|
Term
| Presentaitons of sexual abuse |
|
Definition
explicit sexual behavior outside norm for the kids' age
compulsive masturbation, attemtping to perform sex acts on other kids or adults, asking adults or kids to perform sex acts on them, teens become sexually promiscuous, older kids abuse younger kids
behavioral changes such as social withdrawal, acting out, increased clinginess or fearfulness, distractability, learning difficulties, regression in developmental milestones (new onset enuresis, ecopresis) |
|
|
Term
Most common cause of testicular pain in 12+ (uncommon <10)
- Surgical emergency
s/s: acute onset of unilateral pain, N/V, swollen very tender testicle, scrotal edema, absent cremasteric reflex
tx? |
|
Definition
testicular torsion
tx:
<4-6 hrs - manual detorsion outward can be attempted
4-6 hours of absent blood flow, irriversible loss of spermatogenesis
90% gonad survival if surgery w/in 6 hrs |
|
|
Term
Most common cause of testicular pain in boys 2-10 y/o
s/s: gradual pain, 3-5 mm tender indurated mass on upper pole + "blue dot" sign
tx? |
|
Definition
torsion of appendix testis
inflammation resolves in 3-10 days, non-surgical, bed rest with NSAIDs |
|
|
Term
due to ascending retrograde infection from the urethra
s/s: scrotal pain, erythema, swelling, pyuria
rare before puberty - if present, consider wolffian duct abnormlaity
could be infectious (STD) in sexually active
tx? |
|
Definition
epididymitis
tx: bed rest, decreasaed physical activity, scrotal support and elevation, ice packs, NSAIDs, abx if STD |
|
|
Term
congenital condition wtih abnormal dilation of pampiniform plexus in scrotum
most common surgically correctalbe cause of subfertility
rare <10 y/o bc blood flow is usually not sufficient to cause this before puberty
most common on which side?
s/s: painless or dull aching paratesticular mass, "bag of worms", better when supine, prominent wtih valsalva
tx? |
|
Definition
varicocele
more common on LEFT
tx: varicolectomy is disparity in testicular size or visible wtih inspection w/o valsalva |
|
|
Term
cystic lesion containing sperm that is attached to the upper pole of the sexually mature testis
usually painless
incidental PE finding
tx? |
|
Definition
spermatocele
tx: none unless painful or large |
|
|
Term
accumulation of fluid in tunica vaginalis
usually non-communicating and will disappear by 1 y/o
long term risk? |
|
Definition
hydrocele
risk: inguinal hernia if communicating hydrocele
repair if persists beyond 12-18 mos |
|
|
Term
Testicular tumor:
__% of pre-pubertal tumors are malignant
3 most common kinds?
__% of painless hard masses in adolescents are malignant
workup? |
|
Definition
35% prepubertal
most common: yolk sac, rhabdo, leukemia
98% painless
workup:
US + serum markers (alpha fetoprotein + HCG)
Tx: radical orchiectomy |
|
|
Term
Bacterial meningitis:
1. most common cause in 1 mo- 1 y/o
2. other vaccinable causes?
3. most common cause in <1 mo?
4. 2 peak ages for N. meningitidis
5. s/s?
6. pe?
7. tx? |
|
Definition
1. n. meningitidis
2. s.pneumo and h. flu
3. s. pneumo
4. n mening: <5 y/o and 15-24 y/o
5. s/s: fever, HA, URI, myalgia, poor feeding, seziure, shock, purpura, DIC, coma, death
6. PE: + kernigs/brudzinski if >18 mos, purpura
7. tx: dexamethasone
abx: ampicillin, cephalosporin, vanc, or rifampin |
|
|
Term
Suspicion of meningitis but LP only shows inflammation but no causative agent
CSF: pleocytosis (lots of WBCs) |
|
Definition
|
|
Term
Acute, life threatening infection of blood stream by an encapsulated, gram neg diplococcus
often associated with meningitis
s/s: viral sx, meningitis sx, rapid progression to purpura/petechiae, shock, hypotension, DIC< acidosis, adrneal hemorrhage, renal failure, heart failure, coma
tests?
Tx? |
|
Definition
meningicoccemia
tests:
- definitive: culture of meningicoci from blood, csf, or skin
CBC w/ diff
PT/PTT
LP
Skin bx with gram stain
Urinalysis
tx: cefotaxime or ceftriaxone in peds |
|
|
Term
Solid foods
1. can start to introduce at __-__ mos
2. cues that baby is ready?
3. technique? |
|
Definition
4-6 mos
cues: good head control, loss of extrusion reflex, sitting upright, chewing motions, double birth weight, baby shows curiosity in what a parent is eating
technique: start with pureed solid food, introduce one food at a time, wait at least 3 days after each new food |
|
|
Term
MR:
1. diagnostic criteria
2. severities and adult mental age
3. risks
4. assocaiated defects?
5. dx? |
|
Definition
1. IQ <70 + concurrent deficit in adaptive fxn in at least 2 areas (communication, self care, home living, social skills, use of community resources, self direction, academics, work, leisure, health, safety), age of onset <18 y/o
2. mild: <70 - 9-11 y/o
mod: (35-40)-(50-55) - 6-8 y/o
Severe: (20-25)-(35-40) - 3-5 y/o
Profound: <20-25 - <3 y/o
3. risks: prematurity, maternal substance abuse, perinatal insult
4. CP and autism
5. dx:
< 3 y/o: bayley scales of infant development
>3 y/o: wechsler scale
|
|
|
Term
Childhood d/o of the hip:
1. test that assesses the potential for dislocation in a non-displaced hip
2. test that attempts to reduced a dislocated hip
3. tends to be ligamentum teres, facia lata, or psoas tendon
4. dislocaiton
5 PE findings?
6. ___: place both hips at 90 deg flexion and knees will be uneven height
7. ___: examiner places 3rd finger over greater trochanter and index finger over asis. normal if line points to umbilicus
8. tests?
9. tx?
10. complications |
|
Definition
1. barlow
2. ortolani
3. hip click
4. hip clunk
5. PE: limited abduction (most reliable sign), shortened thigh, proximal greater trochanter, asymmetry of thigh folds
6. galeazzi sign
7. klisic test
8. US for kids < 6 mo
XR for > 6 mos - look at hilgenreiner, perkins, and shenton lines
9. Tx: < 6 mo: pavlik harness for 6 weeks - resolves 95%
6 mo-2 yr: closed reduction w/ casting for 12 weeks then abduction devise for 2 mos
> 2 years: open reduction
most important complications: AVD in 5-15% |
|
|
Term
most commonly occurs in obese males. almost always occurs in adolescence.
stable if child is able to bear weight
s/s: pain in hip or referred to thigh or knee, limp, limited internal rotation, decreased abduction, greater external rotation, abductor lurch
XRay: lateral shows displacement of femoral head
tx? |
|
Definition
slipped capital femoral epiphysis - displacement of proximal femoral epiphysis due to disruption of the growth plate. head of femur is displaced medially and posteriorly to the femoral neck
tx: non weight bearing on crutches
refer to ortho for internal fixation |
|
|
Term
1. knock knees. common in ~8 y/o
2. bow-legged. common in toddlers
3. increased internal or external rotation of tibia. can cause gait abnormalities and genum varum. ___ rotation fixes itself normally after toddlerhood. ___ rotation is unlikely to resolve spontaneously. |
|
Definition
1. genu valgum
2. genu varum
3. tibial torsion - internal resolves, external doesn't |
|
|
Term
Presentation: 4-8 y/o with persistent pain, lim, and limitation of movement
labs: normal
Imaging of hip: effusion with widening joint space and periarticular swelling, may have decreased bone density around joint or widening of femoral head (Coxa plana)
tx? |
|
Definition
AVN of femoral head or Legg-Calve-Perthe Disease
tx: replaement of femoral head |
|
|
Term
|
Definition
adducted great toe (searching toe)
internal tibial torsion
internal femoral torsion (femoral antetorsion)
improves with time, reassure parent
no need for imaging
|
|
|
Term
|
Definition
external rotaiton contracture
external tibial torsion
femoral retroversion
slipped capital femoral epiphysis
pes planus
tx: may improve with time, may need osteotomy |
|
|
Term
causes of toe walking
s/s?
tx?
when to refer |
|
Definition
shortened achilles
idiopathic
s/s; forefoot skin thick, heel skin thin, forefoot discomfort
toddlers: observe
young kids: stretch
tight contracture/older kids: serial casting/braces
older kids: surgery
refer if not resolved by age 2-3 or if unilateral |
|
|
Term
3 features:
- plantar felxion of foot at ankle
- inversion deformity of heel
- medial deviation of forefoot
3 major categories: idiopathic, neurogenic, Larsen syndrome
often associated wtih spina bifida and arthrogryposis
tx? |
|
Definition
talipes equinovarus (clubfoot)
Tx: ponseti technique - manipulation of foot to stretch the contracted tissues on medial and posterior aspects followed by splinting to hold the correction. if don quickly after birth, correction is rapid. rigidity of foot in a matter of days. |
|
|
Term
most common ricketssial infection in the US
cause: rickettsia rickettsii - dog and wood ticks
TRIAD: ha, fever, rash
- prodrome: malaise, ha, n/v, photophobia
- rash after 2-4 days: erythematous macules and papules - start on palms and soles the spread throughout body. may evolve into purpura
tx? |
|
Definition
rocky mountain spotted fever
tx: doxy until pt is afebrile (7-10 days) + support |
|
|
Term
Cause: borrelia burgdorferi
s/s:
- early: 7-14 d after tick bite - erythema migrans: erythematous macule/papule with a round erythematous patch and central clearing. fever, maliase, HA, mild, meningismus, myalgia, lymphadenopathy
- early disseminated: 3-5 weeks after bite - may have multiple migratory lesions. intermittent myalgia/arthralgia, HA, fatigue, conjunctivitis
- late disease: weeks to months after bite - large joint arthritis, encephalopathy, encephalomyelitis, peripheral neuropathy. skin: lymphocytoma cutis, acrodermatitis, chronica atrophicans
DX via?
Tx? |
|
Definition
lyme disease
dx: ELISA
tx: Doxy for 14-21 days
|
|
|
Term
Cause: HHV 6
90% of newborns are seropositive, 80% are infected by 2 years
peak acquisition: 6-15 mos
occurs at all times during the year
spread through saliva
Prodrome: mild URI, possibly enlarged lymph nodes
CLinical illness: high fever (101-106), irritability, anorexia for 3-5 days
- seizures in 5-10%
- Asains have nagayama spots (ulccers at uvulopalatoglossal jxn)
rash within 12-24 hrs after fever resolution
- rose colored 2-5 mm lesions. begins on trunk then spreads to neck, face, proximal extremities. usually not pruritics, no vesicles oor pustules. fades in 1-3 days
tx? |
|
Definition
|
|
Term
Cause: rubavirus
incubation: 14-21 days
sx:
- prodrome: mild URI, low grade fever, sore throat, red eyes, HA, malaise, lymphadenopathy
- Rash: pink-light red. starts on face then spreads. +/- itch. lasts 3 days
- forcheimer spots/petechial hemorrhages on soft palate
Labs: leukopenia, neutropenia, thrombocytopenia
Complications?
tx? |
|
Definition
rubella (german measles)
complications:
- worst is congenital rubella sydnrome - cataracts (salt and pepper retinopathy)+ congenital heart disease + hearing loss + microcephaly
- thrombocytopenia
- post-infectious encephalitis
- porogressive rubella panencephalitisL
tx: antipyretics/analgesics
|
|
|
Term
Cause: RNA virus transmitted through resp tract or conjunctivae
transmission: droplets
sx: prodrome - 3 C's: coryza, cough, conjunctivitis
- exanthem: Koplik's spots (white/blue-grey specks on erythematous base on buccal mucosa. begin 2-3 days after prodrome at 1-4 days before rash
- rash: erythematous maculopapular rash begins at scalp and behind ears and moves down
dx
complications
tx? |
|
Definition
rubeola "measles"
dx: clinical in time of outbreak.
- isolated cases: IgM
complications: penumonia, often giant cell (most common cause of death), croup, tracheitis, bronchiolitis, AOM (most common), sinusitis, mastoiditis, encephalitis, myocarditis,
- subacute sclerosing panencephalitis: 7-13 years after infection. first subtle changes, then massive myoclonus. almost always results in death
tx: supportive |
|
|
Term
Cause: parvovirus B-19
benign, self-limiting virus of childhood
incubation: 4-28 days
Prodrome: mild low grade fever, HA, URI
3 stages:
- erythematous facial flush - "slapped cheek"
- rash spreads to trunk and extremities as a diffuse macular erythema
- central clearing of macules gives "lacy appearance"
- more prominent on extensor surfaces, not soles or palms, mild pruritis, resolves spontaneously w/o desquamation
- more prominent when kids is hot or exercising |
|
Definition
| erythema infectiosum "fifth disease" |
|
|
Term
Diarrhea:
1. incubation: 1-8 hrs
vomiting 3-4+
abd pain 1-2 +
fever 0-1 +
diarrhea 3-4 + watery
2. incubation: 8-72 hrs
vomiting 2-4+
abd pain 1-2+
fever 0-1+
diarrhea 3-4+, watery
3. incubation: 1-8 days
vomiting: 0-1+
abd pain: 1-3+
fever: 0-2+
diarrhea 1-2+, watery
4. incubation: 1-3 d
vomiting: 0-1+
abd pain: 3-4+
fever: 1=2 +
diarrhea: 1-3 + watery or bloody |
|
Definition
1. s. aureus, clostridium perfringens
2. vibrio cholera, e. coli, klebsiella, aeromonas
3. e. coli, giardia, crypto, helminthes
4. c. diff |
|
|
Term
Diarrhea:
1. incubation: 12-72 hr
vomiting: 0-1+
abd pain: 3-4+
fever: 1-2+
diarrhea: 1-3+ bloody
2. incubation: 1-3 d
vomiting: 1-3+
abd pain: 2-3+
fever: 3-4+
diarrhea: 1-3+ watery
3. incubation: 12h-11 d
vomiting: 0-3+
abd pain: 2-4+
fever: 3-4+
diarrhea: 1-4+, bloody
4. incubation: 12h-8d
vomiting: 0-1+
abd pain: 3-4+
fever: 3-4+
diarrhea: 1-2+, bloody |
|
Definition
1. hemorrhagic e. coli
2. rotavirus/norwalk virus
3. salmonella, campylobacter, yersinia
4. shigella, e. coli, entamoeba histolytica |
|
|
Term
Diarrhea:
1. commonly happens after uncooked beef, unpasteurized fruit juice, various uncooked veggies, contaminate water. commonly called "traveler's diarrhea"
2. peak age 6 mos to 2 years. ingestions from meat, milk, cheese, ice cream, eggs
3. abrupt onset abd cramp, urgency, tenesmus, chills, fever, malaise, diarrhea for 3-7 days, high fever, blood and mucus
4. highest rate of infection in kids <5 y/o. from contaminated water and shellfish. light grey diarrhea |
|
Definition
1. enterotoxigenic e.coli
2. salmonella
3. shigella (dysentery)
4. cholera |
|
|
Term
Malabsoprtion: diarrhea + ___ = ?
1. + edema
2. + digital clubbing
3. perianal excoriation, abd distention, good appeitite, explosive diarrhea
4. loose bulky stools
5. pasty, yellowish offensive stools |
|
Definition
1. protein losing enteropathy
2. CF
3. carb malabsoprtion
4. celiac
5. exocrine pancreatic insufficiency |
|
|
Term
most common malignancy of childhood
peak age 4 y/o
due to hyperproliferation of stem cells
hallmark: pancytopenia + circulating blasts
s/s: intermittent fever, bruising, pallor, bone pain
petechiae, purpura, hepatosplenomegaly, lymphadenopathy, SVC syndrome
CBC: anemia with neutropenia and thrombocytopeia
Smear: blasts, teardrop RBCs
CXR: mediastinal widening
Bone xray: demineralization, periosteal elevation, growth arrest, vertebral comprsesion
dx via?
tx? |
|
Definition
ALL
dx: bone marow bx - infiltration of leukemic blasts replacing normal marrow
tx:
prednisone + chemo and radioation
possible marrow transplant |
|
|
Term
Hallmark: pancytopenia + >20% blasts
s/s: fatigue, weakness, anorexia, wt loss, easy bleeding/brusing, fever, lymphadenopathy, hepatosplenomeglay, ecchymosis, CN problems
CBC: anemia, thrombocytopenia, neutropenia
Smear: AUER RODS
tx? |
|
Definition
AML
tx: chemo + radiation + stem cell transplant
less responsive than ALL |
|
|
Term
hallmark: philadelphia chromosomes
s/s: bone pain, fever, fatigue, night sweats, pallor, ecchymosis, hepatosplenomegaly
cbc: anemia, thrombocytosis, leukocytosis
smear: predominance of myeloid cells
tx? |
|
Definition
CML
tx: interferon alpha, imatinib |
|
|
Term
MOST COMMON CANCER IN TEENAGERS
BIMODAL AGE DISTRIBUTION: 15-35 and again >50
Pathognomonic feature: REED STERNBERG CELLS
common presentaiton: painless, non-tender, firm, rubbery cervical or supraclavicular lymphadenopathy
- airway obstruction, pleural effusion, hepatocellular dysfunction
- B sx
CXR: mediastinal mass
CBC: anemia, thrombocytopenia
Dx: lymph node bx
tx? |
|
Definition
Hodgkin's Lymphoma
tx: chemo + radiation |
|
|
Term
Non-Hodgkin Lymphoma:
60% of lymphomas in kids
4 types:
1. abdominal or head and neck disease with dissemination to bone marrow and CNS
2. intrathoracic or mediastinal supradiaphragmatic mass with dissemination to bone marrow and CNS
3. abdominal or mediastinal mass with dissemination to bone marrow and CNS
4. cutaneous manifestations with B sx with dissemination to bone marrow and CNS
tx? |
|
Definition
1. burkitt lymphoma
2. lymphoblastic lymphoma
3. DBLCL
4. Anaplastic large cell lymphoma
tx: chemo |
|
|
Term
classic triad: morning HA, vomiting, papilledema
younger kids: macrocephaly, ataxia, hyperreflexia, CN palsies
Older kids: HA, visual sx, seizure, focal neuro ddef, school failure, personality changes, hydrocephalus, double vision, gait changes
tests?
Tx? |
|
Definition
tests: CT/MRI, LP, serum HcG and alpha fetoprotein
tx: dexamethasone, anticonvulsants, surgery , chemo, radiation |
|
|
Term
smooth well demaracted abd mass that rarely crosses midline + hematuria, fever, htn
tx? |
|
Definition
wilms tumor/nephroblastoma
tx: tumor excision and radiation/chemo
|
|
|
Term
| tumor that presents wtih leukocoria (white pupillary reflex) |
|
Definition
|
|
Term
| complications assocation with chemo/radiation in kids |
|
Definition
| growth retardation, cardiac tox, gonadal tox wtih infertility, secondary malignancies |
|
|
Term
Childhood development:
gross motor, fine motor, language, social, and hearing/vision for birth |
|
Definition
gross motor: cannot hold head
fine motor: follow to midline
language: none
social: regards face 1 mo
hearing/vision: startle response, calm with voice or music. 12 in b/w vision
|
|
|
Term
Childhood development:
gross motor, fine motor, language, social, and hearing/vision for 2 mos |
|
Definition
gross motor: head lag drops back
fine motor: follow past midline
language: smile
social: regards parent
hearing vision: changes body movement/facial expression in response to sound
|
|
|
Term
Childhood development:
fine motor, and hearing/vision for 3 mos |
|
Definition
fine motor: follow 180
hearing/vision: turns eyes/head to sound |
|
|
Term
Childhood development:
gross motor, fine motor, language, social for 4 mos |
|
Definition
gross: head up, roll front to back
fine: reach 2 hands
language: laugh
social: look around |
|
|
Term
Childhood development:
gross motor, fine motor, language, social, and hearing/vision for 6 mos |
|
Definition
gross: sitting, lift head
fine: transfer object, raking
language: babble
Social: strangers
hearing/vision: color at 7 mos, turn to listen to talking
|
|
|
Term
Childhood development:
gross motor, fine motor, language, social for 9 mos |
|
Definition
gross: crawl
Fine: immature pincer
Language: wave bye bye
Social: explore, pat-a-cake |
|
|
Term
Childhood development:
gross motor for 10 mos |
|
Definition
|
|
Term
Childhood development:
gross motor, fine motor, language, social for 12 mos |
|
Definition
gross: walking
fine: mature pincer
laungauge: jargoning, 1 step commands with gesture
sociaL: imitates actions, comes when called
|
|
|
Term
Childhood development:
gross motor, fine motor, language, social for 15 mos |
|
Definition
gross: walk backward
fine: uses spoon, cup, 2 block tower, scribble
language: 1 step commands
social: independent
|
|
|
Term
Childhood development:
gross motor, language, social for 18 mos |
|
Definition
gross: running
language: 5 body parts
social: copies parents |
|
|
Term
Childhood development:
gross motor, fine motor, language, social for 2 yr |
|
Definition
gross: jumping, climbing stairs
fine: 6 block tower
language: 2 word sentences, 50% intelligible, 50 word vocab
social: parallel play |
|
|
Term
Childhood development:
gross motor, fine motor, language, social for 3 yr |
|
Definition
gross: ride tricycle, alternate feet up stairs
fine: draw circle, clothes off
language: 3 word sentences, 75% intelligible, 250 word vocab
social: group play, sharing, taking turns, imagination |
|
|
Term
Childhood development:
gross motor, fine motor, language, social for 4 y/o |
|
Definition
gross: hop on 1 ft, alternate feet walking down stairs
fine: draw square and cross, clothes on, catches ball
language: 4 colors, 100%$ intelligible, remember song/poem
social: gender play, compeitition, imgaingation, night terrors |
|
|
Term
Childhood development:
gross motor, fine motor, language for 5 y/o |
|
Definition
gross: jump over obstacles
fine: draw triangle, tie shoes
language: print first name |
|
|
Term
Newborn heart exam findings:
1. precordial bulge to left of sternum
2. substernal thrust
3. apical heave
4. hyperdynamic precordium
5. estimate heart size?
6. right apical impulse
7. thrill at RLSB
8. apical thrill |
|
Definition
1. enlarged heart
2. RVH
3. apical heave - LVH
4. hyperdynamic precordium - L-R shunt volume overload
5. distance btwn apical impulse and midclavicular line
6. right apical impulse - dextrocardia
7. thrill at RLSB - VSD
8. apical thrill - mitral insufficiency |
|
|
Term
Failure to thrive
Def?
2 types?
presentaion |
|
Definition
def: <3-5th percentile or change in growth that's crossed 2 gorwth percentiles in a short period of time
types: organic (associated medical condition), inorganic (psychosocial)
presentaiton: ranges from failure to meet expected normal to alopeica, loss of subcu fat, decreased muscle mass, dermatitis, recurrent infection, malnutrtion, flattened occiput, delay in milestones, abscence of cuddling |
|
|
Term
SExual maturation:
1. what causes changes?
2. first sign of puberty in boys.. age?
3. girls?
4. when do periods start?
5. peak growth velocity at which stage? |
|
Definition
1. increased levels of hormones released during sleep: LH, FSH, GnRH
2. boys: testicular enlargment - 9.5 yrs
3. girls: breast buds: 8 -12 yrs
4. periods start 2-2.5 years after breasts (SMR 3-4). 95% reach menarche by 10.5-14.5
5. SMR 3-4 |
|
|
Term
Which tanner stage?
Girls:
hair: Sparse, lightly pigmented, straight, medial border of labia
breasts: Sparse, lightly pigmented, straight, medial border of labia
boys:
hair; Scanty, long, slight pigment
penis: minimal change
testes: Enlarged, pink, altered texture |
|
Definition
|
|
Term
Which tanner stage?
girls:
hair: Adult triangle, spread to medial thighs
breasts: Nipple projects, areola part of normal breast contour
boys:
Adult, spread to medial thighs |
|
Definition
|
|
Term
Which tanner stage?
girls:
Coarse, curly, abundant
Areola and papilla form second mound
boys:
Resembles adult but less
penis larger
testes larger with darker scrotum |
|
Definition
|
|
Term
which tanner stage
girls;
Darker, beginning to curl, more
Breast and areola larger, no change in contour
boys:
Darker starts curling, small amt
penis longer
testes larger |
|
Definition
|
|
Term
seizure defs:
1. EEG shows activation of neurons limited to one cerebral hemishpere. ex: foreceful turning of eyes and head to one side, unilateral clonic movmeents, sensory disturbance located to one area
2. EEG shows synchronous involvement of both hemispheres
3. seizures involving increased tone or rigidity
4. seizures with flaccidity or lack of movment
5. rhythmic muscle contraction and relaxation
6. shocklike contaction of muscle
7. EEG shows activation of neurons limited to one cerebral hemishpere. consciouness is retained. aura or motor only.
8. EEG shows activation of neurons limited to one cerebral hemishpere. consciousness affected. aura or deja vu, sense of fear, halluncinations, macro/micropsia precedes decreaed responsiveness, staring, automatisms, salivation, pupillary dilation, flushing |
|
Definition
1. focal
2. general
3. tonic
4. atonic
5. clonic
6. myoclonic
7. simple partial
8. complex partial |
|
|
Term
Seizure types:
1. generalized seizures consisting of staring, unresponsiveness, and eye flutter that last for a few seconds
2. occur secdonary to an acute problem affecting brain excitability such as electrolyte imabalance, brain tumor, or meningitis
3. afebrile, no obvious cause
4. thought to be from distant brain injury such as old stroke
5. d/o of the brain characterized by enduring predisposition to generate seziures and by the neurobiologic, cognitive, psychological, and social consequences of this condition |
|
Definition
1. absence
2. acute symptomatic
3. unprovoked
4. remote symptomatic
5. epilepsy |
|
|
Term
| evalation of first seizure |
|
Definition
immediately: ABCs, temperature, BP, glucose
search for life-threatening causes: meningitis (do LP), sepsis, head trauma, drugs
detailed hx
focal or generalized?
did aura precede?
eye exam: papillary edema, retinal hemorrhage
neuro exam |
|
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Term
| components for dx of epilepsy |
|
Definition
occurence of at least 1 unprovoked seizure with either a second such seizure or enough EEG and clinical info to demonstration enduring predisposition
OR
>2 unprovoked seizures in >24 hr period |
|
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Term
|
Definition
first seizure wtih normal EEG, neuro, and MRI: no tx
Common antiepileptics (AEDs): oxcarbazepine, carbamazepine, valproic acid, phenobarb, topiramate, lamitrogine, ACTH
Ethosuximide for absence |
|
|
Term
SIDS
1. __ leading cause of death in US
2. peak age |
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Definition
|
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Term
Newborn derm:
1. white/grey protective covering made of degenerated fetal epidermis and sebaceous secretions. resolves spontaneously.
2. normal red/blue mottling of skin - immature physiologic response to cold
3. sweat retention due to incomplete differentiation of epidermis
4. 1-2 mm white/yellow superficial cysts on face
5. benign self limited acneform eruption in first 30 days
6. bening blotchy erythema wtih central vesiculation
7. bening self limited condition with blotchy erythema and pustules that heal with pigmentaiton |
|
Definition
1. vernix caseosa
2. cutis marmorata
3. miliaria
4. milia
5. acne neonatorum
6. neonatal pustular melanosis |
|
|
Term
|
Definition
| clean, dry, frequent changes, powders, 1% hydrocortisone |
|
|
Term
chronic pruritic inflammation of epidermis and dermis associated with person and fam hx of ashtma and allergies
dry itchy skin --> rash/lichenification --> increased palmar markings, periorbital atopic pletas
tx/ |
|
Definition
atopic dermatitis/eczema
tx: avoid soaps, limit baths |
|
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Term
coxsackie/enterovirus
4-6d incubation, very contagious
prodrome: fever/maliase, cough, diarrhea
rash: vesicles becoming ulcers in mouth, palms, soles, buttocks
tx? |
|
Definition
hand foot and motuh
tx: supportive |
|
|
Term
sx: pruritus, mostly at night
rash: papules, vesciulopustules, burrows (white-grey thread-like lines) between digitis, wrists, ankles, axillae, waist, groin, palms, soles
may create cutaneous nodules
dx?
tx? |
|
Definition
scabies
dx: mineral oil microscopy
tx: 5% permethrin cream |
|
|
Term
Benign, self-limiting papulosquamous disease
Rash:
Herald Patch first: round, erythematous patch with scaling border and central clearing
W/in 2 weeks: Christmas tree lesion. Generalized pruritis with eruption of small erythematous papules and plaques with central scale. |
|
Definition
pityriasis rosea
tx: supportie, UV light |
|
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Term
cause: exfoliative toxin by staph aureus
most common kids <5 y/o
sx: generalized erythema, tender skin, irritability, fever
flaccid bullae, esp in intertriginous areas
nikolsky sign: lteral pressure on skin causes bullae to erode or enlarge
crusting fissures around mouth with "sunburst" appearance
tx? |
|
Definition
staphylococcal scalded skin syndrome
tx: abx against staph/mrsa |
|
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Term
a. Cause: toxins produced by staph and strep, usually from supporative sites – packing abd abscess, tampons
b. Dx: definite if all 6 criteria, probable if 5
Fever
Diffuse erythema
Desquamation 1-2 weeks after onset, esp on palms and soles
Hypotension
Involvement of 3 or more systems:
1. GI (N/V/D)
2. MSK: myalgia, increased CK
3. Mucus membrane hyperemia
4. Renal: pyruia, BUN or Cr >2x normal
5. Liver: increased bili, AST, ALT
6. Heme: Plt <100K
7. CNS: disorientation, AMS, focal neuro deficit
Neg blood, throat, and CNS cultures and Neg RMSF, leptospirosis, and measles
----------------------------------------------------
Sx: Erythema, conjunctival injection, necrolysis, pustules, desquamation |
|
Definition
toxic shock syndrome
tx: supportie, drainage of pus, MRSA abx (vanc) |
|
|
Term
fever, sore thraot, fatigue
rash: dew drop on a rose petal. lesions in various stages of healing
no longer contagious when lesions have crusted |
|
Definition
varicella
tx: supportive - never give aspirin (Reye) |
|
|
Term
superficial mycotic infx in moist cutaneous sites
erythema, edema, with papular and pustular leisons, erosions, satellite lesions
dx?
tx? |
|
Definition
candida
dx: KOH prep
tx: nystatin |
|
|
Term
Rash in area of skin with sebaceous glands - most commonly face, scalp, diaper
tx? |
|
Definition
seb derm
tx:
scalp: mineral oil and comb
ketoconazole cream or shampoo |
|
|
Term
ddx vomiting in newborn:
1. tends to present at about 4 weeks
2. vomiting every meal, risk for aspiration
3. double bubble sign on xray - gastric bubble + dupdenal bubble
4. due to infarct in mesentery vessel so portion of intestine necroses
5. at birth - due to CF
2 others? |
|
Definition
1. pyloric stensosi
2. TE fistula
3. duodenal atresia
4. intestinal atresia
5. meconium plug
neonatal withdrawl if mom was on drugs
milk protein allergy --> not lactose intolerance |
|
|
Term
mild, self-limited virus that can persist in body for life and can reactivate w/o sx. plays a role in some cancers -lymphoma and nasopharyngeal
incubation: 4-6 wks
s/s: sore throat, fever, lymphadenopathy, loss of apetite, fatigue, chills, HA, bloating, sweats, splenomegaly
complications: ruptured spleen, enceohalitis, meningitis
tests?
tx? |
|
Definition
Mono/epstein barr
tets: monospot (can be neg in kids <4)
CBC: atypical lymphocytosis, anemia, thrombocytopenia
LFTs: mildly elevated
tx: supportive |
|
|
Term
most common genital problem of newborn boys
3% full term
33% preterm
<1% by 9 mos |
|
Definition
|
|
Term
types of cryptorchidism
1. no testicle formed
2. distal to inguinal ring by not in scrutm. can be in perneum or shaft of penis
3. can be in inguinal canal or higher in abd. must be fixed at early age due to increased risk of cacner and infertility
4. due to hyperactive cremasteric reflex
tx? |
|
Definition
1. testicular agenesis
2. ectopic testis
3. undescended testis
4. retractile testis
tx: orchipexy before puberty |
|
|
Term
Tourettes:
1. typically presents <__ y/o
2. sx peak at __-__ y/o
3. sx?
4. dx
5. tx |
|
Definition
1. 7
2. peaks 10-12
3. barking, grunting, shounting obscene words (corprolalia), behavioral/emotional/academic probs, OCD, ADHD, ODD
4. dx: multiple motor tics lasting >1 yr wiht no tic-free interval >3 mos, onset <18 y/o, no medical cause
5. tx: neuroleptics (haloperidol, pimozide, dopaminergic antagonists), risperidone, clonidine, tenex |
|
|
Term
pain over tibial tubercle in growing kids. occurs most in athletes
cause: likely repetitive tensile trauma
PE: point tender over tibial tubercle, increased prominence of tubercle, firm
xr: fragmentory ossificiation |
|
Definition
|
|
Term
rapid RBC turnover. lifespan <120 days, body's EPO production not enough to compensate
sx: jaundice, urine disocloration, splenomegaly, hepatomeglay, skeletal changes
Labs; high LDS and bili |
|
Definition
|
|
Term
types of hemolytic anemia:
1. hallmark: microspherocytosis in blood. due to spectrin def. s/s: neonatal hyperbilirubinemia, splenomegaly, jaundice, pallor, fatigue, malaise. tx?
2. smear: eliptocytes. often no sx to severe anemia. tx |
|
Definition
1. hereditary spherocytosis. tx: folic acid, transfusions, splenectomy
2. hereditary elliptocytosis. tx: folate/splenectomy
3. |
|
|
Term
hemolytic anemia caused by reduced synthesis of globin chains
microcytic anemia
trait: lab features w/o clinical sx
intermedia: clinical impact
major: life-threatening
alpha: disease if only one of 4 alpha globin genes is present. trait if 2/4 present. carrier if 3/4 present. stillborn if 0/4.
beta: affected kids normal at birth then have severe anemia at 6 mos when fetal hgb is replaced and require transfusions throughuot life
sx: growth failure, hepatosplenomegaly, bony deformity, jaundice, body unable to remove iron from transfusions → heart failure, cirrhosis, endocrinopathies → early death
S/S of intermedia: hepatosplenomegaly, bony deformities, no transfusion needed. Survive into adult life |
|
Definition
|
|
Term
autosomal recessive d/o caused by mutated unstable Hgb S which changes shape under stressors
onset during first year of life when fetal hgb is replaced.
s/s: jaundice, gallstones, splenomeglay, poorly healing ulcers, multiple infarcts --> necrosis, delayed puberty, HA
tx? |
|
Definition
|
|
Term
x-linked recessive d/o seen in african american men
episodic hemolysis in response to oxidant drugs or infx
minmially abnormal peripheral smear
oxidized hgb denatures into HEINZ BODIES which damage cell membranes and are hemolyzed in spleen
episodes stimulated by certain drugs |
|
Definition
|
|
Term
most common ped poinsoning - can result in hepatotoxicity
tx? |
|
Definition
acetaminophen poisoning
tx: administer acetylcysteine orally or IV w/in 8 hours
obtain blood levels 4 hours after OD on pills or 2 hours after liquid |
|
|
Term
used to monitor development of kids from birth to 6 years and compare to norm
4 general fxns: personal/social, fine motor/adaptive, language, gross motor |
|
Definition
|
|
Term
small vessel vasculitis where IgA immune complexes are deposited in the vessels of the skin
sx: palpable purpura on feet, legs, arms, and across buttock
fever, polyarthralgiaperiarticular tenderness, swelling of ankles, hips, knees, elbows, wrists, colicky abd pain, abd tenderness, melena, intussusception, chronic renal failure
dx: bx skin lesion and find leukocytoclastic vasculitis w/ IgA
tx? |
|
Definition
henoch-Schoenlein purpura
tx: corticosteroids |
|
|
Term
| DDX MR in newborn/toddler |
|
Definition
poverty/deprivation
hearing loss, brain trauma, blindness
chromosomal abn
fragile x
structural CNS abn
metabolic/endocrine d/o |
|
|
Term
FAS:
criteria for dx?
sx/
tx |
|
Definition
dx: requires all 3 elements, best made 8 mos-8 yrs:
craniofacial dysmorphology: smooth philtrum, thin upper lip, small palpebral fissures
growth retardation: weight/height <10th percentile
CNS defects/MR
sx: ADHD, low IQ, dont make normal connections w/ people, can't deal with time, can't manage money, poor judgment
tx: structure, rx for ADHD/mood d/o |
|
|
Term
most common cause of inherited MR
s/s: men worse than women. shyness, social aniety, learning problems, MR, autistic features, tantrums, hyperarousal
tx? |
|
Definition
fragile X
tx: speech/language therapy, OT, behavioral psych, genetic counseling
treat adhd and anxiety |
|
|
Term
Down's:
1. # chromosomes?
2. sx?
3. physical characteristics
4. associated health probs
5. dx |
|
Definition
1. 47 chroms
2. hyptonia and cognitive disability, aging process acceleration
3. physical: small head, flattened occiput, up-slanting eyes, epicanthal folds, brushfield spot, midface hypoplasia, small/low set ears, small mouth with protruding tongue, simian line on palm, short, obese
4. congenital heart defects, leukemia (12-20x more common), Gi atresia, hirschprungs, conductie hearing loss, resp/ear infx, OSA, cataracts, severe refractive d/o, hypothyroid, DM, early alzheimers, celiac, atlanto-occipital instability
5. dx: amniocentesis w/ karyotype
|
|
|
Term
Autism:
1. manifests when?
2. etiology?
3. sx
4. dx |
|
Definition
1. 1st year - almost always by age 3
2. etiology: unknown
3. s/s: atypical interactions: lack of attachment, inability to cuddle, inability to form reciprocal relationships, avoidance of gaze
insistence on sameness: resistance to change, rituals, intense attachemnt to familiar objects, reptitive acts
speech/language: total muteness to delayed onset of speech to markedly idiosyncratic language
uneven intellect
4. dx: gold standard is autism diagnostic observation schedule given by psychologist
5. tx: behavior therapy, speech and language therapy, OT/PT, drugs (SSRI, antipsychotics, mood stabilizers) |
|
|
Term
Neural tube defects:
1. account for largest # of congenital anomalies of Cns and results from failure of neural tube to close btwn __-__ weeks of development
2. contributing facotrs |
|
Definition
1. 3-4th weeks
2. hyperthermia, drugs (valproic acid), malnutrition, chemicals, maternal obesity/dm, genetic determinants, inadequate folate
3. major defects: spina bifida, meningocele, myelomeningocele, encephalocelen, anencephaly, candual regression syndrome, dermal sinus, tethered cord, syringomyelia |
|
|
Term
synovitis of peripheral joints w/ soft tissue swelling and effusion
3 types:
a. Oligoarthritis/periarticular disease: joints of LE (knees, ankles), single joint involved at onset
b. Polyarthritis: large and small joints of upper and lower extremities, similar to adult RA >5 joints for dx
c. Systemic disease onset: arthritis with visceral involvement such as hepatomegaly, serositis (pericardial effusion), fever with salmon colored rash, Koebbner phenomenon
cause: immunogenetic susceptibility + environmental tirgger (virus)
s/s: morning stiffness, easy fatigue, joint pain later in the day, joint swelling, affected joints are warm have decreased Rom and are NOT red
dx criteria: age < 16, arthritis >/+ 1 joint, duration >/= 6 weks, exclusion of other dx
tests?
tx? |
|
Definition
juvenile RA
tests: ESR, CRP, CBC, ANA, RF
tx: NSAIDS, MTX, etanercept, infliximab, Pt/OT, eye exams to check for uveitis |
|
|
Term
1. Most common organisms: staph and strep
2. Non-bullous: more common
a. First: Papulovesicular lesion surrounded by a localized area of erythema
b. Then: vesicles become purulent and covered with a thick, confluent, amber-colored crust with “stuck on” appearance
c. Mild, chronic illness
d. Lymphadenitis is common
3. Bullous: most common in neonates and young infants
a. Flaccid, transparent bullae usually less than 3 cm
b. Usual distribution – face, buttocks, trunk, perineum |
|
Definition
|
|
Term
1. relatively rare acute GAS infection involving the deeper skin and connective tissue.
2. Sx: swollen, red, tender, with superficial blebs. Sharply defined and slightly elevated. Sx of systemic infection (fever) |
|
Definition
|
|
Term
1. caused by poxvirus. Most commonly affects school-aged kids and immunosuppressed adults.
2. Sx: discrete, pearly, skin-colored, smooth, dome-shaped papules varying in size from 1-5 mm with central umbilication from which a plug of cheesy material may be expressed
a. Can be found anywhere on the body.
b. If found on the genitals in clusters, is usually associated with STD
c. May become inflamed and may be surrounded by an area of erythema or crusted.
3. Tx: self-limited. Lasts 6-9 mos
a. May treat with curettage |
|
Definition
|
|
Term
1. Definition: chronic static impairment of muscle tone, strength, coordination, or movements. Non-progressive from cerebral injury at birth.
2. Forms:
a. Limb spasticity: most common
b. Ataxia of fine coordinated movements of UE and/or LE: 2nd mos common
c. Choreoathetosis: 3rd most common
d. Hypotonia without spasticity: 4th most common
3. Causes:
a. Intrauterine: hypoxia, bleeding, infection, toxins, congenital malformation, complications, genetics
b. Neonatal: infection, kernicterus, metabolic disorder
4. Associated sx: seizure (50%), mild MR (26%), severe MR (27%)
5. PE:
a. Spasticity, hyperreflexia, involuntary movements, microcephaly, cataracts, congenital heart defect
6. Tests:
a. MRI of brain
b. Genetic studies
7. Tx: PT/OT, speech therapy, ortho monitoring, special ed, botox and meds to control spasticity and seizures
8. Prognosis: death from aspiration, pneumonia, infection |
|
Definition
|
|
Term
seizure occur btwn 6-60 mos wtih temps 38C or above.
- simple: no increased risk of morbidity/mortality
- workup: LP to r/o meningitis, No need for EEG if first one
- tx? |
|
Definition
febrile seizure
tx: diazepam for future seizures >5 min. reassruance and support.
**antipyretics do NOT reduce risk of febrile seizures** |
|
|
Term
| If coarctation of aorta is present in a female, think ___ |
|
Definition
|
|
Term
Mono classic triad and rash
complications? |
|
Definition
fatigue, pharyngitis, lymphadenopathy
rash: giannoti-crosti syndrome - symmetrical papular rash on cheeks, extremities and buttocks
complications: splenic rupture, lymphoid malignancy, alice in wonderland sydnrome |
|
|
Term
| why can't pregnant moms or babies <6 mo have ibuprofen? |
|
Definition
mom: closes ductus arteriosus before baby is born
baby: can cause organ ischemia
|
|
|
Term
| how is a baby with a cyanotic heart lesion oxygenated until they can have surgery? |
|
Definition
| ECMO - extracorporeal membranous oxygenation |
|
|
Term
|
Definition
| lethargy, irritability, hypotonia, opsithonos (rigid arched back, head back), seizures, MR, CP, hearing loss |
|
|
Term
Cause of neural tube defects?
How to test for it? |
|
Definition
cause: failure of endoderm to induce ectoderm to form neural plate in 3rd week (27th day of pregnancy - before most women know they're pregnant)
test: alpha fetoprotein - when ectoderm doesn't close, it causes alpha fetoprotein to leak out and therefore it can be detected by amniocentesis |
|
|
Term
midline defect of vertebral bodies w/o protrusion of spinal cord or meninges
sx: usually none.
sometimes patch of hair, lipoma, skin discoloration, dermal sinus - suggests more serious d/o
imaging: roentgenogram - defect in closure of posterior arches and laminae, typically at L5/S1 but no abnormality of meninges, spinal cord, or nerve roots
- MRI to look for associated spinal cord defect
Complications? |
|
Definition
spina bifida occulta
complications: recurrent meningitis due to dermal sinus |
|
|
Term
Meninges herniate through defect in posterior vertebral arches
sx: fluctuant midline mass that may transilluminate
- usually covered by skin and poses no threat
roetgenogram, US, and MRI to determine extent of neural tissue involvement
Cystmetrogram (CMG) - to check for neurogenic bladder
Ct of head - check for associated hydrocephalus
tx? |
|
Definition
meningocele
tx: surgical correction |
|
|
Term
Most severe form of dysraphism (neural tube defect)
incidence: 1/4000
preventions:
- USPHS: all women of childbearing age take 0.4 mg of folic acid daily
- high risk women: 4 mg daily beginning 1 mo before conception
- US and Canada mandate 0.15 mg folic acid per 100 g of flour, rice, pasta, and cornmeal
sx: due to disruption of conus medullaris
- dysfunction of many organ systems
- can be located anywhere along neuraxis, but 75% in lumbosacral region
- flaccid paralysis of LE, absent DTR, lack of sensation, increased incidence of LE defomriteis, urinary dribbling, relaxed anal sphincter, increased bladder pressure/anal sphincter tone
- Hydrocephalus or Type II Chiari malformation in 80% - bulging fontanelle, dilated scalp veins, setting-sun eyes, irritability, vomiting, increased head circumference - hind brain dysfunciton (choking, stridor, apnea, vocal cord paralysis, stastic UE
tx? |
|
Definition
myelomeningocele
tx: surgery w/in 2 days of birth
- shunting to relieve hydrocephalus
|
|
|
Term
Types of enceohaloceles:
1. dysraphism in the skull causing protrusion of tissue through bony defect
2. CSF-filled meningeal sac
3. sac + cerebral cortex, cerebellum, or brainstem
4. autosomal recesssive, occipital encephalocele, cleft palate/lip, microcephaly, microphthalmia, abn genitalia, polycystic kidney, polydactyly |
|
Definition
1. cranium bifidum
2. cranial meningocele
3. cranial encephalocele
4. meckel-gruber syndrome
|
|
|
Term
presentaiton: larg defect in calvarium, meninges and scalp associated wtih a rudimentary brain, folding of ear, celft palate, CHD
prognosis: most die w/in days of birth |
|
Definition
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