Ped Flashcards

Question

Facteurs de risque d'étiologies graves d'un ALTE à l'histoire, l'examen physique et aux ATCD

Answer 1

ATCD: prématurité, comorbidités, moins d'un mois, ATCD de ALTE Histoire: changement de couleur vers bleu, absence de choking, absence de IVRS, plus d'un événement en 24hr EP: examen physique anormal

Answer 2

TAM = âge gestationnel en semaines

Answer 3

Indications for intubation in newborns born through MSAF are the same as those for all neonates; meconium aspiration should only be performed if indicated for signs of airway obstruction secondary to meconium that do not improve despite standard resuscitative measures, including warming and drying and initiation of effective positive-pressure ventilation (PPV)

Answer 4

Resuscitation is not currently recommended for neonates with a confirmed gestational age less than 23 weeks, those with birth weight less than 400 g, and those with confirmed anencephaly, trisomy 13, or trisomy 18. Après 10 minutes sans ROSC

Answer 5

diaphragmatic hernia include barrel chest, ipsilateral absence of breath sounds, tracheal or point of maximum cardiac impulse displacement, and scaphoid abdomen

Answer 6

Ductal-Dependent Pulmonary Blood Flow: Critical pulmonary stenosis, atresia Severe tricuspid stenosis, atresia Severe tetralogy of Fallot Ductal-Dependent Systemic Blood Flow: Hypoplastic left heart syndrome Critical aortic stenosis Interrupted aortic arch

Answer 7

MR SOPA M: Mask adjustment R: Reposition airway S: Suction mouth and nose O: Open mouth P: Pressure increase A: Airway alternative DOPE D: Displacement of ETT O: Obstruction of ETT P: Pneumothorax E: Equipment failure

Answer 8

SOP si \>15mL/kg initialement ou \> 2mL/kg/hr

Answer 9

With signs of herniation, consider 3% hypertonic saline 6.5–10 mL/kg IV (or mannitol 0.25 to 0.5 g/kg IV), if possible elevate the head of the bed, keep the facing forward, and hyperventilate to a PCO2 of 30 to 35 mm Hg. Maintain CPP of at least 50 mm Hg in children and 70 mm Hg in adults.

Answer 10

drainage supérieur à 15mL/kg initialement ou 2cc/kg/hr

Answer 11

Transfusion massive si \>40cc/kg de sang Ratio 1:1:1

Answer 12

après une fx du crâne, déchirure de la couche durale avec protusion des leptoméninges

Answer 13

Patients older than 3 years old do not require imaging if they are alert, have no midline tenderness, neurological deficit, painful distracting injury, unexplained hypotension, or intoxication. In addition to the aforementioned criteria, children younger than 3 years old generally do not require cervical spine imaging if their mechanism of injury is not a MVC, suspected nonaccidental trauma, or a fall from a height of more than 10 feet. Cervical spine imaging should be performed for children not meeting the aforementioned criteria

Answer 14

Ratio Power sup 1 (AB/CD) suggère lésion ligamentaire

Answer 15

Choc spinal \> D1 Choc neurogénique \> D6

Answer 16

BE FIVE PM Blood cultures Echo + Mineurs: Condition prédisposante: valve, UDIV Fièvre Immuno (osler, roth) vasculaire (janeway Echo anormale sans critère majeur Microbio evidence

Answer 17

- Détresse respiratoire importante - Sx inhabituels - Persistance de stridor au repos après cortico et épi ATCD maladie pulmonaire/cardiaque/immuno Déshydratation Tachycardie ou tachypnée persistantes

Answer 18

This test consists of assessment of the rise in arterial oxygenation with the administration of 100% oxygen. An arterial blood gas is measured after several minutes on high-flow oxygen (100% oxygen). When the child is breathing high-flow oxygen, an arterial oxygen partial pressure (PaO2) of more than 250 mm Hg virtually excludes hypoxia due to CHD—a “passed” hyperoxia test.5 An arterial oxygen reading of less than 100 mm Hg (in a child without obvious pulmonary disease) is consistent with a right-to-left shunt and is highly predictive of CHD—a “failed” hyperoxia test. Values between 100 and 250 mm Hg may indicate lesions with intracardiac mixing

Answer 19

The three classic cardiac silhouettes seen in patients with congenital heart defects are the “boot-shaped heart” of tetralogy of Fallot lot (Fig. 170.4), the “egg-on-a-string” silhouette of transposition of the great arteries, and the “snowman-shaped” or “figure-of-eight” heart of total anomalous pulmonary venous return.

Answer 20

Strep viridans et staph aureus

Answer 21

Significant risk factors for coronary aneurysmal formation include male gender, age younger than 1 year old, or older than 8 years old, prolonged febrile period longer than 10 to 14 days, early myocarditis, anemia (hemoglobin \<10 g/dL), white blood cell count more than 30 × 103/hpf, increased band count, elevated ESR, elevated CRP level, low serum albumin levels, aneurysms involving other arteries (renal, axillary, or iliac), and giant coronary aneurysms (\>8 mm in diameter)

Answer 22

Physiologic jaundice of the newborn Breast milk jaundice ABO incompatibility Physiologic breakdown of birth trauma hematoma (cephalhematoma) Intracranial/intraventricular hemorrhage Spherocytosis, elliptocytosis Sickle cell anemia Thalassemia Glucose-6-phosphate dehydrogenase deficiency Pyruvate kinase deficiency TORCHS infections Urinary tract infection Sepsis Meconium ileus Hirschsprung’s disease Duodenal atresia Pyloric stenosis Galactosemia Congenital hypothyroidism Crigler-Najjar syndrome Gilbert’s syndrome

Answer 23

TORCHS infections Urinary tract infection Gram-negative sepsis Listeriosis Tuberculosis Hepatitis B Varicella Coxsackievirus infection Echovirus infection HIV infection Biliary atresia Choledochal cyst Bile duct strictures Inspissated bile syndrome Neonatal hepatitis Alagille syndrome Byler’s disease Congenital hepatic fibrosis Galactosemia Tyrosinemia Glycogen storage disease type IV Niemann-Pick disease Wolman’s disease Gaucher’s disease Cholesterol ester storage disease α1-Antitrypsin deficiency Cystic fibrosis Dubin-Johnson syndrome Neonatal hypopituitarism Zellweger’s syndrome Donohue syndrome (leprechaunism) Rotor syndrome Rx/toxins HAIV

Answer 24

one of three areas of normal physiologic narrowing—upper esophageal sphincter (cricopharyngeus muscle), thoracic inlet (C6-T1); aortic arch, tracheal bifurcation (T4-6); and lower esophageal sphincter, diaphragmatic hiatus (T10-11)

Answer 25

Monteggia’s fracture-dislocations are characterized by a fracture of the proximal third of the ulna plus dislocation of the radial head

Answer 26

Four independent multivariate predictors of septic arthritis have been found (Kocher criteria)—fever, inability to bear weight, ESR of 40 mm/hr or higher, and serum WBC count higher than 12,000 cells/µL. Patients with three of the four predictors had a 93% chance of having septic arthritis, and those with all four had a 99% likelihood.

Answer 27

Couverture gram + : cloxa ou vanco, vanco si suspicion SARM couverture gram - : ceftri, tazo si suspicion pseudo kingela kingae couvert par ceftri

Answer 28

Surgical options range from needle aspiration to open surgical drainage. Indications for surgical drainage in children with septic arthritis include involvement of the hip joint, presence of large amounts of pus or debris in the joint, loculated fluid, recurrence of joint fluid after four or five aspirations, and lack of clinical improvement within 3 days of the initiation of appropriate therapy.

Answer 29

The cause remains unclear; theories are myriad and research results conflicting. It usually occurs in those between the ages of 3 and 12 years, with the peak incidence between the ages of 5 and 7 years. Legg-Calvé-Perthes disease has been reported in teenagers as well as in children as young as 2 years. Boys are affected more frequently than girls, it is bilateral in up to 20% of cases, and it is familial approximately 10% of the time. It is least common in African Americans and East Asians and most common in whites. There is increased incidence at higher latitudes

Answer 30

Radiographic findings in the initial stage include a femoral head that appears smaller than the opposite unaffected femoral head, widening of the medial joint space, subchondral lucent zone, subchondral collapse causing the crescent sign (Caffey’s sign; Fig. 175.24), irregular physeal plate, and blurry and radiolucent metaphysis. In the fragmentation phase, the repair aspects of the disease become more prominent. The epiphysis begins to fragment, and there are areas of radiolucency and radiodensity as new bone forms. During the reossification stage, the repair process continues as normal bone density returns, radiodensities replace radiolucencies, and alterations in the shape of the femoral head and neck become apparent. The healed stage is the final radiographic stage of Legg-Calvé-Perthes disease, and radiographs of the proximal third of the femur will demonstrate residual deformities.

Answer 31

rates affected by several factors: (1) race—higher prevalence in African Americans, Hispanics, and Pacific Islanders than whites; (2) geography—higher rates north of 40-degree latitude and in the northeastern and western United States; (3) gender—boys are affected twice as frequently as girls; and (4) underlying medical conditions—more frequent with endocrinopathies, renal osteodystrophy, and radiation therapy.30,31 The peak incidence is during the adolescent growth spurt, boys between 12 and 16 years of age (mean, 13.5 years) and girls between 10 and 14 years of age (mean, 11.5 years). The age at diagnosis decreases with increasing obesity. Most children with SCFE have delayed skeletal maturation. SCFE is bilateral in up to 80% of cases, although 30% to 40% of these cases are asymptomatic and discovered only on screening radiographs. In unilateral cases, the left hip is affected twice as often as the right.

Answer 32

Drehmann’s sign: rotation externe de la hanche lors de la flexion passive, indication d'un glissement épiphysaire de la tête fémorale

Answer 33

metaphyseal blanch sign - Steel sign: In the early stage of slipping of the capital femoral epiphysis, the epiphysis slips posteriorly in relation to the neck of the femur. When this occurs, the posterior portion of the femoral head is seen on the anteroposterior radiograph as a crescent-shaped area of increased density overlying the metaphysis adjacent to the epiphyseal plate The modified Klein’s line is a comparison of the amount of epiphysis lateral to the Klein line on the symptomatic side compared with the same measurement on the asymptomatic side, with a difference of 2 mm being significant.33 Even with the modified Klein’s line, 13% of SCFEs were missed, highlighting the need for a lateral film

Answer 34

Apophysite du calcanéum Sever’s disease can be associated with growth or tight heel cords. Impact sports, especially those that involve running, and sports in which cleats are worn are implicated in the development of Sever’s disease. Treatment of Sever’s disease consists of ice, massage, stretching of the plantar fascia and involved muscles (gastrocnemius-soleus complex and ankle invertors and evertors), NSAIDs, and shock-absorbing shoe inserts.

Answer 35

Anémie falciforme, néoplasie, maladie immunitaire, médication, drogues, toxines Adulte: Penile erection from sexual arousal, erectile dysfunction medication, urethral foreign bodies, Peyronie’s disease, spinal cord injury, and penile implants occur more commonly in adults than children.

Answer 36

Soulagement douleur, hydratation, analgésie locale (bloc), levée de l'obstruction urinaire, tx condition sous jacente. To perform aspiration, place an 18-gauge angiocatheter (smaller in young children) percutaneously into the lateral aspect of the penile shaft entering the corpus cavernosum. Aspirate and evacuate blood from the corpora cavernosa. Next, irrigate with normal saline (NS) or in combination with an ICI of an α-adrenergic sympathomimetic agent. Instill 1 mL of dilute phenylephrine (100–500 µg phenylephrine/mL of NS) into the corpus cavernosum every 3 to 5 minutes for up to 1 hour. If these measures fail to resolve the priapism, emergent urologic consultation should be obtained for possible surgical shunt placement. Prolonged episodes (\>48 hours) are associated with a high likelihood of erectile dysfunction, irrespective of clinical management

Answer 37

Patients with varicoceles that are sudden in onset, right-sided, or do not diminish in the supine position should undergo imaging (eg, ultrasonography, computed tomography [CT], or MRI) to evaluate for a retroperitoneal neoplasm. Surgical correction may be required if the patient becomes symptomatic or has bilateral varicoceles

Answer 38

Patients with varicoceles that are sudden in onset, right-sided, or do not diminish in the supine position should undergo imaging (eg, ultrasonography, computed tomography [CT], or MRI) to evaluate for a retroperitoneal neoplasm. Surgical correction may be required if the patient becomes symptomatic or has bilateral varicoceles

Answer 39

Tumor types include teratomas, embryonal carcinomas, yolk sac tumors, choriocarcinomas, Leydig cell tumors, and Sertoli cell tumors. Lymphoma and leukemia can also metastasize to the testicle.

Answer 40

Causes of proteinuria can be glomerular or tubular. Glomerular causes include nephrotic syndrome, glomerulonephritis, and posttransplantation rejection. Transient causes of altered glomerular function include exercise, extreme cold or heat, fever, seizures, and stress. Tubular causes of proteinuria include heavy metal poisoning, urinary tract infections, and diabetes, as well as an asymptomatic tubular proteinuria

Answer 41

post strep Néphropathie à IgA Wegener Goodpasture Henoch Schonlein SHU Alport Lupus

Answer 42

Nephrotic-range proteinuria is a daily excretion of more than 3.5 g of protein/1.73 m2 ormore than 50 mg/kg, corresponding to 3+ or 4+ on the urine dipstick.

Answer 43

Primary Essential hypertension Secondary Renal Glomerulonephritis Henoch-Schönlein purpura Pyelonephritis Obstruction or reflux Polycystic kidney disease Diabetic nephropathy Trauma Renal transplant or hemodialysis Tuberous sclerosis Systemic lupus nephritis Endocrine Pheochromocytoma Cushing’s syndrome Congenital adrenal hyperplasia Corticosteroid treatment Hyperthyroidism Neuroblastoma Ovarian tumor Cardiac Congestive heart failure Coarctation of the aorta Vascular Hemolytic-uremic syndrome Kawasaki syndrome Renal artery thrombosis or stenosis Neurologic Central nervous system tumor or infection Central nervous system trauma or abuse Increased intracranial pressure Guillain-Barré syndrome Neoplastic Neuroblastoma Wilms’ tumor Pheochromocytoma Adrenal carcinoma Drugs Corticosteroids Cocaine Sympathomimetics Oral contraceptives Phencyclidine Beta-blocker or clonidine withdrawal Lead, mercury Others Iatrogenic fluid overload Volume overload from end-stage renal disease

Answer 44

Approximately 50% of affected children have a history of previous upper respiratory tract infection, and as many as 75% have group A beta-hemolytic streptococci cultured from the oropharynx. Other theorized predisposing factors include exposure to cold weather, certain foods, drugs, and insect bites. Other possible precipitants include varicella-zoster virus, Mycoplasma species, parvovirus, Campylobacter enteritidis,parvovirus B19, and Epstein-Barr virus

Answer 45

HUS can be classified as primary (or atypical) HUS, caused by compliment dysregulation, and secondary HUS, caused by infections (eg, STEC, Shigella organisms, S. pneumoniae, Aeromonas, or HIV), drugs (eg, chemotherapeutic or transplant antirejection drugs), or other idiopathic causes (eg, pregnancy, lupus). UTIs have also been implicated.

Answer 46

limit the use of dexamethasone to the presumptive treatment of pneumococcal meningitis in infants older than 6 weeks after consideration of the potential benefits and risks. The AAP has suggested that dexamethasone may also be beneficial for infants and children with Haemophilus influenzae meningitis to decrease the risk of neurologic sequelae, including hearing loss, if is given before or concurrently with the first dose of an antimicrobial agent

Answer 47

hypoxic-ischemic encephalopathy, intracranial infection, congenital brain malformation, cerebrovascular events, electrolyte disturbances, metabolic derangements, and nonaccidental trauma.

Answer 48

Toxic ingestions are treated based on the specific toxin involved. Seizures caused by isoniazid (INH) poisoning are particularly resistant to standard seizure treatment, yet respond to pyridoxine. The dose of pyridoxine is 1 g IV for every gram of INH ingested. When the quantity of INH ingested is unknown, 5 g IV may be administered to an adult and 70 mg/kg (maximum, 5 g) to a child.

Answer 49

Acide valproique et propofol

Answer 50

\* La carbamazépine et la phénytoine peuvent exacerber les absences et convulsions myocloniques

Answer 51

migraine, is the most frequent type of pediatric and adolescent migraine and includes the following criteria—more than five attacks that last 2 to 72 hours (untreated or unsuccessfully treated), accompanied by nausea, vomiting, photophobia or phonophobia—and including a minimum of two of the following criteria—unilateral or bilateral location, pulsing quality, moderate to severe intensity, and aggravated by routine physical activities.

Answer 52

Cardiac Congenital heart defects Valvular heart disease Right-to-left shunts Cardiomyopathy Endocarditis, myocarditis Arrhythmia Cardiac tumors Cardiac surgery Hematologic Disorders and Coagulopathies Anemia Sickle cell disease Dehydration Idiopathic thrombocytopenia purpura (ITP) Thrombotic thrombocytopenic purpura (TTP) Hemolytic uremic syndrome (HUS) Thrombocytosis Polycythemia Disseminated intravascular coagulation Leukemia or other neoplasm Congenital and acquired coagulation disorders Pregnancy and the postpartum period Vasculitis, vasculopathies Systemic lupus erythematosus Polyarteritis nodosa Takayasu arteritis Kawasaki disease Moyamoya syndrome, disease Infection Meningitis, encephalitis Mastoiditis, otitis media HIV Varicella Syphilis Tuberculosis Systemic infection Metabolic, Miscellaneous Homocystinuria Fabry disease Organic acidemia Hyperlipidemia Mitochondrial encephalopathy with lactic acidosis and strokelike episodes syndrome Menkes disease Other Vascular Vasospasm (subarachnoid hemorrhage) Migraine Carotid ligation (eg, extracorporeal membrane oxygenation) Fibromuscular dysplasia Cervicocephalic arterial dissection Arteriovenous malformation Arteriography Hereditary hemorrhagic telangiectasia Sturge-Weber syndrome Intracranial aneurysm Trauma (Including Nonaccidental) Blunt and penetrating cervical trauma Brain Tumor DRUGS Cocaine Amphetamines Oral contraceptives L-asparaginase

Answer 53

TEN-4 rule Torse/ ear / neck / anywhere under 4 months

Answer 54

ALTE critères Épisode inquiètant + 2/4 : - étouffement - changement de tonus - changement de couleur - étouffement BRUE Inf 1 an, inf 1 min, auto résolutif et comportant : - cyanose centrale ou paleur - Respiration irrégulière, diminuée ou absente - Hypo ou hypertonie - Changement de la réactivité

Answer 55

Age inf 2 mois age gestationnel inf 32 sem récidive de brue " stress parental"

Answer 56

age sup 60 jours age gestationnel sup 32 semaines premier épisode de brue durée épisode inf 1 minute absence de RCR histoire et E/P rassurant

Answer 57

apres 30-60 sec

Answer 58

On se concentre sur le travail d’équipe, la communication et les compétences en leadership. On insiste sur la réunion préparatoire avant l’accouchement. Si le nouveau-né à terme ou prématuré est vigoureux, on recommande de reporter le clampage du cordon de 30 à 60 secondes. En présence de méconium chez un nouveau-né hypotonique dont les respirations ne sont pas efficaces, l’intubation systématique n’est plus recommandée pour l’aspiration trachéale. On entreprend les étapes initiales de la réanimation et on administre une VPP, au besoin. Puisque le méconium demeure un facteur de risque de transition anormale, une équipe possédant les habiletés nécessaires pour procéder à une réanimation complexe doit être sur place. L’administration de gaz : Si le nouveau-né est à terme, on utilise de l’oxygène à 21 % pour entreprendre la réanimation. Si le nouveau-né prématuré a moins de 35 semaines d’AG, on privilégie plutôt une concentration en oxygène de 21 % à 30 %. Au bout de 15 secondes de VPP, on évalue la FC. Si celle-ci n’augmente pas, on évalue l’excursion thoracique. En présence d’une excursion thoracique, on poursuit la VPP pendant 15 secondes avant de réévaluer la FC. En l’absence d’excursion thoracique, on amorce les mesures correctives (MR SOPA). On réévalue la FC après avoir administré pendant 30 secondes une VPP qui provoque une excursion thoracique. Pour déterminer la profondeur d’insertion de la ST, on respecte les lignes directrices liées à l’AG ou la méthode de la distance entre le nez et le tragus. Il faut obtenir une VPP efficace pendant 30 secondes par une autre méthode de ventilation avant d’entreprendre les compressions. La technique à deux pouces est recommandée pour effectuer les compressions thoraciques. La personne qui les effectue doit se placer à la tête du lit une fois les voies respiratoires ouvertes. On réévalue la FC 60 secondes après le début des compressions thoraciques. Le moniteur cardiaque est privilégié pour évaluer la FC pendant les compressions thoraciques, mais l’auscultation ou la saturométrie sont également acceptables. Le lactate Ringer n’est plus recommandé pour la réanimation liquidienne. De même, il n’est plus recommandé d’administrer de la naloxone au nouveau-né qui présente une dépression respiratoire parce que sa mère a reçu des narcotiques pendant l’accouchement, car les données sont insuffisantes pour évaluer la sécurité et l’efficacité de cette pratique. Si le nouveau-né a moins de 32 semaines d’AG, on recommande un ensemble d’interventions pour optimiser la thermorégulation, y compris le maintien de la température ambiante à 23 °C, la préparation de l’unité chauffante, l’utilisation d’un bonnet, l’installation d’un matelas thermique sous l’unité chauffante et l’utilisation d’une pellicule de polyéthylène. Si le nouveau-né prématuré respire spontanément, mais que sa respiration est laborieuse, on envisage la PPC. S’il faut amorcer la VPP, la PEP est plutôt recommandée.

Answer 59

couper 1 cm à la base du cordon, CVO dans veine à 4 cm, attacher au pourtour

Answer 60

Strep pneumoniae, ceftri/clinda

Answer 61

catarrhale: 7-10 jours Paroxystique: 1-6 sem, ad 10 sem convalescence 7-14 jours hospit si moins 6 mois

Answer 62

obstructif, infectieux, métabolique

Answer 63

alcalose métabolique hypochlorémique hypokaliémique

Answer 64

atrésie duodénale et malrotation de l'intestin, tx ampi-tobra-flagyl

Answer 65

- dilatation anses grêles (obstruction) - target sign a/n hépatique (masse HCD sans air) - air libre - signe du ménisque tx: iléo-colique - lavement à l'air +/- chx si perfo ou échec Tx: iléo-iléale: réassurance

Answer 66

dx: écho Tx gars: tenter réduction Tx fille: ne pas tenter réduction avant écho car pourrait contenir un ovaire et alors il faut éviter de pousser inf 6 sem: chx ped d'emblée, pas réduction , risque perforation

Answer 67

compromis neurovasculaire ouverte déplacement 100% étirement peau distal ou proximal déplacement de plus de 2 cm Athlète de haut niveau

Answer 68

1-3-5-7-9-11

Answer 69

médian artère brachiale

Answer 70

dans la dernière semaine: t 38.5 CRP sup 20 VS sup 40 GB sup 12 pas MEC

Answer 71

SOAP-ME Suctions oxygène Airway - matériel de la bonne grandeur Pharmacie Moniteur Equipment

Answer 72

Critères labo supplémentaires - Albumine \< 30 - Élévation ALT - pyurie, \> 10 GB/champ - Anémie pour l'âge - Plaquettes \> 450 000 - Leucocytes \> 15

Answer 73

Metaphyseal corner (or bucket handle) fractures (image 1 and image 2 and figure 4) ●Rib fractures (image 3) ●Fractures of the sternum, scapula, or spinous processes ●Long bone fracture in a nonambulatory infant ●Multiple fractures in various stages of healing (image 4) ●Bilateral acute long bone fractures ●Vertebral body fractures and subluxations in the absence of a history of high force trauma ●Digital fractures in children younger than 36 months of age or without a corresponding history ●Epiphyseal separations ●Severe skull fractures (eg, multiple, stellate, or depressed) in children younger than 18 months of age