CLIPP Summaries

csv-exportWhat is hyaline membrane disease (respiratory distress syndrome) and what are 7 risk factors? (race, gender, delivery method?)HMD is due to insufficient surfactant at the time of birth. This increases surface tension and decreases lung compliance.

Risk factors include:Male, Premature, Caucasian, Gest. Diabetes, Csection, 2nd born twin, FHx.In infants with HMD, hypoxemia is the result of 3 factors. . .Right to left shunting via:

shunt vessels in the lungpast atelectatiic air spacesPDA, PFOWhat are some other problems on the DDx for HMD?TTN CXR shows higher lung volumes

Bacterial PNA difficult to distinguish from GBS. Routine to treat all HMD babies with ABX until ()Cx are received

Pulmonary Edema many causes

Aspiration PNA meconium or amniotic fluid.Treatment of HMD?1) Prevent premature delivery. 2)If preterm delivery is inevitable, then treat with steroids antenatally3)Surfactant replacement therapyWhat is the most common cause of respiratory distress in newborns?TTNWhat is TTN? How is it treated?What are some risk factors?TTN is a delayed clearance of fetal lung fluid.

Treatment:self limited with resolution within 4872 hours. Some treatment includes fluid restriction and oxygen.

Risk factors include: CsectionPrematureDelayed clamping of the umbilical cordMaternal sedationMaternal diabetesFetal distressWhat are the four levels of cognitive development and the ages at which they occur?Sensorimotor 2 yearsPreoperational 27 y/oOperational 712 y/oFormal >12 y/oWhat are the age ranges of the following in girls:Breast development beginsBreast development completePubic hair appearsGrowth spurt beginsMenarche1) Breast dev. 8132) Breast dev. complete 12183) Pubic hair appears 8144) Growth spurt 9145) Menarche 1016What are the age ranges of the following in boys:1) Testes growth begins2) Pubic hair appears3) Penis growth begins4) Genital growth complete5) Growth spurt starts6) Strength spurt1) Testes growth begins 9132) Pubic hair appears 10153) Penis growth begins 10144) Genital growth complete 13185) Growth spurt starts 10166) Strength spurt 1317How long after the growth spurt does menarche happen? How long after thelarche?3 years after menarche2 years after thelarcheHow many years does puberty take to complete in girls?boys?4 years3 years in boysHow does FSH and LH relate to pubarche?UnrelatedWhat is responsible for pubic hair growth?DHEA, DHEASAverage linear growth begins at what age for boys vs. girls?10 years for girls11.5 for boyswhat is the narrowest point in the pediatric airway?subglottic tracheaCroupmost common ages?When is the cough worse?Management?6 months 5 yearsWorse at nighthumidificationcold airsteroidsepinephrine aerosolshelioxAt what ages should you:double birth weighttriple birth weightquadruple birth weight?Double: 5 monthsTriple: 12 monthsQuadruple 2 yearsHow is mid parental height calculated?Boys: FH + (MH + 5)/2Girls: FH + (MH 5)/2What is the most sensitive test for primary hypothyroidism?TSHWhat is the most common thyroid disorder in kids?Hashimoto's thyroiditisWhat is the age cutoff where no permanent intellectual or neurological damage is done during acquired hypothyroidism3 years oldWhat is the most common cause of hyperthyroidism in kids?GravesWhat antibodies would be present in:Graves diseaseHyper phase of hashimotosHypo phase of hashimotoGraves antiTSIHashimotos, hyper phase antiTPO and anti thyroglobulin

Hashimotos hypo phase same has hyper phaseWhat are 3 antithyroid drug treatments and their side effects (2)PTU, Methimazole, Cabimazole

Side Effects include: agranulocytosis, hepatitisWhat age can children recieve radioactive ablation with no concerns for malignancy?5What percent of patients remain hyperthyroid after initial ablation?2540%What are the remission rates after 2 years of medication therapy for hyperthyroid?25%What is the most appropriate treatment of a 13 year old with Graves disease?MethimazoleWhat is the DDx for a congenital goiter?Neonatal GravesCongenital HypothyroidismDescribe the course of Measles812 day incubation prodrome (conjunctivitis, coryza, fever, cough, malaise) koplik spots maculopapular rash beginning on the head and spreading down. Paramyxovirus. Major complication is subacute sclerosing panencephalitisDescribe the course of RubellaCaused by Rubellavirus (A Togavirus) When infected postnatally, it is often asx. Sx can include, erythematous maculopap discrete rash, with generalized LAD and fever. Transient polyarthralgias

When infected prenatally, it is much more serious. Sx include, heart/eye/auditory defects, neuro malformations, IUGR, blueberry muffin spotsRoseola infantumCaused by HHV6, begins with abrupt fever (103106) for 15 days, child appears well during the fever, after 34 febrile days a MP rash develops on trunk and spreads peripherally, fever resolves as rash appears,Erythema InfectiosumParvovirus B19 Mild, self limiting, no prodrome, low grade fever (if any), Rash begins as slapped cheek, erythematous, pruritic MP rash develops on arms and spreads to trunk/legs. Associated with fetal hydrops during pregnancy.How long are varicella patients contagious for? What test can be used to test for it?24 hours before rash until all lesions are crusted (1 week)Tzank prepHand Foot Mouth disesaseCoxsackie A virus prodrome of anorexia, fever, oral pain followed by crops of ulcers on oral mucosaWhat is the most common cause of hematogenously spread cellulitis?S. PneumoTreatment of the following Tineas:CapitisCorporis/Cruris/PedisOral griseofulvin for 46 weekstopical antifungals for 4 wksDescribe the Dawn PhenomenonIncreasing insulin resistance from 3am8am. Nocturnal GH secretion. Sugar is normal at 3am and high at 8amDescribe the somogyi phenomenonRebound hyperglycemia following hypoglycemia. Low sugar at 3am and high at 8amSingle most critical value in evaluating growth?Height velocityAverage growth velocities for:012 months 1224 mo 2436 mo36 months puberty Puberty012 25cm1224 12cm2436 8cm36mopuberty 47cm per yearPuberty 814cm/yearWhat should be assumed about height deceleration between the ages of 3 and 12 years?Pathologic until proven otherwiseDefinition of short stature2 SD below mean (,3%ile)Delayed BA, subnormal growth rate, obesity (2 possibilities)Cortisol excess or HypothyroidismWhat would you order for lab evaluation of short stature?CBC w/diff, Complete metabolic panel, T4/TSH, IGF1/GFBP3, UA/ESR, Celiac panel (Serum IgA, Antiendomysial Ab, Tissue transglutaminase), Bone age filmWhy can there be a false positive rate on TSH in newborns?Because of the TSH surge that occurs in the first 24 hours of life.How is transient hyperthyroidism treated?Treat vigorously to prevent HF. Hospitalize to monitor HR and EKGTreat with: PTU rather than methimazole because PTU decreases conversion of T4 to T3. Beta Blockers Lugols solution to block release of preformed thyroid hormone Pharmacological doses of glucocorticoids which block conversion of T4 to T3.A baby is screened with a total T4 level which is decreased. The TSH is normal. What is the next step?Free T4. . .if decreased along with normal TSH then you need to rule out central hypothyroidism. If normal, then they have TBG deficiencyWhen do kids adopt adult stooling patterns?1 year oldOsmotic Diarrhea. . stool sodium? Osmolarity?Exogenous vs. endogenous DDx?Stool sodium < 70 meq/L OSM >2x(Na+K)Exogenous: laxatives, artificial sweeteners, antacids, excessive CHO, lactuloseEndogenous: disaccharidase deficiency, pancreatic insufficiency, infectious diarrhea, loss of surface area (short gut, IBD, Celiac, milk protein enteropathy, rota)Secretory DiarrheaSodium?Osmolarity?DDx?Stool sodium >70meq/L OSM=2x(Na+K)DDx: infection with toxigenic organism (Cholera, E. coli, salmonella, C. diff)Mucosal necrosis or atrophy, bile acid malabsorption, Hormone secreting tumorsTreatments of the following:GiardiasisCryptosporidiumGiardiasis: Metronidazole, nitazoxanide, furazolinideCryptosporidium: Nitazoxanide, azithromycinVACTERLVerterbra (hemivertebrae)Anus (imperforate)Cardiac (VSD)TE fistulaRenal (horseshoe)Limb (clubfoot)CHARGE what each letter meansColobomaHeart (ASD)Atresia choanaeRenal (fused kidneys)Ear (deafness)MURCSMullerian duct (absent prox 2/3 of vagina)Renal agenesisCSpine defects C5T1Turner syndrome: heart defects (2), renal, appearanceBicuspid aortic valvecoarctationhorseshoe kidneylow set earswide nipplesAlagille Syndrome: heart defect, liver, eye, vertebral, appearance, causePPSPaucity of intrahepatic bile ductsDirect hyperbiliOpaque margin of corneaButterfly/hemivertebrae, Triangular faceDeep set eyes.

AD inheritancemutation of JAG1Prader Willi: Appearance in the infant. Appearance of older child.Infant: hypotonia, poor feeding, small hands/feet, almond shaped eyesOlder child: marked weight gain, MR, unusual eating behaviors, skin picking, rageCornelia de Lange: appearanceGrowth retardation, long eyelashes, thick eyebrows, upturned nares, hirsutism, hypoplastic nipples, short limbs, missing digits, genital abnormalities. No diagnostic test availableDi George: heart, Endocrine, appearance, inheritanceLeft sided heart lesions, hypocalcemia, prominent nose, long fingers, high arched/cleft palate.

Sporadic inheritance, AD for affected individualWilliams Syndrome: cardiac, endocrine, appearance, inheritanceSupravalvular aortic stenosis, Hypercalcemia, Full lips and lower face, Stellate pattern to iris, mild to moderate MR with cocktail party personality.

AD inheritance for affected individual, sporadic inheritance.Features of Trisomy 18HypertonicOverlapping fingersMost miscarry90% die within a yearTrisomy 13Midline abnormalities, most miscarryWhat vitamin deficiencies are associated with the following diets?Vegan?Goats Milk?Vegan B12 deficiencyGoats milk folate deficiencyWhat anemias are the following ethnicities associated with?African American?Mediterranean?Southeast asian?Northern European?AA HbS, HbC, thalassemia, G6PDMediterranean Thalassemia, G6PDSoutheast asian Thalassemia, HbENorthern EuropeanHereditary SpherocytosisWhat type of anemia is associated with nail spooning?Iron DeficientWhat are the two types of microcytic anemia?Iron DeficientThalassemiaWhat are the 4 types of macrocytic anemia?Aplastic anemiaDiamondblackfanLiver diseaseMyelodysplastic syndromeWhat are the 7 types of normocytic anemia?Sickle cell, HS, G6PD, AIHA, HUS, Infxn, Renal diseaseHow is hemophilia inherited?ARWhat lab abnormalities are seen with hemophilia?aPTT elevated, normal aPTT mix, decreased VIII or IXMild/Moderate Hemophilia A may respond to _____DDAVP1st line treatment for type I vWD?DDAVPWhat is the typical course for ITP?50% resolve within 12 months80% resolve within 6 monthsAt what age would the following actions be cause for concern?