COMQUEST (PEDS)

Oral penicillin with a beta lactamase inhibitor

What is the treatment for uncomplicated acute bacterial sinusitis (UR symptoms that persist longer than 10 days or worsen after initial improvement)

Oral cephalexin (first gen ceph)

Children 2 months or older with febrile urinary tract infections can be treated with

Tay Sachs

Child in the first month of life with progressive neurologic delay, no hepatosplenomegaly, exaggerated response to sound, cherry retina (vision issues)

Renal and bladder US

Bilateral hydronephrosis is a male newborn is suspicious for POSTERIOR urethral values —> what test should be performed

Neurofirbromatosis type 1

Pt is less than 10 years old with hyper pigmented lesions greater than 5 mm with a family hx of seizure disorder, axillary or inguinal freckles, optic glioma, lisch nodules

Vitamin K deficiency

Newborn had a home birth bleeding from rectum, circumcision, nose, umbilicus

Severe malaria in children

nonspecific febrile illness (e.g., fever, chills, headache, diaphoresis, abdominal pain, nausea, and vomiting) and should be suspected in any patient presenting with a febrile illness who has a history of travel to an endemic area.

progress to altered levels of consciousness, seizures, metabolic acidosis, and severe anemia.

Hypoglycemia is another characteristic feature of _________

Immune thrombocytopenia

isolated thrombocytopenia (platelet count less than 100 x 10/mcL) associated with the acute onset of a petechial rash, bruising, or bleeding in an otherwise healthy child.

Hypoplastic left heart syndrome

Presents in the first 24 to 48 hours of life with signs and symptoms of cardiac shock and profound acidosis

Infantile spasms

epileptic disorder of infants most commonly presenting between 3 to 7 months of age and rarely after 18 months. Affected children present with multiple brief episodes of jerking as well as neurodevelopmental delay and regression. The diagnosis is confirmed by the presence of interictal hypsarhythmia on EEG.

Small gestational Age babies (immediate postpartum)

High risk of hypoglycemia, polycythemia, and perinatal asphyxia

fat-soluble vitamins-vitamin A, vitamin D, vitamin E, and vitamin K

Cystic fibrosis patients require pancreatic enzyme replacement and supplements of

Asthma

defined as recurrent episodes of reversible airway disease (e.g., coughing, wheezing, shortness of breath, and chest tightness) that occur in the absence of other etiologies

Ciprofloxacin otic suspension antibiotic

Otitis Externa treatment

IVIG and aspirin

Treatment for Kawasaki disease

Breastfeeding should be initiated as soon as possible after the birth (vitamin D starts at birth and iron is added at 4 months)

In order to establish adequate breast milk supply

Transient synovitis

a self-limited inflammation of the synovium of the hip presenting as hip pain, limp, and decreased range of motion in a non-toxic child often following an upper respiratory infection

Topical benzol peroxide and topical retinoids OR benzoyl with topical antibiotics

What is the treatment for mild acne vulgaris

Nursing bottle caries

breakdown of fermentable sugars to lactic acid by Streptococcus mutans, Streptococcus sobrinus, and Lactobacilli. The resulting lower oral pH causes a characteristic pattern of dental caries that begins along the gingival line of the maxillary incisors and progresses to the maxillary and mandibular molars.

Hemolytic uremic syndrome

triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure. It most commonly presents as fever, change after a few days of watery diarrhea to bloody diarrhea, pallor, hypertension, and decreased urine output.

Rocky Mountain spotted fever

	s a tick-borne illness that presents as headache,
	fever, and rash in a patient with a history of a tick bite. The exanthem begins as a
	blanching, macular rash on the wrists and ankles and evolves into a petechial
	rash that eventually involves the trunk, palms, and soles of the feet. Laboratory
	studies typically show a normal white blood cell count and worsening
	thrombocytopenia with disease progression.

isoniazid prophylaxis at birth

An infant born to a mother with active TB who is considered currently contagious (treated for less than 2 months or symptomatic) should receive

Costochondritis

inflammation of the costochondral or costosternal junctions due to trauma to the chest wall, heavy lifting, or coughing. Patients present with anterior chest wall pain that is reproducible on palpation of the affected area. The mainstay of treatment is activity restriction, ice or heat application, and analgesics (e.g., ibuprofen).

Benign idiopathic hypercalciuria

	patients present with recurrent gross or
	microscopic hematuria, dysuria, or abdominal pain at a young age. Young
	patients presenting with hematuria should be screened for hypercalciuria by
	determination of urinary calcium to creatinine ratio and positive cases confirmed
	by 24-hour urinary calcium

Concussion

	manifest as headaches, dizziness, confusion, loss of consciousness, gait
	abnormalities, vomiting, and emotional lability. Cognitive and physical rest for a
	minimum of 24 to 48 hours after a concussion is the mainstay of treatment.

isovaleric acidemia

	present during the first one to two
	weeks of life with poor feeding, vomiting, hypotonia, and seizures. In addition, the
	accumulation of isovaleric acid results in the characteristic odor described as
	"sweaty feet"

Edema

the key presenting symptom in children with nephrotic syndrome and is often first noticed in the periorbital area, lower extremities, and genitalia. Minimal change disease is the most common cause of nephrotic syndrome in young children.

conductive hearing loss in the affected ear.

Hearing loss with a Weber test that localizes to the affected ear and a Rinne test revealing bone conduction sound is equal to or longer than air conduction (Rinne)

suggests

Cyanotic breath-holding spells

follow a fairly predictable course of a child crying, having forced expiration and breath-holding, cyanosis, apnea, and loss of muscle tone and consciousness

iron deficiency anemia and affected children should be evaluated with a complete blood count and serum ferritin level

Breath-holding spells are commonly associated with

Central precocious puberty

elevated gonadotropins (LH and FSH) along with elevated sex steroid hormones (estradiol and testosterone)

onset of breast development under the age of 8-in females and testicular and penile enlargement under the age of 9 in

exchange transfusion to reduce the level of sickled cells circulating in the blood

New neurologic symptoms in a child with sickle cell disease is stroke until proven otherwise; the therapy is

Primary dysmenorrhea

cyclic lower abdominal and lower back pain that begins just prior to the onset of menses and continues for up to three days; nausea, vomiting, diarrhea, headache, and dizziness can also be associated (condition is considered severe if it affects the person’s ability to attend school)

Retropharyngeal abscesses

most common in children between 2 and 4 years of age. Most are polymicrobial and affected patients present with a sore throat, fever, stridor, torticollis, drooling, and increased prevertebral space on lateral neck radiographs.

Recurrent respiratory papillomatosis (mom has genital warts)

pediatric patients is secondary to human papillomavirus (HPV) acquired from the mother during vaginal delivery.

The median age of onset is 3 years, though cases have been documented at birth. Human papillomavirus types 6 and 11, the types that cause genital warts in adults, are the most common etiological agents.

Atrioventricular reentrant tachycardia

paroxysmal supraventricular tachycardia in adolescents and results from one or more accessory pathways between the atria and ventricles. The presence of an accessory pathway is revealed by delta waves on electrocardiography. WPW

Focused Assessment with Sonography in Trauma (FAST)

helps guide identification of injures due to blunt trauma to the abdomen. Once an area of suspicion is identified, more specific testing for that organ can ensue.

Campylobacter gastroenteritis

	mimic acute appendicitis. _______
	species can be transmitted by ingestion of raw milk, undercooked poultry, or
	contaminated drinking water; exposure to young dogs or cats; and contact with
	fecal material from infected people or animals.

Familial hyperlipidemia

codominant genetic disorder presenting with elevated total cholesterol and LDL from a very early age.

Initial management begins with lifestyle modification and initiation of statin medication (e.g., simvastatin, pravastatin, and lovastatin). The addition of a second-line medication (e.g., ezetimibe) to achieve adequate LDL goals is common.

Tricyclic antidepressant overdose

life-threatening emergency that presents with severe signs of anticholinergic toxicity-mydriasis, tachycardia, hyperthermia, sedation, myoclonic jerking, hypotension, and arrhythmia. Prompt treatment of ingestion in alert patients is with activated charcoal, and symptomatic treatment is aimed at life-threatening complications of arrhythmia, seizure, coma,

and hyperthermia.

Diabetic ketoacidosis

	most severe complication of Type 1 diabetes mellitus.
	It is caused by an interplay of inadequate insulin production and increased
	counterregulatory hormones leading to severe dehydration and metabolic
	acidosis. The hallmark finding on blood gas is an anion gap metabolic acidosis.

pH: 7.18, pCO2: 27 mmHg, HCO3: 13 mmHg

Marfan syndrome

includes tall stature, ecopia lentis, mitral valve prolapse, aortic root dilatation, and aortic dissection.

benign condition —> family reassurance

Children who are growing and developing well with aches and pains but no systemic symptoms or localized findings often have a

Empiric therapy —> nafcillin, oxacillin, cefazolin (pts greater than 3 months)

Treatment of pediatric osteomyelitis

	born in (or
	frequently visits) an area with a high incidence of TB infection or if the child has
	had recent contact with an adult who has TB disease.

PLUS LEAD TEST (12 months to 24 months)

	A tuberculin skin test or a blood interferon-gamma
	release assay is used to screen for tuberculosis (TB) when a child is

surgical repair (orchioplexy) by 6 to 12 months of age

Unilateral and bilateral undescended testis require

Congenital rubella infection

an intrauterine infection that results in a newborn with hearing loss, cataracts, hepatosplenomegaly, thrombocytopenia, blueberry muffin skin, and patent ductus arteriosus or pulmonary artery stenosis. The classic triad of congenital _______ syndrome is deafness, cataracts, and cardiac disease.

Neonatal abstinence syndrome

jitteriness, hyperreflexia, and high-pitched cry in an inconsolable infant. A trial of swaddling in a calm environment may be tried, but if this fails then slow weaning over several weeks of a pharmacologic agent such as morphine or methadone is required.

management is determination of the angle of curvature using plain radiographs of the entire

First step in management of scoliosis

insulin resistance and stimulate gluconeogenesis and lipolysis, leading to elevated early morning blood glucose levels.

During puberty, nocturnal secretions of growth hormone increase

Behçet disease

classically described as recurrent oral aphthous ulcers, genital ulcers that heal with scars, and uveitis

Amoxicillin (children less than 6 months)

Treatment for acute otitis media: fever, ear pain, fussy, bulging tympanic membrane (yellow, white) —> purulent

polyarteritis nodosa (PAN)

(e.g., fever, weight loss, fatigue, and arthralgias) in addition to abdominal pain, painful lower-extremity nodules, and hypertension. Additional hallmark features are mononeuropathy multiplex (e.g., painful asymmetric sensory and motor peripheral neuropathy that affects two separate nerve areas) and orchitis.

obstructive sleep apnea (OSA)

loud snoring, snoring 3 nights per week or more, or witnessed pauses in breathing during sleep. Obesity, adenotonsillar hypertrophy, and conditions that narrow the upper airway or affect neuronal control of the airway should raise concern ~ OTHER SYMPTOMS include enuresis parasomnias excessive daytime sleepiness behavioral/learning difficulties

Still murmur (reassure family)

normal growth and development, along with the findings of a nonradiating, low-intensity, short systolic murmur that decreases upon sitting. An incidental finding of a low-intensity vibratory murmur

	coagulation factors before imaging studies are undertaken or laboratory results
are known

	A known history of hemophilia is a game-changer when evaluating even minor
	injuries. Any level of suspicion for hemorrhage prompts immediate treatment with

11 to 12 years of age, followed by a booster dose at the age of 16 years. It can be given earlier to those traveling to high-risk areas.

The conjugate meningitis vaccine covers serogroups A, C, W, and Y and is routinely given to adolescents at

Von Hippel-Lindau (VHL) disease

autosomal dominant neurocutaneous syndrome that affects the ________ gene located on the short arm of chromosome 3 (3p25.3). _______ disease most commonly causes cerebellar hemangioblastomas and retinal angiomas; but tumors, including pheochromocytomas and cysts (renal, hepatic, pancreatic, or genital tract), can occur in other organs.

surgical removal is indicated

CNS tumors within VHL syndrome are usually benign but it the pt is symptomatic then

Spherocytosis (MCHC and reticulocyte count will be elevated)

An infant or young child with jaundice, anemia, and splenomegaly likely has

helminth infection, more specifically visceral larva

Dirt-eating children with eosinophilia, wheezing, and hepatosplenomegaly likely have a

sensorineural hearing loss in the left ear

The child with hearing loss and with a Weber test that localizes to the normal ear (right) with a normal Rinne test on the both sides (air conduction heard louder than bone conduction) suggests

management of croup

severity of symptoms and begins with supportive care (e.g., cool mist humidifier, antipyretics, and oral fluids) and a onetime dose of dexamethasone. Children with moderate to severe ____ also receive nebulized epinephrine.

Osgood-Schlatter

	recently had a
	growth spurt with pain located over the tibial tuberosity. Clinical findings include
	swelling, pain and sometimes hypertrophy of the tibial tuberosity. Ice, analgesics,
	and stretching is appropriate initial management.

Juvenile ankylosing spondylitis

asymmetric, inflammatory, oligoarthritis that affects the spine and larger joints of the lower extremities. Affected patients complain of pain that is worse at night and does not improve with rest but does improve with exercise, heat, and nonsteroidal anti-inflammatory medications (e.g., naproxen). Anterior uveitis (e.g., photophobia, conjunctival injection, and eye pain) is a common extra-articular manifestation

Diabetes mellitus type 1

honeymoon phase of diagnosis refers to the temporary production of endogenous insulin from beta cells within the first few weeks of diagnosis. It leads to hypoglycemia and decreased exogenous insulin needs.

exogenous insulin. The test that will identify exogenous insulin is an insulin to C-peptide ratio.

This patient has unexplained hypoglycemia. A previously healthy child who presents with profound hypoglycemia and seizures is suspicious for having

received

Wiskott-Aldrich syndrome

thrombocytopenia and eczema in a male infant who then develops life-threatening infections by

encapsulated organisms.

ductal dependent lesion. Immediate prostaglandin E, infusion may be lifesaving

Cyanosis with respiratory compromise in a newborn suggests congenital cyanotic heart disease. Worsening of the cyanosis upon administration of oxygen suggests a

an ultrasound of the lesion

A lump, tuft of hair, or birthmark over the lower spine suggests spina bifida occulta. The first step in management is

with testing (either a rapid strep antigen test in the office or a throat culture in the lab) before antibiotics is appropriate.

The classic presentation of streptococcal pharyngitis is fever, headache, sore throat, and abdominal pain. Clinical findings are tender cervical adenopathy, a

"strawberry tongue," exudate on the tonsils with necrotic debris in the crypts, and petechiae on the soft palate. Confirmation with

Leukocyte adhesion deficiency

combination of delayed cord separation, a history of omphalitis, and repeated labial cellulitis infections that are hard to treat suggests

over-the-counter analgesics or non-steroidal anti-inflammatory medications.

Tension headache presents as tightness across the forehead not associated with a prodrome, nausea, or vomiting, and without interference of normal activity. Initial treatment is

Intraventricular hemorrhage

presents in the neonate typically of less than 32 weeks' gestation either asymptomatically (found of routine head ultrasound screening) or as the sudden onset of new neurologic symptoms (lethargy, hypotonia, altered mental status), pallor, and bulging anterior fontanel.

Goodpasture syndrome (anti-glomerular basement membrane disease)

caused by circulating antibodies that attack the glomerular basement membrane as well as the alveolar basement membrane. One feature that distinguishes ______ from other similar renal causes of glomerulonephritis is that the lungs are affected.

Recurrent cough, hemoptysis, and shortness of breath are common pulmonary symptoms.

gradually retract and fully retract beyond the glans by adolescence. Parents should be instructed to wash and dry the penis during the newborn and infant periods as a part of a regular hygiene routine.

At birth, the foreskin in most male infants will be attached to the glans. As he grows and experiences physiologic erections, the foreskin will

Acute chest syndrome

pt with SCD with a cough, chest pain, fever, new infiltrates on chest radiograph

vocabulary of 50 words (only 50 percent need to be intelligible), use two-word sentences, follow simple commands, and name pictures when asked.

When a child's screen is positive, he or she is referred for a more in-depth developmental, behavioral, and medical evaluation. By around the age of 24 months, children should have a

Wilson Disease (AR)

Kayser Fleishcer rings and low ceruloplasmin —> treat with low copper diet and penicillamine

Peptic ulcer disease

mid-epigastric pain. An endoscopy is warranted for complicated cases where symptoms of weight loss, bleeding, family history of Gl cancer, or recurrent vomiting are present.

localized with plain radiographs, and any button battery lodged in the esophagus warrants emergent endoscopic removal.

If a child over the age of one year is witnessed swallowing or suspected of swallowing a button battery within the previous 12 hours, 5 to 10 mL of honey is administered at home with additional honey or sucralfate administered in the emergency room. The button battery is then

Fragile X syndrome

an inherited X-linked intellectual disability characterized by hypotonia, gastroesophageal reflux disease, and delayed developmental milestones during infancy. As the child ages, he or she develops the characteristic long, narrow face with a prominent chin and forehead, large ears, and large testicles. Language development delay manifests as echolalia, tangential speech,

and perseveration.

close observation, oxygen, intravenous antibiotics, and bronchodilators. One of the most common causes of ______ is infection, so patients should be admitted for broad-spectrum, empiric parenteral antibiotics (e.g., cefotaxime and azithromycin).

Acute chest syndrome is a life-threatening condition in sickle cell patients, treated with

Eisenmenger syndrome

	longstanding increased pulmonary blood
	flow which results in the remodeling of the vascular tree and increased pulmonary
	pressure. The initial left-to-right shunting reverses, resulting in hypoxia, fatigue,
and eventually heart failure.

Scarlet fever

complication of group A streptococcal pharyngitis. In addition to the hallmark symptoms of streptococcal pharyngitis (e.g., tonsillar exudate, petechiae on the palate, strawberry tongue, and fever) _______ classically presents with a fine, papular rash that feels like sandpaper and spares the area around the mouth. Linear petechial markings, known as Pastia lines, are found in the antecubital fossa and axillary folds and are another classic finding associated with scarlet fever.

Epididymitis

presents as the gradual onset of posterior testicular pain, dysuria, and urinary frequency. Because the most common cause in sexually active adolescents is sexually transmitted infections (e.g., Chlamydia trachomatis followed by Neisseria gonorrhea), urethral discharge is another distinguishing feature.

Listeria monocytogenes

diffuse pustular rash and early respiratory failure. There will likely be a history of preterm delivery, brown-tinged amniotic fluid, and flu-like symptoms (e.g., fever, chills, malaise, headache, nausea, and vomiting) in the mother.

giardiasis

hiker or camper who drank poorly filtered or improperly boiled water from a freshwater source. These patients present 7 to 14 days following exposure with foul-smelling diarrhea, steatorrhea, flatulence, abdominal cramping, nausea, weight loss, and malaise. In addition to necessary fluid and electrolyte replacement, tinidazole or nitazoxanide are the treatment of choice in symptomatic patients.

HTN —> renal etiology is MC in young child (renal artery stenosis)

Elevated BP readings on multiple measurements or single readings above the 99th percentile are defined as

Positional posterior plagiocephaly —> initial treatment of positional posterior plagiocephaly is increased time in the prone position and referral to physical therapy

most commonly due to infants spending too much time in a supine position. The predominant features are unilateral flattening of the occiput with a prominence of the forehead and an anterior shift of the ear on the ipsilateral side.

Autism

presents with either a lack of attaining communication skills or regression of early language skills, lack of protodeclarative pointing (pointing to communicate a need), repetitive/stereotypical behavior, lack of symbolic play, unusual reactions to environmental stimuli, abnormal social interactions, and a seemingly high pain threshold.

liquefaction necrosis. Admission for possible esophageal endoscopy is appropriate

Alkaline ingestion (often in the form of drain cleaners) can result in

TMP/SMX

hyperimmunoglobulinemia lgE syndrome (HIES) or Job syndrome with a presentation of recurrent pneumonia and cold skin abscesses, retained primary teeth, eczema, and coarse facial features.

Laboratory studies show an elevated IgE and eosinophil count. Mainstay treatment is prophylactic

ß-thalassemia minor

present with mild anemia that does not respond to oral iron therapy, microcytosis, elevated red blood cell count, low red blood cell distribution width, and possibly target cells on peripheral smear; on further workup, iron studies will be normal and hemoglobin electrophoresis will reveal elevated levels of Hemoglobin A2, Hemoglobin F, or both.

Distal (type 1) renal tubular acidosis

growth failure and hyperchloremic acidosis, hypokalemia, and an inappropriately elevated urinary pH

Staphylococcal scalded skin syndrome

begins with a prodrome (e.g., fever, malaise, and painful skin) that progresses to diffuse, shiny erythema; flaccid bullae; shallow erosions; and superficial desquamation. Skin appears similar to skin that has been scalded with boiling water. Mucosal surfaces are spared.

Honey-colored crusts around the nares, mouth, or umbilical stump or purulent drainage from the conjunctiva are two common sources of primary infection

Laryngomalacia

stridor with crying or agitation in the otherwise healthy 4- to 6-week-old infant. Close observation and family reassurance are appropriate.

hidden penis

caused by excessive prepubic fat, excessive preputial skin, or poor anchoring of the Dartos fascia to the underlying Buck's fascia. Affected males present with concerns of the inability to urinate standing without dribbling urine onto the thighs or scrotum, difficulty maintaining proper hygiene, and concerns about small penis size.

Cat scratch disease

local or regional lymphadenitis after inoculation with Bartonella henselae. Treatment of uncomplicated cat scratch disease in otherwise healthy individuals can be supportive, but antibiotics will result in quicker resolution of symptoms and prevent serious complications.

Antibiotics (e.g., azithromycin) are indicated —>immunocompromised patients or those with severe or systemic disease.

Congenital diaphragmatic hernias

hypoplasia of the lungs causes respiratory distress, a barrel-shaped chest, a scaphoid appearing abdomen, and absent breath sounds on the ipsilateral side. When the herniation occurs on the left (which is the most common), the heart sounds will be shifted to the right. Diagnosis is established on prenatal ultrasound or via chest radiograph postnatally.