Osmosis cards Flashcards
how does complement deficiency C3 present
leads to severe pyogenic sinus and respiratory infections in child hood.
especially with encapsulated bacteria haemophilus influenza
what is transient tachypnea of the newborn and how does it present
benign condition that occurs in late preterm infants that presents as tachypnea, mildly increased work of breathing and presents with mild cyanosis. CXR shows diffuse perihilar streaking, patchy infiltrates, and sometimes air trapping.
what causes transient tachypnea of the newborn
failure of adequate clearance of fluid from alveoli at birth.
what is the cause of blueberry muffin rash
CMV infections and more specifically this is caused by extra medullary hematopoiesis
yolk sac tumors present how
most frequently occur in young boys and secrete Alpha fetoprotein the histological findings are Schiller-duval bodies
what is tuberous sclerosis
this is a phakomatoses. it is inherited autosomal dominant. ash-leaf spots angiofibromas, and shagreen patches. seizures and giant cell astrocytomas are common.
what is the method for approaching weight loss in children
maintenance of weight with increasing age. As the child grows in height they will thin out
what is strabismus
common disorder among children characterized by misalignment of the eyes. there are no visual deficits initially, but eventually the cortex will block one of the images.
how is strabismus managed
with corrective lenses. needs to be treated immediately. then surgery
what is amblyopia and how it is managed
this is lazy. and is characterized by the eyes not working together and results in decreased vision
This can be caused by strabismus. patching of the eye is the treatment
which eye do you patch in amblyopia
the normal eye. this causes the eye with weak extraoccular muscles to be forced back to normal
what is the most common cause of meningitis in infants
group B strep which is a gram-positive cocci
what is first line therapy for shigella in an adult
fluoroquinolone
what is the first line therapy for shigella for in pediatric patient
azithromycin.
what is amniotic band syndrome
this is when strands of amniotic fluid wrap around parts of the developing fetus. this can cause amputations.
anemia with echinocytes on blood smear
could be pyruvate kinase deficiency which is the second most common type of inherited blood disorders.
what is the most likely complication of varicella zoster infection
superimposed skin infection.
what is the presentation of DiGeorge syndnrome
recurrent respiratory infections, bifid uvula poor muscle tone.
22q11.2 microdeletion
what is the test of choice for Digoerge syndrome
FISH
what is the medical treatment for Wilsons disease
D-penicillamine
what is the pathophysiology of pyloric stenosis
this is hypertrophy of gastric outlet smooth muscle
what is the imaging for annular pancreas
characterized by pancreatic tissue surrounding the descending portion of the duodenum.
what is caudal regression syndrome
this is a spinal dysmorphism with veterebal agenesis caused by diabetes mellitus. it often presents with deformations of the lumbar spine and distention of the intestines
what bacteria is associated with dog bites and can produce a cellulitis and what is the treatment
pasturella multocida
penicillin
if left untreated what can a pasturella infection cause
osteomyelitis
what is the presentation of charcot-marie-tooth disease
autosomal dominant involving demyelination and damage of the peripheral nerves. usually results in diminished strength and proprioceptive/vibratory senses. it most commonly involves the peroneal nerves and may feature pes cavus
is life expectancy lower or higher in Charcot Marie tooth
same
what are the side effects of azithromycin
GI disturbance, QT, rash, prolongation, eosinophilia, rash
what is the presentation of croup
stridor and a barking cough. this is a pediatric infection caused by parainfluenza or influenza.
what is the treatment for croup
corticosteroids
what is the scoring system for croup
the Westley croup severity score <3 mild croup 3-7 moderate 8-11 severe >11 impending respiratory failure
what is on the Westley croup severity scoring system
level of consciousness, cyanosis, stridor, air entry, and retractions
what are the VACTERL anomalies
vertebral, anal atresia, cardiac deficits, tracheoesphageal atresia, renal and radial anomalies, limb defects.
what is the steeple sign and what does it indicate
this is narrowing of the trachea on frontal Xray indicative of croup and tracheal inflammation
what is pediatric localized Lyme disease treated with
oral amoxicillin.
what is the presentation of cystic fibrosis
thick and foul smelling bowel movements, hyperinflated lungs, predisposition to infections. decreased height and weight. defect in chloride channels.
what nutrients are sometimes lacking in breast milk that cause deficiencies
infants are highly subject to vitamin K deficiency
as well as vitamin D
what is the APGAR score a measure of
The one-minute APGAR score helps describe how the baby tolerated labor.
The five-minute APGAR score helps describe how thef baby tolerates life outside the womb, stimulation, and resuscitation.
what is the prophylaxis for gonococcal infection of the eye and what is the treatment in newborns
prophylaxis is erythromycin ointment and treatment is ceftrixone.
when do we screen for lead
1 and 2 years.
when do we screen for developmental milestones
9, 18, 30 months
when do we screen for ASDs
18 and 24 months
what should the mother be screened for during a child visit
maternal depression screening
what is the caloric requirement for the first 1-2 months for term infants
100-120kcal/kg/day
what is the caloric requirement for the first 1-2 months for preterm infants
115-130kcal/kg/day
what is the caloric requirement for the first 1-2 months for very pre\term infants
150kcal/kg/day
what are the early signs of hyperbilirubinemia of the newborn
high-pitched cry, jaundice, hypotonia, seizures, poor suck, lethargy.
what are the late signs of hyperbilirubinemia of the newborn
arched back, extensor flexion,
what is kernicterus
pathological term used to describe staining of the basal ganglia and cranial nerve nuclei by bilirubin. “Kernicterus” also describes the chronic clinical condition that results from the toxic effects of high levels of unconjugated bilirubin. abnormalities in tone and reflexes, choreoathetosis, tremor, oculomotor paralysis, sensorineural hearing loss and cognitive impairment.
what is one cause of hyperbilirubinemia of the newborn
hemolysis from Rh incompatibility.
how often does a newborn void at day 3
3-4 times a day
how often does a newborn void at day 6
6-8 times a day
how many stools does a newborn pass at day 6
meconium should no longer appear by day 3. the stools will be 3-4 times and often occur with feedings
what are the major risk factors for neonatal jaundice
Pre-discharge total serum bilirubin (TSB) or transcutaneous bilirubin (TcB) level in the high-risk zone
Jaundice observed in the first 24 hours of life
Blood group incompatibility, with positive direct antiglobulin test
Gestational age 35–36 weeks
Previous sibling received phototherapy
Cephalohematoma or significant bruising
Exclusive breastfeeding, particularly if nursing is not going well and weight loss is excessive
East Asian
what are the minor risk factors for neonatal jaundice
Pre-discharge TSB or TcB level in the high intermediate-risk zone Gestational age 37–38 weeks Jaundice observed before discharge Previous sibling with jaundice Macrosomic infant of a diabetic mother Maternal age > 25 y Male gender
what decreases the risk of neonatal jaundice
TSB or TcB level in the low-risk zone Gestational age 41 week Exclusive formula feeding Black Discharge from hospital after 72 hours
what are the signs of hunger in a baby
rooting, increased alertness, increased physical activity, mouthing
what is the definition of lethargy
as a level of consciousness characterized by the failure of a child to recognize parents or to interact with persons or objects in the environment.
what is the definition of listless
A listless child shows no interest in what is happening around herself.
what is the definition of toxic appearing child
A toxic condition is characterized by an appearance of pending physiologic collapse such as may be seen in sepsis, poisoning, acute metabolic crises, or shock. The child may be febrile, pale or cyanotic, with depressed mental awareness or extremely irritable and may demonstrate tachycardia, tachypnea and prolonged capillary refill.
what is the definition of a distressed child
A distressed child may have the appearance of working hard to maintain physiologic stability such as grunting, rapid breathing in order to maintain adequate oxygenation and ventilation.
how does congenital hypothyroidism present
Feeding problems Decreased activity Constipation Prolonged jaundice Skin mottling Umbilical hernia
how does congenital adrenal hypoplasia present
Decreased feeding and activity are common in infants with CAH.
Salt-losing CAH presents with lethargy, vomiting, and dehydration that can progress to shock.
what are the causes of large fontanelles
skeletal disorders, chromosomal abnormalities such as Down syndrome, hypothyroidism, hydrocephalus, malnutrition.
what are the causes of small fontanelles
microcephaly, craniosynostosis, hyperthyroidism, normal variant
what is the cause of sunken fontanelles
dehydration
what are the causes of bulging fontanelles
meningitis, hydrocephalus, subdural hematoma, lead poisoning
what is the import in checking a serum ammonia on a baby
for inborn errors in metabolism
when does congenital hypothyroidism present
around the second week of life because the mothers thyroid hormone is somewhat protective
what is the presentation of congenital hypothyroidism
feeding problems Decreased activity Constipation Prolonged jaundice Skin mottling Umbilical hernia
myxedematous facies
what other consequence does congenital hypothyroidism have
one of the most common causes of intellectual disability
when do most vaccine reactions occur
within 14 days
what is the most common cause of fever without a source
viral illness
what are some other causes of fever without a source
Urinary tract infection (UTI) - most common Meningitis Sepsis/Bacteremia Pneumonia Bacterial gastroenteritis Osteomyelitis Septic arthritis
what is kernigs sign
Kernig’s sign is resistance to extension of the knee.
what is brudzinskis sign
Brudzinski’s sign is flexion of the hip and knee in response to flexion of the neck by the examiner.
what is the best choice of antibiotic for UTI in children
ceftriaxone
what is the definition of a macular rash
Flat, circumscribed discoloration < 1 cm (> 1 cm is a patch)
what is the definition of a papular
Elevated, circumscribed solid lesion < 1 cm
what is the presentation of adenovirus
May cause upper respiratory tract infection, pharyngitis, conjunctivitis, tonsillitis, or otitis media
Potential for more severe infections in immunocompromised hosts
what is the presentation of Kawasaki disease
Fever for at least 5 days
Cervical adenopathy
Nonpurulent conjunctivitis
Nonspecific ("polymorphic") rash
Swelling and erythema of extremities
Mucosal inflammationwhat is the presentation of measles
After a prodrome of fever (over 38.3 C, or 101 F), cough, coryza, and conjunctivitis, this maculopapular rash starts on the neck, behind the ears, and along the hairline.
The rash spreads downward, reaching the feet in two or three days.
The initial rash appears on the buccal mucosa as red lesions with bluish white spots in the center (known as Koplik spots). These have frequently disappeared by the time the patient presents to medical attention.
Immunization is very effective in preventing this infection.
what is the presentation of scarlet fever and what is the cause
group A strep
Fever
A diffuse, erythematous, finely papular rash (described as having a “sandpaper” texture) is pathognomonic
Rash often begins at neck, axillae, and groin and then spreads over trunk and extremities, typically resolving within four or five days
what is the presentation of varicella
Chicken pox:” rash starts on trunk and spreads to extremities and head
Each lesion starts as an erythematous macule, then forms a papule followed by a vesicle before crusting over
Lesions at various stages of development are seen in the same area of the body
Immunization is effective in preventing this infection
what is erythema infectiousum and what is the presentation
infection with Parvo virus B19
Also called 5th disease
Low grade fever followed by a rash, which starts as a facial erythema to the face (“slapped cheek” appearance), which can spread to the trunk and extremities and appears lacy
Can lead to pain and swelling of the extremities, as well as development of transient pure red cell aplasia which can lead to severe anemia in patients with underlying hemolytic disease.
what is roseola and what is it caused by
“Exanthem subitum.” Also called sixth disease
Erythematous macules start on trunk and spread to arms and neck (less commonly face and legs)
Rash is typically preceded by 3 to 4 days of high fevers, which end as the rash appears
Usually occurs in children under age 2 years
human herpes VI
what diseases often have strawberry tongue
Streptococcal pharyngitis
Kawasaki disease
Toxic shock syndrome
what is Kawasaki diseease
panvasculitis of unknown etiology. autoimmune response to unknown trigger. seasonal patterns of outbreaks, more likely to occur in Asians.
what is the acute phase of Kawasaki
Acute phase: onset through ~10 days. Fever and clinical findings are present, with serologic evidence of systemic inflammation (elevated acute phase reactants).
what is the subacute phase of Kawasaki
Subacute phase: 10 days through ~3 weeks. Fever resolves and clinical findings largely subside (often with peeling of hands and feet). Serologic evidence of inflammation continues.
what is the convalescent phase of kawasaki
Convalescent phase: 3 weeks through 6-8 weeks. All clinical findings have resolved. Continued serologic evidence of inflammation.
what is the cardiovascular complication of Kawasaki
coronary artery aneurysms
what is the treatment of kawasaki
high dose aspirin or IVIG
what are the most common causes of wheezing in children
viral URI, asthma, foreign body, gerd
what is the definition of chronic cough
greater than 4 week s
what are the two most likely pathogens in acute otitis media
strep pneumonae and haemophilus influenza
also morexella catarrhalis
what viruses are associated with acute otitis media
influezna, RSV and rhinovirus
what is the best treatment for otitis media
amoxicillin.
when is otitis media treated with amoxicillin/clavulunate
when it is concurrent or H flu is suspected.
what are the features of cerebral edema
headache, recurrent vomiting, inappropriate slowing of the heart rate (bradycardia), hypertension, irregular respirations, restlessness, increased drowsiness, abducens nerve palsy, abnormal pupillary responses, fixed dilated pupils.
what is a rare but serious complication of DKA
cerebral edema. this is rare, but the morbidity and mortality is high
what are the risk factors for cerebral edema
young age, high BUN at presentation, profound acidosis and with hypocapnia, administration of bicarbonate.
what are kussmaul respirations
distinctive deep rapid breathing where the patient is trying to blow off excess CO2.
what are the initial steps for treating DKA
aggressive fluid resuscitation. this will dilute the glucose, but insulin is the only thing that will correct the metabolic acidosis by suppressing lipolysis and keto genesis. need baseline CBC to see if an infection is the inciting factor. serum osmolality and urinalysis are necessary.
what is the sodium measurement in DKA
usually hyponatremia. this is due to the osmotic effects of glucose causing water to come out of the cell.
why are children more susceptible to dehydration than adults
Higher surface area:body mass ratio; hence, a greater relative area for evaporation to occur
Higher basal metabolic rates than adults, which generates heat and expends water, and
Higher percentage of body weight that is water (in infants, 70% of body weight is water; in children, 65%; and in adults, 60%).
what is the most likely causative organism for septic arthritis
staph aureus
what is the most likely causative organism for septic arthritis of the neonate:
group B strep
what is the most likely causative organism for septic arthritis of the infant and older child:
Group A and Streptococcus pneumoniae
what is the most likely causative organism for septic arthritis of in unimmunized children
Haemophilus influenzae type b
what is the most likely causative organism for septic arthritis of in (adolescents)
Neisseria gonorrhea
what is the most likely causative organism for septic arthritis of in children less than 4 years
Kingella kingae
what is the most common type of seizure in children
generalized tonic clonic
what is a simple partial seizure
With this type, there are often motor signs in a single extremity or on one side of the body.
However, focal onset seizure activity may spread to become generalized, making it difficult to distinguish from a generalized seizure.
what is a complex partial seizure
This type of seizure can occur at any age.
Altered level of consciousness is one of the hallmark features.
Complex partial seizures may include blank stare, lip-smacking, drooling, gurgling, as well as nausea and vomiting.
Automatisms are quasi-purposeful motor or verbal behaviors that are repeated inappropriately and commonly accompany complex partial seizures.
Complex partial seizures often last 30 seconds to 2 minutes and are associated with a post-ictal phase of confusion, sleep, or headache.
Secondary generalization can occur in up to one third of children, so it is important to question witnesses about initial features to help differentiate a complex partial seizure from a generalized seizure
why dont we perform a lumbar puncture in someone with increased intracranial pressure
because of the risk of brain herniation f
what is the treatment for chlamydia
doxycycline
what is the treatment gonnorrhea
ceftriaxone
what is the treatment for PID
ceftriaxone one time dose and doxycycline for 14 days
ceftriaxone and azithromycin
ceftriaxone, doxycycline and metronidazole.
when do we hospitalize patients for PID
Pregnancy
Previous noncompliance
High fever
Intractable vomiting
Inability to exclude a surgical emergency
Inadequate response on oral therapy within 72 hours
Tubo-ovarian abscess
what is the toxidrome for cholinergic (organophosphates)
Miosis and blurred vision
Increased gastric motility (nausea, vomiting, diarrhea)
Excessive tearing, salivation, sweating and urination
Bronchorrhea and bronchospasm
Muscle twitching and weakness
Bradycardia
Seizures and coma
Mnemonic: “SLUDGE” (salivation, lacrimation, urination, defecation, GI motility, emesis)
what is the toxidrome for anticholinergic (diphenhydramine/tricyclics)
Mydriasis (dilated pupils) "blind as a bat" Dry skin "dry as a bone" Red skin (flushed) "red as a beet" Fever "hot as Hades" Delirium and seizures "mad as a hatter" Tachycardia Urinary retention Ileus
what is the toxidrome for sedative/hypnotic
Blurred vision (miosis or mydriasis) Hypotension Apnea and bradycardia Hypothermia Sedation, confusion, delirium, coma
what is the toxidrome for opioids
Miosis (constricted pupils) Respiratory depression Bradycardia and hypotension Hypothermia Depressed mental status (sedation, confusion, coma)
what is the toxidrome for sympathomimetics such as cocaine/pseudoephedrine
Mydriasis
Fever and diaphoresis
Tachycardia
Agitation and seizures
what are the broad categories that cause brain damge
hypoxia, hypoglycemia, shock
what is the most sensitive exam for volume status
heart rate
what is the definition of shock
a physiological state in which there is inadequate delivery of substrates and oxygen to meet the metabolic demands of the tissues.
How does early shock present
elevated heart and respiratory rates, peripheral blood vessel constriction (causing cool, clammy extremities and delayed capillary refill time), and decreased peripheral pulses (due to vasoconstriction and decreased stroke volume).
what is the drug of choice for meningiococcal prophylaxis in adults and the alternatives
ciprofloxacin
alternatives are rifampin, azithromycin and ceftriaxone
what is the atopic triad
asthma, allergies, eczema.
what are the common causative agents for impetigo
staph or strep pyogenes.
what are the treatments for impetigo
topical antibiotics such as mupirocin. sometimes, due to the serious complications such as abscess formation, systemic antibiotics are required.
what is the definition of failure to thrive
an infant is < 5th percentile for weight
an infant is < 5th percentile in weight for length, or
the rate of growth results in the infant crossing more than two major lines on the standard infant growth curve.
what are the organic causes of failure to thrive
Congenital heart defects Cystic fibrosis Gastroesophageal reflux Neurologic disorders Metabolic disease Genetic abnormalities
what are the causes of non-organic failure to thrive
most are psychosocial
how does a maternal breast feeding issue present
the infant trying to feed more frequently and continually acting hungry.
what is the normal palpable liver edge
1 cm below the costal margin
what is the differential of hepatomegaly in infancy
Congestive heart failure Hepatitis Congenital infections Inborn errors of metabolism Anemias Tumors (less commonly)
classic findings of CHF in an infant
dyspnea with feedings diaphoresis poor growth an active precordium hepatomegaly
what murmurs are more common in school aged children
Atrial septal defect and bicuspid aortic valve
what are the likely structural causes of CHF in infancy
VSD
Severe aortic stenosis
Coarctation of the aorta
Large patent ductus arteriosus
what are the most common presenting symptoms of CHF in infancy
trouble feeding and respiratory symptoms
why are VSD murmurs unlikely to present in an infant at the nursery
because they have increased pulmonary vascular resistance. this makes the systemic and pulmonary vascular resistances the same and there is a failure to shunt thus the murmur is null
what are the treatments for CHF in a newborn
furosemide, digoxin, enalapril
what is mottled skin a sign of
circulatory insufficiency or collapse.
what are the causes of splenomegaly in a child
Infection (e.g. Epstein-Barr virus, cytomegalovirus, bacterial sepsis, endocarditis) is the most common cause of splenomegaly in children. Other causes include hemolysis (sickle cell disease), malignancy (leukemia, lymphoma), storage diseases (e.g. Gaucher disease), systemic inflammatory diseases (e.g. systemic lupus erythematosus, juvenile idiopathic arthritis), and congestion (a complication of portal hypertension).
what are the most common causes of arthritis in children
Trauma Septic arthritis Transient synovitis Reactive arthritis (e.g., post-streptococcal arthritis) Lyme disease Rheumatic fever Juvenile idiopathic arthritis Systemic lupus erythematosus Henoch-Schönlein Purpura
what is henoch-shonlein purpura
(also known as anaphylactoid purpura) is a self-limited, IgA-mediated, small vessel vasculitis that typically involves the skin, GI tract, joints, and kidneys. most commonly diagnosed form of vasculitis in children (about 50% of cases). Boys are more affected than girls.
what is the hallmark of henoch-shonlein purpura
hallmark of HSP is non-thrombocytopenic purpura
what is a serious complication of henoch-shonlein purpura
About 5% of children with HSP progress to chronic renal failure. Fewer than 1% will develop end-stage renal disease.
50% of the patients with HSP will also develop GI symptoms, such as GI bleeding
5-10% develop intussusception.
How does HSP and ITP differ
ITP has low platelet
what is the most likely disease course of HSP
goes away in a month without treatment
what is the most common cause of nephrotic syndrome
minimal change disease.
what is the most common cause of apnea in children
RSV
what is BRUE
brief resolved unexplained event. characterized by cyanosis or pallor
absent, decreased, or irregular breathing
marked change in tone (hyper- or hypotonia)
altered level of responsiveness.
what is the pathophysiology of sickle cell disease
SCD is a group of disorders characterized by substitution of valine for glutamic acid at the sixth amino acid position of the hemoglobin molecule. This mutation leads to the formation of polymers of hemoglobin when the hemoglobin becomes deoxygenated. These polymers lead to deformation of the red blood cell into the characteristic “sickle” cells. Sickle cells have increased adherence and block blood flow in the microvasculature, which leads to local tissue hypoxia, pain, and tissue damage.
what are the two most common surgeries in children with sickle cell disease
tonsillectomy and cholecystectomy.
why do children with sickle cell disease get cholecystectomy
because of all the hemolysis which leads to accumulation of bilirubin gallstones
why do children with sickle cell get tonsillectomy
Lymphoidal-tissue hypertrophy involving Waldeyer’s ring is common in children with sickle cell disease. Excessive snoring may be observed, as well as obstructive sleep apnea.
Some physicians think tonsillar hypertrophy may relate to desaturation of hemoglobin and increase the risk of sickling.
Tonsillectomy with adenoidectomy will improve the obstructive apnea for most patients.
why is penicillin given to children with sickle cell
to prevent infections that lead to sepsis. they have autosplenectomy and are at risk for encapsulated infections
what can be given to patients with sickle cell if they have increase vasoocclusive symptoms
hydroxyurea
what are some common complications of sickle cell disease
jaundice, anemia, stroke. pneumonia and lung issues are also common.
what are the two leading bacteria that cause morbidity and mortality in sickle cell patients
haemophilus and pneumococcal
what is the inheritance for sickle cell
autosomal recessive
do children with sickle cell have normal growth?
impairment in growth in sickle cell is common
what causes the growth impairment in sickle cell
Chronic anemia Poor nutrition Painful crises Endocrine dysfunction Poor pulmonary function
what are the baseline hemoglobin for sickle cell patients
between 6 and 9
is fever serious in sickle cell disease
yes. fever is a medical emergency in a sickle cell patient
what are some medical emergencies in sickle cell disease
fever, splenic enlargement, slurred speech, chest pain, rapid breathing, increased pallor, jaundice, priapism
what are the features of the down syndrome facies
Upslanting palpebral fissures
Small ears (usually less than 34 mm at maximum dimension in a term infant)
Flattened midface
Epicanthal folds
Redundant skin on back of neck (nuchal skin)
Hypotonia (most consistent finding in infants with Down syndrome) small brachycephalic head, Brushfield spots, small shaped mouth, single transverse palmar crease, short fifth finger with clinodactyly, and wide spacing and a deep plantar groove between the first and second toes. The degree of cognitive impairment is variable and may be mild (IQ of 50–70), moderate (IQ of 35–50), or occasionally severe (IQ of 20–35).
what other congenital findings are associated with downs syndrome
congenital hearing loss, congenital cataracts, heart disease, gastrointestinal atresia, hip displasia and hypothyroidism
what medical monitoring should be performed in Down syndrome
Annual thyroid screening (due to an increased incidence of hypothyroidism, even if not present at birth)
Vision screening (due to increased incidence of vision problems)
Hearing screening (due to increased incidence of hearing problems)
Complete blood count in first month to assess for leukemoid reactions, or transient myeloproliferative disorders (TMD)
Referral to a pediatric cardiologist (due to the increased incidence [50%] of structural heart disease in patients with Down syndrome and the difficulty of auscultating some of these cardiac defects)
Beginning at 1 year of age, and then annually, a hemoglobin and hematocrit should be obtained to screen for iron deficiency anemia (due to increased risk for iron deficiency due to lower dietary iron intake than their peers)
Referral for evaluation by early intervention is key to a child with Down syndrome receiving any needed therapies as early as possible.
what are the physical exam findings for turners syndrome
Webbed neck
Low ear placement
Edema of the hands and feet
Hyperconvex nails, and
“Shield” chest, with widely spaced nipples
Coarctation of the aorta is found in about 20% of affected girls.
Short stature is common, and some girls are not diagnosed until early adolescence when they present with short stature and delayed sexual maturation (due to gonadal dysgenesis).
Most have a normal IQ.
what are the domains of developmental monitoring
Gross motor
Fine motor
Communication (sometimes broken down into receptive and expressive language)
Personal-social
Problem-solving (also called self-help, cognitive, or adaptive in some frameworks)
when is development screened
9, 18, 24, 30 months
what are the types of cerebral palsy
spastic quadriplegia, spastic diplegia, dyskinetic cerebral palsy, hemiplegia, ataxic cerebral palsy
what is the etiology of and clinical scenario for spastic diplegia
usually legs greater than arms, periventricular white matter abnormality, found in premature infants.
what is the etiology of and clinical scenario for dyskinetic cerebral palsy
basal ganglia, cerebellum, thalamic abnormalities. perinatal ataxia, kernicterus
what is the etiology of and clinical scenario for spastic hemiplegia
arm and leg on one side; unilateral UMN, stroke
what is the etiology of and clinical scenario for ataxic cerebral palsy
affects the entire body, cerebellar abnormalities, cerebellar hypoplasia, pontocerebellar hypoplasia.
what are the leading causes of cerebral palsy
prematurity by far the most common. intrauterine growth retardation, chorioaminitis, perinatal ataxia
what is the def of failure to thrive
Weight falls below the 3rd percentile
Weight for height/length falls below the 3rd percentile
The rate of weight gain slows compared with previous growth, crossing two or more major percentiles on the growth chart in a downward direction.
what is the most common cause of failure to thrive
insufficiency of caloric intake
Insufficient intake
Excessive losses
Excessive caloric need.
what is the most common cause of abdominal pain in school-aged children
functional abdominal pain.
what is functional abdominal pain
chronic recurrent abdominal pain that is nonspecific and non-life threatening. considered a functional disconnect between the gasterenteric nervous system and the mental nervous system.
what are the red flag symptoms for abdominal pain in children
Involuntary weight loss
Deceleration of linear growth
Gastrointestinal blood loss
Significant vomiting
Chronic severe diarrhea
Persistent right upper or right lower quadrant pain
Unexplained fever
Family history of inflammatory bowel disease
Abnormal or unexplained physical findings
what brain tissues does Hyperbilirubinemia affect
basal ganglia, cranial nerve nuclei, subthalamic nuclei.
how does acute bilirubin encephalopathy present
hypotonia, somnolence, and loss of primitive reflexes.
what is the main source of heme in neonatal jaundice
from the breakdown of red blood cells/aging red blood cells
what is the minor sources of heme in neonatal jaundice
Minor sources come from ineffective erythropoiesis and breakdown of hemoproteins including muscle myoglobin and liver enzymes.
