Studydroid is shutting down on January 1st, 2019

by mtoom


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What is Wilms Tumor & what age is diagnosed at?
Age 2-5
  • Most common primary renal neoplasm of childhood 
What is the most common presentation of a Wilms tumor?
80% present with:
  • Asymptomatic unilateral abdominal mass 

May also present with 
What is a significant concern with Wilms tumors?
Congenital syndromes
  • Mental retardation
  • Genital anomalies
  • Eye problems
  • Enlarged organs (eg. tongue) 
What is the management for Wilms tumors?
1. Staging (+/- nephrectomy)
2. Chemotherapy/radiation

Prognosis is 90% long-term survival
Most common ages for meningitis?
6-12 mo.
  • 90% of cases in kids less than 5 years old
Etiology of meningitis by age?
0-28 days: GBS, E coli, Listeria
  • Ampicillin, cefotaxime 
More than 90 days: S. pneumo, N. meningitidis
  • Ceftriaxone, vancomycin
Risk factors for meningitis in kids
  • not vaccinated
  • immunocompromised (asplenia, HIV, etc.)
  • recent or current infxn
  • neuroanatomy abnormal
clinical presentation and exam of meningitis in infants
symptoms
  • fever
  • lethargy
  • irritability
  • poor feeding
  • vomit, diarrhea
  • seizures
physical exam
  • toxic
  • hypothermia
  • bulging fontanelle
  • resp distress
  • apnea
  • petehcial or purpura rash
  • jaundice
clinical presentation and exam of meningitis in children
symptoms
  • fever, headache, photophobia, nausea, vomit, confusion, back/neck stiffness, lethargy, irritability 
physical
  • toxin, decrease LOC, nuchal rigid, Kernig and Bruzinski, focal neuro, petechial or purpura rash
Kernig
Bruzinski
  • Kernig: Pt cannot fully extend knee joint when hip is flexed 90 degrees
  • Bruzinski: When flexing Pt neck they flex knees and hips in response 
Investigations for meningitis
  • CBC
  • electrolytes
  • Cr
  • BUN
  • glucose
  • LP
  • gram stain & culture of petechial lesions
  • Urinalysis & culture in infants

On the LP:
  • gram stain
  • bacterial C&S
  • acid-fast if TB suspected
  • WBC/RBC
  • CSF cloudy? 
CSF fluid analysis
  • bacterial 
  • viral
  • Bacterial
    -cloudy
    -elevated WBC
    -elevated protein
    -elevated opening pressure
    -low glucose
  •  Viral
    -clear
    -normal opening pressure
    -elevated glucose (60% or more of serum)
    -elevated protein 
Treatment of meningitis
  • Supportive Tx: fluids, manage elevated ICP, BP management
  • Empiric ABx while awaiting cultures
  • Isolated
  • Hearing test
  • Acyclovir for HSV menginitis
  • Adjuvant dexamethasone before ABx if HiB meningitis
What is a SCFE?
  • What is the injury, and where is it?
  • What is the population? 
  • What age?
Slipped Capital Femoral Epiphesis (the answer is in the name)
  • Salter-Harris Type 1 - Epiphyseal injury at proximal hip
  • Obese adolescent boys
  • SCFE age: 10-18 years
What are symptoms of SCFE?
  • Acute: Sudden, severe pain with limp
  • Chronic: Limp (with pain in medial knee or anterior thigh) 
What are other physical exam findings of SCFE?
  • Positive Trendelenburg sign on affected side
  • Tender over join capsule
  • Pain at extremes of ROM
  • Leg externally rotates when laying on bed
How do you investigate SCFE?
X-Rays: AP, frog-leg, lateral
  • Klein line
How do you treat SCFE?
  • If mild, surgery to pin it
  • If severe, ORIF surgery
Most common complication of SCFE?
Avascular necrosis
What is developmental dysplasia of the hip?
Spectrum of conditions leading to hip subluxation and dislocation; painless
  • femoral head is dislocated
  • femoral head may dislocate easily 
What is Barlow test?
  • Hips and Knees at 90 degrees
  • One at a time, move leg into full adduction
  • Pushing posteriorly
Palpable subluxation is a positive test

Barlow = Going out (to the bar)
What is Ortolani test?
  • Abduct leg while applying anterior force with finger tips
  • See if the leg pops back inwards
Used to confirm subluxation

Ortolani = H(o)me, put the femoral head back home into acetabulum
Which hip is more likely to be dislocated?
Left
Name 4 risk factors for hip dislocation
  • Family history
  • Female
  • Breech
  • First born
Investigations for hip dislocation?
  • Newborn: US (first 3 months) to view cartilage
  • X-ray (after 3 months)

Reasonable to order US if any risk factors
What is treatment of hip dislocation?
  • Pavlik harness
  • Reduction under GA with spica cast
  • Open reduction 
What is Legg Calve Perthes (LCP)?
  • What age group? 
Self-limited avascular necrosis of the femoral head
  • Etiology is unknown, the plate growth seems to outstrip the blood supply
  • Age: 4-10 year olds (compare with SCFE in 10-18 year olds) 
What are clinical features of LCP?
  • Child with hip pain & limp
  • Tender over anterior thigh
What investigations for Legg Calves Perthes (LCP)?
  • x-rays: negative early on
    --AP
    --frog leg lateral 
  • bone density scan or MRI are more diagnostic
What is treatment for LCP?
  • Conservative (good in 50%)
    --physiotherapy
    --brace in flexion/abduction
  •  Surgical
    --femoral or pelvic osteotomy
What is common complication of LCP?
Osteoarthritis (OA)
What are features of febrile seizures?
  • Child age less than 6
  • Febrile
  • Short = 1 min (always less than 5 mins)
  • Generalized tonic-clonic seizure
  • Short post-ictal state
  • No acute systemic metabolic abnormal
  • Often no associated illness, fever or family hx
  • No evidence of CNS inflammation or infection
  • No history of non-febrile seizures
What is the history for febrile seizures?
  • Focus of fever
  • Description of seizure
  • Medications
  • Trauma history
  • Development
  • Family history
What is the exam for febrile seizures?
  • LOC
  • Signs of meningitis
  • Neurological exam
  • Head circumference
  • Focus of infection
What investigations in febrile seizure?
If simple febrile, only investigate to determine source of fever
  • Septic work-up with LP (if child less than 18 mo, or if meningeal signs)
  • EEG if complex febrile
What do you counsel on febrile seizures?
  • Risk of epilepsy? 
  • They do not cause brain damage
  • Small risk of developing epilepsy 2% as compared to 1% of general population
  • No prophylaxis recommended
  • If high risk for recurrect, have lorazepam at home
How do you treat febrile seizures?
  • Tylenol, fluids (neither prevent seizures)
  • Treat underlying cause of fever
What are features of complex febrile seizures?
  • 15 mins or more
  • Focal features/onset
  • Recurrent (more than 1 in 24 hr)
  • Previous neuro impairment or new deficit after seizure
What is hypotonia?
Decreased resistance to passive movements: a "floppy baby"
What is the DDx for hypotonia?

Central
  • Chromosomal (Down, Prader-Willie, Fragile X)
  • Metabolic (hypoglycemia, kernicterus)
  • Perinatal (asphyxia, ICH)
  • Endocrine (hypothryoid, hypopituitary)
  • Infections (TORCH)
  • CNS malformations
  • Dysmorphia

Peripheral
  • Motor neuron (Spinal muscular atrophy, Polio)
  • Peripheral nerve (Charcot Marie Tooth)
  • NMJ (Myasthenia gravis)
  • Muscle fibers
What is the physical exam for hypotonia?
  • Postural maneuvers
  • Neuro exam (UMN vs LMN)
  • Muscle weakness
    Joint mobility
  • Muscle bulk
  • Fasciculations
  • Spontaneous posture
  • Dysmorphic features
  • Cognitive ability
  • Reflexes
What investigations for hypotonia?
  • Rule out systemic disorders (blood glucose, CK, serum/urine tests)
  • Neuroimaging: MRI
  • EMG, muscle biopsy
  • Chromosome, genetic, metabolic, neuromuscular testing

Treatment depends on condition
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