Doctor High Yield Pediatrics

neonate 0-3m old:

most common bugs

empiric tx

GBS

E coli

Listeria

suspect PNA or meningitis--> tx ampicillin and gentamicin

>3m/o:

most common bugs

empiric tx

strep pna

h flu

moraxella

tx vancomycin, ceftriaxone

CSF findings b/w bacterial, viral, and fungal: WBC, glucose, proteins

TB CSF findings

looks like fungal: WBC= lymphocytes, low glucose

TB mengitis imaging findings

basilar enhancement

HSV meningitis imaging findingd

temporal lobe involvement + seizures

if bacterial sinusitis ascends, what CN are affected

CN 3, 4, V1, V2, V6

diphtheria presentation and tx

blue grey membrane on posterior pharynx

no DTAP

tx: diphtheria antitoxin

more pain with ear pulling-- OE or OM?

OE

fluid bubbles behind TM-- tx?

supportive

infected LN-- bug?

staph aureus

u/l v b/l parotitis-- cause?

b/l= mumps

u/l= staph aureus

impetigo tx

mupirocin

erysipelas and cellulitis cause and difference

strep pyogenes

diff:

erysipelas= rapid onset in 1 day w/ very sharp borders (dermal lymphatic infection)

nec fasc + crepitus-- cause

clostridium perfringes

PSGN v IgA nephropathy

PSGN

- start w/ strep

- 2 weeks later: cola colored urine 2/2 glomerular bleeding w/ dysmorphic RBC

IgA nephropathy

- happens w/i 3-5 days after URI

- hematuria

Rubella vs. Measles (Rubeola) differentiation and tx

Maculopapular rash (both start up top and descend down)

rubella-- more joint pain

- TX: supportive

- fetus can get PDA, pulm stenosis

measles-- cough, coryza, conjunctivitis

- TX: vit A

aspergillus key lab finding

eosinophils!!!

likes upper lobes of lung

TB

silicosis

aspergillus

malaria on histo

presentation of toxoplasma for fetus

chorioretinitis

hydrocephalus

intracranial calficications

RMSF rash

rash move from peripheral to center

erlichia presentation

decreased WBC after tick bite

lyme dz presentation

erythema migrans

babesia presentation

evidence of hemolysis

latent v active TB tx

active: rifampin, isoniazid, pyrazinamide, ethambutol

latent: isoniazid x9m if + PPD but - CXR

active TB dx based on PPD findings

15cm+ in regular population

10cm+ in healthcare workers, incarcerated, immigrants, kids <4 y/o

5cm+ in close contact w/ TB pt or if pt has HIV/AIDS

fixed, split S2

ASD

coarctation of aorta tx

prostaglandins

if kid given 100% O2 and PaO2 doesn't rise=

congenital heart defect

does rise= lung problem

transposition of great vessels tx

associated w/?

arterial switch + keep PDA open

associated w/ gestational DM

only cyanotic heart condition w/ LVH

tricuspid atresia

who need ppx abx prior to dental procedures?

hx of congenital heart disease

prosthetic heart valves

previous infective endocarditis

fetus w/ complete heart block-- what does mom have?

lupus

tetralogy of fallot findings in heart and presentation

VSD

pulmonic stenosis

overriding aorta

RVH

tet spells to increase total peripheral resistance

holosystolic murmur ddx

MR, TR, VSD

most common cardiac defect

VSD

laryngomalacia v vascular ring

laryngomalacia= collapsed larynx, p/w inspiratory stridor, worse when supine

vascular ring= caused by anomaly of aortic arch stroking trachea, p/w inspiratory and expiratory stridor, better w/ extension of neck

croup cause

parainfluenza

croup tx

1- cool mist

2- systemic steroids

3- racemic epi (stridor at rest + respiratory distress)

bacterial tracheitis bug

staph aureus

croup advances

atelectasis=

collapsed lung

bronchiolitis cause

RSV

bronchiolitis presentation

nonspecific URI, <2 y/o, progresses to asthma-like presentation w/ tachypnea and crackles

cxr: hyperinflation, atelectasis

tx: supportive

b/l infiltrates on CXR-- what bugs most likely?

mycoplasma, chlamydia, legionella

chlamydia PNA key

buzzword: staccato cough

eos

pertussis tx

macrolides

asthma dx and tx

CF pathophys

CFTR channel actively secretes Cl- into lungs and GI tract, and actively reabsorbs Cl- from sweat. misfolded protein->retained in RER-> dec Cl (and H2O) secretion->inc intracell Cl-> compensate inc Na reab via epi Na channels-> inc H20 reab-> abnrl thick mucus and negative transepi potential diff, bronchiectasis

kid w/ abdominal pain, nausea, bilious vomiting

midgut volvulus

midgut volvulus dx modality

upper GI series

jejunal atresia dx and association

triple bubble sign

maternal cocaine use

duodenal atresia dx and association

double bubble sign

Down's syndrome

intussusception tx

air enema

no barium!!

meckel's diverticulum v intussusception

meckel's w/ painless bleeding

necrotizing enterocolitis presentation

premie baby who feeds too early then later has rectal bleeding

XR: pneumocystis intestinalis (air in intestinal wall)

criggler najjar cause and lab

deficiency in glucornyl transferase --> unconjugated hyperbili

most common nephrotic syndrome, histo?

MCD

histo: podocyte foot process effacement

most common hypercoagulable state in nephrotic syndrome

renal vein thrombosis= sudden onset flank pain

encapsulated organisms mnemonic

please SHiNE MY SKiS

Pseudomonas

Strep pneumo

H flu

Neisseria

E coli

MYcoplasma

Salmonella

Klebsiella

gbS

TTP: mnemonic for symptoms

FAT RN

Fever

Anemia

Thrombocytopenia

Renal

Neuro

too much VW factor= increased plt adhesion--> blocks up arteries --> shistocytes

uremia manifestations

pericarditis

HUS

plt dysfunction

alport syndrome sx

hematuria and deafness

RTA type 1

1 letter= can't excrete H+

kidney stONEs

RTA Type 2

2 letters= Bi

Bicarb

RTA Type 4

4 letters= aldo

hypoaldosterone

*HyperK

posterior urethral valves-- when to suspect? dx?

oligohydramnios

boy who was just born and hasn't urinated

dx: VCUG

high pH kidney stone

proteus= struvite stones

Wernig-Hoffman disease

looks like botulism but has been present since birth

signs of botulism

constipation

dilated pupils

tachycardia

flaccid paralysis

dandy walker

no cerebellum, enlarged 4th ventricle

tuberous sclerosis sx and tx

tx: ACTH

angiomyolipoma= benign renal neoplasm composed of fat, vascular, and smooth muscle

sumatriptan MOA

serotonin agonist

Cytoalbuminologic dissociation

GBS

= high protein in the cerebrospinal fluid without many (usually less than 6) white blood cells

tx for GBS

IVIG and plasmapheresis

Duchenne muscular dystrophy v becker's

duchenne= happens earlier and can't survive

baby only drinking cow milk -->

vit D deficiency

baby only drinking goat milk -->

folate deficiency

vWD labs

increased bleeding time since PLT don't stick

increased PTT

wilms tumor v neuroblastoma

wilms WILL not cross

neuroblastoma will cross w/ dancing eyes and dancing feet and flushing

VACTERL v CHARGE

VACTERL w/ anal atresia

ewing sarcoma dx

onion skinning

w. small round blue cells

osteosarcoma dx

codman's angle and sunburst pattern

osteoid osteoma

lytic bone lesion on bone cortex

CVID labs

low Ab only

SCID labs

low B

low T

low Ab

looks like AIDS

bruton labs

low B cells

XLR inheritance

CGD presentation

no oxidative burst --> Cat+ bugs infxn (S aureus, Escherichia coli, Candida, Klebsiella, Pseudo- monas, Aspergillus)

tx: BMT

chediak higashi

albinism, peripheral neuropathy, neutropenia

↑ Incidence of overwhelming pyogenic infections withS pyogenes, S aureus, and Pneumococcus species

giant granules in neutrophils

rashes that occur on hands

kawasaki KARS

kawasaki dz

coxsackie A

Rickettsia

Syphillis

lupus tx

NSAIDs + hydroxychloroquine

dermatomyositis presentation and association

weakness + grotton's papules + heliotrope rash

elevated CPK

underlying cancer!!

lyme dz <8 y/o-- tx w.?

amoxicillin

cant use doxy because affects teeth

down's syndrome GI associations

duodenal atresia

hirschsprung dz= FTPM + bilious vomiting w.i 48h of life

spondylolysis vs spondylolisthesis

Spondylolysis

- Stress fracture of the pars interarticularis - scotty dog

- Seen in dancers, gymnasts, lifters

Spondylolisthesis

- Vertebral sliding (step-off)

- Seen in dancers and gymnasts

developmental dysplasia of the hip sx and tx

malformed acetabulum w/ clunking hip, asymmetric buttfold

tx: pavlik harness

SCFE sx and tx

epiphysis of femur slips

fat kid, ~12 y/o

tx: surgical pinning

Legg-Calve-Perthes Disease

idiopathic avascular necrosis

tx: PT

septic arthritis v transient synovitis

septic= can't bear weight, systemic sx

transient= no systemic sx, recent URI or diarrhea

red joint-- first step?

aspirate!

50k+ WBC= need abx