[Music] okay so today we're gonna cover pediatrics so neonate who is between 0 to 3 months old and they have signs of infection what are the most common bugs they are Group B Strep ecoli and Listeria and that spells out Bell and most of the time in a fever or an infection of someone less than three months old you should suspect either pneumonia or meningitis and so you will treat with ampicillin or gentamicin to cover Group B Strep ecoli and Listeria once they're older than three months then you will switch to the most common causes of bacterial meningitis and pneumonia which are strap pneumo H flu and Moraxella and then with those ones you want to give the empiric antibiotics of vancomycin and ceftriaxone again any neonate who's less than 28 days old with the fever must be hospitalized for safety and for a workup in terms of CSF findings remember that you should know the difference between bacterial viral and fungal CSF findings so bacterial CSF will have elevated protein and then decreased glucose because the bacteria will consume the glucose and then elevated white blood cells but neutrophil predominant whereas viral will be normal glucose levels elevated protein but elevated white blood cells but lymphocyte predominate and then the last is fungal and fungal infections are what I think of like in between they're kind of like a mix of bacterial and viral so then what will happen is that there will be low glucose but it will be lymphocyte predominant and remember that TB is one of those strange bacteria that kinda has fungal type of labs so it'll also have lymphocyte predominant on CSF with low glucose and TV is kind of the exception and then remember fungal meningitis is more common in immunocompromised patients and the classic is the AIDS patient who has Cryptococcus neoformans which will have positive India ink sting and then you want to treat that with amphotericin some key associations that TB meningitis will have basilar enhancement on brain imaging whereas HSV meningitis has involvement of the temporal lobe as well as seizures in terms of sinusitis the majority of sinusitis is actually viral and with viral sinusitis you want to treat it with supportive care but in terms of bacterial sinusitis signs of bacterial sinusitis or if it's been over a week and it's worsening and not improving and on top of that the nasal discharge will be purely so if it's purulent and it's been over a week and it's not improving that's more bacterial sinusitis so you want to treat that with antibiotics mainly amoxicillin and you want to cover the most common bugs which are strap pneumo h flu and Moraxella remember strep pneumo H flu Moraxella are the most common for sinusitis for pneumonia and for acute otitis media it's also very common for meningitis but instead of for meningitis the third most common instead of mark cell is actually Neisseria meningitidis yeah and then sometimes bacterial sinusitis can progress to something more dangerous where it can start invading your venous sinuses it can irritate the nerves like your cranial nerves 3 4 D 1 v 2 and 6 and so you'll have like blurry vision or double vision at that point if it's in V it seems like to be progressing beyond just the sinuses and it seems to be getting worse and that's when you want to to a CT sinus remember that our upper respiratory tract infection most of them are also viral too the diagnosis is mostly a diagnosis of exclusion it'll present with cough runny nose sore throat but not necessarily a fever and then for those it's supportive care and the most important thing in kids is just adequate hydration diphtheria is seen with the pharyngitis with the gray leather plaque in the pharynx it's seen in vain' yes where the kid has no history of DTaP vaccine and then you want to treat that with diphtheria antitoxin Accu otitis media is also a very common pediatric infection and this will be seen with Otis Coupee you'll see all Jing erythema death and panic membrane and on pneumatic insulation which means when you blow air against the eardrum it'll be very stiff this will have fever and ear pain the main way to diagnose is just by the otoscopy findings you want to treat that as well with amoxicillin you have to be able to distinguish this from otitis externa the key here is otitis externa that your drum will be fine it's the ear canal which is inflamed and infected and the key thing here is with otitis externa it hurts with more with your polling whereas in acute otitis media your polling actually improves the pain a kid with otitis externa when they pull their ear it hurts a lot so they won't even let you do that and the number one bug for that is Pseudomonas and you treat that with antibiotic eardrops and then the third type of ear infection is otitis media with effusion which is where you kind of see like a serious drainage in the middle ear but they made all ear itself isn't infected there's just fluid in the middle here which isn't training and on otoscope you'll see little fluid bubbles behind the tympanic membrane and you don't treat that you just let it pass and then there's cervical lymphadenitis which is a lymph node that is erythema painful and swollen and if you see a lymph node that is infected it's most likely staph aureus and you want to treat that with either a first-gen cephalosporin or penicillin it's important to know the difference between parotitis that's unilateral versus bilateral if it's bilateral it's most likely mumps mumps is a viral infection that is can be protected with mmm RV vaccine so kids who don't have the MMR or MMR vaccine will have mumps and that causes bilateral parotitis it causes meningitis it can also cause pancreatitis and it can also cause or tightness which is inflammation of the testicles if its unilateral parotitis then the most common answer would be staph aureus impetigo is where you'll have a vignette with the kid who has like a honey crusted lesion around his mouth or it can be anywhere on the skin a lot of times it is on around the mouth though and then this is extremely contagious and first-line treatment for impetigo is mute burros you should also know the difference between IRISA palace and cellulitis so IRISA palace and cellulitis are both common most commonly caused by strep pyogenes but they like to test you and to see if you know the difference and the two main differences are that is IRISA palace as has a very rapid onset so it'll happen over the course of a day and it's orders are well demarcated it has sharp lines where it goes from red to a normal skin it'll be very sharp borders this is a dermal lymphatic infection whereas cellulitis is an infection within the dermis and this has more indolent increase it gets more and more red over a couple days and the borders are kind of indistinct so basically from red to normal skin it's more of like a soft gradient yeah and then you also treat those with either a cephalosporin or a penicillin and then necrotizing fasciitis the two most common culprits or strep pyogenes and Clostridium perfringens and then this is the one where it's severe pain out of proportion you'll have some sort of skin wound and it looks kind of red but as soon as you touch it they're like screaming and pain so it's severe pain out of proportion from what you would expect you might even see how magic lay and if there is crepitus which means like there's gas bubbles then goeth C perfringens because C perfringens creates gas bubbles if no crepiness I'm going strep pyogenes so next is scarlet fever scarlet fever just think of the combination of strep throat plus a sandpaper rash that's all you need to know and then the rash usually starts on the trunk and spreads to the limbs post repla merula nephritis PS GN you need to know the difference between this and IJ nephropathy so post trap plumeria low nephritis starts off with strep throat and then two weeks later the kid will complain of cola colored urine which is due to hematuria and uh this is actually glomerular bleeding so they'll you'll see red blood cell casts and just more fake red blood cells and the key thing here between this and I GA nephropathy is the timing so PS GM will happen around two weeks later after the throat infection whereas I J and a frothy happens within like three to five days definitely under a week so timing is key and IgA nephropathy actually follows an upper respiratory tract infection not necessarily strep throat it can be confusing because they both involve upper infections and they both have hematuria but the timing is key you should know about toxic shock syndrome cause most likely by staph aureus and in the history there will be either a kid who had a nosebleed who was packing it with paper tissue papers for too long or a female who has had a tampon in for too long and this leads to septic shock because the staph aureus exotoxin actually stimulates the T cells to release a lot of cytokines so you'll have shock with a desquamation of the skin so you want to treat that by giving fluids antibiotics and then removing the tampon or the tissue the two most common causes of gastroenteritis are rotavirus and Norwalk virus so rotavirus is more in the winter months and it has vomiting and diarrhea but this is kind of self-limited so you want to treat it supportively remember that this type of diarrhea is not inflammatory diarrhoea so there's no bloody stools and there's no white blood cells in the stool and then Norwalk virus is also a non bloody diarrhea and it also has vomiting and diarrhea but the key here is that it occurs a lot in daycares in schools and cruise ships both rota and Norwalk virus are associated with these locations which should be hints for you so then there's the inflammatory diarrhea's which are Campylobacter and taro hemorrhagic ecoli ahac Salmonella Shigella and Yersinia all of these are inflammatory diarrhea's which means that they have bloody diarrhea the stool analysis which is the first thing you want to do will show white blood cells in them which indicates inflammatory diarrhoea and they might also have fevers as well so some key associations is that Shigella can cause seizures Yersinia can mimic right lower quadrant pain which can mimic appendicitis Campylobacter is associated with eating raw chicken and then salmonella is associated with being around reptilian animals or like eggshells or like being at the zoo yak is associated with eating uncooked hamburgers patties and then these all cause inflammatory diarrhea's and then the last diarrhea I want you to know about is CF Clostridium difficile which is associated with taking broad-spectrum antibiotics and then this leads to opportunistic infection of CDF which colonizes your intestine and colon and it can cause something on colonoscopy which can reveal pseudomembranous colitis which can cause raised lesions in the colon and then they can mimic ulcers and then you want to treat this which was updated recently depending on your test form it's classically metronidazole and vancomycin but per the new Q Bank answers nowadays it's just straight vancomycin so use this to your own discretion and remember it's oral not IV or intramuscular it's oral because you want the antibiotics to hit the colon so next is Pneumocystis Euro veggie which is an opportunistic infection from people who are immunocompromised so kids who have AIDS or who are on immunosuppressive that they will usually have a dry cough with fever with diffuse interstitial pulmonary infiltrates and you want to treat this with TMP SMX and then there's infectious mono which is caused by epstein-barr virus it's you know the kissing disease so it's transmitted by saliva this can present very similarly to strep throat where they'll have the pharyngitis with the exudates and they'll also have cervical lymph adenopathy but usually it's posterior cervical lymph adenopathy and they might have splenomegaly as well but the key thing here is the difference between strep throat and mono is that mono has severe malaise so these kids will be very exhausted and tired and then you want to treat this supportively because it's a virus sometimes people get confused they may give these kids or teenagers amoxicillin and this can cause a rash so if someone had symptoms of pharyngitis and then they were given amoxicillin and then they develop a rash that means it was diagnosis and it was most likely that they had mono and so remember on peripheral blood smear with mono you will see atypical lymphocytes so these lymphocytes will have but abnormally kind of melted look to them next is measles measles is caused by paramyxovirus it's also vaccine preventable but it presents with the four C's cough coryza cop lick spots and conjunctivitis these are the four C's coryza just means runny nose cop lick spots are just these kind of ulcers that are grey blue on the buccal mucosa and it causes a rash a papular macular rash that starts at the head and descends this is something that can be compared and contrasted with rubella rubella also starts with the rash that starts at the top and goes down but it does not have the four C's and it has more joint pain instead so those are the differences measles you treat it with vitamin A we fear it's complications the two main ones with which is pneumonia and the second one is sspe which is subacute sclerosing pan encephalitis and this is a severe brain infection that can happen 10 years later on that will be fatal and then rubella you want to treat that supportively and the dangerous thing about rubella is that if a mom gets rubella then her kid the fetus is at danger for being born with some congenital defects mainly cardiac defects cataracts and deafness the cardiac defects will be patent ductus arteriosus and pulmonary stenosis then there's Aspergillus Aspergillus is it's a key lung infection these questions are often hard to get on question banks because a lot of times they can overlap with a lot of other things but the main thing here is yoson ophelia so Aspergillus will always have use in Ophelia and there's three subtypes there's allergic bronchopulmonary aspergillosis and there is systemic Aspergillus and then there is a sperg loma which is a fungus ball so allergic bronchopulmonary aspergillosis is something that presents like asthma so they'll have wheezing they might have hemoptysis and fever but the key thing is yoson ophelia and you treat that with steroids systemic Aspergillus will be hemoptysis fever night sweats weight loss almost kind of like a TV picture with the hemoptysis but like i said it'll have a asana folia and then the last one is aspergillum oma which is a fungus ball that you'll see on chest x-ray it usually is in the upper lobes Aspergillus likes the upper lobes of the lung the ones that like the upper lobes of the lung or TB silicosis and Aspergillus and then with the fungus ball this usually likes to grow in pre-existing TB cavitation and to me ba histolytica which is just remember right upper quadrant pain with diarrhea and then this will be treated with metronidazole and entamoeba histolytica usually the vignette will have someone who is travelling in like South America somewhere Giardia remember it's associated with people who go hiking and then they drink contaminated water and then later on they get these greasy fat fatty bulky stools so that's kind of a vignette you're looking for and you also treat that with metronidazole then there's malaria malaria look for recent travel to Africa with recurrent fevers and member malaria is goes after red blood cells so they'll have markers of hemolysis right anemia elevated reticulocyte count and decrease haptoglobin and then this is transmitted by the Anopheles mosquito usually it's like recurring fevers because certain types of malaria like vivax ovalle falciparum and malaria they have different timings where this fevers recycled because that's when the malaria starts to burst out of the red blood cells there's Toxoplasma and this is associated with cat feces and eating undercooked meat the mom can have a mano like illness but we care because it's one of the congenital torch infections and the baby will present with Koryo retinitis hydrocephalus and intracranial calcifications then there's inter obvious vermiculite which is diagnosed by the scotch tape test on the AMS and you treat this with albendazole Strongyloides ancylostoma and Makeda are all hookworms you step on them usually through sand contact on bare feet penetrates goes into the lungs and then you cough it up and then swallow it into GI system and it invades your GI lumen and this will cause iron deficiency and you muster slow chronic bleeding but the key here is yoson Ophelia as well and you treat with then dissolves then the last parasite is neuro sister kosis which is infestation of T solium eggs and it can cause calcifications in the brain and it can cause seizures the next ones we're gonna cover or tick bite can transmit five different bacteria and cause five different diseases one is Rocky Mountain spotted fever the second is ehrlichia the third is Anna plasma the fourth is Lyme disease and the fifth is Babesia so Rocky Mountain spotted fever is caused by Rickettsia Roquette CI and that goes after the vascular endothelium and then this can cause a rash that starts from the extremities and moves towards the center that's the key caused by a tick bite and it can cause hemorrhaging because the endothelium will get inflamed and dilate and this can cause anemia thrombocytopenia and symptoms of septic shock ehrlichia goes after a granulocytes so those are like the white blood cells so you'll have decreased white blood cells and a plasma also goes for instead of a granule Thiet sites goes after granulocytes those are basal fills us in AFER's and neutrophils and this will cause so look for decreased white blood cells after tick bite and then look at the differential where they show neutrophils the to monocytes Osuna Phil's basophils whatever is kind of low with respect to the reference then those are the bacteria you're looking for but those ones aren't as common Lyme disease you definitely need to know about which causes the target rash known as erythema migrans and then later on it can cause Bell's palsy or meningitis or it can cause arthralgias and then the last one is Babesia Babesia also goes after red blood cells like malaria so you'll see evidence of hemolysis so those are the tick bites cat scratch disease which is a cat scratch can transmit bartonella henselae which is a bacteria and then this can cause inflammation of a lymph node proximal to that along the drainage line so you'll see like a lymphadenitis proximal to a cat scratch and you want to treat that with macrolides or doxycycline TB remember that you have two types of TB like a latent TB and active T V so active TV presents with night sweats fevers weight loss with hemoptysis that will show signs of infection on chest x-ray and you treat that with the right regiment rifampin isoniazid Arizona might and isombu tall whereas latent TB is where when you do a PPD test and there's positive swelling then you do the chest right after if the chest x-ray is normal then you want to treat that with ice and ice it for nine months all right next is cardiology so in cardiology remember if I say fixed split s2 you should think about atrial septal defect coarctation of the aorta you treat it with prostaglandin Yi because distal to the core act a ssin there's not enough blood flow so you want to keep that patent ductus arteriosus up in to improve blood flow to the lower limbs even though that blood flow is hypoxemic it's better than having not enough blood reach there so you rather just keep the PDA open and then you treat that with exit the core our tation via surgery or a balloon angioplasty and it has an excellent prognosis remember this is key to an event yet if the kid was given a hundred percent oxygen test and the PA owes who doesn't rise then that means it's a congenital heart defect whereas if the oxygen does rise up then that's a lung problem so if it doesn't correct that's a heart problem if it does correct it's a lung problem and that helps you narrow your differentials then you have transposition of the great vessels this is when your aorta and pulmonary artery are switched so out of the right ventricle comes the aorta and out of the left ventricle comes the pulmonary artery the only way to fix this is to do an arterial switch operation and you also want to keep the PDA open for this one as well the key thing here is it's associated with pre gestational diabetes that's a very high yield association tricuspid atresia means that the tricuspid valve doesn't open and doesn't work so to survive the baby relies on atrial septal defect to go from right to left and then when it goes down to the left ventricle one variant there's a VSD in the other variant there's no VSD and then this is unique because it's the only cyanotic heart condition that has left ventricular hypertrophy so if you see a cyanotic congenital heart disease with left ventricular hypertrophy then this is tricuspid atresia remember transposition of the great vessels tricuspid atresia and truncus arteriosus as well as tetralogy of fellow have a single s2 because transposition of the great vessels thus single s2 comes because the aorta is anterior and it drowns out the pulmonic valve so you hear the aorta more it's very loud and then in tricuspid atresia there's only a single s2 because usually the pulmonic valve is at radicand too weak and making anyways truncus arteriosus has a single s2 because as you know for this one there is no separation between the aorta and pulmonary artery it's just one giant pipe so you have a single s2 there isn't too distinct valves it's usually truncus arteriosus since there's excess flow to the pulmonary branches the pulmonary artery and all of its branches this patient it's a velop s-- alma nary hypertension very easily and right in terms of kids who need prophylactic antibiotics for dental surgery remember you only give prophylactic antibiotics if they've had some sort of congenital heart disease if they've have prosthetic heart valves or if they've had previous infective endocarditis this is a high-yield Association as well which is fetus who has a complete heart block what is most likely wrong with the mother the mother most likely has lupus and then the last one is tetralogy of fellow tetralogy of fellows is characterized by a VSD pulmonic stenosis overriding aorta and right ventricular hypertrophy and then remember here the main murmur is actually the pulmonic stenosis murmur and not the VSD kids with tetralogy of fellow can have tat spells which means when they are crying or exercising they have decreased systemic vascular resistance and because there's such low pressure in the aorta this can favor flow instead of going towards the pulmonary artery it'll go through the path of least resistance and go across to the VSD and then up through the aorta so this causes right to left shunting and then will turn blue when they cry or exercise so to counteract this they do squatting and what squatting does is it increases total peripheral resistance so it increases the pressure over the aorta and then this favors right-sided blood from the right ventricle will go up to the pulmonary artery instead so that's kind of the you want to know about two challege you follow and then you want to correct that surgically remember too that any holosystolic murmur or any diastolic murmur is considered pathological so if you hear a diastolic murmur or any holosystolic murmur you need to do an echo next remember that there's only three types of holosystolic murmur z' one is mitral regurg the second has tricuspid regurgitation and the third is ventricular septal defect the most common defect congenitally is a ventricular septal defect next is pulmonology so you need to know the difference between laryngomalacia versus a vascular ring so Loraine go Malaysia is caused by collapsed larynx cartilage and then remember that if you have upper airway obstruction that causes Strider whereas a lower airway obstruction causes wheezing so you need to know what those words mean because that helps you know whether it's upper or lower so in Lorain go Malaysia that collapsed larynx cartilage is higher up so this causes Strider but Lorraine go Malaysia is worsened when supine when they're laying down on their back because the collapsed cartilage collapses even more whereas a vascular ring this is caused by an anomaly of the aortic arch where it basically chokes off the trachea and makes a ring around it and this kid has inspiratory and expiratory Strider and then this improves with extension of the neck and you need to know about croup so croup is mostly viral and it's caused by para influenza they'd like to ask you what kind of virus is causing it it can create the Stifel sign but the main thing is clinically they have the working cough with Strider and there's three tiers of treatment one is cool mist the second is steroids and the third is racemic epinephrine if there's not many symptoms and there's no Strider at rest and they're not in respiratory distress then you go with cool mist if they have Strider at rest but they are in no respiratory distress then you want to pick systemic steroids if they have Strider at rest and respiratory distress then you pick racemic epinephrine racemic epinephrine is the high yields answer here that you want to look out for and then sometimes viral croup can progress to a bacterial tracheitis and then the main bug here is staph aureus and this is when croup advances so much that they get a fever and they have a lot of mucus and pus in the trachea but the main thing for that I want you to remember is if it becomes bacterial at staph aureus know why atelectasis means which is collapse of the lung which can show up like opacities on chest x-ray which can look like pneumonia but it's not you need to know about bronchiolitis which is mostly caused by RSV respiratory syncytial virus and it's the key here is the history so usually the kid starts up with a upper respiratory tract infection nonspecific so they'll most likely have like a runny nose a little bit of a cough and this kid is usually pretty young like less than two years old and then this progresses to asthma like an asthma like kind of presentation with wheezing and tachypnea and sometimes a little bit of crackles so it can kind of be like a hybrid of like pneumonia and asthma and the diagnosis is difficult on chest x-ray you'll see hyperinflation with Adil activist and bronchiolitis is treated supportive versus pneumonia remember pneumonia the number one cause is viral and this presents with interstitial infiltrates with lymphocytes because remember lymphocytes they're usually the ones that fight viruses whereas neutrophils fight bacteria but if it is bacterial then you'll see fever with leukocytosis mostly a neutrophil dominant and then the classic is louver consolidation so you'll see a white patch over a certain bow and this is more like a more severe symptoms and you want to treat for which three bugs again strep pneumo H flu or Moraxella sometimes bacteria can also be interstitial which is on x-ray you'll see interstitial infiltrates bilaterally and then these ones are mostly caused by mycoplasma chlamydia or Legionella chlamydia pneumonia is like a random zebra pneumonia that you might get a question on and the key here is just to remember that the buzzword is staccato cough and there will also be EOS in Ophelia and you treat that with a macrolide and then mycoplasma is also treated with a macrolide pertussis is also known as the whooping cough it's the hundred-day cough and the kid will have so much coughing consecutively that they might even vomit after they cloth and they will have being coughing so much that they're basically holding their breath and then don't have a whoop afterwards which is the inspiratory gasp for air because after coughing a hundred times they're out of breath and they you took they're hungry for air and then this usually has a prodrome for like two weeks where they have kind of like nonspecific symptoms of like a runny nose on a cloth followed by the whooping stage and this lasts four months and then you want to treat this with macrolides asthma is most common pediatric disease and this is where a kid whenever they exercise or randomly throughout the day they'll have episodes of coughing and wheezing and difficulty breathing but no signs of infection and on Chester II it'll show a hyperinflation because this is an obstructive disease which causes bronchus constriction of the smooth muscles of the bronchioles and you want to treat this depending on certain stages the first-line treatment is a beta-2 agonist like albuterol and as you progress you want to add a low dose steroid a medium dose steroid or a high dose there and it depends on how many days of the week they're coughing so if they just caught intermittently and it's not out very often then you just give a beta agonist but if it's like two to seven times a week then you add a low dose turns if it's every day then you add a medium dose stir it if it's multiple times a day then you will add a hydro steroid lastest cystic fibrosis cystic fibrosis is you want to know what are the main culprits in kids under than 20 years it's deaf or yes but in kids greater than 20 years its Pseudomonas and usually um in cystic fibrosis this is due to the CF mutation which can cause problems with chloride transport so the chloride transporter helps add like more liquid to whatever gland that's excreting so what if that sweat glands then someone with CF will have really salty sweat because there's not enough water coming out and this can also affect the lungs the lungs need to stay lubricated if there's not enough chloride transport which water follows then their lungs will be really sticky and dry and mucousy and then they're predisposed to lung infections like pneumonia and they can get repeated bouts of pneumonia which then leads to brought the actus s which is where you have the permanently destroyed blown up bronchi and there are no cilia anymore so they can get repeated infections and then this can also affect the pancreas since the pancreas has to release enzymes which need to flow out very smoothly like a juice into the intestine if the pancreas juices are really sticky and dry and the kids be able to secrete pancreatic lipase ha's and because of this lipase breaks down fat soluble vitamins like vitamin D EA and k and they won't be able to absorb vitamin D EA and K because lipase isn't making its way out to break these down so they can get the a K deficiency this is a restrictive lung disease and then you want to just supplement with like an creati enzymes and good hygiene next is GI make sure you know that sometimes kids can present with symptoms of asthma but in reality it could be GERD so Gerda's gastric esophageal reflux disease where they acid when it reflux is up to the lower esophageal sphincter this can trigger the vagus nerve to have caused reflux bronchoconstriction which causes wheezing Ladd's bands are little peritoneal adhesion bands that can squeeze off the dude you know I mean this is seen in a mid gut volvulus which can cause acute small bowel obstruction it got volvulus is when remember during embryology when the small intestine doesn't twist 270 degrees counterclockwise and it doesn't come back into the abdomen properly you have mal positioned intestines where basically your cecum is in the right upper quadrant instead and then this can predispose to a volvulus which basically means like twisting of the intestine think of making like balloon animals that's basically like oh volvulus and then the kid will present with abdominal pain nausea bilious vomiting because the obstruction is usually distal to the sphincter of Oddi which secretes bile acids and then they will have been not passing any gas not having any bowel movements and then the first thing you want to do with this is upper GI series which basically means you get them to swallow contrast fluids and then take an x-ray and then the x-ray will show that there's a blockage and then if there is a mid got volvulus this is an emergency you want to first treat them supportively with the NG tube to help relieve their vomiting so they don't ask free and then you want to get them to the or immediately to fix the volvulus and there's the general atresia look for the triple bubble sign this is usually caused to vascular accidents in utero it's mostly associated with maternal cocaine use and then this should be contrasted with duodenal atresia which is associated with an syndrome which has the double bubble signer intussusception intussusception is when you get telescoping of the ilium into the cecum and this can cause inflammation and ischemia of the part that has telescoped so this kid will have colicky usually right lower quadrant pain with jolly stools the reason why their current jelly and bloody is because of the mucosal sloughing off of the telescoped part that is now becoming ischemic and it's colicky it comes and goes and the kid will usually try to end their legs up to their chest like their knees up to their chest so if get some relief you want to treat this with like an air enema or an animal if a contrast soluble dye like gastrografin but don't use barium because barium if it leaks out into the peritoneum it can cause problems versus a meckel's diverticulum meckel's diverticulum is it's a diverticulum that has actually ectopic gastric and pancreatic tissue and then this can cause painless bleeding so that's the difference between intussusception and meckel's is that in meckel's there's painless bleeding and you have your inflammatory bowel diseases this can be in older kids like older teenagers and the two main ones are ulcerative colitis you see versus Crohn's disease and you should be able to compare and contrast the two of these as well you see always involves the rectum and it has severe inflammation but for you see it's more limited to the mucosal layer whereas Crohn's which means it's full-thickness you see is also associated with toxic megacolon and also it's associated with primary sclerosing cholangitis of the biliary tree they're associated with pyoderma gangrenosum which is one of those ulcers you see on the skin that are white but they're sterile so you treat pyoderma gangrenosum with steroids necrotizing enterocolitis just remember this kid can also have rectal bleeding and what it's usually associated with the premature baby who feeds too early so a premature baby who feeds early and then later has rectal bleeding this is necrotizing enterocolitis on x-ray of the abdomen you might see Pneumocystis and test analysis which means there's air in the intestinal walls the last that I want to talk about or Craig they're in a jar so Craig learn ajar is due to a deficiency in glue Carano transferase this means that the child does not have any glue Carano transferase so they are unable to conjugate bilirubin from its unconjugated to conjugated form so they'll have unconjugated hyperbilirubinemia how can you diagnose that well hyperbilirubinemia is defined as the Lubin levels above one and usually your direct component if it's above 20% that's a direct hyperbilirubinemia but if it's under 20% then that's a indirect hyperbilirubinemia indirect as the same as unconjugated and direct is the same as conjugated remember conjugated is water soluble and unconjugated is water insoluble the unconjugated form can actually pass the blood-brain barrier and this can cause connector s because the bilirubin can actually damage the basal ganglia trigger in a jar causes a unconjugated hyperbilirubinemia which is the way i think about it is like craig learn a jar light it has this person doesn't have an absolute deficiency of glue Carano transferees they have a mild deficiency and it's only visible or apparent when the patient gets sick or they're under stress and they might get slight jaundice and unconjugated hyperbilirubinemia but only when they're sick and then there's Dubin Johnson which is where they are able to conjugate the bilirubin but they're not able to let it escape out of the hepatocytes so this person will have a black liver on pathology and they will have a direct hyperbilirubinemia versus roader syndrome which is like Dupin Johnson a more mild form but the liver isn't black and that's GI next is nephrology so remember the most common nephrotic syndrome and a kid is a minimal change disease this is nephrotic syndrome is defined as proteinuria greater than 3.5 grams a day or a greater than proteins are creatinine ratio of greater than 3.5 that is classified as Anna fraud exonym nephrotic syndrome you're more prone to excreting proteins like albumin if you excrete albumin you have decreased intravascular oncotic pressure this can cause edema and swelling so they'll have swelling of the face and body and then also they will more prone to excreting antibodies and because they excrete antibodies they get antibody deficiency so they're more prone to getting infections because they are losing so many proteins as well there's less oncotic pressure in the blood so the body will try to compensate by making more coagulation factors and more lipids so they are prone to getting hyperlipidemia as well as well as a hypercoagulable state the most common hypercoagulable manifestation of nephrotic syndrome is renal vein thrombosis so this kid might have a sudden onset of flank pain and that is renal vein thrombosis from a nephrotic syndrome the most common syndrome is minimal change disease on histology you'll see a faced pota site so the podocytes will be flattened they'll um they also lose remember podocytes usually have the negative charge which repels albumin which is also negatively charged when it loses that negative charge albumin can filter through and you treat minimal change disease with steroids so remember - I said infections this increases their risk of specifically encapsulated organisms there's a mnemonic for encapsulated organisms and this is please shine my skis which is Pseudomonas strep pneumo H flu Neisseria a coli Salmonella Klebsiella and Group B Strep kids who also have sickle cell disease who have gotten splenectomy are also prone to getting encapsulated organism infections so remember that Association as well sickle cell kids or people who have a splenic are at prone for encapsulated organism infections then there is hemolytic uremic syndrome this is caused by eating undercooked beef which leads to infection by antara hemorrhagic ecoli a hack which causes the inflammatory bloody diarrhea but this can progress to hemolytic uremic syndrome if the kid was given an antibiotic such as a fluoroquinolone sometimes doctors will give antibiotics to people with inflammatory diarrhea's especially if they're really young or mu not compromised or really elderly people in between or immunocompetent and generally healthy will not be given antibiotics but ye hack is the exception where if the person is infected with you hack you definitely don't want to give fluoroquinolone because this leads to hemolytic uremic syndrome which is a type of micro angio pastic hemolytic anemia and as a very similar mechanism - TTP which is known as thrombotic thrombocytopenic purpura which is the mnemonic is phat RM fever anemia thrombocytopenia renal problems and neural problems so they get so their platelets basically bunch up because remember and TTP this is due to antibodies against Adams TS 13 Adams TS 13 is enzyme that breaks down von Willebrand factor so if you have antibodies against this then your von Willebrand factor is an access this causes increased platelet adhesion these platelets are everywhere in your circulatory system and they kind of block off your arteries like like spikes so when the red blood cells try to swim through they get sheared and this causes schistocytes but the schistocytes also causes the red blood cells to chemo eyes so that's where you get the hemolytic anemia so that's why you get the anemia and the thrombocytopenia because of the schistocytes a sheer red blood cells go down the platelet count goes down because they're all clumped up and then so basically H us is a variant of TTP through a micro ng Pathak hemolytic anemia but it doesn't cause fever or neural problems and anytime you have any manifestations of your V Mia then you want to treat it with dialysis so the manifestations of uremia will be pericarditis then that means dialysis hu s also needs dialysis platelet dysfunction also needs dialysis next is Alport syndrome Alport syndrome i want you to remember hematuria and deafness there's hematuria and deafness the diagnosis is locked-in pick Alport syndrome type 1 which is where you cannot excrete hydrogen so the hydrogen builds up that leads to acidosis that's a that is associated with kidney stone that's huge second one is bicarb where you cannot absorb bicarb and because of that you get acidosis the trick here is one should remind you of H hydrogen 1/2 bicarb I that's 2 so that's you can't absorb bicarb and type 4 has 4 number 4 1 2 3 4 that matches up with Aldo Ald oh she reminds of aldosterone that is hypoalle so they will have hyperkalemia hyponatremia possibly low blood pressure and this is the only one with hyperkalemia those are the 3 RTA's i want you to remember posterior urethral valve this happens in boys any boy who was born and still hasn't urinated you should suspect posterior urethral valve you diagnosed this with the vcug remember that you need to treat this with surgery and then the posterior III valve is since they were a fetus so the clue here is they can't urinate if they can't urinate in the amniotic sac then it's associated with Oleg oh hi cam knows only UTI that has a high urinary pH 8 plus is Proteus next is neurology there's spinal muscular atrophy which is also known as word Meg Hoffman disease this is where you get destruction of the lower motor neurons of the anterior Horn of the spinal cord of the gray matter and then this because it's lower motor neurons this will cause hyporeflexia fasciculations and like flaccid paralysis so if you see Sid with that then it's word neg Hoffmann but remember sometimes botulism can present like that too but botulism the kid was doing well before and then they bought it whereas working Hoffman it's manifested since they were born with botulism also if the symptoms go beyond just muscular skeletal this affects their GI - and their pupils their heart rate their breathing their sweating everything remember botulism is caused by the toxin that prevents the release of acetylcholine so they will have flaccid paralysis it's usually um top down paralysis and they'll also have the first sign what is the first sign it's because there's no acetylcholine to stimulate the GI they'll also have constipation and then also because they don't have a cetyl choline to affect their pupils then they will also have dilated pupils and if there's no acetylcholine to act on the heart then they'll also have tachycardia but the main thing is flaccid paralysis plus constipation think about botulism you diagnosed it with the stool toxin and you treat it with botulism immunoglobulins dandy Walker is when the kid doesn't have a cerebellum this leads to compensation of the enlarged fourth ventricle and blocks flow of CSF the symptoms of ICP that I want you to remember are headache nausea and projectile vomiting I need kid who has symptoms of increased intracranial pressure you always want to do a head CT before you do the lumbar puncture to prevent herniation the only exception is in infants who still have their fontanelles haven't fused yet because their fontanelles have infused yet that means that they have access space to relieve pressure so with kids who don't have fused of fonteneau's and they have you're fearing like meningitis then you can go straight to lumbar puncture but if they're fontanelle's have fused always do a head CT scan first to find out what's causing the increased ICP if everything looks good then you proceed with the lumbar puncture to diagnose meningitis to risk fluorosis is characterized by the mnemonic ash leaf so ash leaf spots shag green patches heart rhabdomyosarcoma long hamartomas epilepsy angio myeloma and facial ngo5 you cheat this with ACTH migraine headaches can also happen in kids and there's the pound criteria pulsatile one day duration unilateral nausea vomiting and it's debilitating it's usually worsened with noises and being in the quiet and the dark helps a lot you want to treat this first with Tylenol if you can but if it's really bad then you treat with sumatriptan which is a serotonin agonist and if you want and if they keep getting repeated migraines you can treat prophylactically with the beta blocker Yan bar a syndrome is you need to remember ascending paralysis that's symmetrical starts in the feet and the fingers and it rises up the main danger here is that it can cause respiratory of paralysis so the first thing you want to do in someone with youngberry is check their vital capacity how much can they breathe because if they can't breathe very well then you might have to intubate them um CSF this is a unique thing for guillain-barre a is it shows saito albumin illogic dissociation which means saito meaning cells and albumin there's a dissociation so there's no cells like no white blood cells but there's a lot of albumin this is a marker for a guillain-barre and you want to treat youngberry with IVIG and plasmapheresis the plasmapheresis will help take out the antibodies that are attacking your peripheral nervous system the last is muscular dystrophy you have Deschenes muscular dystrophy and Becker's muscular dystrophy do Shayne's happens a lot earlier and Becker's the kid can survive longer into their 20s whereas Duchene is more severe early onset and then this muscle gets replaced with fibroblasts and lipids this is due to of the missing dystrophin in their muscle and the key thing is hypertrophic calves and the Gower sign which means they have problems getting up on their own and they usually have to use their arms too I'm up their legs - and this is muscular dystrophy remember that cow milk is low in iron and goat milk is low in Foley so if the kid is all he is drinking his cow milk he can get iron deficiency anemia the kid only drinks goat milk he can get a macrocytic anemia or a megaloblastic anemia when someone takes iron make sure to give with vitamin C because it helps increase absorption von Willebrand's disease remember there's a deficiency of von willebrand so they will see increased bleeding time because von Willebrand is needed for platelets to stick and then if the platelets don't stick that is what measures bleeding time so that will be increased and von Willebrand also carries factor 8 which is part of the intrinsic pathway so they will also see an increased PTT spoon-shaped nails is a sign of iron deficiency anemia this is called Cuello Nikia wiskott-aldrich syndrome should know the mnemonic water abuse for Wescott a for eldritch tea for thrombocytopenia e for eczema and R for recurrent infections this is a cytoskeleton abnormality so remember that hamana wagger is w w AGR a Wilms tumor Weidman as in beckwith Weidman aniridia genital urinary and retardation the abdominal masses you must know the difference between Wilms tumor versus neuroblastoma so Wells will not cross whereas neuroblastoma will across both sides of the abdomen from right to left it can be on both sides and and on top of that neuroblastoma has symptoms of hyper catecholamine emia which means they'll have hypertension and flushing so that's what will make the difference between neuroblastoma and Wilms tumor sometimes they'd like to ask you about vac Durrell and charge and it might ask you what else is associated with this kid so if they have like anal atresia then you have to remember what vac doll stands for and think that there might be cardiac and anomalies and then the answer might be like go cardiogram so that's where memorizing doctor all will help and charge is the same concept Hodgkin and non-hodgkin lymphoma will often have p symptoms so that's fever night sweats and weight loss Ewing sarcoma has the onion skinning of the bone with the small round blue cells osteosarcoma is a bone cancer as well look for the cod man's angle and the sunburst pattern osteoid osteoma look for a little bone lesion on the bone cortex treatment of rhinitis runny nose intranasal steroids cvid low antibodies only skin severe combined immunodeficiency this is low b-cells low t-cells and low antibodies and they present similarly with kids who have AIDS but they don't have AIDS so they'll have thrush and diarrhea and Pneumocystis year of itchy these kids need monthly IVIG and PCP prophylaxis and possibly bone marrow transplant as well ataxia telangiectasia ataxia with telangiectasias the a should remind you of low IgA wiskott-aldrich syndrome I already told you water Bruton the B should remind you of B cells they have low B cells and because they have no B cells they don't have antibodies either treat with IVIG monthly chronic granulomatous disease is due to NADPH oxidase deficiency they can't have they have problems with killing bacteria because they don't have their oxidative burst anymore and because of that they rely on hydrogen peroxide to kill bacteria but because of this they are prone to getting catalase positive bug infections because catalase bugs are able to break down hydrogen peroxide which is the only weapon that these white blood cells have left and the catalase positive bugs are you can think of bass Vass or cold area Aspergillus Serratia and staph aureus you treat CJD with a bone marrow transplant last is Chetty Ekadashi its care surprised by albinism and giant granules and the neutrophils and then last is leukocyte adhesion deficiency these kids have basically remembered the umbilical cord as a delayed falling off phase it takes a while to in velu and also these kids the white blood cells have problems extra of a savings so they have leukocytosis the white blood cells will always be in their bloodstream and then because the white blood cells can't go out into the tissues they have poor wound healing and they're prone to skin infections but then if you look at their skin infections there will be no pus because pus is a sign of white blood cell presence and it will be there