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warfarin: craninofacial, IUGR, central nervous system, stillbirth
IgA deficiency: mild symptoms of respiratory and GI infections, suspect if anaphylaxis to immunoglobulins
most common malignancy newborn: neuroblastoma
hydrocephalus symptoms: due to increased intracranial pressure - enlarging head size, lethargy, irritability, vomiting, headaches, poor feeding/appetite, confusion
meconium ileus: small intesetine obstruction at birth from inspissated meconium
nephrotic syndrome present: dependent edema, moring periorbital edema, and even ankle and foot edema - preceding viral URI common
hypocalcemia: - jittery carpopedal spasam (muscle spasm hands and feet), bronchospasm and seizures
CF die of: respiratory failure complicated by secondary pulmonary hypertension and right heart failure (cor pulmonale)
retropharyngeal abscess: high fever, severe dysphagia
HMD risk factor: maternal diabetes, premature
WPW diagnosis: electrophysiologic testing
partial seizures either: simple or complex
child abuse: shaken baby, retinal hemorage, duodenal hematoma - in absense of severe trauma, frenulum injuries (forcing bottle into mouth)
epiglotitis where tx: operating room, as may precipitate airway obstruction
HMD due to: deficiency of pulmonary surfactant (produced type II pneumocytes)
noncommunicating hydrocephalus cause: neoplasm or congenital anomaly - aqueductal stenosis
HD symptoms obscure: Pruritus, cervical adenopathy, - immuno deficiency, splenomegaly
Chronic mucocutaneous candidiasis: recurrent Canida infection s(skin, thrush, nails) with no other immune problems; HYPOthyroidism
DiGeorge Syndrome is: 3rd and 4th paryngeal pouches maldevelopment
viral menengitis cause: enteroviruses (coxsackievirus A/B, echovirus)
meconium aspiration: chemical pneumonitis, term or post term infants - prolonged or stresful deliveries, oligohydraminos and placental insufficiency increase risk
strep throat: streptococcal pharyngitis
FAS signs: intrauterine growth retardation (IUGR), small-for gestational age, microcephaly, mental retardation, learning disorders, behaviroal problems
simple seizure: no impared consciousness
HD symptoms common: vague constitutional systems "B" symptoms - fatigue, malaise, low-grade fever, weight loss, and night sweats
foreign body tx: heimlich maneuver or back blows in infants, NOT BLIND finger sweep (ok if see object)
FAS cardio: ventricular septal defect or aterial septal defect
hydrocephalus classic sign: rapidly enlarging head circumference > 95% - bulging fontanelle, enlarged scalp veins - "setting sun" sign
HIV test infant: All ifnants of HIV positive mom - within 72 hours birth - DNA PCR HIV test or HIV culture.
TTN lasts: 6-36 hours, if improvement in this time then was not HMD
signs of sepsis: hypotension, leukocytosis, or seizures
C5-C9 complement deficiencies: recurrent Neisseria infections, low specific complement level
WPW is a: type of ventricular preexcitation, or premature stimulation of the ventrical by an accesssory conduction pathway bypasses AV node
hypertrophic obstructive cardiomyopathy: harsh midsystolic creschedo-decrescendo systolic murmor, and a strong two-part (bifid) apical impulse)
athletes pass out: hypertrophic obstructive cardiomyopathy
communicating hydrocephalus cause: meningitis or hemorrhage
epiglotitis tx: immediate airway management, entrotracial intubation, dpt should not be agitated (do not start IV before intubation)
CF tricky: rectal prolapse and bleeding varices
why treat GAS: prevent rheumatic fever and development of scarlet fever, does not prevent poststreptococall glomerulonephritis
Chediak Higashi syndrome: autosomal recessive, giant granules in neutrophils, oculocutaneous albinism, microtubule polymerization defect
peritonsillar abscess: locked jaw (trismus), muffled voice, fever, drooling, asymmetric tonsillar enlargement
pharyngitis on PE: beefy red pharynx w/ whitish or yellowish tonsillar exudate, tender cervical adenopathy, leukocytosis with neutrophils > 75%
HIV mom how long treat child: AZT for 6 weeks after birth (regardless of symptoms)
without Hib you get: Epiglottitis
CF respiratory: cough, wheezing, and/or lung infections (pseudomonas or staphylococcus aureus)
DiGeorge Syndrome missing: parathyroid glands and hypoplastic absent thymus
VSD sounds: Characteristically, a loud, harsh, or blowing holosystolic murmur is best heard over the lower left sternal border in the third or fourth intercostal space. This is frequently accompanied by a thrill. Sometimes, the murmur ends before the second heart sound, presumably because of closure of the defect during late systole.
epiglotitis PE: high fever, appear acutely ill/toxic and anxious, respiratory distress and dyspnea, lean forward droolwing, leukocytosis
down syndrome cause: maternal nondisjunction during meiosis
ALL think: down syndrome then think of
hydrocephalus etologies: arnold-chiari, aqueductal stenosis, tumors, meningitis, hemorage
aspriated foreign body either: sudden respiratory distress or RECURRENT pneumonia when chronic
complex seizure: impaired consciousness
X-linked agammaglobuniemia (Brutton's): males, low B cells, infections start at 6 MONTHS, when maternal antiboides disappear, lung/sinus infections
ALL is the: most common childhood malignancy
nephrotic syndrome other cause: glomerular sclerosis - similar presentation to minimal change dz, does not respond steroids
WPW history: arrhythmias, shortness of breat, syncope, or palpitations - atrial fibulation or other tachycardia
epilepsy: recurrent seizures due to an intrinsic brain abnormality
epiglotitis tx not helpful: racemic epinephrine
peak age ALL: 4y old, down syndrome, family history, fanconi syndrome, ataxia telangiectasia, radiation, benzne, or chemotherpay
Roseola PE w/ fever: often alert, active not too irritable, appetite may be nearly normal
menengitis empiric coverage: ampicillin plus cefotaximine, ceftriaxone or gentamicin in those < 3 months, cefotaxime or ceftriaxone plus vancomycin in older children
DiGeorge S. cardiac: aortic arch abnormalities or trunctus arteriosis w/ VSD - so cyanosis
rib fracture w/ callus formation: at least 3wks old, child abuse
HIV positive infants: immunzations and give MMR, prophylatic antibotics (bactrim for pneumocystis) when CD4 < 200, antiretrovial medications
Chronic granulomatous disease: X linked, recurrent catalase positive organism infections (STAPH), deficient nitroblue tetrazolium dye test (absent respiratory burst from NADPH oxidase deficiency.
luekemia and: down syndrome blood
if DNA-PCR for HIV negative: repeate after 1 month (as low sensitivity), then ELSA at 18 months
menengitis PE: bluging fontanelle, fever, photophobia, alterned level of consciousness
tonic-clonic seizure: classic generalized seizures - grand mal
nephrotic syndrome: hallmark is proteinuria 50mg/kg/day in children - results in hypoalbuminemia and edema - most often minimal change dz
meconium aspiration xray: patchy infiltrates, atelectasis and/or scattered areas of hyperinflation
3 Hertz: absense seizures
GAS tx: oral penicillin for 10days, erythromycin if allergic.
subdural hemorage: think child abuse
Confirm true puberity: admin GnRH as it causes a marked increase in serum level luteinizing hormon once puberity has been reached.
setting sun sign: bilateral lid retraction and increased, tonic downward gaze - and/or upward gaze palsy - papilledema likely
ALL due to: malignant transformation of the B cell lymphocyte
head circumference: spared in benighn causes of FTT or delayed growth including endocrine, while abnormal in serious FTT - utero insults or genetic
Roseola Tx: supportive - acetaminophen to lower fever, and fluids
peritonsillar abscess uvula moves: away from the affected side
WPW EKG: shows short PR interval (< 0.12sec), wide QRS complex (> .12) and a slurred QRDS upstroke or delta wave, which causes the double peak in the QRS complex
foreign body tests: inspiratory and expiratory chest xray to confirm air trapping
AIDS symptoms children: lymphocytic interstitial pneumonia (chornic, stable, noninfectious), HIV encephalopathy, and wasting syndrome - recurrent fevers, chronic diarrhea, adenopathy, hepatosplenomegally
WPW when: congential, symptoms may not occur until adolescense or even adulthood
generlized seizure: seizure starts in BOTH hemispheres at the same time
nephrotic syndrome complication: hypercoagulable state - leads to thrombosis, classically the RENAL vein
HD diagnosis: biopsy lymph node
HD xray: bulky bilateral mediastinal adenopathy
RDS PE: rales, arterial blood gas - hypoxia and acidosis, mechanical ventilation, admin surfactant, recover in week
HIV test infant NOT helpful: ELISA IgG anti-HIV serology not helpful, unless negative - as circulating maternal antibodies can be detected for upto 18 months
meconium: first stools of infant - typically greenish and contain epithelial cells, mucus and bile. First past in utero or within 48 hours birth.
Hyper-IgE syndrome: Job or Job-Buckley syndrome, fair skin, red hair, eczema, and recurrent staph skin infections, high IgA levels
we avoid asprin: Reye syndrome
Roseola PE rash: classically macular or macularpapular - chest and abdomen, less on the face and extermities. lasts less than 2 days.
WPW abbrev.: wolff parkinson White
WPW tx: radiofrequency ablation or procainamide or DC cardioversion. DO NOT slow the AV node (ie. betablockes or verapamil)
bacterial menengitis CSF: WBC count 1340, neutrophils 85%, glucose 10mg/dL, protein 112 mg/dL (nl 15-45)
DiGeorge S. at 24-48 hours: signs of hypocalcemia
precocious puberty def: secondary sex characteristics before age 8 femals, 9 males
DiGeorge S. PE: low-set ears, micrognathia (small mandible) and hypertelorism (widely spaced eyes)
CF tx: antibiotics, exocrine pancreatic enzyme replacment, nutritional support (fat soluable vitamins)
arrhythmia symptoms: shortenss of breath, syncope, or palpitations
minimal change dz tx: corticosteroids - oral prednisone 4-5wks, diuretics and salt-restriction supportive to reduce edema, if fail to respond renal biospy, in increased susceptibility to infection (encapsulated organsims) as loss immunoglobins in urine
Roseola PE nodes: posterior auricular and/or cervical adenopathy
mcune albright syndrome: look for coexisting cafe-au-lait spots and polyostotic fibrous dysplaisa with precocious puberity
lithium: cardiac (Ebstein's) anomalies
epiglotits tx med: third generation cephalosporin
cause menengitis not neonate: S. pneumoniae, Neisseria meningitdits, haemophilus influenza type b
absense seizure are: a generalized seizure
ALL signs PE: multiple petechiae and purpura, result in severe thrombocytopenia
ALL diagnosis: bone marrow biopsy
hypertrophic obstructive cardiomyopathy TX: beta blockers (avoid diuretics and positive inotropes)
2nd most common malignancy of childhood: central nervous system turmors - pilocytic jev
meconium aspiration PE: respiratory distress, tachypnea, retractions and rales or rhonchi.
RDS: at birth respiratory difficulty, gets worse within the first few hours - tachypnea, grunting, nasal flaring, substernal intercostal and supraclavicular retractions - cyanosis perhaps
aspirated foreign body where: right lower lobe or middle lobe bronchus
RS cell from: B lymphocyte
if meconium: neonate immediately intubated with suction performed below the vocal cords
CF confirmed by: DNA probe
in utero HIV: fulminant course - early adenopathy, hepatosplenomegaly at birth - death by 5y
meningtiis treatment: IV fluids and antibioitcs - not delay. on boards - choose treatment over securing a diagnossi with LP
pharyngitis uncommon PE: palatal petechie - uncommon, but highly suggestive of GAS.
bacterial menengitis signs: poor feeding, vomiting, jaundice, lethargy, irritablity, and fever
during pregnancy FAS: no alcohol is good alcohol (often > 5 drinks/day typical)
bruises days 5-7: greenish yellow, while red days 0-1, and purple 1-4. delay in seeking treatment consider child abuse
ALL present with: anemia (pallor, fatigue, shortness of breath), thrombocytopenia (petechiae, easy brusing), leukonemia (fever, infections) and/or system symptoms (weight loss, anorexia), e
Roseola progression: 6m to 3years old, starts fairly abrupt onset of HIGH fever (104), not very sick appearing, w/ high fever febrile seizures, lasts 3-4 days then rash
HD biospy lymphocyte depleted: rare poor prognosis
partial seizure: seizures starts in one area or one side of the brain, EEG changes can often be localized to one area
HD associated with: Epstein-Barr virus (EBV) and African Burkitt's lymphoma.
mom HIV should: not breastfeed
diagnosis pharyngitis GAS: CONFIRMED on the boards, as atypical cases frequent - rapid antigen assays - only average sensitivity - not the gold standard
Herpes encephalitis classically: personality changes and temporal lobe abnomralitys on CT/MRI - diagnose with PCR of CSF - tx acyclovir
Patau syndrome: deafness, microcephaly, HOLOPROSENCEPHALY (brain not devided into two separate hemisphers), MICROPHTHALMIA, rocker-bottom feet, cleft lip, tri 13
Wiskott-Aldrich syndrome: X-linked (males), eczema, thrombocytopenia, and recurrent respiratory infections
Edward syndrome: microcephaly, clenched fist and index finger overlapping 3rd and 4th, tri 18, abnormal number of fingers, low-set ears, club feet, rockre bottom feet, cleft lip
Roseola seizures: consider bacterial infections (meningitis) - the difference is roseola pts are NOT very sick appearing - white count not high. AVOID extensive workup. if atypical or child seems ill - do LP and aggresively antibiotics
Hodgkin's disease distribution: bimodal age peak at 15-34
TTN xray: see hyperinflation (opposite of HMD), increased perihilar markings, possibly fluid in fissuers or small effusions.
sudden onset wheezing: no history of asthma think foreign body aspriation, xray focal hyperinflation (as ball-valve phenomenon), if esophagus severe dysphagia of sudden onset
down syndrome symptoms: placid and rarely cry, brushfield spots (white spots on iris), 5th finger clinodactyly, ventricular septal defect or atrioventricular canal defect
HD biospy nodular sclerosing: more common females
alheimer's dz and: down syndrome mind
diphenylhydantoin: craniofacial, limb, metnal retardation, cardiovascualr defects
membranoproliferative glomerulonephritis: nephtroic syndrome with hematuria and HTN
female virilization: heterosexual precocious puberity (male-pattern facial hair, clitoral enlargement, voice deepending) always abnormal due to androgen secreting neoplasms, cushing syndrome, or congential adreanl hyperplasia
meconiumsspiration tx: prevenation - infants mouth routinely aspirated/suctioned with catheter before shoulders delivered
hydrocephalus tx: surgical - shunt to decompress ventricular system. Ventriculoperitoneal shunt.
atypical GAS: rhinorrhea, cough, conjunctivitis, and hoarseness - viral etiolgoy and sick contacts
minimal change dz: postinfectious, immune -mediated results in effacement of the foot process of renal epithelial podocytes - leading to nephrotic syndrome
thalidomide: phocomelia
nephrotic syn. PE: periorbital edema, and often soft pitting edema in lower extermities - lab shows hypoalbluminemia an dlipedemia (elevated cholesterol and triglycerides), proteinuria and lipiduria - no hypertension and no hematuria
children HIV when: 5 or 6years of age
RDS complications: bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolititis, pneumothorax, and pulmonary interstitial emphysema
Fetal alcohol syndrome (FAS): maxillary hypoplasia, shortened palpebral fissures, flat nasal bridge, and thin upper lip
classic GAS: school age child, fairly rapid onset of fever, sore throat and constitutional symptoms (headache malise, stomache, nausea/vomiting)
pneumoia same location: think chronic aspriated foreign body or structural lung abnormalitis - often peanuts, coins, small toys
Severe combined immunodeficiency: autosomal recessive, due to adenosine deaminase deficiency, B and T cell problem, severe infections tsart after birth, cutaneous anergy
acute pharyngitis etiologies: viral and group A streptococcus (GAS)
VSD PE: displaced cardiac apex with a similar holosystolic murmur, as well as an apical diastolic rumble and third heart sound (S3) at the apex, caused by the increased flow through the mitral valve.
meconium stained: thick particulate or pea soup appearance.
Roseola infantum: exanthem subitum
epiglottitis signs: fairly rapid onset of fever, trouble breathing and dysphagia, may or may not preceded by brief upper respiratory infection - cough absent or mild
hydrocephalus is: ventricular enlargement w/ excessive cerebrospinal fluid
owl eyed cell: reed sternberg cell (RS)
transient tachypnea of newborn (TTN): due to delayed resorption of the fetal lung fluid - term or near-term infant, delivered by cesarean section, better in 24-26 hours, while HMD get worse
hydrocephalus forms: communicating (CSF can flow) and non-communicating
cause menengitis neonate: GROUP B STREP!, then Escherichia coli and Listera
absense seizures PE: no other symptoms, may have eyelid fluttering, or mild motor symptoms (automatisms), lip smacking, increased muslce tone during seizures
CF pancreatic: chornic steatorrhea and/or diarrhea
febrile sezures: 5m to 5y, high fever, one brief seizure, no other signs, very slight increased risk of epilepsy - watchful waiting
down syndrome PE: oblique palpebral fissures, small ears, nose small with flattened bridge, mouth open, mild muscle hypotonicity present, large gap 1st and 2nd toese.
CF GI: billiary cirrhosis may develop with portal hypertension and varices
hyaline membrane dz (HMD): DIFFUSE, BILATERAL, "GROUND GLASS" OR GRANULAR INFILTRATE
WPW on boards: classic rhythm strip patient is asymptomatic - ex: pts has two separate episodes of passing out at football practice
GAS gold standard: culture - perform GAS culture or rapid antigen assay in all infectious cases of pharyngitis (unless clearly viral) if gen option, ESPECIALLY before treating with antibioitics.
CF signs: meconium ileus, rectal prolapse, dehydration, hypernatremic, hypochloremic metabolic alkalosis
epiglotitis lateral xray: wide, rounded, markedly enlarged epiglottits - thumb sign
absense seizure characterizied by: breif (15-45 seconds), few or hundrends of seizures per day, onset abrupt, no aura, no postictal drowsiness
Tx absense seizures: ethosuximide or valproic acid

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