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Flashcards in Pediatrics Deck (22)
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1
Q

Consent for treatment of minors, categories (3)(1,5,3)

A
  • Life / limb-threatening emergency
  • State-protected right to treatment: Child abuse, Pregnancy, Sexually transmitted disease, Substance abuse, Outpatient mental health (some states)
  • State-defined “emancipated minor” status: Married, Member of armed forces, Self-supporting and living on own
2
Q

Inconsolable crying, most common cause, other categories (3)

vomiting infant clues to cause

Jaundice
hypoglycemia, metabolic acidosis
Billious emesis
projectile vomiting

abdominal exam with

A

Colic; trauma (abuse, hair tourniquet, corneal abrasion), infections (move all the joints), surgical (incarcerated hernia, testicular torsion, anal fissure, volvulus/intuss)

Jaundice - hepatobiliary disease
hypoglycemia, metabolic acidosis - inborn errors of metabolism
Billious emesis - malrotation of gut
projectile vomiting - pyloric stenosis

abdominal exam with incarcerated hernia

intussusception

3
Q

diarrhea

Viral diarrhea with vaccine

high fevers, seizures - cause

bacterial diarrhea, season

metabolic cause

infant blood in stool, most common cause, tx

A

Viral diarrhea with vaccine - rotavirus

high fevers, seizures - cause - Shigella due to neurotoxin

bacterial diarrhea, season - summer

metabolic cause - secondary lactase deficiency

infant blood-idiopathic, observe
note, swallowed maternal blood seems unlikely when color is red

4
Q

Necrotizing enteritis - what? Cause?
Timing

major risk factor

TX (2)

A

what? Cause? Sloughing of intestinal lining due to ischemia precipitated by unclear causes with infection possible
Timing - 3 to 10 days old

major risk factor - prematurity 50 to 80% incidence

TX (2) - antibiotics, surgery consult

5
Q

Pictured entity, features

A

Necrotizing enterocolitis

  • Intramural air
  • Double density layering of the abdominal wall
  • Generalized bowel dilation
  • Loss of haustrations
  • Gas lucencies over the liver (intraportal gas)
  • Intramural bowel gas
6
Q

Neonatal jaundice, cause categories (3)

_____ hyperbilirubinemia always requires admission

lab tests (2)

Glucuronyl transferase inhibitors in breast milk implies

A

Categories: physiologic 50%, sepsis related, breastmilk 10%
direct hyperbilirubinemia always requires admission

CBC, Coombs which indicates hemolytic antibodies

implies breastmilk jaundice

7
Q

Physiologic jaundice, etiology

peaks during

breastmilk jaundice, treatment

phototherapy thresholds

A

etiology - rate of hemolysis of fetal RBCs > liver can handle

peaks during day to today for

tx: only stop breast-feeding if bilirubin > 20; peaks days 10-20
thresholds: days 1-2: 15, 2-3: 18, 3+: 20

8
Q

Pictured entity

best test
common location

ALTE: definition (4)

peak age

able to diagnose in ?%

A

best test: US
common location: vertically oriented mass in epigastric or RUQ, 66%

some combination of color change, apnea, choking, change in muscle tone
1 to 3 months
70%

  • CNS infections – ? LP / septic eval
  • Seizures – (10%) ? chemistries, glucose
  • Gastroesoph. reflux (laryngeal stimulation)(20-54%)
  • Intracranial hemorrhage, increased ICP – ? CT
  • Botulism – ? stool for clostridial cult. / botulinum
  • Lower respiratory tract infection (8%) (RSV), obstruction, pneumonia, pertussis? CXR
  • Low glucose, low calcium – ? test
  • Dysrhythmia, cardiomyopathy, congenital heart disease – EKG
  • Sepsis – septic eval with pan cultures / SBI 2.7%
  • Non-accidental (battering [3%], OD, Munchausen)
  • Idiopathic (apnea of infancy)
9
Q

Review ALTE treatment algorithm - period of monitoring?

ALTE high risk (6)

A

24 hours
greater than 10 seconds, occurred during sleep, seizures, marked hypotonia, feeding associated, suspected abuse

10
Q

Most common cause of death, one month to one year

associated with ALTE?

Risk factors (4)

risk reduction (3)

A

SIDS

no
advanced maternal age, increasing parity, maternal drug abuse, sibling with SIDS

risk reduction: sleep on back, pacifier, firm bedding

11
Q

Neonatal pneumonia - causes, most common + 3

staccato cough =

paroxysmal cough, posttussive emesis

treatment

A

Group B strep, strep pneumo, H flu, chlamydia

staccato = chlamydia; also afebrile, conjunctivitis

pertussis - can also lead to rectal prolapse, hernias

erythromycin or Septra

12
Q

Bronchiolitis - agent
indication for admission

complications

tx (3+)

A

RSV 60%
oxygen saturation < 92

apnea
tx: humidified oxygen, nebulized epinephrine, heliox, +/- steroids (not current)

NO albuterol/ipratropium

13
Q

Febrile seizure, complex definition (4)

pediatric hypoglycemia tx

Arnold-chiari malformation leads to

A

Duration > 15 minutes, >1 in 24 hours, focal, age < 6 mo or > 6 years

tx D10

leads to non-communicating cerebellar hydrocephalus

14
Q

sx/Signs of Hydrocephalus (4)

shunt obstruction sign and tx

infection most commonly occurs within

tx (2)

A

Irritability, Sixth cranial nerve weakness, strabismus, increase lower extremity tone

valve reservoir on scalp will not compress; consider emergency tap if severe symptoms

within six months of insertion, skin flora

tx: ceftaz and vanco

15
Q

Pulsatile tinnitus can suggest
meningitis
< 2 mo causes (3) + tx (2)

> 2 mo causes (2+1) tx (2-3)

A

Idiopathic intracranial hypertension
E. coli, strep, listeria; ampicillin (listeria), cefotaxime

strep pneumo, Neisseria, H flu (rare); ceftriaxone/cefotaxime, vanc?, steroids

16
Q

Pictured entity

primary physiologic cause of pathology and prevention

childhood HIV physical exam clue

most common opportunistic infection
classic clinical dyad

A

Tetralogy of Fallot

RV outflow tract obstruction + VSD

prevention: agitation of child will cause increased right to left shunting (Tet spell)

HIV: hepatosplenomegaly, lymphadenopathy

PCP pneumonia

hypoxia out of portion to chest x-ray findings

17
Q

Pictured entity
unifying underlying pathophysiology
criteria (5)

treatment

A

Autoimmune vasculitis of small to medium vessels
4/5: measles like rash, oral signs, limb signs (including desquamating hand/foot rash), lymphadenopathy, conjunctivitis

IV gamma globulin

18
Q

Recurrent respiratory infections, hypochloremic alkalosis?

Other major system affected

pictured entity

primary other symptom

other organ system involved
treatment

A

Cystic fibrosis

G.I.: pancreatic exocrine dysfunction, obstruction, intussusception
HSP

abdominal pain
renal dysfunction
steroids

19
Q

Multisystem complication of diarrheal illness

clinical dyad
caused by

peripheral smear finding
antibiotics?

A

HUS
MAHA + renal failure
E. coli 0157:H7

shistocytes/helmet cells

no antibiotics

20
Q

weight based defibrillation and cardioversion dose

ET tube size

most common cardiac arrest rhythm
preferred inotrope

Pediatric maintenance fluids 24 hours

A

Defib: 2 J/kilogram; cardioversion: 0.5 J/kilogram

(16+ age)/4

asystole
epinephrine

–100 mL/kg for each of the first 10 kg of weight

–50 mL/kg for each of the second 10 kg of weight

–20 mL/kg for each remaining kg of weight

21
Q

Apgar pneumonic

infants are obligate ?

Bradycardia often due to ?

UA for all febrile children up to ?

A

How ready is the child: heart rate (>100 BPM), respiratory effort
irritability (more = better), tone, color

obligate nose breathers
due to hypoxia

UA -> two years (1 year for circumcised boys)

22
Q

X-ray to exclude respiratory foreign body

dehydration, metabolic acidosis, hypoglycemia, encephalopathy suggests? and tx (2)

pediatric hyperkalemia, don’t use

A

No; greater than 75% radio Lucent

inborn error of metabolism; supportive treatment + NPO

insulin due to risk of severe hypoglycemia