2 diseases with strawberry tongue?
Time to development of coronary artery aneurysms in Kawasaki disease? Risk of long term aspirin treatment for Kawasaki disease?
Risk of coronary artery aneurysm after Kawasaki disease and change in risk w Aspirin vs IVIG treatment in Kawasaki?
What happens to the ESR after the fever in Kawasaki disappears?
Complications of Kawasaki's?
Diseases associated with diffuse adenopathy? Palm/sole rash?
Rashes that start on trunk?
Fever in Erythema infectiosum (B19) vs Measles?
Rashes that follow fever?
Triad of RMSF?
Rash of SJS?
Who to suspect bacterial cervical adenitis in?
Appearance of someone with mycobacterial lymphadenitis?
Coughs that are worse at night? Dry coughs?
Barking cough?
Paroxysmal coughs?
Brassy/honking cough?
Change in voice implies what? Radiology findings in TB?
Who uses inhaled steroids?
Who gets methacholine, histamine, or exercise challenge? Abx to treat sinusitis?
Timing of sinus development? Complications of sinusitis?
Cause of rhonchi?
Stages of asthma exacerbation?
Cerebellar hemispheric vs deep cerebellar nuclei lesions?
Most common childhood brain tumors?
Classic vs common migraine?
Triad of ICP signs?
Complication of pseudutumor cerebri? Causes of pseudotumor cerebri?
Location of germ cell tumors in brain?
Presentation of supratentorial vs infratentorial tumor?
Male predominance of what types of brain tumors? Two peaks of incidence of brain tumors?
Ages where supra or infratentorial tumors are more common?
Who does post–infectious cerebellitis appear in?
Examples of toxins that can cause sudden ataxia?
Age of neuroblastoma/opsoclonus–myoclonus? Initial workup for CHF?
Murmurs associated with CHF?
When is a VSD first heard? EKG changes with VSD?
When are ASD and Coarctation detected? Most common murmur in kids?
What does Still's murmur sound like?
Digoxin and Lasix treat what?
Most common hip disorder in adolescents?
Complications of Legg–Calve–Perthes disease?
How long after and after what types of infections does reactive arthritis occu What action is impaired with a SCFE?
How is pain from transient synovitis and septic arthritis relieved? Key way to distinguish transient synovitis vs septic arthritis? What worsens pain with osteomyelitis?
Time of ESR vs CRP elevation?
3 reasons kids are at higher risk of dehydration?
Diagnosis of DKA?
Dx of diabetes?
Most common cause of diabetes–associated death in children? Replacement complications of hyponatremia and hypernatremia?
Cause of iso/hypo/hyper tonic/natremic dehydration?
Risk factors for cerebral edema?
Other Abs to check in DM workup?
Sodium concentration in oral rehydration solution? Where's the blood in malrotation (+/– volvulus)? Current jelly stools?
Electrolyte changes in vomiting from pyloric stenosis? Time of presentation of pyloric stenosis?
Most important characteristics of ear exam?
Appearance of TM in AOM? Bacterial causes of AOM?
Who do we treat AOM with amoxicillin–clavulanate with (as opposed to just am Alternative treatments for AOM?
Use of conventional vs visual reinforcement audiometry (VRA)?
Which hearing test is used in newborn assessments?
Findings associated with otitis external?
Who to use abx vs no abx for AOM?
Who should get a hearing test?
Test for 0–6yo that reports percent of children who successfully perform each Complications of untreated chronic OME?
Cause of RUQ pain in PID?
What should you ask the child to do during a rectal exam? Presentation of hernia?
Use of CT for abd pain? Use of US in abd pain?
Use of KUB in abd pain?
What causes Fitz–Hugh–Curtis?
Immediate treatment of hypoglycemia?
What can be given to inhibit insulin release with sulfonylurea overdose? EKG findings with TCA overdose?
2 causes of hypotension with TCA overdose?
2 types of breath holding spells?
Time period of colic?
Time of SIDS vs ALTE (apparent life threatening event)?
Other names for Mongolian spots?
Fracture that can be confused for abuse? Posterior rib fractures can result from what? What's the fattest baby" age?"
When is the physiologic nadir for Hgb?
What can cause false positive sweat test results? Screening vs confirmatory test for CF?
What percent of CF pts present with pancreatic insufficiency?
Pain scales by age?
Most common cause of abd pain in kids? First signs of chronic GI illness?
What percent of pts with HSP have guiac positive stool? 2 problems with barium enema?
Are crypt abscesses are more common with UC or CD? 2 studies to distinguish UC vs CD?
2 characteristics of Crohn's on barium enema?
Does UC or CD have a stronger inheritable component? Treatments for IBD?
When do you stop using prematurity corrected charts?
Most variable component of development?
When does the AAP recommend developmental screening? What causes pigeon–toe–ing?
How long does it take the pedal arch to develop? When does child gait look like an adult?
When do you screen for autism? 3 realms of changes in autism?
Which types of diseases will cause regression of milestones? Description of cerebral palsy?
Risk factors for cerebral palsy?
Sequence of events in retinopathy of prematurity?
Complication associated with IVH? Complications of kernicterus?
2 surgeries common in sickle cell patients? Cause of gallstones in sickle cell?
Which sickle cell pts get abx prophylaxis? PCV23 is given to who and when?
2 things that can worsen anemia with sickle cell pts? Who gets transcranial doppler (TCD) and why?
Causes of impaired height and weight in sickle cell?
What happens to the spleen of sickle cell pts?
Baseline Hgb in sickle cell?
Treatment of painful crises in sickle cell? Peak time of lymphoid tissue growth?
Most common infection with steroid use for nephrotic syndrome? Management of nephrotic syndrome?
What are pts with nephrotic syndrome predisposed to?
4 categories of MCD?
PID and TOA are best detected with which type of imaging? Chronic abd pain is best assessed with which type of imaging? Who needs to be seen immediately for a fever?
What is the worst measure of circulatory status?
What do the D and E stand for in the ABCDEs of assessment?
What's a practical problem with vasoconstriction in shock?
Next line of management if you can't get a peripheral IV in for a pt in shock?
Prophylaxis for meningococcus?
Complications of meningococcal meningitis?
Problem with penicillin treatment of meningococcus?
Contraindications to IO line?
Complications of IO line?
Sympathomimetic toxidrome?
Opioid toxidrome?
Sedative–hypnotic toxidrome?
Anticholinergic toxidrome?
Cholinergic toxidrome?
What is given with activated charcoal in poisoning cases?
Best tests for dx of von Willebrand's disease?
Genetics of vWD?
Meds to treat vWD?
Most common hereditary bleeding disorder? When does fever after a vaccine usually present?
3 clinical tests/findings in meningitis?
Most common organism in occult bacteremia?
How common is occult bacteremia in kids with fever? Indications for LP?
Who doesn't needed to be cultured for strep throat?
Treatment options for UTI?
Who should get a VCUG?
Who should get a renal technetium scan? How prevalent is VUR?
Management of grade 1–2 VUR?
What percent of pts with HSV gingivostomatitis are symptomatic?
Sequelae of bronchopulmonary dysplasia?
What is grunting a sign of?
Signs and cause of paradoxical breathing?
Sounds with narrowing of airways above vs below thoracic inlet?
Sounds from secretions causing airway narrowing? Cause of fine vs coarse crackles?
What should you get before getting a bronchoscopy? Dynamic eval over several breaths to see foreign body? Two manifestations of foreign body and findings on imaging?
Most consistent finding with Down syndrome? Findings on US with Down syndrome?
Standard karyotype test?
Purpose of annual CBC in pts with Down syndrome?
Which vaccines are first given at adolescence? Methods of calculating BMI?
Characterization of chest pain in precordial catch syndrome?
Tanner stage with increased penis length AND circumference?
Tanner stage with small amount of pubic hair but still childlike phallus?
Tanner stage with moderate curly pubic hair and phallus of increased length? Differentiation of costochondritis pain with precordial catch syndrome?
Symptoms of hypoglycemic syncope?
Erythema multiforme progression?
Common time of onset and treatment of candidal rash?
Selenium sulfide is used to treat what? Treatment of tinea capitis?
Zinc oxide is used to treat what? What can help distinguish it from other ras
Strength of steroids?
Location of staph folliculitis vs nodular/cystic acne? Pseudofolliculitis appearance?
Radiographic appearance of intussusception? Most common manifestations of HSP?
What is small for gestational age (SGA) most often due to? 3 risks for babies with SGA?
Presentation of polycythemia in infants? Respiratory distress
Poor feeding Hypoglycemia Sluggish blood flow"
Symmetric vs asymmetric IUGR?
5 basics of newborn resuscitation?
What percent of newborn and 12mo olds have palpable spleens?
Most common presentation of congenital CMV?
5 types of treatments for eczema?
2 things to prevent dental caries?
2 metabolic causes of hyperbili?
Severe manifestations of kernicterus?
Signs of kernicterus in those who survive?
When and how does biliary atresia usually present?
How does jaundice progress?
Time of breast feeding vs breast milk jaundice?
Is PE common in neonates?
Is prematurity a risk factor for TTN?
Are APGAR scores predictive of neurologic outcome?
Small, appropriate, and large for gestational age percentiles?
Complications of LGA?
What is Transient Tachypnea of the Newborn (TTN) due to and what is it also Causes of persistent pulmonary HTN of the newborn (PPHN)?
Which cardiac anomaly is associated with maternal diabetes? Best indicator of fetal malformations in moms with diabetes?
Relationship of respiratory rate and feedings?
Hypoglycemic glucose values that require intervention?
What can happen after giving a hyperinsulinemic infant glucose water? When are electrolyte values indicative of the infant's status?
What are the risk factors for DDH?
Distinguish neonatal seizures from jitteriness? Risks of home deliveries?
Definition of polycythemia in term newborn? When does OTC deficiency present?
Causes of large anterior fontanelle?
Causes of premature closure of anterior fontanelle?
Later symptoms of congenital hypothyroidism?
Most common time and presentation of botulism? Risk of adulthood obesity with childhood obesity?
Psychiatric condition with the highest comorbidity with ADHD? When to start vision and hearing screening?
Sequelae of obesity?
When to suspect secondary causes of HTN?
Who and how to screen for type 2 DM?
Causes of absent red reflex?
Times of administration of Hep B?
Times of administration of Rotavirus?
Times of administration of Hep A? Times of administration of Varicella?
Times of administration of MMR?
Times of administration of IPV?
Times of administration of PCV?
Times of administration of Hib?
EBV, CMV, HIV, Histo, Toxo, Mycobacteria, Measles, Lymphoma, Leukemia, Neuroblastoma, Rhabdomyosarcoma, Histiocytosis
Blistering, purpuric macules on face/trunk, erythema multiforme, severe mucosal changes (stomatitis) Strep pharyngitis_x000D_
Kawasaki disease 4 weeks_x000D_
(follow up with Cardiology within 2 weeks) Reye syndrome if you get the flu_x000D_ (make sure they get flu shots!)
20%_x000D_ down to 2–4%
Aspirin reduces febrile course of illness (DON'T use Ibuprofen)_x000D_ _x000D_
IVIG reduces risk of coronary artery aneurysm Stays elevated!_x000D_
_x000D_
(Platelets are also elevated) CNS (90%)_x000D_
Coronary artery aneurysm (20–25%)_x000D_ Liver dysfunction (40%)_x000D_ Arthritis (30%)_x000D_ Hydrops gallbladder (10%) Enterovirus (coxsackie)_x000D_ Syphilis_x000D_ RMSF_x000D_ Kawasaki
Varicella (mild fever after)_x000D_ _x000D_
Roseola (fever first) (in kids < 2) B19: temp of 100–101_x000D_ _x000D_
Measles: T > 101
B19: rash follows fever 7–10d later_x000D_ _x000D_
Roseola: rash 3–4d after fever Fever_x000D_
Headache_x000D_ Rash
High fever > 5 d_x000D_
Changes in oral mucosa_x000D_ Extremity changes (red/swell)_x000D_ Rash_x000D_
Conjunctivitis_x000D_ Cervical adenopathy
Laryngeal irritation (can be from rhinitis, GERD, etc)
When asthma is suspected but spirometry is normal 1–5 yo with recurrent URI, strep, or staph_x000D_ _x000D_
Pt has high fever, toxic appearance, sometimes cellulitis or fluctuance
Often appear well_x000D_ _x000D_
Nodes can rupture through skin though ––> tx with surgical excision
Asthma_x000D_ Sinusitis Environmental irritant_x000D_ Fungal infection_x000D_ Asthma Croup_x000D_ Subglottic disease_x000D_ Foreign body Pertussis_x000D_ Chlamydia_x000D_ Mycoplasma_x000D_ Foreign body Habitual cough_x000D_ Tracheitis
Primary complex (large hilar adenopathy with initial lung focus)_x000D_ Focal hyperinflation_x000D_
Atelectasis_x000D_
Small local pleural effusions
All pts with persistent asthma_x000D_ _x000D_
Need to monitor BP, glucose, growth delay, cataracts
Cefuroxime_x000D_ Amoxicillin–clavulanate
Ethmoid and maxillary at birth_x000D_ Frontal start around 6–8 yr
Orbital sinusitis_x000D_
Cavernous sinus thrombosis_x000D_ Meningitis_x000D_
Epidural abscess
Mucus/secretions in airways_x000D_ _x000D_
Continuous, low pitched, polyphonic Lymphoid hyperplasia_x000D_
Blindness from elevated pressure around optic nerve sheath
Pineal gland or suprasellar region
Early asthmatic reaction: 1 hr, PGs/LTs, permeability, hypersecretion, bronchoconstriction_x000D_
_x000D_
Late: 2–3 hrs later, epithelial destruction, fibrotic remodeling, hyperplasia of bronchial smooth muscle_x000D_
_x000D_
Airway hyperresponsiveness can persist for days to weeks
Hemispheric: limb abnormalities, nystagmus, tremor, dysmetria (spares speech)_x000D_
_x000D_
Deep nuclei: resting tremor, myoclonus, opsoclonus (neuroblastoma)
Medulloblastoma (20%)_x000D_ _x000D_
Juvenile pilocytic astrocytoma (20%) Classic has aura_x000D_
_x000D_
Common: no aura, more common HTN_x000D_
Bradycardia_x000D_ Irregular respiration
Obesity_x000D_
Meds (Vit A, tetracycline, OCPs, steroids)_x000D_ Metabolic disorders (galactosemia, hypo–PTH)_x000D_ Infection (sinusitis, OM)
Infratentorial: cerebellar signs, signs of raised ICP_x000D_ _x000D_
Supratentorial: focal motor and sensory abnl on opposite side of lesion
Medulloblastoma_x000D_ Ependymoma First decade_x000D_ 8th decade Supra < 2yo_x000D_ Infa in kids_x000D_ Supra in adolescents/adults 1–3 yo_x000D_
Several wks after viral infection (varicella, coxsackie)_x000D_ CSF w/ pleocytosis, high prot
Mumps_x000D_ Enterovirus_x000D_ EBV_x000D_
6mo to 3yo
Preschool age
2–4 wks after GI or GU infection Internal rotation
By opening the hip capsule (hold hip in flexion and external rotation)
Elevated ESR, CRP in septic arthritis (can wait for lab values before doing joint tap if low suspicion) Alcohol_x000D_
Anti–convulsants_x000D_ _x000D_
Often get dysmetria and nystagmus also
CXR_x000D_ EKG_x000D_
(save echo for later) Aortic stenosis_x000D_ Coarctation_x000D_ PDA_x000D_
VSD
Days to weeks of age_x000D_
– occurs as pulmonary resistance decreases Large: RVH and upright T wave in V1_x000D_ Moderate: LVH_x000D_
Small: nl
Innocent murmur_x000D_ 3–7 yo
Musical/vibratory_x000D_
Best heard LLSB, supine_x000D_ 3–7 yo
Symptoms of CHF_x000D_ _x000D_
– Digoxin: not good for VSD SCFE_x000D_
_x000D_
– posterior displacement of capital femoral epiphysis from femoral neck through cartilage growth plate
Femoral head deformity_x000D_ Degenerative arthritis_x000D_ _x000D_
often in boys 4–10 yo
Weight bearing_x000D_ _x000D_
Cerebral edema
45–50 mEq/L
Blood in stool but not in vomit
Hypochloremic, hypokalemic metabolic alkalosis 3–12 weeks
ESR: remains elevated for weeks after improvement_x000D_ _x000D_
CRP: elevated 4–6 hrs after initial insult, peaks at 36–50 hrs, and returns to normal after 3–7 days
1. Higher SA to body mass ratio_x000D_ 2. Higher basal metabolic rate_x000D_
3. Higher percentage of body weight that's water 1. Random BS > 200_x000D_
2. pH < 7.3 or HCO3 < 15_x000D_ 3. Mod–lg ketonuria or ketonemia
1. Sx and random glucose > 200_x000D_ 2. Fasting > 126_x000D_
3. 2–hr GTT > 200_x000D_ 4. HbA1c > 6.5
Hyponatremia: replacement can cause central pontine myelinolysis_x000D_ _x000D_
Hypernatremia: replacement can cause cerebral edema
Iso: AGE, diarrhea_x000D_
Hypo: adrenal insufficiency_x000D_
Hyper: breastfeeding failure, DI, inappropriate rehydration solutions
High BUN_x000D_
Acidosis with hypocapnia_x000D_
Attenuated rise in Na+ with treatment_x000D_ Admin of bicarb
Anti–pancreatic (Anti insulin, GAD, IA2)_x000D_ Autoimmune thyroiditis and celiac_x000D_ _x000D_
DON'T check TFTs (can be elevated due to non–thyroidal illness)
Intussusception_x000D_ _x000D_
– also bilious emesis, crampy abd pain, and sausage mass on exam
1. General obs_x000D_ 2. Eyes_x000D_
3. CV/Lungs/Abd_x000D_ 4. Ears/oral cavity
Bulging, yellow, poorly mobile
Kid with fever > 39C or moderate to severe otalgia
Denver II
Fitz–Hugh–Curtis
Bear down as you enter the rectum to relax the external sphincter
Abscesses and Appendicitis PID, tubo–ovarian abscess (TOA) Mobility and Position_x000D_ _x000D_
– Also color, translucency, and other
1/2. S. pneumo/Non–typeable H. inf_x000D_ 3. M. catarrhalis_x000D_ 4. S. pyogenes Azithromycin_x000D_ Erythromycin_x000D_ Clindamycin
VRA: good 6 mo to 2.5 yo, not ear specific_x000D_ _x000D_
Conventional: > 4yo, frequency–specific Otoacoustic emissions (OAE)_x000D_ _x000D_
– measure cochlear fxn in response to presentation of stimulus Bullous myringitis_x000D_
Radial vascular dilation (bicycle–spoke distribution)_x000D_ Marked erythema with cobblestone" appearance of TM"
Abx: < 6mo, 6mo to 2 yr: if certain dx or severe disease, >2 yo with severe illness_x000D_
_x000D_
No abx: 6mo to 2yr with uncertain dx, > 2yo without severe illness
Effusion > 3mo_x000D_ If nl, follow q3–6mo_x000D_
If not, consider bilateral myringotomy with tube placement
Permanent sensory neural hearing loss (SNHL)_x000D_ Tympanosclerosis_x000D_
Adhesive otitis media_x000D_ Cholesteatoma_x000D_
TM perforation_x000D_
Mastoiditis, Labyrinthitis, Meningitis_x000D_ Epidural/brain abscess
<1 yo, more F_x000D_
– Pain, irritability, vomiting, abd distention (if intestinal obstruction)
Chronic abd pain (IBD)_x000D_ Dx intussusception
Bacteria spills from uterus, tracks along paracolic gutter, and causes inflammation of the hepatic capsule and diaphragm
Octreotide
Toddler's fracture: fracture of tibia in walking children Squeezing baby's thorax (shaken baby syndrome) 4mo: 25% of weight is fat
Ileus_x000D_
Fluid levels_x000D_ Fecaliths (appy)_x000D_
Free air (perforated viscus)_x000D_ Malrotation_x000D_
Gallstones
20 cc/kg NS bolus_x000D_ D25 bolus_x000D_
Maintenance D10 drip
Wide complex tachycardia_x000D_ – inc PR interval_x000D_
– QRS widening_x000D_ – QT interval prolongation
Myocardial depression of Na+ channels_x000D_ _x000D_
Alpha–1 block
Pallid (acyanotic): associated with fall_x000D_ _x000D_
Cyanotic: associated with anger_x000D_ _x000D_
– occurs 6mo to 6yr
Several hours > 5 nights/week_x000D_ _x000D_
Age: > 2 wks, peaks at 6 wks, lessens by 3–4 mo SIDS: most are midnight to 6am_x000D_
_x000D_
ALTE: most are 8am–8pm
Congenital dermal melanocytoses_x000D_ _x000D_
Slate gray patches
Around 7–9 weeks_x000D_ Hgb 11_x000D_
Then starts to rise after Adrenal insufficiency_x000D_ Hypothyroidism
Screening (newborn): detects immunoreactive trypsinogen in blood_x000D_ _x000D_
Functional abdominal pain
50% are guiac positive
UC CD Language 9, 18, and 30 months 18 and 24 months 85–90%_x000D_
aka 10–15% don't have it (they have normal weight gain, normal stools) FLACC (face, legs, activity, cry, consolability) for non–verbal kids_x000D_ _x000D_
FACES: for 3–8 yo_x000D_ _x000D_
0–10 scale: > 8 yo
Slowing of weight gain (or especially weight loss)_x000D_ _x000D_
Change in height velocity suggests more long standing illness
1. Contrast delays potential colonoscopy_x000D_ _x000D_
2. Increased risk of toxic megacolon with UC
Upper GI study_x000D_ Colonoscopy
1. Cobblestoning_x000D_
2. Separation from nearby loops (bowel wall thickening) 1st line: aminosalicylates (mesalamine)_x000D_
––> Corticosteroids, abx (cipro, metro), immunomodulators (6–MP, MTX), anti–TNF
age 2_x000D_ _x000D_
premature infants should catch up by then
Internal tibial torsion_x000D_
– common in childhood, resolves with growth 8 yrs_x000D_
– can have flat feet until then 3 yo_x000D_
– heel strike present
1. Social interaction_x000D_ 2. Communication_x000D_
3. Restricted repetitive and stereotyped patterns Neurodegenerative disease_x000D_
Psychosocial
Heterogeneous group of non–progressive disorders_x000D_ – motor and postural dysfunction
Hemolytic anemia ––> bilirubin gallstones ––> cholelithiasis ––> cholecystitis
6–9
IVF and IV narcotics
Perinatal asphyxia (10%)_x000D_ Intrauterine infection (28%)_x000D_ Prematurity (78%)_x000D_
IUGR (34%)
Extraretinal fibrovascular proliferation_x000D_ Detachment_x000D_
Blindness/visual impairment_x000D_ _x000D_
– risk: BW < 1500g
Periventricular Leukomalacia (PVL)_x000D_ – damage from hypoxia, ischemia, inflammation
Abnl motor development (choreoathetoid cerebral palsy)_x000D_ Sensorineural hearing loss
Tonsillectomy_x000D_ Cholecystectomy
Age 2 mo to 5–6 yrs_x000D_ – oral penicillin BID
Pts with sickle cell get PCV23_x000D_ _x000D_
– 2yo and then repeat 3–5 yr later_x000D_ – same schedule for meningococcal
1. Myelosuppression by viruses (parvovirus)_x000D_ 2. Hypersplenism (spleen enlarges and traps RBCs) Sickle cell pts between 2–15 yo_x000D_
– determine risk of stroke (10% risk by 15 yo) Chronic anemia_x000D_
Poor nutrition_x000D_ Painful crises_x000D_
Endocrine dysfunction_x000D_ Poor pulmonary function
Becomes progressively fibrotic and no longer palpable by age 4–6_x000D_ _x000D_
Hgb SC or S–beta–thal can have splenic enlargement into adolescence
Age 4–6 yo_x000D_
– tonsils can be mildly enlarged during this time Spontaneous peritonitis_x000D_
– often S. pneumo or GNRs 1. Albumin infusion_x000D_ 2. IV furosemide_x000D_
3. Corticosteroids (taper over wks)_x000D_ 4. Sodium restriction (1500–2000 mg/d)
Ultrasound Barium study
Kids younger than 6–8 wks
Vasoconstriction can make it difficult to get a good pulse ox measurement
Rifampin, cipro, or ceftriaxone Venous thrombosis_x000D_
– urinary loss of anti–coagulants, lipids destabilize platelets, inc fibrinogen, inc blood viscosity (high Hct)
Steroid responsive_x000D_ Relapsing_x000D_
Steroid–dependent_x000D_ Resistant (––> bx)
Cold extremities_x000D_
(pt can be cold with adequate circulation)
D: disability (quick neuro assessment – ICP, toxidromes, etc) and dextrose (check for hypoglycemia)_x000D_
_x000D_
E: exposure/environment (expose all parts of pt, keep pt warm)
Intraosseus line_x000D_
– if peripheral IV can't be placed in 90 seconds_x000D_ – central line also acceptable in older kid or adult
11–19% get complications:_x000D_ – hearing loss_x000D_
– neuro disability_x000D_
– digit/limb amputations_x000D_ – skin scar
Doesn't eliminate carrier state._x000D_
– Need rifampin (kids, young adults) or cipro (adults) or 5–7 d ceftriaxone to eliminate carrier state
Osteogenesis imperfecta_x000D_ Fracture_x000D_
Recently used site_x000D_ Infection
Fracture_x000D_
Fluid into subQ (––> compartment syndrome)_x000D_ Osteomyelitis_x000D_
Microscopic fat, BM emboli Inhibit reuptake of NE_x000D_
Antagonize ACh (––> hypotension), Na+ channels (––> dysrhythmias), and GABA (––> seizure)
Mydriasis_x000D_ Fever_x000D_ Diaphoresis_x000D_ Tachycardia_x000D_ Agitation_x000D_ SZ Miosis_x000D_ Resp depression_x000D_ Hypotension_x000D_ Bradycardia_x000D_ Hypothermia_x000D_ AMS Miosis OR mydriasis_x000D_ Hypotension_x000D_ Bradycardia_x000D_ Hypothermia_x000D_ Sedation Mydriasis_x000D_ Dry skin_x000D_ Flushing_x000D_ Tachycardia_x000D_ Ileus_x000D_ Urinary retention_x000D_ Fever_x000D_ Delirium, SZ Miosis_x000D_ n/v/d_x000D_ Tears_x000D_ Sweating_x000D_ Urinating_x000D_ Bronchorrhea_x000D_ Bronchospasm_x000D_ Muscle twitch_x000D_ Bradycardia_x000D_ SZ, coma Cathartics_x000D_
– charcoal helps absorb the toxins and cathartics accelerate defecation Amenorrhea_x000D_
Bradycardia_x000D_
Postural hypotension_x000D_ Electrolyte abnormalities_x000D_
Continued deficiency of Ca, Mg_x000D_
S. pneumo
present in 3–5% of 3–36mo with fever
After second febrile UTI or with concerning findings on renal/bladder ultrasound Pts who don't respond to tx
Present in 25–50% of infants following first UTI Platelet function tests_x000D_
Factor VIII activity_x000D_
vWf antigen and activity (Ristocetin)_x000D_ aPTT (but can be normal, other tests are better)
Autosomal dominant with variable penetrance: Type 1 and 2_x000D_ _x000D_
Autosomal recessive: Type 3
Intranasal or IV desmopressin_x000D_ vWF_x000D_
OCPs/levonorgestrel IUD (for menorrhagia) von Willebrand's disease_x000D_
– 1% of population
Usually 24–72 hours after_x000D_ _x000D_
MMR and Varicella: can be 7–10d after 1. Kernig's: resist knee extension_x000D_
2. Brudzinski's: flex hip/knee in response to neck flexion_x000D_ 3. Opisthotonos: hyperextension of neck and spine_x000D_ _x000D_
– often NOT positive in infants <12mo
<3 or <12 mo (depends on clinician)_x000D_ toxic appearing_x000D_
WBC > 15,000 with left shift_x000D_ T > 40
Kids <2yo_x000D_
Strep throat uncommon in young kids and ARF very rare in kids < 3yo Ampicillin (E coli often resistant)_x000D_
Ceftriaxone (careful of ppts with Ca)_x000D_ Piperacillin/tazobactam (expensive)_x000D_ Ciprofloxacin (kids > 1 yo)_x000D_
TMP–SMX: good
Most common type_x000D_
– most often resolves spontaneously in 2–5 yrs_x000D_
– PCP can follow (whereas grade 3–5 needs to be referred to urology)
Exposes pt to smaller doses of radiation than VCUG_x000D_ – preferred imaging study to follow pts with VUR
Rhonchi
Obtain imaging (x–ray or fluoroscopy) first Chest fluoroscopy
Only 10–30%_x000D_
– some just have fever and irritability_x000D_ – most common in 10 mo – 3 yr
Increased caloric requirement_x000D_ Illness_x000D_
Neuro disease
Respiratory distress_x000D_ – closure of glottis with expiration
Chest drawn in with inspiration, abd rises_x000D_
– Force of contraction from diaphragm >> ability of chest wall muscles to expand
Above: stridor_x000D_ _x000D_
Below: wheezing
Coarse: purulent secretions in alveoli_x000D_ _x000D_
Fine: pulmonary edema, interstitial disease
Partial obstruction: get air trapping/hyperinflation_x000D_ _x000D_
Complete obstruction: get atelectasis, signs of volume loss of x–ray (mediastinal shift)
#1 finding = Hypotonia_x000D_ – small ears are also common Nuchal skin thickness_x000D_ Nasal bone ossification_x000D_ Growth parameters
Lymphocyte karyotype_x000D_ – easier than skin fibroblasts
Infancy: leukemoid rxn, transient myeloproliferative disorders (TMD)_x000D_
_x000D_
> 1 yo: iron deficiency anemia Tdap_x000D_
Meningococcal
Total body water_x000D_ Total body potassium_x000D_ Bioelectrical impedance_x000D_ Dual–energy x–ray absorptiometry
Stage 4 Stage 2 Stage 3
Costochondritis: lasts hrs to days (compared to seconds to minutes)
Tinea versicolor
PO griseofulvin, 6–8 wks
Clobetasol > Betamethasone > triamcinolone > hydrocortisone Folliculitis often below waste/groin
Mass with central ring of hypoattenuation (mesenteric fat in intussusceptum)
Constitutional factors – maternal ethnicity, parity, weight, height
Ruddy"/red color to skin
Sudden, sporadic onset, sharp_x000D_ Location: LSB_x000D_
Exacerbated by deep inspiration_x000D_ Lasts sec to min_x000D_
Resolves spontaneously
Diaphoresis_x000D_ Anxiety_x000D_
Tremulousness_x000D_ Hunger
Dusky red macules ––> wheals ––> target lesions ––> fixed for 1–3 wks_x000D_
_x000D_
Most common with HSV, meds
Diaper dermatitis, 7–10 mo (can also have satellite lesions)_x000D_ _x000D_
Tx: nystatin or imidazole antifungals
Irritant dermatitis_x000D_ _x000D_
– spares intertriginous creases
Papules NOT pustules_x000D_
– distinguish from acne by presence of inflammation 75% – arthritis_x000D_
65% – colicky abd pain_x000D_ 25% – renal involvement_x000D_ 5–10% – intussusception
Hypoglycemia_x000D_ Hypothermia_x000D_ Polycythemia
Opisthotonus, rigidity, oculomotor paralysis, tremor, hearing loss, ataxia Symmetric: both head and abd circumference decreased
proportionately_x000D_ _x000D_
Asymmetric: greater decrease in abd than head (head sparing phenomenon")"
Dry_x000D_
Warm (large SA/V)_x000D_ Position_x000D_
Suction_x000D_
Stimulate (vigorous cry) 30% of newborns_x000D_ 10% of 12 mo_x000D_ _x000D_
Often palpable 1–2cm below L costal margin
> 90% have no clinical evidence of disease as newborns_x000D_ _x000D_
But 40% are SGA, 30% preterm, 25% of males have inguinal hernias
Lubrication_x000D_
Anti–inflammatories_x000D_ Topical hydrocortisone_x000D_
Antihistamines (sedating and non)_x000D_ Calcineurin inhibitors
Stop bottle feeding by 12–15 mo_x000D_ _x000D_
Fluoride (promotes re–mineralization of Ca into enamel) Galactosemia_x000D_
_x000D_
Hypothyroidism
Lose suck reflex_x000D_ Lethargy_x000D_
Irritability_x000D_ Seizures_x000D_ Death
> 2 wks_x000D_
Direct hyperbili (progressive)_x000D_ Acholic stools
Cephalocaudal direction_x000D_
– 4–5 at face, 10–15 below knees_x000D_
– dermal zones often underestimate true level though >/= 24 hrs after birth_x000D_
– earlier: might miss PKU and other metabolic disorders that require accumulation
NO. Often only occurs with underlying clotting disorder or placement of central venous catheter
Transposition of the great arteries (TGA)
Babies with RR > 80 often can't tolerate oral or NG feeds and need IV nutrition
Rebound hypoglycemia 1–2 hrs after Breast feeding: early 1st week_x000D_ _x000D_
Breast milk: first 4–7d, peaks 10–14d, can last up to 12 wks
NO_x000D_ _x000D_
TTN: more common in term babies_x000D_ – risks: mother with DM, C/S delivery
NO_x000D_ _x000D_
– Documented asphyxia is correlated with neuro outcome. Check cord arterial blood gas for acidosis.
SGA: < 10th %_x000D_ AGA: 10–90th %_x000D_ LGA: > 90th %
Fractured clavicle_x000D_ Brachial plexus injury_x000D_ Facial nerve palsy_x000D_
Complications of C/S, forceps, and vacuum_x000D_ Hypoglycemia
Delayed absorption of pulmonary fluid_x000D_ – aka persistent postnatal pulmonary edema. Meconium aspiration syndrome_x000D_ Diaphragmatic hernia_x000D_
Hypoplastic lungs_x000D_ In utero asphyxia
Major malformations are directly related to the First–Trimester HbA1C level_x000D_
– HbA1C levels >12: 12x risk
< 35 if asymptomatic_x000D_ _x000D_
< 45 if symptomatic
After 12–24 hours_x000D_ _x000D_
– sooner: indicative of mother's status and any medications administered
– Breech position: 30–50% of DDH cases occur in infants born in the breech position._x000D_
– Gender: 9:1 female predominance._x000D_ – Family history.
Myelopathic signs/sx for atlantoaxial instability_x000D_ – importance of cervical spine positioning during procedures
Jitteriness: stimulus–sensitive movements, generalized symmetric
> 65%
ODD/CD
Neonatal tetanus_x000D_ Omphalitis_x000D_
Hemorrhagic disease of the newborn (with no Vitamin K)
1–2 days_x000D_
– sx due to protein in breast milk or formula ––> poor feeding, lethargy, and vomiting
Skeletal disorders (rickets, osteogenesis imperfecta)_x000D_ Chromosomal abnl (Down)_x000D_
Hypothyroid_x000D_ Malnutrition_x000D_ ICP Microcephaly_x000D_ Craniosynostosis_x000D_ Hyperthyroidism_x000D_ Nl variant Large tongue_x000D_ Hoarse cry_x000D_
Puffy myxedematous facies 3–4 mo_x000D_
poor suck and weak cry 20% of obese 4 yo_x000D_ 80% of obese adolescents Vision: start 3 yr_x000D_ _x000D_
Hearing: newborns, then resume at 4 mo Sleep apnea (7% of overweight)_x000D_ Dyslipidemia_x000D_
HTN (33% of obese)_x000D_ Nonalcoholic fatty liver In young kids_x000D_ _x000D_
> 6 yo: most is primary
> 10 yo or puberty onset_x000D_
q2 yr with fasting serum glucose_x000D_ _x000D_
– overweight, FH, race/ethnicity, insulin resistance (AN, PCOS, HTN, dyslipid)
< 2 yo: rear facing car seat_x000D_ 2–4 yo: forward facing car seat_x000D_ 4–8 yo: belt booster seat
12 mo, second dose 6 months after and before 2nd birthday Cataracts_x000D_ Glaucoma_x000D_ Retinoblastoma_x000D_ Chorioretinitis 0, 1, 6 mo_x000D_ _x000D_ 3 times 2, 4, 6 mo_x000D_ _x000D_ 3 times 1 yr and 4–6 yr_x000D_ _x000D_ 2 times_x000D_ – same as MMR 1 yr and 4–6 yr_x000D_ _x000D_ 2 times_x000D_ – same as Varicella 2, 4, 6 mo, 4–6 yr_x000D_ _x000D_ 4 times 2, 4, 6, 12 mo_x000D_ _x000D_ 4 times_x000D_ – same as Hib 2, 4, 6, 12 mo_x000D_ _x000D_ 4 times_x000D_ – same as PCV 2, 4, 6, 15mo, 4–6 yr_x000D_ _x000D_ 5 times_x000D_
EBV, CMV, HIV, Histo, Toxo, Mycobacteria, Measles, Lymphoma, Leukemia, Neuroblastoma, Rhabdomyosarcoma, Histiocytosis
NO. Often only occurs with underlying clotting disorder or placement of central venous catheter
