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41-60 of 82 results by Rose Chasm
- vasculitis of small vessels with neutrophilic infiltration of venules and arterioles
- classic triad: painful recurrent oral and genital ulcers with inflammatory eye disease
- key finding of recurrent buccal apthous ulcers (nearly 100% of patients)
- diagnosis is made when recurrence of oral ulceration occurs at least 3 times in 1 year plus 2 of the following: recurrent genital ulceration , eye lesions, skin lesions, or positive pathergy test.
- initial ED treatment is corticosteroids (oral or topical). Reserve colchicine and pentoxifylline for ulcerative maifestations.
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- causes gastric outlet obstruction and vomiting
- 1 in every 500 infants; with a 4:1 male-to-female ratio and a family history in another sibling
- symptoms begin 2-4 weeks after birth, with projectile NON-bilious vomiting
- firm, mobile, nontender, olive-shaped mass in right hypochondrium or epigastric area
- diagnosis confirmed with US or upper GI series
- treatment is a pyloromyotomy, but fluid and electrolyte replacement is vital in ED
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- ocurs with significant lateral traction during vaginal delivery of an infant
- results in damage to the upper part of the brachial plexus, especially the 5th and 6th cervical roots
- results in paralysis of hte shoulder and arm
- the affected arm is held in adduction and internal rotation
- most resolve spontaneoulsy, but some may require physical therapy after 2 weeks
- surgery is rarely required, and has poor results
- always palpate for ipsilateral clavicel fractures!
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- 0.3-1.5% of all pediatric DKA cases
- 21-24% mortality rate
- usually at 4-12 hours after therapy starts
- risk factors: <5years old, new onset diagnosis, increased BUN at presentation, severity of acidosis at presentation, bicarbonate use
- have low threshold to diagnose and treat: don't wait to treat for the CT!
- newborns have a thick right ventricle resulting in a mean QRS axis which points anteriorly and to the right demonstrating a right axis deviation (70-180degress) and large R waves in the precordium
- by 3 months of age, the QRS axis in the frontal plane shifts to the left with a mean of 65degress (0-125degress)
- by older childhood, the normal mean QRS axis is -30-100degress)
- thus, with age the R wave decreases in V1 and increases in V6
- take home: right-axis deviation is often a normal finding in children and young adults when you see left-axis deviation in children consider tricuspid atresia, atrioventricular septal defects, and LVH as the most associated conditions
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- occurs when the small opening in the abdominal muscles which allows passage of umbilical cord does not completley close after birth
- allowing intestinal loops to pass through the opening
- 10% of all children are affected
- more common in blacks, girls, and premature infants
- most resolve by age 1year, but consider outpatient referral if becoming larger or still present after 2-3 years of age
- emergent consultation if not reducible, but rarely as most are harmless
- radial head subluxation
- usually 1-3 years of age
- often after sudden longitudinal traction on extended arm with wrist in pronation
- tearing of annular ligament attachment to radial neck, with detatched portion trapped between subluxed raidal head and capitellum
- children refuse to use affected arm and hold in a flexed pronated position
- traditionally, reduce by supination of forearm with elbow in 90degrees of flexion
- newer reduction technique, hyperpronation with elbow flexion has better success rateand less pain
- second most common vasculitis of childhood
- leading cause of acquired heart disease in children
- usually in children <5years old
- year-round with clusters in spring and winter
- highest incidence in children of asian decent
- clinical diagnosis requires fever for at least 5 days and a minimum of 4 of the following:
- bilateral conjunctival injection without exudate
- rash (often macular, polymorphous with no vesicles, most prominent in perineum followed by desquamation
- changes in the skin of the lips and oral cavity (red pharynx, dry fissured lips, strawberry tongue)
- changes in the extremities (edema, redness of hands and feet followed by desquamation)
- cervical lymphadenopathy
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- seborrheic dermatitis is most common in infants within the first two months of birth
- appears as erythematous, greasy yellow scales most commonly on the scalp (cradle cap), and may also occur on the face
- most cases resolve spontaneously within weeks to months, but severe cases may be treated with 1% hydrocortisone cream, sahmpooing with selenium sulfide, and using an emollient to remove scales
- in extreme cases, consider hte possibility of Langerhans cell histicytosis, especially if atrophy, ulceration, or purpura are also present
- rarely occurs in children between 1 and 12 as they do not have active sebaceous glands, but will appear as dandruff in adolesecents
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- disorder in which the entire left side of the heart is underdeveloped
- the right side of the heart is dilated and hypertrophied, and supports both the systemic and pulmonary circulations via PDA
- accounts for nearly 1/4 of all cardiac deaths in the first year of life
- infants present within the first days or weeks of life acutely ill with signs of CHF
- PE often shows cyanosis and poor pulses but hyperdynamic cardiac impulses
- CXR shows cardiac enlargement and prominent pulmonary vasculature
- EKG shows RA and RV hypertrophy
- echo is diagnostic
- acute treatment is PGE1 to maintain the PDA.
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- syndrome of hematuria at the END of urination
- evidenced by spotting of blood in underwear
- occurs only in boys
- may last up to a year or longer
- symptoms are usually intermittent and recurrent
- physical examination is normal
- renal ultrasound usually helps rule out structural anomalies, but will usually be normal
- self-limited, with no specific therapy other than reassurance
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- occurs in 1/1000 live births, but found in 15% of neonatal autopsies
- usually weigh <2500 grams at birth with prematurity the most common risk factor
- present with bleeding from the nose and mouth with severe respiratory distress
- immediate treatment with tracheal suctioning, oxygen, and positive-pressure ventilation
- ventilation goal is to maintain a high, positive expiratory pressure of at least 6-10cm H20
- also check for and correct any underlying bleeding disorders
- extremely high mortality, but no long-term pulmonary deficits if the infant survives
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Necrotizing Enterocolitis
- NEC is an inflammatory lesion of bowel which can progress to intestinal gangrene, with perforation, and /or peritonitis
- characterized by abdominal distension, feeding difficulties, and GI bleeding
- mainly affects pre-term infants, and most commonly affects distal ileum and proximal colon
- usually presents during the first 2 weeks of life, but may occur up to 3 months of age in infants who who born weighing <1000grams
- classic finding on abdominal XR is pneumatosis intestinalis or air in the bowel wall (pathognomonic) and is present 50-75% of the time
- treat emergently with nasogastric decompression, IVF recussitation, NPO, and IV antibiotics
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Colic
- excessive, unexplained paroxysms of crying in an otherwise well-nourished normal infant
- lasts >3 hours/day, and occurs >3 days/week...ughh!
- usually occurs at the same time of the day or evening
- usually resistant to most attempts to quell it
- infant may have excess flatus and draw legs up during episodes (but don't change formulas)
- beings in first week of life and ends by 4 months of age
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- most common cause of low platelets in children
- immune-mediated destruction of circulating platelets
- acute ITP peak incidence between 2-5 years of age; chronic ITP peaks in adolescence
- recent history (1-6 weeks) of viral infection or immunization is common
- no hepatosplenomegaly
- low platelets with megathrombocytes on smear, with normal hemoglobin (which differentiates from TTP, HUS, and DIC)
- nearly 90% of children will have normal platelet counts in 6 months
- treatment reserved for platelet counts <20,000 or significant bleeding: IVIG (best response rate of 95%), corticosteroids (79% resposne rate), anti-rH (D) immunoglobulin (82% reesponse reate)
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- newborns have increased rates of bilirubin production due to RBC's with shorter life spans, and a decreased rate of bilirubin elimination due to decreased ability of the neonatal liver to conjugate bilirubin
- about 60% of newborns will become clinically jaundiced
- bilirubin levels peat at 4 days of life, and may not decline before day 7
- admission and treatment should be considered urgently when serum total bilirubin >25mg/dL, with exchange transfusion if it is >30mg/dL or the infant has signs of kernicterus
- there are nomograms which plot the bilirubin level according to the infant's age in hours to determine if an infant is at risk for being at toxic levels
- the most common pathologic etiologies are due to increased bilirubin production: blood-group incompatibilities, RBC-enzyme deficiency, and RBC structural defects
- when jaundice occurs between days 4-7, strongly consider sepsis, UTI, congenital infection (syphilis, CMV, etc)
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- autossomal dominant disorder most commonly in Scandinavian and British descent due to deficiency of HMB-synthetase
- most heterozygotes are asymptomatic unless some factor increases the production of pyrogens, usually medications
- common drugs include steroids, alcohol, low calorie diets, and drugs (barbituates, sulfonamide antibiiotics, grisefulvin, and synthetic estrogens (birth-control)
- attacks of abdominal pain lasting several hours is the most common symptom and may be secondary to ileus or distension, but tenderness on exam and fever are absent
- peripheral neuropathy and muscle weakness improves over days, but may take years to return to normal
- diagnose: gold standard test measures RBC HMB-synthetase, screening test of normal PBG (porphobilinogen) level in urine rules out the condition
- treatment: narcotics, IV glucose (300g/day), and IV heme (4g/day)
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- in the US, the right of an adolescent (<18yrs) to seek and receive treatment without parental consent varies from state to state.
- usually, the right to self-consent for treatment is specified through public health statutes when there is clinical suspicion of a STD
- many states allow minors to seek help for pregnancy, contraception, substance abuse, and mental health issues without parental consent
some absolutes or almost always cases include the following:
- emancipated minors: moved outside of the home and support themselves financially, married, in the military, or has a child
- emergencies: patient is unconscious or unable to give consent
- mature-minor: possess the ability to comprehend the risks and benefits of treatment/therapy
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- seizure disorder occuring in infants and children <1 year of age
- mostly occur between ages 4-8 months
- classic spasm is sudden, simultaneous flexion of the head and trunk with felxion and adduction of the extremities (salaam attack Blitz-krampf)
- occurs in clusters of diminishing severity
- initiated or aggrevated by transition from sleep to wakefulness or emotions
- EEG demonstrates hypsarrhythmia: high-voltage, irregular, slow waves occuring out of synch with multiple foci
- most resolve over time without therapy, but most children have some level of mental retardation or other seizure disorder
- also known as acute cerebellitis of childhood
- most commonly affects children 2-6 years old
- about 50% have a history of recent URI or viral GI illness
- abrupt onset of ataxia which may be mild to severe, and findings usually include hypotonia, tremor, horizontal nystagmus, and dysarthria
- child often is irritable with nausa/vomiting
- sensory exam and DTR's are normal
- CT and MRI are normal
- CSF usually demonstrates an increase in WBC, with a predemonance of lymphocytes
- 90% recover without any specific therapy in 6-8 weeks (steroids are not indicated).