Pediatrics Flashcards
(52 cards)
What are risk factors for severe respiratory disease in children?
Premature birth
Age < 6-12 weeks
Low birth weight
Hemodynamically significant cardiac disease
Hx of Immune deficiency, neuromuscular disorder, lung disease, or anatomical defects of the airway
Family history of wheezing
Household contacts who are cigarette smokers
Indigenous peoples
Breastfeeding is protective
Ref: iLearn Peds case 3 month old with cough
What questions on history are relevant to assess hydration status in an infant ?
History of emesis - volume and frequency
Number of wet diapers
Milk intake
Solid intake
Ref: iLearn peds three month with cough
What are the 3 most common causes of bronchiolitis?
Respiratory Syncytial Virus (64%)
Rhinovirus (16%)
Human metapneumovirus
What surgical conditions commonly present with abdominal pain in children?
Appendicitis
Intestinal obstruction
Testicular torsion
Intussusception
Ref: iLearn Peds Module 2
- Examine genitalia in younger male children c/o Abdo pain
A pediatric patient presents with perforated appendicitis. What is the management?
Admission
IV antibiotics, then oral
Repeat ultrasound to ensure resolution of collection, inflammatory mass, or phelgmon
Delayed or interval appendectomy in 4-6 weeks from initial presentation
In pediatric patients with abdominal pain, what are red flags that point to a possible surgical cause?
Children less than 5 years Previous abdominal surgery Progression of pain Pain far away from umbilicus Bilious vomiting Vomiting without diarrhea No pain like this before Disturbance in gait Return visit for same pain within 72 hours
When is a diagnosis of epilepsy made?
After 2 or more unprovoked seizures
Name 4 immediate management steps for a patient having an actute seizure episode. (Not including medications)
ABCs!! And G
Support the airway
100% oxygen
Monitor (record vitals and BP)
Get a glucose reading
Febrile seizures happen in what age group?
5 months to 5 years
Less than 5 years old
Peak between 12 and 18 months of age
Seizures are treated acutely when they last longer than 3-5 minutes. What can you give (dose and route for pediatrics) if there is no IV access? If there is IV access?
Lorazepam 0.1 mg/kg buccal or PR (max 4 mg/dose)
Diazepam 0.5 mg/kg PR (max 20 mg/dose)
If IV available:
Lorazepam 0.1 mg/kg IV (max 4 mg/dose) administer over 30 to 60 seconds slow push to minimize risk of respiratory depression
Midazolam 0.1 mg/kg IV (max 10 mg/dose)
What is Todd’s paralysis?
Post ictal paralysis or weakness
Should only last a few hours, and by definition resolve by 24 hours
What are red flags with bruising or injury in pediatrics?
Any unexplained bruising in an infant younger than 6 months
No history of trauma or a vague history
A changing story
A different story from different caregivers
An injury not compatible with history or developmental stage
A delay in seeking medical attention
When considering the possibility of non accidental trauma, what details do you need to elicit on history?
Developmental stage (is the child rolling, cruising, walking)
Any developmental regression?
Temperament (irritable or excessive crying)
More information about caregivers
Prior involvement of CAS or police
Domestic violence or caregiver hx of abuse
Mental health and substance abuse problems
Other children
FHx - bleeding disorders
What is the most common cause of serious head injury in children less than 1 year of age?
Child abuse
You’ve admitted an infant (6 week old) with a subdural hemorrhage and unexplained bruising which are suspicious for non accidental trauma. What additional investigations are you going to order as part of your evaluation for physical abuse?
- Additional blood work to rule out an underlying bleeding disorder
- CBCD, INR, PTT, fibrinogen, vWD screen - Screening labs for abdominal trauma
- AST, ALT, lipase and u/a
- consider imaging if Abdo bruising, distension, or tenderness (CT with contrast modality of choice) - Ophthalmology consult to assess for retinal hemorrhage
- Skeletal survey
- recommended in all cases of suspected physical abuse in children less than 2
+/- bone scan
What finding on fundoscopy is specific for abuse?
DIFFUSE retinal hemorrhages (multilayer)
In children less than a year, what percentage of rib fractures are from abuse?
70%
Rib fractures are often posterior and bilateral in inflicted trauma. But any rib fractures without a clear mechanism should raise concerns for inflicted trauma.
Neonates with fever less than or equal to 1 month of age should receive a full septic workup. What investigations does this include?
CBCD Blood culture Urinalysis and urine culture Lumbar puncture (protein, glucose, cell count, gram stain, viral, and bacterial culture) Peripheral blood glucose
Infants 28 to 90 days old with fever without a source who meet low risk criteria should have a partial septic workup. What investigations are included in this?
CBCD
Blood culture
U/a and culture
+/- stool culture if diarrhea and greater than 5 WBC/hpf
If you suspect ITP, what tests should you order?
CBC
Peripheral smear
Retics
INR, PTT, fibrinogen
Ref: iLearn Peds Module
A 2 year old has gastroenteritis. When can she return to daycare?
48 hours of no symptoms with normal stools
Ref: iLearn peds
For a term, healthy infant, what is a normal caloric intake?
100-120 kcal/kg/day
To ensure appropriate catch up growth in the setting of FTT, what percent of baseline caloric intake is required?
150%
What 3 infectious agents most commonly cause sepsis in healthy children?
Staphylococcus sp
streptococcus sp
Escherichia coli
Ref: iLearn Peds
