2-6 years old, sudden fever, refuses to eat, mouth hurts, muffled voice, drooling, insists on sitting up
Epiglottitis
Most common cause of pneumonia a in kids aged 1 month- 5 years
RSV
Most common cause of lower respiratory tract in children younger than one year
RSV
full term baby, tachypnea, nasal flaring, grunting, cyanosis on room air, intercostal muscle contraction
Transient tachypnea of the newborn: inadequate clearing of fetal lung fluid
Drugs used to treat TB?
ethambutol, isonazid, pyrazinamide, rifampin
Peaks in winter and early spring, recent URI, fever, cough and chest pain
Bronchitis, treatment is supportive
cold, fever, tough, no appetite, chest hurts, intercostal retractions, grunting, crackles
bacterial pneumonia
Most common cause of bacterial pneumonia in neonate?
e. coli, group B strep, M or C pneumonia, klebsiella
Most common cause of viral pneumonia in neonate?
Herpes or RSV
Most common cause of bacterial pneumonia in 1 month - 5 year old?
strep pneumoniae, H influenza, staph aureus
Most common cause of viral pneumonia in 1 month - 5 year old?
RSV!!!
Most common cause of community acquired pneumonia in school aged teens?
chlamydia and mycoplasma
Most common cause of bacteria pneumonia in school aged teens?
strep pneumoniae
Most common cause of viral pneumonia in school aged teens?
rhinovirus, influenza, adenovirus
forced expiration against party closed glottis?
Grunts
inspiratory sound of partly obstructed extra-thoracic airway
stridor
partial obstruction of the lower airway heard on exhalation
wheeze
fluid or secretion int he alveolar spaces that may clear with a cough
rhonchi
most common risk factor for children with OSA
adenotonsillar hypertrophy
cough that sounds like a seal?
croup
steeple sign on x-ray
croup
meconium staining
clue that baby was in respiratory distress before birth
red, dry, cracked lips, strawberry tongue, swollen red skin on palms and soles, peeling skin
Kawasaki Syndrome
this heart sound is normally split with inspiration and single on expiration in children
S2
left to right shunt
Acyanotic heart defects
rough machinery murmur best heard at 2nd intercostal space of LSB, inferior to left clavicle, Decrescendo, often diastolic murmur at apex
patent ductus arteriousus
most common congenital heart defect
VSD: ventricular septal defect (second is the ASD)
systolic ejection click with wide S2 split, rough systolic murmur
pulmonary valve stenosis
systolic ejection murmur at aortic area along LLSB, heard best in left axilla and in left back
coarctation of the aorta
systolic crescendo-decrescendo
aortic stenosis
most common cause of HTN in children?
obesity, body size
better heard sitting, disappears in supine position and when child turns neck
venous hum, best heard in neck and upper chest
noisy, rough and dissonant, systolic murmur heard at 2nd intercostal space of LSB, S2 split in heard and varies with respiration, murmur is loudest supine and increases with exhale
pulmonary flow murmur (similar to ASD, if the S2 split is wide and fixed then think ASD)
systolic ejection low pitched murmur heard best at the LUSB, murmur transmitted to both infra-clavicular regions, axilla, and back
peripheral pulmonary arterial stenosis murmur
heard best at apex and transmits to LLSB, medium pitched and musical, loudest when child is supine, may decrease when sitting up but does not go away entirely
Stills (vibratory) murmur
systolic murmur heard best in neck above the clavicles, radiates to neck and upper chest. Present both supine and sitting but disappears/diminishes with hyperextension of shoulders
supraclavicular systolic murmur or carotid bruit
friction rub w/ chest pain, leaning forward makes it feel better
acute pericarditis
most common cause of sudden death in young athletes
hypertrophic cardiomyopathy
murmur heard with hypertrophic cardiomyopathy?
systolic murmur that gets louder with valsalva, rapid murmur makes it softer
Hypertrophic cardiomyopathy on ECG?
LVH, prominent Q waves, deep T wave inversion
extremely tender scrotal sac, absent cremasteric reflex, one teste higher than the other, scrotum is swollen and discolored
testicular torsion
Afebrile child with appetite decrease, stomach hurts, urine dipstick shows + leukocyte esterase, + nitrates, blood +1 and protein +1 (no casts seen on urine microscope)
UTI
intact foreskin, urinating “all over” the bathroom, physical exam shows urethral meatus in an abnormal location
hypospadias
unable to palpate testicles in male toddler, perhaps undecended
cryptorchidism
what is veisocoureteral reflux?
abnormal flow of urine from the bladder back up the ureters, increasing the risk of UTI which can cause ESRD if left untreated
Quick description of renal tubular acidosis
hyperchloremic, non-anion gap, metabolic acidosis
diabetes insipidus
inability of kidneys to concentrate urine d/t inappropriate ADH
What is Bartter Syndrome?
defect in furosemide sesitive Na-K-2Cl transporter leading to polyuria, dehydration, hypokalemic alkalosis
What syndrome is shown as: dehydration, constipation, vomiting, muscle weakness, polydipsia, polyuria, salt craving, urine Ca wasting, FTT, short stature, hyper reninemia, and no HTN, and diagnosed with polyhydramnios at birth
Bartter’s Syndrome
What is Gitelman Syndrome?
similar to Bartter’s but more mild, defect in thiazide sensitive NaCl transporter, high renin, no HTN, hypokalemic metabolic acidosis, low Mg levels
What is Liddle Sydrome?
HTN, metabolic alkalosis, hypokalemia, primary increase in collecting duct Na reabsorption and K secretion
Hyper-Aldosternism?
hypokalemia and alkalosis + HTN
What is Wilm’s tumor?
Nephroblastoma, the most common form of kidney cancer. Associatd with birth defects such as hypspadias and aniridia (absence of iris in the eye), peaks at age 3
most common cause of post infection glomerulonephritis?
group A beta-hemolytic streptococci
kidney problem in child 1-4 weeks after strep infection with coca-cola urine, abdominal pain and puffy face, red casts in urine
post-strep glomerulonephritis
What is alport syndrome?
thin basement membrane disease/benign familial hematuria disease, x linked inheritance of mutation of collagen
boy with nephritis, nerve deafness, eyes show corneal dystrophy and lens dislocation, urine shows hematuria, proteinuria
Alport Syndrome
What is hemolytic uremic syndrome?
most common cause of short term, acute renal failure in children. usually due to e. coli infection
How would a patient with hemolytic uremic syndrome present?
pale, listless, covered in bruises, edematous arms and lefts, elevated BP, dark urine with minimal output, bloody diarrhea, with proteinuria and hematuria
What is minimal change syndrome?
most frequent cause of nephrotic syndrome in children, relatively benign, characterized by diffuse effacement of foot processes/podocytes in glomerulus
Child presents with albumin in urine and edema, there is no hematuria, she recently had prophylactic immunizations when you treat with corticosteroids she quickly gets better, what did she have?
minimal change nephrotic syndrome (often occurs after immunizations or URI)
“active” urine sediments, red cell casts, leukocytes, presents clinically with hematuria, azotemia (diminished GFR, increased BUN/Cr), mild to moderate proteinuria, HTN, acute onset, oliguria (not enough pee)
nephritic syndrome
Foul smelling greasy stool?
CF
Is single S2 normal in children?
no, could be TGA
rough machinery mumur, best heart at 2nd intercostal space of LSB, inferior to L clavicle, Decrescendo, often diastolic at apex
PDA
pansystolic murmur along LLSB, 4th intercostal space
VSD, if large VSD the murmur may be palpable S2 with accented P2 and may be diastolic at apex and the child will look ill , SOB, FTT, have prominent precordium and bulging sternum
What is the most common heart defect in Turner’s Syndrome?
coarctation of the aorta
What is used to keep patent ductus arteriosus open?
prostoglandins
What is the definitive test for acute pericarditis?
echo