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54 Cards in this Set
- Front
- Back
fluorosis
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white patches of brown discoloration from high fluoride content of water, swallowed toothpaste, tetracyclines if given from 7 months gestation to 7 years
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delayed eruption of primary teeth
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hypothyroidism, hypopituitarism, trisomy 21, rickets
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acute causes of diarrhea
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in infants, children and adolescents MCC are gastroenteritisand systemic infection
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chronic causes of diarrhea in infants
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postinfectious lactase deficiency
milk/soy intolerance chronic diarrhea of infancy celiac disease cystic fibrosis |
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chronic causes of diarrhea in children
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postinfectious lactase deficiency
irritable bowel syndrome Celiac disease lactose intolerance giardiasis IBD |
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chronic causes of diarrhea in adolescents
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irritable bowel syndrome
IBD lactose intolerance giardiasis laxatives |
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bacterial causes of diarrhea
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campylobacter
enteroinvasive E. coli salmonella shigella yersinia E. coli 0157:H7 |
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viral causes of diarrhea
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rotavirus
adenovirus astrovirus calicivirus Norwalk agent |
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parasitic causes of diarrhea
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giardia
entamoeba histolytica |
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acute diarrhea presentation
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diarrhea, vomiting, abdominal cramps, nausea, fever
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management of acute diarrhea
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proper hydration
antidiarrheals are never used in children |
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acute diarrhea diagnosis
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stool exam
mucus, blood, leukocytes --> colitis if blood and leukocytes or suspected HUS --> stool culture if recent antibiotics --> C. difficile ova and parasites immunoassays for viruses |
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presentation of chronic diarrhea
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weight, height and nutritional status is normal
if carbs present in diarrhea --> carb malabsorbtion if fat present in stools and weight loss --> fat malabsorption |
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workup for chronic diarrhea
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hyistory and physical
stool --> pH, reducing substances, fat, leukocytes, toxin, ova, parasites blood studies --> CBC, differential, ESR, electrolytes, glucose, BUN, creatinine sweat test + 72-hour fecal fat |
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diarrhea management
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most need supportive therapy only
if HUS suspected --> no antibiotics for entamoeba and giardia --> metronidazole |
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Schwachman-Diamond syndrome
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pancreatic insuficiency
neutropenia malabsorption |
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intestinal lymphagiectasia
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lymph fluid leaks into bowel lumen
steatorrhea protein-loosing enteropathy |
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disaccaridase deficiency
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osmotic diarrhea
acidic stools |
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abetalipoproteinemia
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severe fat malasbsorption from birth
acanthocytes very low to absent plasma cholesterol and triglycerides |
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fat malabsorption screening
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most common in pancreatic insuficiency and CF
fat in stools with Sudan stain confirm with 72-hour fecal fat in stools if positive --> sweat test serum trypsinogen is also good screen |
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carbohydrate malabsorption screening
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measure reducing substances in stools
breath hydrogen test after carb load |
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protein loss malabsorption screening
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spot stool alpha-1-antitrypsin levels
serum Fe, folate, Ca, Zn, Mg, B12, D, A |
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differential diagnosis of malabsorption
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giardiasis
HIV or congenital T/B cell deficiencies small bowel --> gluten enteropathy, abetalipoproteinemia, lymphangiectasia pancreatic insuficiency CF malrotation short bowel |
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celiac disease presentation
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diarrhea
failure to thrive growth retardation vomiting anorexia ataxia all from hypersensitivity to gluten, rye, wheat, barley |
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celiac disease diagnosis and treatment
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antiendomysial and antigliadin antibodies
biopsy to confirm is mandatory treat with gluten-free diet |
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VACTERL association
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Vertebral anomalies
Anal atresia Cardiac defects TracheoEsophageal fistula Renal anomalies Limb anomalies |
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tracheoesopahgeal fistula presentation
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cough, cyanosis, respiratory distress, bubbling, regurgitation and aspiration in first feed
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tracheoesophageal fistula diagnosis
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inability to pass nasogastric tube
x-ray shows tube coiled with air-distended stomach for isolated TE fistula --> esophagogram with contrast media or endoscopy |
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GERD presentation
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postprandial regurgitation
esophagitis feeding aversion obstructive apnea, cough, wheezing |
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GERD diagnosis
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most by history and physical
best test --> lowes esophagus pH barium esophagogram and upper GI studies endoscopy if erosive |
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GERD treatment
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conservative
prokinetic agents have no efficacy in children first line drugs --> H2 antagonists (ranitidine) second line --> proton pump inhibitors surgery if refractory |
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GERD differential diagnosis
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milk/food allergy
pyloric stenosis intestinal obstruction infection TEF |
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pyloric stenosis presentation
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nonbilous projectile vomitingbefore 5 months of life
palpation of firm 2cm nonmovable olive-shpaed mass in epigastrium |
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pyloric stenosis diagnosis and treatment
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best test is ultrasound
treat with liquid and electrolyte correction then surgery |
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duodenal atresia presentation
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bilous vomiting without abdominal distention on first day of life (there's distention in ileal or jejunal atresia)
polyhydramnios prenatally jaundice |
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duodenal atresia diagnosis and treatment
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x-ray --> double bubble with no distal bowel gas
do x-ray of spine and ultrasound for other associated anomalies treat with nasogastric decompression, IV fluids, surgery |
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malrotation and volvulus presentation
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acute or chronic obstruction with bilous emesis and recurrent abdominal pain in first year of life
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malrotation and volvulus diagnosis
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ultrasound or contrast x-ray
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Meckel diverticulum
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acid-secreting mucosa causes intermittent painless rectal bleeding; may have anemia, obstruction or diverticulitis
diagnosis --> Meckel radionucleotide scan treat with surgery |
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intussusception presentation
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sudden onset of severe paroxysmal colicky abdominal pain
progressive weakness shock and fever bile vomit hematochezia |
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intussusception diagnosis
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x-ray --> increased density; look for perforation
air enema is diagnostic and curative |
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intussusception treatment
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emergent reduction with fluoroscopy
if shock or peritoneal signs --> surgery |
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causes of GI bleeding
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Meckel
intussusception anal fissure accidental swalloing of maternal blood peptic ulcer disease |
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Crohn disease presentation
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persistent fever of unknown origin
arthritis weight loss, growth retardation episodes of abdominal pain and bloody diarrhea anywhere in GI tract perianal abscess and fistulas |
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Crohn diagnosis
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high ESR
small bowel obstruction on x-ray string sign and skip lesions on upper GI study cobblestoning of mucosa fistulas gold standard is colonoscopy and biopsy |
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Crohn treatment
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steroids
azathioprine and metronidazole for fistulas infliximab and anti-TNF drugs surgery if drug failure |
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Crohn differential diagnosis
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infectious enteropathy
recurrent abdominal pain arthritis leukemia |
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ulcerative colitis presentation
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involves only colon
bloody diarrhea with mucus abdominal pain and tenesmus anemia, leukocytosis, fever and tachycardia vary according to severity |
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ulcerative colitis diagnosis
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diagnosis of exclusion with symptoms present at least 3-4 weeks
endoscopy with biopsy is best test |
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ulcerative colitis treatment
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symptomatic relief
aminosalicylates and sulfasalazine steroids anti-TNF agents (infliximab) surgery if medical failure |
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ulcerative colitis complications
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higher risk of colon cancer
toxic megacolon with perforation |
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Crohn Vs. UC
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Crohn --> perinanal disease, mouth ulcers, strictures, fissures, fistulas,skip lesions, transmural, granulomas
UC --> bloody diarrhea, toxic megacolon, crypt abscess |
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Hirchsprung
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full-term infant with delay in passage of meconium > 48 hours
diagnosis --> rectal manometry + biopsy treatment --> surgery |
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functional constipation Vs. Hirchsprung
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functional constipation --> after 2 years, no abdominal distention, stool in ampulla, relaxation of sphincter in manometry
Hirchsprung --> at birth, abdominal distention, no stool in ampulla, no relaxation of internal sphincter in manometry |