5 Flashcards
(51 cards)
What are some important physical exam findings for pneumonia?
tachypnea, dyspnea, crackles, decreased breath sounds.
When should sinusitis be considered in ddx?
symptoms > 10 days worsening, or severe
What should you look for in an ear exam (COMPT)?
C = Color (gray, white, red or yellow)
O = Other (bubbles, air-fluid interface, scarring, or perforation)
M = Mobility (absent, reduced, normal, or hypermobile)
P = Position (normal, retracted, or bulging)
T = Translucency (opaque or translucent)
Rather than color, what two things are more important predictors of AOM?
Position and mobility - many things can cause TM to be red
What does a normal ear look like?
translucent TM that is in neutral or retracted position with normal mobility.
What are some risk factors for development of AOM?
Day care attendance Tobacco exposure Allergies Bottle propping at bedtime Pacifier use Drinking formula from a bottle rather than breastfeeding Significant family history of AOM Male gender Lower socioeconomic status Respiratory allergies
What are two common bugs in AOM?
S. pneumo and Haemophilus Influenza
Ear exam indicates AOM in L ear, temp has been < 39 and child is consolable. Are abx a must?
NO, specifically because unilateral and lower temp. Discuss with parent.
How do you categorize severe AOM?
Toxic-appearing, persistent pain for 48 hours, or Fever > 39 C
Who should get tympanostomy tube placement?
OME > 4 months + hearing loss, language or developmental delay, structural abnl of ear
What physical exam findings reflect hydration status?
Weight HR, BP fontanel, eyes sunken, mucous membranes Skin turgor, temperature, cap refill Mental status/level of activity
A kid ways 30000 g last week and repeat weight is 29500 this week after viral gastroenteritis. What percent of weight has he lost? How dehydrated is he?
500/30000 = 1.7% = < 3% is MILDLY DEHYDRATED1
What percent dehydration is SEVERE?
> 9%
Kid is lethargic, has mottled skin, heart rate is bradycardic. How dehydrated is the kid?
Severely, >9% fluid weight lost
What is the regimen for ORT of mildly-moderately dehydrated children?
50-100mL/kg total volume over 2-4 hours in small aliquots
If bowel obstruction is above the ligament of treitz, will vomiting be billious?
NO
Pyloric stenosis = ABOVE = NON-bilious
What symptoms do you expect with intussesception?
bilious emesis, crampy/intermittent abdominal pain, bloody stool
In a vomiting child without fever, should you consider etiologies due to increased intracranial pressure?
YES - hydrocephalus, intracranial neoplasm, and trauma (accidental or non-accidental)
Are sx of UTI non specific in infants?
YES - fever, poor feeding and vomiting, leading to dehydration
What electrolyte abnormalities do you expect with pyloric stenosis?
metabolic alkalosis, hypochloremia, hypokalemia
What is the maintenance fluid algorithm for children?
For the first 10 kg, 4mL/kg/hour
For the second 10 kg, 2mL/kg/hour
For any additional kg, 1mL/kg/hour
You are determining ongoing fluid losses for a child in the PICU. What should you take into account?
vomiting, diarrhea, NG output, and insensible losses (fever, tachypnea)
What is the anion gap equation and what is a normal number?
(Na + K) - (Cl + HCO3)
Normal is < 11
What is Cushing’s triad (signs of cerebral edema and increased ICP)?
Hypertension, bradycardia, irregular respirations
