File Size : 9 MB. In this part of the article, you will be able to access the. Download File. You may send an email to admin cmecde. Save my name, email, and website in this browser for the next time I comment. Notify me of follow-up comments by email. Even if you are sure you do not want to be a pediatrician, it can be a very fun and rewarding experience. There are three key components to the rotation: 1 what to do on the wards, 2 what to do on outpatient, and 3 how to study for the exam.
Free Download Here. Sign in. Log into your account. Forgot your password? Eat light, balanced meals. Make sure your meals are balanced, with lean protein, fruits and vegetables, and fiber. Take practice exams. The point of practice exams is not so much the content that is contained in the questions, but the training of sitting still for 3 hours and trying to pick the best answer for each and every question. Tips for answering questions. All questions are intended to have one best answer.
When answering questions, follow these guidelines: Read the answers first. For all questions longer than two sentences, reading the answers first can help you sift through the question for the key information. Finally, remember—children are not just small adults. They present with a whole new set of medical and social issues.
More than ever, you are treating families, not just individual patients. We advise that you make a copy of these cards, cut them out, and carry them in your coat pocket when you are on the wards. Germ Layers See Table Heart Week 3: Paired heart tubes begin to work. Summary of Germ Layer Derivatives Ectoderm Neural Crest Cells Ectoderm Striated and smooth muscle VII, IX, X; sensory neurons PNS Endoderm Connective tissue, cartilage, bone Spinal nerves; cranial nerves V, CNS, peripheral nervous system Mesoderm Epithelial lining of gastrointestinal tract, respiratory tract, and middle ear, including eustachian tube Sensory epithelia of eye, ear, nose Autonomic ganglia Blood and lymphatic systems Epidermis, hair, nails Adrenal medulla Ovaries, testes, genital ducts Tonsil parenchyma Mammary glands, pituitary Meninges Serous membranes lining body Thymus cavities Pigment cells, glial cells of gland, subcutaneous glands Spleen, adrenal cortex peripheral nerves Tooth enamel Parathyroid and thyroid glands Liver, pancreas C i r c u l at i o n See Figure Blood from the artery to vein is preferentially shunted through the foramen ovale to the left atrium, while blood from the lower inferior vena cava, right hepatic circulation, and superior vena cava enters the right ventricle.
See Figure H e m o g lo b i n Fetal erythropoiesis occurs in the yolk sac 3—8 weeks , liver 6—8 weeks , spleen 9—28 weeks , and then bone marrow 28 weeks onward. WARD TIP Failure of testicle s to descend, cryptorchidism, may need to be corrected surgically to prevent progressive dysplasia and may affect fertility. Metanephri permanent kidneys start functioning at 9 weeks; urine is excreted into amniotic cavity.
Mom is given steroids. C e n t r a l N e r v o u s S y s t e m CNS Lecithin-to-sphingomyelin ratio in the amniotic fluid greater than 3 indicates fetal lung maturity. Neural tube openings rostral and caudal are closed by 25—27 days.
By week 5, subdivisions of forebrain, midbrain, and hindbrain are formed. Failure of caudal neural tube to close completely can result in spina bifida unfused vertebral arch with or without unfused dura mater and spinal cord , commonly seen in the lumbar area. Failure of the rostral neural tube to close can result in anencephaly.
Maternal portion is derived from endometrium. Transport Nutrients, electrolytes, water, and gases are diffused or transported across the placenta.
Prenatal Disturbances Infections Infants who have experienced an intrauterine infection have a higher-thanaverage incidence of being small for gestational age, hepatosplenomegaly, congenital defects, microcephaly, and intracranial calcifications. Congenital rubella syndrome is rare due to the effectiveness of the rubella vaccine. The amount of alcohol consumed correlates with the severity of spectrum of effects in the neonate, ranging from mild reduction in cerebral function to classic fetal alcohol syndrome see Figure Notice the depressed nasal bridge, fl at philtrum, long upper lip, and thin vermillion border.
Underrecognition of prenatal alcohol effects in infants of known alcohol abusing women, J Pediatr. He feeds poorly and has diarrhea. Think: Cocaine or heroin withdrawal. Cocaine readily crosses the placental barrier, placing the fetus at risk.
Symptoms of cocaine withdrawal include tremors, high-pitched cry, irritability, excess suck, apnea, and tachycardia, which can become evident within the first 72 hours of life.
Opiates also cross the placenta. Tremor and irritability are the common symptoms of opiate withdrawal. Vague autonomic symptoms such as yawning and sneezing are often present.
Obtain urine drug screen and meconium screen if opioid use in the mother is suspected. Phenytoin Phenytoin is associated with fetal hydantoin syndrome, which includes IUGR, mental retardation, dysmorphic facies, and hypoplasia of nails and distal phalanges.
Tetracycline Tetracycline causes tooth discoloration and inhibits bone formation. Isotretinoin Accutane Accutane is associated with hydrocephalus, microtia, micrognathia, and aortic arch abnormalities.
Warfarin Warfarin causes abnormal cartilage development, mental retardation, deafness, and blindness. Once the whole body is delivered, the newborn is held at the level of the table and the umbilical cord is clamped. It is not a substitute for assessing the ABCs in neonatal resuscitation. Resuscitation efforts should not be delayed or interrupted to assign an Apgar score. Skin Erythema toxicum is a pustular rash distributed over the trunk, face, and extremities, which resolves over a week.
Anterior fontanelle closes at 9—12 months. Large fontanelle is seen in hypothyroidism, osteogenesis imperfecta, and some chromosomal abnormalities.
An absent red reflex in one or both eyes signifies blockage of the passageway between the cornea and retina such as associated with cataracts or eye tumor retinoblastoma. Head CT consistent with TORCH infection—marked ventricular dilation, extensive encephalomalacia involving both cerebral hemispheres, absent corpus callosum, periventricular calcifications, skull deformity with overriding sutures.
Retractions, grunting, and tachypnea may signify respiratory distress nasal flaring, intercostal retractions, use of accessory muscles. Murmur in a newborn infant can be due to open ductus arteriosus, but persistent murmur is always pathologic and needs evaluation.
Examine umbilicus for omphalocele and gastroschisis. Also assess for crepitus. Back Look for dimples or tufts of hair that may indicate spina bifida. G e n i ta l i a Girls may have vaginal bleeding and swollen labia secondary to withdrawal of maternal estrogens. There are two broad categories, early and late onset. Those at risk are infants of diabetic mothers, postmature infants, and those with Beckwith-Wiedemann syndrome. Birth Trauma Clavicular Frac ture Most common bone fracture during delivery.
C aput Succedaneum Area of edema over the presenting portion of the scalp during a vertex delivery. Depressed fractures are often visible and may require surgery. Temporary asymmetry of the skull from the overlapping of bones that occurs following prolonged labor and vaginal deliveries. Involves the lower arm and affects the seventh and eighth cervical and first thoracic nerve roots. Involves the fifth and sixth cervical roots, and the arm is adducted and internally rotated, but the grasp reflex is intact see Figure Diagnosed in the mother by the Ob-Gyn during labor and delivery.
Nomograms developed by AAP are used to plot bilirubin levels and to categorize infants into low-, medium-, or high-risk group and need for treatment. Content Cell-free live attenuated varicella virus.
Avoid salicylates for 6 weeks after vaccine administration. LAIV should not be given to children aged 2—4 years who have had wheezing in the past 12 months. Reproduced with permission from the American Thoracic Society. He has not had separation of his umbilical cord, which remains attached, and the surrounding skin is erythematous and indurated.
The patient is admitted with diagnosis of sepsis and labs are obtained. Think: defective neutrophil migration. Aggressive antibiotic management of infections. Think: C5—C9 deficiency. Complement Complex system of nine serum proteins C1—C9. Functions of Complement Opsonization. Bacteria cell lysis. C1q deficiency: Systemic lupus erythematosus SLE. C5—C9 terminal complement deficiency: Neisseria infection Table Hereditary angioedema: Laryngeal edema airway obstruction ; intestinal edema colicky abdominal pain ; edema of face, limbs, and genitals.
Oral thrush and bilateral rhonchi were present. There is no lymphadenopathy. Her white blood cell count is Chest x-ray shows diffuse bilateral interstitial infiltrates. Think: PCP. Oral thrush, extensive diaper rash, and failure to thrive are the prominent features. E tiology A group of genetic abnormalities that result in severe T-cell depletion or dysfunction and B-cell dysfunction e. Female infants are at four times higher risk than males.
Authorities do not recommend routine blood work in well-appearing, immunocompetent, immunized children just on the basis of fever. Diagnostic Workup Urinalysis demonstrating leukocyte esterase more sensitive or nitrites more specific. Reflux of urine increases risk of renal scarring. Cephalosporins are a good first-line agent. Treatment IV broad-spectrum antibiotics. Manage shock with aggressive IV fluid resuscitation and vasopressors as needed to maintain blood pressure, perfusion, and oxygenation.
Physical examination shows a temperature of He is rapidly progressing to shock. Think: Meningococcemia. Typical presentation is sudden onset of fever, vomiting, headache, and lethargy. Most patients have petechiae on presentation. The infection can progress rapidly to profound shock and DIC. Atlas of Emergency Medicine, 3rd ed.
Photo contributor: Richard Strait, MD. Progresses rapidly within hours to septic shock due to endotoxin. Exanthem: Lesion on the skin rash. Polymorphous rash: Consists of various primary elements. For example, in a new immigrant or in an adoptee. No workup is generally needed in wellappearing child with classic blanching, maculopapular rash. Prior to developing the rash, she had a 4-day history of runny nose, pink eyes with crusting, barking cough, and high fever.
Three tiny, whitish, round spots are present on her buccal mucosa. Think: Measles. The rash usually begins on the face and appears several days after the initial symptoms.
Conjunctivitis is exudative yellow discharge. Koplik spots rubeola. Atlas of Emergency Medicine, 1st ed. Rash starts as faint macules on upper lateral neck, behind ears, along hairline, and on cheeks.
Diagnosis Clinical. Laboratory evaluation rarely necessary for diagnosis but important for confirmation and surveillance. Otitis media.
Pneumonia may be fatal in HIV patients. Encephalitis—most feared complication. Treatment Supportive. The World Health Organization recommends vitamin A for all children with measles, regardless of their country of residence. She was recently adopted from Romania, and her immunization history is unknown. She is brought in because of a fever for 1 day. On physical examination, she is not ill-appearing, her temperature is Suboccipital and posterior cervical lymph nodes are palpable.
WBC 7. Think: Rubella. Rubella has a prodrome of low-grade fever, sore throat, red eyes, headache, malaise, and anorexia. Suboccipital or postauricular lymphadenopathy is common. Rash is usually the first symptom, which appears on the face and spreads centrifugally to the extremities. Rubella is contagious from 1 week before the rash appears to 1 week after it fades. Etiology Togavirus RNA virus.
Signs and Symptoms Mild fever prodrome for 1—2 days. As it spreads to trunk, it clears on face. C o n g e n ita l R u b e l l a S y n dr o m e The reason for rubella immunization is to prevent this syndrome.
Generally given at 12—15 months with a booster given at 4—6 years. He had no vomiting, did not look sick, and his neurologic examination was normal. The only finding at the time was small suboccipital lymph nodes. No workup was done. Think: Roseola. Roseola is associated with high fever for 3—5 days. There is a high association with febrile seizures. Rash appears when the fever disappears. Mild cervical or occipital lymphadenopathy may be present. By the age of 4 years, almost all children are immune.
Mild upper respiratory symptoms or commonly no symptoms other than fever. F ift h D is e as e Er y t h e ma I n f e c ti o s u m An 8-year-old girl has a 4-day history of fever and bright red cheeks. Now she has rash everywhere and complains of knee pain. On examination, she is not sickappearing, her temperature is Her joints are intact with full range of motion. Think: Erythema infectiosum, Parvovirus B Erythema infectiosum is a self-limiting exanthematous illness in children. Slappedcheek appearance is the classic presentation.
In addition, a lacy, reticulated appearance on the extremities is often present. E tiology Parvovirus B Pathophysiology Attacks red blood cell precursors. Transmitted in respiratory secretions.
Intravenous immune globulin IVIG should be considered for immunocompromised patients. His classmate had similar symptoms 1 week ago. He has red tonsils, swollen, tender bilateral anterior cervical lymphatic nodes 2.
Think: Scarlet fever. Scarlet fever has an abrupt onset of fever, chills, malaise, and sore throat with a distinctive rash that begins on the chest. Circumoral pallor is often present. The rash has a rough, sandpaper-like texture. Signs and Symptoms Fever, often with sore throat. Confluent erythematous erythroderma sandpaper-like rash.
R h e u mati c f e v e r s e e a l s o Cardi o v as c u l ar D is e as e c h apt e r A year-old girl presents after recently immigrating from Central America with fatigue, a swollen, painful knee, and a truncal rash.
She has no known medical history but indicates that she had a sore throat for a few weeks prior to leaving her home country. Think: Rheumatic fever. Rheumatic fever is a diagnosis based on Jones criteria. Signs and Symptoms Nonspecific and due to the individual, particular manifestations of disease. Diagnosis Jones criteria: Based on evidence of recent Group A Streptococcus infection plus two major or one major and two minor criteria.
Vari c e l l a C h i c k e n p o x A 5-year-old boy has had a fever for 3 days and an itchy rash that started yesterday. He is a recent immigrant from overseas. On examination, his temperature is There are crops of papules, vesicles, pustules, and crusts on his face, trunk, and extremities.
Think: Varicella. Varicella is a highly contagious disease characterized classically by a prodrome of URI symptoms followed by a generalized, vesicular, pruritic rash with a centripetal distribution. In a patient with chickenpox, erythematous macules, papules, vesicles, and scabbed lesions are present in various stages simultaneously.
Definition Highly contagious, self-limited viral infection characterized by multiple pruritic vesicles Figure E tiology Varicella-zoster virus VZV , group of herpesviruses. Note dewdrop appearance of lesion and that there are lesions in multiple stages of eruption.
Epidemiology Ninety percent of patients are 4 years. Epidemiology Fecal-oral and respiratory routes of infection. Summer and fall seasonal pattern exist against a background of year-round disease.
Ulcerative mouth lesions small, superficial, round erosions. Hand and foot lesions are tender and vesicular. Hands more commonly involved than feet. May be ONLY oral. May occur on palms and soles. Complications Aseptic meningitis. On examination, he was active and had trismus inability to open wide the mouth and swelling in front of the earlobes.
There was no redness or purulent discharge at Stenson duct openings. At a follow-up visit 8 days later, his parotid swelling has resolved, but now he has a swollen, tender left testis. Think: Mumps orchitis. Parotid swelling is the classic feature of mumps. Parotitis is often accompanied by a prodrome of low-grade fever, myalgias, and anorexia.
Epididymo-orchitis is a common extra—salivary gland complication of mumps in postpubertal males. It is characterized by marked testicular swelling and severe pain and may be associated with fever, nausea, and headache.
Testicular atrophy may follow, although sterility is not common. E tiology Paramyxovirus RNA virus. Pathophysiology Spread via respiratory secretions. Incubation period of 14—24 days. Swelling and tenderness in one or both parotid glands. The fever escalates in the next 7 days. He develops abdominal pain and refuses to eat. His last bowel movement occurred prior to the onset of fever and was normal. There are fine pink spots on the abdomen and a palpable spleen 2.
Abdomen is soft, with mild, inconsistent tenderness and no guarding or rebound. WBC is 2. Think: Typhoid fever. Typhoid fever is characterized by a prolonged fever, relative bradycardia, splenomegaly, rose spots, and leukopenia. It is caused by infection with Salmonella typhi. Pathophysiology Fecal-oral transmission.
Incubation period of 7—14 days. Intestinal perforation. Consider dexamethasone for severe cases with altered mental status. T i c k - B o r n e I n f e c ti o n s Lyme Disease A 6-year-old boy develops limping, swelling, and pain in his right knee; there is no fever. Physical examination shows temperature of There is no rash, murmur, or organomegaly. Think: Lyme disease vs. An year-old girl presents with an enlarging erythematous, non-itchy spot on her left shoulder.
She was camping in upstate New York 2 weeks ago. On examination, her temperature is No regional lymphadenopathy is noted. Think: Lyme disease. Lyme disease is a tick-borne, inflammatory disorder due to the spirochete Borrelia burgdorferi. The most common manifestation of Lyme disease in children is erythema migrans rash and arthritis.
Most cases of Lyme disease are from the Mid-Atlantic states and upper Midwest. Definition A multisystem disease transmitted by the bite of an Ixodes tick infected with spirochetes. Etiology Borrelia burgdorferi. Epidemiology Patients are often unaware of the tick bite. Incubation period: 2—31 days see Table Not necessarily found at the site of the bite.
Erythema chronicum migrans rash characteristic of Lyme disease. During the first 4 weeks of infection, serologic tests are negative and therefore not recommended. If delayed diagnosis, may have permanent neurologic or joint disabilities. Carditis—can be evidenced by heart block most common.
She attended a family picnic 1 week ago. On examination, she has a temperature of She is complaining of headache and has a macular rash on her wrists, palms, ankles, and soles. There are no other significant findings. Her platelets are 68 and serum sodium is Think: Rocky Mountain spotted fever.
RMSF is a systemic tick-borne illness caused by Rickettsia rickettsii. Moreover Medstudentscorner. If you feel that we have violated your copyrights, then please contact us immediately. Your email address will not be published. Save my name, email, and website in this browser for the next time I comment.
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