Step 3 - Pediatrics

management of the newborn

blue/gray macules on presacral back/posterior thigh; usually fade in first few years

firm, yellow, white papules/pustules with ery base which peak on the second day of life

Permanent unilateral vascular malformation

Red, sharply demarcated, raised lesions appearing in first 2 mos, rapidly expand and involute in 5-9years

preauricular tags/pits; assoc with hearing loss and GU abn

defect in iris

change syndrome

absence of iris

mass lateral to midline

Mass in midline that moves with swallowing and tongue protrusion

GI tract protrusion through umbillicus with sac

abdominal defect lateral to midline w/o sac

congenital weakness where vessels of the fetal and infant umbilical cord exitited through rectus abd muscle

scrotal swelling with translumination

Unilateral absence of testes in scrotal sac

urethral opening on ventral surface

urethral opening on dorsal surface

inguinal buldge or reducible scrotal swelling

lab abn in the infant of a diabetic mother

assoc abn in the infant of a diabetic mother

test for a neonate in RDS

complications of neonatal RDS

term newborn delivered by C-sec or rapid second phase labor with tachypnea, usu resolves in 24-48hrs

CXR after meconium aspiration shows?

tx of meconium aspiration

complications of meconium aspiration

pt with respiratory distress and scaphoid abdomen

associated with meconium plugs

Meconium ileus assoc with

VACTERL abn

ddx of double bubble on xr

premature infant with low apgar and blood stools, apnea, lethargy; abd wall erythema and distention

NEC dx and tx

xr finding of NEC

pathologic jaundice

Physiologic Jaundice

when is hyperbili pathologic

jaundice in first 24 hours, what is the workup?

if jaundice>2wks and no elevation in conjugated bili what to consider?

prolonged jaundice and elevation of conjugated bili

feared complication of jaundice

tx jaundice

early onset sepsis (first 24hrs)

late onset sepsis (after first 24hrs)

emperic sepsis abx

general features of TORCH infections

toxoplasmosis in newborn

rubella in newborn

CMV in newborn

herpes in newborn

syphilis in newborn

varicella in newborn

dx work up of seizures in a newborn

tx of seizures in newborn

WD of from drugs in first 48hours

WD in newborn seen in first 96hrs up to 2 wks

infants of addicted mothers are higher risk of what

tx of oppiod WD in infant

anesthetics effect on neonate

barbiturate effect on neonate

mag sulfate effect on neonate

phenobarb effect on neonate

sulfonamides effect on neonate

NSAIDs effect on neonate

ACE I effects on neonates

isotretinoin effect on neonate

phenytoin effects on neonate

DES effect on neonate

tetracycline effect on neonate

Lithium effect on neonate

Warfarin effect on neonate

valproate and carbamazepine

patient with upward slanting palpebral fissures, speckling of iris, inner epicanthal folds, small stature, late fontanel closure, MR

dx work up/ assoc with trisomy 21

low set, malformed ears, microcephaly, micrognathia, clenched hand, rocker bottom feet, hammer toe, omphalocele

dx workup of trisomy 18

defect of midface, eye, forebrain development, holoprosencephaly, microcephaly, micropthalmia, cleft lip/palate

dx workup of trisomy 13

WAGR syndrome

low IQ, behavioral problems, slim with long limbs, gynocomastia

dx workup of klinefelter syndrome

Small stature female, gonadal dysgenisis, low IQ, congenital lymphadema, webbed posterior neck, broad chest, wide spaced nipples

dx workup with turner's

macrocephaly in early age, large ears, large testes, most common cause of MR in boys

multiorgan enlargement, macrosomia, macroglossia, pancreatic beta cell hyperplasia so hypoglycemia, large kidneys with neonatal polycythemia

dx workup of beckwith-wiedemann

obesity, MR, binge eating, small genitalia; decreased life expectancy due to obesity

MR, inappropriate laughter, absent speech of <6 words, ataxia, and jerky arm movements resemble puppet gait and recurrent seizures

mandibular hypoplasia, cleft palate; obs possible over first four weeks of life

birth weight doubles by 6 mos and triples by first year

height percentile at 2 years correlates with final adult height

indicator of acute malnutrition

best indicator of under or over weight

skeletal maturity is related to sexual maturity

most common cause of failure to thrive

when do you work up growth in child

ddx of growth pattern with dec weight and dec lenght/height

normal weight gain, but decrease in height

ddx of growth pattern with dec weight gain equal to dec length

advantages to breastfeeding

contraindications to breastfeeding

drugs that make breastfeeding contraindicated

infant reflexes that appear at birth and diappear at 4-6mos

infant reflexs present at 6-8mos and persist

present at 9 mo

present at 12mos of age

present at 15mos of age

present at 18mos of age

present at 2 years of age

present at 3 years of age

present at 4 years of age

invol voiding urine at least twice a week for at least 3mos in childern over 5 yo

dx testing of enuresis

tx of enuresis

unintentional passge of feces in clothes etc in children > 4

dx testing for Encopresis

tx encopresis

are immunizations altered for LBW or premature infants

dont give live vaccines to immunocompromised pts

following are not contraindications to immunizations

egg allergy not contraindication for MMR, yellow fever, and flu vaccine

MMR does not cause autism or IBD

hep b vaccine does not cause demyelinating neuro disorders

Meningiococcal vaccine not related to development of GBS

review vaccine schedule chart

immunization ppx after exp to measles

ppx immunization after exp to varicella

Hep exposure ppx

mumps and rubella post exp

Hep B vaccine schedule

DTaP vaccine schedule

HiB vaccine

has been associated with herpes zoster development after immunization

dx tests for child abuse

tx steps of child abuse

child age 3mo-5yr with URTI, rhionrheaa, sore throat, hoarse, deep bark cough, insp stridor, tachypnea, worse a night

management for croup

sudden onsent muffled voice, drooling, dyphagia, high fever and stridor; pts sits tripod and toxic appears

mgmt of epiglotitis

what abx is needed as PPX for family contacts to epigolotits pt

Brassy cough, high fever, respiratory distress, but no drooling or dysphagia; child<3yrs usually occurs after viral URTI

gray white pharyengeal membrane, may cover soft palate and bleeds easily

sudden coughing of choking w/o warning

patient drooling and difficult swallowing

patient has continued symptoms with treatment

sudden allergic reaction with swelling, needs steroids and epi or intubation

severe cough develops after 1-2wks with whoop and spells, look for child with incomplete immunization history

what do you r/o if recurrent respiratory infections in a child

bronchiolitis basics

best prevention against bronchiolitis

child<2 with mild URI, fever, Parosyxmal wheezy cough, dyspnea, tachypnea, Apnea; wheezing prolonged expirations

dx, tx, and prevention of bronchiolitis

URI symps, low grade fever, tachypnea

acute onset, sudden, shaking chills, high fever, prominent cough, Pleuritic CP, diminished breath sounds, dullness to percussion

infants 1-3mos of age with insidious onset, no fever or wheeze, staccato cough and peripheral eosinophillia, maybe conjunctivitis at birth

CXR viral PNA

CXR of Pneumococcal PNA

CXR of mycoplasma/Chlamydia

Dx of PNA in children

tx PNA in child

infant with meconium ileus, FTT, malabs, steatorrhea, vit ADEK def, rectal prolapse, persistent cough. Assoc with undescended testes, infertility (no vas deferns), ABPA

dx tests of CF

tx of CF

acyanotic congenital HD

cyanotic defects

what causes delayed presentation of CHD

presentation of CHD

abn of exam of CHD

murmur heard with fever, infection or anxiety; only systolic; grade<2/6

Dx testing of CHD

Harsh holosystolic murmur over L sternal border, loud pulmonic S2; half close spont in first 6mos; surgical repair if FTT, pulm HTN, or R to L shunt

Loud S1, wide fix split S2, systolic ejection murmur along left upper sternal border, most ASx and close by 4 (secundum type) if primary they need surgery; PFO needs closure if embolic occur

Combo of primum ASD, VSD adn common AV valve; presents like VSD; surgery in infancy before pulm htn develops

can be asx or result CHD, give PGE1 at birth, attempt balloon valvuloplasty

wide pulse pressure, bounding arterial pulses, machine gun murmur; use intomethacin in preme's to close it; term infants need surgery closure

early systolic ejection click at apex of left sternal border, replace valve and anticoagulate

BP higher in arms than legs, PDA dependent so give PGE1 to maintain; repair after stabalize

VSD + RVH + Routflow obs + overidding aorta; RV impulse, thrill along L sternal border; hyperpnea, irritability, cyanosis

more common in IODM, S2 single and loud, murmur absent, ductus dependent; Sx needed

abx ppx for endocarditis

blood pressure >95% on nomogram

Secondary causes HTN in newborn

early childhood causes of secondary HTN

adolescent causes of HTN

causes of Renal vascular HTN in children

Dx testing for secondary HTN

causes of acute diarrhea

dx testing for acute diarrhea

initial tx for acute diarrhea

tx of shigella diarrhea

tx of campylobacter diarrhea

salmonella diarrhea tx

Tx C. Diff diarrhea

tx of E. histolytica or Giardia

tx Cryptosporidium

young child 5-10d after infection with pallor, weakness, oliguria, and acute renal failure

fat malabs testing

Carbohydrate malabs

protein malabs

with malabs test for vit def

child with chronic diarrhea, FTT, GR, anorexia

Celiac patients have increased risk of what

tx of GERD in infant

first 6wks of life, vomit after feeds, hypoCl and met alkalosis and firm abd mass

painless rectal bleed in an infant

tx of cystits and pyelo in kids

do not give the follow abx in kids

further mgmt of UTI in kids

if VCUG shows reflux

most common causes of obs uropathy

presents in children 5-12yo, 1-2wks after strep or 3-6wks after impetigo; see edema, HTN, and hematuria

Dx test for APGN

tx APGN

has a normal C3 presents after URI, in 20-30yo and need BP control

b/l flank masses and hypoplasia, HTN, oliguria, ARF

MCD tx

complications of nephrotic syndrome

most common cause of CAH (aut recessive)

infant with vomitting, dehydrated, hyponatremia, hypoglycemia, hyperkalemia, ambiguous genitalia at birth

labs for CAH

tx CAH

patient with fever for 5days has b/l conjuctivits w/o exudate, strawberry tongue, dry cracked lips, erythema and swelling of hands and desquemation of fingertips, nonvesicular rash, cervical LAD

dx testing for Kawasaki dz

tx of kawasaki dz

2-8 yo child with Maculopapular rash (purpura), fever, abd pain, hx of URI

HSP assoc with what

dx test for HSP

tx HSP

anemia is common in the term and exagerated in the preterm infant?

when do you seen anemia from decreased iron intake in infants

tx iron def anemia in infants

child with hyperactivity, aggression, learning disability, impaired growth, constipation and mental lethargy

screening for lead poisoning

tx of lead poisoning in kids

most common causes of mortality in pediatric SCD

Dx testing of SCD

transfusion in SCD

when do we give hydroxyurea

routine care for SCD

Defenitive tx of SCD

2nd month of life, prog anemia, hypersplenism, and cardiac decompensation, expanded medulary space with inc expansion of face and skull, extramedullary hematopoesis; hepatosplenomegaly

dx test for Beta thal

tx of beta thal

what is increased in coags for Hemophelia A and B

what coags are off in VWD

clotting factor assay show decreased levels of factor 8 or 9

quantitative assay for vWF ag, vWF activity

mixing study results

tx of hemophillia A

tx of hemophillia B

tx VWF disease

if hemophelliac prior controlled now not what do you do

ITP basics

tx of ITP

PE in ITP

febrile seizure has increased risk of epilepsy based on what factors

define epilepsy

when to stop seizure medications

EEG and tx of Absence Sz

jerky movements in the morning at the onset of adolescence

JME EEG and tx

infantile spasms for first year of life, 75% have underlying CNS problem (usu Downs)

West syndrome EEG and tx

simple partial sz description

tx of simple or complex partial sz

generalized sz description

generalized sz EEG and tx

fever of unk focus is <1 week but FUO is >3 wk duration

fever of unknown focus get empiric abx if....

fever of unknown focus in neonate

fever of unknown focus in infant

complications of menegitis

complication of S. pneumo menegitis

complication of HiB menegitis

complication of meningococcus

ppx abx for n. menegitis and Hib only?