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153 Cards in this Set
- Front
- Back
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causes of child with limp
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trauma (MC)
neoplasia infection arthritis synovitis |
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Child with limp:
0-3 yrs old 4-12 yrs old >12 yrs old |
developmental dysplasia
Legg Calve Perthes Slipped capital femoral epiphysis |
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Developmental dysplasia:
physical examination Dx Tx Complications |
physical exam -Barlow is most important exam: will dislocate an unstable hip
Dx-U/S best test Tx- Pavilk harness for 1-2 mths old, surgery, casting Complications: acetabular dysplasia |
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where does hip pathology refer pain
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too the knee
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cause of capital femoral epiphysis
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avascular necrosis
|
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who has capital femoral epiphysis
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growing child
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Legg Calve Perthes presentation
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mild intermittent pain in anterior thigh with painless limp, decreased restriction of motion
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Legg Calve Perthes Dx
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x ray shows compression, collapse and deformity of femoral head
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Most common adolescent hip disorder
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slipped capital femoral epiphysis
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Clinical presentation of slipped capital femoral epiphysis
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sudden onset extremem pain; cannot stand or walk
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complications of SLipped capital femoral epiphysis
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osteonecrosis (avascular necrosis) and chrondrolysis (degeneration of cartilage)
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Clinical presentation of transient synovitis
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acute pain with limp
pain in groin, anterior thigh and knee |
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Cause of transient synovitis
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viral; 7-14 days after URI
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Dx transient synovitis
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small effusion
slight increase in ESR Normal x-rays |
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What is talipes equinovarus
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clubfoot
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what is the difference between talipes equinovarous and metatarsus adductus
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in talipes equinovarus the patients hell cant go flat on the exam surface as opposed to metatarsus adductus in which the heel can
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child cant get heel flat on exam table
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talipes equinovarus (clubfoot)
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most common cause of intoeing >2 yrs of age
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internal femoral torsion
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most common of intoeing <2 yrs of age
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internal tibial torsion
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What is Genu varum
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bowleg
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What is genu valgum
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knock knees
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WHat is popliteal cyst (Baker cyst)
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distension of bursa by synovial fluid behind knee
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Dx of Popliteal cyst
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U/S for aspiration
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Presentation of Osgood Schlatter Disease
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swelling, tenderness, increased prominence of tubercle
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Cause of Osgood Schlatter
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overuse injury
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Dx scoliosis
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Adams test: > 20 degree curvature
x-ray |
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Presentation of Torticollis
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twisted neck
head tipped to one side chin rotates to other side |
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Cause of Torticollis
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in utero positioning
labor trauma |
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Nursemaid elbow presentation
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child refusing to bend his arm at the elbow
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What is nursemaid elbow
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longitudinal traction causes radial head subluxation
history of pulling on arm |
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describe x-ray for osteomyelitis
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initially normally
changes are not seen until 10-14 days |
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Causes of osteomyelitis
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S. aureus-MC
Neonate-GBS Pseudomonas-puncture wound Salmonella-sickle cell |
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Test for osteomyelitis Dx
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blood culture
CBC ESR C-reactive protein (CRP) |
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Organism for septic arthritis
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almost all are S aureus
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Presentation of osteomyelitis
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pain with movement in infants
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Dx for osteomyelitis and septic arthritis
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1. initial plain film to exclude other causes
2. U/S 3. MRI (best test) |
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Osteogenesis imperfecta triad
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fragile bones
blue sclera early deafness |
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most common genetic cause of osteoporosis
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osteogenesis imperfecta
|
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osteogenesis imperfecta inheritance
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AD
|
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cause of osteogenesis imperfecta
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structural defect in type I collagen
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Most common malignant bone tumor
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osteogenic sarcoma (Ewing sarcoma if younger than 10 yrs old)
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|
compare x ray of osteogenic sarcoma and Ewing sarcoma
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osteogenic sarcoma-sunburst
Ewing sarcoma-onion skin |
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Metastases of Bone tumor
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go to bone and lung
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Clinical presentation of congenital hypopituitarism
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normal size and weight at birth then severe growth failure in first year
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Clinical presentation of acquired hypopituitarism
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no progression of sexual maturation, amenorrhea
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Laboratory evaluation for hypopituitarism
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-screen for low serum IGF-1 and IGF binding protein 3
-definitive test: GH stimulation test |
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Most common type of hyperpituitarism
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adenomas secreting corticotropin
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Laboratory evaluation for hyperpituitarism
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-screen IGF-1 and IGF-BP3 for growth hormone excess; confirm with glucose suppression test
- Need MRI of pituitary |
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Define precocious puberty
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girls sexual development <8
boys sexual development <9 |
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Evaluation of Precocious puberty
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-screen- significant increase in LH
-definitive- GnRH stimulation test; if positive order MRI |
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Clinical presentation of hypothyroidism
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-prolonged jaundice
-large tongue -umbilical hernia -edema |
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Most common cause of congenital hypothyroidism
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thyroid dysgenesis
|
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Test for osteomyelitis Dx
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blood culture
CBC ESR C-reactive protein (CRP) |
|
Organism for septic arthritis
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almost all are S aureus
|
|
Presentation of osteomyelitis
|
pain with movement in infants
|
|
Dx for osteomyelitis and septic arthritis
|
1. initial plain film to exclude other causes
2. U/S 3. MRI (best test) |
|
Osteogenesis imperfecta triad
|
fragile bones
blue sclera early deafness |
|
most common genetic cause of osteoporosis
|
osteogenesis imperfecta
|
|
osteogenesis imperfecta inheritance
|
AD
|
|
cause of osteogenesis imperfecta
|
structural defect in type I collagen
|
|
Most common malignant bone tumor
|
osteogenic sarcoma (Ewing sarcoma if younger than 10 yrs old)
|
|
compare x ray of osteogenic sarcoma and Ewing sarcoma
|
osteogenic sarcoma-sunburst
Ewing sarcoma-onion skin |
|
Metastases of Bone tumor
|
go to bone and lung
|
|
Clinical presentation of congenital hypopituitarism
|
normal size and weight at birth then severe growth failure in first year
|
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Clinical presentation of acquired hypopituitarism
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no progression of sexual maturation, amenorrhea
|
|
Laboratory evaluation for hypopituitarism
|
-screen for low serum IGF-1 and IGF binding protein 3
-definitive test: GH stimulation test |
|
Most common type of hyperpituitarism
|
adenomas secreting corticotropin
|
|
Laboratory evaluation for hyperpituitarism
|
-screen IGF-1 and IGF-BP3 for growth hormone excess; confirm with glucose suppression test
- Need MRI of pituitary |
|
Define precocious puberty
|
girls sexual development <8
boys sexual development <9 |
|
Evaluation of Precocious puberty
|
-screen- significant increase in LH
-definitive- GnRH stimulation test; if positive order MRI |
|
Clinical presentation of hypothyroidism
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-prolonged jaundice
-large tongue -umbilical hernia -edema -mental retardation -anterior and posterior fontanels wide -mouth open -hypotonia |
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Most common cause of congenital hypothyroidism
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thyroid dysgenesis
|
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Lab evaluation of hypothyroidism
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low T4
increased TSH |
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First sign of hypothyroidism
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deceleration of growth
|
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Most common cause of acquired hypothyroidism
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Hashimoto
|
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Which conditions have an increased risk of hypothyroidism
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Down
Turner Klinefelter Rubella |
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Describe thyroid in Hashimoto
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diffusely increased firm nontender thyroid
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describe exopthalmos in Graves disease
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infiltration of thyroid and retro orbital tissue with lymphocytes and plasma cells
|
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what is thyroid storm
|
acute onset of hyperthermia, severe tachycardia, restlessness-> rapid progression to delirium, coma, and death
|
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Lab evaluation of hyperthyroidism
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increased T4, T3
decreased TSH |
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Tx for hyperthyroidism
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PTU, methimazole
Beta blockers for acute symptoms |
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Clinical presentation of hypoparathyroidism
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-laryngeal and carpopeal spasm
-seizures (hypocalcemic seizures in newborn think DiGeorge) |
|
Lab evaluation for hypoparathyroidism
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decreased serum calcium
increased serum phosphorus normal or low alk phosp low 1,25 D3 (calcitriol) normal Mg Low PTH EKG prolongation of QT |
|
Causes of hypoparathyroidism
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1. aplasia/hypoplasia- DiGeorge
2. X linked recessive-embryogenesis defect 3. AD- Ca sensing receptor mutation 4. postsurgical 5. autoimmune- polyglandular dz |
|
Tx for hypoparathyroidism
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calcium gluconate
calcitriol (1,25 D3) |
|
Tx for Congenital adrenal hyperplasia
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hydrocortisone
fludrocortisone (if salt losing) increased doses of both hydrocortisone and fludrocortisone in times of stress |
|
Most common type of CAH
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21- hydroxylase def
|
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Clinical presentation of 21 hydroxylase deficiency
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hypoglycemia, hyponatremia, hyperkalemia
-affected females masculinized external genitalia (internal organs normal) |
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Lab evaluation for CAH
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-increased 17 OH progesterone
-low serum sodium and glucose, high potassium, acidosis -low cortisol, increased androstenedione and testosterone in affected males -increased renin and decreased aldosterone -Definitive test: measure 17-OH progesterone before and after IV bolus of ACTH |
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Most common cause of Cushing syndrome
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prolonged exogenous glucocorticoid administration
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what is Cushing disease
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excess ACTH from pituitary adenoma
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Lab evaluation Cushing syndrome
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-Dexamethasone-suppression test (single best test)
-Determine cause - CT scan or MRI |
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Clinical presentation of Cushing syndrome
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moon facies, truncal obesity, impaired growth, striae, delayed puberty and amenorrhea, hyperglycemia, osteoporosis
SOAP 'n GO HOME |
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Causes of type I DM
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T cell mediated autoimmune destruction of islet cell, insulin autoantibodies, and glutamic acid decarboxylase
|
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Clinical presentation of Type I DM
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polyuria
polydipsia polyphagia wt loss DKA |
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Tx for DKA in Type I DM
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-insulin must be started at beginning of Tx
-rehydration lowers glucose -sodium is falsely low |
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Diabetes Diagnostic criteria
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1.Symptoms + random glucose >200
2. fasting sugar>126 3. 2 hr oral glucose tolerance test > 200 |
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Most important initial approach for Type II DM
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nutritional education-wt loss and increased physical activity
|
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Symptoms for Type II DM
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_-excessive wt gain
-fatigue -glycosuria -ACANTHOSIS NIGRANs |
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Clinical presentation for Juvenile rheumatoid arthritis
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morning stiffness
easy fatigability joint pain, joint swelling, warm joints with decreased motion no redness |
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Pathophysiology of Juvenile rheumatoid arthritis
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vascular endothelial hyperplasia and progressive erosion of articular cartilage
|
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Tx for Juvenile rheumatoid arthritis
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NSAIDS (1st line)
methotrexate sulfasalazine azathioprine cyclophosphamide |
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Types of Juvenile rheumatoid arthritis
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-Pauciarticular (fewer than 5 joints)- joints of lower extremity (hip never presenting joint; almost never upper extremities)
-Polyarticular (five or more joints)- rheumatoid nodules on extensor surfaces of elbows and achilles tendon -systemic onset- arthritis and visceral involvement - hepatosplenomegaly, lymphadenopathy, serositis, iridocyclitis, salmon colored rash |
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Clinical presentation of SLE
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-females
-fever, fatigue, arthralgia, arthritis, rash |
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Causes of SLE
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-autoantibodies against self antigens
-drug induced- especially with anticonvulsants, sulfonamides, antiarrhythmics |
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Best screen and test for SLE
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screen-ANA
test-anti dsDNA |
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Tx for SLE
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NSAIDS if no renal disease
hydroxychloroquine for mild dz steroids for kidney dz cyclophosphamide for severe dz |
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Dx of SLE
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"MD Soap 'n Hair"
Malar rash discoid rash serositis oral ulcers ANA-positive photosensitivity neurological d/o hematologic d/o arthritis immune d/o renal d/o |
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what should be done to any child suspected of having Kawasaki dz
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echo
|
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Platelet lab values with kawasaki
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platelets high/normal in week 1, then significant increase in weeks 2-3 to more than a million
|
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Most important Dx for kawasaki
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2D echo; repeat at 2-3 wks and if normal at 6-8 wks. Also get ECG, follow platelets
|
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Tx for Kawasaki
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acute- IV immunoglobulin
high dose aspirin |
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what is HSP
|
IgA mediated vasculitis, usually follows URI
|
|
abnormal Labs for HSP
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increased IgA, IgM
|
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complications of croup
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hypoxia only when obstruction is complete
|
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Dx of Croup
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clinical, x-ray not needed (steeple sign)
|
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Tx for Croup
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cool and warm mist
nebulized epinephrine corticosteroids |
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Signs and symptoms of Croup
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URI 1-3 days, then barking cough, hoarseness, inspiratory stridor, worse at night, gradual resolution over one week
|
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cause of croup
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parainfluenza
|
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cause of epiglottis
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H influ type B
Strep pyogenes strep pneumonia Staph aureus mycoplasma |
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Tx for Epiglottis
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1. intubate (establish patent airway)
2. Antibiotics to cover staph, HiB, and resistant strep (antistaph plus third generation cephalosporin) |
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Dx of Epiglottis
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1. clinical first
2. cherry red swollen epiglottis 3. x-ray not needed (thumb sign) |
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cause of Bacterial tracheitis
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staph aureus
|
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Tx for bacterial tracheitis
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antistaph antibiotics; may require intubation if severe
|
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signs and symptoms of bacterial tracheitis
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brassy cough, high fever, respiratory distress, but no drooling or dysphagia
|
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cause of acute infectious laryngitis
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viruses
|
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signs and symptoms of acute infectious laryngitis
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URI with sore throat, cough, hoarseness
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Differential dx for acute infectious laryngitis
|
-diphtheritic croup
-foreign body aspiration -retropharyngeal abscess -angioedema |
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most common foreign body
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peanuts
|
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Dx of Airway foreign body
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chest x-ray reveal airtrapping
bronchoscopy for definite dx |
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Tx of airway foreign body
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removal by rigid bronchoscopy
|
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signs of acute bronchitis
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URI symptoms
dry, hacking cough is persistent, then may be purulent coarse and fine crackles |
|
Dx of Bronchiolitis
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-chest x-ray- hyperinflation with patchy atelectasis
-immunofluorescence of nasopharyngeal swab |
|
Tx for bronchiolitis
|
-give trial of beta2 agonist nebulization
-no steroids -ribavirin still controversial |
|
Bronchiolitis prevention
|
hyperimmune RSV IVIG or monoclonal antibody to RSV F protein in high risk patients only
|
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definition of pneumonia
|
inflammation of the lung parenchyma
|
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causes of pneumonia
|
-viruses are predominant cause in infants and children younger than 5 yrs of age (RSV, parainfluenza, influenza, adenovirus)
-nonviral causes are more common in children older than 5 yrs of age (Strep pneumo, M pneumo, C. pneumo) |
|
Tx for inpatient and outpatient pneumonia
|
inpatient: cefuroxime (if suspect S. aureus, add vancomycin or clindamycin)
outpatient: amoxicillin (best) alternative: cefuroxime Chlamydia or mycoplasma: erythromycin or other macrolide |
|
MCC of exocrine pancreatic deficiency in children
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Cystic fibrosis
|
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pathophysiology of Cystic fibrosis
|
membranes of CF epithelial cells unable to secrete Cl- in response to cyclic adenosine monophosphate
|
|
How does cystic fibrosis manifest
|
bronchiectasis
large nasal polyps |
|
Clinical presentation of cystic fibrosis
|
meconium ileus
frequent, bulky, greasy stools, and failure to thrive acute pancreatitis fat soluble vitamin def (ADEK) rectal prolapse cough, purulent mucus salty taste of skin |
|
Dx of cystic fibrosis
|
Sweat test (best)
X-ray- hyperinflation of chest |
|
Tx for cystic fibrosis
|
1. clear airway secretions and control infections: albuterol/saline, daily dose of human recombinant DNAse (mucolytic)
2. chest physical therapy with postural drainage 3. Antibioitics: most frequent is Pseudomonas (less common H inflluenza, S. aureus, B. cepacis) Aerosolized antibioitcs -tobramycin 5. Hospitalization: pseudomonas-pipercillin plus tobramycin or ceftazidime 6. Nutrition: pancreatic enzyme replacement and fat soluble vitamins |
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What is sudden infant death syndrome (SIDS)
|
sudden death of an infant unexplained by history
|
|
Differential diagnosis of SIDS
|
infections
congenital anomaly unintentional injury traumatic child abuse |
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Pathology findings for SIDS
|
petechial hemorrhages
pulmonary edema |
|
risk factors for SIDS
|
low socioeconomic status
AA or native americans highest at 2-4 mths ; most by 6 mths more in winter more in males |
|
Reduce SIDS risk
|
supine sleeping
no soft surfaces no bed sharing |
|
Differential Dx of allergic rhinitis
|
nonallergic inflammatory rhinitis (no IgE antibodies)
vasomotor rhinitis nasal polyps (think CF) septal deviation overuse of topical vasoconstrictors |
|
Differential Dx of eosinophilia
|
neoplasms
asthma/allergy addison dz collagen vascular d/o parasites |
|
Allergic rhinitis physical exam
|
-allergic shiners
-transverse nasal crease -pale nasal mucosa, turbinate hypertrophy -postnasal drip |
|
Pharm Tx
|
1st line: Antihistamines
2nd line but most effective -intranasal corticosteroids |
