Peds New Info

Coarctation of the aorta

acyanotic congenital heart lesions

first 6 months of life with HF

L to R shunt CHD (acyanotic)

ventricular septal defect, atrial septal defect, patent ductus arteriosus, and endocardial cushion defects

cyanotic CHD list (R to L)

1. trunctus arteriosus

2. transposition of great vessels

3. tricuspid atresia

4. tetralogy of fallot

5. total anomalous pulmonary vascular return

ebstein anomaly

tricuspid valve malformed → tricuspid regurg

caused by lithium

pulmonary atresia

absence or severe underdevelopment of the pulmonary valve, which obstructs blood flow from the right ventricle to the lungs

tricuspid atresia

complete absence of the tricuspid valve, resulting in an absence of direct communication between the right atrium and right ventricle

→ underdeveloped RV

epiglottitis

most common cause of bronchiolitis

RSV

pt has a clunking sensation when adducting the hip. what is the next step?

refer for otho (This is dev dysplasia of hip)

if <4 mos = U/S

birth recommendations

1. start vit D supp

6 months recommendation

1. exclusively breastfed until 12-24 mos

4-6 months of age recommendation

1. intro of potentially allergenic foods

2. intro of solid foods

3. iron supp

1-2 years old recommendation

transition to whole milk

>2 yo recommendation

switch to reduced fat-milk

12 months milestone

1. single world speech

2 years old developmental guidelines

switch to front-facing car seat

electrolyte imbalance with pyloric stenosis

hypoK

hypoCl

CF airway clearance options

1. postural drainage

2. chest percussion

3. inhaled recombinant human deoxyribonuclease

4. hypertonic saline

CF tx options

1. exercise

2. CFT modulators

3. pancreatic enzyme replacement

4. lung transplant (def mgmt)

med for focal onset seizures with impaired awareness (complex partial seizures)

levetiracetam

Which of the following is the most common type of child abuse?

neglect

Chronic iron overload is seen in…

1. thalassemia

2. sickle cell disease

tx for Chronic iron overload

deferasirox PO (monitor kidney and liver fx, watch for GI hemorrhage)

you suspect testicular torsion. what is FIRST step?

manual detorsion

epididymitis tx

IV ceftriaxone + PO doxy

dx for testicular torsion when you don’t know for sure

scrotal U/S

ciguatera toxicity

seen in big fish

GI and neuro sx (hot-cold reversal, tooth looseness, ataxia) and CV (bradycardia, hypotension, pulm edema)

tx = antiemetics + IV fluids

suboptimal intake jaundice sx*

dark, sticky stools**

(relative stasis of stool within the intestines, permitting more time for enterohepatic recirculation of bilirubin)

what electrolytes seen in infants with indaequate milk intake?

hyperNa

hyperBilirubin

virus that causes mumps and measles

paramyxovirus

coryza definition

inflammation of nasal mucus

seen in measles or rubella

child has displaced earlobe and testicular swelling, dx?

mumps parotitis

a blueberry muffin rash should make you think of what dx

german measles (rubella)

what virus causes chickenpox

varicella zoster (human herpes)

best way to treat a rash with violaceous papules on the flexor surface and lacy lesions in the mouth?

occlusive dressing

phototherapy

TOP steroid (tacrolimus)

biopsy is definitive dx (lichen planus)

what pathogen causes diaper rash?

staph

maintenance fluid recommended for pediatric burn patients?

LR

tinea versicolor tx

selenium sulfide or ketaconazole ointment

drugs for mod-severe acne

tetracyclines

spironolactone

definitive dx for SJS or toxic epidermal necrolysis?

skin biopsy

best tx for painful acne with significant inflammation and pustules

isotretinoin (accutane)

what chem substance causes liquefaction of necrosis

bases

parkland formula

burn pts - ½ of fluids in first 8 hours, remaining over next 16 hours

gonococcal conjunctivitis tx

erythromycin drops

ceftriaxone IM

mastoiditis tx*

IV cefazolin

followed by PO abx

AOM RF

URI

daycare

smoke

drinking when laying flat

facial hypoplasia/deformity (down syndrome/cleft palate)

acute bacterial pharyngitis tx*

PCN or amoxicillin

definitive dx for epiglottitis

laryngoscope

first step dx if you suspect epiglottitis

CT with contrast

preseptal cellulitis tx*

augmentin

tx for orbital cellulitis*

IV vanco

or IV nafcillin and clindamycin

how soon after birth does congenital chlamydial conjunctivitis develop?

7-14 days after birth

what age group most at risk for developing OM?

6-18 months

most common etiology of epilottitis

h flu

fistula test

used to diagnose TM perforation

epiglottitis tx*

admit to ICU

give IV ceftriaxone or clindamycin and vanco

intubation

3 complications of untreated acute pharyngitis/tonsillitis (caused by GAS)

peritonsillar abscess

scarlet fever

rheum fever

PSGN

tinnitus

OM

what drugs to avoid with TM perforation?

aminoglycosides

steroids

where do peritonsillar abscesses develop?

b/w superior constrictor muscle and the tonsil

routes of transmission for toxoplasmosis

cat feces

soiled unpasteurized milk

raw undercooked meat

diffuse petechiae and choreo retinitis, eosin stain shows owl inclusion bodies. dx?

cytomegalovirus

3 year old has vesicular bullous rash, osteochondritis, and hutchinson’s teeth - what organism?

treponema pallidum

congenital cytomegalovirus

petechiae/purpura

perventricular brain calcificiations

choreo retinitis

dev delays

vision/hearing issues

8 yo has sore throat, chills, vomiting, exudative tonsillitis, pallor, and strawberry tongue with pasture lines. tx?

penicillin V K

(this is scarlet fever)

toxoplasmosis s/sx

intracranial calficiations

choreo retinitis

glaucoma

cataracts

pathogen that causes scarlet fever

strep pyogenes (GAS)

which torch infx caues gingiva stomatitis?

HSV

which age group highest risk of dev TB?

1-4 yo

complications of infectious mono

1. splenic rupture

2. airway obstruction

3. neuro defs

4. reyes syndrome

5. GBS

oral candidiasis RF

1. DM

2. obesity

3. immunocompromised

4. breast fed babies

5. ICS

6. dentures

7. recent abx

8. estrogen use

9. pregnancy

what condition assoc with coal black spots?

rubeola/measles

HHV 3

varicella zoster

tx for oral candidiasis

PO nystatin and mouth rinses

congenital syphilis tx

benzathine PCN

IM for mom and baby

leukocytosis with atypical lymphocytes should make you think of what dx

infectious mono

scarlet fever findings

1. fever

2. sore throat

3. tonsillitis

4. circumaural pallor

5. strawberry tongue

6. punctiforme lesions on palate

7. blancing sandpaper rash

8. pasture lines

9. desquamation

toxoplasmosis tx

pyrimethamine and sulfadiazine

what conditions is TB of spine?

POTTS disease

what are TORCH infx?

congenital diseases passed from placenta

1. Toxoplasmosis

2. orthers (syphilis, hep B, HIV, varicella, parvovirius b19, cytomegalovirus)

3. rubella

4. cytomegalovirus

5. HSV

HHV 5 = ?

cytomegalovirus

papular urticaria/insect allergy/skeeter syndrome

hypersensitivity disorder in which insect bites (mosquito, bedbugs) → recurrent itchy papules/nodules

clinical dx

chronic and cycling disorder

tx = nonsedating antihistamines, TOP steroids, reassurance

impetigo tx

top mupirocin

when widespread to all body → PO cephalexin

hx of multi fractures and fam hx of fracture and hearing loss makes you suspect

osteogenesis imperfecta

autosomal dom

osteogenesis imperfecta findings

blue sclera

excess or atypical fractures, short stature, blue sclerae, hearing loss, scoliosis, basilar skull deformities, opalescent teeth that wear quickly, increased laxity of the ligaments and skin, wormian bones, and easy bruisability

osteomalacia

bone pain

fractures

elevated alk phos

pertussis

perioral cyanosis

fever

coughing > 3 weeks

abnormal CBC with lymphocytosis

pertussis best test*

PCR

von willebrand disease (vwd)

abnormal bleeding time

normal or long aPTT

normal PT and INR

mucosa surface bleeding - pistaxis, bleeding gums, GI bleeding, and menorrhagia

tx for VWD

desmopressin

protein c deficiency

prolonged bleeding time, low platelet count, and increased PT and aPTT.

oopositional defiant disorder vs. conduct disorder

conduct disorder disregards rights of others

cephalohematoma

collection of blood under the periosteum

does NOT cross bony sutures

RF = vacuum/forceps assisted delivery

reassure and observe

Physical examination shows a prominent right ventricular impulse and a systolic thrill. A crescendo-decrescendo murmur with a harsh systolic ejection quality is heard along the left upper sternal border. dx?

tetralogy of fallot

bronchiolitis

infants <2 yo

RSV

intercostal retractions, diffuse soft expiratory wheezing, and coarse crackles.

hyperinflation

atelactasis with volume loss

patent foramen ovale (PFO)

midsystolic murmur

supposed to close before 2 year old

dx: echo or TEE (bubble test)

INC risk of cryptogenic stroke (paradoxical embolism), migraines, decompression sickness

Tonsillopharyngitis (strep) cause

strep pyogenes (GAS)

Tonsillopharyngitis (strep) tx

PCN

cephalosporins

macrolides

clinda

strep dx

culture/rapid antigen detection testing

Sickle cell disease (SCD) preventative care

autosomal recessive

meningococcal vaccines (2 4 6 and 12-15 mos)

**PCN prophylaxis until 5 yrs

hydroxyurea at 9 months

annual transcranial U/S at 2-16 yo

spleen palpation

flu every year

pneumococcal >/2 yo

avoid cold temperatures

Acute chest syndrome finding

new radiodensity on chest imaging with fever or respiratory symptoms in patients with SCD