Intussusception 1.

Presentation:
= Telescoping of bowel. Results in intestinal edema and leads to ischemia, perforation, and A. Severe, Intermittent Abdominal Pain. Crampy. Knee to Chest position.
peritonitis B. Palpation of sausage shaped mass on the R side of the abdomen
1. Classic Presentation (3) C. Current Jelly Stools (bloody+mucous)
2. Diagnosis 2. Abdominal Ultrasound (100% sensitive and specific)
3. Treatment 3. Reduction of Intussusception with a hydrpostatic or air contrast study
4. Complication of treatment 4. Bowel Perforation

Cystic Fibrosis
- Autosomol Recessive 1. Sweat Chloride Test
- Caused by a mutation of cystic fibrosis transmembrane conductance regulator
(CFTR), which regulates the movement of chloride and sodium ions across epithelial
membranes. Mutation leads to thick, viscous secretions.
1. How do you diagnose CF?

1. S. Aureus; H. Influenxa
Cystic Fibrosis
2. Pseudomonas aeuroginosa
1. MC organism in Pneumomia for younger kids 3. Tobramycin & Ticarcillin-Clavulanate
or Tobramycin & Piperacillin-Clavulanate
2. MC organism in Pneumonia for older kids or Amikacin & Ceftriaxome
3. Tx or Amikacin and Cefepime

Henoch-Schnlein purpura 1. Purpura, Arthitis, Abdominal Pain

1. Classic Triad 2. HSP is often preceded by an infection, such as
2. Usually preceeded by what? pharyngitis.
3. What other organ can be affected? 3. Kidney (renal involvement)

Fever, Pallor, PETECHIA, Confusion

Thrombotic thrombocytopenic purpura
- Severe thrombocytopenia
- Microangiopathic Hemolytic Anemia
- Renal Failure

Respiratory syncytial virus (RSV) 1. Bronchiolitis (inflammation of the bronchioles)

1. Can cause what? 2. young infant (<2years old), winter months, px with coughing, wheezing, SOB, respiratory
distress. Lungs are hyperinflated., pushing out the liver and spleen (palpable but not enlarged)
2. Presentation
3. Rapid detection of RSV antigen in nasal secretions
3. Diagnosis?
4. Admission; Respiratory Isolation; Bronchodilators
4. Treatment 5. Asthma
5. Pts with RSV are at increase risk of developing what later in childhood?

Croup (laryngotracheitis) 1. Inspiratory CXR. Steeple SIgn (Subglotic narrowing)

-Px: 2y/o with rhinorrhea, cough, fever, harsh barking cough, INSPIRATORY
2. Croup is self limiting Tx can be:
STRIDOR
1. Diagnosis and findings a. Reassurance to the parents (mild dz) or
2. Treatment b. Oral corticosteriods

Epiglottitis 1. inflammatory edema of the epiglottis that blocks airway

1. What is it? 2. respiratory distress
2. What can it cause? 3. H. Influenza
3. Caused by what organism?
4. Intubation
4. Treatment

Mononucleosis 1. splenic rupture

1. What are pts at risk for?
2. How can this be avoided? 2. avoid sports and physical activity
3. What's a finding on peripheral blood smear? 3. Atypical lymphocytes

Rubella vs Rubeola?
RUBEOLA
- 3 C's : cough, conjunctivitis, Coryza (cold sx)
- Koplick Spots (blue/white spots in bucal mucosa)
- maculopapular rash
Rubella vs Rubeola?
- fever
- lymphadenopathy of posterior cervical and suboccipital nodes
RUBELLA
- maculopapular rash
- arthrtiis
- thrombocytopneia
- encephalitis?

Febrile Seizure 1. Age <6

- Temp >38C
1. Criteria for febrile seizure - No Prior seizure activity
2. Diagnosis - No evidence of CNS infection or metabolic abnormalities
2. Clinical. No further work up
3. Treatment
3. Reassurance to parents
4. These pts are at risk for? 4. Pts have slightly increase risk of epilepsy in later life compared to the general population

Bacterial Pneumona 1. S. pneumonae

1. MC organism 2. Amoxicillin
2. Treatment

Acute Otitis Media 1) 1. Strep pneumonia

- Presentation= ear pain, fever, decreased hearing
2. H. Influenza
- Exam: tympamic membrane is red/bulging with limited mobility w/insulfiation.
1 MC organisms (Top 3) 3. Moraxella Catarrhalis
2. Treatment 2) Ampicillin
3. Treatment for reccurent infections 3) Amoxicillin/Claovulanate

Acute Otitis Externa

1) 1. Staph aureus
-Exam : erythematous external canal and normal
tympanic membrane 2. Psuedomonas aeruginosa
1. MC organsis (Top 2)

Bacteria Conjunctivitis 1. Staph aureus, Strep pneumonaie, Moraxella

- Px: eye redness, mucupurulent discharge
Catarrhalis, H. Influenzae
1. MC organisims
2. Treatment 2. Erythromycin ointment
3. Complication 3. Keratitis (inflammation of the cornea)

Arbovirus or Enterovirus
MCC of Viral Meningitis - Easter/Western Equine Encephalitis
- St Louis Encephalitis
- California Encephalitis
- Colorado tick fever

12 months of treatment
Treatment of Tuberculosis Meningitis
- Isoniazid, Rifampin, Pyrazinamide x 2 months
then
- Isoniazid, Rifampin x 10 months

1. Tx of TB if PPD is positive 1. Isoniazid x 9 months

2. Tx of TB if PPD is + and you're 2. Rifampin x 6 months
resistant to normal medication?

When is a pt with active TB infection no after 3 negative sputum acid fast

longer considered infectious? smears on 3 different occasions
Neonatal Sepsis 1. Group B Strep, E. Coli, Klebsiella, Enterobacter species
- Px: poor appetite, decreased reactivity to external stimuli, decreased oral intake
2. Ampicillin and Ceftriaxome. or
1. MC organisms:
2. Treatment Ampicillin and Cefotaxime
3. If the neonate has hyperbilirubemia, which treatment do you avoid and which tx 3. AVOID: Ampicillin and Ceftriaxome b/c it will make the bilirubemia worse.
do you give? GIVE: Ampicillin and Cefotaxime

Infant Botulism 1. Constipation -> Letheragy -> Poor sucking and weak
- Honey, Farm Soil, Canned food
cry
1. Presentation:
2. What reflex can be impaired? 2. Gag Reflex (can result in aspiration)
3. Treatment 3. Human derived botulism antitoxin & supportive care

Malnurished kids 1. Avoid IV hydration b/c these kids are

1. What should be avoided at risk of heart failure and edema
2. Treatment 2. Warming and Oral Hydration/Feeding

Refeeding Syndrome 1. Seen 2-3 weeks after anorexic or malnurished kids start eating again.
Tissue hypoxia and depletion of energy stores occurs. Can lead to HEART
1. What is it? What can it cause?
FAILURE and EDEMA as well as DELIRUM and CARDIAC ARREST
2. What is it due to? 2. Due to hypophosphatemia
3. How do you treat it? 3. Replete phosphate

Why should Cow Milk be avoided in Can casuse iron deficiency anemia and
babies <1 y/o? electrolyte imbalance

Thalassemia Major
- A severe, congenital hemolytic anemia 1. Hypertransfusion regimen
- Pts usually die early in life due to anemia and catastrophic expansion of erythroid
precursors 2. severe organ damage due to iron
1. Treatment
2. Problem of Treatment overload

Aplastic Crisis 1. Parvovirus B19

2. Transient failure of erythropoesis with an abrupt
1. Caused by what? reduction in blood hemaglobin and several erythroid pre-
2. What is it? cursors in the bone marrow

Who gets Hematogenous osteomylelitis Sickle Cell Dz pts

with Salmonella?

Jaundice (hyperbilirubinemia) 1. Unconjugated = physiologic

Conjuncated = pathologic (most severe = Biliary Atresia, requires surgical
1. Unconjugated vs Conjugated intervention)
2. Phototherapy (helps convert bilirubin into a water soluable form that
2. Treatment can be excreted more easily)

Neonatal Jaundice 1. Pathologic cause (think immune or non-immune

hemolysis, like G6PD Deficiency Anemia)
1. If < 24 hours of life
2. Physiologic
2. If > 24 hours of life
 Breast Feeding Jaundice 1. Cause = Dehydration and insufficient caloric intake
2/2 failed initiation of breast feeding ("breast feeding
1. Cause failure)
2. Duration 2. occurs in 1st week of life

Breast Milk Jaundice 1. Caused by factor in breast milk that increases the enterohepatic
circulation of bilirubin
1. Cause
2. May last until the 10th week of life
2. Duration
3. Continue breast feeding, Self limiting. No need for
3. Treatment phototherapy

GERD in babies 1. thicken formula w/cereal

1. 1st line Tx? 2. Ranitidine (H2 blocker)
2. 2nd Line tx?

How often should newborns be fed? q2-3 hours

How often should newborns poop? 6-8x/day

What happens at 4 wks of life? After 4wks of life: 1-2x/day to 3x/week

failure to pass meconium in the first 48 hours; OR

Hirshsprung's Dz chronic constipation and failure to thrive;
megacolon

Nocturnal Enuresis
- Normal if <7 years old
1. Alarms
- Provide reassurance to parents that kids will usally grow out of 2. Alarms & behavioral changes
this
1. Treatments (3) 3. Desmopressin

Undescended Testicles 6months

- how long do you wait before surgery is
recommended?

By when should boys undergo puberty? 1. age 14

How big should their testicles be? 2. greater than 2.5cm

Benign Premature Thelarche 1. Bilateral breast enlargement in babies without other

1. Presentation? signs of precocious puberty
2. When is it seen? 2. age 18-24 months
3. Treatment 3. Expectant management
 McCure-Albright Syndrome 1. Excessive estrogen production from ovaries
1. What is it? Cause? 2. Precocious puberty + cafe au lait spots +
2. Presentation fibrous dysplasia of bone

Addision's Disease (Adrenal Insufficiency)

- Px: abdominal pain, weakness, fatigue, weight loss, myalgia,
1. -Hyponatremia; Hyperkalemia
hyperpigmentation (freckles), decrased axillary and pubic hair) 2. ACTHS stimulation test or early
1. What electrolyte imbalances would you see?
2. Diagnosis? morning cortisol level

Congenital Adrenal Hyperplasia 1. 21-hydroxylase deficiency

1. MCC

21-hydroxylase deficiency 1. Hyponatremia, Hyperkalemia, Hypoglycemia

1. What electrolyte imbalances do you see and why? - due to decrease in mineralcorticoids and glucocorticoidds
2. Diagnosis 2. Elevated 17 alpha hydroxyprogesterone
3. Difference 21 hydroxylase deficiency and 11 hydroxylase 3. 11 hydroxylase deficiency has HTN, Hypernatremia, and
deficency? Hypokalemia

Sydenham's Chorea (aka Saint Vitus Dance) 1. Rheumatic Fever

- MC in girls age 5-13 2. Emotional Liability
1. it's a classic manifestation of what? 3. Jerky movements of the face/hand/feet
2. Preceded by a period of what? Hypotonic state
3. Characteristic presentation - Sudden changes in the pitch and volume of the voice
4. Treatment 4. Penicillin

- slouched back; postural round back, corrected by

Flexible Kyphosis
voluntary hyperextension
- common in adolescents
- No adverse physical effects

- Not corrected by voluntary efforts

Structural Kyphosis
- sharp angulation is seen on forward bending
- If <70degrees, tx with brace
- if >70 degrees, tx w/surgical correction

Transient Synovitis of the hips

1. Xray or Ultrasound (demonstrates
- Condition in young boys, causes pain in hip/thigh/knee
- May be preceeded by viral infection widening of the joint space of the hip)
1. Diagnosis?

Developmental Dysplasia of the hip

- Abnoral formation of the hip joint that prevents the femerol head from seating refer to orthopedic surgeon
properly into the acetabulum
- Risks: breech delivery, female gender, family hx
- Evaluation= attempt to dislocate hip (barlow test)
- Tx:___

Slipped Capital Femoral Epiphysis 1. separation of the ball of the hip joint from the thigh bone
1. What is it? (femur) at the upper growing end (growth plate) of the bone.
2. Who is it seen in the most? 2. Obese children
3. What can it lead to? 3. Avascular Necrosis
4. Treatment 4. Immediate internal fixation with a single screw
 Erb's Palsy 1. Arm is adducted and internally roated, forearm is pronated and wrist is flexed
2. C5, C6, C7
1. Presentation
3. Complication= diaphragmatic paralysis due to phrenic nerve involvement
2. Involves which nerves? 3. Good prognosis. 80% change of full or near full recovery
3. severe complication?
4. Prognosis

- HYPERpigmentated caf au lait spots

Neurofibromatosis Type 1
- OPTIC Gliomas
- Cutaneous neurofibromas
- Bone dysplasia

Neurofibromatosis Type 2 - HYPOpigementated spots

- BILATERAL ACOUSTIC NEUROMAS (DEAFNESS)
- Autosomal Dominant

Treatment of Lead Poisoning 1. Enviromental/Behavioral interventions (identify source, remove

family from lead containing enviroment, clean enviroment,
1. if lead level > 10
educate family)
2. if lead level > 44
2. oral chelation therapy w/Dimercaprol OR IV EDTA
3. if lead level >70 3. hospitalization, IV Dimercaprol AND IV EDTA

Candidial Diaper Rash vs Diaper Dermatitis
1. What is the difference btwn the 2?
2. How do you treat each one?
1. Candidial Diaper rash = rash in the diaper area that involves the crural folds.
Diaper Dermatitis= rash in the diaper area that does NOT involve the crural folds
2. Tx for Candidal Diaper Rash: Nystatin or Clotrimazole cream
Tx for Diaper Dermatitis= Zinc Oxide Ointment, Petrolium Ointment

Atopic Dermatitis Topical steriods or Topical Immune

- Red, scaly rash on face and cheeks
- associated with allergic/immulogic component
Modulators (Tacrolimus). Responds
1. Treatment? quickly

Absence Seizures Ethosuximide

- Staring spells
1. Treatment?

The use of what antibiotic is associated with the risk of development of

Pyloric Stenosis? erythromycin

What is the risk of reoccurance in the risk of reoccurance is that of the general
population
Turner Syndrome (45X0)? - increasing maternal age does NOT increase risk

Which crosses the suture line: Caput Caput Succedaneum

Succedaneum or Cephalohematoma?
 MC extraneural complication of bladder dysfuction
myelomeningocele?

Pts with Marfan Syndrome are at risk of Acute Aortic Dissection

developing what?

Kids with Down Syndrome are at Acute Leukemia

increase risk of developing what later in
life?

How do you diagnose Shingles? (Herpes it's a clinical diagnosis

Zoster)

When can you perform reconstruction 10 weeks of life

surgery in infants w/cleft lip and/or
palate?

Polycythemia
- Hgb > 22, Hct > 65 1. IV hydration
- Plethoric, Lethergic
- Can cause hypoglycemia, jaundice, and apnea due to hyperviscosity which
decreases blood flow to diff tissue including the brain and gut
Partial Exchanged Transfusion
1. Treatment