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Pediatrics
Neonatal Jaundice
Jaundice Prehepatic Hemolysis Hemorrhage ↑ Enterohepatic corculation Breastfeeding jaundice → <7d → Poor feeding → Feed more Breast milk jaundice → >7d → No gut bacteria → Feed formula Pyloric stenosis Intrahepatic Uptake Craigler-Najjar Gilbert Physiologic jaundice Secretion Dubin-Johnson Rotor Hepatitis Posthepatic Billiary atresia Sepsis Metabolic Gallstone Cancer Pathologic...
Read moreNeonatal ICU
Respiratory Distress Syndrome (RDS) Hyaline Membrane Disease Etiology Preterm Surfactant deficiency Presentation First 48-72h RR >60 Progressive hypoxemia Cyanosis Nasal flaring Intercostal retraction Expiratory grunting Diagnosis Clinical Rule out infection CXR Ground-glass Air bronchogram No focal opacity Treatment CPAP or intubation Artificial surfactant → ↓ Mortality Prevention Corticosteroid to...
Read morePeds – Ophthalmology
Amblyopia → Cortical blindness Causes Strabismus Congenital cataract Strabismus → Lazy eye Patch good eye Congenital cataracts Genetic TORCH Galactosemia Retinoblastoma Rb gene White reflex Surgery NO radiation Later → Osteosarcoma Retinopathy of prematurity High O2 to neonates Laser ablation Ophthalmia Neonatorum Day 1 → Chemical (Silver nitrate) 2-7d → Gonorrhea Bilateral Eyelid edema Purulent discharge Ceftriaxone...
Read moreChildhood Rashes
Erythema infectiosum (Fifth Disease) Etiology Parvovirus B19 Presentation Prodrome None Low fever URI ? Rash Arm → Trunk → Leg Slapped cheek Parvovirus B19 in mother can cause Hydrops fetalis in newborn Diagnosis → Clinical Complications Arthropathy Aplastic crisis in Sickle cell Spherocytosis Iron deficiency anemia Treatment → Supportive Measles...
Read morePeds – Orthopedics
Congenital Hip Dysplasia Etiology Infants Presentation Found in newborn screen exam Click and clunk in the hip Diagnosis Barlow maneuver → Dislocates (Clunk) Ortolani maneuver → Fixes (Click) Allis (Galeazzi) sign → Knees have different height in supine position when flexed Asymmetric inguinal skin folds Best initial <4m →...
Read morePeds – Pulmonology
Bronchiolitis Organisms RSV → Most common Parainfluenza 1, 2 Influenza virus Metapneumovirus Etiology <2y Small airways of lower respiratory tract Fall/winter Presentation Day 1-3 Fever Rhinorrhea Cough Infants with RSV → Risk of Apnea Day 4-6 Tachypnea → Earliest sign Respiratory distress Hypoxia Intercostal retraction Washing machine sounds Crackles...
Read morePeds – Infectious Disease
Neonatal Sepsis Causes Pneumonia Meningitis Organism Early onset GBS from mom E. coli Listeria Late onset Staph E. coli Group B strep Diagnostic workup CBC with diff Blood culture Urine culture U/A CXR LP (if irritable/lethargic → meningitis) Treatment Ampicillin Gentamicin Cefotaxime Pediatric Meningitis Etiology Viral → Enterovirus Bacterial...
Read moreCongenital GI Disease
Atresias Esophageal Atresia Choanal Atresia Duodenal Atresia Blind esophagus Buccopharyngeal membrane Failed duodenal canalization Trisomy 21 Presentation Frothing Coughing Cyanosis Feeding → Resp distress No resp distress at rest Presentation Resp distress Cyanosis with breastfeeding Pink when crying Presentation Bilious vomiting NO Resp distress Initial test CXR Most diagnostic...
Read moreAcyanotic Cardiac Lesions (L→R)
Ventricular Septal Defect (VSD) Most common congenital heart lesion Etiology Trisomy 13, 18, 21 Fetal alcohol syndrome TORCH Cri du chat syndrome Apert syndrome Cranial deformity finger/toe fusion VSD Presentation Dyspnea Respiratory distress High-pitch holosystolic murmur → Smaller VSD = Louder sound Loud pulmonic S2 Mid-diastolic apical rumble (↑...
Read moreCyanotic Cardiac Lesions (R→L)
R→L shunt PDA dependent VSD Surgery Tetralogy of Fallot ✖︎ If severe ✖︎ ✖︎ Transposition of Great Vessels ✖︎ ✖︎ VSD or ASD ✖︎ Hypoplastic Left Heart Syndrome ✖︎ ✖︎ ✖︎ Truncus arteriosus ✖︎ ✖︎ ✖︎ TAPVR ✖︎ ✖︎ Tricuspid Atresia ✖︎ ✖︎ ✖︎ ✖︎ Tetralogy of Fallot Most...
Read moreDevelopmental Milestones
Developmental Milestones (Full) Age Gross Motor Fine Motor Language Social/Cognitive 2m Lift head/chest in prone Track past midline Coo Alert to sound Social smile Recognize parents 4m Roll over First front to back Then back to front Grasp rattle Laugh, Squeal Orient to voice Look around 6m Sit up...
Read moreRoutine Management of Newborn
After Delivery Suction mouth and nose Clamp and cut umbilical cord Dry Wrap Place under warmer Gently rub or stimulate heels → Stimulate crying/breathing Respiratory distress → ABG + intubation GI decompression → NG tube Sepsis → Antibiotics Normal Vital Signs RR: 40-60 HR: 120-160 Apgar Score Measures need for and effectiveness...
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