PEDIATRICS Flashcards by Trinitine Poblete

Bilous vomiting in neonate, commonly associated with Down’s syndrome

Duodenal Atresia

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Nonbilous vomiting in neonate, presents with olive-shaped mass, high risk in patients with Turner’s syndrome and Trisomy 18

Pyloric Stenosis

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Rule of 2’s: Meckel’s Diverticulum

2% of normal population
2 feet from ileocecal valve
2 inches long
2x more common in males

often symptomatic by age 2
2 complications: bleeding, perforation
2 types of tissue: pancreas and gastric
2 presentation: GI bleed and diverticulitis

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Most common cause of lower GI bleeding in children

Meckel’s diverticulum

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Antibiotic that can cause Pyloric stenosis

Erythromycin

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Mutation that causes failure of ganglion cells to migrate to wall of colon in Hirschsprung disease

Tyrosine Kinase receptor (RET gene)

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Causative agent of Slapped cheek appearance in Erythema infectiosum/ fifth disease

Parvovirus b19

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Live attenuated vaccines (6)

BCG
Measles
Mumps
Rubella
Varicella
Rotavirus

(BCG + MMRV + Rota)

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Immunity induced through administration of antibody-containing preparation

Achieved by administration of PREFORMED ANTIBODIES

Passive immunity

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Administration of a vaccine or toxoid to stimulate the immune system to produce a prolonged humoral and/or cellular immune response

Active immunity

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4 m/o
No BCG vaccine yet
+ exposure to TB patient

What will you do?

Do PPD testing prior to giving BCG

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Most common cardiac manifestation of maternal rubella syndrome

Patent ductus arteriosus

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Machinery like murmur

PDA

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Pharmacologic closure of PDA

Prostaglandin Synthase Inhibitor
Indomethacin

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Most common cyanotic congenital anomaly

Tetralogy of fallot (TOF)

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Four cardinal features of TOF

P-ulmonary infundibular stenosis
R-VH
O-verriding of aorta
V-SD

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Cyanosis
Dyspnea on exertion
Paroxysmal hypercyanotic attacks (Tet spells)

Dx?

Tetralogy of fallot

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Blue baby

TOF

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Boot shaped heart
Couer en sabot

Caused by?

Right ventricular hypertrophy

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Management of Tet spells

-Squatting or knee chest position
-Administer oxygen
-Beta adrenergic blockade - Propanolol

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Palliative surgery done in Tetralogy of fallot

Blalock-Taussig shunt
Most common aorticopulmonary anastomosis

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Mucocutaneous lymph node syndrome
Infantile polyarthritis nodosa

Kawasaki disease

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Vasculitis with a predilection for the coronary arteries

Kawasaki disease

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High fever for 5 days which is unresponsive to antibiotics
Bilateral nonexudative conjunctival injection with limbal sparring
-Strawberry tongue and red cracked lips
Edema and erythema of hands and feet

Kawasaki disease

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Cardiac involvement in kawasaki disease

Myocarditis Coronary aortic aneurysm

Tx of kawasaki disease

2g/kg IVIG and high dose Aspirin within 10 days of disease onset

Earliest sign of puberty in girl

Thelarche (breast bud)

Measurement of physical growth (wt and height) and body composition (mid up arm, waist and hip circumference)

Anthropometry

Assesses prevalence of Vit A def l, Iron def anemia and other nutrient deficiencies

Biochemical

Food fortification act

Vit A Iodine Iron (Fe)

STGs directly related to health

2 - zero hunger 3 - good health and wellbeing 6 - clean water and sanitation

Vulnerable group

Under five clinics Pregnant and lactating Elderly

Exclusively breastfed children prone to IDA

Breastmilk deficient in iron

DOH program suggest composition of Filipino meal

Pinggang pinoy

Leading cause of death in the philippines

Cardiovascular disease

When does Ductus arteriosus close?

1. Physiologic - 14-15hrs after birth 2. Anatomic - after 2-3 weeks after birth

Primary closure of patient with gastrochisis

Intragastric pressure <20cm H2O and CVP does not increase by 4mmHg or more as the abdominal viscera are replaced into the abdominal cavity

Triad of Respiratory distress Cyanosis Apparent dextrocardia

Congenital diaphragmatic hernia

Primary prognostic variable of congenital diaphragmatic hernia

Degree of associated pulmonary hypoplasia

Bowel segments typically involved in intestinal atresia

Duodenum Jejunum Terminal Ileum Anus

Etiology: intrauterine mesenteric ischemia Presentation: bilious emesis

Jejunal-ileal atresia

Nonbilious projectile vomiting Defect occurs in 1/3000 births and is most common in 1st born males Olive may be palpable in epigastrum on PE

Pyloric stenosis

Noninvasive diagnostic test of pyloric stenosis

Ultrasound

Leading cause of death in childhood

Trauma

MC type of choledochal cyst

Type 1 - involves CBD only Tx- hepaticojejunostomy

Problems of children with Tracheoesophageal Fistula repair may be encountered

Have reactive airway disease or other lung disease suggestive of chronic aspiration Esophageal stenosis may require dilatation and bougienage

Preferred maintenance fluid of children older than 6mon of age

5%dextrose in 0.45% saline

Preferred maintenance fluid of children younger than 6mon of age

5% dextrose in 0.2% saline

Most prevalent in infants. Subacute in onset Lower temperature Lower WBC count

Croup

More prevalent in toddlers and preschoolers High fever Toxic appearance Brief course before onset of respiratory distress

Epiglottitis

Cyst like structure in neck of infant. Midline. Moves with swallowing

Thyroglossal duct cyst - derived from foramen cecum and can have abberant thyroid tissue with malignant transformation potential Tx: excision of thyroglossal duct cyst with hyoid bone

Tumor of childhood MC malignancy in child with VMA and N-myc

Neuroblastoma

Most common solid malignancy of childhood Hypertension is present in 25% Tumor markers: catecholamines / metenephrines Tumors occur anywhere along the sympathetic chain/nerve distribution

Neuroblastoma

MC organism encountered in cervical lymphadenitis

Group A Streptococcus and Staphylococcus aureus

Intermittent crampy abdominal pain with severe bouts of colic Mucous and bloody stool Clinical bowel obstruction w bilious vomiting and poor PO tolerance Dilated small bowel and air fluid levels on KUB Involution of distal ileum into R colon is the most frequent site w TARGET SIGN

Intussusception

MC type of TEF

Blind ending proximal esophageal pouch w fistula from lower esophagus to the trachea (85%) Inability to pass NGT Cough with feeds Tx: R anterolateral thoracotomy

Normal urine output of newborn babies

1-2 cc/kg/hr

Fundamental steps required in Ladd procedure for malrotation

Detorsion of volvulus, Division of Ladd's bands overlying duodenum Mobilization and straightening of duodenum Appendectomy

MC brachial cleft anomaly

2nd brachial cleft sinus

MC location of diaphragmatic hernia

80% Left PosteroLateral chest through foramen of Bochdalek

Associated anomalies should be excluded in eval of neonate with esophageal atresia

Those of VATER or VACTERRL syndrome (Vertebral, Anorectal, Cardiac, Tracheoesophageal, Radial, Renal, Limb)

Geneteic abnormality with Duodenal atresia

Trisomy 21 (Down's syndrome) Polyhydramnios ----DOUBLE BUBBLE Etiology: mucosal web 2ndary to failure of bowel recanalization

Tx for Duodenal atresia

Duodenoduodenostomy

MC cause of colonic obstruction in infants

Hirschprung's disease Male Presentation: failure to pass meconium

Gold standard dx of Hirschsprung in newborn

Absent Meissner and Auerbach plexus on rectal biopsy Aganglianosis Hypertrophic nerves Increased cholinesterase staining

MC cause of infantile GI perforation

Midgut volvulus w intestinal ischemia, vasopressor medications and indomethacin

Most common malignant childhood malignancy

Leukemia

MC hepatic malignancy in a child <4yo

Hepatoblastoma

MC hepatic malignancy in a child >4yo

Hepatocellular carcinoma

MC soft tissue tumor of childhood

Rhabdomyosarcoma Tx: sx excision

Embryonic remanant that causes Meckel's diverticulum

OMPHALOMESENTERIC DUCT

Tx for imperforate anus

Below levators- anoplasty Above - temp colostomy, vagina/bladder repair PRN, delayed coloanal repair

MC cause of rectal bleeding in children >1yo

Juvenile polyps

MC location of gonadal germ cell tumot in childhood

Ovary

MC location of extragonadal germ cell tumor in childhood

Sacrococcygeal region

Pt with bilious emesis

Malrotation of midgut

Large painless abdominal mass (MC presentation) Mets in the lungs

Wilm's tumor (nephroblastoma)

MC leading to liver transplantation in pedia population

Biliary atresia

MC intraabdominal tumor diagnosed during childhood

Wilm's tumor

MC indication for cholecystectomy in pedia age group

Cholelithiasis 2ndary to sickle cell disease

MC indication of splenectomy

Hereditary spherocytosis

Tx of choice in biliary atresia

Hepatoportoenterostomy (Kasai procedure)

4mon old Barking cough Inspiratory stridor for 2 months Bright red lesion on back that has been gradually enlarging Asymmetric narrowing of subglottic region

Subglottic hemangioma

Large port wine stain in forehead and maxilla

Sturge- Weber syndrome - capillary malformation involving V1 and V2 - vascular malformation involving brain --- seizures and cognitive impairment

8yo boy Draining ear filled w friable tissue Punched-out lytic lesion of temporal bone Lipid laden histiocytes Dx?

Histiocytosis X

Posterior compression of esophagus demonstrated on barium esophagogram most likely caused by

Aberrant subclavian artery

Coagulative necrosis Protect deeper tissues

Acid burn

Liquefactive necrosis More extensive burns

Alkaline burn

Tx for caustic injury to the entire esophagus with full thickness mescoris

Esopahgectomy with colon interposition replacement

Medical therapy may be beneficial for patients with corrosive burns of esophagus

Antibiotic hasten epithelialization Corticosteroids decrease stricture formation

3yo constant purulent nasal drainage Recurrent pneumonia Dextrocardia on chest xray

Kartagene's syndrome

PEDIATRICS Flashcards

(91 cards)