Notes

Advanced Prenatal Tests

Peds – Gastroenterology

Bilious Vomiting Duodenal Atresia Volvulus Intussusception Onset Day 1 Year 1 Year 1 Initial test AXR → Double bubble AXR U/S → Doughnut First step NGT IV fluid IV fluid Treatment Surgery Surgery Air enema Volvulus Twisted bowel loop → bowel obstruction Presentation Bilious vomiting Colicky abdominal pain Diagnosis Best initial...

Peds – Neurology

Cerebral Palsy Pyramidal (spastic) Extrapyramidal (dyskinetic) Seizure Febrile Seizure Etiology 6-60m High fevers in Roseola Otitis media 30% recurrence Types Simple <15m Generalized tonic-clonic 1 in 24h Return fast to baseline T>39℃ Complex >15m Focal >1 in 24h No return to baseline Low-grade fever Treatment >5m → Abort with Benzodiazepine First...

Peds – ENT

Acute Otitis Media Etiology S. pneumoniae H. influenza M. cataralis Influenza A virus RSV Parainfluena virus Presentation Crying Pain ↓ Hearing Fever Irritability Difficulty feeding/sleeping Diarrhea Tug on ear Diagnosis Tympanic Redness Bulging ↓ Light reflex Most sensitive → Pneumatic Insufflation ⇒ Immobility Most accurate → Tempanocentesis → Sample Recurrence No response to treatment...

Shingles

Etiology Varicella zoster virus Dormant in dorsal root ganglion sensory neurons Age >60 → Immune compromised Presentation Rash Painful prodrome Vesicular → Similar to chicken pox rashes Dermatomal distribution Never cross midline Diagnosis Clinical Complication Postherpetic Neuralgia After shingles in 15% Presentation Pain over the area Treatment TCA Amitriptyline...

Peds – Allergies

Anaphylaxis Defined by severity, not cause! Anaphylactic reaction Previous sensitization Immediate hypersensitivity IgE mediated Binds to mast cells → Release granules Histamine Prostaglandins Leukotriens Anaphylactoid reaction No previous sensitization Non-IgE mediated Etiology Insect bite Food Latex Medications Penicillin Phenytoin Lamotrigine Quinidine Rifampin Sulfa drugs Presentation Rash Urticaria Hypotension Tachycardia SOB...

Sickle Cell Disease

Etiology Beta globin chain 6th position → Point mutation → Valine replaces Glutamic acid Presentation African American Acute crisis Billirubin gallstones ↑Infections Autosplenectomy Encapsulated bacteria Salmonella Osteomyelitis Retinopathy Stroke Heart Enlarged Hyperdynamic Systolic murmur Skin ulcers in lower limb Avascular necrosis of femoral head Best initial test → X-ray Most accurate...

Child Abuse

Shaken Baby Syndrome Retinal hemorrhage Subdural hematoma

Preventable Trauma

Parkland formula in kids Only difference is we subtract 9% from the legs and give it to the head

Vaccinations

Hep B 3x Hep A 2x DTaP 3x <1y 2x 1-4y 2x in adults Tdap Td Tetanus Vaccine Td every 10y One Tdap booster Tetanus Ig in nonvaccinated Dirty wound → Booster after 5y Clean wound → Booster after 10y MMRV 2x Prevents shingles Zostavax All adults >60y Hib Disease does...

Brief Resolved Unexplained Event

ALTE/BRUE SIDS

Peds – Urology

Posterior Urethral Valve Etiology Redundant tissue at the beginning of urethra Presentation No urine at birth Distended bladder Oligohydramnios Seen on prenatal U/S ↑Cr Diagnosis Best initial → U/S → Hydronephrosis Next → VCUG → Rule out reflux Catheter → Massive output Treatment Best initial → Catheter Most accurate → Surgery Hypospadias/Epispadias...