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
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
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
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
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
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
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
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
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
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
Pinworm (Enterobius Vermicularis)
- Pathophysiology
- Nematode (Roundworm)
- Ingestion of Eggs
- Intestinal Infection
- Anal Pruritus
- Diagnosis
- Scotch Tape Test
- Treatment
- Albendazole
- Pyrantel Pamoate
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
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
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
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
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
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
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
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
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
