1. Differential of syncope in a pediatric patient:
-General: dehydration, vasovagal, orthostatic, heat, hypoglycemia
-Cardiac: structural (HOCM) vs arrhythmogenic (WPW, long QT)
-CNS: seizures
-Psych
-Tox
-Pregnancy
2. Sarcoidosis: non-caseating granulomas that can cause restrictive heart/lung disease, LAD particularly in parotid/salivary glands, and sjogren's like symptoms. It can also be associated with vitamin-D toxicity (from macrophages).
3. Males that present with classic congenital adrenal hyperplasia will present at birth with (subtle) scrotal darkening, and will present 1 week later with symptoms of salt wasting-- they will appear toxic, will be vomiting, dehydrated. DDx for these symptoms: sepsis, congenital heart failure, metabolic syndromes.
4. Primary amenorrhea: defined as lack of onset of menses by age 14 (absence of other secondary sexual characteristics) or age 16 (in presence of secondary sexual characteristics). Differential:
-Anatomic: lack of uterus (mullerian agenesis, androgen insensitivity, etc), imperforate hymen
-Hormonal: turners (most common cause of primary amenorrhrea-- look at growth chart), hyper/hypothyroid, CNS tumors affecting pituitary/hypothalamus.
Workup: FSH, LH, TSH, bone age.
5. Differential of acute-onset scrotal pain:
-Torsion: very acute onset, afebrile, no cremasteric reflex, nausea is frequent
-Epididymitis: slightly less acute onset, febrile, +cremasteric reflex, +prehn's sign (questionable how good it is to differentiate epididymitis from torsion; upward lifting of scrotum alleviates pain)
-Trauma
-Incarcerated Hernia
-Orchitis
6. Most common causes of dysfunctional uterine bleeding-- menorrhagia, metrorrhagia, menometrorrhagia
-bleeding diathesis-- 25% of cases of von willebrand's disease are diagnosed at the onset of menses
-foreign object (tampon)
-trauma
-pregnancy-related: ectopic, previa, abruption
-PID
-birth control, esp progesterone-only
7. Management of DKA in kids: first NS bolus 10mg/kg in first hour, if necessary another 10mg/kg over the next hour. After the fluid repletion is complete, insulin drip 0.1 units/kg per hour. Do not bolus insulin.
8. Ecoli sepsis in a newborn-- think galactosemia
9. Latrotoxins (venom of the black widow family of spiders) contain tetrameric proteins that bind receptors at presynaptic nerve terminals and form pores that allow the influx of divalent cations, notably Ca, causing continuous nerve depolarization.
10. Fox fact: foxes belong to the canidae family. Male foxes are called reynards, and females vixens. They live in small family groups, and they are omnivores, hunting small game (rodents), but also eating insects and fruits.