Show:
Keepin' the kids healthy
The Dreaded ED!
Heme, because duh
Teens, Yuck!
Rheum
100
A 6 week old cries 3 hours a day lately. It happens 3-4 times per week for the past 3 weeks.  The baby cries excessively and is difficult to console.


What would you tell this parents is going on?

Colic.


With a normal physical exam , you can reassure the parents. They can try quiet environment, music, swings, and car rides. Soy formulas or lactose free formulas have not been shown to help. 

100
What is the most common fracture in children?
Clavicular fracture.


Usually the middle or later portions of the clavicle are affected.  Most occur as result of falling on an outstretched arm or shoulder, or direct trauma. Be suspicious of abuse in non-ambulatory children. Treatment is immobilization of the affected arm or simple sling in older children. 

100
With macrocytic anemia, what vitamin deficiencies are occurring, and what part of the SI absorbs these?
Folate= Jejunum

Vitamin B12= ileum

100
What is the most common cause of secondary amenorrhea?
Pregnancy!

No explanation needed.

If not pregnant- hypothalamic, pituitary, ovarian or outflow tract etiology. 

100
2nd most common vasculitis of childhood, and the leading cause of acquired heart disease in children in the US.  What is it?!?
Kawasaki Disease.


Generally found in children under 5yrs of age.  Diagnosis is based on atleast 5 days of fever with 4/5 S&S:

bilateral conjunctival injection w/o exudates

macular polymorphous rash on trunk and perineal area, followed by desquamation

Changes in lips: red, dry, fissured, strawberry tongue

Edema/redness of hands/feet

Cervical LN- 1 node >1.5cm in diameter.

200
What Vaccinations do you get at the 1 year visit, assuming you are on the normal CDC recommended schedule?
MMR, Varicella, Hep A.


And flu x2 if it is the season for it!

200
A little girl comes in to the ED with a dog bite (because obviously her cat wouldn't do that to her).  What specific bugs are you worried about, and what is the antibiotic treatment?

Pasteurella multocida and Staph aureus.

Also Capnocytophaga canimorsus

Augmentin. If allergic, consider clindamycin plus bactrim.  Treatment is now debatable, and less efficacious than thorough wound cleaning.  Consider treatment if high-risk areas like feet, immunocompromised patients, or infection prone wounds- deep puncture, massive crush injury, late presentation, or wounds sutured closed.

200
I am due to a structural or functional abnormality of cytoskeletal proteins, spectrin, ankyrin, band 3, or protein 4.2. What condition am I? And what can you see on labs that can help identify me??
Hereditary Spherocytosis.


Increased MCHC (mean corpuscular hemoglobin concerntration), anemia, reticulocytosis.


Splenectomy is sometimes required to prolong RBC survival.  If this happens, need PCN ppx.

200
St. Patrick's day was on a Saturday, and you got a little crazy this weekend! (whoops) But now you have painful unilateral inguinal lymphadenitis, and a painful penile inflammatory papule that is starting to ulcer with foul-smelling exudate. What's going on?

Chancroid.


Bug= Haemophilus ducreyi

Dx on a clinical basis.

Treatment: Azithromycin 1gm or CTX 250mg IM

200
This vasculitis doesn't discriminate based on vessel size and can involve any size or type.  It presents with a classic triad of painful recurrent oral and genital ulcers, and inflammatory eye disease.  Key PE finding is buccal aphthous ulcers found in nearly 100% of patients with this diagnosis.

Bechet disease. 


Most common symptoms include painful mouth sores, genital sores, inflammation of parts of the eye, and arthritis.

Younger children may present with periodic fever syndrome. More common in children from the Mediterranean and Far East.

300
A child can copy a circle and a square for you, but cannot copy a triangle.  What is the likely age of this child?
Age 4!!!

Age 3-3.5 = circle

Age 3.5-4= Cross

Age 4= Square

Age 5= Triangle

300
Your working a evening shift in the ED, and a young boy just comes in by EMS after being found in the garage with a bottle container of liquid the child got his hand on.  Dad shows the attending the bottle, and the attending tells you this is a serious case, as this patient can go blind from this ingestion.  What did the child ingest??
Methanol.


Found in windshield washer fluid, deicer, and is a fuel additive.  It is metabolized by alcohol dehydrogenase to formic acid, which can cause blindness due to optic nerve damage.

Common triad to look for is visual complaints, abd pain, and metabolic acidosis with high anion gap, without lactic acidosis.

Antidote is IV fomepizole which competitively inhibits alcohol dehydrogenase. Folate can help enhance metabolism of formic acid to less toxic metabolites. 

300
I'm bleeding!! And I also happen to know that its because I have giant platelets that are not aggregating because I have a deficiency of glycoprotein 1b (Gp1b)!
Bernard-Soulier syndrome.


Autosomal recessive. Glycoprotein 1b is the receptor for vWF, allowing platelet adhesion and platelet plug formation at site of vascular injury. Presents with severe mucocutaneous bleeding starting in infancy.

300
HPV has >40 different types that can affect the genital tract.  What 2 types are responsible for >90% of genital warts?
HPV types 6 and 11.  


Types 16, 18, 31, 33, 35 are of greater concern associated with cervical neoplasia.

300
Rare autoimmune exocrinopathy with keratoconjunctivitis sicca and xerostomia.  What lab findings would help you get to your diagnosis, and are more specific for this process?
Sjogren syndrome!  Anti-SSA/Ro and Anti-SSB/La.


Children born to mothers with Sjogren's who have these antibodies are at increased risk for developing neonatal lupus.

400

Nightmares, night terrors, and sleepwalking, oh my!  Which of these happens during which phase of the sleep cycle??

Nightmares occur during REM sleep. Peak age is 3-5yrs. Tend of occure the last 1/3 of night.


Night terrors occur during stage 3 or 4 slow wave sleep. Most occur around12- 2am. Peak age 5-7 years. Frequently these is an associated family history.

Sleeping walking occurs during transition from stage 4-non REM sleep. Peak age 4-8yrs. 

Treatment of sleep problems is regular daily routine and regular pre-sleep routine.

400

Name 4 of the findings you will see with basilar skull fractures.

Raccoon eyes

Battle sign

Hemotypanum

CSF leakage from ear or nose

CN palsy

Hearing loss

400
See Slide 4! They have severe thrombocytopenia with no megakaryocytes in the bone marrow. 

Thrombocytopenia with Absent Radii (TAR Syndrome). 

Presents in infancy with bleeding or easy bruising and becomes less severe over time. Other features that can occur in TAR syndrome include malformations of the heart or kidneys. Some people with this disorder have unusual facial features including a small lower jaw (micrognathia), a prominent forehead, and low-set ears. 

400
What are the top 3 leading cause of death in adolescents 15-19 year of age?
1. Accidents

2. Suicide

3. Homicide

400
You run into the attending in the hallway, and you drop all your papers and accidently grab the wrong folder as you walk away.  You see the chief complaint for this patient was a rash with bilaterally muscle weakness. You're nosey, so you skim the labs and notice an elevated CPK and aldolase. When you go to return the papers, confident if he pimps you, you know the diagnosis, he instead asks you what the common skin findings are with this condition.  You respond with your board buzz words....

Heliotrope rash: A violet-colored or dusky red rash, most commonly on the face, eyelids, and areas around the nails, elbows, knees, chest, and back. The rash, which can be patchy with bluish-purple discolorations, is often the first sign of dermatomyositis. 

Gottron papules: A rash on the knuckles occasionally can be misdiagnosed as eczema when on fact it is dermatomyositis.

500
Behavioral issues in children can be common, for which sometimes medications are needed. Sometimes starting this class of medication can unmask a tic disorder.
Stimulants.


It does not cause a tic disorder, just unmask one. Discontinue the medication only if the tic becomes more of a problem than the ADHD.  This is not a contraindication.

500
A 15year old girl (Wt: 50kg)comes in to the ED with 2nd degree burn to whole chest and abdomen and all of left leg from coffee spilling on her, when her sister jumped out of the kitchen cabinet to scare her.  How much fluid resuscitation should she receive in the first 8 hours?

3600ml

First body surface area: 18% + 18% = 36%

Parkland formula. 4 x %TBSA x Kg.


For this patient: 4 x 50 x 36 = 7200 / 2 = 3,600ml

500
This disease presents similar to cystic fibrosis, including failure to thrive, pancreatic exocrine insufficiency, and recurrent infections. They are also neutropenic.  Sweat test will be normal.  What disease is this?
Shwachman-Diamond Syndrome.


Autosomal recessive, mutation in the SBDS gene.  Treatment includes pancreatic enzyme replacement, G-CSF, possible BMT.  Pt are predisposed to AML.

500
You are working up a 18-year-old girl for primary amenorrhea. She has had breast budding but no pubic hair development. She has a low hairline, low-set ears, and lymphedema of the hands. What syndrome does she have?
Turner Syndrome. 45 XO


Occurs in 1 out of every 2,500 newborn girls worldwide.

They can also have short stature, webbed neck, cardiac anomalies, horseshoe kidney, ADHD, learning disabilities. 

500
4 year old male comes in with purpuric lesions on legs and bottom, bilateral knee pain, and some abdominal pain. The hospital is full, so this kiddo spent quite a while down in the ED.  When he gets up to 4hope he is having persistent and worsening abdominal pain.  What do you want to order based on your clinical suspicion?
Abdominal US looking for intussusception.  This can occur in 2-14% of children with Henoch-Schonlein Purpura (HSP), the most common vasculitis of childhood.  50% of the time, this is preceded by an upper respiratory infection.