Adam Shared Pediatrics - 325 Picmonics

Celiac Disease Diagnosis and Treatment

Blunting of Intestinal Villi

Lymphocytes in Lamina Propria

Anti-gliadin Antibodies (IgA)

Anti-endomysial Antibodies (IgA)

Anti-tissue Transglutaminase Antibodies (IgA)

Gluten-Free Diet

Corticosteroids

Dapsone

Intestinal Lymphoma

2 mins

Strawberry Hemangioma (Superficial Infantile Hemangioma) 4404

Most common benign vascular tumor in children

Composed of capillaries separated by connective tissue

Bright red, shaqily demarcated plaques that blanch with pressure

Can also be found in deep tissues and the viscera (eg, liver)

Appear during the first days or weeks after birth and grow rapidly during the first 1-2 years of life

Majority of these lesions regress spontaneously

A minority of lesions can be disfiguring, ulcerating, disabling (eg, strabismus from eyelid hemangioma), or life-threatening (eg, tracheal lesions)

Beta blockers (eg, propranolol) are recommended for patients at risk for complications

May present as patch of telangiectasias at birth

TOPICAL beta blocker

Vision impairment if near eye

Rarely requires surgical intervention

Immune Thrombocytopenic Purapura

Most common cause of thrombocytopenia in both children and adults

IgG against platelet antigens GPIIb/IIIa

Autoantibodies produced by plasma cells in the spleen

Antibodies associated with platelets are consumed by splenic macrophages

Acute: Occurs in children weeks after a viral infection or immunization, resolves in weeks

Chronic: Occurs in adults, usually women of childbearing age; primary or secondary (SLE)

IgG can cross placenta causing temporary thrombocytopenia in offspring

HIV and Hepatitis C association

Low platelet counts, normal PT/PTT, increased megakaryocytes on bone marrow biopsy

Increased Bleeding time

Petechia, purapura, ecchymosis

Corticosteroids, effective for children, temporary relief for adults with later resistance

IVIG used in acute cases

Splenectomy (removes source of antibodies) in corticosteroid resistant cases

Alternative treatment: Rituximab

Children: Skin manifestations only: Observe, Bleeding: IVlg OR Glucocorticoids

Adults: Platelets ≥30,000/μL without bleeding Observe, Platelets <30,000/μL OR bleeding: IVig OR Glucocorticoids

Diagnosis of Exclusion

Negative direct antiglobulin test

Acute and self-limiting in children but usually becomes a chronic disorder in adults

Corticosteroids are a first-line treatment, IVIG is for resistant cases

Anti-Rh (D) is an alternate treatment option in rhesus-positive non-splenectomized patients

Fetal Alcohol Syndrome 565

Newborns of alcohol-consuming mothers have increased incidence of congenital abnormalities

Including pre- and postnatal developmental retardation, microcephaly, facial abnormalities (Pictured)

Leading cause of intellectual disability in the US

Smooth philtrum, thin vermillion border [upper lip], small palpebral fissures, limb dislocation, heart defects

Heart-lung fistulas and holoprosencephaly in most severe form

Mechanism is failure of cell migration

VSD, PDA, ASD, tetralogy of Fallot

Social withdrawal, and delays in motor and language milestones

Down Syndrome (OLD VERSION)

Trisomy 21

Meiotic nondisjunction

Mental retardation

Flat facies

Prominent epicanthal folds

Simian crease

Duodenal Atresia

Endocardial cushion defects

Septum primum type ASD

Increased risk of Acute lymphoblastic leukemia

Hirschsprung's disease

Alzheimer's Disease

2 mins

Phenytoin

Status Epilepticus

Tonic-Clonic Seizures

Blocks Na+ Channel Activation

Inhibition of Glutamate Release

Class IB Antiarrhythmic

Teratogenic

Macrocytic Megaloblastic Anemia

Induce Cytochrome P450

Drug-induced Lupus

Neuropathy

Hirsutism

Gingival Hyperplasia

1 min

Acute Cervical Adenitis in Children 4353

Acute lymphadenitis (LAD) arises over a few days

Nodes are enlarged, tender, warm, and erythematous; If untreated --> progress to suppuration and abscess

Empiric antibiotic therapy for acute, unilateral lymphadenitis typically involves clindamycin

Staphylococcus aureus (most common) and Streptococcus pyogenes

Pronounced erythema, tenderness

Most common is staph aureus

Another question says staph and strep pyogenes are both the most common

Anaerobic bacteria (eg, Prevotella buccae)

Dental caries, periodontal disease

Bartonella Henselae

Papular nodular at site of cat scratch or bite

May be eyrhtematous (overlying the adenopathy)

Mycobacterium avium

Gradual onset, nontender

Francisella tularensis

Fever, chills, headache, and malaise

Adenovirus

Pharyngoconjunctivitis

EBV/CMV

Mononucleosis

Inguinal and axillary adenopathy are also usually present, cervical region is most prominent

322 Congenital Hypothyroidism (Cretinism), Subacute Granulomatous Thyroiditis (de Quervain), Riedel Thyroiditis

Fetal hypothyroidism due to maternal hypothyroidism, thyroid agenesis, thyroid dysgenesis (most common in US)

Additional causes: iodine deficiency, dyshormonogenetic goiter; congenital defect in thyroid peroxidase

Findings: Pot-bellied, Pale, Puffy-faced child with Protruding umbilicus, Protuberant tongue, and Poor brain development: the 6 P’s

Short stature with skeletal abnormalities

Uncomplicated umbilical hernia

U. Lethargic, hoarse cry, poor feeding, constipated, jaundice, dry skin, large fontanelles

U. Treat with levothyroxine by 2 weeks to reduce developmental issues

Most often asymptomatic

Diagnosis: Newborn screening, increased TSH, decreased T4

Management: Confirm TSH, T4, Start levothyroxine immediately, thyroid ultrasound, Refer to endocrinology

At risk for permanent neurological defects without treatment

Most infants lack clinical signs of hypothyroidism at birth as maternal T4 crosses the placenta

Intellectual disability if hormone replacement is not initiated by age 2 weeks

Self-limited disease often following a flu-like illness (eg, viral infection); may progress to hypothyroidism

Hyperthyroid early in course, followed by hypothyroidism; early in course neutrophil infiltrate which is replaced by granulomas

Histology: granulomatous inflammation

Findings: Increased ESR and CRP, jaw pain, very tender/painful thyroid

Decreased radioiodine uptake

Treatment: symptomatic via beta blockers (thyrotoxic symptoms), NSAIDs for pain; Glucocorticoids for NSAID resistant pain

Other possible findings include leukocytosis, mild anemia, and mild elevation of liver enzymes

Thyroid replaced by fibrous tissue with inflammatory infiltrate (Pictured)

Fibrosis may extend to local structures (eg, trachea, esophagus), mimicking anaplastic carcinoma

1/3 are hypothyroid

Manifestation of IgG4-related systemic disease (eg, autoimmune pancreatitis, retroperitoneal fibrosis, noninfectious aortitis)

Findings: fixed, hard (rock-like), painless goiter

Mimics anaplastic carcinoma but patients are around 40 and no malignant cells

Hypertrophic Cardiomyopathy Mechanisms

2/3 Autosomal-Dominant

1/3 Sporadic Type

Mutation in Gene for Sarcomere Protein

Cardiac Myosin Binding Protein C

Asymmetric Septal Hypertrophy

Outflow Tract Obstruction

Diastolic Dysfunction

2 mins

Pediatric Viral Myocarditis 4854

Coxsackie B virus

Adenovirus

Viral prodrome

Heart failure: Dyspnea, syncope, tachyca rdia, nausea, vomiting, hepatomegaly

Impairment of systolic and diastolic function.

Chest x-ray:

Cardiomegaly

Pulmonary edema

Healthy infants age 1 transverse cardiothoracic ratio of ≤60% (older than 1 has ≤50%)

ECG: Sinus tachycardia

Echocardiogram:

Decreased ejection fraction

Diffuse hypokinesis

Endomyocardial biopsy (gold standard): Inflammatory infiltrate of the myocardium with myocyte necrosis

Mortality:

Newborns: -75%

Older infants/children: - 25%

Outcome of survivors:

Full recovery within 2-3 months: -66%

Dilated cardiomyopathy/chronic heart failure : -33%

Diuretics and inotropes

Monitored in the intensive care unit due to the risk of shock and fatal arrhythmias

Troponins, CK-MB, ESR and CRP can give clues to degree of cardiac disease

Pinworm (Enterobius Vermicularis)

Nematode (Roundworm)

Ingestion of Eggs

Intestinal Infection

Anal Pruritus

Scotch Tape Test

Albendazole

Pyrantel Pamoate

2 mins

Differential Diagnosis of Stridor 4497

Croup

Foreign body aspiration

Most common in infants/toddlers

Laryngomalacia

Vascular ring

Presents in infants (usually under one year of age)

Biphasic (more prominent in exhalation) stridor that improves with neck extension (decreases tracheal compression)

Abnormal development of the aortic arch, causing tracheal, bronchial, and/or esophageal compression

Complete (circumferential around trachea and/or esophagus), such as double aortic arch, or incomplete (pulm artery sling)

Up to 50% of patients also have a cardiac anomaly

Esophageal (eg, dysphagia, vomiting, difficulty feeding) symptoms

Barium swallow identifies indentations of the structures, confirmed by MRI with angiography

Can present in adulthood, often presenting symptom is dysphagia

Iron Deficiency Anemia

Malnutrition/Malabsorption

Hemorrhage

Microcytic, Hypochromic Anemia

Decreased Heme Synthesis

Decreased Reticulocytes

Decreased Ferritin

Increased Red Cell Distribution Width (RDW)

Poikilocytosis

Anisocytosis

Increased Central Pallor

2 mins

Febrile Seizure 4841

Fever from mild viral/bacterial illness or recent immunization

Family history

Typically age 3 months to 6 years

No previous afebrile seizure

No meningitis or encephalitis

No acute metabolic cause

Abortive therapy (if greater than or equal to 5 minutes)

Reassurance

Normal development/intelligence

-30% risk of recurrence

<5% risk of epilepsy

Does not cause brain injury

Antipyretics for comfort, but no evidence that these will reduce the risk of future febrile seizures

Rate of rise that causes seizure (but now they dont know if its rate or height)

Only 1 x 24 hours, < than 15 minutes, must be complex ie affect entire brain (if negative on one then its complex febrile seizure)

Regardless of simple or complex give a benzo

If complex do EEG if you think its a seizure, an LP if you think its meningitis and an MRI looking for anything else in the brain

Long term anti epileptics if complex

Focal Seizure 2280

Originates from 1 cerebral hemisphere

+/- Loss of consciousness

May generalize to involve both hemispheres

EEG: abnormal electrical activity that is sustained with a distinct start and stop (different from baseline)

Motor: Jacksonian march, turning of eyes/head/trunk

Sensory: Paresthesias, vertigo, visual phenomena

Autonomic: Sweating, epigastric "rising" sensation

Psychic: "Deja vu" affective changes (eg, fear)

May also present with a decline in academic performance

Hyper IgM Syndrome

Deficient CD40 Ligand on Helper T-cells

Defective CD40 Receptor on B-cells

Inability to Class Switch

Pyogenic Abscess

Decreased IgG, IgA, IgE

4 mins

Friedreich's Ataxia

Trinucleotide Repeat

GAA Repeat

Frataxin

Mitochondrial Dysfunction

Autosomal Recessive

Hammertoes

High Arches

Kyphoscoliosis

Lateral Corticospinal Tract

Posterior Column

Spinocerebellar Tract

Type I Diabetes Mellitus

Hypertrophic Cardiomyopathy

1 min

Timeline of Infant Nutrition 2479

Symbols

Iron deficiency anemia is the single most common nutritional deficiency in infants and children and is often asymptomatic

Born with iron stores that prevent them from developing iron deficiency anemia until age 4-6 months, regardless of dietary intake

Prematurity, and early introduction of cow's milk before age 12 months increases the risk

Supplementation should be continued until age 1 year in preterm infants

All exclusively breastfed infants should be started on 400 International Units of vitamin D daily within the first month of life

Pureed fruits and vegetables should be introduced first followed by pureed proteins such as meats

No evidence suggesting that early introduction of highly allergenic foods such as eggs is associated with an increased risk of allergies

American Academy of Peds (AAP): exclusive breastfeeding until 6 months, earlier intro of solids --> gastrointestinal infections

Maternal vitamin D deficiency increases risk of deficiency in the infant

Borrelia burgdorferi

Lyme Disease

Spirochete

Dark-field Microscopy

Giemsa Stain

Silver Stain

White-footed Mouse

Ixodes Tick

Babesia

Anaplasmosis

Flu-like Symptoms

Erythema Migrans

Bulls Eye Rash

Bilateral Bell's Palsy

Conduction Defects

Arthropathy

Doxycycline

Ceftriaxone

3 mins

Breastfeeding Contraindications 4892

Breast milk is recommended as the exclusive source of. nutrition for infants age

Longer postpartum anovulation

More rapid uterine involution & decreased postpartum bleeding

Faster return to prepartum weight

Improved maternal-infant bonding

Improved child spacing

Decreased breast and ovarian cancer risk

Active untreated tuberculosis (mothers may breastfeed after 2 weeks of anti-tuberculin therapy)

Maternal HIV infection (in developed countries where formula is readily available)

Herpetic breast lesions

Active varicella infection (<5 days prior to or within 2 days of delivery)

Chemotherapy or radiation therapy

Active substance abuse including alcohol

Mothers with hep B/C should breastfeed unless nipples are cracked or bleeding

Improved gastrointestinal function

Prevention of infectious diseases:

Improved immunity

Otitis media, Gastroenteritis, Respiratory illnesses, Urinary tract infections

Decreased risk of childhood cancer, type I diabetes mellitus & necrotizing enterocolitis

Psychological well being

Galactosemia

HIV-positive women in resource-rich countries are advised to feed their infants with formula rather than breast milk

Resource-poor countries should breastfeed; high rates of infant death from water-borne diseases associated with formula

Adam Shared "Pediatrics" - 325 Picmonics

Pediatrics

Ace Your Medicine (MD/DO) Classes & Exams with Picmonic:

Over 1,990,000 students use Picmonic’s picture mnemonics to improve knowledge, retention, and exam performance.

Choose the #1 Medicine (MD/DO) student study app.

Works better than traditional Medicine (MD/DO) flashcards.

It's worth every penny