As easy as ABC
This is the first test you would order if you suspect a language disorder
What is a hearing screen?
12 year old girl with history of Salmonella diarrhea 2 weeks ago presents with:
- subjective fever
- conjunctivitis
- oral ulcers
- WBC in her microscopic urine test
- Arthritis of her L. knee and right ankle
What is reactive arthritis?
classic triad (not typically in younger kids) is urethritis, conjunctivitis, and arthritis..."can't pee, can't see, can't climb a tree"
This is the most likely diagnosis when a 2 week old infant presents with inspirational stridor. It is much worse when the child is upset.
What is Laryngomalacia?
Most common cause of stridor in newborn period. Laryngeal cartilage just not stiff enough so narrows upon inspiration. Stridor can occur at birth but most commonly presents at 2 wks. Most outgrow by 12-24 months.
This is the most likely diagnosis in a child with high BMI who presents with:
- Loud, frequent, disruptive snoring
- Restless sleep
- Daytime sleepiness and drowsiness
- Increased irritability
- Anxiety
What is OSA?
Prevalence in children 1-3%. Most common reason for OSA in children remains adenotonsillar hypertrophy, but obesity also important risk factory. Gold standard: overnight polysomnogram.
A newborn presents with 1-2 mm firm, white papule that appear on the surface of pilosebaceous units on the face. What is the diagnosis?
What is Milia?
No treatment resolve over several months
This is the normal weight gain after 2 years of age per year until adolescence.
what is 5 lbs/year?
1-6 years: weight in pounds= (age x 5) +17
7-12 years: weight in pounds = (age X 7) +5
This is what you would expect to see on x-ray of affected joints in a patient with juvenile idiopathic arthritis (JIA) vs systemic lupus erythematosus (SLE).
What is erosive joint damage with JIA?
-JIA can cause juxtaarticular osteopenia and erosive joint damage, late in course. SLE commonly causes avascular necrosis, especially of hips, knees, and shoulders. SLE can cause a non erosive joint abnormality called Jaccoud arthropathy, reversible subluxation at the metacarpophalangeal joints of the hands
This is the most likely diagnosis of a girl who presents with abrupt onset:
high fever, sore throat, drooling, and stridor. Doesn't respond to treatment for croup.
What is epiglottitis?
A newborn presents with:
- intermittent cyanosis, especially when being fed
- inability to pass a firm catheter through either nostril to a depth of 3 cm
What is the diagnosis?
What is Choanal atresia?
Choanal atresia is the most common congenital anomaly of the nose. Typically infants present with cyanosis that resolves with crying and worsens when feeding. CT scan confirms. Due to high association with other anomalies, cardiology and ophthalmology consultations are warranted.
A patient presents with small, grouped, freckle-like, cafe au lait spots measuring 1-4 mm in the axilla. What disease should you consider?
What is Neurofibromatosis Type 1 (NF1)?
Lesions described are known as the Crowe sign, which occurs in the axilla or groin. Crowe sign is among the major diagnostic criteria of NF1. Other major criteria: >/= 6 cafe au last spots (>5mm if prepubertal or >15mm if postpubertal).
This is the percentage that birth length increases by 1 year of age.
What is 50%?
Average birth length is 20 inches. Avg height at 1 year of age is 30 inches, an increase of 50%.
This is the class of antibodies that would be responsible for a 32 year old woman with SLE having a history of multiple miscarriages
What is antiphospholipid antibodies?
These include lupus anticoagulant, anticardiolipin, and B2-glycoprotein-1 antibodies. Additionally these antibodies can cause thrombocytopenia, livedo reticularis, and/or blood clots in about 25% of patients.
This the most likely bacterium causing this 15 year old boys abrupt onset of:
- Fever, cough and wheezing, joint pains, and rash
What is mycoplasma pneumoniae?
Extrapulmonary manifestations of M. pneumoniae include hemolytic anemia, splenomegaly, erythema multiforme (and SJS), arthritis, pharyngitis, tonsillitis, and neurologic changes - especially confusion
Are full term, normal-weight newborns farsighted or nearsighted or do they have normal vision?
What is Farsighted (hyperopic)?
-premature and low birth weight infants tend to be less hyperopic or even myopic, often with some degree of astigmatism.
A 9 year old girl with a history of atopic dermatitis now presents with areas of hypopigmentation with a fine scale, mostly affecting the cheeks and extensor extremities. What is the most likely diagnosis?
What is Pityriasis alba?
common in school- aged children with atopic dermatitis and presents as described. It is more apparent on children with darker skin and during summer because the affected skin does not tan normally.
These are the 3 primitive reflexes present at birth that typically disappear at 3-4 months of age.
What is rooting, stepping, and sucking?
crossed adductor (disappears by 7 mos)
toe grasp (disappears 9-12 mos)
moro (disappears at 3-6 mos)
palmar hand grasp (3-6 mos)
Babinski (9-12 mos)
A 14 year old girl presents with:
Recurrent parotitis
Dry eyes
Conjunctival inflammation
Dryness of the mouth
Lab positives: RF, ANA, Anti-Ro
What is Sjogren syndrome?
Always suspect SS in child with recurrent parotitis. Most cases present with recurrent parotitis and keratoconjunctivitis sicca
This is the most likely diagnosis when a 3 year old boy presents with the following:
Waking up in the middle of the night with a barking cough and mild stridor.
The next day, child is healthy. That night, the sxs reoccur. The next day, the child is again healthy. This occurs 3 nights in a row
What is spasmodic croup (noninfectious)?
This can be related to reflux.
A 10 year old boy presents after being hit in the eye with a baseball. He is sleepy, nauseated, and complains of eye pain. You see a layer of blood obscuring the lower third of the iris. The pupil looks normal.
What is a hyphema?
presence of blood in the anterior chamber of the eye. Usually occurs after trauma. Occasionally spontaneous. In this case need to check for blowout fracture (diplopia, limited upward gaze) and a ruptured globe. Complications include glaucoma and rebleeding.
Infants with port-wine stains of the lower extremities are at risk for what syndrome?
What is Klippel-Trenaunay syndrome (KTS)?
KTS presents with vascular malformation (often mixed capillary-venous-lymphatic) of an extremity, with soft tissue and/or limb overgrowth and varicose veins. Limb overgrowth is generally progressive in nature.
A young child uses a cup well, has scribbled for several months, and can build a tower of 4 cubes. He began to walk well 2-3 months ago but has just started to run.
What is 18 months?
18 months, build tower 4 blocks, walk well but not able to run or go upstairs with 2 feet on each step. Most use cup well, but can't use spoon. Most begin to scribble by 15-18 most of age.
This is the type of antinuclear antibody (ANA) pattern seen in children with mixed connective tissue disease (MCTD).
What is speckled ANA?
MCTD assoc with anti-U1 ribonucleoprotein Ab. Labs show a high-titer speckled ANA, anti-U1 RNP Ab, RF, and hypergammaglobulinemia. Dx requires high-titer Ab against U1 RNP auto antigen.
This is what is likely causing the recurrent episodes in the below patient.
15 yr old with asthma presents with recurrent episodes of : Malaise, coughing up brownish mucous plugs, occasional hemoptysis, peripheral eosinophilia, high IgE.
Improves with corticosteroid therapy, but 2-3 most later, sxs recur.
What is allergic bronchopulmonary aspergillosis (ABPA)?
This typically occurs in patients with asthma and CF. Major clues are recurrent nature with associated eosinophilia and very high IgE.
What common cause of midline neck masses is often associated with an ectopic thyroid gland?
What is Thyroglossal duct cyst?
common cystic midline-masses that are often seen with ectopic thyroid glands. Cyst typically move with swallowing. Usually asymptomatic unless infected. Surgically remove.
In a patient with extremely severe seborrhea, what diagnosis should you consider?
What is Langerhans cell histiocytosis?
Consider this particularly if atrophy, ulceration, or petechiae are present. Send for skin biopsy to diagnose.