HY lecture notes:
Transient tachypnea of the newborn (TTN) is a really HY diagnosis that contrasts with neonatal respiratory distress syndrome (NRDS).
TTN –> TERM neonate who was born via C-section or fast vaginal delivery –> not enough time for amniotic fluid to be cleared from lungs. They may or may not say there are increased fluid markings on chest x-ray.
NRDS –> preterm + dyspnea + low lecithin (dipalmitoyl phosphatidylcholine) to sphingomyelin ratio. To prevent, two boluses of corticosteroids are given to the mom if she’s <34 weeks gestation. After 34 weeks, the steroids aren’t given.
Meconium aspiration syndrome –> dyspnea in neonate –> answer if darkly stained amniotic fluid + meconium visible in/on the airways.
Bronchopulmonary dysplasia –> restrictive lung disease in neonate caused by receiving oxygen; for instance, neonate born at 28 weeks gestation and on ventilator + needed home oxygen –> leading to restrictive lung disease.
Retinopathy of prematurity –> abnormal vascular proliferation on the retina caused by receiving oxygen after birth.
If you get a vignette of an asymptomatic patient who’s partner tested positive for chlamydia or gonorrhea, the answer is yes, you treat the asymptomatic patient (ceftriaxone PLUS azithro or doxycycline; always cotreat). This is a Q on one of the newer peds forms.
Metronidazole is for trichomoniasis (patient + partner) and bacterial vaginosis (Gardnerella)
“Absence of ganglion cells in the bowel wall” –> Hirschsprung (Down syndrome)
“Double bubble sign” –> Duodenal atresia (Down syndrome) or annular pancreas; bilious vomiting in neonate
“Forceful vomiting” –> hypertrophic pyloric stenosis; non-bilious vomiting –> low K, low Cl, high bicarb, high pH; can be caused by erythromycin (motilin receptor agonist); also seen in first-born males.
“Exocrine pancreas insufficiency” –> cystic fibrosis –> inspissation of secretions leads to malsecretion into duodenum.
“Villous atrophy” –> Celiac
If you get a vague vignette where it’s hard to differentiate Celiac from lactose intolerance, and they tell you the onset is in a teenager or young adult, the answer is lactose intolerance (can be adult-onset).
Celiac notably presents with iron deficiency anemia. Diagnose with IgA anti-tissue transglutaminase, anti-gliadin (anti-endomysial) antibodies. After positive antibody screen, must do duodenal biopsy to confirm; in other words, “no further studies indicated” is the wrong answer.
Lactose intolerance –> check for decreased stool pH or do hydrogen breath test to diagnose. Secondary lactose intolerance can be seen after viral gastroenteritis (classically children with rotavirus infection who get bloating with meals for a couple weeks following). Do not perform duodenal biopsy, but if it’s done, it’s normal.
Super-high lymphocytes in kid –> usually ALL, but if infection, this is actually pertussus (which is weird because it’s bacterial, but this is HY).
Pertussis –> lymphocytes, e.g., at 30,000 cells/mm3, paroxysms of cough; hypoglycemia and vomiting may also be seen; give erythromycin to patient and close contacts, irrespective of vaccination status.
Strawberry tongue + body rash –> Scarlet fever –> Group A Strep (S. pyogenes) –> give penicillin to prevent rheumatic fever. Won’t prevent PSGN.
Young child with “spiking fever followed by a rash” –> Roseola –> HHV6 –> self-limiting
Slapped-cheek appearance –> Parvo B19; can also cause aplastic anemia (do bone marrow biopsy if all cell lines down); adults can get arthritis + lacy body rash; classic for daycare centers in Qs; increased risk of aplastic crisis in sickle cell.
Body rash that moves head to toe + suboccipital/post-auricular lymphadenopathy –> Rubella (German measles)
Body rash that moves head to toe + Koplik spots –> Measles (Rubeola)
“Cough, coryza, conjunctivitis” not specific for measles and more or less just reflect viral infection.
Meningitis, orchitis, parotitis –> Mumps; rash not characteristic.
