Which condition uses the rule of 3’s: more than 3 hours, more than 3 days per week, for more than 3 months?
Colic
What is the criteria for a child to have enuresis?
Child over 5 years old
2 times per week
For 3 weeks
What is the most common cause of encopresis?
Constipation
What is the definition of failure to thrive (FTT)?
Weight less than 5th percentile on multiple occasions
OR
Weight deceleration that crosses two major percentile lines
What is the most common primary nephrotic syndrome and between what ages does it occur?
Minimal Change Nephrotic Syndrome
Occurs between ages 1-8
What is the leading cause of hypertension in children (according to the lecture)?
Vesicoureteral Reflux
What is the test of choice for vesicoureteral reflux?
Voiding Cystourethrogram (VCUG)
What specific gravity is required for a 1+ protein on dipstick to be considering proteinuria and what if it is higher than that?
Specific gravity of < 1.015
If higher than this… needs to be 2+ protein.
What conditions should imaging be done for a child with a UTI?
Child with 1st UTI before age 5
Febrile UTI
Recurring UTI
Male with UTI
What is heme-positive urine caused by and what do each of these indicate?
Hemaglobinuria = presence of hemoglobin free from red blood cells – caused by hemolytic anemia
Myoglobinuria – caused be skeletal muscle injury (ex. rhabdomyolysis)
A child comes in with his foreskin trapped behind his glans penis. What is the condition and how is it treated?
Paraphimosis
This is a MEDICAL EMERGENCY.
Treatment = emergent circumcision
- What is the treatment for voiding dysfunction?
- At what age is pharmacological therapy avoided until?
- At age 7, what can we use?
1. Reassurance is key!
2. Pharmacological therapy is avoided until age 7!
- Desmopressin Acetate (synthetic analog of antidiuretic hormone) and Imipramine (tricyclic antidepressant)
Do we circumsize a child who was diagnosed with hypospadias?
No - foreskin is needed because it may be used in surgical repair.
What pediatric orthopedic condition is more common in females?
What physical exam tests would you administer?
Developmental Dysplasia of the Hip
Administer Barlow’s test (dislocation test) and Ortolani test (relocation test)
What sign is seen on x-ray for a child with idiopathic osteonecrosis of the femoral head?
Well first - this is Legg-Calve-Perthes Disease
Sign on x-ray = cresent sign
What is the most common adolescent hip disorder?
Slipped Capital Femoral Epiphysis
I say “obese 10-year-old girl with hip pain and a limp”. You say….
Slipped Capital Femoral Epiphysis
What is the most common cause of “toeing in”?
Internal tibial torsion
What is the most common cause of “toeing in” after age 3?
Femoral Anteversion
What othopedic disorder has point tenderness at tibial tubercle?
Osgood-Schlatter’s Disease
What is the most common cause of scliosis?
Idiopathic (roughly 65% of the time)
What is the diagnostic test of scoliosis?
Adam’s forward bend test
At an angle greater than ___, surgical intervention is needed to treat scoliosis.
50 degrees
What is unilateral contraction of the sternocleidomastoid muscle?
Torticolis
What is the most common type of Salter-Harris Fracture?
Type II (75%) - transverse through physis into the metaphysis
What orthopedic disorder is characterised by blue sclera and decreased hearing?
Osteogenesis Imperfecta
What condition is known as the 100 day cough and requires treatment of everyone in the family?
Pertussis
What are the 3 stages of pertussis?
Catarrhal stage: 1-2 weeks - URI symptoms, fever, cough, runny nose – when child is MOST CONTAGIOUS
Paroxysmal Stage: 1-6 weeks, “post-tussive vomiting, inspiratory whoop”
Convalescent Stage: recovery 2-3 weeks - cough lessens
A child comes into urgent care with a barking cough and inspiratory stridor.
1. Identify the disorder
2. Name the causative agent
3. Name the hallmark finding on x-ray
- Croup
- Parainfluenza
- “Steeple sign” on chest x-ray
What is the medical condition that has fallen in incidence due to the HiB vaccination and what would you see on x-ray?
Epiglottis
“Thumb sign”
Is epiglottis a medical emergency?
Duh
A patient presents with fatty, greasy, white stools and recurrent respiratory infections. What test would you order to confirm your diagnosis and what disease are you testing for?
Sweat chloride test - Why? Because this disorder is an abnormality in the Cystic Fibrosis Transmembrane Conductance Regulator (a chloride channel)
This is obviously cystic fibrosis.
What non-asthmatic medication could be beneficial to tr in a child who has asthma and why?
Trial of PPI’s since asthma and GERD are commonly connected!
What types of foreign bodies in the nose are you concerned with and why?
Batteries and Magnets
Can cause septal perforation
When would you see a “ground glass appearance” on chest x-ray and what are these patients lacking?
This is hyaline membrane disease - these patients are lacking surfactant.
What is the most common craniofacial anomaly in children?
Cleft lip/palate
What is the passage of gastric contents into the esophagus causing troublesome symptoms or complications?
GERD
What is the passage of gastric contents into the esophagus, but is a normal physiologic process in infants and children - does not cause symptoms, esophageal injury or complications and resolves by 18 months?
GER (Gastroesophageal Reflux)
Define a tracheoesophageal fistula and esophageal atresia.
A congenital anomaly of the respiratory tract causing a connection of the esophagus to the trachea and the development of a false pouch (esophageal atresia) instead of an esophagus.
How are tracheoesophageal fistulas and esophageal atresias diagnosed?
Inability to pass a NG tube into the stomach
Definitive test = upper GI series with endoscopy for direct visualization
An infant comes in who is projectile vomiting after being fed but remains hungry. What would you expect to find on an upper GI series and on physical exam?
Upper GI series = string sign
Physical exam = olive shaped mass felt in RUQ
An abdominal x-ray shows a “double bubble sign”. What is causing this sign?
Ladd bands have caused a volvulus, which is showing air in the duodenum and stomach only
What GI pediatric disorder presents with sudden onset of bilious vomiting (green vomit)?
Volvulus
What condition would present with currant jelly stool and a bulls eye or target sign?
Intussusception
What GI pediatric disorder causes children to draw legs/knees towards their abdomen?
Intussusception
What disease involves the absence of ganglion cells in the distal rectum and colon?
What sign would be present on DRE?
Hirschsprungs Disease
On DRE… “squirt sign”
What disease presents with failure to pass meconium (first stool) within the first 72 hours of life?
Hirschsprungs disease
What is the most common congenital anomaly of the small intestines?
Meckel’s Diverticulum
What GI disorder has the buzz word “vitelline duct”?
Meckel’s Diverticulum
What disorder is characterized by the rule of two’s?
Meckel’s Diverticulum
Occurs in 2% of the population, male to female ratio is 2:1, within 2 feet of the ileoceccal valve, can be 2 inches long, usually present before age 2
What is the most common condition in children requiring emergency abdominal surgery?
Appendicitis
What happens when a child has an imperforate anus?
They’re full of shit.
HA. That sucks.
What is the imaging of choice for appendicitis?
CT
What type is hernia is most common in children?
Which type is most dangerous?
Most common = umbilical
Most dangerous = diaphragmatic
What is the diagnostic test for lactose intolerance in children?
Lactose breath hydrogen test
What suture is most commonly affected by craniosynostosis?
Saggital
What is Hering’s Law and what disorder is it for?
Agonist muscles in both eyes receive equal innervation to ensure coordinated movements (eg, as right eye abducts, the left eye will adduct)
Strabismus
What often presents with unilateral purulent nasal drainage, epistaxis, nasal obstruction and mouth breathing?
Nasal foreign body
A child presents after a possible untreated ear infection. When you look at him, you immediately notice that one of his ears is “sticking out”. What condition do you immediately need to consider?
Mastoiditis
What is a pseduocyst of minor salivary gland origin?
What is a pseudocyst of the sublingual glands and submandibular glands?
Salivary gland origin = mucoceles
sublingual and submandibular gland origin = ranulas
What is a huge sign of child abuse?
Any bruise in an infant less than 6 months old
What is the most frequent diagnosis in sick children in the US?
Otitis Media
Who needs treatment for otitis media?
Who can be observed?
Treatment = children less than 2 years old and older children with bilateral disease or otorrhea
Observation = children older than 2 years with minimal symptoms and unilateral disease
Do we treat otitis media with effusion with antibiotics?
Negative - this is a plumbing problem
Time is the only remedy
What is the first line treatment for otitis media?
HD Amoxicillin
Is sinusitis more commonly caused by a virus or bacteria?
Virus
What is commonly caused by Group A Coxsackie virus?
Hand, Foot and Mouth Disease
What is one of the first symptoms of hand, foot and mouth disease?
Refusal to feed due to oral sores
What physical exam finding would you expect to see in a child with erythema infectiosum?
Slapped cheek appearance
A child presents to your office with a 4-day history of high fiver that finally stopped last night. The child now has a diffuse maculopapular rash. What do you think is going on with them?
Roseola - Exanthem subitum
What is the causative agent of fifth’s disease?
Parvovirus B-19
What condition can cause a potential life-threatening formation of a pseudomembrane in the posterior pharynx?
Diphtheria
What is the worldwide 5th leading cause of death in children under 5?
Measles
A child presents to your office with a 5-day history of a high fever as well as a strawberry tongue. What is the most likely diagnosis?
Kawaskai’s Disease
Why should we all boycott monday’s exams and just sleep?
Mumps
What is the most common congenital heart disease?
Ventricular Septal Defect (VSD)
What physical exam finding would you expect upon auscultation of a patient with an atrial septal defect?
Widely split S2 through inspiration and expiration
Grade II-III midsystolic crescendo-decresendo murmur
What is the most common anatomic type of atrial septal defect?
Ostium secundum - defect in the mid septum at the fossa ovalis (80%)
What cardiac disorder has a loud (Grade III-IV) harsh crescrendo-decrescendo murmur heard at the upper LSB radiating towards clavicles and is louder with inspiration?
Pulmonic stenosis
For managing pulmonic stenosis, valvuloplasty is always indicated for gradient > ____.
75mm
What condition would you expect to find a continuous “machinery murmur” and how it is treated?
Patent ductus arteriosus
Indomethacin
What do ventricular septal defect, atrial septal defect and patent ducut arteriosus have in common?
Left to right shunting
What condition would you expect to find a difference of more than 10mmHg between the upper and lower extremities?
Coarctation of the aorta
What is the diagnostic imaging for coarctation of the aorta?
Cardiac MRI/MRA and CT
What condition causes a right to left shunt?
Tetralogy of Fallot
What disease is treated with high dose aspirin and puts children at risk for coronary artery aneurysms?
Kawasaki’s Disease
What is the most common nutritional deficiency in children?
Iron deficiency
What is the most common malignancy in children?
Leukemia - 33%
What is the most common abdominal tumor in children?
Wilms tumor
What type of juvenile rheumatoid arthritis involves a quotidian fever pattern with a rash?
Systemic arthritis
What type of pediatric rheumatic condition presents with Kobner’s phenomenon?
Systemic arthritis
Identify the difference between persistent and extended oligoarthritis.
Persistent = no other joint involvement after the first 6 months
Extended = four or less joints over the first 6 months and then increases in number over time
What is highly indicative of psoriatric arthritis?
Arthritis in a single DIP
What is the most common vasculitis in children and how does it most commonly present?
Henoch Sholien Purpura
Rash = most common presentation
What condition involves a deletion in chromosome 22 causing low PTH and Ca levels?
DiGeorge syndrome
What disorder involves a female phenotype with an XY genotype?
Androgen insensitivity
Define cephalohematoma.
Blood between the periosteum and the bone due to difficult labor or delivery with suction or forceps
Does not cross suture lines
What condition is caused by a brachial plexus injury during birth?
Erb palsy
Why is it dangerous for cat ladies to become pregnant?
Toxoplasmosis Gondii
What are the 3 components of the atopic traid?
Asthma
Atopic dermatitis
Allergic rhinitis
What is the most common allergic disorder and what are some physical exam findings you would see?
Allergic rhinoconjunctitivitis
Physical exam = allergic shiners, allergic salute, cobblestoning of the posterior pharynx
What are the most common causes of anaphylaxis in the following age groups:
- Children
- Adults
- Elderly
Children = food
Adults = venom
Elderly = medications
Which immunologic disease requires daily prophylactic antibiotics and antifungal agents?
Chronic Granulomatous disease
What is the most common neurologic disorder of infants and young children?
Febrile seizures
What is considered an abnormal head size?
2 standard deviations above or below normal
What is the most common cause of persisting proteinuria in children?
Orthostatic proteinuria
What are the signs and symptoms associated with primary nephrotic syndrome in children?
Facial and lower extremity edema
Progresses to generalized and aggressive edema
How do you treat minimal change disease?
Corticosteroids
Which type of primary nephrotic syndrome can lead to end stage renal disease?
Focal segmental glomerulosclerosis
The following is diagnostic criteria for which disorder:
- 3-4+ proteinuria on dipstock
- Over 150mg on 24 hour urine
- Increased serum creatinine
Primary nephrotic syndrome
Treatment for primary nephrotic syndrome. Fill in the blank.
If the child is between the ages of __ and __: no biopsy needed - just treat
If the child is less than ___ or older than ___: biopsy needeed prior to treatment
If the child is between the ages of 1 and 8 : no biopsy needed - just treat
If the child is less than 1 or older than 8 : biopsy needeed prior to treatment
The following triad is for which genitourinary disorder in children?
1. fever
2. rash - maculopapular/urticarial
3. Arthralgia with steady increasing creatinine
*No hematuria or proteinuria*
Acute tubulointerstitial nephritis
What presents with persisting hematuria and proteinuria that lacks any other explanation?
Membranous glomerulopathy
What is the most common cause of acute renal failure, typically in children under 4 years old?
Hemolytic-uremic syndrome
What is the triad for hemolytic uremic syndrome?
Hemolytic anemia
Uremia
Thrombocytopenia
What disorder is preceded by an acute GI illness in 80% of children?
Hemolytic-uremic syndrome
I say helmet and burr cells on peripheral blood smear.
You say…
Hemolytic-uremic syndrome
When do we start screening for hypertension in children?
Age 3
What is pediatric hypertension defined as?
Systolic and diastolic blood pressure over the 95th percentile for weight, height, age and gender.
At what age does toileting start?
At what age are most children dry through the night?
Toileting starts around age 2-3
Most kids are dry through the night by age 5
When does the anterior fontanelle close?
10-24 months
When does the posterior fontanelle close?
By 2 months
What is the most common form of strabismus?
Pseudostrabismus
During the midsummer, a child presents to your office with his mother. She mentions her son has had a fever, sore throat, and is refusing to eat. You do an oral exam and notice diffuse oral lesions.
- What is your diagnosis?
- What is the most common causative agent?
1. Herpangina
2. Coxsackie A virus
A child presents to your office with a fever and is refusing to eat according to his mother. You also notice the child has tender lesions on his hands, feet and buttocks.
What diagnosis should climb to the top of your differential?
Hand, foot and mouth disease
What is the causative agent of roseola?
Herpes virus 6
What is the most common cause of impetigo?
Staph aureus
Then, group A streptococcus
How do you treat impetigo?
Topical mupirocin
If severe - Dicloxicillin
What is the most common causative agent for epiglottis?
Haemophilis Influenzae B
I say… drooling and tripoding in a 5 year old.
You say…
Epiglottis
Treatment for epiglottis. Go.
Ceftriaxone (Rocephin)
Anti-pyretics for fever
Secure airway
IV steroids
Is streptococcus pharyngitis caused by Group A or Group B streptococcus?
Group A
What is the DOC for treating streptococcus pharyngitis?
Penicillin
What is a manifestation of streptococcus pharyngitis if left untreated for 2-4 weeks?
Rheumatic fever
Symptoms:
- Migratory athritis
- Pancarditis/valvitis
- CNS involvement
- Erythema marginatum
- Subcutaneous nodules
Symptoms include hot potato voice, drooling, trismus, ipsilateral ear pain.
1. What is the diagnosis?
2. How do we treat it?
1. Peritonsillar abscess
2. Drainage + oral Augmentin or Clindamycin
What is the leading cause of blindness in children?
Uveitis
Also known as “still’s disease”
Arthralgia of the knees, ankles and wrists most commonly
Quotidian fever pattern
Macular salmon rash with Kobner phenomenon
Systemic juvenile idiopathic arthritis
What disorder causes arthritis of 1-2 joints but quickly progressives to 5 or more joints over a 6 month course?
Polyarthritic juvenile idiopathic arthritis
What is the most common subtype of juvenile idiopathic arthritis representing roughly 50% of cases?
Oligoarthritis
What is the diagnostic criteria for Henoch Shoilen Purpura?
Need 2 out of the 4:
- Purpura
- Bowel angina
- Biopsy
- Pediatrics group
What is the most common cause of excessive growth hormone?
Pituitary adenoma
What is the definitive treatment for Grave’s disease (hyperthyroidism)?
Radioactive iodine
What are some complications of hyperparathyroidism?
Dig deep in those brains.
- Pathologic fractures
- Urinary calcium stones
- CNS changes (if calcium rises too rapidly)
- Renal failure
What is the hallmark finding of hypoparathyroidism?
Low ionized calcium
I say Chvostek and Trousseau sign. You say…
Hypoparathyroidism
What has a URI prodrome with cough, coryza, and conjunctivitis.
It also causes Koplik spots in the mouth and a brick red rash starting at the hairline and progressing head to toe - sparing palms and soles.
Measles
What is the causative agent for measles?
Paramyxovirus
What disease is caused by the togavirus?
Rubella
3 day pink maculopapular rash
Posterior cervical and posterior auricular lymphadenopathy
Forcheimer spots
Rubella
Is the infection from congenital rubella syndrome chronic or acute?
Chronic
Low grade fever
Fatigue, headache
Parotitis within 2 days of prodromal symptoms
Mumps
Dew drops on a rose petal
Varicella zoster
Describe the progression of the rash associated with varicella zoster.
Begins on the face and trunk and spreads to extremities.
Which of the following is not caused by the paramyxovirus?
A) Measles
B) Fifth’s Disease
C) Mumps
D) Respiratory Syncytial Virus
B) Fifth’s Disease - Parvovirus B19
What disease starts as a URI then progresses to fever, expiratory wheeze that is junky sounding, nasal flaring, grunting, retractions, low O2 sat?
Bronchiolitis
Do we treat bronchiolitis with steroids and antibiotics?
Hell to da no.
Treatment = nasal suctioning and hydration.
What can we give infants with pulmonary dysplagia, premature birth or congenital heart disease to prevent bronchiolitis?
Palivizumab
What is the causative agent of croup?
Parainfluenza virus 1
What are some hallmark findings for croup?
“Steeple sign” on x-ray
Barking, seal cough
Inspiratory stridor
Coughing at night especially when laying down
Respiratory distress (retractions, low O2 sat)
How do we treat mild croup?
How about moderate - severe croup?
Mild = Dexamethasone
Moderate/Severe = oxygen, racemic epi, consider hospital admission
What has asymmetric skin folds?
Developmental Dysplagia of the hip
What do you perform at 6 weeks gestation if the fetus is female and breech?
An ultrasound is check for developmental dysplagia
What is the treatment for Legg-Calve-Perthes Disease?
Observation - femoral head can revascularize in 12-18 months
Limit vigorous activity
Crutches
NSAIDs
What is the treatment for Slipped-Capital-Femoral Epiphysis?
Surgical fixation
Single screw into the epiphysis
What is a normal foot angle?
0-30 degrees
What causes pes planus (flat feet)?
External tibial torsion
What is medial rotation of forefoot that is present at birth and occurs at the TMT joint?
Metatarsus adductus
What is a congenital deformity of the foot causing plantar flexion of the ankle, adduction of the heel and high arches?
This is also known as “club foot”
Talipes Equinovarus
What is the treatment for talipes equinovarus?
Immediate casting before hospital discharge
Serial casting every 1-2 weeks
Surgery after 4 months of treatment
Scoliosis: lateral curvature of the spine over ____ degrees.
10 degrees
What angle do you measure on the x-ray for scoliosis?
Cobb angle
Treatment for scolisos.
If over __ to ___ % = brace
If over ___% = surgery
If over 20 to 40 % = brace
If over 50 % = surgery
What is the treatment for nursemaid elbow?
Opposite of MOI.
Pressure on the radial head with forced flexion and supination.
How many doses in the MMR vaccine?
When are they given?
2 doses!
1st: 12-15 months
2nd: 4-6 years
What are the 3 most common diseases seen in schools?
Influenza
Pertussis
Varicella
What is the best diagnostic study for influenza?
PCR
What is the best way to prevent influenza?
Influenza vaccine!
Get it between august/september
These are signs of _____ _____.
Tachycardia, retractions (intercostal and sternal), nasal flaring, grunting, head bobbing, abdominal breathing, tripod position.
Respiratory distress
DOC for pneumonia?
2nd line?
DOC = Amoxicillin
2nd line = Macrolide
What is the leading cause of death in a <1 year old infant?
Sudden infant death syndrome
How do you treat hyaline membrane disease?
Corticosteroids - induces formation of surfactant in fetal lungs
Or give surfactant
What are some ways to evaluate for dehydration in a child with diarrhea?
Urinary frequency
Skin turgor
Mucous membranes
What is the treatment for volvulus?
Immediate surgery
How do you diagnose Meckel’s Diverticulum?
Meckel scan (nuclear medicine)
Diarrhea, steatorrhea, weight loss, vitamin deficiency
Herpetic dermatitis
Celiac Disease
Abdominal pain, bloating, flatulence, diarrhea
1. Disorder?
2. How to diagnose?
3. Treatment?
Lactose Intolerance
Lactose hydrogen breath test
Don’t eat lactose ya dumb dumb