Adam Shared "Pediatrics" - 325 Picmonics

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Pediatrics

Celiac Disease Diagnosis and Treatment
Diagnosis
Blunting of Intestinal Villi
Lymphocytes in Lamina Propria
Anti-gliadin Antibodies (IgA)
Anti-endomysial Antibodies (IgA)
Anti-tissue Transglutaminase Antibodies (IgA)
Treatment
Gluten-Free Diet
Corticosteroids
Dapsone
Complications
Intestinal Lymphoma
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2 mins
Strawberry Hemangioma (Superficial Infantile Hemangioma) 4404
Most common benign vascular tumor in children
Composed of capillaries separated by connective tissue
Bright red, shaqily demarcated plaques that blanch with pressure
Can also be found in deep tissues and the viscera (eg, liver)
Appear during the first days or weeks after birth and grow rapidly during the first 1-2 years of life
Majority of these lesions regress spontaneously
A minority of lesions can be disfiguring, ulcerating, disabling (eg, strabismus from eyelid hemangioma), or life-threatening (eg, tracheal lesions)
Beta blockers (eg, propranolol) are recommended for patients at risk for complications
May present as patch of telangiectasias at birth
TOPICAL beta blocker
Vision impairment if near eye
Rarely requires surgical intervention
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Immune Thrombocytopenic Purapura
Most common cause of thrombocytopenia in both children and adults
IgG against platelet antigens GPIIb/IIIa
Autoantibodies produced by plasma cells in the spleen
Antibodies associated with platelets are consumed by splenic macrophages
Acute: Occurs in children weeks after a viral infection or immunization, resolves in weeks
Chronic: Occurs in adults, usually women of childbearing age; primary or secondary (SLE)
IgG can cross placenta causing temporary thrombocytopenia in offspring
HIV and Hepatitis C association
Low platelet counts, normal PT/PTT, increased megakaryocytes on bone marrow biopsy
Increased Bleeding time
Petechia, purapura, ecchymosis
Treatment
Corticosteroids, effective for children, temporary relief for adults with later resistance
IVIG used in acute cases
Splenectomy (removes source of antibodies) in corticosteroid resistant cases
Alternative treatment: Rituximab
Children: Skin manifestations only: Observe, Bleeding: IVlg OR Glucocorticoids
Adults: Platelets ≥30,000/μL without bleeding Observe, Platelets <30,000/μL OR bleeding: IVig OR Glucocorticoids
Diagnosis of Exclusion
Negative direct antiglobulin test
Acute and self-limiting in children but usually becomes a chronic disorder in adults
Corticosteroids are a first-line treatment, IVIG is for resistant cases
Anti-Rh (D) is an alternate treatment option in rhesus-positive non-splenectomized patients
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Fetal Alcohol Syndrome 565
Newborns of alcohol-consuming mothers have increased incidence of congenital abnormalities
Including pre- and postnatal developmental retardation, microcephaly, facial abnormalities (Pictured)
Leading cause of intellectual disability in the US
Smooth philtrum, thin vermillion border [upper lip], small palpebral fissures, limb dislocation, heart defects
Heart-lung fistulas and holoprosencephaly in most severe form
Mechanism is failure of cell migration
VSD, PDA, ASD, tetralogy of Fallot
Social withdrawal, and delays in motor and language milestones
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Down Syndrome (OLD VERSION)
Trisomy 21
Meiotic nondisjunction
Mental retardation
Flat facies
Prominent epicanthal folds
Simian crease
Duodenal Atresia
Endocardial cushion defects
Septum primum type ASD
Increased risk of Acute lymphoblastic leukemia
Hirschsprung's disease
Alzheimer's Disease
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2 mins
Phenytoin
Indications
Status Epilepticus
Tonic-Clonic Seizures
Mechanism of Action
Blocks Na+ Channel Activation
Inhibition of Glutamate Release
Class IB Antiarrhythmic
Side Effects
Teratogenic
Macrocytic Megaloblastic Anemia
Induce Cytochrome P450
Drug-induced Lupus
Neuropathy
Hirsutism
Gingival Hyperplasia
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1 min
Acute Cervical Adenitis in Children 4353
Acute lymphadenitis (LAD) arises over a few days
Nodes are enlarged, tender, warm, and erythematous; If untreated --> progress to suppuration and abscess
Unilateral
Empiric antibiotic therapy for acute, unilateral lymphadenitis typically involves clindamycin
Staphylococcus aureus (most common) and Streptococcus pyogenes
Pronounced erythema, tenderness
Most common is staph aureus
Another question says staph and strep pyogenes are both the most common
Anaerobic bacteria (eg, Prevotella buccae)
Dental caries, periodontal disease
Bartonella Henselae
Papular nodular at site of cat scratch or bite
May be eyrhtematous (overlying the adenopathy)
Mycobacterium avium
Gradual onset, nontender
Francisella tularensis
Fever, chills, headache, and malaise
Bilateral
Adenovirus
Pharyngoconjunctivitis
EBV/CMV
Mononucleosis
Inguinal and axillary adenopathy are also usually present, cervical region is most prominent
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322 Congenital Hypothyroidism (Cretinism), Subacute Granulomatous Thyroiditis (de Quervain), Riedel Thyroiditis
Congenital hypothyroidism (cretinism)
Fetal hypothyroidism due to maternal hypothyroidism, thyroid agenesis, thyroid dysgenesis (most common in US)
Additional causes: iodine deficiency, dyshormonogenetic goiter; congenital defect in thyroid peroxidase
Findings: Pot-bellied, Pale, Puffy-faced child with Protruding umbilicus, Protuberant tongue, and Poor brain development: the 6 P’s
Short stature with skeletal abnormalities
Uncomplicated umbilical hernia
U. Lethargic, hoarse cry, poor feeding, constipated, jaundice, dry skin, large fontanelles
U. Treat with levothyroxine by 2 weeks to reduce developmental issues
Most often asymptomatic
Diagnosis: Newborn screening, increased TSH, decreased T4
Management: Confirm TSH, T4, Start levothyroxine immediately, thyroid ultrasound, Refer to endocrinology
At risk for permanent neurological defects without treatment
Most infants lack clinical signs of hypothyroidism at birth as maternal T4 crosses the placenta
Intellectual disability if hormone replacement is not initiated by age 2 weeks
Subacute granulomatous thyroiditis (de Quervain)
Self-limited disease often following a flu-like illness (eg, viral infection); may progress to hypothyroidism
Hyperthyroid early in course, followed by hypothyroidism; early in course neutrophil infiltrate which is replaced by granulomas
Histology: granulomatous inflammation
Findings: Increased ESR and CRP, jaw pain, very tender/painful thyroid
Decreased radioiodine uptake
Treatment: symptomatic via beta blockers (thyrotoxic symptoms), NSAIDs for pain; Glucocorticoids for NSAID resistant pain
Other possible findings include leukocytosis, mild anemia, and mild elevation of liver enzymes
Riedel thyroiditis
Thyroid replaced by fibrous tissue with inflammatory infiltrate (Pictured)
Fibrosis may extend to local structures (eg, trachea, esophagus), mimicking anaplastic carcinoma
1/3 are hypothyroid
Manifestation of IgG4-related systemic disease (eg, autoimmune pancreatitis, retroperitoneal fibrosis, noninfectious aortitis)
Findings: fixed, hard (rock-like), painless goiter
Mimics anaplastic carcinoma but patients are around 40 and no malignant cells
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Hypertrophic Cardiomyopathy Mechanisms
Pathophysiology
2/3 Autosomal-Dominant
1/3 Sporadic Type
Mutation in Gene for Sarcomere Protein
Cardiac Myosin Binding Protein C
Asymmetric Septal Hypertrophy
Outflow Tract Obstruction
Diastolic Dysfunction
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2 mins
Pediatric Viral Myocarditis 4854
Etiology
Coxsackie B virus
Adenovirus
Clinical Presentation
Viral prodrome
Heart failure: Dyspnea, syncope, tachyca rdia, nausea, vomiting, hepatomegaly
Diagnostic Studies
Impairment of systolic and diastolic function.
Chest x-ray:
Cardiomegaly
Pulmonary edema
Healthy infants age 1 transverse cardiothoracic ratio of ≤60% (older than 1 has ≤50%)
ECG: Sinus tachycardia
Echocardiogram:
Decreased ejection fraction
Diffuse hypokinesis
Endomyocardial biopsy (gold standard): Inflammatory infiltrate of the myocardium with myocyte necrosis
Prognosis
Mortality:
Newborns: -75%
Older infants/children: - 25%
Outcome of survivors:
Full recovery within 2-3 months: -66%
Dilated cardiomyopathy/chronic heart failure : -33%
Treatment
Diuretics and inotropes
Monitored in the intensive care unit due to the risk of shock and fatal arrhythmias
Troponins, CK-MB, ESR and CRP can give clues to degree of cardiac disease
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Pinworm (Enterobius Vermicularis)
Pathophysiology
Nematode (Roundworm)
Ingestion of Eggs
Intestinal Infection
Anal Pruritus
Diagnosis
Scotch Tape Test
Treatment
Albendazole
Pyrantel Pamoate
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2 mins
Differential Diagnosis of Stridor 4497
Acute
Croup
Foreign body aspiration
Most common in infants/toddlers
Chronic
Laryngomalacia
Vascular ring
Presents in infants (usually under one year of age)
Biphasic (more prominent in exhalation) stridor that improves with neck extension (decreases tracheal compression)
Abnormal development of the aortic arch, causing tracheal, bronchial, and/or esophageal compression
Complete (circumferential around trachea and/or esophagus), such as double aortic arch, or incomplete (pulm artery sling)
Up to 50% of patients also have a cardiac anomaly
Esophageal (eg, dysphagia, vomiting, difficulty feeding) symptoms
Barium swallow identifies indentations of the structures, confirmed by MRI with angiography
Can present in adulthood, often presenting symptom is dysphagia
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Iron Deficiency Anemia
Causes
Malnutrition/Malabsorption
Hemorrhage
Signs
Microcytic, Hypochromic Anemia
Decreased Heme Synthesis
Labs
Decreased Reticulocytes
Decreased Ferritin
Increased Red Cell Distribution Width (RDW)
Poikilocytosis
Anisocytosis
Increased Central Pallor
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2 mins
Febrile Seizure 4841
Risk factors
Fever from mild viral/bacterial illness or recent immunization
Family history
Diagnostic criteria
Typically age 3 months to 6 years
No previous afebrile seizure
No meningitis or encephalitis
No acute metabolic cause
Management
Abortive therapy (if greater than or equal to 5 minutes)
Reassurance
Prognosis
Normal development/intelligence
-30% risk of recurrence
<5% risk of epilepsy
Does not cause brain injury
Antipyretics for comfort, but no evidence that these will reduce the risk of future febrile seizures
Rate of rise that causes seizure (but now they dont know if its rate or height)
Simple febrile seizure
Only 1 x 24 hours, < than 15 minutes, must be complex ie affect entire brain (if negative on one then its complex febrile seizure)
Regardless of simple or complex give a benzo
If complex do EEG if you think its a seizure, an LP if you think its meningitis and an MRI looking for anything else in the brain
Long term anti epileptics if complex
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Focal Seizure 2280
Originates from 1 cerebral hemisphere
+/- Loss of consciousness
May generalize to involve both hemispheres
EEG: abnormal electrical activity that is sustained with a distinct start and stop (different from baseline)
Types
Motor: Jacksonian march, turning of eyes/head/trunk
Sensory: Paresthesias, vertigo, visual phenomena
Autonomic: Sweating, epigastric "rising" sensation
Psychic: "Deja vu" affective changes (eg, fear)
May also present with a decline in academic performance
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Hyper IgM Syndrome
Pathophysiology
Deficient CD40 Ligand on Helper T-cells
Defective CD40 Receptor on B-cells
Inability to Class Switch
Signs and Symptoms
Pyogenic Abscess
Decreased IgG, IgA, IgE
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4 mins
Friedreich's Ataxia
Trinucleotide Repeat
GAA Repeat
Frataxin
Mitochondrial Dysfunction
Autosomal Recessive
Hammertoes
High Arches
Kyphoscoliosis
Lateral Corticospinal Tract
Posterior Column
Spinocerebellar Tract
Type I Diabetes Mellitus
Hypertrophic Cardiomyopathy
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1 min
Timeline of Infant Nutrition 2479
Symbols
Iron deficiency anemia is the single most common nutritional deficiency in infants and children and is often asymptomatic
Born with iron stores that prevent them from developing iron deficiency anemia until age 4-6 months, regardless of dietary intake
Prematurity, and early introduction of cow's milk before age 12 months increases the risk
Supplementation should be continued until age 1 year in preterm infants
All exclusively breastfed infants should be started on 400 International Units of vitamin D daily within the first month of life
Pureed fruits and vegetables should be introduced first followed by pureed proteins such as meats
No evidence suggesting that early introduction of highly allergenic foods such as eggs is associated with an increased risk of allergies
American Academy of Peds (AAP): exclusive breastfeeding until 6 months, earlier intro of solids --> gastrointestinal infections
Maternal vitamin D deficiency increases risk of deficiency in the infant
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Borrelia burgdorferi
Characteristics
Lyme Disease
Spirochete
Dark-field Microscopy
Giemsa Stain
Silver Stain
White-footed Mouse
Ixodes Tick
Babesia
Anaplasmosis
Signs & Symptoms
Flu-like Symptoms
Erythema Migrans
Bulls Eye Rash
Bilateral Bell's Palsy
Conduction Defects
Arthropathy
Treatments
Doxycycline
Ceftriaxone
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3 mins
Breastfeeding Contraindications 4892
Breast milk is recommended as the exclusive source of. nutrition for infants age
Maternal Benefits
Longer postpartum anovulation
More rapid uterine involution & decreased postpartum bleeding
Faster return to prepartum weight
Improved maternal-infant bonding
Improved child spacing
Decreased breast and ovarian cancer risk
Maternal Contraindications
Active untreated tuberculosis (mothers may breastfeed after 2 weeks of anti-tuberculin therapy)
Maternal HIV infection (in developed countries where formula is readily available)
Herpetic breast lesions
Active varicella infection (<5 days prior to or within 2 days of delivery)
Chemotherapy or radiation therapy
Active substance abuse including alcohol
Mothers with hep B/C should breastfeed unless nipples are cracked or bleeding
Infant Benefits
Improved gastrointestinal function
Prevention of infectious diseases:
Improved immunity
Otitis media, Gastroenteritis, Respiratory illnesses, Urinary tract infections
Decreased risk of childhood cancer, type I diabetes mellitus & necrotizing enterocolitis
Psychological well being
Infant Contraindication
Galactosemia
HIV-positive women in resource-rich countries are advised to feed their infants with formula rather than breast milk
Resource-poor countries should breastfeed; high rates of infant death from water-borne diseases associated with formula
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