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Flashcards in pediatrics Deck (191):
1

at what age is a fever of 100.4 most concerning?

less than 3 months

2

at what age is a fever of 100.4 most concerning?

3

HR starts ___ and gets ____ as a child grows

higher and gets lower

4

how to observe respiratory rate inkids

abdominal excursions, stethoscope in front of mouth, listen to chest

5

respiratory rate starts __ and gets ___ throughout childhood

higher and gets lwoer

6

blood pressure starts __ and gets __ throughout childhood

low and gets higher

7

when can we do a standing heigh for a kid?

>2 years old

8

stuff to look for at 2 months:

Gross motor
Holds head steady while sitting
Raises head to 45 degrees prone
Fine motor
Grasps objects put in hand
Hands to midline
Social
Social smile
Language
Cooing, vowel sounds “eh”
Visual
Fixes and follows

9

what age does pincer grasp start?

9 months

10

what age does stranger anxiety start?

9 months

11

when to start screening for lipids if family history?

5 years!

12

• Interruption of the normal progression of retinal vascularization

retinopathy of prematurity (premies at risk of retina not developing--need dilated fundoycopic exams0

13

weight, length (laying down) and head circumference

14

increased risk of ear infections

First episode at

15

stuff to look for at 2 months:

Gross motor
Holds head steady while sitting
Raises head to 45 degrees prone
Fine motor
Grasps objects put in hand
Hands to midline
Social
Social smile
Language
Cooing, vowel sounds “eh”
Visual
Fixes and follows

16

what age does pincer grasp start?

9 months

17

what age does stranger anxiety start?

9 months

18

when to start screening for lipids if family history?

5 years!

19

• Interruption of the normal progression of retinal vascularization

retinopathy of prematurity (premies at risk of retina not developing--need dilated fundoycopic exams0

20

ddx of wheeze in kids

Functional
• GERD
• Cystic Fibrosis
• Immune Def.
• Vocal cord dysfunction
• Aspiration
• BPD
• primary ciliary disease
Chronic
• Anatomic
• Vascular compression • Cardiomegaly
• Chronic lung disease
• Congenital Heart disease
Acute
• asthma
• Infectiousbronchiolitis
• FB
• Esophageal FB
• Bacterial tracheitis
• Anaphylaxis
• Acute respiratory distress syndrome

21

increased risk of ear infections

First episode at

22

concomitant ear infection and conjunctivitis is usu d/t?

h flu, start amox/clav first

23

3 main RFs of CDH

female, first born, family history

24

what test do you use for a baby 4 mos old with suspected CDH?

US and look at angles, or can use barlow (disc locatable?) or ortolanis test (reducible?) also "fresh" position

25

• Insidious onset of limping and pain in groin, hip, thigh, knee regions in a kid makes you think of what?

perthes

26

ddx of limping in kid or pain in knee, groin, hip thigh

• perthes
Transient synovitis
• Osteonecrosis-septic arthritis
• Sickle cell disease
• Corticosteroid therapy
• Skeletal dysplasias
mucopolysaccharidoses

27

are SCFEs most often unilateral or bilateral?

usually unilateral but still get bilateral anyway b/c other things that can cause hip pain can be bilateral

28

causes of SCFE

• Weakened or compromised physis and physiologic forces and vice versa
• Endocrinopathies: thyroid, Growth hormone, hypogonadism, parathyroid hormone
• Renal osteodystrophy
• Prior radiation therapy
• Mechanical: obesity, increased femoral retroversion (angle of head of femur is toward spine, ours are usually anteverted or more angled toward front of body), decreased neck shaft angle, increased physeal obliquity

29

how long does genu varum (bow legged) last for? after that what do you work it up for?

usually 2 years, after that work up for Bone dysplasias, rickets, blounts disease

30

when do you become concerned about genu valgum (knocked knees)

after age 7

31

juvenile arthritis with poorest pg

systemic

32

work up of juvenile arthritis

multiple painful, swollen joints, ESR, CRP, RF, ANA

33

which marker for JIA is most associated with uveitis?

ANA

34

4 types of jIA

systemic, oligarticular, polyarticular (>5 joints), and seronegative (i..e reiters, etc)

35

ddx of cough in kids (not d/t lung disease)

• GERD
• Aspiraton d/t suck and swallow fcn
• CNS disease/hypotonia leading to GERD and/or aspiration
• Cardiac
• Psych/habit
• Anatomic
• Med induced (ACEI?)

36

ddx of stridor in kids

• Foreign body aspiration
• Anaphylaxis
• Viral induced (croup?)
• Post-intubation complications
• Retropharyngeal abscess
• Laryngomalacia (floppy larynx that doesn’t create tight seal)
• Tracheomalacia (trachea collapses)
• Inhalational injury
• Blunt tracheal disruption
• Epiglottitis?

37

which group of kids always gets antibiotics for ear infections?

38

which sinus is least likely to be infected in a 2 or 3 year old?which are most likely?

frontal, doesn't develop until 3-9 years, ethmoid and maxillary develop earlier and are more likely

39

which disease has sx of: • Low grade fever
• Malaise
• HA
• Myalgias
• Anorexia
• Parotitis
and potential complications of • Meningitis
• Encephalitis
• Orchitis

mumps

40

what physical exam techniques do you need to do for pediatric cardiology every time?

mumur
pulses (ue AND le)
BP
HR
location of pMI
newborn pulse ox screen
growth pattern
other abnormalities: cyanosis, retractions, clubbing, diaphoresis, mottling,

41

types of q

Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
Coarctation of the Aorta
Tetralogy of Fallot
Ebstein’s Anomaly
Hypoplastic Left Heart Syndrome
Atrioventricular Septal Defect
Transposition of the Great Arteries
Vascular Ring

42

what will the EKG of an ASD show?

Right axis deviation, right ventricular hypertrophy +/- RBBB

43

what complications can develop from a ASD/

CVA (stroke), untx'd adults: pulm HOTN, CHF and RV dysfcn

44

harsh holocystic murmur at LLSB +/- thrill means what?

ventricular septal defect (both small and moderate)

45

what kind of sx can occur with moderate to large

Sx of CHF at 6-8 wks: tachypnea, poor feeding/weight gain, sweating, irritability, hepatomegaly, increased pulmonary infections

46

what is diagnostic for congenital heart disease?

echocardiogram

47

what can an EKG show in VSD?

normal (small VSD), LVH, or BVH

48

what can CXR show in VSD/

cardiomegaly, increased pulmonary vascular markings, enlarged MPA shadow

49

Postnatal communication between main pulmonary trunk & descending aorta

patent ductus arteriosis

50

what is a very common heart problem in premature babies?

80% have patent ductus arteriorsis

51

continuous systolic "machinery" murmur heard at LUSB/left infraclavicular area +/- thrill +/- apical diastolic rumble

patent ductus arteriorsis

52

tx of pPDA in preterm babies

indomethacin (prostaglandin inhibitor)

53

tx of PDA in term babies

surgery (ligation +/- division), cath lab (device closure)

54

Narrowing of aortic arch, usually at ductal insertion (juxtaductal)

coarctation of aorta

55

what syndromes are assoc with coarc of aorta?

turner syndrome and trisomy 13 and 18

56

Systolic ejection murmur left sternal border (absent in 50%), > in back (left subscapular area)
Thrill in suprasternal notch
Ejection click (if bicuspid AV or hypertension)
Diminished/absent peripheral pulses (LE)
Hypertension (UE)
CHF: Hepatomegaly, gallop

coarctation of the aorta

57

in a neonate:
Diminished lower body perfusion as PDA closes
Signs of shock (severe acidosis, renal/hepatic failure, NEC, death)
infant: tachypnea, heart failure, FTT

coarc of aorta

58

which disease? EKG: LVH in children, normal, RBBB
CXR: “rib notching” (rare

coarc of aorta

59

treatment of critical coA

keep PDA open with prostaglandins

60

what do these four criteria indicate?
Ventricular Septal Defect
2.Pulmonary Stenosis (Subvalvar, Valvar, Supravalvar)
Infundibular stenosis 45%
Infundibular + PV stenosis 30%
Pulmonary atresia 10%
3.Right Ventricular Hypertrophy
4.Overriding Aorta

tetralogy of fallot

61

signs and sx of tetralogy of fallot

murmur of VSD and PS, pulmonary stenosis: cyanosis

62

which dx? EKG: RAD, RVH CXR: boot shaped heart (main PA segment has an upturned apex)

tetralogy of ballot

63

Downward displacement of septal & posterior leaflets of TV into RV cavity (portion of RV is incorporated into RA) (atrialized RV)

ebstein's anomaly

64

most frequent syndrome causing CHD

down syndrome

65

tx of hypertrophic cardiomyopathy?

Tx: Beta-blocker 1st line, surgery if severe (septal myotomy), ICD placement, avoid strenuous exercise, screen family, transplant

66

lymes disease can present as what kind of heart problem?

AV block

67

causes of sudden cardiac death in kids

Coronary abnormalities (anomalous origin, aneurysm-Kawasaki’s disease), arrhythmia, myocarditis, HCM, Long QT syndrome

68

challenges in pediatric prescribin

lack of adequate studies or suitable pediatric dosage forms, optimal dose is hard to know, adherence is hard

69

neonates don't feel pain T or F

F: they may feel it even more

70

T or F: distraction is better with painful procedures than empathy or reassuranc

T!

71

black box warning in pedaitrics

no codeine or tramadol after tonsillectomy or adenoidectomy because of risk of OSA and higher breathing problems

72

which pain killer is best to use for tonsillectomy or adenoidectomy?

morphine

73

which ethnicities are more likely to be ultra rapid metabolizers of codeine, tramadol, hydrocodone and oxycodone?

n. african and arabs (30% are ultra rapid metabolizers) and 5% of AA and whites

74

what should be noted about how pediatric drugs are dose?

mg/kg and look closely for PER DAY OR PER DOSE

75

how should a drug be dosed for a child

weight based

76

how should a drug be dosed for children >40 kg?

weight based unless patients dose >adult dose or specific medication labeling notes a diff dose max for kids

77

ways to reduce dosing errors in kids

Always double-check calculations
 Computerized dose checking programs can reduce errors
 Always use a leading zero before a decimal point (0.1 vs .1)
 Never use a trailing zero after a decimal point (1 vs. 1.0)
 Use current reference books
 Use a small personal formulary
 Include use for drug on prescription

78

medications that taste good

Ceclor, Suprax, Lorabid, Omnicef, Cefzil taste pretty good

79

medications that taste bad

Prednisone intensol, dicloxacillin, KCl, Biaxin, Vantin taste pretty bad

80

identifying measles

koplik spots and rash while fever, rash coalesces

81

identifying rubella

tender LAD, low grade fever, swollen glands, discreet pink spots that don't coalesce

82

identifying roseola

under 2, high fever that stops and rash breaks out, mildly maculopapualr

83

identifying erythema infectiosum

elementary schooler,

84

what is tx for inguinal hernias in babies/

ALWAYS SURGERY

85

what is tx for umbilical hernia?

reduce it, reassure it most likely goes away

86

what else can get trapped in hernias in babies?

ovaries, intestines, etc

87

red, moist thing in belly button of baby is what? how do you treat it?

umbilical granuloma. treat topically with silver nitrate, unless really big then can do surgery

88

• Embryologic connection to urinary bladder from umbilicus

urachus

89

baby presents with vomiting, abdominal distention (bowel obstruction) but has no signs of incarcerated hernia. what do you think of?

patent omphalomesenteric duct

90

meckel's diverticulum rule of 2s

• 2% of population
• 2 years, age at common presentation
• 2 feet from ileocecal valve(ileum)
• 2 inches long

91

3 ways a meckel's diverticulum can present or cause problems

bleeding, obstruction, diverticulitis

92

Bleeding per rectum (>1/3)- Dark red blood, painless, decrease hemoglobin substantially, what do you think of?

bleeding meckel's diverticulum from heterotypic gastric mucosa that is causing ulceration into blood vessels

93

what condition can cause peritonitis and bowel pain and can look like appendicitis?

meckel's diverticulitis

94

what do these sx make you think of? • Cramping episodes, pulling up the legs
• Interspersed lethargy, Vomiting
• Bloody mucoid stools - “currant jelly”-

intussusception

95

tx of intussusception

hydrostatic/pneumatic reduction by radiologist

96

• Concentric hypertrophy of pyloric muscle

pyloric stenosis

97

string sign or palpable "olive" in epigastric region makes you think of?

pyloric stenosis

98

lump at level of hyoid cartilage makes you think of what?

thyroglossal duct cysts

99

• Anterior border sternocleidomastoid muscle +/- hole or drainge in neck of kids makes you think of?

branchial cleft cyst

100

• Fibrotic mass in midportion of sternocleidomastoid and turning of neck

torticollis

101

soft spongy cystic ballotable mass in kids

lymphangioma

102

if a baby is born with down syndrome what do you want to do?

get a karyotype--if d/t translocation that has huge repercussions for reproduction of parents

103

gold standard test for newborns with CF: what result does it show?

sweat test: elevated chloride is diagnostic

104

is pulm disease and pancreatic insufficiency leading to malnutrition and FTT is suggestive of what?

cystic fibrosis

105

if a newborn has a positive CF screen, does that mean they have CF?

no--it could be just a carrier--send off for sweat test

106

if newborn has negative CF test does that mean they don't have CF?

no--it could be the mutation they have is not covered in the panel

107

history questions for diarreha

• Ask- how many times?
• Color?
• Watery? blood; mucus?

108

history qs for vomiting

• How many episodes?
• Last time?
• Fluids since then? • Related to foods?
• Forceful? (key element) Color? Yellow is stomach secretions, green is bile (farther down obstruction) Blood?
• Smell? feces smell means even lower blockage
• Still drinking?
• How’s he acting?
• Apparent pain? • Urinary changes?
• Cough/cold symptoms?
• Fever? Rash?
• Ill contacts? Day care? Water source, food source?
• Recent travel or “just got off the boat”?
• Lots of antibiotics recently? C. diff
• Past medical history: “normal” child? Or, chronic GI issues? UTIs? •

109

PMH, SX, FMHX, ETC for kids with vomiting

ROS: not as important in this case. Sore throat? Scrotal swelling? Swellings of extremities? Skin pallor? Decreased mental status?
• Social history: not as important here. Many office/ED visits?
• Family history: not as important here. In infant, pyloric stenosis, In older child: appendicitis, IBD, celiac disease

110

life threatening causes of vomiting by age

• Newborn: anatomic problems, central nervous system infection, inborn errors of metabolism
• Older infant: obstruction (intussusception, pyloric stenosis, incarcerated hernia, malrotation with volvulus), gastroenteritis with dehydration, occult head trauma
• Older child: GI (intussusception, appendicitis), neurologic (mass lesions), renal (uremia), infectious, metabolic (DKA, adrenal insufficiency, inborn errors), toxins/drugs

111

definition of severe dehydration in kids (by weight)

• 15% loss of weight in infant, 9% loss in older child

112

most dehydration is usually isotonic, isonatremic T or F?

T

113

why are children more susceptible to dehydration than adults?

• The smaller the child, the more susceptible- Higher surface area-to-volume ratio
• Higher metabolic rate • Behavioral: “won’t drink”
• Depend on adults for care

114

are most cases of gastroenteritis viral or bacterial/

viral

115

in which case do you suspect salmonella in gastroenteritis?

food born outbreaks

116

in which case do you suspect s type in gastroenteritis?

typhoid fever

117

in which case do you suspect shigella in gastroenteritis?

usually mild; if severe, causes fever, abdominal pain, stools with blood and mucus; toxin may irritate CNS, seizures possible; antibiotic treatment is recommended

118

in which case do you suspect yersinia and campylobacter in gastroenteritis?

abdominal pain prominent

119

in which case do you suspect c diff in gastroenteritis?

pseudomembranous colitis; associated with antibiotic use

120

what are the results of hemolytic uremic syndrome from e coli 0157:h7?

hemolytic anemia, thrombocytopenia, acute renal failure; usually in children under 5 y/o

121

signs of bacterial infection in gastroenteritis

• More than 10 stools/day or more than 4 days diarrhea
• Blood in stool
• Temp 39.5
• Clinical toxicity
• PMNs in stool

122

• Antibiotics in E coli O157:H7 might increase incidence of what?

HUS

123

approach to vomiting and diarrhea--questions to ask?

• Does vomiting OR diarrhea predominate?
• What age and sex is the child?
• Is pain a significant part?
• Fever or other systemic sx?
• Blood?
• On exam, degree of dehydration and toxicity

124

what should topical abx always be used with to avoid resistance when txing acne?

BPO

125

cause of infantile acne, tx

maternal androgens. can do BPO. reassure.

126

identifying miliaria rubra, tx

covered areas, flexural areas. papules/vesicles on erythematous base. reassure. avoid over clothing

127

identiyfing milia, tx

white or yellow (sebaceous) bumps on newborn. really common. superficial epithelial cysts. reassure.

128

identifying erythema toxicum, tx

local immune response to new skin flora (most likely) 50% of newborns have it in first 24-48 hours. reassure

129

how do you distinguish between irritant and candidate diaper rashes?

irritant will have flaky confluent erythema and will not be in intertriginous areas, candidate will be in intertriginous areas and will have satellite lesions

130

distinguishing points of measles

starts on face, starts with prodrome persisting through rash, dark and red rash that coalesces, koplik spots

131

distinguishing rubella from measles

both start on face, though rash of rubella does not coalesce (is more discreet) isn't as red as measles, and the kid doesn't look as sick. it also spreads faster than measles and can have arthralgia.also + tender LAD

132

distinguishing roseola from other rashes

starts with high fever that goes away then rash. rash usually ends up mostly on trunk. coalescing pink maculopapules. kid will be happy. no URI. also kids will usually be under 2.

133

distinguishing erythema infectious from other diseases

"slapped cheeks' + mild URI. cheeks distinguishes from measles and rubella, URI distinguishes from roseola + lack of high fever.+ lacy appearance on rest of body also adults may have arthralgia. and rash can recur with stimuli like sunlight.

134

virus in erythema infectiosum

parvovirus b19

135

can kids with erythema infectious go back to daycare?

yes, not contagious once rash starts.

136

sandpaper rash after strep throat that looks like a sunburn

scarlet fever

137

features of down syndrome

(1)Dysmorphic
features
•Upslanting
palpebral
fissures
• Epicanthal
folds
• Flatnasalbridge
• Low
set
small
ears
• Brachycephaly
• Protruding
tongue
• Short
neck/excessive
skin
at
back
of
neck
• Short
stature
(2)
Extremities
• Short
broad
hands
• Curved
fifth
finger
• Transverse
palmar
crease
(single)
• Sandal
gap
(wide
space
between
first
&
second
toes
• Hypermobile
joints
CHD, VISION AND HEARING LOSS, LEUKEMIA, IMMUNODEFICIENCY, ENDOCRINE, INTELLECTUAL DISABILITY AND GI probs

138

required test to confirm down syndrome

karyotype

139

which congenital genetic disorder i x linked dominant?

fragile x syndrome

140

gene of fragile x syndrome, what goes wrong?

FMR1, CGG repeats

141

if someone comes in with new onset tremor or ataxia, or premature ovarian insufficiency what should you consider in your ddx?

fragile x syndrome carrier

142

tx of fragile x syndrome

tx of mental health issues

143

autosomal dominant syndrome with CHD, bleeding problems, delayed puberty and vision and hearing problems

noonan syndrome

144

causes of spina bifida

folate deficiency, AEDs, genetics

145

disorder of motor or postural abnormalities noted during development

cerebral palsy

146

is familial CP common or uncommon?

uncommon

147

sx of CP

low muscle tone, muscle spassms/stiff, feeding/swallowing difficulties, delayed mile stones, late to walk or speech

148

T OR F there is great variability between adolescents

T!

149

average age of height spurt for girls and guys

guys 11-13.5, girls 9-12

150

characteristics of psychosocial development for 10-14 yo

rapid growth, concerns about deviations from normal, curiosity about sexuality, reliant on friends, independence/dependence struggle

151

characteristics of psychosocial development for 15-17 yo

less precipitation with physical changes, formal operational thinking, less family influence, highly influenced by peer subculture

152

characteristics of psychosocial development for 18-21 yo

emotional stability, individuality, willing to seek parental advice, formalized sense of values, perspecgive

153

important points of adolescent history taking: HEADSSS

home, education/employment, activities, drugs/etoh/tobacco, sexuality, suicide, safety

154

anticipatory guidleines for parents of teens; PANTSED

physical changes, alcohol/drugs/substances, need for privacy, talk, sex, emotional changes, diet/exercise

155

causes of ADHD

genetics, environmental :lead, etoh, tobacco, diet, nutritional deficiencies, Parenting and Society
• Fast paced, high stimulus
• Instant gratification

156

components of ADHD diagnosis

• Symptoms lasting at least 6 months
• Impairment in two or more settings
• Significant impairment in social, academic, and occupational functioning all need to be affected • Some of symptoms present before age of 12- changed from age 7, more accurate for adult diagnosis, adults with new onset sx prob not ADHD
• Symptoms not due to another mental disorder or oppositional behavior or failure to understand tasks or instructions
• Has 6 or more of either Inattentive or Hyperactive-Impulsive symptoms

157

examples of inattention sx

Six (or more) of the following symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level (for individuals ≥ 17 only 5 symptoms needed):
• Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
• Often has difficulty sustaining attention in tasks or play activities need to not be able to pay attention in all areas whether you like it or not
• Often does not seem to listen when spoken to directly
• Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
• Often has difficulty organizing tasks and activities • Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
• Often loses things necessary for tasks or activities (eg, toys, school assignments, pencils, books, or tools)
• Is often easily distracted by extraneous stimuli
• Is often forgetful in daily activities

158

when is inattentive type of ADHD usually diagnosed?

9-10 (later b/c not causing behavioral problems in class)

159

ddx of ADHD

Developmental
• Normal variation
• ASD
• Giftedness
• Learning disorders Emotional/Behavioral
• Mood disorders
• Anxiety (PTSD or OCD)
• ODD
• Conduct disorder Environmental
• Child abuse/neglect- not completing homework
• Poor parenting
• Sociocultural differences
• Inappropriate school setting
Medical
• Fetal Alcohol Syndrome negative response to stimulant
• Fragile X
• Lead Poisoning
• Neurodegenerative d/o • Tourette syndrome
• Iron deficiency anemia
• Thyroid abnormalities
• Diabetes mellitus • Substance abuse- in older children and adults
• Medication side effects: Bronchodilators, Corticosteroids, Neuroleptics, isoniazid

160

what is req'd for a dx of ADHD?

meeting DSM-V criteria, must be verified by parents and teachers, need to assess for coexisting conditions

161

2 categories of drugs for ADHD

methylphenidate (ritalin and concerta) and amphetamines (dexedrine and vyvanse, adderall)

162

does autism cause intellectual disability?

no--they go together but they are separate entities

163

etiology and risks of autism

etiology: no one knows, vaccinations don't cause it
risks: • Very nonspecific
• Older parental age
• Low birth weight
• Fetal exposure to Depakote only specific med that shows slight increase, don’t know why this is yet

164

early characteristics of autism

may appear deaf--doesn't turn when you enter room, may seldom cry, or may be really fussy, fussy eater, no anticipatory response, avoids looking at people, tunes out, delayed speech, doesn't like changes, don't imitate friends or peers, sensory sensitivity

165

when are medications appropriate for autism?

for sx of − Aggression
− Hyperactivity and inattention may have ADHD but can’t tx it the same way
− Behavioral rigidity
− Perseveration and/or stereotyped behaviors
− Depression and/or anxiety

166

Is an isolated hydrocele or one with a communicating hernia most likely to persist?

one with a communicating hernia, isolated hydroceles are more likely to spontaneously reduce

167

tx of a hernia and hydrocele in infant

hernia: always needs surgery: elective if reducible and immediate if incarcerated; hydrocele wait to see if spontaneously resolves after 1 year and if it doesn't then surgery b/c most likely

168

do umbilical hernias usually incarcerate?

no--just observe, may take years

169

what does this make you think of: substantial drainage of meconium from belly button + visible sinus. how to treat?

patent omphalomesenteric duct: tx with surgery

170

patent urachus

connection between umbilicus and urinary bladder, may be filled with fluid or may be flat with a hole in it: needs surgery

171

rule of 2s for meckel's diverticulum (remnant of omphalomesenteric duct)

• 2% of population
• 2 years, age at common presentation
• 2 feet proximal to ileocecal valve(ileum)
• 2 inches long

172

what portions of intestines are involved in most intussusception cases

ileo-colic

173

projective vomiting, non bilious in a 3-6 wk yo

pyloric stenosis

174

what areas are rare to have bruises on for kids?

upper arms, genitalia, trunk, face, buttocks, ears, neck

175

currant jelly + cramping and vomiting makes you think of what?

intussusception

176

tx of intussusception

hydrostatic/pneumatic reduction/enema

177

palpable "olive' and string sign mean what?

pyloric stenosis

178

Vasculitis of unknown etiology in kids

kawasakis disease

179

dx of kawasakis must include?

fever for 5 days + 4/5: changes in extremities, rash, oropharyngeal changes, bulbar conjuctival injection, cervical lymphadenopathy

180

coronary artery aneursym in kid on echo makes you think of what?

kawaskaki's dz

181

immunoglobulin A deposition
dz

HSP

182

most common cause of acute renal failure in young children

HUS

183

Classic triad of what dz?
Microangiopathic hemolytic anemia
Thrombocytopenia
Renal insufficiency/injury

HUS

184

when a kid has UTI, what cause do you have to think about?

vesicoureteral reflux

185

how can we try to prevent vesicoureteral reflux?

prenatal ultrasounds looking for hydronephrosis

186

UTI sx in kids

Clinical symptoms: fever, vomiting, diarrhea, irritability, poor feeding, jaundice (nonspecific findings)
Failure to Thrive
Malodorous urine
Fever without source (5% have UTI) UA part of any fever work up

187

what test should be done in everyone

voiding cystourethrogram or radionuclide cystogram

188

T OR F: you should work up every kid with UTI

T!

189

indications for sending kids to pediatric trauma center

Multi-system trauma
Unstable vital signs NEVER reassure yourself that their abnml vital sign (HR) is b/c they are crying
Axial skeleton #
Neurovascular injury
Acute cord injury
Complicated TBI
Low trauma score

190

signs of hypoxemia in kids

Cyanosis
Agitation
Poor capillary refill fingers, head, neck
Bradycardia esp bad if started tachy then went brady—about to go into respiratory arrest, may still have to start compressions even if really low but not gone
Desaturation measured by pulse oximetry
Signs of inadequate ventilation
Stridor (croup? Epiglottitis?) or wheezing (asthma?)
Tachypnea not normal
Nasal flaring
Grunting
Retractions

191

indications for CT scan in kids

abdominal tenderness
abdominal distention
abdominal bruising
hematuria
vomiting, neurologic obtundation
falling or low hematocrit
absent bowel sounds