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At what age do you start taking kid's BP
3 years
How is Cystic Fibrosis diagnosed?
Sweat chloride test
Genetic testing
Discuss the treatment of pertussis
Azithromycin is first line. It won't shorten length of symptoms but it will shorten the time that they are contagious. (They are typically contagious for 2 week after the cough)
Stay well hydrated. Get Dtap!
How is sickle cell anemia diagnosed?
Hemoglobin electrophoresis
What is cryptorchidism and when to refer?
Undescended testes.
Refer to Urology by 6 mo.
Risk for testicular cancer and fertility issues
What is the difference between Mono and Strep
Mono- more fatigue, spleen enlargement (supportive care)
Strep- exudate, palatine petechiae. (Use amoxicillin or macrolide if PCN allergy)
Mono + Strep- treat with Macrolides or Cephalosporins NOT penicillin (morbilliform rash) Penicillin VK is the exception
What is one of the top concerns for patient with CF?
Life span is around 30 years
Signs of Epiglottitis
Drooling, stridor, leaning forward to breathe, muffled voice, thumbprint sign on X-ray
Vaccine to help prevent this? HIB
What is Thalassemia?
Diagnosed by hemoglobin electrophoresis
Common prob- Transfusion dependent risking iron overload that leads to organ injury and mortality
What is Vesicoureteral Reflux?
Backwards flow of urine
Signs- asymptomatic or UTIs or bladder incontinence.
Most resolve over time
Refer to Uro if greater than Grade 3 (out of 5)
When is a baby most at risk for iron deficiency anemia and what can we do to prevent?
4-6 months old. This is b/c around this time, the iron stores built up in the womb during pregnancy begin to deplete, and they often aren't getting enough iron from their diet alone
Give iron fortified foods and avoid cow's milk until 12 mo.
What are the 4 defining features of Tetralogy of Fallot?
Overriding aorta, pulmonary artery stenosis, VSD, right ventricular hypertrophy
Describe intussusception
Bowel telescopes on itself.
Sausage like mass felt in abdomen. Currant jelly-like, mucousy stools. Crampy abdomen.
Refer to ER
How to treat infant reflux?
H2 blockers or PPIs for short term. Wean off.
What do we need to assess in Down Syndrome children before clearing them for sports?
C spine x ray to assess for atlantoaxial instability. (Instability of the cervical spine)
Legg-Calve-Perthe Disease vs. Slipped capital femoral epiphysis
Legg-Calve-Perthe Disease- osteonecrosis of femoral head. Hip pain, limp, + trendelenburg test (Cannot stand on one leg without tilting pelvis). (Usually ages 4-8 years) REFER
Slipped capital femoral epiphysis-femoral head slips out. Can damage growth plate. Knee pain, unevel leg length, limp, inability to stand on bad leg. Common in adolescents. Risk- rapid growth spurt. Xray and REFER
Nephroblastoma/Wilms Tumor
Presents as small abdominal mass near flank.
Does not cross midline
Do not vigorously palpate (can rupture tumor)
REFER
Kleinfelter Syndrome
Boy born with extra X chromosome.
Testosterone deficiency results.
Presents as: Large head circumference, delayed milestones, mental disabilities.
Hip dysplasia- signs and tests
Unequal leg lengths, asymmetric gluteal folds, abnormal gait.
Tests:
Barlow- adduct hip and assess for dislocation and palpable clunk
Ortolani- abduct hip and try to relocate and already dislocated femoral head back into place. Assess for palpable clunk as femoral head slides back into place.
Confirm with US
If diagnosed early - Pavlik harness
If diagnosed later- may need closed reduction/spica cast
Febrile seizures
Do not cause long term damage
Treat underlying fever.
When to go to ER
Inability to lower fever with meds
Seizure longer than 5 min
Breathing problems or ill appearing
Turner Syndrome
Only occurs in females. One X chromosome. Webbed neck, short stature.
Complications with puberty and fertility
May need hormone therapy to go through puberty
What are Salter Harris Fractures?
Normally occurs after trauma/injury
Xray
1-mild (splint), 4 and 5- severe (refer for surgery)
SALTER
1- Slipped epiphysis
2- Above physis (most common)
3- BeLow physis
4- Through physis
5- Erasure of growth plate