Pediatrics

Pediatrics Congenital Anomalies                                        

Down syndrome – brushfield’s spots, clinodactyly, atlantoaxial dysplasia, duodenal atresia Down syndrome – dysplastic ears, broad flat face, falt occiput Full trisomy – most common type of Down syndrome Small wrinkled tongue – NOT a characteristic feature of Down syndrome Neurogenic bladder – least likely to be found in Down syndrome Not true of Down syndrome – nondisjuction of sex chromosomes, rather autosomes Endocardial cushion defect – most common cardiac anomaly in Down syndrome Patau syndrome – holoprosencephaly, microphthalmia, polydactyly Edward syndrome – rocker bottom feet, nail hypoplasia, growth retardation, severe MR, low-set ears Cri Du Chat syndrome – hypertelorism, antimongoloid slat cat-like/mewing cry Turner syndrome – redundant skin at nape, low posterior hairline, edema of dorsum of feet Turner syndrome - cubitus valgus, wide-carrying angle TAPVR – figure of “8” Ebstein anomaly – Box-like, maternal use of lithium TOF – boot shaped, CHF not common TGA – egg on its side, maternal DM or use of cocaine TA – waterfall, hilar COA – figure of “3”, Turner Syndrome, 45X PDA – continuous murmur maximum in the 1 st & 2nd left ICS MCL; bounding peripheral pulses PDA – continuous, machinery-like murmur, maximal at 1st ICS, peripheral pulses bounding, wide pulse pressure PDA 1 year after surgical ligation – may not require anti-microbial prophylaxis ASD – fixed, widely spaced, split 2nd heart sound VSD – most common pathologic cardiac murmurs in childhood Not a characteristic of large VSD – normal development (usually small) 3 – number of babies born w/ congenital heart disease in every 100 babies delivered according to latest study Choanal atresia – neonate is cyanotic but gets pinkish when crying Scrotal tongue – requires immediate attention Achondroplasia – typical dwarf Talipes Equinovarus – most common type of congenital clubfoot deformity True of clubfoot – may be associated w/ myelodysplasia & anthrogryposis Bilateral clubfoot – found among males Pierre-Robin Syndrome – hypoplastic mandible (micrognathia), large tongue, glossoptosis, cleft palate Upper Airway Obstruction – most urgent problem in infants w/ Pierre Robin Syndrome DiGeorge’s syndrome – low set ears, hypocalcemia, absence of thymic shadow on chest roentgenogram DiGeorge’s syndrome - persistent candidiasis Responsible gene found in the sex chromosome – not a characteristic of autosomal recessive inheritance True of autosomal dominant – affects male & female equally, no sex predilection Austosomal recessive inheritance – both parents must be carriers of responsible gene Austosomal recessive inheritance - may manifest in consanguinous relationship; male & female equally affected Absent or low GH after provocative test - definitive & confirmatory in growth deficiency

Congenital Hypothyroidism     

Congenital hypothyroidism – apathetic, dull-looking, constipated w/ decreased bone age Congenital hypothyroidism - feeding difficulty is an early sign, more common in boys Na-Levothyroxine – drug of choice for congenital hypothyroidism Na-Levothyroxine - precaution of its use is observed when taken simultaneously w/ iron Dysgenesis – most common cause of congenital hypothyroidism

Congenital Hyperthyroidism 

Not true of congenital hyperthyroidism – birth wt & length are normal

Congenital Adrenal Hyperplasia   

17—dehydroxyprogesterone – parameter in NB screening to detect CAH Biochemical abnormalities in salt-wasting CAH – hyponatremia, hyperkalemia, hypotension & hypoglycemia Grossly male genitalia – male NB positive for CAH, deficient in 17-beta-dehydroxylase

Congenital Syphilis     

Congenital syphilis – characterized by involvement of the long bones Congenital syphilis - diffuse copper-colored maculopapular rash Syphilis – maternal disease not capable of causing mental handicap in the offspring Bullous lesions of palms & soles – most suggestive of early congenital syphilis Hutchinson’s Triad – late manifestation of congenital syphilis

Congenital Rubella  

Congenital Rubella Syndrome – common manifestations include cataract, glaucoma, PDA,VSD & deafness Glaucoma – can be a manifestation of a congenital rubella syndrome

Inborn Errors of Metabolism  

Valine, leucine, isoleucine – degradation of these AA results to organic acids as intermediate metabolites leading to organic academia Glucose-6-phosphate dehydrogenase deficiency – sometimes referred as “Favism”

Immunologic       

Type I: Immediate hypersensitivity – anaphylazis, allergies, bronchial asthma (atopic forms) Type II: Ab-mediated hypersensitivity – AIHA, Goodpasture syndrome Type III: Immune Complex – Acute poststreptococcal glomerulonephritis; SLE, Serum sickness; Arthus reaction Type IV: Cell-mediated – Contact dermatitis, multiple sclerosis, type 1 diabetes, transplant rejection, TB Type IV – tuberculin reactivity Henoch-Schonlein Purpura – crampy abdominal pain, rashes on back of legs, buttocks & extensor surfaces of Forearm, urinalysis revealed proteinuria & microhematuria Aqueous epinephrine IM – initial treatment of choice for anaphylaxis

Neonatal 

Cephalhematoma – may not be visible until several hours after birth

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Subdural hemorrhage – more common among term rather than premature infants Convection – heat loss to cooler surrounding air Neonatal polycythemia – may be a cause of hyperbilirubinemia 1 g Hb – yields about 35 mg of bilirubin Hypotonia, lethargy & poor suck – early signs of kernicterus Fever, seizures & opisthotonos – late findings of kernicterus Jaundice – earliest & most consistent finding finding in mild HDN < 40 mg/dL – hypoglycemia in a term infant < 48 hours old > 15 mg/dL – indication for phototherapy; relative indication for phototherapy > 20 mg/dL – absolute indication for exchange transfusion > 20 mg/dL – kernicterus usually occurs Sole of foot covered w/ creases – indicate most reliably that infant was mature 1st 6 hours of life – clinical signs of RDS generally 1st appear ROP – major danger assoc. w/ an arterial pO2 >100 mm Hg in premature infant receiving O2 for RDS Premature synostosis of saggital suture – usually associated with scaphocephaly Umbilical vein – carries highly oxygenated blood from the placenta towards the heart Meconium aspiration syndrome – least likely cause of respiratory distress in a term NB w/ an APGAR score of 9, 10 Mongolian spots – take months to disappear Craniotabes – may be an early sign of rickets, may be a manifestation of Vit. A toxicity, may be normal in NB Vein of Galen malformation – most common malformation in neonate Embolization – treatment of vein of Galen malformation Suffocation – type of accident usually happens among infants 0 – 4 months old

Newborn Care    

Multiple sole creases - indicate that NB is term Many superficial veins – may indicate that the infant is preterm Choanal, esophageal & imporferate anus - congenital anomalies rule out during routine NB care APGAR score of 10 – good respiratory movements w/ a strong cry

Reflexes  

Tonic neck reflex – reflex disappear allowing the infant to examine objects at midline Rooting – aid in infant feeding

Infancy (0 – 1 year)    

6 weeks - crying in infants usually peak 6 months – sit w/ slight support 8 months - infant neat pincer grasp Infants – started on solid foods by at least 4 or 5 mos. because infants are then able to be taught how to chew

Toddler (2 – 3 years) 

Toddler – bed time rituals are particularly important

Pre-school (3 – 6 years)

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Best describes a preschooler – play increases in complexity & imagination Preschool – differentiation between good or bad Teaching goal for a preschool – decrease the number of mealtime spills Teaching goal for a preschool – enforce table manners Enuretic – when a child has not attained full bladder control by the age of 5 years

School Age (6 – 12 years)    

6 years - conscience develops Board game – play activities appropriate for a 6-year old child 7 years – 20/20 vision achieved 9 years – ceiling age for sitting

Adolescence (12 – 20 years)    

Not true of menarche – occurs later in those residing in urban areas Thelarche – 1st sign of puberty in girls Breast engorgement – one of the maternal estrogenic effect in NB usu. found in fullterm, male & female infants Therapeutic communication w/ adolescent – best accomplished by relating on a peer level

Anthropometrics          

35 cm – average head circumference of a term infant at birth 8 cm - increment in head circumference during the 1st yr 12 – normal increment in cm of the head circumference in the 1 st year of life 2 cm - increment in head circumference during the 2 nd year Head circumference - influenced by nutritional status until 36 weeks of life 2 years of age - male infant will have its birth weight by 4x, half of mature height kg/m2 – BMI age in yrs x 2 + 8 - best formula to approximate weight Preterm LGA – 30 weeks, 3000 grams 1 year – infant triples his birth weight

Dermatologic         

Inflammatory bullae – initial lesions of incontinentia pigmenti Subcutaneous fat necrosis – lesions beneath fading forceps marks folloeing trauma or cold exposure Eosinophils – revealed in the wright’s stain of the contents from a lesion of erythema toxicum Pityriasis alba – does not present w/ vesicobullous lesions (herpes zoster, erythema multiforme, Steven-Johnson Syndrome) Fungus in nails - hardest to treat Herpes zoster - group vesicles w/ erythematous base Varicella - no dermatomal characteristic Wrinkled skin - NOT of a manifestation of kwashiorkor or edematous protein deficiency Wrinkled skin – marasmus

Scabies 

Scabies - pruritic papules over plams & nodules, similar eruptions to other siblings, not generalized

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Scabies – caused by burrowing & release of toxic substances by female mite Scabies - 1st sign of infestation consists of 1-2 mm red papules Permethrin - drug of choice for scabies Not true of scabies - sites of predilection are head, neck, palms & soles

Seborrheic dermatitis  

Seborrheic dermatitis - dermatosis not causing pruritus, scaly but not pruritic Seborrheic dermatitis – diffuse scaling & crusting of scalp & greasy scaly erythematous papules on face, retroauricular areas & axillae which seem non-pruritic

Skeletal    

Right scliosis curvature – NOT a danger sign in children w/ back pain Gait asymmetry - main consequence of leg length discrepancy Not a charac. of rheumatic arthritis – if left untreated, deformity most likely to occur, no deformity Rheumatoid arthritis – w/ deformity

Muscular  

Douchene - difficulty climbing stairs, hypertrophied calf muscle Extreme wasting away of fat muscles – noted in severe caloric deficiency

Neurologic                 

Cerebral hamartoma – not a neurological complication of meningitis Pseudotumor cerebri – Vitamin A excess, manifests as papilledema, drowsiness, CN palsy Spastic – most common type of cerebral palsy Athetoid – hyperbilirubinemia Ataxia – seen in kernicterus, basal ganglia involvement Flaccid – hypoxia Febrile seizure – anti-convulsants not routinely used Group B streptococci – most frequent cause of neonatal meningitis CMV – transmitted w/ greater risk among premature; microcephaly, cerebral calicifications & blindness Anti-Ach receptors – Ab implicated in Myasthenia gravis Progressive weakness involving proximal muscles – true of muscular dystrophies Presence of meningitis – not a poor prognostic sign for patient w/ meningococcemia Poor prognostic signs of meningococcemia – presence of petechiae for < 12 hours PTA; presence of shock; normal or low peripheral WBC count Flexion of arms – not a characteristic of spasms of tetanus (painful, lasts for seconds, opisthotonos) Involuntary mov’t associated w/ lesions in the brain except – anterior horn cell (sensory) Puretone - test not used in babies, you need cooperation of the px, not feasible for neonate Rattle test – testing hearing grossly

Hydrocephalus  

Hydrocephalus – if left untreated can cause mental retardation because gradually increasing size of the ventricle presses the brain against the bony cranium, anoxia & decrease blood supply result Communicating hydrocephalus – most serious complication of meningitis in young children

Attention Deficit Disorder & Autism  

Feeding difficulty - NOT a co-morbidity of attention deficit disorder, seen in autism Autism – associated w/ dysfunctional family environment

Special Senses 

Excessive or impacted cerumen in young adolescent – removed by mineral oil drop & tepid water irrigation

Oral Cavity, Phraynx, Larynx   

True of laryngomalacia - associated w/ larngopharyngeal reflux Laryngomalacia – inspiratory, self-limiting Epiglottitis – commonly caused by adenovirus

Thyroid & Parathyroid 

Simple goiter - 10 year-old child, lagging of upper eyelid when looked down, eyes cannot converge

Cardiovascular                

Heart block – manifestation of the neonatal lupus that tends to be permanent Excessive sweating – may be a manifestation of heart failure in a young infant CHF in early infancy – feature not seen in VSD ↑ ASOT – not a major criterion for diagnosis of rheumatic fever (carditis, arthritis, subcutaneous nodules) Pulse oximeter - non-invasive way of monitoring oxygenation True of pediatric cardiopulmonary arrest – apnea usually precedes bardycardia w/ poor perfusion Ventricular fibrillation – more common in adults 1st approach to the therapy of dysrhthmia – iced saline bag placed over the face to regulate rhythm back to normal IM erythromycin - not used as secondary prevention for rheumatic fever (given orally) Heart failure - common manifestation of myocarditis in children Heart less than half of the thorax – average size Peripheral edema – among the last signs of heart failure in infant & child Congenital R to L shunt cardiac defect – elevated hematocrit Audible heart murmur – major common symptom in a child w/ L to R shunt of the heart Osler’s nodes – bacterial endocarditis Osler’s nodes – painful, tender, pea-sized nodules appearing on pads of fingers & toes in bacterial endocarditis

Kawasaki Disease       

Subacute phase – MI in Kawasaki 20 - 25 % - coronary involvement in Kawasaki 6 mo to 2 yr – peak occurrence of Kawasaki Steroids – controversial in the management of Kwasaki disease 2g/kg within 10 – 12 hr – dose of IV Immunoglobulin in Kawasaki disease Kawasaki disease – bilateral conjunctivitis, dry, red, fissured lips, cervical lymphadenopathy NOT a consistent feature of KD – macula-papular rash over the buttocks & extremities

ECG 

T wave inversion – digitalis toxicity seen on ECG

Hematologic   

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Hemolysis – result of blood group incompatibility Acquired prothrombin complex deficiency – generalized seizure, born at home, purely beastfed, pale, drowsy, bulging fontanel, liver edge 4 cm below the right subcostal margin & right hemiparesis Acute leukemia – swelling of the right knee, intermittent fever, pain on right knee during ambulation, limping, Pale conjunctivae, lever edge 3 cm below the right costal margin, splenic edge 1 cm below left costal Margin 1 month duration of tx – not true of IDA IDA – microcytic, hypochromic; caused solely by inadequate dietary iron & unsual before 4-6 months of age; therapeutic dose of 6 mg/kg/day Splenomegaly is common – not true of ITP ITP – occurs 1-4 weeks following exposure to viral infections; BM shows normal or ↑ number of megakaryocytes & spontaneous remission achieved by majority of cases Uncorrected bleeding diathesis – contraindication in doing a lumbar tap in a 6-month old infant aPTT – measures factor VIII Platelet function - determined by bleeding time

Respiratory                    

Red nasal mucosa – not a common finding in px w/ allergic rhinitis (edematous nasal turbinates, profuse clear nasal discharge, dark circles under the eyes) Anti-histamines – most effective treatment for allergic rhinitis Wheezing – not a common finding in RDS/HMD Child infected w/ Mycobacteria – Mantoux test was done on a 2-year old child who had no previous BCG; after 48 hours, the result was a 12 mm induration Amoxicillin – empiric treatment administered if bacterial etiology is strongly considered for PCAP A or B Penicillin G – for patients classified as PCAP C w/o previous antibiotic & has completed primary immunization against Haemophilus influenza type B (100,000 units/kg/day Q6H) IV Ampicillin – if primary immunization against Hib has not been completed (100 mg/kg/day in 4 divided doses) 4 hours – number of hours a px should fast for controlled intubation Dopamine – not given via endotracheal tube True of pleural effusion in children – often a complication of pneumococcal pneumonia Aspiration - most common cause of lung abscess Haemophilus influenza type C - NOT an agent of infectious croup Staphylococcus aureus - most common cause of purulent pleuyrisy Auscultation - most helpful in diagnosisng lung disease Lymphadenopathy – hallmark of childhood TB Calcification, cavitation – only seen in adults after 6 months of infection Sputum culture - gold standard in the diagnosis of PTB Low pressure aspiration or gastric aspiration - best way to collect sputum in children 5: 1 - compression-ventilation ratio for intubated children Feed the baby in upright position – best prevention for aspiration in pediatric px aged 4-7 month old

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Prevent drying & damage to mucous membrane – rationale for humidifying oxygen in a px w/ Bronchopneumonia Treatment in children w/ bronchiolitis – high humidity, oxygen as needed, postural drainage & vibration Left pneumothorax – adolescent, sudden onset of resp. distress, cyanosis, retractions, ↓ breath sound left lung

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RDS – symptoms should be observed in an infant whose mother is Type I Diabetic NB of few hours appears less cyanotic when crying – should observe for sterna retractions of RDS

RDS

Pneumonia  

Tachypnea - most consistent manifestation of pneumonia Children at higher risk of invasive pneumococcal infection – those w/ cochlear implants

Bronchial Asthma       

Inhaled corticosteroids - cornerstone in management of persistent asthma Long acting beta agonist – moderate to persistent type of asthma Short acting beta agonist – mild, intermittent type of asthma Theophylline – alternative treatment Not true in bronchial asthma - silent chest is a good sign Viral infection - most common precipitant of asthma in infancy RR of 55 cpm is considered tachypnea – true regarding asthma in a 6-month old

Gastrointestinal             

Vomiting – usual manifestation of intestinal malrotation & annular pancreas in childhood NEC – began to vomit on 3rd day of life, abdominal distention & bloody stools; repeated episodes of hypoxia or poor perfusion; hypoxia & ischemia of the bowel sets for invasion of bowel by certain bacteria Pyloric stenosis - 2 week old infant, frequent postrandial vomiting, non-bilious, upper GI series showed string sign (narrowing or obstruction) Hyperthropic pyloric disease - string sign, double tract sign Volvolus – non-bilous vomiting, beak-sign Malrotation – bilious vomiting Duodenal atresia – bilious vomiting, double bubble sign Duodenal atresia – hx of polyhydramnios, no abdominal distention Hypokalemia (ileus) - 2 yr old child w/ diarrhea & vomiting, distended abdomen, hypoactive bowel sounds Small amounts of uncojugated plasma bilirubibin does not cause BBB – because it is tightly bound in albumin Cholera is the least likely cause - 2 yr old child, bloody mucoid diarrhea, fever, crampy abdominal pain History of eating spoiled food – vomiting & fever are anticipated Failure to thrive – long-term consequence of gastric ulcers in infant

Hepatic    

Biliary atresia - bile plugs, fibrosis, absence of bile, acholic stools Persistent acholic stool – most common manifestation of biliary atresia True of biliary atresia – surgical reconstruction w/in 60 days (8 weeks o flife) Kasai procedure – best mangement

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90% prognosis - before 8 weeks of life Point ot probable dx of extrahepatic biliary atresia except – poor hepatic uptake of radiographic nuclei marker (this is seen in intrahepatic) Spider angiomata – sign of portal HTN Blue muffin appearance in infants w/ TORCH infection – most likely represents metastatic hepatic tissue

Meckel’s Diverticulitis    

Meckel’s diverticulum – persistence of yolk sac Meckel’s diverticulitis - painless rectal bleeding, currant jelly stool Meckel’s diverticulum – often confused w/ acute appendicitis Meckel scan – test to be requested in a 2 yr old boy, passage of grossly bloody stools, pale, no fever, w/ pain & Vomiting

Hirschsprung’s Disease  

Hirschsprung’s disease – congenital aganglionic megacolon Intestinal obstruction – most common presentation of Hirschsprung’s disease in newborn

Intussusception  

Intussusception – in pain repeated periodically w/ periods of sleep, palpable mass around the umbilicus Intussusception – suspected in an infant who experiences bloody diarrhea

Constipation   

Constipation – seen in megacolon, hirschprung, Vitamin B deficiency Constipation – seen in hypercalcemia Constipation – not seen in hypocalcemia & hypokalemia

Typhoid Fever      

Blood or BM culture – reliable diagnostic measure for Typhoid fever Bone marrow - best & most sensitive specimen for salmonella, present throughout the illness In the BM- present althroughout the course of typhoid Blood – most helpful specimen in the 1st week of typhoid Urine & stool – 2nd week of typhoid Salmonella typhi - serotype of salmonella causing typhoid fever

Shigellosis  

Shigellosis - common cause of bloody, mucoid diarrhea Shigellosis – convulsion, high grade fever; passed large volume of watery stools w/ blood & mucus

Pheochromocytoma   Urinary

Pheochoromocytoma – growth failure seen, ↑ VMA Not true of pheochromocytoma – proteinuria & hematuria are common findings

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Suprapubic tap - an E. coli count of 2,000 cfu/mm3 would be a definite evidence of UTI if sampled urine was collected through this Hyperlipidemia – least likely in a 6-year old boy w/ tea-colored urine & healing impetigo (periorbital edema, Hypertension & red cell cast) Cushingoid appearance – not a complication of Acute Post-strep GN (CHF, ARF, hypertensive encephalopathy) Polycystic renal disease - NOT associated w/ intracranial bleed Not true of nephritic syndrome – hypertension, proteinuria, edema Bilateral renal agenesis – amnion nodosum on placental membranes Living related donor renal transplantation – best treatment for pediatrics showing evidence of ESRD

Endocrine         

Epiphyseal dysgenesis – most suggestive of hypothyroidism Primary hypothyroidism - ↓ T3 & T4, ↑ TSH Hypoparathyroid state – not true of Hashimoto’s thyroiditis Adrenal carcinoma - most common cause of Cushing syndrome ↓ Storage of substrate – risk of developing hypoglycemia among preterms & SGA Thyroid releasing hormone – not secreted by the anterior pituitary gland (GH, LH-FSH, ACTH) Gynecomastia - not common in young children Diabetid ketoacidosis in a 3-year old female IDDM px – confusion, paresthesia Polyuria & breath odor – NOT consistent symptoms of diabetid ketoacidosis in a 3-year old female IDDM px

Metabolic   

Hypocalcemia – 24-hour-old infant noted to have irritability, apnea, cardiac arrhythmias & finally seizures Hypercalcemia – unusual in pxs w/ simple (nutritional) rickets Alkalosis – observed in cases of uncontrolled vomiting

Reproductive 

5-alpha-reductase – responsible for abnormal development of genitalia among males

Systemic 

True of fever of unknown origin – cannot be identified after 1 week evaluation in the hospital

Human Milk  

Low in human breast milk – Vitamin K, iron (but better absorbed than cow’s milk), Vitamin D, Chloride 20 calories per ounce - caloric density of human milk

Fluids & Electrolytes      

20 mEq/L – potassium content of ORS Oral rehydration therapy – NOT indicated in ileus, coma or shock Old ORS component – Na : 90, K : 20, Cl : 80, citrate : 10, osmolality : 311 New ORS component –Glucose 75, Na : 75, K : 20, Cl : 65, citrate : 10, osmolality : 245 D5LR Na content per liter is 130 - half of that is 65, since 500 mL was given D5LR – 1st choice of fluid in a 10 month old baby boy who lost 10 % of weight

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PNSS – 154 Na IMB – 20,20,25

Degree of Dehydration        

Mild dehydration w/ vomiting – choice of IV : D5 0.3 NaCl for 6 hours Mild wt loss w/ mild dehydration - episode of vomiting 2 hours prior to consult, 12kg to 11.5 kg after Moderate to severe dehydration - D5LR is the 1st fluid of choice Hypernatremic dehydration – associated w/ warm, doughy skin Severe dehydration - passed 5 watery stools, irritable, sunken eye, rapid pulses, skin retratcted slowly Severe dehydration – PLR is the fluid of choice, give fluids by 30 cc per kg in first 30 min, next 70 cc per kilo given in the next 2 and ½ hours based on IMCI Hypertonic dehydration – diarrhea of 2 days duration & irritability; irritable infant w/ doughy, warm skin & rapid pulse Thirst – remain useful in assessing dehydration among malnourished children

Nutritional              

400 ug – recommended daily dietary allowance of Vit. A for an infant 10 ug - recommended daily dietary allowance of Vit. D for an infant Biotin - vitamin deficiency common among those eating raw egg white – biotin Nyctalopia (night blindness) - early symptom of Vitamin A deficiency Pyridoxine – added to prevent peripheral neuritis Vit B12 – deficient in a strict vegan diet Vit E – dietary supplementation advisable for premature infants Vit. K – vitamin higher in concentration in cow’s milk than human milk Vit. K - this vitamin deficiency could be life threatening in px w/ cholestatsis Dermatitis commonly found in areas exposed to sunlight – not true of edematous PEM Edematous PEM – edema usually develops early; flag sign is reversible Vegan diet – low energy, deficient in 1 or more amino acids, low Vit. B 12 Hormonal therapy – not a widely recommended step in promoting lactation 6 ½ calories – a fun-loving teenager loses when he laughs

Immunization & Counselling        

Live attenuated vaccines – more likely to induce immune response stimulating response to natural infection Vaccination – administration of live vaccine, breastfeeding, administration of immunoglobulin Lifelong immunity – follows w/ the ff type of poliomyelitis: abortive, non-paralytic, paralytic Interruption of immunization schedule – resume regardless of duration of delay In children – you can give all vaccines at one time Right after birth - best time to give preconception counseling Fever 5 days after immunization – reassure the father of the px & advice him to give an antipyretics as the fever Will last only 1 – 3 days Contraindications for smallpox vaccination - nursing & pregnant mothers - AIDS, HIV, immunocompromised pxs, those on chemotherapy - px w/ eczema

OPV  

OPV – immunization not given to an immunocompromised child IgA – on entry into the gut, OPV produces local immunity by producing this Ig

BCG  

BCG – keloid scar BCG & Hepatitis B - most number of vaccine given in neonates

Measles     

Measles – given as ealy as 6 weeks Measles – could flare up latent TB (same w/ Pertussis) Measles - fever an expected finding 5 to 6 days after injection Rashes in measles – at the height of fever Measles – high fever & presence of Koplik’s spots

Pertussis   

Pertussis – causes seizure Pertussis - could flare up latent TB Pertussis – NB exposed to some infectious diseases would probably come down w/ this disease; mother received the recommended immunization

Tetanus        

Immunization of tetanus toxoid on pregnant women – method of control of tetanus among infants Tetanus - requires periodic booster to acquire immunity Tetanus & Diphtheria - Recovery from infectious disease, w/c will not confirm life-long immunity 5 – optimum number of TT doses that gives protection throughout childbearing Td, no pertussis – most appropriate management in a 15 yr old boy, sustaining abrasions ,2 nd DPT boster at age of 5 nd 2 booster at 10 years - no need to give TIG, booster every 10 years Respiratory distress – most serious complication in a child who develops an acute tetanus infection Tetanus neonatorum - prognosis is worse when diagnosed late - portal of entry is usually the umbilical cord - incubation period: 1-30 days - NOT : risus sardonicus commonly observed

Rabies 

Rabies – not routinely recommended vaccine

Drugs   

Chloramphenicol – gray baby syndrome Vancomycin – redman syndrome Clindamycin - most common cause of antibiotic-associated diarrhea in infants & children

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Metronidazole – disulfiram-like reaction Diphenylhydantoin – anti-epilectic drug causing gingival hypertrophy & hirsutism Inhaled corticosteroids – cornerstone in the management of persistent asthma Convulsions - might respond to a pharmacologic dose of pyridoxine Term & full size infants – infants born to Phenobarbital-abusing mothers Intravenously – safest route of administration of acetaminophen to a child following febrile seizure

Viral   

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Mumps – fever, malaise & headache; pain over the area from the back of mandible towards the mastoid Space; earlobe on affected side appears to be sticking upward & outward Rubeola – 5 days fever associated w/ cough & coryza; developed maculopapular rashes over the face & nape; Pinpoint lesions on a bright red buccal mucosa in the area opposite the lower molar Rubella – mild sore throat & low grade fever 3 days PTC; tender swelling of wrists & redness of lip 2 days PTC; rash on face & anterior chest; mild tenderness & marked swelling of posterior cervical & occipital lymph nodes & diffuse generalized blanching maculopapular rash Dengue - hemoconcentration, leokopenia DHF - high grade fever, 3 day, 4th day px become afebrile, weak, poor suck, sleeps most of the time Roseola infantum – runny nose, cough, remain active & playful Rotavirus - most common viral etiology of acute gastroenteritis among infants & children Encephalitis – can be a complication of chickenpox

Fungal 

Candida albicans – intensely erythematous confluent plaque w/ sharply demarcated border & satellite papules

Poisoning 

Saxitoxin – abdominal pain & nausea, followed by perioral numbness; had respiratory arrest & was intubated; Patient had eaten shellfish about 2 hours before the onset of symptoms

Antidote         

Lead – EDTA Iron – Deferoxamine Acetaminophen – Acetylcysteine Organophosphate – Atropine Cyanide – Sodium Nitrite Ethylene glycol – Ethanol Morphine – Naloxone Isoniazid – Pyridoxine Organochlorine – No antidote

Radiologic Findings    

TTNB – sunburst pattern; perihilar streaking; wet lung; type II RDS Pneumomediatinum – angel wing appearance Meconium Ileus/Plug – soap bubble area Intussusception – coil spring appearance

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Wilson-Mikity Syndrome – reticulonodular & bubbly changes Ascitis – ground-glass appearance Pneumothorax – mediastinal shift to the opposite side

Diagnostic Procedures  

India Ink Preparation – capsule of Cryptococcus neoformans in the CSF is best seen Mantoux tuberculin skin test – results interpreted in 48 – 72 hours

Tables from nelsons Most common type of CP? among premature infant – diplegia Not an early … in cerebral palsy – absence of bubbling at 8 Aspiring may exacerbate asthma Questions from IMCI Colostrum – secretion of breast 3 month old baby,2nd DPT & OPV dose seizure after 2nd hour of DPT & OPV – pertussis causes seizure, next time give