Pediatrics Flashcards
(74 cards)
1
Q
Distinguishing timing difference between epiglottitis and retropharyngeal infection
A
Epiglottitis - more acute
RPA or other infection - progresses more slowly over several days
2
Q
Imaging of choice for suspected RPA?
A
CT of neck with contrast (even in peds!)
3
Q
When is surgical draining indicated for for RPA?
A
Greater than 2.5 cm squared
4
Q
First line abx choice for RPA?
A
Ampicillin-sulbactam or Clindamycin
5
Q
What measurements of the retropharyngeal space on a lateral neck radiograph are considered abnormally widened and suggest abscess formation?
A
Greater than 7mm at C2 or greater than 14 mm at C6
6
Q
What is pseudosubluxation?
A
Anterior displacement of the anterior border of C2 and C3
- Normal in children <8 years old (40% of children demonstrate this)
- picture Q7 Exam 1 (343744)
7
Q
Pediatric Cervical Spine Injuries
A
- Upper injuries (C1-C3) > Lower injuries
- Pseudosubluxation between C2 and C3
- Common to have spinal cord injury without radiographic abnormality
- Hyperextension, hyperflexion injuries more common
8
Q
Most common fracture involving the elbow in children < 8?
A
Supracondylar fracture
9
Q
Supracondylar fractures are high risk for neurovascular injury to what?
A
Brachial artery and median nerve
10
Q
Age of Ossification in children’s bones
A
CRITOE Capitellum - 1 y/o Radial head - 3 y/o Internal (medial) epicondyle - 5 y/o Trochlea - 7 y/o Olecranon - 9 y/o External (lateral) epicondyle - 11 y/o
11
Q
Which branch of the median nerve is commonly injured in supracondylar fractures?
A
Anterior interosseous - check by strength of patient making “OK” sign
12
Q
Clinical presentation of bacterial tracheitis
A
- Recent URI or croup improves initially, then worsens
- Will look like croup, but toxic
13
Q
Definitive diagnosis of bacterial tracheitis
A
Direct visualization with bronchoscopy or laryngoscopy showing laryngotracheal erythema, edema, and thick purulent secretions
Q#447581
14
Q
Bacteria implicated in bacterial tracheitis
A
- *Staph aureus
- H. flu
- Moraxella catarrhalis
- Strep pneumo
- beta-hemolytic strep
15
Q
Tx for bacterial tracheitis
A
Third-generation cephalosporin combined with a penicillinase-resistant penicillin e.g. nafcillin. Vanc if MRSA prevalent
16
Q
Major causes of lower GIB in children by age
A
Q#330394 graph
17
Q
What is the most common cause of neonatal hemorrhage?
A
Failure to administer vitamin K in the immediate postpartum period (associated with home births)
18
Q
Neonatal sepsis work up
A
- CBC
- UA and culture (obtained by cath or suprapubic aspiration)
- BCx
- LP
- CXR (only with respiratory sx)
- Stool analysis (only with diarrhea)
19
Q
Abx for sepsis in < 4 weeks old
A
Ampicillin PLUS gentamicin or cefotaxime
20
Q
ETT size for pediatrics formul
A
CUFFED: Age/4 + 3.5
UNCUFFED: Age/4 +4
21
Q
What is single finding most closely associated with acute otitis media?
A
Bulging tympanic membrane
22
Q
First line abx tx for uncomplicated acute otitis media?
A
High-dose amoxicillin at 80-90 mg/kg/day
23
Q
Kocher criteria to determine risk for pediatric septic joint
A
- NWB on affected side
- ESR >40 mm/hr
- Fever >38.5 (101.3)
- WBC >12,000
4/4 = 99% 3/4 = 93% 2/4 = 40% 1/4 = 3%
24
Q
Pediatric dextrose administration in hypoglycemia
A
By Age:
>8 - D50 1ml/kg
1-8y/o - D25 2ml/kg
<1 yr - D10 2-5 ml/kg
25
What is tracheomalacia?
Weak tracheal rings resulting in collapse of trachea during expiration
Can be congenital, but also a frequent complication of surgical repair of esophageal atresia and tracheoesophageal fistula
26
Clinical manifestations of tracheomalacia
- Brassy, barking cough
Severe:
- Stridor at rest
- Biphasic stridor
- Dyspnea with feeding
- Expiratory wheezing with respiratory infections
- “Death spells” beginning after 2-3 months of age - associated with feeding, crying or coughing and characterized by cyanosis, apnea, bradycardia, hypotonia that requires resuscitation
27
Management of tracheomalacia
Most with close observation, but those with recurrent death spells require nasal CPAP temporarily and aortopexy or tracheostomy for long-term relief
28
At what age do most cases of isolated congenital tracheomalacia resolve by?
1 year of age
29
Which type of bacterial meningitis usually produces lower WBC counts in CSF?
Gram positive meningitis
30
Abx therapy for bacterial meningitis in neonates (<1 mo)
Ampicillin + Gentamicin
31
What is phimosis?
Benign condition caused by stenosis of distal foreskin which may cause the inability to retract the foreskin over the glans penis
32
Evaluation of phimosis
Confirm there are no signs of urinary obstruction or local infection such as balanitis -> topical steroid cream, good hygiene, periodic gentle retraction, pediatrician follow-up
If urinary obstruction, gentle dilation of foreskin should be attempted to relieve obstruction
If signs of ischemia of the glans -> dorsal slit procedure
33
What is paraphimosis?
Inability to reduce foreskin back to anatomic position -> urologic emergency
34
What are the locations of the dorsal penile nerves?
2 and 10 o’clock positions at the base of the penis, just deep to the Buck fascia
35
Low risk characteristics after brief resolved unexplained event
- > 60 days old
- Born >32 weeks gestation
- No CPR performed by trained medical provider
- Occurrence of only one BRUE
- Duration of BRUE <1 min
- No concerning historical or physical exam findings
36
Concerning historical features related to BRUE
- Social risk factors for child abuse
- Respiratory illness or exposure
- Recent injury or other sx in days preceding event (fever, fussiness, diarrhea, decreased intake)
- Administration or access to meds
- History of episodic vomiting or lethargy
- Developmental delay or congenital anomalies
- Family h/o BRUE or sudden unexplained death in a sibling
37
Concerning physical exam findings in BRUE
- Any signs of injury
- Bleeding or bruising (especially on scalp, trunk, face, or ears)
- Bulging anterior fontanel
- Altered sensorium
- Fever or toxic appearance
- Respiratory distress
- Abdominal distention or vomiting
38
What are the three most likely disorders that can be elicited on history or exam as a cause to an apparent life-threatening event, thus negating the dx of BRUE?
1. Respiratory infection
2. Gastroesophageal reflux leading to laryngospasm
3. Seizure
39
Most common metabolic problem in neonates
Hypoglycemia
40
Etiology of SCFE
Thought to be due to physeal cartilage weakness associated with onset of puberty and growth spurt, but may be multifactorial, tends to be in obese adolescents
41
Clinical presentation of SCFE
Obese, adolescent with hip, thigh, or isolated knee pain
- limited range of motion of hip
- external rotation deformity
42
Tx of SCFE
Operative stabilization
43
Complications of SCFE
Avascular necrosis of hip and premature closure of the physis
44
Most common type of TE fistula?
Proximal esophageal atresia with distal anastomosis
Most common type diagnosed after newborn period: H-type
45
Clinical presentation of papular acrodermatitis (i.e. Gianotti-Crosti syndrome)
- Symmetric papular or papulovesicular rash usually beginning on face, buttocks, and extensor aspects of the arms and legs
- Pruritus is mild
- Mucosal lesions NOT present
- Usually occurs in children younger than 5 years
- Recent URI or GI illness
46
What can papular acrodermatitis (i.e. Gianotti-Crosti syndrome) be associated with?
Hepatitis B or EBV and less so with other viral pathogens
| Reported to occur after vaccinations including influenza, measles-mumps-rubella, hepatitis A and B, and oral polio
47
What conditions become an indication to treat a fever?
- Shock
- Burns
- Post-op patients
- Major head trauma
- Post-cardiac arrest
- Underlying neurologic or cardiopulmonary disease
48
Clinical presentation of cat scratch disease
Primary inoculation papule followed by regional lymphadenopathy 1-3 weeks later
49
Tx for cat scratch disease
Azithromycin (first line)
| Can also treat with rifampin, bactrim, ciprofloxacin
50
Clinical presentation of malrotation with midgut volvulus
- Bilious vomiting
- Abdominal distension
- Tenderness
- Palpable mass
33% present within 1st week of life; 50% within first month; 85% within first year
51
Congenital defects associated with midgut volvulus
- Congenital diaphragmatic hernia
- Congenital heart disease (herotaxy syndrome)
- Omphalocele
52
Dx of midgut volvulus
Plain film may show dilation of stomach and duodenum and a paucity of bowel gas distally
Upper GI series or ultrasound will confirm diagnosis
53
Tx for midgut volvulus
NG tube decompression and laparotomy
54
Most common cause of painful rectal bleeding in infants?
Anal fissure
55
What are infantile spasms?
1. Clusters of myoclonic seizures on awakening
- flexor spasms, extensor spasms or mixed
2. Hypsarrhythmia pattern on EEG
3. Developmental delay
56
What disease process is associated with infantile spasms?
Tuberous sclerosis
57
Tx for infantile spasms
ACTH
Steroids
Antiepileptic medications
58
Difference between gonococcal and chlamydia ophthalmia neonatorum
Gonococcal: 2-5 days old, purulent conjunctivitis, profuse exudate and swelling of eyelid, corneal involvement, can lead to corneal rupture, impaired vision
Chlamydia: 5d-5w old, minimal eyelid swelling, pneumonia is common complication
59
Tx for gonococcal ophthalmia neonatorum
Hospitalization
| Cefotaxime preferred over ceftriaxone in hyperbilirubinemia
60
Clinical presentation of pediatric discitis
- Sudden onset of back pain and refusal to walk
- Radicular symptoms common
- Fever
- Neurologic deficits UNCOMMON
- Lumbar spine most commonly involved
- Avg age of patients is 7 y/o
61
Diagnostic study of choice when concerned for pediatric discitis
MRI
62
Most common etiologic agent of discitis?
Infection with staph aureus
63
Clinical presentation of neonatal abstinence syndrome
CNS DYSFUNCTION
- high-pitched cry
- restlessness
- hyperreflexia
- tremor
- myoclonic jerks
METABOLIC, VASOMOTOR, RESPIRATORY
- Diaphoresis
- Fever
- Yawning
- Tachypnea
GI DYSFUNCTION
- Excessive sucking or rooting
- Poor feeding
- Vomiting
- Loose stools
64
Distinguishing feature between acrocyanosis and true cyanosis?
Mucous membranes would be involved in true cyanosis
65
What is the name of the benign lacy, reddish, mottled skin appearance of the extremities that may be associated with acrocyanosis?
Cutis marmorata
66
At what age can kids start receiving ibuprofen?
Greater than 3 months of age
67
What is a severe complication of perioral electrical burn?
Delayed bleeding from labial artery 5-21 days after injury
68
Most common location for pediatric pseudosubluxation?
C2-C3
| Normal (deviation <2mm) in children under 8 years old
69
Clinical picture of coarctation of aorta
Depends on how severe
Neonates: asymptomatic while PDA is open or if not severe - heart failure and shock when PDA closes
Older infant, children: most asymptomatic; BP in upper extremities > lower extremities; brachial-femoral pulse delay; hypertension
Adults: hypertension; rib notching
70
Coarctation of the aorta is associated with what genetic disease?
Turner syndrome
71
How long after birth does umbilical vein stay patent?
One week
72
What is the most common rhythm in pediatric cardiac arrest?
Asystole
73
Most common complication of acute mastoiditis
Facial nerve paralysis
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Others:
- Subperiosteal or deep neck abscess
- Hearing loss
- Labyrinthitis
- Osteomyelitis
Less common:
- Epidural or subdural abscess
- Meningitis
- Sinus venous thrombosis
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74
What infectious organism is associated with intussusception?
Rotavirus
