pediatrics Flashcards
(191 cards)
1
Q
at what age is a fever of 100.4 most concerning?
A
less than 3 months
2
Q
at what age is a fever of 100.4 most concerning?
A
3
Q
HR starts ___ and gets ____ as a child grows
A
higher and gets lower
4
Q
how to observe respiratory rate inkids
A
abdominal excursions, stethoscope in front of mouth, listen to chest
5
Q
respiratory rate starts __ and gets ___ throughout childhood
A
higher and gets lwoer
6
Q
blood pressure starts __ and gets __ throughout childhood
A
low and gets higher
7
Q
when can we do a standing heigh for a kid?
A
> 2 years old
8
Q
stuff to look for at 2 months:
A
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
Q
what age does pincer grasp start?
A
9 months
10
Q
what age does stranger anxiety start?
A
9 months
11
Q
when to start screening for lipids if family history?
A
5 years!
12
Q
• Interruption of the normal progression of retinal vascularization
A
retinopathy of prematurity (premies at risk of retina not developing–need dilated fundoycopic exams0
13
Q
A
weight, length (laying down) and head circumference
14
Q
increased risk of ear infections
A
First episode at
15
Q
stuff to look for at 2 months:
A
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
Q
what age does pincer grasp start?
A
9 months
17
Q
what age does stranger anxiety start?
A
9 months
18
Q
when to start screening for lipids if family history?
A
5 years!
19
Q
• Interruption of the normal progression of retinal vascularization
A
retinopathy of prematurity (premies at risk of retina not developing–need dilated fundoycopic exams0
20
Q
ddx of wheeze in kids
A
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 • Infectiousbronchiolitis • FB • Esophageal FB • Bacterial tracheitis • Anaphylaxis • Acute respiratory distress syndrome
21
Q
increased risk of ear infections
A
First episode at
22
Q
concomitant ear infection and conjunctivitis is usu d/t?
A
h flu, start amox/clav first
23
Q
3 main RFs of CDH
A
female, first born, family history
24
Q
what test do you use for a baby 4 mos old with suspected CDH?
A
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
```
