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Flashcards in Pediatrics Deck (52)
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1
Q

Provide a DDx for acute testicular pain.

A

Testicular torsion (intermittent or persistent)
Torsion of the testicular appendix
Epididymitis
Epididymo-orchitis
Cellulitis of the scrotal skin
Hernia (incarceration/strangulation can cause pain)
Nephrolithiasis

2
Q

In a boy with acute testicular pain, what features should raise your concern for testicular torsion?

A

Hemiscrotal redness and swelling
Nausea and emesis
Severe intensity of pain
Sudden onset

3
Q

In evaluating a boy for testicular torsion, it’s important to note that if the ultrasound is negative it could ___________________.

A

be that he has intermittent torsion/detorsion

The reason this is important to know is that if it is detorsing then surgical correction is still warranted.

4
Q

Describe the evaluation and management of epididymo-orchitis.

A

The presentation of epididymo-orchitis appears like torsion, so an US must be ordered. This will show findings of EO.

If the UA is positive for UTI, treat with antibiotics. In sexually active men, swab for G/C.

If it is negative (which is often the case in children), then supportive care is all that is needed because it is likely viral. Advise NSAIDs, supportive underwear, and ice packs.

  • Epididymo-orchitis looks like torsion w/ a gradual onset and no nausea/vomiting.
5
Q

In a fingernail injury, what should you assess?

A

First, look for nerve damage by assessing for sensation and movement.

Second, look for subungual hematomas. If there is a hematoma > 50% of the nail, trephination is indicated for relief of pain and protection of the nail.

Third, look for gross instability of the nail. If it is near to falling off, then the nail should be removed.

Fourth, if there is a laceration through the nail that is actively bleeding or there is a concern for foreign body, then remove the nail to stop bleeding and/or remove the foreign body.

6
Q

In manipulating a nail, you need to be careful not to ______________.

A

remove any of the underlying nail matrix. If you do, the nail may not grow back effectively

7
Q

Sterile foil for nail folds can be found in _________________.

A

suture packaging

8
Q

Meconium ileus with a ground glass opacity in the right hemiabdomen is pathognomonic for __________.

A

CF

The mass is the meconium plug at the ileocecal junction.

9
Q

A child who was born at 35 weeks gestation presents at 9 months. He is cognitively normal. He is noted to be missing gross motor milestones and has LE hypertonia. What diagnostic test should you order next?

A

MRI of the brain (looking for signs of cerebral palsy such as periventricular leukomalacia, ischemia, or other anomaly)

10
Q

Describe the “scissoring of the legs” physical exam that can be seen in young kids with cerebral palsy.

A

If you hold a hypertonic young, nonambulatory child up by the axillae, the legs might remain stuck crossed (as opposed to dangling freely with spontaneous movement like they should).

11
Q

A newborn screens positive for congenital hypothyroidism. TSH is elevated and T4 is mildly low. What should you do?

A

Begin levothyroxine immediately.

Congenital hypothyroidism can lead to intellectual disability if untreated. Treat and refer to endocrinology.

12
Q

What is an easy formula for volume of feeds in the first few months of life?

A

Age in months +2

13
Q

Review the types of formula and the brand names of each.

A

Milk-based: Enfamil, Similac Advance

Soy-based: Soy Isomil, ProSorbee

Hydrolyzed: Nutramigen, Alimentum, Progestimil

Elemental: Elecare, Neocate, Nutramigen AA

14
Q

In addition to asking about how many diapers in the last 24 hours, you should also ask what?

A

When was the last diaper?

A baby should have a wet diaper every six hours.

15
Q

Review the differential for hematochezia in an infant.

A
  • Anal fissure or excoriation from diaper rash or diarrhea (most common)
  • Milk protein allergy
  • Malrotation
  • Infectious diarrhea
16
Q

What bruising patterns are concerning for NAT?

A
  • Atypical locations: sides of the head (anterior and posterior are more typical), buttocks, cheeks, hands, ears
  • Bruises on a non-ambulatory child
  • Bruises in the shape of an object.
17
Q

Intussusception usually happens in what age group?

A

6 months to 3 years

18
Q

What concerning feature do you need to ask about in infants (younger than 3 months) with coughing episodes?

A

Apneic periods

19
Q

The Broselow tape should always be in what orientation (color-wise)?

A

“Red to head”

20
Q

The Broselow goes from the tip of the head to ___________.

A

the heel (not the toes!)

21
Q

How are pediatric code carts different than adult code carts?

A

They are organized by color to match the Broselow.

22
Q

Looking at the Broselow tape, how it is it organized?

A

PALS drugs in the left column, RSI and sedation drugs in the right column

23
Q

Review the TEN-4-FACES-P mnemonic for brusies concerning for NAT.

A

Torso
Ears
Neck
Child less than 4 months
Frenulum
Angle of the jaw
Cheeks
Eyes
Subconjunctival hemorrhage
Pattern (object-shaped, particularly repeated patterns)

24
Q

What does literature say about aging bruises?

A

It is inaccurate. The best thing you can do is take photos for the chart.

25
Q

The most pathognomonic frqcture for NAT is _____________.

A

metaphyseal corner fracture (aka bucket handle fracture)

This happens in children 2 and younger from shaking back and forth. Microfractures cause chips of the metaphysis to break off.

26
Q

The second most pathognomonic fracture for abuse (after bucket handle fractures) is what?

A

Rib fractures

Children’s ribs are very flexible and only break under high force like a high-mechnaism mvc or fall.

27
Q

Neonates should get bagged at what rate?

A

30-60 BPM

28
Q

What syndrome is like sixth disease (roseola from HHV6) but only localized to the cheeks at first and appearing in older children?

A

Fifth disease (erythema infectiosum), caused by parvovirus B19

Sixth disease typically affects children younger than 2.

29
Q

What are the age criteria of dextrose administration?

A
  • 1 year and younger: D10 x 5 mL/kg
  • 2-12 years: D25 x 2 mL/kg
  • Adolescents: D50 x 1 mL/kg
30
Q

Review the presentation and management of an infantile hemangioma.

A

Infantile hemangiomas are the most common tumor of childhood. Most go through a growth period in the first year of life but then stabilize and totally resolve by nine years of age.

The risks include scarring, bleeding, and functional impairment if it is in a high-risk area such as the airway.

Consultation with a pediatric dermatologist is warranted if it is higher risk for cosmetic concerns or other risk.

31
Q

What is the dose of epinephrine for pediatric anaphylaxis?

A

0.01 mg/kg IM with a max dose of 0.5 mg

32
Q

“Frothing at the mouth” and cyanosis with feeding in a neonate are suggestive of what diagnosis?

A

TEF

33
Q

What other non-aneurysm cardiac pathologies can Kawasaki cause?

A

Myocarditis
Pericarditis
Valvular pathology

34
Q

When do cardiac pathologies present in Kawasaki disease?

A

3-4 weeks after the development of KD

35
Q

Which location of scalp hematoma is least concerning in a young child?

A

Forehead

In the PECARN study, children younger than 2 with an occipital, temporal, or parietal hematoma made clinical exclusion of ICH impossible w/o CT.

36
Q

What scoring system is there for croup?

A

Westley (0-17)

Mental status:
- Normal 0
- Altered/disoriented 5

Cyanosis:
- None 0
- With agitation 4
- Resting 5

Retractions:
- None 0
- Mild 1
- Moderate 2
- Severe 3

Stridor:
- None 0
- With agitation 1
- Resting 2

Air entry:
- Normal 0
- Mildly decreased
- Markedly decreased

A score of 0-2 is mild, 3-7 is moderate, 8-11 is severe, and 12 or more is impending respiratory failure.

37
Q

Even after surgical repair, children with Hirschsprung’s can get what serious complications?

A

Hirschprung’s enterocoliitis (treat with Flagyl)

38
Q

Urine coming from the umbilicus is a sign of ___________.

A

patent urachus

39
Q

Bladder diverticulum comes from what embryologic structure?

A

Urachus

40
Q

True or false: silver nitrate cannot prevent C. trochomatis conjunctivitis.

A

False

It can, though it’s more effective at preventing gonococcal conjunctivitis.

41
Q

What is the usual symptom timeline in croup?

A

Stridor resolves and then cough and other URI symptoms continue.

42
Q

What is the tube, tape, tap mnemonic?

A

For intubated kids, think 2, 3, 4
- Tube: 2x the ETT size is the depth of OG/NG
- Tape: 3x ETT is the depth of ETT
- Tap: 4x the ETT is the size of chest tube for trauma

43
Q

What is a complication of neonatal seborrheic dermatitis in darker individuals?

A

Post-inflammatory hypopigmentation

44
Q

What is the distinguishing feature of diaper candidiasis?

A

“Beefy” red rash

45
Q

What are the causes of the various coughs?
- Staccato
- Barky
- Unrelenting with intermittent stridulous gasps

A
  • Staccato: Chlamydia
  • Barky: croup
  • Unrelenting with intermittent stridulous gasps: B. pertussis
46
Q

Per the boards, when do you treat pediatric constipation with dietary changes and when do you use PEG?

A

Dietary changes: all cases except if there is anal fissure

PEG: Anal fissure

47
Q

True or false: if a febrile infant age 29 - 60 days has negative IM and positive UTI, you do not need to do the LP.

A

True

48
Q

Review the mnemonic IT CRIES for inconsolable infants.

A

Intussusception
Trauma
Cardiac anomaly
Rectal fissures
Ingestion
Eye pathology (corneal abrasion or foreign body)
Sepsis

49
Q

What is the treatment for neonatal gonococcal conjunctivitis?

A

IV ceftriaxone

50
Q

True or false: small intraperitoneal fluid surrounding an intussusception is a contraindication to air-enema reduction.

A

False

The only contraindication for air-enema reduction is hemodynamic instability.

51
Q

Treatment for Kawasaki disease?

A

Aspirin

52
Q

Why should you not give 100% O2 to an infant with a suspected ductal-dependent lesion?

A

SpO2 levels greater than 95% cause pulmonary vasodilation. This can worsen flow through the PDA.

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