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PGY1 > Pediatric > Flashcards

Pediatric Flashcards

1
Q

Investigations for eating disorders

A

CBC, lytes, extended lytes, thyroid, LH/FSH, estradiol, prolactin, BHCG, ECG if abnormal lytes, bone density (family MD)

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2
Q

Hospitalization requirements for anorexia nervosa

A

< 75% ideal body weight or ongoing weight loss despite intensive MGMT, refusal to eat, body fat < 10%, HR < 50 at daytime, < 45 at night, sBP < 90, orthostatic change in pulse > 20 or > 10 in sBP, T < 35.6, arrhythmia

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3
Q

Hospitalization requirements in bulimia nervosa

A

syncope, K+ < 3.2, esophageal tears/hematemesis, arrhythmias, suicide risk, intractable vomiting

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4
Q

SSRI of choice for children

A

fluoxetine

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5
Q

Chlamydia treatment ABx

A

azithromycin 1 g PO or doxycycline 100 mg BID x 7 days

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6
Q

Complications of chlamydia

A

chronic pelvic pain due to PID, ectopic pregnancy, infertility, reactive arthritis, epididymo-orchitis

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7
Q

To r/o in bartholian cysts

A

malignancy, STI (gonorrhea)

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8
Q

Abx of choice for gonorrhea

A

ceftriaxone 250 mg IM or cefixime 400 mg PO x 1 an azithromycin 1g PO x 1

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9
Q

MGMT of gonorrhea

A

Abx, sexual abstinence for 7 days, f/u cultures within 4 - 5 days post-tx, repeat screening after 3 months (not done with chlamydia)

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10
Q

Causes of Cyanosis with 1st hours

A

ToF, ebstein’s, pulmonary atresia

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11
Q

Definition of Ebstein’s anomaly

A

tricuspid valve is displaced towards apex of RV

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12
Q

Causes of cyanotic congenital heart disease

A

ToF, ebstein’s anomaly, TGA, trucus arteriosis, tricuspid atresia, total anomalous pulmonary venous return (TAPVR)

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13
Q

5Ts of cyanotic congenital heart defects

A

ToF (overriding aorta, VSD, PA stenosis, RV hypertrophy), truncus arteriosus (single trunk for aortic arch, pulm arteries and coronary arteries), TGA (RV –> aorta and LV to PA), tircuspid atresia (forces systemic venous return across ASD –> mixing of pulmonic venous return), TAPVR: PV not connected to LA

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14
Q

definition of patent ductus arteriosus

A

persistent patency of structure between L pulmonary artery and descending aorta

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15
Q

Signs of CHF in pediatric patients

A

2Ts and megalies: tachycardia, tachypnea, cardiomegaly, hepatomegaly

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16
Q

Pathological/Abnormal fractures in children

A

< 18 months, non-ambulatory children, metaphyseal, rib, scapula, vertebrae, sternum

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17
Q

Disorders to r/o in child abuse

A

birth injuries, osteomalacia, congenital syphilis, bone disorders (ricket’s, osteogenesis imperfecta, NM disorders, copper deficiency)

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18
Q

Definition of macule

A

flat, circumscribed area of colour change, < 1 cm; if greater, patch

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19
Q

Definition of papule

A

elevated palpable lesion, if > 1 cm plaque

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20
Q

Definition of vesicle

A

fluid-filled elevation (i.e., pus), If > 1 cm = bullae

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21
Q

Definition of pustule

A

circumscribed elevation of skin containing purulent exudate

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22
Q

Definition of nodule

A

palpable solid lesion, if > 1 cm tumour

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23
Q

Key skin disorders in newborns (5)

A

acne neonatorum, erythema toxicum neonatoroum, infantile hemangioma, milia, transient neonatal pustular melanosis

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24
Q

Acne neonatorum

A

closed comedones on corehead, nose and cheeks, resolves with 4 months without scarring

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25
Q

erythema toxicum neonatorum

A

pustular eruption on face/trunk/proximal extremities, sparing palms and soles. flea-bitten appearance. resolves over 5 - 7 days usually but up to several weeks

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26
Q

infantile hemangioma

A

benign vascular tumour, red appearance, may grow rapidly but ultimately resolves by age 12 at the latest, 50% by age 5

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27
Q

milia

A

1-2 mm pearly white or yellow papules often seen on forehead, cheeks, nose and chin, self-resolving with 3 months of life

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28
Q

transient neonatal pustular melanosis

A

vesiculopustular rash, seen in black newborns, can involve palms and soles; self limiting

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29
Q

diaper rash definition

A

beefy red plaques and confluent erosions, + fine scales, +painful, satellite papules and pustules on thigh/abdomen, involving skin folds; MGMT: topical antifuncal 1% clotrimazole

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30
Q

contact dermatitis definition

A

shiny erythematous rash, macerations and erosions, skin folds are NOT involved (the line of the diaper); MGMT: barrier cream

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31
Q

Skin disorders of childhood (5)

A

scabies, impetigo, tinea, urticaria, molluscum contagiosum

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32
Q

Definition of exanthem

A

skin eruption + fever, always involves the mucosa (check the mouth)

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33
Q

Measles Presentation

A

morbiliform rash starting from hairline down (face/neck/trunk), 3Cs (conjunctiva, coryza, cough), koplik spots on buccal mucosa; infectious 4 days before and after rash requiring respiratory isolation, MGMT: vitamin A, Ig +MMR vaccine for contacts. complications: pneumonia, OM, encephalitis, myocarditis

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34
Q

Rubella presentation

A

pink maculopapular rash on face/neck/trunk, occipital and retroauricular nodes, low grade fever; MGMT: symptoms. complications: STAR - sore throat, arthritis, rash, congenital anomalites if during pregnancy (TORCH)

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35
Q

Roseola presentation

A

pink maculopapular rash (HHV-6), MGMT: symptoms. complications: febrile seizures

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36
Q

Erythema infectiosum presentation

A

parvovirus B19; slapped cheeks, can be provoked with exercise or sun exposure. MGMT: STAR, glove & stocking distribution, aplastic crisis in SCD

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37
Q

Chicken pox presentation

A

incubation is 21 days, ithcy vesiculobullous rash with crusts, dew drops on rose pedals; MGMT: symptoms, Complications: bacterial super-infections, necrotizing faschiitis, CNS: encephalitis, cerebellar ataxia, hepatitis, DIC

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38
Q

Herpes Simplex presentation

A

grouped vesicles with erythematous base; MGMT: topical or oral antivirals; Complications: encephalitis, hepatitis, skin infections, keratitis, gingivostomatitis, DIC

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39
Q

Hand-foot-mouth disease presentation

A

Coxsackie disease; vesicles and pustules with eruthematous base involving tongue, posterior pharynx. MGMT: symptoms. Complications: dehydration

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40
Q

Gianotti-Crosti syndrome

A

associated with EBV/HBV/coxsackie/parvovirus; acrodermatitis (involving hands and feet) papular, preceeding viral prodrome; MGMT: self-limiting

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41
Q

Scarlet Fever presentation

A

GAS: generalized red papules with sand-paper texture, flexural accentuation (pastia’s lines), desquamation, strawberry tongue, petechie on palate; MGMT: penicillin V/ampicillin/amoxicillin; complications: pneumonia, pericarditis, meningitis, hepatitis, glomerulonephritis, rheumatic fever

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42
Q

Kawasaki disease presentation

A

fever 5+ days and 4/5 of: unilateral LN, red/cracked lip/strawberry tongue, edema, erythema of palms and soles, generalized maculopapular rash, non-purulent bilateral conjunctivitis; MGMT: aspirin high-dose, IVIG, baseline ECHO and repeat in 6 months; complications: coronary artery aneursym

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43
Q

Dermatitis definition

A

red, inflammatory skin changes with poorly demarcated borders

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44
Q

Common types of dermatitis in pediatric patients (4)

A

contact dermaitits, atopic dermatitis (eczema), seborrheic dermatitis, nummular dermatitis, scabies

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45
Q

Eczema definition & MGMT

A

papules/plaques of edema and erythema +/- excoriation/lichenification, dry skin, pruritus; MGMT: skincare (emollients and moisturizers), topical corticosteroids for flare control (mid to high potency), lower potency for maintenace, topical calcineurin inhibitors

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46
Q

Distribution of eczema as per age group

A

infants: face + extensors
toddlers: flexural surfaces
adults: face, dorsum of feet, hands and eyelids

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47
Q

Eczema herpeticum definition & MGMT

A

severe and lethal complication of atopic dermatitis (eczema) due to superimposed HSV infection; Complications: blindness, mortality Sx: fever + grouped punched-out erosions; MGMT: high-dose systemic antiviral therapy, optho consult

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48
Q

Papulosquamous Disorders definition + common types in pediatric patients (4)

A

red, itchy, scaly lesions with well-defined borders, hyperkeratotic and well-demarcated; psoriasis, pityriasis rosea, tinea, corporis, drug eruptions

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49
Q

Psoriasis definition + MGMT

A

papulosquamous plaques with silvery scale; Auspitz sign: bleeding with removal of scales; nail involvement, arthritis, pruritus, involving extensor surfaces, scalp, genitalia, gluteal folds

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50
Q

Night terrors vs. nightmares

A

Night terrors: 1st third of the night, +autonomic agitation, high arousal threshold, agitated if awakened, no daytime sleepiness or recall of event; Nightmares: lasts 3rd of sleep (REM), +/- autonomic agitation, low arousal threshold, agitated after event, can have daytime sleepiness and frequent vivd recollection of event

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51
Q

Primitive Reflexes:

A

Root (0-4 months), Suck (0 - persists), Hand-toe grasp (0 - 3 months), Moro (0 - 6 months), asymmetric tonic neck reflex (2wks - 6 months), protective equilibrium (4 mos - persistent), parachute rection (8 months - persistent)

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52
Q

Pediatric hypoglycemia DDx

A

endocrine vs. non-endocrine; Endocrine ketosis, GH deficiency, panhypopituitarism, ACTH deficiency, addison’s disease, excess exogenous insulin; Non-endocrine: sepsis/shock, liver disease, ingestion, inborn error

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53
Q

signs and sx of hypoglycemia

A

tremors, sweating, weakness, tachycardia, nervousness, hunger, neuroglycopenic - lethargy, irritability, confusion, hypothermia, seizures, coma

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54
Q

Inv for hypoglycemia NYD

A

CBC+lytes, VBG, GH, cortisol, FFAs, beta-hydroxybutyrate, lactate, NH4, etc. ketones, substances

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55
Q

MGMT of hypoglycemia in infants:

A

treat if < 3.3 + symptoms or < 2.8 mmol/L; 5 mL/kg of D10W or 2ml?kg of D25W bolus, continuous dextrose to maintain glucose, if no IV access, glucagon IM or SC (0.03 - 0.5 mg/dose for children < 20 kg; 1mg/dose for > 20 kgs) q20 mins

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56
Q

SVT vs sinus tachy in pediatric patients

A

SVT: >220 BPM if < 1 yo; > 180 if > 1 yo

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57
Q

Definition of shock

A

inadequate blood flow and oxygen delivery to meet tissue metabolic demands

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58
Q

Signs of Compensated shock vs. Decompensated shock

A

Compensated: normal sBP, tachycardia, cool and pale distal extremities, delayed cap refill, weak peripheral pulses vs. central; decompensated: hypotension + depressed mental status, decreased U/O, metabolic acidosis, tachypnea, weak central pulses, colour changes (mottling)

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59
Q

Initial MGMT of Shock

A

ABCs: position the patient, optimize oxygen content, support ventilation, establish lines; frequent assessment of vitals, ancillary tests, specific treatments; INV: CBC, lytes, curea, Cr, glucose, CRP, lactate, ABG, VBG, blood cx, imaging

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60
Q

Trendelenburg improves circulation in shock: T or F?

A

false (CJEM 2004; Johnson et co): does not improve circulation, detrimental effects on RVEF, head injuries and IOP, aspiration, pulmonary disorders

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61
Q

Glucose MGMT for pediatric patients

A

**in all critically ill or injured children perform rapid glucose test to r/o hypoglycemia as a cause or contributing factor to poor clinical status: MGMT: newborns: D10W 5 - 10 mL/kg; infants and children: D25W 2 - 4 mL/kg; Adolescents: D50W 1-2 mL/kg

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62
Q

Hypoglycemia MGMT for pediatric patients: rule of 50s

A

D10W x 5ml/kg; D25W x 2 ml/kg; D50W 1 ml/kg

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63
Q

DDx for tachypnea in the newborn(9)

A

respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), pneumothorax, meconium aspiration, hypoglycemia, hypothermia, cardiac abnormalities (cyanotic vs. noncyanotic), neonatal sepsis, congenital diaphragmatic hernia

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64
Q

H&P for respiratory distress in newborn

A

Birth history: C/S vs. SPV, maternal health factors, GBS, drug use, ROM prolonged?, maternal fever/infections, meconisum in amniotic fluid, birth weight, APGAR score

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65
Q

APGAR score

A

normal: 8+; A:appearance (pale, pink), Pulse (absent, below or over 100), grimace (floppy, responding to stimulation), activity (muscle tone), respiration (crying, slow, etc.)

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66
Q

Fluid resuscitation in neonates

A

4-2-1 rule does NOT apply to neonates; use D10W until second day of life (inability to concentrate fluids)

67
Q

Fluid resuscitation in infants + children

A

maintenance fluid: D5W0.9%NaCl + K

68
Q

Severity of dehydration: mild

A

<5%; HR is slightly elevated, normal sBP, UO is slightly decreased, mucous membrane is slightly dry, thirst is slightly increased; normal LOC, normal anterior fontanelle, normal eyes and skin turgor

69
Q

Severity of dehydration: moderate

A

elevated HR, can have normal sBP, decreased UO, dry mucous membranes, sunken anterior fontanelle, sunken eyes, decreased skin turgor, moderately increased thirst

70
Q

Severity of dehydration: severe

A

++tachycardia, hypotensive, marked decreased UO/anuria, very dry mucous membranes, very sunken anterior fontalle, very sunken eyes, tenting of skin, greatly increased thirst, lethargy or coma

71
Q

MGMT of mild dehydration

A
  1. rehydrate 50 mL/kg ORT over 4 hours; 2. replace ongoing losses
72
Q

MGMT of moderate dehydration (5 - 10%)

A
  1. rehydrate with 100 mL/kg ORT over 4 hours; 2. replace ongoing losses
73
Q

MGMT of severe dehydration

A
  1. resuscitate with NS 20 mL/kg IV bolus; 2. reassess and repeat if necessary; 3. rehydration once patient is stable; 4. replace ongoing losses
74
Q

Contraindications for ORF

A

severe vomiting, severe dehydration, hemodynamic instability, impaired LOC, ileus,

75
Q

Fluid choice for resuscitation in pediatric patients

A

NS first. no D5W or K+ (only for maintenance; add K+ once voiding)

76
Q

Gastroenteritis Sx and MGMT

A

rotavirus; duration 3 - 7 days, viral –> bacterial after 2+ yo; Inv: stool analysis, cultures, C.Diff; MGMT: fluid replacement, ORF, nausea control; Complications: hypovolemia, electrolyte imbalance, shock, tissue acidosis, cerebral edema from hyponatremia, pontine myelinolysis due to rapid correction

77
Q

DDx for vomiting in newborns

A

newborn: meconium ileus, malrotation with midgut volvulus, intestinal atresia, necrotizing enterocolitis, inborn errors

78
Q

DDx for vomiting in infants (0 - 3 months)

A

pyloric stenosis, GERD, milk/soy allergy, malrotation

79
Q

DDx for vomiting in children (3+ months)

A

intussusception, intracranial mass, gastroenteritis

80
Q

Definition of chronic diarrhea

A

2+ weeks of stool frequency, consistency, volume and duration of symptoms

81
Q

Types of diarrhea:

A

osmotic, secretory, dysmotility, inflammatory, infectious

82
Q

DDx of diarrhea without FTT

A

infectious, malabsoprtion (toddler’s diarrhea up to 3 years of life), IBS, medications

83
Q

DDx of diarrhea with FTT

A

autoimmune (celiac disease, allergic, eosinophilic gastro, IBD), immune deficieincy (HIV), malabsorption (CF, pancreatic insufficienc), GI protein loss (lymphatic obstruction, mucosal), bowel obstruction/dysmotility (Hirschsprung’s disease), neuroendocrine tumours

84
Q

DDx of RUQ abdo mass

A

liver mass

85
Q

DDx of RLQ abdo mass

A

appendix, abscess, lymphoma, ectopic kidney, ovarian/testicular mass

86
Q

DDx of LUQ mass

A

kidney (MCD, polycystic, hydronephrosis, renal vein thrombosis), neuroblastoma, Wilm’s tumour, adrenal hemorrhage

87
Q

DDx of periumbilical

A

GI duplication, mesenteric cyst, omental cyst, urachal cyst, meconium pseudocyst, pancreatic cyst

88
Q

DDx of chronic abdo pain

A

GI: constipation, IBS, lactose intolerance, esophagitits/gastritis, celiacl disease, PUD, IBD, parasitic infection, recurrent pancreatitis; GU: dysmenorrhea, endometriosis, ovarian cyst; Neuro: migraine/abdo migraines; ENDO: hyperparathyroidism (hypercalcemia), addison’s disease; CVS: superior mesenteric artery syndrome; HEME: SCD, leukemia/lymphoma, porphyria; Other: recurrent abdominal pain of childhood

89
Q

DDx of Constipation

A

functional vs. organic; organic causes: hypothyroidism, DM, hypercalcemia, Hirschsprung’s, SCI, CF, celiac disease, bowel obstruction, anal abnormalities, drugs

90
Q

Hirschsprung’s disease signs and symptoms

A

passage of meconium > 48 hrs after delivery, FTT, small stools, bilious vomiting, tight anal sphincter

91
Q

Recurrent Abdo Pain of Childhood Dx and MGMT

A

Dx: rule of 3s - 3+ attacks for ages 3+ over 3+ months; r/o constipation, abdo migraine, PUD, IBD, biliary colic, UPJ/renal colic, ovarian cyst celiac disease, parasitic infections, conversion reactions; MGMT: support

92
Q

Red Flags of Abdo Pain for pediatric patients

A

FTT, weight loss/growth delay, fever, joint pain, oral lesion, rash, rectal bleeding, localized pain away from umbilicus, rebound tenderness, radiation to back/shoulder/leg, nocturnal pain, N/V, diarrhea, encoperesis

93
Q

Pyloric Stenosis Dx and MGMT

A

3weeks - 3 months; M»F, associated with erythromycin use in first 2 weeks; Sx: projectile vomiting, nonbilious, dehydration, hungry, weight loss; +palpable olive-like mass at RUQ; Inv: US abdo, electrolytes (hypochloremic hypokalemic metabolic alkalosis from excessive vomiting); MGMT: NPO, NG tube, rehydration with IV NS, surgery

94
Q

Malrotation Dx and MGMT

A

due to abnormal embryological development at week 4 GA; Dx: any rotation < 270 degrees counterclockwise; Complications: volvulus, bowel ischemia; Sx: bilious vomiting, crampy abdo pain, abdo distension, mucous and blood in stool; Inv: AXR - gastric outlet obstruction: large gastric bubbles; duodenal obstruction: double-bubble sign, multiple air fluid levels, dilated bowel loops; Inv: upper gI series, contrast enema, abdo US; MGMT: NPO, NGT, fluid resuscitation, broad-spectrum antbiotics, urgent surgical intervention; Complications: short bowel syndrome

95
Q

Causes of Respiratory Distress in a Newborn

A

sepsis, RDS, TTN, meconium aspiration congenital pneumonia, air leak/PTX, structural abnormality, cardiac

96
Q

Definition of transient tachypnea of newborn

A

“wet lung” appearance on CXR; respiratory distress that resolves within 3- 5 days; delayed reabsorption of lung fluid; MGMT: ventilatory support and oxygentation, antibiotic coverage and gavage feeds; risk of air leak

97
Q

Definition of Meconium Aspiration Syndrome

A

in utero passage of meconium with aspiration –> airway obstruction and chemical pneumonitis; MGMT: ventilation, oxygenation, antibiotics, surfactant

98
Q

CXR finding for Tetraology of Fallot

A

boot-shaped heart

99
Q

Respiratory Causes of Cyanosis in the Newborn

A

RDS, TTN, MAS, PNA, congenital lung disease

100
Q

Cardiac causes of cyanosis in the newborn

A

TGA, TOF, TA, TAPVD, trucus arteriosus, pulmonary atresia, ebstein’s anomaly of teh tricuspid valve

101
Q

Non-resp/cardiac causes of cyanosis in the newborn

A

sepsis, polycythemia, methylhemoglobinemia, meningitis, ICH, drugs, hypothermia, hypoglycemia

102
Q

Hyperoxic test method

A

baseline pO2 in RA then 100% oxygen for 10-15 mins then ABG; failed hyperoxic test: PaO2 < 150 in 100% O2. if > 100, likely lung; 50 - 100: heart or lung, < 50: likely heart

103
Q

Method and reasoning behind pre-post ductal sat

A

Pre duct: R arm and head; post ductal: lower limbs or umbilical artery

104
Q

Bilirubin level where jaundice is visible

A

85 - 120 umol/L

105
Q

Opisthotonos definition

A

seen in kernicterus - tetanic spasm where spine and extremities are bent, back arched body is resting on heads and heels

106
Q

Clinical sx of kernicterus

A

poor sucking, stupor, hypotonia, seizures –> hypertonis, opisthotonus, retrocollis, fever, hypertonia

107
Q

Causes of conjugated hyperbilirubinemia

A

TORCH, sepsis, hepatitis, metabolic (alpha1 antitrypsin, galactosemia, hypothyroidism, CF), drugs, TPN, idiopathic, biliary atresia, choledochal cyst

108
Q

MGMT of jaundice

A

phototherapy, IVIG, exchange transfusion

109
Q

Hypoglycemia in infants RF

A

DM, LGA infants (hyperinsulism), prematurity, SGA

110
Q

Sx of hypoglycemia in infants

A

apnea, cyanosis, lethargy, seizures

111
Q

Definition of neonatal hypoglycemia

A

2.6 mmol/L or less

112
Q

MGMT of neonatal hypoglycemia

A

< 2.0 immediately after feeds or < 1.8 mmol/L at 2 hours post feed = IV dextrose; if persistently < 2.6 mmol/L despite multiple feeds = IV dextrose

113
Q

Definition of hemolytic uremic syndrome

A

triad of MAHA, thrombocytopenia, AKI; most common cause of renal failure in pediatric patients; Typical (D+HUS e.coli toxin, assocaited with abdo pain, diarrhea, bloody diarrhea) vs. Atypical (S.pneumo, drugs, collagen disease, genetics)

114
Q

Inv for HUS

A

CBC+diff, Cr, BUN, haptoglobin, LDH. coomb’s, UA

115
Q

MGMT of HUS

A

supportive, dialysis, transfusions, plasmapheresis, do not give antibiotics

116
Q

When to do a rectal temperature?

A

anyone < 3 yo

117
Q

Temperature associated with brain damage

A

> 41.5 degrees celsius

118
Q

Correlation between bacteremia and temperature

A

duration (number of days) vs. actual degrees

119
Q

T or F: child with tactile fevers correlates well with true fever

A

Yes! be sure to do a thorough assessment, ask about antipyretics

120
Q

Pediatric doses of tylenol

A

15 mg/kg q6hrs

121
Q

Pediatric doses of of advil

A

10 mg/kg q8hrs

122
Q

Vital Sign Changes to fever for every 1 degree

A

RR +5 for 1 degree; HR by 10 for 1 degree above 38

123
Q

Normal vital signs for Infant (0 - 6 mo)

A

HR: 100 - 160; RR: 30 - 60; BP: 65 - 90 sBP

124
Q

Normal vital signs for 6 - 12 months

A

HR 100 - 160; RR: 24- 30; sBP 80 - 100

125
Q

Normal vital signs for 1 - 5 yo

A

HR: 70 - 120; RR 20 - 30; sBP: 90 - 110

126
Q

Normal vital signs for 6 - 11 yo

A

HR: 70 - 120; RR: 12 - 20; sBP: 90 - 110

127
Q

DDx for abnormal vital signs after fever correction

A

dehydration, early compensated shock, early sepsis; ask about perfusion, mentation and urine output

128
Q

Difference between fever without a source vs. fever of unknown origin

A

Fever without source: no identifiable source after complete H&P; unknown origin: 2+ weeks of fever without identifiable source despite investigations

129
Q

Types of Serious Bacterial Infections

A

UTI, PNA, bacteremia, meningitis

130
Q

(5) most common sources of fever/infection

A

“LUCAS” - lungs, urine, CNS, abdo, skin

131
Q

UTI RF in pediatric patients

A

< 24 months F; < 24 M uncircumsized, < 6 mo M circumsized, fever for 2+ days, fever > 39 degrees, +hx of UTI

132
Q

T or F; urine dipstick in not toilet-trained kids is accurate

A

F: these patients can be urinating too often and not let the urine incubate

133
Q

Indications for admission for UTI

A

< 2 months, dehydration, sepsis

134
Q

F/u for UTI in < 2 yo

A

outpatient ultrasound to look for vesico-ureteral reflux and structural anomalies

135
Q

Abx of choice for UTI

A

outpt: cephalexin; in hospital: IV amp + gent

136
Q

Signs and Sx of PNA in pediatric patients

A

URTI several days then fever, fever > 5 days, cough > 10 days, temp > 40 degrees, increased WOB, tachypnea, WBC: >20 000

137
Q

Indications for BW in pediatric patients:

A

if patient is well and immunized, no BW needed.

138
Q

FSWU Definition:

A

CBC, blood cx, UA, urine cx, CSF (cell, culture, stain, protein, glucose, viral studies)

139
Q

HSV meningitis indications

A

if meningitis, start IV acyclovir; highest risk if < !4 days old; can cause hepatitis and pneumonitis

140
Q

Low risk criteria for 1 - 3 months febrile infants

A

no obvious source, no complex history, WBC 5 - 15, normal UA, normal stool WBC, normal CXR; if all these criteria met, 1.5 % chance of SBI

141
Q

age group for croup

A

6mo - 3yo

142
Q

Sx for croup

A

stridor, sore throat, seal/barky cough, rhinorrhea, low grade fever, sx worse at night

143
Q

most common pathogen for croup

A

parainfluenza, influenza, RSv, adenovirus

144
Q

invesgtigations for croup

A

clinical, CXR shows steeple sign from subglottic narrowing

145
Q

anatomy involved in croup

A

laryngotracheobronchitis; supglottic laryngitis

146
Q

MGMT for croup

A

stridor at rest = EMERGENCY! no evidence for humidified O2; dexamethasone PO 1 dose, racemic epi, neb 1-3 doses q1-3 hr if unwell/resp distress, intubation if not responding to treatment

147
Q

epiglottitis affected anatomy

A

supraglottic laryngitis

148
Q

pathogens invovled in epiglottitis

A

h.flu, beta hemolytic strep

149
Q

age range for epiglottitis

A

2yo - 6yo

150
Q

sx and signs for epiglottitis

A

very sick!! rapid progressions, 4Ds - drooling, dysphagia, dysphonia, distress; stridor, tripod position,

151
Q

investigation for epiglottitis

A

avoid examining throat to prevent further exacerbation; it is clinical! CXR thumbprint sign

152
Q

MGMT of epiglottitis

A

intubation, antbiotics, Hib vaccine

153
Q

bacterial tracheiitis age

A

all ages!

154
Q

pathogen for bacterial tracheiitis

A

strep, s.aureus, GAS, M catarrhalis

155
Q

sx for bacterial tracheiitis

A

more rapid deterioration than group, high fever, toxic

156
Q

investigation for tracheiitis

A

endoscopy for definitive diagnosis, clinical otherwise

157
Q

anatomy involved for bacterial tracheiitis

A

subglottic tracheitis

158
Q

MGMT for tracheitis

A

Abx, intubation

159
Q

HSP Definition

A

IgA vasculitis seen in ages 4- 6 yo

160
Q

HSP Sx

A

“ARENA” - abdo pain, rash, edema, nephritis, arthritis/arthralgias

161
Q

DDx for HSP

A

DIC, acute abdomen, testicular torsion, systemic vasculitis/rheum, ITP, TTP, HUS, endocarditis, meningococcemia

162
Q

HSP abdo complication

A

intussussception

163
Q

HSP rash distribution

A

lower extremities/pressure dependent areas (gravity)

164
Q

Investigations for HSP

A

CBC, lytes, coag, ESR/CRP, stool guaiac

PGY1 (12 decks)

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