PEDIATRICS

Compilation of Tables from Topnotch Pedia Handout

# cien toporcien tolasaly an o # P L E 2 0 1 7 # n evershallw efail

NEWBORN PHYSICAL FINDINGS CONGENITAL INFECTIONS

Slate blue, well demarcated areas of Vesicular lesions on the face

Mongolian Spots HSV-2
pigmentation over the buttocks and back and mouth

history of infection during pregnancy

An IUGR baby born to a mother with
Small, white occasionally vesiculopustular
papules on an erythematous base develop Purpuric hemorrhagic lesions
Erythema Toxicum all over the body (blueberry Rubella
after 1-3 days
muffin)
Contains eosinophils
Vesiculopustular eruption over a dark Maculopapular rash,
macular base around the chin, neck, back, Pustular periostitis of the bone, Syphilis
snuffles
and soles Melanosis
Contains neutrophils
Chorioretinitis,
Cysts appearing on the hard palate which is periventricular calcifications
Cytomegalovirus
composed of accumulations of epithelial Epstein Pearls
cells
Chorioretinitis, microcephaly,
Pearly white papules seen mostly on the hepatosplenomegaly, Toxoplasmosis
Milia intracerebral calcifications
chins and around the cheeks
Open and closed comedones or
Cutaneous scars, cortical
inflammatory pustules and papules on the
Neonatal Acne atrophy
Varicella
cheeks of the baby usually after a week from
delivery
Pink macular lesions on the glabella, upper MICRONUTRIENT DEFICIENCIES
Nevus Simplex
eyelids, or nasolabial region Findings Deficiency
Hair that covers the skin of preterm infants Vesiculobullous, eczematous, dry, scaly or
Lanugo
Seen on term infants around the shoulders psoriasiform lesions; symmetric perioral, Zinc
Thick, white creamy material acral and perianal areas, chronic diarrhea, (acrodermatitis
Vernix Caseosa low ALP, stomatitis, glossitis, irritability, enteropathica)
usually absent in post-term infants
superinfection
Mottling of the skin with venous
Cutis Marmorata Generalized scaly dermatitis, alopecia, Essential Fatty
prominence, cobblestone, lacy appearance
thrombocytopenia, failure to thrive Acid
Edema, erythema and burning of sun-
RESPIRATORY CONDITIONS exposed skin on the face, neck, hand on
Niacin (Vit B3)
butterfly distribution dermatitis around the
Finely granular lungs Hyaline Membrane neck, diarrhea, dementia
Ground glass appearance Disease Pellagra, Casal necklace, pellagrous glove
Vit B3
Prominent pulmonary vascular markings Transient Tachypnea and boots, glove and boots lesion
Fluid lines in fissure of the Newborn Alopecia with neurological symptoms Biotin
“Bubbly lungs” and cystic lucencies Bronchopulmonary Follicular hyperkeratosis, xerosis and night
Dysplasia Vitamin A
blindness
Coarse streaking granular patterns of Meconium Aspiration Bitot spots, xerosis conjunctivae, xerosis
both lung fields Syndrome Vitamin A
cornea
Perihilar streaking Neonatal Pneumonia Hyperostosis, absence of metaphyseal
Vit A intoxication
changes, pseudotumor cerebri
Follicular hyperkeratosis, perifollicular
NEONATAL JAUNDICE erythema and hemorrhage; bleeding, Vitamin C
ABO swollen gums
First-born child
incompatibility “White line” on end of shafts, scorbutic
Vitamin C
rosary/beads
Second-born child Rh incompatibility
Bowlegs or knock knees, caput quadratum,
Within 24 HOL periosteal osteoid, craniotabes, pingpong
History of prolonged Vitamin D
second stage of labor
Sepsis ball sensation, rachitic rosary, pigeon chest,
JAUNDICE

Harrison groove
History of maternal
infection during TORCH Perleche Vit B2/Zinc/Vit C
pregnancy

2-3 days of life; Baby Physiologic

otherwise normal Jaundice
3-4 days; Mother
supplements Breastfeeding
After 24 HOL breastfeeding with Jaundice
sugar water

>1 week; Baby is Breastmilk

purely breastfed Jaundice

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NON-INFLAMMATORY DIARRHEA RENAL CONDITIONS

Day care center, infants Rotavirus Hx of hemoptysis and severe

and toddlers Goodpasture
Watery diarrhea, vomiting
E. coli respiratory distress
Hematuria, 3 weeks ago with SVI, purpuric
Profuse diarrhea and
vomiting, flecks of mucous Cholera hypertension rash most prominent at the HSP
and voluminous diarrhea and signs of buttocks, pain in the joints
renal Hx of vomiting, bloody diarrhea
Profuse diarrhea after
eating raw oysters or
Vibrio insufficiency and fever, hx of eating
undercooked shellfish parahemolyticus hamburger, dehydrated,
HUS
hepatosplenomegaly
Person-to-person spread,
vomiting, winter bug Norwalk virus

Sudden onset of gross hematuria, febrile

Greasy stool after camping, with URTI or GIT infection IgA nephropathy
gas Giardia lamblia
Normal C3

Watery diarrhea with Sudden onset of gross hematuria

vomiting after history of E. coli Hx of strep throat or pyoderma APSGN
travel Severely depressed C3
Child discovered to have asymptomatic
INFLAMMATORY DIARRHEA / DYSENTERY microscopic hematuria during yearly
checkup at school Alport syndrome
Wears very thick glasses and hearing aid
Trophozoites with ingested RBCs Amoebiasis Child has uncles with the same condition
Bloody diarrhea, pus and

Abdominal cramps, systemic toxicity

after antibiotic use C. difficile STEROID-RESISTANT, FREQUENT RELAPSER, OR STEROID-
WBC in stools

DEPENDENT?

Abdominal cramps, tenesmus, Relapse within 28 days of stopping

abundant pus and WBC in stool Shigella prednisone therapy
Dependent

Patient who responds well to prednisone

High fever, headache, drowsiness, therapy but relapse 4 or more times in a Relapser
confusion, meningismus, seizures and Salmonella
12-month period
abdominal distention; hx of eating
eggs, poultry unpasteurized milk
typhi
Children who fail to respond to
Resistant
prednisone therapy within 8 weeks
Diarrhea with blood after eating
hamburger, renal failure EHEC Relapse on alternate-day steroid therapy Dependent
Children who continue to have
proteinuria (+2 or greater) after 8 weeks Resistant
DIARRHEA of steroid therapy

Abdominal Ham, potato salad, cream, pastry S. aureus

cramps, Reheated fried rice B. cereus PATHOLOGY CROSS-OVER
diarrhea, Home-canned food, muscle
sweating, no weakness, diplopia, blurring of C. botulinum MEMBRANOUS GLOMERULONEPHRITIS
fever vision î LM: Diffuse thickening of glomerular capillary walls
î IF: Granular IgG and C3
î EM: Subepithelial deposits of electron-dense material
PATIENTS PRESENTING WITH OBSTRUCTION
î “Spike and Dome” appearance
Cannot pass NG tube, severe MINIMAL CHANGE DISEASE
pain and emesis, omega sign or î LM: Normal
Volvulus
coffee bean sign on AXR, î EM: Diffuse effacement of epithelial foot processes; no
inverted U sign deposits
Bloody currant jelly stools,
sausage-shaped RUQ mass, MPGN
Intussusception
absence of bowel sounds on î LM: Large, hypercellular glomeruli
Abdominal RLQ, coiled spring sign î Increased mesangial matrix
pain, Post-prandial vomiting, î Double contour or tramtrack appearance
vomiting, nonbilious, ab distention, Down
+/- distention syndrome, olive-shaped mass, Pyloric Stenosis FSGS
barium studies show shoulder î LM: Focal segmental sclerosis and hyalinosis
sign, double tract sign î EM: Loss of foot processes, epithelial denudation
Normal hx or recurrent
obstructive sx, painless rectal
Meckel
bleeding, intermittent pain;
diverticulum
scintigraphy scan to detect
gastric tissue

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HEMATOLOGY MENINGITIS

What is the most common hereditary No mention of proper

vWF disease HiB
bleeding disorder? vaccination, <5 y/o
What is the most common and most Headache, Properly vaccinated child,
serious congenital coagulation factor Hemophilia A fever, abrupt in onset, toxic-looking Meningococcus
deficiency? confusion, with rashes all over
What is the most common hereditary lethargy, Young adults Pneumococcus
Factor V Leiden nuchal
hypercoagulable disorder? Renal transplant Listeria
What is the hallmark of hemophilia? Prolonged bleeding
rigidity,
vomiting Gradual onset of s/sx, not toxic-
Enterovirus
What is the earliest joint hemorrhage in looking
Ankle
children? RBCs in the CSF examination HSV

ONCOLOGY NASAL DISCHARGE

Most common malignancy ALL Prominent itching & sneezing,

Allergic Rhinitis
Most common solid tumor Brain tumors nasal eosinophilia
Most common solid tumor outside CNS Neuroblastoma Unilateral foul-smelling d/c,
Foreign Body
Most common soft tissue tumor Rhabdomyosarcoma bloody nasal secretion
Malignancy with highest mortality Brain (PNET) Headache, facial pain,
Sore,
periorbital edema, rhinorrhea Sinusitis
scratchy
for >2 weeks
throat, nasal
CNS INFECTIONS Persistent rhinorrhea w/ onset
obstruction Congenital
in the first 3 months of life
and Syphilis
Prefrontal headache, high fever, disturbance (snuffles)
N. fowleri rhinorrhea
in smell, swimming in warm water Hx of prolonged use of topical Rhinitis
Bell palsy, systemic disease, cutaneous or oral decongestant Medicamentosa
Borrelia
lesions, carditis Paroxysms of cough, leaving
Whooping
Ascending paralysis, hx of GIT infection, hx of the baby breathless,
C. jejuni Cough
respiratory infection subconjunctival hemorrhages

Lethargy and irritability, hx of viral infection,

Reye Syndrome UPPER AIRWAY OBSTRUCTION
chicken pox, aspirin use
Ocular nerve palsies, previous hx of TB, active Patchy infiltrates & ragged Bacterial
TB meningitis Antibiotics
TB tracheal column tracheitis
Sepsis, seizure, irritability, lethargy, bulging of Thumb sign
GBS Epiglottitis Antibiotics
fontanelles, rigidity. Patient is <2 months old
Subglottic narrowing, Racemic Epinephrine/
Croup
steeple sign Dexamethasone
Air trapping on the right
Foreign
lung with mediastinal shift Rigid Bronchoscopy
body
towards the right lung

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WHEEZING CYANOSIS IN CONGENITAL HEART DEFECTS

Hx of viral infection among the family Manifesting within few hours at birth or
Bronchiolitis TOGV
members. Patient is 2 y/o within a few days of life
Hx of atopy in the family. Recurrent wheezing Manifesting after the first year of life,
Bronchial TOF
especially after mild viral infection or after usually in an infant or toddler
Asthma
exercise
Wheezes are e heard loudest over the CXR FINDINGS IN CONGENITAL HEART DEFECTS
trachea. Persistent wheezing never seems to Chondromalacia
go away Couer en sabot/boot-shaped TOF
Absent breath sounds on the right lung. Egg on a string TOGA
Foreign Body
Patient is 3 y/o Figure of 8, snowman TAPVR
Rib-notching, inverted E, 3 sign COA
PNEUMONIA

HEART DISEASES
Poorly nourished,
unvaccinated, w/ onset of Measles
rashes all over the body Late systolic murmur with opening
MVP
click
Px has CF. Px has CGD. Px is
Pseudomonas Disparity in pulsation and BP in the
neutropenic. Px is a burn px
arms and legs; weak popliteal,
Fever, Cough Px is a teen/young adult, lives in COA
Complaints of posterior tibial and dorsalis pedis
and a dorm; initial cough is non- pulses
Mycoplasma exercise
Tachypnea productive; CXR: diffuse
infiltrates intolerance, S2 widely split and fixed in all
ASD
easy phases of respiration
Px has his own aviarium in his
Psittacosis fatigability Loud, harsh, blowing holosystolic
home VSD
murmur
Hx of eye discharge during the
Chlamydia Wide pulse pressure, bounding
1st 5-14 days of neonatal period
peripheral arterial pulses, PDA
continuous murmur
PNEUMONIA

CONGENITAL HEART DEFECTS: SURGICAL INTERVENTIONS

Attaches to respiratory epithelium
Inhibits cellular destruction
Mycoplasma Blalock-Taussig shunt with GoreTex conduit
Sloughed cellular debris and inflammatory
cells and mucus cause airway obstruction Aortopulmonary window shunt
TOF
Waterson Cooley
Extensive areas of hemorrhagic necrosis, Pott shunt
irregular areas of cavitation,
Staphylococcus Rashkind atrial septostomy
pneumatocoeles, empyema and
bronchopulmonary fistulas Jantene arterial switching TOGA
Senning and Mustard
Diffuse infection with interstitial pneumonia,
necrosis of tracheobronchial mucosa, Fontan procedure Tricuspid atresia
formation of large amounts of exudate, GABHS Norwood procedure Hypoplastic Left
edema and local hemorrhage, involvement of Glenn anastomosis Heart Syndrome
lymphatic vessels and pleura
Local edema that aids in the proliferation of CONGENITAL HEART DEFECTS: ASSOCIATIONS
organisms and spread into adjacent areas Pneumococcus
resulting in focal lobar involvement Rubella PDA
Pulmonic stenosis
PNEUMONIA DM TOGA
Lupus Complete heart block
Lobar consolidation Pneumococcus
Aspirin PPHN
Child with Hyperinflation with bilateral
Alcohol VSD, PS
cough, colds, interstitial infiltrates and RSV
fever, peribronchial cuffing Lithium Ebstein anomaly
wheezing, Prominent areas of cavitations
Staphylococcus
stridor and multiple pneumatocoeles CHILD PRESENTING WITH CHF
Right-sided hilar adenopathy PTB
Neonate is 4
Neonate w/ systemic Hypoplastic
TYPES OF COUGH days old and is
hypoperfusion and shock w/ Left Heart
NOT cyanotic
low CO and weak peripheral
Staccato Chlamydia pulses. Severe respiratory Neonate is 4
distress and grunting days old and is TAPVR
Brassy S. aureus
cyanotic
Barking “seal” Parainfluenza
6-week-old baby presenting w/ increasing
Whooping; post-tussive vomiting Bordetella CoA
respiratory distress, diaphoresis, lethargy
Most severe in the morning Cystic Fibrosis
With vigorous exercise Asthma
Disappears with sleep Habitual cough
Tight-sounding w/ wheezing Asthma

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INFECTIVE ENDOCARDITIS CUTANEOUS LESIONS

Normal person, no underlying disease S. aureus Multiple infected wounds on lower extremities.
Echthyma
Underlying heart disease, dental procedure Viridans Strep Lesions started as mosquito bites and child
(ulcerative
kept on scratching them.
GUT or lower bowel manipulation Group D Strep impetigo)
Multiply dry, heaped up, tightly adherent crusts
After open heart procedure Fungal Lesions started as mosquito bite and child kept
Staph on scratching them. Initially vesicular. Honey-
IV drug abuser S. pyogenes
Pseudomonas crusted lesion, catalase negative, no pain, no
(+) CVP, (+) prosthetic valves CONS systemic sx
Chills, fever, arthralgia, myalgia, acute- Lesions started as mosquito bite and child kept
S. aureus on scratching them. Initially vesicular. Longer-
looking, developing a new heart murmur S. aureus
lasting and bigger bullae formation. Catalase-
A child with known CHD w/ fever, fatigue,
positive
weight loss, painful skin lesions on fingers.
Viridans Strep Malignant pustule; pustule w/ dark red fluid,
Px has poor oral hygiene or has just Anthrax
undergone root canal necrosis to black eschar
A child with known CHD w/ fever, fatigue, Target lesion/bull’s eye, fever, headache, rashy
Borrelia
weight loss, panful skin lesions on fingers. Fungal border, bite site
Recent repair of VSD
A child with known CHD w/ fever, fatigue, VESICULAR LESIONS
weight loss, panful skin lesions on fingers. Pseudomonas
Child is an IV drug user Preceded with neurological pain HZV
Very large bullous lesions, progressing rapidly,
RED EYE IN NEONATES preceded by fever, fatigue, malaise; toxic- S. aureus
looking patient; denuded areas
Red eye with purulent discharge, Multiple vesicular lesions, some papules, some
Varicella
tense edema of eyelids with crusted, all at different age
Ceftriaxone
marked chemosis N. gonorrheae
50 mkD
2-5 days CELLULITIS OR SUBCUTANEOUS LESIONS
Onset at birth or until day 5 of life
Mild to severe swelling of eyelids Red, raised, butterfly rash in
C. trachomatis Erythromycin
with copious purulent discharge appearance with dermal pain Erysipelas
(inclusion 50 mkD q6 x Inflamed
Incubation period: 5-15 days and rapid spread
blenorrhea) 2 weeks erythematous
Tarsal conjunctiva
Following contact with
Days 5-18; edema and erythema Systemic skin, tender saltwater or oysters Vibrio
of eyelids, purulent discharge, antibiotics, and warm
Pseudomonas Burn px, blue-green pus,
pannus formation, Gentamycin Pseudomonas
grape-like odor
endophthalmitis, sepsis eye ointment
First 6-12 hours of life Chemical LYMPHATIC OBSTRUCTION OR LYMPHOCUTANEOUS LESIONS
Self-limiting
Clears in 24-48 hours Conjunctivitis
Solitary or lymphocutaneous lesions, rose
CONJUNCTIVITIS Sporotrichosis
gardeners, likes lying in the garden
LGV
Red itchy eyes, thin exudate, pain & W/ hx of painless genital ulcer
Adenovirus (Chlamydia)
photophobia, +/- cough and colds
Fever, headache, elephantiasis of limbs or
Red eyes, presence of pus S. aureus Filariasis
genitalia
Red eyes, pus, inclusion bodies in scrapings Chlamydia
Inturned eyelashes, corneal scarring, GRANULOMATOUS LESIONS AND DRAINING SINUS TRACT
Chlamydia
blindness
Jaw area swelling, sinus tract formation,
EYELID INFECTIONS yellow exudate, carious teeth, dental Actinomyces
procedure, yellow granules in exudates
Bilateral eyelid swelling, eosinophils, muscle pain Mycobacterium
Trichinella Tropical fish enthusiasts
Hx of GIT infection marinum
Stye S. aureus Subcutaneous swelling of shoulder; sinus tract
Nocardia
Unilateral inflammation at bite site around eye or formations; granules
mouth T. cruzi Usually in the cervical area; child has chronic
Hx of travel to Mexico or South America TB
cough
Retinopathy w/ keratitis in a newborn or a young
CMV
child. Mother has a hx of drug abuse INFECTED WOUND

SKIN INFECTIONS Hx of animal bite, cellulitis with lymphadenitis Pasteurella

Hx of cat bite or scratch, or no hx of bite but
Furuncle/carbuncle in the neck, axillae, face, Bartonella
S. aureus with pet kitty; lymphadenopathy with stellate
buttocks henselae
granulomas
Furuncle/carbuncle from neck down; has Hx of shallow puncture wound through
bath tub at home; loves to play in the bath Pseudomonas Pseudomonas
tsinelas or through rubber shoes
tub
Surgical wound (clean or dirty) S. aureus
Inflammation of sebaceous glands & follicles
Propionibacterium Trauma C. tetani
in a teenager

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ENT INFECTIONS RASHES

AOM; red, bulging tympanic membrane, fever Pneumococcus Cough, coryza, conjunctivitis, fever Rubeola
Sinusitis; sinus pain, low-grade fever Pneumococcus Posterior cervical or auricular LN Rubella
Common cold, sneezing, scratching throat, Slapped cheek then spreading to trunk with Erythema
Rhinovirus
runny nose central clearing Infectiosum
Abrupt onset of fever with URTI for 3-4 days.
SORE THROAT Fever disappears and rashes appears on trunk Roseola
and spread
Inflamed tonsils or pharyx, purulent, fever GABHS Preceded by rapid onset of fever, myalgia,
White papules with red base on posterior ocular pain, hyperesthesia; rashes blanch on Dengue
Herpangina
palate and pharynx, first 3 years of life pressure
Purulent tonsils, fatigue, lymphadenopathy,
EBV
hepatosplenomegaly
Low-grade fever w/ gradual onset of By: JB Goza-Borja
membranous nasopharyngitis; bull neck from Diphtheria
lymphadenopathy
Finely popular, erythematous eruption
producing a bright red discoloration of the
skin, which blanches on pressure, more
intense along the creases of the elbows,
Scarlet fever
axillae and groin.
(GABHS)
The skin has goose-pimple appearance and
feels rough. After 4 days, the rash begins to
fade and is followed by desquamation,
sandpaper-like rash

INFECTIOUS ARTHRITIS

All ages except between 15-40 S. aureus

Pain, redness,
low-grade 15-40 y/o, sexually active N. gonorrhea
fever, tender Prosthetic joint S. epidermidis
joints, reduced
Following GIT infection few
mobility Reiter’s disease
weeks ago
Formatting: Bobet J
OSTEOMYELITIS

Adults, children, infants, w/o

Fever, bone major trauma or special S. aureus
pain w/ conditions
swelling,
Neonates, <1 month old S. aureus
redness,
associated Sickle cell anemia Salmonella
cellulitis
History of trauma Pseudomonas

TOXIC-LOOKING RASHES

Petechiae to purpuric lesions, generalized,

abrupt onset w/ fever, chills, prostration and N. meningitides
shock
Petechiae to purpuric lesions, fever, headache,
R. ricketsii
rash that INCLUDES palms and soles
Petechiae to purpuric lesions, fever, headache,
R. prowazekii
rash that SPARES palm and soles
Erythematous, maculopapular rash, sandpaper-
like, trunk and neck and then extremities, Scarlet fever
associated with sore throat and fever
Diffuse erythematous macular sunburn-like
rash, trunk and neck and then extremities with
TSS
desquamation on palm and soles; acute onset
of fever, pharyngitis, diarrhea, hypotension

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