A Review of Pediatric Medical Conditions for the Physician Assistant Exam
For the Physician Assistant Exam, you will need to be familiar with a few pediatric medical conditions, such as jaundice, rotavirus, Reye’s syndrome, and other medical conditions specific to pediatric care.
You may see a question or two on the test concerning neonatal jaundice. The cause of icterus and jaundice in the neonate is the buildup of bilirubin in the body. This happens in most newborns and is referred to as physiologic jaundice.
Very high levels of bilirubin can cause kernicterus, a type of toxic neurologic encephalopathy. The most common type of therapy for physiologic jaundice is the use of phototherapy (light therapy), which helps the bilirubin break down into metabolites that are easier for the body, especially the kidneys, to eliminate.
Rotavirus and diarrhea
The rotavirus is the commonest cause of infectious diarrhea in the pediatric population. People transmit it by touching stool and then not washing their hands. Then they contaminate everything they touch. Think about children in daycare. If you’re a healthcare professional dealing with diapers and you don’t wash your hands, you can become a mode of transmission.
The clinical presentation of rotavirus can mimic that of other infectious diarrheas. It includes nausea, vomiting, and (of course) diarrhea. The treatment is supportive, including aggressive intake of fluids to prevent dehydration.
Infants can get a vaccine (RotaTeq or Rotarix) to prevent rotavirus. This vaccination is administered to babies beginning at 2 months of age.
Kawasaki’s disease (also called mucocutaneous lymph node syndrome) is a rheumatologic disorder that can affect the heart. You see Kawasaki’s in a higher percentage of children of Asian descent. The initial presentation can include a very high fever for several days. In addition, the child may have a characteristic “strawberry tongue” and a skin rash.
The rash typically begins as perineal erythema and desquamation, followed by macular, morbilliform, or targetoid skin lesions of the trunk and extremities. There’s significant adenopathy. If Kawasaki’s is left untreated, a possible side effect is vasculitis or aneurysm, especially of the coronary arteries. The treatment is prednisone.
Childhood avascular necrosis
Legg-Calvé-Perthes syndrome (Perthes disease) is a form of avascular necrosis in children. No one’s certain why it occurs, but there’s a problem with the blood flow to the head of the femur. The clinical presentation for a child is similar to an adult’s, where you see pain in the hip, the inguinal area, or even the knee. The child may present with a limp.
You can make the diagnosis by radiograph, but if it’s questionable, the MRI is a much better study. The treatment is to maintain strength and mobility in the joint. Extensive physical therapy is mandatory. Orthopedic surgery is done only when medical therapy doesn’t work.
One pediatric medical emergency that you can count on seeing on the test is Reye’s syndrome. This clinical syndrome can cause liver failure and brain injury. It can occur when a child takes aspirin or other salicylate derivatives in the setting of a viral illness. Diagnosing Reye’s early is important. In the worst-case scenario, Reye’s can result in encephalopathy, coma, and even death. The key is prevention.