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child < 5
gets sick a week before (not always)
patient appears well
then has enlarged, erythematous, tender, cervical node
possible abscess formation

Acute Unilateral Cervical Lymphadenitis
most commonly due to staph or strep
anaerobes associated with periodontal disease (poor dental hygiene)

use antibiotic therapy (clindamycin or amoxicillin-clavulanate)
do incision and drainage if abscess present


complications of bronchiolitis

apnea (especially infants age < 2 months)
respiratory failure


diagnostic criteria for acute bacterial rhinosinusitis

1. persistent 10 or more days without improvement
2. severe onset (fever > 39C or 102.2F + drainage) more than 3 days
3. worsening symptoms following initial improvement

*need 1/3
*give amoxicillin + clavulanate


what do you give to a premature baby that is exclusively breast fed

-preterm infants are at higher risk of iron deficiency so they should be on iron up till age 1
-all exclusively breast fed babies get vitamin D supplementation

*full term babies have enough iron for the first 4-6 months of life


management of a baby with hypospadias

defer circumcision
urologic evaluation for surgical repair
possible karyotype analysis, get pelvic ultrasound if severe


thyroglossal duct cyst vs pharyngeal cleft cyst

TDC --> anterior midline mass that moves with swallowing, embryologic anomaly made up of normal thyroid tissue
*can present after URI*
confirm presence of normal thyroid tissue then surgically resect the cyst , associated tract, and central portion of the hyoid bone

PCC --> lateral neck mass due to persistent cervical sinus that does not move with swallowing


how does cervical reactive lymphadenopathy present

enlarged neck mass after URI
involves multiple nodes
does not move with swallowing


kid has down syndrome and no meconium.. what do you think



kid has CF and no meconium.. what do you think

meconium ileus


management of neonatal clavicular fracture

usually gets better within 7-10 days so do nothing but be gentle with them
you can also staple their shirt to the their sleeve so they dont move their arm for further damage


patient with very low fever or no fever with some hip pain and difficulty walking but can bear weight on it and was sick with a viral illness but has all normal labs

transient synovitis
full recovery within 1-4 weeks
conservative management with NSAIDs


how to treat patients and their families if someone has pertussis

its so contagious that you freaking treat them allllll with macrolides REGARDLESS OF VACCINATION STATUS


kid with purple "bruises" on his legs, arthritis/arthralgias, abdominal pain, and blood in urine

henoch-schonlein purpura
-IgA mediated vasculitis
-they are purpura not bruises
-abdominal pain, intussusception
-renal disease (hematuria- most common)
-symptoms often preceded by mild URI

supportive therapy (hydration and NSAIDs)
hospitalization and systemic glucocorticoids in pts with severe symptoms


migratory arthralgias and no gram stain or culture found/grown

borrelia burgdorferi


decreased B cells due to absent T cells

severe combined immunodeficiency


common variable immunodeficiency

defect in B cell differentiation
decrease in plasma cells and immunoglobulins


most common cause of a child with back pain that has pain with extension and rotation but not flexion

-fracture of pars interarticularis then usually pinches L5


risk factors for hypertrophic pyloric stenosis

first born boy
bottle feeding
*you will see an olive shaped abdominal mass


acute rheumatic fever

JONES criteria
O = shape of heart
Nodules (subcutaneous)
Erythemia marginatum
Sydenham chorea

*give penicillin for group A strep


baby with pale stools and hepatomegaly

biliary atresia
*most common indication for peds liver transplant


transient tachypnea of newborn vs. respiratory distress syndrome

TTN --> tachypnea begins shortly after birth and resolves by day 2 due to inadequate alveolar fluid clearance at birth resulting in mild pulmonary edema, bilateral perihilar linear streaking ... usually in term baby born via c-section

RDS --> premature infant with grunting, flaring, and retractions immediately after birth due to surfactant deficiency resulting in alveolar collapse and diffuse atelectasis, ground glass appearance on x-ray with granularities
*treat with continuous positive pressure ventilation



severe allergic reaction with HYPOTENSION or symptoms involving > 2 organ systems after exposure to allergen
*treat with IM epinephrine


what do patients have in turner syndrome (XO)

short, wide chest, webbed neck, narrow/high arched palate, coarctation of aorta (diff bp in upper vs lower extremities), bicuspid aortic valve, horseshoe kidney, and streak ovaries/amenorrhea/infertility

pts are at increased risk of osteoporotic fractures due to estrogen deficiency from ovarian dysgenesis

*more than 50% of these pts also have congenital lymphedema due to lymph network dysgenesis, presents as nonpitting carpal and pedal edema


what does organophosphate poisoning look like

acetacholinesterase inhibitors

Diarrhea /diaphoresis
Bronchospasms, bronchorrhea, bradycardia

Nicotinic: muscle weakness, paralysis, fasciculations


vagina ends in blind pouch and kid has no uterus or ovaries but has bilateral abdominal masses

androgen insensitivity (XY)


clinical features of sturge-weber syndrome

port wine stain (trigeminal nerve distribution V1/2)
leptomeningeal capillary-venous malformation
seizures (possibly with hemiparesis)
intellectual disability
visual field defects

dx via MRI of brain with contrast

treat with laser therapy, antiepileptic drugs, intraocular pressure reduction


acute chest syndrome

pulmonary vasoconstriction or infection
pt presents with fever, chest pain, new infiltrate on chest radiograph


what to think about in pts with acute severe anemia in sickle cell patients

1. aplastic crisis (decreased reticulocytes)
-transient arrest of erythropoiesis
-secondary to infection (parvo B19)

2. splenic sequestration crisis (increased reticulocytes and decreased platelets)
-splenic vaso-occlusive --> rapidly enlarging spleen
-occurs in children prior to autosplenectomy


patient with hemophilia A or B will have what joint findings

hemosiderin deposition and fibrosis
-they can develop hemophilic arthropathy from recurrent hemarthroses associated with hemosiderin deposition leading to synovitis and fibrosis within the joint

*treat by replacing factor and possibly adding desmopressin


baby with empty/hypoplastic/poorly rugated scrotum or hemiscrotum with or without inguinal fulness presenting with fussiness and in a lot of abdominal pain

baby has cryptorchidism (testicle is in abdomen and has torsion)
risk factors --> prematurity, small for gestational age, low birth weight, genetic disorders
treatment --> orchioplexy before age 1
complications --> inguinal hernia, testicular torsion, subfertility, testicular cancer