** emma holliday **

PEDS NOTES - QBank

Tender swollen testicles (posterior)

● Epididymitis
● Chlamydia and Gonorrhea
● Also associated with urethral discharge
● Reflux of urine most common cause

Absent cremasteric reflex

● Testicular torsion
● Medical emergency

Kidney stone, dx?

● Non-contrast CT

Enlargement of scrotum with valsalva maneuver

● Communicating hydrocele
● Dx: transillumination

Sickle cell patient with RUQ pain, think:

● Acute cholelithiasis (gallstone)

Acute cholecystitis, dx?

● Ultrasound of abdomen

Newborn with decreasing appetite + peeing a lot. Think?

● Diabetes insipidus

AVPR2 gene mutation

● Diabetes insipidus

Tracheoesophageal fistula is associated with

● VACTERL
● Also seen with anal atresia
● Finding of one of these, you should look for another

Projectile vomiting + tube coiled in the upper esophagus

● Tracheoesophageal fistula

Tall, joint laxity, bad vision. Think?

● Marfan syndrome
○ Also associated with MVP
○ Discoloration of lens
○ Long limbs
○ Aortic root dilatation
○ Aortic dissection
● Note: Ehlers danlos do not have vision defects
○ But also tall with joint laxity

Infant with: hypertension + incidental abdominal mass

● Wilms tumor
● Most common childhood abdominal malignancy
 ● Usually asymptomatic, unitaleral
● Can be associated with Beckwith Wiedemann Syndrome, WAGR syndrome, etc

Infant with: respiratory distress at birth that resolves when the infant begins to cry
● Bilateral choanal atresia
● Diagnosis: feeding tube through both nostrils

New diabetic + temporary decrease in need for insulin

● “Honeymoon period” after newly diagnosed-diabetes
● Can have unpredictable periods of hypoglycemia

Neonate: Jaundice after sulfa-containing antibiotic

● G6PD
● X-linked disorder

Tx of Labial adhesions?
● Estrogen cream

Fever + vomiting + myalgia + headache + backache + recent travel to africa/south america

● Yellow Fever

Tx of oral thrush?
● Nystatin oral suspension

Downward displacement of the acromion

● AC joint separation
● After lateral hit to the shoulder

A long and narrow head shape + closed anterior fontanelle + in a 6 week old infant
● Premature closure of sagittal suture
● Scaphocephaly

HOCM suspected, next step?

● Echocardiogram

Infant with: upper respiratory infection (ie runny nose), followed by a fever and cough + shortness of breath
● Bronchiolitis / RSV
● CXR: lung hyperinflation
● Diffuse rales, Wheezing
Fever + arthritis + young sexually active female
● Gonococcal arthritis
● Septic arthritis

Tx of Gonococcal arthritis?
● IV Ceftriaxone

Tx of Viral Conjunctivitis “pink eye”?

● Supportive care
● Most commonly due to adenovirus
Sickle cell pt + cough + fever + new-onset pneumonia
● Acute chest syndrome

History of heavy menstrual bleeding with each menstrual cycle, think?

● Von Willebrand Disease
● Measure vWF

Newborn: born to mom using methadone/opiates + tachypnea + hyperactive, think?

● Neonatal abstinence syndrome

Neonatal abstinence syndrome, next step?

● Oral morphine or methadone - for slow weaning over several weeks

Child with recurrent sinopulmonary and ear infections, and pneumonia, next step?
● Measure serum IgG, IgA, IgM and IgE levels
● Could be Bruton agammaglobulinemia

Diagnosis: recent viral illness + features of congestive heart failure + muffled heart sounds
● Viral myocarditis
● Coxsackie

Diagnosis: bloody diarrhea after contact with dog/animal or undercooked chicken

● C. Jejuni gastroenteritis

Diagnosis: seizure + hypopigmented spots + tiny red spots on face + neurologic/brain abnormalities
● Tuberous sclerosis
● Asc-leaf macules - hypopigmented spots
● Autism or epilepsy
● Angiofibromas on the face
● Shagreen patches on the back or neck

Marfan syndrome is associated with which cardiac anomaly?

● Mitral valve prolapse
● Aortic dissection is high

Diagnosis: Hyperflexible joints + tall + dislocation of lens

● Marfan syndrome
Diagnosis: Hyperflexible joints + tall stature + long, think face + prominent ears, forehead, and jaw
● Fragile X

Diagnosis: Hyperflexible joints + pectus excavatum + scoliosis + high arched palate

● Fragile X

Diagnosis: Hyperflexible joints + macroorchidism

● Fragile X

Diagnosis: Tall stature + gynecomastia + hypogonadism

● Klinefelter syndrome

Diagnosis: prolonged jaundice + poor tone + failure to thrive + large anterior fontanelle
● Congenital hypothyroidism
● + macroglossia
● + constipation
 ● + coarse facies
● + umbilical hernia
● + hoarse cry

Diagnosis: self-mutilating behaviour + musty odor

● PKU

Diagnosis: child with acute hepatitis + “boiled cabbage” smell

● Tyrosinemia
● Fever, inrritabilitly, vomiting, hemorrhage, hepatomegaly
● Evidence of liver disease

Diagnosis: sweaty feet odor + acidosis in newborn

● Isovaleric acidemia

Diagnosis: red nodule on the eyelid, painless, recurrent

● Chalazion

Diagnosis: history of chronic tearing + red, swollen area below medial corner of eye
● Dacryocystitis
● Congenital nasolacrimal duct stenosis
● Persistent clear discharge from the eye
● Presents in the first month of life

Diagnosis: conjunctivitis + itchy + pale, bluish-gray nasal mucous membranes

● Allergic conjuctivitis

Tx: Animal bites to hand/foot/genitalia (vital areas)

● Amoxicillin-clavulanate (augmentin)
● Prophylactic

Tx: Animal bites to non-vital areas

● Cleansing and observation only
● IF needed: Amoxicillin-clavulanate (augmentin)

Tx: human bites

● Clean, then Amoxicillin-clavulanate (augmentin)
 EMMA HOLLIDAY - PEDS

APGAR Scoring

● 1 minute apgar score tells us…

○ how the baby tolerated labor
● 5 min apgar score tells us
○ how the baby is responding to stimulation
● Does APGAR predict outcome?
○ No
● Does APGAR guide therapy?
○ No
● The right arm remains extended and medially rotated.
○ Erb Duchenne Palsy
○ C5-C6
● When palpating the clavicles on a LGA newborn, you feel crepitus and discontinuity on the left.
○ Clavicle fracture
● What to do for Erb Duchenne palsy?
○ Refer if not better in 3-6 months
○ Refer to neuroplasty
● What to do for clavicle fracture?
○ No treatment needed
○ Can use a splint after 8 weeks
● Edema on scalp crossing suture lines, called
○ Caput succedaneum
● Edema on scalp, not crossing suture lines
○ Cephalohematoma
○ Fluctuant
● Blue, slightly gray macule on the back or thigh
 ○ Mongolian spots
○ Arrested melanocytes
● Pale pink vascular macules, face and nuchal area
○ Nevus simplex
● Firm white papules, day of life 1, filled with keratin
○ Milia
● After 1-2 weeks of life
○ Neonatal Acne
● Firm white papules on a erythematous base
○ Erythema toxicum
○ Eosinophils
● An area of alopecia with orange colored nodular skin
○ Nevus Sebaceous
● Nevus Sebaceous, tx?
○ Remove before adolescence
○ Risk of malignant degeneration if not removed
● Thick, yellow/white oily scale on an inflammatory base
○ Seborrheic Dermatitis
● Treatment with Seborrheic Dermatitis?
○ Gently clean w/ mild shampoo
● MR, vomiting, athetosis, seizures, developmental delay over
○ Phenylketonuria
● Deficient Phenylalanine hydrolxalase
○ Phenylketonuria

● Bowel sounds in thorax + scaphoid abdomen

○ Diaphragmatic hernia
● Diaphragmatic Hernia, dx?
○ Babygram (imaging) to see loops of bowel in the thorax
○ Surgery a 3-4 days later
○ Have her deliver at the ECOM capability
● Necrotizing Enterocolitis, tx?
○ Conservative: stop feeding
○ If necrotic : resection
○ Risk factor: prematurity
● 2 month old, currently jelly stool, sausage shaped mass in the in RUQ
○ Intussusception
● Intussusception, dx
○ Barium enema - dx
● Newborn male with no palpable testes
○ Cryptorchidism
● Cryptorchidism, dx
○ Look in Inguinal canal
○ If not found, do US
● Cryptorchidism, tx
○ Surgery by 1 year if not descended not on their own
○ Due to increased risk of cancer if not descended
● Urethral opening on ventral opening
○ Hypospadias
○ Do not circumcise
● Newborn with ambiguous genitalia + 1 month later has hyponatremia, hypokalemia and acidosis
○ CAH
● 21-hydroxylase deficiency
○ Congenital Adrenal Hyperplasia
■ 21-hydroxylase deficiency is the most common cause of CAH
● Congenital Adrenal Hyperplasia, Dx:
○ 17-hydroxyprogesterone (with ACTH bolus)
● Congenital Adrenal Hyperplasia, Tx:
○ Cortisol + Fludrocortisone
● Anterior midline mass + doesnt pee for 2 days + abdominal distension (aneuria for first couple days of life)
○ Posterior urethral valve
○ Tx: Catheterize, then surgery
● LGA - increased risk of (3)
○ birth trauma, brachial plexus injury, TTN (bc of C-Section)
○ Often seen in babies born to moms with gestational diabetes
● Hypoglycemia (due to fetal hyperinsulinemia)
○ Complications - seizures
● Hypoglycemic child, tx
○ If over 40: feed
○ If under 20: IV glucose (D10)
● Hypocalcemia in a neonate, risk of
○ Seizures
● Polycythemia in a neonate, causes include:
○ LGA, needs more oxygen than its getting
○ Hypoxia triggers increased production of EPO
○ More RBCs → risk of clotting
● Child with seizures, must check
○ Glucose + Calcium
● Infant to diabetic mother, increased risk of RDS. Why?
○ Insulin causes suppression of surfactant production (due to prevention of surge of cortisol)
○ Check L/S ratio
● Neonate with fever of 101, child doesnt look sick
○ Fever in neonate is always a big deal
○ Order everything
○ Including LP
○ Look for signs of infection in the mom
● Most common cause of neonatal sepsis
○ Group B strep
○ Listeria
○ Ecoli
● Neonatal sepsis, tx:
○ Ampicillin and Gentamycin
○ Cultures must be negative for 48 hours before stopping treatment
● TORCH Infections - Maculopapular rash in hands and soles
○ Syphilis
● TORCH Infections - Hydrocephalus + intracranial calcifications + chorea
○ Toxo
● TORCH Infections - Cataracts + Deafness + heart defects + (extramedullary hematopoiesis)
○ Rubella
○ PDA
● TORCH Infections - Microcephaly + periventricular calcifications + deafness + thrombocytopenia + petechiae
○ CMV
● TORCH Infections - Limb hypoplasia + cutaneous scars + cataracts +chorioretinitis + cortical atrophy
○ Congenital varicella
○ (if mom gets it 5 days prior to 2 days after, baby gets the immunoglobulin)
● Day of life 1-3 - conjunctiva red and tearing, cause?
○ Chemical
● Day of life 3-5 - conjunctiva red and tearing, cause?
○ Gonorrhea
● Purulent conjunctival, describes what pathogen?
○ Gonorrhea
● Mucopurulentl, describes what pathogen?
○ Chlamydia
● Chlamydial conjunctivitis, potential complication?
○ Pneumonia
● A newborn baby has decreased tone, oblique palpebral fissures, a simian crease, big tongue,
● white spots on his iris
○ Down syndrome
○ Developmental Delay
● Down syndrome, cardiac associations? (3)
○ Endocardial cushion defects
○ Duodenal Atresia
○ Hirschsprung
○ (also annular pancreas, imperforate anus)
● Down syndrome, endocrine association?
○ Hypothyroidism
● Down syndrome, msk association?
○ Atlantoaxial instability (when you intubate, it can cause cervico spinal instability)
● Down syndrome, neuro complication?
○ Alzheimers (by 30s-40s)
○ Bc amyloid precursor protein is on ch 21
● Down syndrome, cancer associated?
○ AML
● Omphalocele + rocker bottom feet + hammer toe + microcephaly
○ Edward syndrome
○ Trisomy 18
● Holoprosencephaly + cleft lip/palate + microcephaly and mental retardation
○ Patau syndrome
○ Trisomy 13
● Girl with no secondary sex characteristics + short stature + high FSH
○ Turner syndrome
● Primary amenorrhea + high FSH + short stature
○ Turner syndrome
● Turner syndrome, cardiac abnormalities?
○ Coarctation of the aorta
○ Bicuspid aortic valve
○ Aortic dissection
 ● Turner syndrome, renal abnormality?
○ Horseshoe kidney
● Treatment of turner syndrome?
○ Estrogen therapy
○ Must avoid osteoporosis
● Coarctation of the aorta, which chromosomal defect?
○ Turner syndrome
● Tall boy + gyenomastia + hypogonadism
○ Kleinfelter’s syndrome
● Klinefelter syndrome, which major association to look out for?
○ Increased risk of gonadal malignancy
● Cafe-au-lat spots, seizure, big head, autosomal dominant
○ Neurofibromatosis
● Most common cause of mental retardation?
○ Fetal alcohol syndrome
● Smooth philtrum + thin upper lip + microcephaly + ADHD-like behavior
○ Fetal alcohol syndrome
● Most common cause of mental retardation in boys?
○ Fragile X
● Large testicles + Large ears + mental retardation in boys?
○ Fragile X
● CGG repeats
○ Fragile X
● Multiple infections + no tonsils? (pathology + cell type deficiency)
○ Bruton agammaglobulinemia
○ B cell deficiency
● Multiple infections + no thymus?
○ DiGeorge Syndrome
○ T cell deficiency
● Multiple infections + no tonsils + no thymus? (pathology + cell type deficiency)
○ SCID
○ Both B and T cell deficiency

● Most common B-cell defect. Recurrent URIs, diarrhea.

○ IgA deficiency
○ May have a severe anaphylactic reaction if given transfusion
● 3wk old M with seizure + truncus arteriosus + micrognathia.
○ DiGeorge Syndrome
○ microdeletion on Chromosome 22
● Keep getting admitted for skin abscesses
○ CGD
● 18mo M baby w/ severe ezcema, petechiae, and recurrent ear infxns.
○ Lots of IgE and IgA
○ Wiskott-Aldrich Syndrome

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MILESTONES
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CARDIAC

Benign Murmurs

Systolic murmur, 2/6, best heard @ lower-mid sternum,

● Stills murmur
● Benign
● Not pathologic

Murmur best heard in anterior neck, disappears when jugular vein is compressed
● Venous hum

Diastolic murmur, or greater than 2/6

● Never normal

Infant with diastolic murmur, next step?

● Echo

Newborn cyanotic, O2 does not improve, next step?

● PGE1 (need to keep the PDA open)
● Diagnosis: Transposition of Great Vessels (arteries)
● Most common in infants of diabetic mothers

Child with cyanotic + squats down when tired

● Tetralogy of fallot
● Systolic ejection murmur (VSD)

Infant with systolic ejection murmur + single S2, think?

● VSD - Tetralogy of fallot

Infant to bipolar mother, holosystolic murmur worse on inspiration

● Ebstien anomaly
● Tricuspid insufficiency

Ebstein anomaly is associated with what arrhythmia?

● WPW

Cyanosis @ birth,

Pro tip: Murmurs worse with inspiration are …

● right sided murmurs
 OME Notes

FAILURE TO PASS MECONIUM

● What is failure to pass meconium?

○ Have not passed meconium in 48 hours
○ Most kids pass in 24 hours

// Imperforate Anus
● Imperforate Anus, diagnosis?
○ XRay Cross table
● Imperforate Anus, treatment of mild?
○ Surgical repair at birth
● Imperforate Anus, treatment of severe?
○ Colostomy now
○ Surgical repair later
● Imperforate Anus, part of which syndrome?
○ VACTERL syndrome
● VACTERL,
○ V - Vertebral - US of sacrum
○ A - Anus - XRay
○ C - Cardiac - Echo
○ TEF - Cather + Xray, look for it to coil + XRay
○ E - Esophageal atresia - Cather + Xray, look for it to coil + XRay
○ R - Renal - U/S
○ L - Limbs - XRay

// Meconium Ileus
● Meconium, typically seen in which pathology?
○ Cystic Fibrosis
● Meconium Ileus, diagnosis?
○ XRay - may show
● Meconium Ileus, treatment?
○ Water enema
● Meconium Ileus, follow up?
○ Sweat Chloride test
○ Supplementation
■ Pancreatic enzymes
■ Vitamin ADEK

//Hirschsprung
● No meconium, palpable colon, explosive diarrhea
○ Hirschsprung
○ -
○ 10% only present with chronic diarrhea + overflow incontinence
● Hirschsprung, dx
○ XRay
■ Good colon - dilated
■ Bad colon - normal
○ Contrast Enema
○ Anorectal Manometry
■ Will see increased tone
○ Best diagnostic - rectal suction biopsy
● Hirschsprung, treatment?
 ○ Surgical resection

// Voluntary Holding
● Child who recently started school + not passing a lot of stool + overflow incontinence
○ Voluntary holding
○ (may have transitioned to involuntary incontinence)
● Voluntary holding of stool, diagnosis?
○ Clinical picture
● Voluntary holding of stool, treatment?
○ Behavioural - Create bowel passing regimen
○ Disimpaction - under anesthesia