Past CMS Peds Things to Remember

Form 5

• Papules on dorsal fingers and and weakness of proximal muscles = dermatomyositis

• When leukocyte and platelets are low, that’s aplastic anemia

• Duchenne muscular dystrophy is X-linked recessive

• Any exposure to Chlamydia or gonorrhea needs to be treated with doxycycline and ceftriaxone, regardless of symptomatic status

• Distal thigh swelling without redness should make you think fracture; get X-ray

• Legg-Calve-Parthes disease is the idiopathic avascular necrosis, which shows normal X-ray but decreased uptake; SCFE is displacement of epiphysis

• Paroxysmal cough and vomiting should make you think pertussis; prevent with DTaP

• Entamoeba causes the flask shaped ulcers

• Remember that HIV can be vertically transmitted; if someone is having recurrent infections and there is maternal history of mycobacterial infection or Pnemocystis jirovecii infection, it’s likely the patient has HIV

• When pulmonary vascular resistance decreases (after birth), LV pressure > RV pressure, making VSD murmurs more intense

• Persistent pulmonary hypertension of the newborn occurs because the PVR fails to decrease (vasodilate); oxygen will not fix the hypoxemia

• Hypertension in PSGN is because of salt and water (volume) overload

• X-ray doesn’t have to show foreign bodies to suspect foreign body aspiration; if there is acute onset of difficulty breathing and nebulized albuterol doesn’t provide relief, it’s likely a foreign body aspiration and endoscopy should be done

• If length stays stable but there’s failure to gain weight (decreased percentile of weight), first try dietary intervention like a diet diary; if it still persists, then do the malabsorption tests inpatient

• OSA in children is due to hypertrophy of adenoids and tonsils

• The first step for someone who is in respiratory distress and has altered mental status is intubation

• HBIg should be given within 1 week if maternal HBsAg comes back positive or unknown; it doesn’t need to be given immediately

• Hirschsprung’s is the reason why Down syndrome patients fail to pass stool

• Renal involvement of SLE is the most important for determining progression, so when you suspect SLE in a kid, get renal biopsy

• Upper GI series ≠ upper endoscopy, which is what is done for PJS; along with upper endoscopy, colonoscopy should be done

• Hypoglycemia because of diarrhea and vomiting can be because of inadequate caloric intake, especially if there is no interest in eating

• Hypovolemia because of gastroenteritis can lead to lactic acidosis

• Assessing hematuria should be the step to take in instances of blunt kidney injury

• Appendix testis torsion ≠ testicular torsion; will see everything you think of with testicular torsion but intact cremasteric reflex

• Hashimoto’s thyroiditis has high anti-TPO antibody concentration

Form 6

• Onset of pallor and lethargy with hematuria = HUS

• Space heaters generate CO; treatment is with oxygen

• If the newborn screen picked up increased TSH and mother takes hyperthyroid meds, it’s best to repeat the screening for TSH and T4 levels

• Tinea capitis is treated with oral antifungals

• Spinal muscular atrophy develops over months and will have LMN defects

• Nephrotic syndrome can predispose formation of ascites, which can lead to peritonitis; will see distention and tenderness in all quadrants

• PCOS is associated with diabetes

• Salicylate = aspirin, which is A in GOLDMARK elevated anion gap acidosis; it does not mess with Na or K

• If endotracheal tube goes in too far, it could cause the right mainstem bronchus to collapse, leading to haziness in affected lobe

• High grade fever, diffuse joint pain, rash = SLE; lupus can also cause heart issues like peaked T waves from hyperkalemia, so first thing to do is treat with calcium chloride

• SIADH can occur because of infections like meningitis

• If a newborn isn’t breathing well immediately after birth, first thing is tactile stimulation

• Fever and rash with family history of meningococcemia should have you thinking meningococcemia as well

• If someone is on ACE inhibitors and develops hyperkalemia, it’s because aldosterone is suppressed

• Volvulus will have dilated loops of bowel with air fluid levels

• Positive occult bleeding from stool but no pain = Meckel diverticulum

• Childhood obesity can occur because of excessive consumption of total calories

• Macroglossia, omphalocele, visceromegaly, hypoglycemia = Beckwith-Wiedemann syndrome

• VUR —> renal scarring —> CKD —> HTN; since there’s a history of VUR, get BUN and creatinine to evaluate extent of CKD

• Atopic dermatitis involves lichenification on face and diaper area

• “First 3 months of life in hospital; during that time, on mechanical ventilation” —> BPD; BPD leads to pulmonary HTN

• Exclusive breastfeeding for the first 6 months can prevent allergies

Form 7

• SVT will show rapid, narrow tachycardia; treat with cardioversion

• If bed wetting still occurs after 5, it’s a maturation delay

• Acute onset of fever and N/V/D is gastroenteritis; biggest thing is to correct hydration status, especially for kids

• Within the first 6 months, 3 doses of Dtap, IPV, Hep B, HiB, Prevnar, and Rotavirus should be given

• If someone is wolfing down water and is all of a sudden having vomiting, headache, and weakness, it’s because of hyponatremia

• 9 month olds should be sitting without support

• CGD = impaired leukocyte microbicidal activity

• Trich is an STI; if seen in a young child, that’s a red flag for sexual abuse

• CMV has periventricular calcifications, while Toxo will have ring-enhancing lesions; can do urine culture or blood culture to confirm

• “Hit someone in the mouth with fist with small laceration” = unintentional human bite; mixed flora are cause of swelling

• Initial treatment for asthma includes daily inhaled corticosteroid and SABA as needed

• Esophagoscopy/upper endoscopy should be done when caustic ingestion occurs

• If someone is taking amoxicillin and now develops desquamation, fever, and malaise, it’s SJS

• Infections due to SHiN bugs are because of Wiskott-Aldrich syndrome

• Features of achondroplasia include macrocephaly, frontal bossing, varus, and hypotonia

• Features of intussusception include colicky abdominal pain, nausea, vomiting, and bloody diarrhea

Form 8

• There will be decreased mobility with otitis media with effusion but treatment is supportive because there are no signs of active infection

• Bicuspid aortic valve increases the risk of developing bacterial endocarditis

• RMSF will have fever of ≤5 days, headache, and rash on palms and soles that follows fever

• “Begins to cry and oxygen suddenly drops to hypoxemia levels” = tet spells of TOF

• AIS is diagnosed with karyotype analysis

• Lupus will show low complement levels

• If recurrent pneumonia exists and T cell count is really low, it’s because of HiB, so give the HiB vaccine

• HIV involves recurrent infections of all kinds with hepatosplenomegaly and lymphadenopathy

• Most common cause of bloody diarrhea is from Salmonella; it is also associated with reptiles, turtles, and chickens

• “Vomiting immediately after feeds” = pyloric stenosis

• If automatic BP measurement gives HTN, try the manual method before anything else

• Malaise, fatigue, splenomegaly, anemia, thrombocytopenia are some of the features for ALL; if you see all these, next thing is to get bone marrow biopsy

• When there is something in the thyroid region, think thyroglossal duct cyst; when it starts becoming painful, it’s infected

• CVID and X-linked agammaglobinemia are similar in that there will be low levels of Ig, but X-linked agammaglobulinemia is seen in boys

• Another name for autism spectrum disorder is pervasive developmental disorder

• JONES criteria: Joint pain, O (like heart for myocarditis), Nodules, Erythema marginatum, Sydenham chorea

• DDH occurs because of poorly developed acetabulum