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Pediatric Clerkship Notes

This document provides summaries of common pediatric conditions seen in a clerkship. It includes brief descriptions of cryptorchidism, absence seizures, breath holding spells, inattentive staring, sudden infant death syndrome, Legg-Calve-Perthes disease, transient synovitis, septic arthritis, hematogenous osteomyelitis, slipped capital femoral epiphysis, developmental dysplasia of the hip, Kawasaki disease, scarlet fever, staphylococcal scalded skin syndrome, hand foot mouth syndrome, adenovirus, osteogenesis imperfecta, Ewing's sarcoma, chronic osteomyelitis, Down's syndrome, serum sickness, acute rheumatic fever, metatarsus ad

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530 views4 pages

Pediatric Clerkship Notes

This document provides summaries of common pediatric conditions seen in a clerkship. It includes brief descriptions of cryptorchidism, absence seizures, breath holding spells, inattentive staring, sudden infant death syndrome, Legg-Calve-Perthes disease, transient synovitis, septic arthritis, hematogenous osteomyelitis, slipped capital femoral epiphysis, developmental dysplasia of the hip, Kawasaki disease, scarlet fever, staphylococcal scalded skin syndrome, hand foot mouth syndrome, adenovirus, osteogenesis imperfecta, Ewing's sarcoma, chronic osteomyelitis, Down's syndrome, serum sickness, acute rheumatic fever, metatarsus ad

Uploaded by

xx_caligurl_93xx
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Pediatric Clerkship Notes

Cryptorchidism:
- If they havent descended by 6 months, do surgery.
- Perform orchiopexy before age of 1 year
- Subfertility is a complication
- Associated with patent processus vaginalis (repair to avoid hernia)
Absence Seizure:
- <20 seconds generalized seizure (impaired consciousness); age 410 years
- Presence of eyelid fluttering (automatism), no post ictal state, no
loss of postural tone
- Mistaken for ADHD, childhood staring spells
- Provoked with hyperventilation 3 Hz spike wave pattern
Breath Holding Spells:
- 6 months 6 years w/ cyanosis or pallor following upsetting
event/minor injury
Inattentive staring:
- Variable length usually > 1 minute, during boring activities
Sudden Infant Death Syndrome:
- RF: 2nd hand smoking, prematurity, bed sharing, sibling with SIDS,
loose bedding
- Prevent: Firm surface, room sharing, pacifier use
- Sleep in supine position to avoid
- 1 month 1 year
Normal Vital Signs for Newborn:
Heart Rate
Blood Pressure
Respiratory Rate -

Legg-Calve-Perthes:
- Boys 4-10 years old (peak at 7)
- Insidious hip OR knee pain
- Predisposing factor = thrombophilia
- Antalgic gait (shorter time weight bearing on affected leg)
- Initial x-ray may be ve (commonly mistaken for transient synovitis);
can take months for changes on x-ray to appear.
- MRI will show early changes. Useful for early diagnosis.
- Persists longer than a month
- Tx: Splinting or surgery
Transient Synovitis:
- Typically follows viral infection

Pediatric Clerkship Notes


-

Resolves within 1-4 weeks

Septic Arthritis:
- Acute fever
- Warm, swelling, pain single joint
Hematogenous Osteomyelitis:
- Metaphysis of long bones
- ILL (fever, systemic symptoms)
Slipped capital femoral epiphysis:
- Limp, insidious HIP pain. (KNEE pain common presentation but this
is REFERRED pain, so always be suspicious if obese, even of not
presenting with hip pain)
- Obese kids (12 in girls, 13.5 boys)
- Tx: Surgically pin slipped epiphysis (lessens risk of avascular
necrosis)
Developmental dysplasia of hip:
- During infancy
- Untreated limp when toddler walks
- Progresses to painful degenerative joint disease over time
- Hx of chronic limping
Kawasaki:
- Fever >5 days
- 4/5 (Nonexudative conjunctivitis, extremity changes (desquamation
of hands and feet), cervical lymphadenopathy (usually unilateral,
not always seen), oral mucosal changes (fissured lips, strawberry
tongue), polymorphous rash)
- Children <5 years.
- Do ECG at time of diagnosis & 6-8 weeks later
- Tx: IV Ig & aspirin (start within 10 days)
- Risk of thrombosis & coronary artery aneurysm
Scarlet Fever:
- Fever, strawberry tongue, rash, lymphadenopathy (all similar to KD)
- OCULAR SYMPTOMS NOT SEEN
- sandpaper rash sparing palms & soles
- Exudative pharyngitis can be there
Staphylococcal scalded skin syndrome:
- Fever, irritability, rash
- NEWBORNS susceptible
- Diffuse erythema begins around mouth rapidly spreads through
body
- +ve Nikolskys sign (1-2 days later blisters in flexural areas)
- Bactermia can be complication

Pediatric Clerkship Notes


Hand
-

Foot Mouth Syndrome:


Coxsackie virus
Fever, oral vesicles on buccal mucosa & tongue
Small lesions on pams & soles
Self limited (resolves in 2-3 days) w/o complications

Adenovirus:
- Fever, conjunctivitis
- Pharyngitis
- No extremity changes
- Keratitis and vision loss are potential complications
Osteogenesis Imperfecta:
- Autosomal dominant
- Normal intelligence
Ewings Sarcoma:
- White male (1st or 2nd decade)
- Pain & swelling for weeks months
- Leukocytosis, warmth of local area, anemia, increased ESR (can be
confused with osteomyelitis, use x ray to tell apart)
- onion skinning periosteal reaction
- moth eaten appearance + extension into soft tissue
- Tx: Surgery, radiation, chemotherapy (multi drug)
Chronic Osteomyelitis:
- Central lytic bone lesion w/ surrounding sclerosis (Brodies abscess)
Downs Syndrome:
- Atlantoaxial instability: due to excessive laxity in POSTERIOR
transverse ligament (UMN damage presentation). Diagnosis by
xray in flexion, extension and neutral position. Tx: surgical fusion of
C1 to C2.
- Normally hypotonic
- Hypothyroidism (can present with delayed reflexes)
- Higher risk of Alzheimer (40-50 yrs)
Serum Sickness:
- Fever, urticarial, polyarthralgia, lymphadenopathy (1-2 weeks post
TMP SMx or penicillin exposure)
- Remove offending agent. Severe case = Glucocorticosteroid
Acute Rheumatic Fever:
- RARE after antibiotic therapy has started, usually follows untreated
strep
Metatarsus Adductus:
- Forefoot turned inward, hindfoot normal. Flexible foot (resolves
spontaneously).

Pediatric Clerkship Notes


-

Usually bilateral, first born.


Tx: Reassurance

Congenital Clubfoot (Talipes Equinovarus):


- Rigid position. Both hindfoot and forefoot medially deviated.
- Tx: Serial manipulation & casting, surgery of refractory case
- Consider karotyping

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