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Royal College: Emergency Medicine > Pediatrics > Flashcards

Pediatrics Flashcards

This deck covers Chapters 160-177 in Rosens, compromising all of pediatrics.

1
Q

What medication should be given to babies (~2-3 weeks) presenting with cyanotic CHD? Dose? Side effects?

A

PGE1 0.05-0.1 ug/kg/min IV infusion

Side effects:

  • Fever
  • Seizure
  • Apnea
  • Hypotension
  • Bradycardia
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2
Q

List 7 anatomical differences in children and the relevance.

A
  1. Large surface to weight ratio = More heat loss
  2. Large head, floppy neck = Higher rate of head injury
  3. Narrow airway = More easily obstructed
  4. CV Compromise/Hypotension is late = Well until crashing
  5. Pliable bones = More force to vital organs
  6. Physeal plates are weakest = Growth plate injuries
  7. Nose breathers = Secretions cause significant WOB
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3
Q

List 5 causes of decreased stroke volume in children

A
  1. Dehydration
  2. Pericarditis w/ tamponade
  3. Myocarditis
  4. CHF
  5. HOCM
  6. Dilated cardiomyopathy
  7. Tachydysrhythmias
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4
Q

List 6 treatment options for a child having a “tet spell”

A
  1. Oxygen
  2. Knee-to-chest
  3. Calm the child
  4. Morphine 0.1 mg/kg IV/IM
    * Fentanyl 1 ug/kg IV/IM
  5. Ketamine 1 mg/kg IV
  6. Phenylephrine 20 ug/kg IV
  7. Propranolol 0.01 - 0.02 mg/kg IV
    * Esmolol 500 ug/kg bolus IV
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5
Q

What are the historical features (4) concerning for child abuse?

A
  • Lacking details
  • Inconsistent on repeat questioning
  • Inconsistent with developmental status
  • Inconsistent mechanism with injury
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6
Q

Draw a diagram outlining fetal circulation.

A

From mom, through umbilical vein (1)

Bypass liver via ductus venosus

Enter heart at IVC

Bypass lungs via patent foramen ovale to aorta

Bypass RV via patent ductus arteriosus to aorta

Blood then leaves placenta via umbilical arteries (2)

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7
Q

List 5 infectious and 3 non-infectious causes of HUS

Why are antibiotics contraindicated?

A

Infectious

  • E. coli O157:H7
  • Shigella
  • S. pneumoniae
  • Aeromonas
  • HIV

Non-Infectious

  • Drugs
  • Hereditary
  • Familial
  • Idiopathic

ABx enhances release of bacterial verotoxin

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8
Q

What is the peak age for SCFE?

Name 6 associations with SCFE

A

Peak age = 12 y/o, older in boys

  1. Male
  2. Obesity
  3. Black
  4. Endocrine disorders
  5. Radiation therapy
  6. Renal osteodystrophy
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9
Q

List 6 causes of childhood ataxia

A
  1. Acute cerebellar ataxia
  2. Post-infectious demyelinating encephalomyelitis
  3. Brainstem encephalitis
  4. Drug ingestion
  5. Inborn errors of metabolism
  6. Migraine
  7. MS
  8. Brain mass
  9. Seizures
  10. Stroke
  11. Vertebral artery dissection
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10
Q

List 4 CHDs that are duct dependent for Left to Right

  • Duct required to get blood into pulmonary circulation

List 3 CHDs that are duct dependent for Right to Left

  • Duct required to get blood into the arterial circulation
A

Left to Right

  1. Pulmonary atresia
  2. Tricuspid atresia
  3. Tetralogy of Fallot
  4. Hypoplastic right heart
  5. TGA

Right to Left

  1. Hypoplastic left heart
  2. Pre-ductal coarctation
  3. Severe aortic stenosis
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11
Q

List 8 episodic disorders that may mimic seizures in children

A
  1. BRUE
  2. Breath-holding spell
  3. Rigors
  4. GERD
  5. Migraine
  6. BPPV
  7. Syncope
  8. Stroke
  9. Sleep disorders
  10. Movement disorders
  11. Psychogenic seizure
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12
Q

Provide a DDx for a systolic murmur in the following locations:

  • LUSB
  • LLSB
  • RUSB
  • Apex
A

LUSB

  • Pulmonary stenosis
  • PDA
  • Flow murmur
  • ASD

LLSB

  • Tricuspid regurgitation
  • Still’s murmur
  • VSD
  • Tetralogy
  • HOCM

RUSB

  • Aortic stenosis
  • Coarctation

Apex

  • Mitral regurgitation
  • Still’s murmur
  • HOCM
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13
Q

Provide 2 congenital and 2 acquired causes of stridor in each of supraglottic, glottic, and infraglottic areas.

A

_Congenital_

  • Supraglottic
  • Micrognathia
  • Pierre Robin syndrome
  • Treacher Collins
  • Thyroglossal duct cyst
  • Lingual thyroid
  • Choanal atresia
  • Down syndrome
  • Macroglossia
  • Storage diseases
  • Glottic
  • Laryngomalacia
  • Vocal cord paralysis
  • Laryngeal web
  • Laryngocele
  • Infraglottic
  • Subglottic stenosis
  • Tracheomalacia
  • Tracheal stenosis
  • Vascular ring
  • Hemangioma cyst

_Acquired_

  • Supraglottic
  • Foreign body
  • Pharyngeal abscess
  • Epiglottitis
  • Tonsillar hypertrophy
  • Adenopathy
  • Glottic
  • Foreign body
  • Papillomas
  • Infraglottic
  • Foreign body
  • Croup
  • Bacterial tracheitis
  • Subglottic stenosis
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14
Q

List the most common organism for each of croup, epiglottitis, and bacterial tracheitis.

A
  • Croup = Parainfluenza virus
  • Epiglottitis = H. flu
  • Bacterial tracheitis = S. aureus
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15
Q

List 10 causes of vomiting in children

A
  • Meningitis
  • Brain mass
  • Overdose
  • DKA
  • CAH
  • UTI
  • CHF
  • Pneumonia
  • AOM
  • Sepsis
  • Any GI issue…
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16
Q

List the normal vital signs by age (HR, RR, BP)

A

Heart Rate

  • <1 year = 100 - 160
  • 1-2 years = 90 - 150
  • 2-5 years = 80 - 140
  • 5-12 years = 70 - 120
  • 12+ years = 60 - 100

Respiratory Rate

  • <1 year = 30 - 60
  • 1-2 years = 24 - 40
  • 2-5 years = 22 - 34
  • 5-12 years = 18 - 30
  • 12+ years = 12 - 16

Blood Pressure

  • <1 month = 60 mmHg
  • 1-12 months = 70 mmHg
  • 1-10 years = 70 + (Age x 2)
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17
Q

How do you manage bronchiolitis in the ED?

Name 2 treatments that have evidence for, 2 against, and 2 equivocal.

A

Treatment = Supportive

Evidence for:

  1. Oxygen
  2. Hydration

Equivocal:

  1. Nebulized epinephrine + Dexamethasone
  2. Nasal suction

Against:

  1. Ventolin/Atrovent
  2. Steroids
  3. Antibiotics
  4. Hypertonic Saline
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18
Q

List 8 things on a DDx for bacterial meningitis

A
  1. Stroke
  2. Brain bleed
  3. CNS vasculitis
  4. SAH
  5. AOM
  6. Sepsis
  7. Meningitis
  8. Encephalitis
  9. Brain abscess
  10. Brain mass
  11. Sympathomimetics
  12. ASA
  13. Anticholinergics
  14. Thyrotoxicosis
  15. NMS
  16. SS
  17. MH
  18. Heat stroke
  19. Viral URTI
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19
Q

What is the CPS statement on steroids in meningitis?

A

Dexamethasone 0.6 mg/kg IV div q6h

  • Give within 4h of ABx (earlier is likely better)
  • Mortality benefit with S. pneumoniae
  • Hearing loss benefit with H. influenzae
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20
Q

What investigations would you order as a “critical sample”?

A

Usual

  • Electrolytes
  • LFTs
  • Glucose
  • Lactate

Nutrients

  • Ketones
  • Free Fatty Acids
  • Amino Acids

Hormones

  • Growth Hormone
  • Cortisol
  • Insulin
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21
Q

What are the diagnostic criteria for Kawasaki disease?

A

CREAM

Fever >5 days plus 4 of the following:

  • Conjunctivitis (bilateral, non-suppurative)
  • Rash (generalized maculopapular rash)
  • Extremity changes (swelling/red, sloughing on hands/feet)
  • Adenopathy (>1.5 cm)
  • Mucosal involvement (Strawberry tongue, red lips/throat)
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22
Q

What is the treatment of phimosis?

A
  • Topical steroids (Betamethasone x6 weeks)
  • Dilation
  • Dorsal slit/Circumcision
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23
Q

How is the desired amount of ORT estimated and given?

A
  • Estimate degree of dehydration
  • Mild 30 mL/kg, Mod 60 mL/kg, Sev 90 mL/kg
  • Calculate the desired volume
  • Multiply weight by severity
  • Replace ongoing losses
  • 10 mL/kg per stool
  • 2 mL/kg per vomit
  • Administer 25%/hr x4 hr
  • Re-evaluate at 4 hours
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24
Q

What is the etiology and treatment for septic arthritis by age?

  • 0-2 months
  • 2 months - 5 years
  • 5 - 12 years
  • >12 years
A

0-2 months

  • GBS
  • S. aureus
  • N. gonorrhea

2 months - 5 years

  • S. aureus
  • Streptococcus
  • Kingella
  • H. influenzae

5 - 12 years

  • S. aureus
  • Streptococcus pyogenes

>12 years

  • S. aureus
  • N. gonorrhea

Treatment

  • Cefotaxime/Ceftriaxone + Vancomycin
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25
Q

How do you manage an upper airway obstruction in an infant (<1 year) vs. a child (>1 year)?

A

Infant (<1 yr)

  • 5x back blows then 5x chest compressions

Child (>1 yr)

  • Heimlich

If unconscious, start CPR. No blind finger sweeps.

Needle cric if necessary

  • 14-18G needle on a 3 mL syringe without the plunger
  • Connect to BVM using 3-0 ETT connector
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26
Q

Review the developmental milestones in children <2 years old

A
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27
Q

List 10 drugs that may cause seizures

A

OTIS CAMPBELL

  • Oral hypoglycemic
  • Theophylline, TCA
  • Insulin, Isoniazid
  • Sulphonylureas, Sympathomimetics
  • Camphor, Cocaine, CO
  • ASA, Anticholinergics
  • Methanol
  • PCP, pesticides
  • Botanicals, BZD/Barbituate w/d
  • Ethylene glycol, Ethanol w/d
  • Lidocaine
  • Lithium
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28
Q

Outline the Boston Criteria

A
  • Age 28-89 days
  • Fever >38.0 degrees
  • Well looking
  • Labs
  • WBCs < 20
  • UA < 10 WBCs/hpf
  • CSF <10 WBCs/hpf
  • CXR normal (if obtained)
  • NPV 94.6%
  • All children received a dose of IM ceftriaxone
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29
Q

List 3 conditions that cause a double-bubble sign on AXR

A
  1. Pyloric stenosis (non-bilious - 4 weeks progressive)
  2. Duodenal atresia (bilious - immediate)
  3. Midgut volvulus (bilious - 4 weeks sudden)
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30
Q

List 4 indications for LP in suspected acute bacterial meningitis

A
  1. Fever <60 days
  2. Neonatal sepsis
  3. Altered mental status/Neck stiffness
  4. Suspected sepsis in abnormal host
  5. Consider in:
    * Fever + Seizure
    * Fever + Petechiae
    * Fever + Contact
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31
Q

Name 6 risk factors for meningitis in children

A
  1. Neonate
  2. Native
  3. Black
  4. Malnourished
  5. Low SES
  6. Daycare
  7. Sickle Cell

Immune Compromise

  1. AIDS
  2. Asplenia
  3. Renal Disease
  4. Hepatic Disease
  5. DM
  6. Dysgammaglobulinemia
  7. Immunosuppressive medication
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32
Q

What is the peak age for Legg-Calve Perthes disease?

Name 8 associations with the disease.

A

Peak age = 7 y/o

  1. Male
  2. Breech
  3. Low birth weight
  4. Later birth order
  5. Older parents
  6. Short
  7. Asian
  8. Low SES
  9. HIV
  10. Renal disease
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33
Q

Describe the Salter-Harris classification system

A
  1. Straight
  2. Above
  3. beLow
  4. Through
  5. cRush
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34
Q

Give a DDx for conjugated and unconjugated jaundice in an infant.

A

Conjugated

  1. Obstructive
    * Biliary atresia
    * Bile duct stricture
    * Choledochal cyst
  2. Infectious
    * Sepsis
    * TORCH infection
  3. Metabolic/Genetic
    * Cystic fibrosis
    * Galactosemia
    * Alpha-1 antitrypsin deficiency

Unconjugated

  1. Hemolysis
    * G6PD
    * Spherocytosis
    * Sickle Cell
    * ABO incompatibility
    * Cephalohematoma
  2. Infectious
    * Sepsis
    * TORCH infection
  3. Obstructive
    * Duodenal atresia
    * Pyloric stenosis
  4. Metabolic/Genetic
    * Galactosemia
    * Crigler-Nejar syndrome
    * Gilbert syndrome
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35
Q

What is the treatment for paraphimosis?

A
  • Analgesia (nerve block)
  • Reduce edema (ice)
  • Reduce foreskin (two thumbs, pull shaft)
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36
Q

List 6 cardiovascular causes of sudden death in an athlete.

A
  1. HOCM
  2. Brugada
  3. WPW
  4. ARVD
  5. Commotio cordis
  6. Long QT
  7. Mitral valve prolapse
  8. Coronary disease from Kawasaki
  9. Aortic rupture from Marfans
  10. Dilated cardiomyopathy
  11. Myocarditis
  12. Aortic stenosis
  13. Congenital coronary anomaly
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37
Q

What is the inpatient and outpatient antibiotic regimen for pneumonia treatment in children >3 months?

A

Outpatient

  • Amoxicillin 90 mg/kg/day TID x10 days
  • PCN Allergic: Clarithromycin 7.5 mg/kg BID x10 days

Inpatient

  • Ceftriaxone 50-100 mg/kg q24h

and

  • Azithromycin 10 mg/kg on day 1, 5 mg/kg on days 2-5
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38
Q

What are the 4 radiographic classification stages of Legg-Calve-Perthes disease?

A
  1. Initial - femoral head smaller than opposite
  2. Fragmentation - epiphysis fragments
  3. Re-ossification - bone density restores
  4. Healed - residual deficits remain
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39
Q

List 3 ways to estimate ETT size for children >1 y/o?

A
  1. Breslow tape
  2. Diameter of little finger
  3. Cuffed = 3.5 + (age/4)
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40
Q

How do you counsel a parent regarding febrile seizures?

A
  • Risk of epilepsy from 1% to 2%
  • 30% of kids will have another
  • Younger they are, higher the risk
  • During seizure
  • Protect from injury, nothing in mouth
  • If seizure <5 min
  • Check airway, recovery position, seek MD advice
  • If seizure >5 min
  • Call 911
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41
Q

List 7 factors associated with priapism

A
  1. Sickle cell
  2. Leukemia
  3. Anticoagulation
  4. Immunosuppression
  5. Trauma
  6. Spinal cord injury
  7. Drugs - SSRI, sedatives OAC, abuse
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42
Q

List 4 organism that cause a ‘whooping cough’

A
  1. B. pertussis
  2. C. pneumoniae
  3. M. pneumoniae
  4. Adenovirus
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43
Q

What risk factors (8) are referred to in the phototherapy guidelines for risk of bilirubin related encephalopathy?

A

Some Ailing Babies Have to Get Lower Phototherapy Thresholds

  • Sepsis
  • Albumin <30
  • Blue (Asphyxia)
  • Hemolysis
  • G6PD
  • Lethargy
  • pH (Acidemia)
  • Temperature instability
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44
Q

List 10 complications of status epilepticus

A
  1. Brain ischemia
  2. Tachycardia
  3. Hypertension
  4. Hyperpyrexia
  5. Rhabdomyolysis
  6. Hyperglycemia
  7. Lactic acidosis
  8. Aspiration
  9. Takotsubo cardiomyopathy
  10. CHF
  11. Apnea
  12. Neurogenic pulmonary edema
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45
Q

What is first-line treatment for pneumonia in 0-3 months?

A

0-30 days

  • Ampicillin 50 mg/kg q8h + Cefotaxime 50 mg/kg q8h

30 - 90 days

  • Ceftriaxone 100 mg/kg IV q24h
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46
Q

What does the CPS recommend in regards to the management of status epilepticus?

A
  • Lorazepam 0.1 mg/kg IV, then
  • Fosphenytoin/Phenytoin 20 mg/kg, then
  • Phenobarbital 20 mg/kg, then
  • RSI + Midaz infusion
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47
Q

When (10) would you work-up a child with acute diarrhea?

A
  1. <6 months
  2. Premature
  3. Chronic medical conditions
  4. Fever
  5. Bloody stool
  6. High output
  7. Persistent vomiting
  8. Dehydration
  9. Altered
  10. Poor ORT in ED
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48
Q

List 10 causes of diarrhea in children

A
  1. Overdose
  2. CAH
  3. Addisonian crisis
  4. Thyrotoxicosis
  5. UTI
  6. Pyelonephritis
  7. Pneumonia
  8. AOM
  9. Sepsis
  10. Malabsorption
  11. CF
  12. Intussusception
  13. IBD
  14. Gastroenteritis
  15. IBS
  16. Short gut syndrome
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49
Q

List 10 causes of HTN in children

A
  1. Essential HTN
  2. Conn’s
  3. Pheo
  4. Renal artery stenosis
  5. Coarctation
  6. Nephritic syndrome
  7. ICP
  8. Brain mass
  9. HSP
  10. PCKD
  11. SLE
  12. Diabetic nephropathy
  13. Cushing’s
  14. CAH
  15. Chronic steroids
  16. OCP
  17. Sympathomimetics
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50
Q

What are the risk factors (6) for febrile seizure recurrence?

A
  1. Age on onset <18 months
  2. Fever <39 degrees
  3. 1st-degree relative FHx
  4. Fever <1h before the seizure
  5. Multiple seizures in the same illness
  6. Daycare
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51
Q

What do you do if a child has a fever for 6 days and only 2 criteria for Kawasaki?

A

Incomplete Kawasaki Workup

  1. ESR >40 + CRP >30
  • If not, stop
  • If so, get: HgB, WBC, Plt, Alb, ALT, Urine
  • HgB AbN
  • WBC >15
  • Plt >450
  • Alb <30
  • ALT AbN
  • Sterile pyuria (>10 WBCs/hpf)
    * If 3+ AbN, get an echo and treat
    * If 0-2 AbN, get an echo
    * If echo AbN treat
    * If echo normal, stop
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52
Q

Name the top 3 bacterial causes of pneumonia by age:

  • 0-3 weeks
  • 3 weeks - 3 months
  • 3 months - Adolescent
A

0-3 weeks

  • E. coli
  • GBS
  • L. monocytogenes

3 weeks - 3 months

  • C. trachomatis
  • S. pneumoniae
  • H. influenzae

3 months - Adolescent

  • C. pneumoniae
  • M. pneumoniae
  • S. pneumoniae
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53
Q

What pediatric patients are at higher risk of UTI?

A
  • Female < 2 years
  • Male < 1 year uncircumsized
  • Male < 6 months circumsized

*Send UCx even if dip negative

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54
Q

Name 13 infectious causes of diarrhea

A
  1. Campylobacter jejuni
  2. Clostridium difficile
  3. E. coli - STEC
  4. E. coli - ETEC
  5. Salmonella, non-typhoid
  6. Salmonella typhi
  7. Shigella
  8. Vibrio cholera
  9. Vibrio parahemolyticus
  10. Yersinia enterocolitica
  11. Cryptosporidium
  12. Entamoeba histolytica
  13. Giardia
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55
Q

List the 5 components of the Westley Croup Score.

What defines mild/moderate/severe?

A

CARLS

  • Cyanosis (0/4/5)
  • A/E (0/1/2)
  • Retractions (0/1/2/3)
  • Level of Consciousness (0/5)
  • Stridor (0/1/2)

Mild = 0 - 2 (Dex 0.15-0.6 mg/kg then home)

Moderate = 3 - 5 (Dex 0.15-0.6 mg/kg then observe)

Severe = 6 - 11 (Dex 0.15-0.6 mg/kg + Epi 5 mL neb)

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56
Q

What is a Tillaux fracture? How is it managed?

A

SH3 fracture of the distal tibia epiphysis caused by an avulsion of the AITFL

Ortho to see in ED

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57
Q

List 5 fracture patterns that are worrisome for child abuse

A
  1. Non-linear skull fractures
  2. Long bone in a non-ambulatory child
  3. Posterior rib
  4. CML
  5. Vertebral body
  6. Fractures at different stages of healing
  7. Multiple fractures
  8. Any fracture <1-year-old
58
Q

Compare and contrast extension vs flexion-type supracondylar fractures:

  • How common?
  • Mechanism?
  • Physiology? What nerves are injured?
  • Presentation?
A

How common?

  • Extension = 95%
  • Flexion = 5%

Mechanism?

  • Extension = Hyperextension with FOOSH
  • Flexion = Direct blow to flexed elbow

Physiology?

  • Extension = Ant. cortex breaks with post. displacement
  • Flexion = Post. cortex breaks with ant. displacement

Presentation?

  • Extension = Holds in extension, arm in “S”
  • Flexion = Holds in flexion, olecranon missing

Nerves Injured?

  • # 1 anterior interosseous nerve (AIN) (branch of median n.)
  • # 2 radial nerve palsy
  • ulnar nerve palsy (seen with flexion-type)
59
Q

What is a triplane fracture? How is it managed?

A

An angled fracture of the distal tibia in 3 planes

Age 10-17

Ortho in ED

60
Q

What are the different lines on the phototherapy guideline?

A
  1. Term (>38) and well
  2. Term + risk factors OR 35-37+6 wk and well
  3. 35-37+6 wk + risk factors
61
Q

List 8 complications from HSP

A
  1. Intussusception
  2. Renal failure
  3. Gallbladder hydrops
  4. Pancreatitis
  5. GI bleed
  6. Bowel ischemia
  7. Coronary artery vasculitis
  8. Headache
  9. Orchitis
62
Q

List 8 causes of headache in children

A
  1. Stroke
  2. SAH
  3. AVM
  4. HTN
  5. Meningitis
  6. Encephalitis
  7. Brain abscess
  8. Brain mass
  9. Hydrocephalus
  10. AOM
  11. Cocaine
  12. Congenital malformation
  13. Abuse
  14. Dehydration
  15. Migraine
  16. UTI
  17. Pyelonephritis
  18. Pneumonia
  19. Medication S/E
63
Q

List 10 causes of dysuria in a child

A
  1. UTI
  2. Pyelonephritis
  3. Renal colic
  4. Balanitis
  5. STI
  6. Vaginitis
  7. Pinworms
  8. Vaginal FB
  9. Chemical irritant (soap, bubble bath, etc.)
  10. Sexual abuse
  11. Masturbation
  12. Straddle injury
64
Q

What are the most common causes of fever in the following age groups? Name 3 bacterial and 3 viral.

  • 0-28 days
  • 1-3 months
  • 3-36 months
  • 3 years - Adult
65
Q

List the three components of the Pediatric Assessment Triage

A
  1. Appearance
  2. Circulation to Skin
  3. Work of Breathing
66
Q

Provide a DDx (3) for cyanotic heart disease with decreased and increased vascular markings on CXR.

A

Increased vascular markings

  1. Transposition
  2. Truncus arteriosus
  3. TAPVR
  4. Hypoplastic left heart

Decreased vascular markings

  1. Tricuspid atresia
  2. Pulmonary atresia
  3. Tetralogy of Fallot
67
Q

List 5 mimics of child abuse

A
  1. Metaphyseal cupping & spurring
  2. Osteogenesis imperfecta
  3. Rickets
  4. Scurvy
  5. Hypervitaminosis A
  6. Congenital syphilis
  7. Congenital rubella
  8. Periosteal new bone formation
68
Q

What are the indications for IE prophylaxis for patients undergoing procedures? What procedures? What medication?

A

Indications

  • History of IE
  • Hardware
  • CHD
  • Transplant

Procedures

  • Dental with mucosal involvement
  • Resp incision
  • Infected Skin

Prophylaxis

  • Amoxicillin 50 mg/kg PO (max 2g)
  • PCN Allergic: Clindamycin 20 mg/kg (max 600 mg)
  • Give 30-60 minutes before procedure
69
Q

Outline the Rochester Criteria

A
  • Age < 60 days
  • Fever >38.0 degrees
  • Well looking
  • Labs
  • WBCs 5 - 15
  • Bands < 1500
  • UA < 10 WBCs/hpf
  • Stool <5 WBCs/hpf
  • Sens 92%
  • NPV 98.9%
70
Q

What are 4 conditions associated with severe RSV infection?

A
  1. Chronic lung disease
  2. Pulmonary hypertension
  3. Chronic heart disease
  4. Prematurity
  5. Immunodeficiency
71
Q

List the pediatric doses for the following asthma medications:

  • Ventolin MDI
  • Ventolin Neb
  • Atrovent MDI
  • Atrovent Neb
  • Dexamethasone
  • Prednisone
  • Methylprednisolone
  • Epinephrine
  • Magnesium sulfate
A
  • Ventolin MDI
  • <20 kg = 4 puffs
  • >20 kg = 8 puffs
  • Ventolin Neb
  • <20 kg = 2.5 mg
  • >20 kg = 5 mg
  • Atrovent MDI
  • <20 kg = 4 puffs
  • >20 kg = 8 puffs
  • Atrovent Neb
  • <20 kg = 250 ug
  • >20 kg = 500 ug
  • Dexamethasone 0.6 mg/kg IV
  • Prednisone 2 mg/kg (max 60 mg)
  • Methylprednisolone 1-2 mg/kg (max 125 mg)
  • Epinephrine 0.01 mg/kg IM
  • Magnesium sulfate 50 mg/kg
72
Q

What is the dose of:

  • Cardioversion
  • Defibrillation
  • Epinephrine
  • Atropine
  • Adenosine
  • Amiodarone
  • Procainamide
  • Lidocaine
  • Magnesium
A
  • Cardioversion = 1 J/kg
  • Defibrillation = 2-4 J/kg
  • Epinephrine = 0.01 mg/kg
  • Atropine = 0.02 mg/kg
  • Adenosine = 0.1 mg/kg
  • Amiodarone = 5 mg/kg
  • Procainamide = 15 mg/kg
  • Lidocaine = 1 mg/kg
  • Magnesium = 50 mg/kg
73
Q

What are physical exam and radiographic findings (7) are concerning for child abuse?

A
  1. Bruising in young infant
  2. Patterned bruises/burns
  3. Bruises on ears/neck/trunk/inner thigh/groin
  4. Posterior rib fractures
  5. Classic metaphyseal fracture
  6. Any fracture in a non-ambulatory child
  7. Fractures of different stages of healing
74
Q

List 8 conditions at high risk for developing arrhythmia

A
  • Kawasaki
  • Myocarditis
  • CHD
  • Congenital heart block
  • WPW
  • Long QT
  • Rheumatic heart disease
  • Commotio cordis
  • Hypoxia
  • Electrolytes
  • Hypothermia
75
Q

Name and describe 3 physical exam techniques to diagnose development dysplasia of the hip

A
  1. Ortolani (Okay - reduces hip)
    * Stabilize pelvis, abduct hip, pull up on thigh
  2. Barlow (Bad - dislocates hip)
    * Stabilize pelvis, adduct hip, push down
  3. Galeazzi Sign
  4. Femur length discrepancy by bending knees
76
Q

What are 6 signs/symptoms of acute bilirubin encephalopathy?

A
  1. Arching
  2. Fever
  3. High-pitched cry
  4. Hypertonia
  5. Opisthotonos
  6. Retrocollis
77
Q

What is the DDx for a child with altered mental status?

A

AEIOU TIPS

  • Alcohol
  • Electrolytes
  • Infection
  • Oxygen, Overdose
  • Uremia
  • Trauma, Tumour
  • Insulin, Intussusception
  • Psychiatric
  • Seizure
78
Q

Name 8 non-infectious causes of pneumonia-like presentation.

A
  1. Asthma
  2. FB
  3. Pneumothorax
  4. Congenital anomalies (TE fistula, bronchopulm. dysplasia)
  5. Pericarditis
  6. CHF
  7. Anaphylaxis
  8. Aspiration
  9. Cystic Fibrosis
  10. PE
79
Q

When would you (in ED) reduce a supracondylar fracture?

A

Indications

  • Pale, pulseless, cool hand by ED
  • Pulseless but perfusing should be done by ortho!

Reduction

  • In-line traction
  • Correct lateral/medial displacement
  • Hold elbow and flex elbow to 40 degrees
  • Splint in place
80
Q

What are the most common causes of jaundice in a newborn?

A

Breastfeeding jaundice

  • Increased RBC mass
  • Decreased hepatic uptake of bilirubin
  • Increased hepatoenteric circulation of bilirubin
  • Bilirubin normal at birth, peaks at day 3, normal by 1 week

Breast milk jaundice

  • Mechanism unknown
  • Bilirubin continues to rise, peaking at day 10-21
  • Responds to withdrawal of breast milk for 48h
81
Q

What is Baumann’s (outer) angle? What is it used for?

A

For subtle supracondylar fractures

  • Line from growth plate of capitellum
  • Line parallel to humeral shaft

Normal = 75 degrees or <5 degrees between sides

82
Q

In SCFE, how is slip severity described?

A

As a percentage of displacement

  • Mild =
  • Moderate = ⅓ - ½
  • Severe = >½
83
Q

List the 7 acyanotic heart diseases

A
  1. ASD
  2. VSD
  3. Endocardial cushion defect
  4. PDA
  5. Aortic stenosis
  6. Pulmonic stenosis
  7. Coarctation
84
Q

Describe the physiology of a “tet spell”

A

Crying causes a decrease in SVR

This causes a R-to-L shunt across the VSD

Hypoxia ensues

85
Q

Describe how to perform the hyperoxia test

A

100% O2 for 10 minutes, get ABG before/after

PaO2 > 250 = lung

PaO2 < 100 = heart

86
Q

List 5 causes of neonatal seizures

A
  1. HIE
  2. CNS infection
  3. Intracranial bleed
  4. Ischemic stroke
  5. Chromosomal abnormality
  6. Metabolic disturbance
    * Hypoglycemia
    * Hypocalcemia
    * Hypomagnesemia
    * Pyridoxine deficiency
    * Inborn error of metabolism
  7. Drug withdrawal
87
Q

Explain the Gartland classification system

A

For extension-type supracondylar fractures:

  • I = non-displaced fracture
  • II = anterior cortex displaced
  • III = anterior + posterior cortex displaced
88
Q

What are the three phases of pertussis? How is it diagnosed? Treatment?

A

Phases

  1. Catarrhal phase - URTI
  2. Paroxysmal phase - cough, post-tussive emesis
  3. Convalescent phase - chronic cough

Diagnosis

  • NP Swab for PCR or Cx

Treatment

  • Azithromycin 10 mg/kg day 1, then 5 mg/kg on days 2-5
  • Vaccine
  • Public health
  • Isolate
89
Q

List 10 causes of acute renal failure in children

A
  1. Dehydration
  2. DKA
  3. Cardiogenic shock
  4. AIN
  5. RTA
  6. ATN
  7. Glomerulonephritis
  8. HUS
  9. TTP
  10. Pyelonephritis
  11. Posturethral valves
  12. Renal vein thrombosis
  13. Nephrolithiasis
  14. RCC
90
Q

What nerve is at risk in flexion-type supracondylar fractures? Extension-type?

A
  • Flexion = Ulnar
  • Extension = AIN (Median)
91
Q

List 5 x-ray findings consistent with epiglottitis.

A
  1. Thumbprint sign
  2. Thickened epiglottitis
  3. Thickened aryepiglottic folds
  4. Dilated hypopharynx
  5. Lack of air in the vallecula
92
Q

List 8 differences between the adult and pediatric airway.

A
  1. Prominent occiput
  2. Large tongue
  3. Large tonsils
  4. Dynamic airway collapse w/ res
  5. Large, floppy epiglottis
  6. Anterior/Cephalad larynx
  7. Cricoid is narrowest
  8. Small airways
93
Q

List 3 clinical clues that can help differentiate cardiac vs respiratory central cyanosis

A
  1. Response to hyperoxia test
  2. Response to crying
  3. Work of breathing
94
Q

What is the ED management of SCFE? List 2 complications.

A

Treatment

  • NWB (crutches or wheelchair)

Complications

  1. AVN
  2. Chondrolysis
  3. Non-union
  4. Growth arrest
  5. Arthritis
95
Q

How do you differentiate SVT and sinus tachycardia in a baby?

A

SVT

  • No precipitating event (fever, pain, etc.)
  • No variability
  • No response to fluids
  • No p waves on ECG
  • Rate >220
96
Q

What is the risk of serious bacterial infection in a neonate (0-28 days)? What about 29-60 days?

A
  • Neonate (0-28 days) - 10-20%
  • Infant (29-60 days) - 10%
97
Q

List 7 causes of phimosis in a child

A
  1. Physiologic
  2. Trauma
  3. Infection
  4. Chemical irritation
  5. Poor hygiene
  6. Congenital
  7. Circumcision
98
Q

List 5 complications of supracondylar fracture.

A
  1. Vascular injury
  2. Nerve injury
  3. Compartment syndrome
  4. Volkmann’s contracture
  5. Gunstock deformity
99
Q

Name 5 risk factors/Px findings that are associated with severe bronchiolitis.

A
  1. Underlying heart disease
  2. Underlying lung disease
  3. Prematurity
  4. RR >70
  5. SpO2 <95%
  6. Ill appearance
  7. Atelectasis on CXR
100
Q

What makes a heart murmur more likely to be pathologic?

A
  1. Diastolic
  2. Any thrill
  3. Murmur with click/rub/gallop
  4. Weak pulse
  5. Cyanosis
  6. Respiratory distress
  7. ECG abnormality
  8. CXR w/ cardiomegaly
101
Q

Outline an approach to a febrile neonate (0-28 days)

A

Workup

  • CBC
  • BCx
  • UA + UCx
  • LP
  • CXR
  • +/- Stool Cx

Treatment

  • Ampicillin 50 mg/kg/dose
  • Cefotaxime 50 mg/kg/dose
  • +/- Acyclovir 20 mg/kg/dose if RF for HSV
102
Q

What diagnosis must you consider in a boy with a left-sided varicocele? Right-sided?

A
  • Left
  • RCC with left renal vein occlusion
  • Right
  • IVC thrombosis/compression
103
Q

Provide a DDx of 8 things for a child with wheeze

A

Infectious

  1. Croup
  2. Bronchiolitis
  3. Pneumonia
  4. Tuberculosis
  5. Bronchiolitis obliterans

Anatomy

  1. GERD
  2. CF
  3. CHF
  4. Tracheoesophageal fistula
  5. Mediastinal mass
  6. Vascular ring

Acquired

  1. Foreign body
  2. Anaphylaxis
104
Q

Compare and contrast the various degrees of dehydration

A

Mild (<3%, 30 mL/kg)

  • Alert
  • Normal vitals
  • Normal cap refill

Moderate (6%, 60 mL/kg)

  • Irritable
  • Maybe normal vitals
  • Abnormal cap refill

Severe (9%, 90 mL/kg)

  • Lethargic
  • Hypotensive/Tachycardic
  • No urine
105
Q

List 5 central and 5 peripheral causes vertigo in children

A

Central

  1. AVM
  2. Meningitis
  3. Encephalitis
  4. CNS Abscess
  5. CNS Mass
  6. Migraine
  7. Trauma

Peripheral

  1. BPPV
  2. Benign Paroxysmal Vertigo of Childhood
  3. Cholesteatoma
  4. DM
  5. Labyrithinitis
  6. Lyme
  7. AOM
  8. Ototoxin
  9. Trauma
  10. Vestibular Neuritis
106
Q

List and differentiate 4 types of diarrhea

A

Secretory

  • Enterotoxin induced cAMP causing Cl and HCO3 secretion to lumen

Osmotic

  • Poorly absorbed solutes draw water into lumen

Altered Motility

  • Neurologically increased transit time

Dysentery

  • Enteroinvasive bowel ischemia causing poor absorption
107
Q

What is the treatment for infectious diarrhea?

A
  • Azithromycin for most
  • CTX for typhoid
  • Doxy for cholera
  • Vanco for C. diff
  • Flagyl for protozoa

Fluoroquinolones are often 2nd line agents

108
Q

List 5 low-risk criteria for bacterial meningitis

A
  1. Negative gram stain
  2. CSF protein <80 mg/dL (<0.5 g/L)
  3. CSF ANC <1000 cells/mL
  4. WBC <10
  5. No seizures
109
Q

When and how much steroid is given in meningitis?

A

As per CPS: Within 4h of ABx (earlier = better)

Dexamethasone 0.15 mg/kg IV q6h

110
Q

What does the IDSA recommend in regards to when to culture (6) stool in a traveler with diarrhea?

A
  • Diarrhea 2+ weeks
  • Bloody
  • Mucoid
  • Fever
  • Severe abdominal pain
  • Sepsis
111
Q

When do you work up a jaundiced baby (5)?

A
  1. Jaundice at birth
  2. Fever
  3. Looks unwell
  4. Conjugated hyperbilirubinemia
  5. >3 weeks
  6. Not responding to phototherapy
  7. Rapidly rising bilirubin not explained by hx/pe
112
Q

Name 6 lead points that can cause intussusception

A
  1. Lymphoma
  2. Meckel diverticulum
  3. IgA vasculitis (formerly called Henoch-Schönlein purpura or HSP)
  4. Mesenteric lymphadenitis
  5. Peyer’s patches
  6. Polyps
  7. Celiac disease
  8. CF
113
Q

How does fetal circulation change at birth?

A

First gasp fills lungs with air, reducing hypoxic vasoconstriction

RV resistance drops and blood prefers RV over LV

With this shift, LA pressures increase and close the PFO

Increased oxygen causes PDA and PDV to close

114
Q

What is the treatment of meningitis by age?

  • 0-28 days
  • 1-3 months
  • 3+ months
A

0 - 28 days

  • Dexamethasone 0.15 mg/kg
  • Ampicillin 75 mg/kg
  • Cefotaxime 75 mg/kg
  • Gentamycin 3 mg/kg

1-3 months

  • Dexamethasone 0.15 mg/kg
  • Ceftriaxone 100 mg/kg
  • Vancomycin 15 mg/kg

3+ months

  • Dexamethasone 0.15 mg/kg
  • Ceftriaxone 100 mg/kg
  • Vancomycin 15 mg/kg
115
Q

List 5 steps in the management of a child with a suspected inborn error of metabolism?

A
  1. ABCs
  2. NPO
  3. Critical Sample
  4. D5NS at 2x maintenance
  5. NaHCO3 if no resolution of acidosis
  6. Dialysis if necessary
  7. Ammunol if encephalopathic
116
Q

Which diarrhea-causing bugs (4) do not require antibiotics?

A
  • E. coli STEC
  • Salmonella, non-typhoid
  • Vibrio parahemolyticus
  • Yersinia enterocolitica
117
Q

List 5 indications for neuroimaging in children with headache

A
  1. Trauma
  2. Focal neuro deficits
  3. VP Shunt
  4. Morning headaches
  5. Meningimus
118
Q

Outline the Philadelphia Criteria

A
  • Age 29-60 days
  • Temperature >38.2 degrees
  • Well looking
  • Labs
  • WBC < 15
  • Bands:Neutrophil < 0.2
  • UA < 10 WBCs/hpf
  • CSF < 8 WBCs/hpf
  • CXR normal (if obtained)
  • Stool negative (if obtained)
  • Sens 98%
  • NPV 99.7%
119
Q

What is the DDx for the sick neonate?

A

THE MISFITS

  • Trauma
  • Heart, Hypovolemia, Hypoxia
  • Endocrine (CAH)
  • Metabolic
  • Inborn Error of Metabolism
  • Sepsis
  • Formula
  • Intestinal Catastrophe
  • Toxin
  • Seizure
120
Q

List 8 risk factors associated with death from asthma

A
  1. Three ED visits in 12 months
  2. Two admissions in 12 months
  3. One ICU admission
  4. One ED/hospitalization in last month
  5. >2 MDIs in the last month
  6. Current use/withdrawal from systemic steroids
  7. Difficulty perceiving symptoms
  8. Low SES
  9. Illicit drug use
  10. Psychosocial problems
  11. Chronic heart disease
  12. Chronic lung disease
  13. Chronic psychiatric illness
121
Q

What is the DDx of a crying infant?

A

IT CRIES

  • Infections
  • Trauma, Torsion
  • Cardiac
  • Reflux
  • Intestinal Catastrophe
  • Eye
  • Strangulation
122
Q

Describe the ossification centers around the elbow.

A

CRITOE

  • 1 - Capitellum
  • 3 - Radial head
  • 5 - Internal (medial) epicondyle
  • 7 - Trochlea
  • 9 - Olecranon
  • 11 - External (lateral) epicondyle
123
Q

What are 4 x-ray findings in SCFE?

A
  1. Blurring of the metaphyseal-growth plate junction
  2. Blanch sign of steel
  3. Klein’s line doesn’t intersect lateral femoral head
  4. Enlarged angle of Southwick
124
Q

What return instructions do you give for children with diarrhea?

A
  1. V/D worsens
  2. Vomiting >24h
  3. Bloody vomit/stool
  4. Decreased U/O
125
Q

A 4yo boy presents with seizure and a sodium of 110 mEq/L.

Calculate how much 3% saline to get his sodium to 125 mEq/L

A

Amount Na = (0.6 x weight) x (desired Na - measure Na)

Weight = 10 + (Age x 2) = 18

(0.6 x 18) x (125 - 110)

10.8 x 15 = 162 mEq Na

513 mEq/L of 3% saline

(162 / 513) x 1000 cc = ~320 cc

Give 2 cc/kg q10min until seizure stops

126
Q

What is the treatment for Kawasaki disease?

A
  • IVIG 2 g/kg IV over 2 hours
  • ASA 20-25 mg/kg q6h
  • Steroids in refractory cases
127
Q

What are the Rule of 2’s in a Meckel’s?

A
  • 2 cm wide
  • 2 cm long
  • 2 ft from the ileocecal valve
  • 2% of the population
  • 2% symptomatic
  • ½ present by age 2, most age 20
128
Q

What are the 5 diagnostic criteria for a febrile seizure?

What 4 things define simple vs. complex?

A
  • Seizure + Fever with no other cause
  • Etiology = rapid rise in fever
  • Dx:
    1. Age 6 mo - 6 yr
    2. Fever >38 degrees
    3. No CNS infection
    4. No acute metabolic abnormality
    5. No previous afebrile seizures
  • Simple:
    1. <15 mins
    2. 1 per 24 h
    3. GTC
    4. Neurologically normal
129
Q

List 7 complications of circumcision

A
  1. Bleeding
  2. Infection
  3. UTI
  4. Urethral meatus stenosis
  5. Phimosis
  6. Skin bridges
  7. Inclusion cysts
130
Q

List 10 causes of hip pain in children

A
  1. AVN
  2. Reiters
  3. Septic joint
  4. Juvenile arthritis
  5. Osteomyelitis
  6. Fracture
  7. Abuse
  8. SCFE
  9. Ewing’s sarcoma
  10. Sickle cell
131
Q

What is the workup for a jaundiced baby?

A
  • CBC w/ smear
  • Bili - direct and indirect
  • Haptoglobin
  • LDH
  • TSH
  • BCx
  • G6PD assay
  • Coomb’s test
  • U/S abdomen
132
Q

List 10 causes of hematuria in a child

A
  1. Trauma
  2. UTI
  3. Pyelonephritis
  4. Renal colic
  5. RCC
  6. Nephritic syndrome
  7. AIN
  8. ATN
  9. PCKD
  10. HSP
  11. SLE
  12. SS
  13. Mono
  14. Hemophilia
  15. Munchausen’s
133
Q

Which diarrhea-causing bugs (9) require antibiotics?

A
  • Campylobacter
  • Clostridium difficile
  • Cryptosporidium
  • E. coli ETEC
  • Entamoeba histolytica
  • Salmonella typhi
  • Shigella
  • Vibrio cholerae
  • Giardia
134
Q

Provide two formulas to estimate the weight of an infant/child

A
  1. Neonate (0-12m): Weight (kg) = 4 + (Months / 2)
  2. Child (1-12y): Weight (kg) = 10 + (Age x 2)
135
Q

Name four possible x-ray findings in intussusception

A
  1. Target sign - air in intussusceptum
  2. Meniscus sign - air compresses from invaginating bowel
  3. Crescent sign - lucency in LUQ soft tissue mass
  4. Free air
136
Q

List 6 admission criteria for croup.

A
  1. Hypoxemia
  2. Significant work of breathing
  3. Tachycardia/Tachypnea
  4. Stridor at rest after treatment
  5. Complex PMHx
  6. Dehydration
137
Q

What is a BRUE? List 4 diagnostic criteria.

A

Event occurring in an infant <1 year with a sudden, brief, resolved episode with at least one of:

  1. Change in colour
  2. Change in breathing
  3. Change in tone
  4. Altered LOC
138
Q

List 5 criteria to define a LOW RISK BRUE.

A
  1. Age > 2 months
  2. Born >32 weeks + Corrected age >45 weeks
  3. No CPR by a medical person
  4. Lasted <1 minute
  5. First event
139
Q

List 8 DDx for BRUE

A
  1. Choking/Gagging
  2. Periodic breathing
  3. Breath-holding
  4. Respiratory infection (pertussis, RSV)
  5. Sepsis
  6. Intestinal catastrophe
  7. Inborn error of metabolism
  8. Endocrine
  9. Abuse
  10. GERD
  11. Arrhythmia
  12. Cardiomyopathy
  13. Seizure
  14. Syncope

THE MISFITS

140
Q

What is the #1 cause of death in infants 1 mo - 1 yr old?

A

SIDS

Unknown cause of death after thorough investigation/autopsy

141
Q

List 10 risk factors for SIDS

A

Baby

  1. Premature
  2. Prone
  3. Pillows
  4. Puny (Low birth weight)
  5. Penis (Male)
  6. Age 1 - 6 months

Maternal

  1. Late/no pre-natal care
  2. Smoking during pregnancy
  3. <20 years old

Environment

  1. Second-hand smoke
  2. Born fall/winter
  3. Overheating
  4. Bed-sharing
142
Q

List 8 AAP recommendations to prevent SIDS

A
  1. Sleep supine
  2. Firm sleeping surface
  3. No pillows
  4. No co-sleeping
  5. No smoking
  6. No overheating
  7. Pacifier at bedtime
  8. Breastfeed
  9. Sleep in crib in parents room to 6 months
  10. Prone while awake to prevent plagiocephaly

Royal College: Emergency Medicine (25 decks)

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