Flashcards in Random problems Deck (106):
Crying that occurs in otherwise healthy infant for >3 hrs daily (usually evening), >3 times a wk and for a duration of >3 wks
feeding patterns checked
Gynecomastia in pubertal boys causes
transient increased testicular production of estrogen over testosterone and peripheral conversion of prohormones to estrogen
kid with Fever> 5 days,
oral muosal changes
acute vasculitis of small/medium arteries
Peak age: 18-24 months
Do Dx kawasaki what do you need?
Should have fever >5 days and 4/5 findings:
Conjunctivits: bilat, nonexudative, spares limbus
Oral mucosal changes: erythema, fissured lips, "Strawberry tongue"
Extremity: erythema, edema
desquamtion of hand/ft, (usually last manifestation)
Cervical LAD: >1.5cm
Supporting lab values for Kawasaki Disease
Increased CRP/ ESR
leukocytosis w/ neutrophilia
Sterile pyuria on urinalysis
Complications of Kawasaki disease
Coronary artery Aneurysms
MI or ischemia
Rx of Kawasaki disease
Aspirin plus IVIG
What to be aware with Rx of kawasaki and when to stop?
Aspirin can cause Reye syndrome: hepatic encephalopathy
but it prevents coronary thrombosis
Clopidogrel can be substitued during acute influenca or VZV
Intussusception can be assoc with
Mongolian spots are
congenital dermal melanocytosis
benign usually on lower back and buttock
Fade by 1st decade of life
Adrenal enzyme: 21-hydroxylase deficiency symptoms
Ambigous genitalia in girls
Salt wasting(vominting, hypotension, Decrease Na, increased K)
Dx 21 hydroxylase def
Adrenal enzyme 11B-hydroxylase deficiency symptoms
Ambigous genitalia in girls
Fluid and salt retention
DX 11B hydroxylase def?
Incresed testosterone and 11-deoxycorticosteone & 11 deoxycortisol
Decreased Cortisol and aldosterone
Adrenal enzyme 17a hydroxylase deficiency C/F
All patients: phenotypicaly female
Dx 17a hydroxylase
Decreased cortisol & testosterone
Normal anion gap acidosis
failure to thrive
Renal tubular acidosis
RTA type 1
Distal: poor H ion secretion into Urine
Urine pH> 5.5
Serume K: low to normal
Causes of RTA1
AI disorders (SS, RA)
RTA type 2
Proximal: poor hCO3 resorption
urine pH: below 5.5
Serum K-low to normal
Causes of RTA2
Fanconi syndrome (glucosuria, phosphaturia, AAuria)
RTA type 4
Urine pH: Below 5.5
Serum potassium: High
Causes of RTA4
Congenital adrenal hyperplasia
Kid with sickle cell comes in with ABD pain and jaundice. type of blood issue
Chronic hemolysis: extravascular
Increased LDH, unconjugated bilirubin, reticulocytes
Seperation anxiety is normal when
Child (9 months)with history of otitis media and used to babble but stopped. raises concern for?
Do a audiology evaluation
Girl seen due to hair loss for a week. Mom has vitiligo
P/E: scaling slightly erythematous patch on scalp; no LAD
Tinea capitis infection
Tinea capitis C/F
Scaly, erythematous patch on scalp
Hair loss w/ residual black dot
Possible painful LAD
Human->huma or fomite transmission
KOH exam of hair shaft to document spores
Rx: Griseofulvin or oral terbinafine
Smooth and discrete circular areas of hair loss w/out scaling... DX?
well demarcated plagues, inflammation and scarring of hair follicles, cutaneous lesions, and maybe photosensitivity.... Dx?
Discoid lupus erythematosus
Itchy scalp, neck and ears or asymptomatic. Whole family some how got it... Dx?
Lice: Pediculosis humanus capitis
MCC of 2ndry HTN in kids
Fibromuscular dysplasia (FMD)
20% of all cases of renal htn
Physical exam for FMD in kid with HTN?
hum or bruit in the costovertebral angle due to well -developed collaterals
R renal artery more affected than L
Angiography pattern in FMD
"string of beads" pattern to the renal artery
Kid OD's on grandmas TCA meds cause he is a moron. What to give him to help?
SUpplemental O2, intubation
Charcoal within 2 hrs
IV Sodium Bicarb for QRS widening or ventricular arryhthmias
Kid comes in with bleeding from bottom, bruises, multiple pneumonias, and thrombocytopenia.. Dx?
Wiskot aldrich syndrome
X-linked WAS gene
T cells cunable to reorganize atin cytoskeleton
Wiskot aldrich syndrome mnemonic?
A: IgA/IgA Increased
Response to bacterial polysacharides decreased
typical infections in WAS?
Febrile seizure R/Fs?
Fever from mild viral or bacterial infection (influenza, adenovirus, HHV-6)
Immunizations (DTaP, MMR)
Dx febrile seizure
Age 6m- 6 yrs
No hx of seizure
No CNS infection
No acute systemic metabnolic cause of seizures
Rx Febrile seizure
Kid with a infection, conjunctival redness, rhinorhea and high fever spike next day. Has seizure. upon arrival to ER feels better. Dx?
Bacterial vs viral conjunctivitis?
B- thick mucopurulent discharge
Kid comes in with a scotal swelling after a fever and cough which progress for 2 weeks. Also has rash on buttock, bloody urine. Dx?
Abd pain, intussusceptions
Renal disease similar to IgA nephropathy
Severe cases: scrotal pain
Cause of HSP?
IgA mediated leukocytoclastic vasculitis
Rx of HSP
Supportive: hydrate and NSAIDS
Hospitilization and systemic steroids if severe
R/F for cholecystitis
Sickle cell anemia
Increased incidence of colonic diverticula and abd wall/inguinal hernia are seen in?
Recurrent Sinopulmonary infections, chronic cough, Nasal polyps, and digital clubbng.... Dx?
episodes of impaired consciousness, failure to respond to various stimuli during the episode, staring spells, automatism and post ictal confusion. Dx?
Complex partial seizure
Brief (few s) periods of impaired consciousnes, have automatisms, NO post ictal state
typical abscence seizure
EEG generalized 3hz spike waves
EEG slow spike and wave activity with frquency less than 2.5 hz, 20 second impaired consciousness, Dx?
Atypical absence seizure
Adolescent w/ unilateral or bilateral myoclonic jerks
usually in Am and precipated by sleep deprivation, Dx?
juvenile myoclonic epilepsy
Childhood seizures of multiple types, impaired cognitive function, Spike and wave activity on EEG; Dx?
Cyclic vomiting syndrome
>3 epidose in 6 month period
last 1-10 days
vomits >4 times/hr at peak
no symptoms btw vomiting episodes
no underlying condition
reassurance to parents
CVS is associated w/
FH of migraine headaches in parents
more like a abd migraine
Vomiting electrolyte imbalance
Hypochloremic, hypokalemic M. alkalosis
ph: high- alkalosis
Fever, uriticaria and polyarthralgia 1-2 wks after first exposure;
H, Edema, LAD & splenomegaly less common
Serum sickness- like reaction
usualy from antibiotics (B-lactams, sulfa)
Breath holding spells
Cyanotic: crying followed by breath holding in forced expiration, apnea, cyanosis, limpness & LOC
Pallid: Minor trauma followed by LOC, breath holding, pallor & diaphoresis
Rx: breath holding spells
Refeeding syndrome in purger
Incred glycogen synthesis
increased protein synthesis
inc intracellular uptake of phosphorus, K, Mg, thiamin
In refeeding syndrome electrolyte issues
Drop in Phosphorus, K, Mg
Increased Na and H2O
Clinical manifestations of refeeding syndrome
CHF (pulmonary edema, peripheral edema)
when to check lipid levels in kids?
screen for dyslipidemia 9-11 and 17-21
relatively stable just prior and after puberty
normal weight loss in newborn in first 5 days of life?
7% birth weight
regained by 10-14 days
Heroin abuse in mom, kid has... c/f
Neonatal abstinence syndrome (NAS):
irritability, high-itched cry, poor sleeping, tremors, seizures, sweating, sneezing, tachypnea, poor feeding, V/D
W/drawal around 48hrs
Methadone withdrawal in newborn occurs when
48 to 72 hrs after birth
prenatal exposure to cocaine, c/f of kid
hyperactive MORO relfex
long term, behavior, attention and intelligence problems
infants shouldnt drink cow milk until what age? and why?
until age 1 and
Continued ear drainage for several weeks despite appropriate antibiotic therapy think of
Cholesteatoma is what
Chronic middle ear disease leads to formation of a retraction pocket in tympanic membrane which can fill with granulation tissue and skin debris
Rx a cholesteatoma
referr to otolaryngologist
possibly Ct or surgical visualization to confirm Dx
erythematous vesicle symmetrically distributed on extensor surfaces
Newborn with cyanosis that is aggravated by feeding and relieved by crying; dx?
watery Diarrhea, dermatitis, dementia(poor concentration, mental status change, aggressive), beefy red tongue
Pellagra, Def of Vit B3= Niacin
Cheilosis, glossitis, seborrheic dermatitis (often affecting genital areas), pharyngitis, edema or erythema of mouth; Dx?
Def of Vit B2: Riboflavin
Breastfeeding benefit for kid
Improved GI function
Prevents infections: Otitis media, gastroenteritis, Resp Illness, UTI
Decreased risk of childhood cancer DMI, NEC
Maternal benefit to breastfeeding
Reduced risk of ovarian and breast cancer
rapid uterine involution and decreased postpartum bleed
faster return to prepartum weight
improved child spacing
Lethargic newborn, hoarse cry,, poor feeding, constipation, jaundice, scleral icterus, dry skin,
TSH high, low free T4; Dx?
mcc: Thyroid dysgenesis
C/I to rotavirus vaccine
Anaphylaxis to vaccine ingredients
History of intussusception
Hx of uncorrect congential malformation of GI tract (e.g meckels)
Late onset (nonclassical) congenital adrenal hyperplasia C/F
severe facial acne, advanced pubic/axillary hair, normal testicular volume, advanced bone age;
Late onset CAH labs
LH low at baseline and doesn't increase with GNRH stimulation
Vit B2: riboflavin def c/f
Angular cheilitis: fissures
Glossitis: hyperemic tongue
Stomatitis: hyperemic/edematous oropharyngeal mucous membranes, sore throat
Drugs for Enuresis management
1st line: Desmopressin
2nd: Imipramine, amitriptyline, desipramine
Lead poisoning screened by capillary blood; next step?
Venous lead measurements
Rx to lead poisoning 3 types:
Mild: 5-44 mcg/dl- no meds, repeat in 1 month
Moderat: 45-60- DMSA
Severe: >70- Dimercaprol + EDTA (calcium disodium edetate)
Congenital hypothyroidism C/f
Maternal factors that lead to abnormal fetal growth(5)
Infants who are small for gestational age are at risk for (7)
Large for gestational age infants are at risk of
SSSS is what
exfoliative toxin producing strains of S.aures;
toxins against desmoglein: keratinocyte adhesion in superficial epidermis
In SSSS what starts in 24-28 after fever, irritability, skin tenderness
erythema starts on faces and generalizes in that ime
gentle lateral pressure on skin surface adjacent to a blister causes slipping and detachment of a superficial layer of skin
Cystic fibrosis most patients will have
Pulmonary and pancreatic insufficiency
95% f men: infertile: congenital bilateral absence of vas deferens
inability to take in water,(Concentrate urine)
Addisons crisis labs
Glucose 6 phosphatase def na/k labs
as a rule are hyperlipidemic: increased TG concentration decreases the volume of aqueous compartment
hypokalemia, hyponatremia can be factiticously seen
Neonatal presentation with neonatal thyrotoxicosis
mom with Hx of Graves
low birth weight
Rx neonatal thyrotoxicosis
dx: anti-TSH R ab transplacental
Rx: methimazole and B-Blocker if severe
What are infants of diabetic mothers at increased risk for?
Caudal regression syndrome
Congenital heart disease/septal hypertrophy
RDS (insulin delays surfactant production)