Newborn
Identify the two photos provided and describe the difference between the two!
Caput vs Cephalohematoma
Identify the two photos and describe the differences between the two conditions. Which of the two is associated with other disorders?
Gastroschisis vs. Omphalocele
1 month old with non-bilious emesis that mother reports shoots across the room. Diagnosis? Metabolic complications? Treatment?
Pyloric Stenosis: diagnosed on ultrasound! Hypochloremic, Hypokalemic Metabolic Alkalosis Correct electrolytes THEN surgery (myomectomy)
You are seeing a healthy 6 year old in clinic. You don't see a murmur documented in the chart but think you hear a Still's Murmur. Child is growing and developing well. What qualities about the murmur reassure you its a Stills Murmur?
- Vibratory - Soft - Musical - LMSB-LLSB - Louder with lying down
Name the cyanotic heart diseases!
ONE big trunk: Truncus arteriosus TWO interchanged vessels: Transposition THREE: Tricuspid atresia FOUR: Tetralogy of Fallot FIVE words: Total Anomalous Pulmonary Venous Connection
Identify the skin findings in the provided photos!
Mongolian spot, nevus simplex, pustular melanosis, Erythema toxicum, Milia, port wine stain
Infant is born with retractions and tachypnea, also noted to have a scaphoid abdomen. You obtain a CXR. What is the diagnosis? What is the biggest concern moving forward?
Diaphragmatic hernia! Surgical correction, then must deal with pulmonary hypoplasia
13 day old infant brought into ED with temperature 102F, irritability, and poor feeding for past day. What bacteria are you worried about? Antibiotics?
GBS, E. Coli, Listeria! AMP/GENT
6 year old in emergency room with abdominal pain x 2 days. Three weeks ago he had a URI which has resolved. Physical exam shows + abdominal tenderness, lower extremity stiffness with passive movement, and palpable rash over legs and buttocks. CBC, coags, BMP are normal. UA shows microscopic hematuria and mild proteinuria. What is the diagnosis? What GI pathology do you need to consider?
IgA Vasculitis (Henoch-Schonlein Purpura)! Ileo-Ileal Intussusception! (enlarged peyers patches as lead point)
Criteria for kawasaki disease?
****Fever > 5 days****
With 4/5:
- bilateral conjunctival injection (non-exudative)
- mucosal involvement (cracked lips, strawberry tongue)
- Rash: polymorphous non-vesicular
- Edema (hands, feet, both)
- Adenopathy: unilateral, cervical
When assessing the moro exam on a LGA newborn in the nursery you notice the right arm remains extended and medially rotated with extended fingers. What is this called and what is the underlying pathology?
Erb-Duchenne Palsy! C5-C6
38 week old LGA infant born via C section to a mother with diabetes p/w respiratory distress, tachypnea and grunting. What is the most likely diagnosis? What would you expect to see on X ray?
TTN!
Toxoplasmosis! What would you see with congenital CMV?
Mother brings 4 year old into clinic after finding an abdominal mass during bathing. Mass does not cross midline. Blood pressure in clinic is 120/65. Diagnosis? What syndrome should you think of.....
Wilms Tumor: Nephroblastoma WAGR: Wilms tumor, Aniridia, GU malformation, Retardation
7 year old male comes to clinic with painless limp for the past 3 days, now with right anterior thigh pain. What is the next step in work up? What is the diagnosis?
Legg-Calve Perthes Disease AP and frog leg views of pelvis
You are in the DR and an infant is born with HR130, mild blue discoloration to hands and feet bilaterally, crying, flexion in upper and lower extremities, and grimace with stimulation. What is the APGAR score?
APGAR score: 8! Pulse: 2 Color: 1 Grimace: 1 Tone: 2 Respiration: 2
Infant born with respiratory distress and excess drooling. What is the diagnosis and what is the diagnostic test? What else should you look for in your work up?
TE fistula Pass an NG tube and obtain chest/abdomen XR! VACTER association!
What is CAH! Most commonly 21 hydroxylase deficiency
6 year old in emergency room with fever for 3 days. Has associated myalgias and mild abdominal pain. Feeling fatigued. Parents brought him in today after they noticed a rash over his wrists and ankles. Rash is macular, pink. Recently traveled with his boy scout troop to North Carolina. Diagnosis? Treatment?
Rocky Mountain Spotted Fever! Caused by Rickettsia rickettsi DOXY FOR EVERYONE! NO MATTER WHAT AGE!
8 year old with poor school performance. Teacher complains he often stares into space and is unresponsive for 3-4 seconds multiple times throughout the day. Returns immediately back to normal after. Diagnosis? EEG findings? Treatment?
Absence seizures, EEG with 3 Hz spike wave, treatment with Ethosuximide
Name this skin finding! And what should be done?
Nevus Sebaceous! Needs to be removed prior to adolescence 2/2 possibility for malignant degeneration!
1 week old infant noted to be cyanotic with feeds but pinks up with crying. Diagnosis? What else should you look for in your work up?
Choanal atresia! CHARGE association!
5 month old infant only lays in frog leg position. Not growing well, <5% secondary to poor feeding coordination. Hypotonic on exam with fascinations of tongue and no DTRs. Diagnosis?
SMA-1: Werdnig Hoffman Disease
9 year old with sickle cell comes with with recent URI now feeling very fatigued with pale skin and shortness of breath. CBC shows decreased Hct and low reticulocyte count compared to last CBC. Diagnosis?
Aplastic crisis 2/2 ParvoB19. Tx: Transfusions, supportive care
8 year old with difficulty walking 2/2 poor balance. On exam + babinski bilaterally, absent patellar DTR, reduced sensation in legs. Also noted to have explosive, dysarthric speech. Diagnosis? MCC Death?
Friedrichs Ataxia : autosomal recessive, trinucleotide (GAA) repeat MCC death: HCOM!