Pediatrics: Uworld Notes
What are the two types of breath-holding spells, are they pathological and at what age are breath-
holding spells common? - Two Types of breath-holding spells:
1. Cyanotic - Crying followed by breath-holding, cyanosis, & Loss of consciousness
2. Pallid - Minor trauma followed by breath-holding, pallor, diaphoresis & loss of consciousness
Are they Pathological?
1. Breath-holding spells are generally benign. Parents should be reassured that these spells are typically
harmless and children will still develop normally.
When should breath holding spells stop?
1. Breath-holding spells most commonly occur in children age 6 months to 2 years—but could last up to
5 years of age.
Describe Gonadotropin-dependent (central) precocious puberty: Including its etiology, clinical
presentation, next step in management of patient, and treatment? - Gonadotropin-dependent (Central)
precocious puberty:
1. Etiology:
a. Gonadotropin-dependent (central) precocious puberty results form premature activation of the
hypothalamic-pituitary-gonadal axis
2. Clinical Presentation:
a. Premature adrenarche (axillary and pubic hair)
b. Premature thelarche (breast development)
c. Premature menarche
d. *Advanced Bone Age*
e. *Luteinizing hormone* levels are high at baseline
,3. Next step in management of patient:
a. MRI of brain with contrast - need to rule out hypothalamic or pituitary tumors. Idiopathic
gonadotropin-dependent precocious puberty is a diagnosis of exclusion.
4. Treatment:
a. GnRH agonist therapy to prevent epiphyseal plate fusion and maximize adult height potential.
Describe Laryngomalacia: Including its pathophysiology, clinical presentation, and how its diagnosed? -
Laryngomalacia:
1. Pathophysiology
a. Increased laxity of supraglottic structures ("floppy" supraglottic structures)
2. Clinical Presentation:
a. Inspiratory stridor worsens when *supine* - Improves when prone or sitting up.
b. Peaks at age 4 - 8 months
c. Often patients will also have gastroesophageal reflux
3. Diagnosis:
a. Usually clinical
b. Diagnosis is confirmed by flexible laryngoscopy for moderate/severe cases
How do you differentiate acute otitis media versus otitis media with effusions? - *Acute Otitis Media*
1. Middle ear effusions plus acute eardum inflammation (e.g., bulging eardrum with pneumonatic
insufflation, fever).
*Otitis media with Effusions*
,1. Otitis media with effusions can be distinguished from acute otitis media by the lack of acute
inflammatory signs (e.g., fever, bulging of the tympanic membrane).
2. Children who recover from acute otitis media often have persistent effusions for weeks but do not
require ongoing antibiotic treatment.
Describe Cerebral Palsy: Including its clinical presentation and leading risk factor: - Cerebral Palsy:
1. Clinical Presentation - 3 primary subtypes:
a. Spastic Diplegia - hypertonia and hyperreflexia that involve predominantly the lower extremities with
both feet pointing down and inward (equinovarus deformity).
b. Dyskinetic
c. Ataxic
d. About half of patients have intellectual disability.
2. Leading risk factor:
a. *Prematurity before 32 weeks gestation* with spastic diplegia being the most common form.
How is meningitis managed in an infant > 1 month - 12 months of age? - Meningitis in an infant:
1. First: Lumbar puncture followed by second empiric antibiotics
a. Typically we do not use IV antibiotics first because it can sterilize CSF and make definitive diagnosis
difficult.
b. Herniation is extremely rare in infants with fontanelles still open so a CT imaging is almost always
unnecessary.
2. Antibiotics used:
a. Third generation cephalopsorins - ceftriaxone or cefotaxime
b. Vancomycin is given due to increase prevalence of resistant S. Pneumoniae
, Note: Ceftriaxone is not given in neonates (cefotaxime is used instead) due to it displacing bilirubin from
albumin and increasing the risk for kernicterus (billiary sledging)
Describe Acute Lymphoblastic Leukemia: Including its epidemiology, clinical features, and how its
diagnosed - Acute Lymphoblastic Leukemia
1. Epidemiology:
a. Most common childhood cancer
b. Peak age: 2 - 5 years
2. Clinical Features:
a. Bone pain
b. Lymphadenopathy
c. Hepatosplenomegaly
d. Lymphoblasts, anemia, thrombocytopenia
3. Diagnosis:
a. Bone marrow biopsy with >25% lymphoblasts.
Describe Pediatric Viral Myocarditis: Including its etiology, clinical presentation, and gold standard
diagnostic study - Pediatric Viral Myocarditis:
1. Etiology:
a. Coxsackie B Virus
b. Adenovirus
2. Clinical Presentation:
a. Viral Prodrome:
b. Heart failre: Dyspnea, syncope, tachycardia, nasuea, vomiting, hepatomegaly
What are the two types of breath-holding spells, are they pathological and at what age are breath-
holding spells common? - Two Types of breath-holding spells:
1. Cyanotic - Crying followed by breath-holding, cyanosis, & Loss of consciousness
2. Pallid - Minor trauma followed by breath-holding, pallor, diaphoresis & loss of consciousness
Are they Pathological?
1. Breath-holding spells are generally benign. Parents should be reassured that these spells are typically
harmless and children will still develop normally.
When should breath holding spells stop?
1. Breath-holding spells most commonly occur in children age 6 months to 2 years—but could last up to
5 years of age.
Describe Gonadotropin-dependent (central) precocious puberty: Including its etiology, clinical
presentation, next step in management of patient, and treatment? - Gonadotropin-dependent (Central)
precocious puberty:
1. Etiology:
a. Gonadotropin-dependent (central) precocious puberty results form premature activation of the
hypothalamic-pituitary-gonadal axis
2. Clinical Presentation:
a. Premature adrenarche (axillary and pubic hair)
b. Premature thelarche (breast development)
c. Premature menarche
d. *Advanced Bone Age*
e. *Luteinizing hormone* levels are high at baseline
,3. Next step in management of patient:
a. MRI of brain with contrast - need to rule out hypothalamic or pituitary tumors. Idiopathic
gonadotropin-dependent precocious puberty is a diagnosis of exclusion.
4. Treatment:
a. GnRH agonist therapy to prevent epiphyseal plate fusion and maximize adult height potential.
Describe Laryngomalacia: Including its pathophysiology, clinical presentation, and how its diagnosed? -
Laryngomalacia:
1. Pathophysiology
a. Increased laxity of supraglottic structures ("floppy" supraglottic structures)
2. Clinical Presentation:
a. Inspiratory stridor worsens when *supine* - Improves when prone or sitting up.
b. Peaks at age 4 - 8 months
c. Often patients will also have gastroesophageal reflux
3. Diagnosis:
a. Usually clinical
b. Diagnosis is confirmed by flexible laryngoscopy for moderate/severe cases
How do you differentiate acute otitis media versus otitis media with effusions? - *Acute Otitis Media*
1. Middle ear effusions plus acute eardum inflammation (e.g., bulging eardrum with pneumonatic
insufflation, fever).
*Otitis media with Effusions*
,1. Otitis media with effusions can be distinguished from acute otitis media by the lack of acute
inflammatory signs (e.g., fever, bulging of the tympanic membrane).
2. Children who recover from acute otitis media often have persistent effusions for weeks but do not
require ongoing antibiotic treatment.
Describe Cerebral Palsy: Including its clinical presentation and leading risk factor: - Cerebral Palsy:
1. Clinical Presentation - 3 primary subtypes:
a. Spastic Diplegia - hypertonia and hyperreflexia that involve predominantly the lower extremities with
both feet pointing down and inward (equinovarus deformity).
b. Dyskinetic
c. Ataxic
d. About half of patients have intellectual disability.
2. Leading risk factor:
a. *Prematurity before 32 weeks gestation* with spastic diplegia being the most common form.
How is meningitis managed in an infant > 1 month - 12 months of age? - Meningitis in an infant:
1. First: Lumbar puncture followed by second empiric antibiotics
a. Typically we do not use IV antibiotics first because it can sterilize CSF and make definitive diagnosis
difficult.
b. Herniation is extremely rare in infants with fontanelles still open so a CT imaging is almost always
unnecessary.
2. Antibiotics used:
a. Third generation cephalopsorins - ceftriaxone or cefotaxime
b. Vancomycin is given due to increase prevalence of resistant S. Pneumoniae
, Note: Ceftriaxone is not given in neonates (cefotaxime is used instead) due to it displacing bilirubin from
albumin and increasing the risk for kernicterus (billiary sledging)
Describe Acute Lymphoblastic Leukemia: Including its epidemiology, clinical features, and how its
diagnosed - Acute Lymphoblastic Leukemia
1. Epidemiology:
a. Most common childhood cancer
b. Peak age: 2 - 5 years
2. Clinical Features:
a. Bone pain
b. Lymphadenopathy
c. Hepatosplenomegaly
d. Lymphoblasts, anemia, thrombocytopenia
3. Diagnosis:
a. Bone marrow biopsy with >25% lymphoblasts.
Describe Pediatric Viral Myocarditis: Including its etiology, clinical presentation, and gold standard
diagnostic study - Pediatric Viral Myocarditis:
1. Etiology:
a. Coxsackie B Virus
b. Adenovirus
2. Clinical Presentation:
a. Viral Prodrome:
b. Heart failre: Dyspnea, syncope, tachycardia, nasuea, vomiting, hepatomegaly
