Pediatric Presentations Flashcards Preview

Block 5 - Pulm and Skeletal > Pediatric Presentations > Flashcards

Flashcards in Pediatric Presentations Deck (32):
0

What pathogen is associated with croup?

Parainfluenza

1

What pathogen is associated with bronchiolitis?

RSV

2

What pathogen is associated with exacerbations of asthma?

Rhinovirus

3

Prodrome of cold, hoarseness and barking cough, minimal to severe inspiratory stridor, not toxic appearing, stridor best heard over neck with clear lung fields, low grade fever, Steeple sign (subglotting narrowing on CXR)

Croup (viral) (laryngotracheobronchitis)

4

Prodrome of URI, hoarseness and barking, inspiratory stridor, toxic appearing, high grade fever, subglottic narrowing

Bacterial tracheitis (typically s. aureus)

5

What pathogen is associated with pertussis?

Bordatella pertussis or bordatella parpapertussis
GNRs

6

Coughing spells, post-tussive whooping, vomiting, no fever, elevated WBC, cough lasting more than 7-14 days

Pertussis

7

Edema, increased mucus secretion and eventual necrosis of small airways, rhinitis, cough, *tachypnea, wheezing and crackles

Bronchiolitis

8

Cough, grunting, chest pain, tachypnea, nasal flaring and retractions, cyanosis, dullness to percussion, decreased breath sounds, bronchial breath sounds, abrupt onset, high fever, toxic appearance

Bacterial pneumonia

9

Prominent URI symptoms, low grade or absent fever, diffuse findings or wheezes on exam, possible diffuse infiltrates

Viral pneumonia

10

Tachypnea, mild hypoxemia, lack of fever, wheezing, interstitial infiltrates

Atypical pneumonia - infancy (<3 mos)
Chlamydia trachomatis (also look for conjunctivitis at 10 days)

11

Gradual onset, low grade fever, diffuse eam findings, diffuse infiltrates

Atypical pneumonia - older children (>5 yrs)
Mycoplasma

12

How long can an abnormal appearance on CXR continue in bacterial pneumonia?

6 weeks

13

When should CF be suspected in a child?

Recurrent episodes of cough, pneumonia, or sinusitis
Unexplained poor weight gain or FTT
Nasal polyps, rectal prolapse, hypochloremic alkalosis or FH of CF

14

What tests can be used to diagnose CF?

Immunoreactive trypsinogen (IRT) - pancreatic enzymes elevated in CF, used in the newborn screen
Sweat chloride test - gold standard - >60 is positive
DNA analysis to identify CTFR mutations

15

Bowlegs

Genu varum
Pathologic if asymmetric, unilateral, painful, or if progression different from expected

16

Knock knees

Genu valgum

17

Metatarsal bones of foot adducted

Metatarsus adductus

18

What further work up is needed for metatarsus adductus?

Needs correction
Stretching exercise of foot straightens with gentle pressure, casting or bracing if rigid

19

Medial malleolus is posterior to lateral malleolus

Tibial torsion - noticeable when child begins to walk
No treatment needed

20

Twist in femur between hip and knee, kid sits in W position, kissing knees upon standing

Femoral anteversion or medial femoral torsion (MFT) - no treatment needed

21

Pain and disuse of arm, no distress but arm guarding, slight flexion and pronation of elbow

Radial head subluxation = nursemaid s elbow
Treatment is manipulation back into place
Radiographs usually normal and not indicated unless history of fall and concern for fracture

22

Pain and swelling around elbow, decreased range of motion, possible gross deformity

Supracondylar humerus fracture
Must ensure neurologic and vascular status of arm - if concerning it is a surgical emergency - lots of arteries and nerves run through

23

Knee pain during puberty, gradual pain localized at tibial tuberous it's, relieved by rest, worse with activity

Osgood-schlatter disease - rest, ice, NSAIDs, compression, stretching
Resolves after growth spurt

24

What is often the cause of knee pain?

Pain referred from pathology at the hips

25

What lab values suggest an infectious process?

WBC >12, ESR >20, CRP >1, fever >38
More than 2 of 4 positive

26

9 month to 3 year old, refusal to bear weight, point tenderness over tibia

Toddlers fracture
Immobilize until healed
Initial radiographs often negative, follow up shows callus

27

Hip pain, child up to 10 years (boys 4-8), confirmed hip effusion and exclusion of other conditions, negative hip tap

Transient synovitis
NSAIDs, resolves on its own

28

Fever >38, cannot bear weight, ESR>40 in first hour, WBC>12

Septic arthritis - urgent need for surgical washout and antibiotics
Most commonly staph aureus
Group b strep in neonates

29

4-8 year old boy, active with insidious onset of limp, possible pain, pain can be referred to thigh or knee, limited abduction and internal rotation at hip, smashed ice cream of femoral head

Legg-calve-perthes disease - mostly not weight bearing treatment

30

Female, first born, breech, family history, galeazzi, Barlow test, ortolani test

DDH
Bracing or casting to hold in abduction, flexion, external rotation
Possible surgery
Radiographs useful only after 4-6 months of age

31

Insidious or acute pain or limp, may be referred to thigh or knee, early pubertal age, obese, preferred position is foot externally rotated with flexion at the hip, limited internal rotation with pain, ice cream falling off cone

Slipped capital femoral epiphysis (SCFE) - surgical emergency - can stunt growth