peds Flashcards
bacterial meningitis peds:
0-2 mo
3mo - 2 years
2yrs - 18 years
0-2 mo: GBS, Ecoli, Listeria
3mo - 2 years: Strep pneumo
2yrs - 18 years: Neisseria meningitidis
dx: lumbar puncture, blood culture, CSF analysis
tx: initial: empiric: vanco + cefotax/ceftriax — add IV dexamethasone for HiB
coryza, cough, conjuctivitis, fever
morbilliform rash body and palms – macular rash start at back of neck and ears, then face, the downards
tiny grayish white dots on buccal mucosa
measles - rubeola
paramyxovirus
10-12 days
Koplik spots
tx: supportive, vitamin A
delayed immunizations, low grade fever, pinpoint rash, rose spots on soft palate, post-occipital retro-auricular lymphadenopathy
Rubella - 3 day measles
14-21 days
Forschemier spots
polyarthritis
rash on face spread downard
High fever for 3-4 days, fever goes away and gets a maculopapular rose colored rash starting on trunk spreads outward
Roseola – exanthem subitum – HHV-6
5-15 days
febrile seizure
swelling in face masseter muscle, fever for last 4 days, not immunized,
MUMPS – paramyxovirus
unilateral/bilateral salivary gland swelling
orchitis oophoritis
rhinorhea, nasal congestion, oodynophagia, b/l cervical lymphadenopathy, muffled voice, tonsils red with exudates
retropharyngeal abscess
neonatal conjuctivitis
ppx: topical erythromycin for all babies
sore throat and fever, month later gets chorea, prolonged P-R interval with diffuse ST evelation,
Strep Pyogenes – acute rheumatic fever
acute pharyngitis in kids – sore throat fever exudates
next step?
1) Rapid strep antigen
2) Throat culture
3yo with acute unilateral neck swelling
clindamycin
5 year old, fever, oropharynx has 1 mm vesicles onf anterior palate, gray shallow ulcers on soft palate and uvula
herpangina coxsackie
congential infections
under 2 years old and has expiratory wheezing (asthma symtpoms) with rhinorhea
bronchiolitis RSV supportive tx
puncture wound 1-2 months ago, now has encephalitis like symptoms; numbness over wound site
high pitched noise during inspiration 2 yo cough
congneital infection with periventricular calcifications microcephaly
mode of transmission
CMV
bodily fluids urine saliva
bilious emesis with dilated loops and increased rectal tone
next step?
contrast enema
abdominal pain, RUQ palpable mass, jaundice (increased bilirubin)
u/s: extrahepatic cystic mass and normal gallbladder
biliary cyst
increased risk of cholangiocarcinoma
2-8 weeks old: jaundice, acholic stools, hepatomegaly
direct hyperbilirubinemia
next step?
liver biopsy
intraoperative cholangiography
tx:
hepatoportoenterostomy kasai
failure to pass meconium, normal rectal tone, no stool in rectal vault, dilated loops of small bowel with no rectal air and no free air
intestinal obstruction by inspissated stool
meconium ileus
patient with enteral feeds, premature and LBW at 3 weeks old, has tense abdomen and distended hypoactive bowel sounds. labs: leukocytosis and metabolic acidosis
abdominal xray with air in the bowel wall and portal veins
watery stools that turn bloody within 3 days
baby less than 1 week old, has elevated indirect bilirubin, after 6 days is audibly swallowing more breast milk
lactation failure jaundice
necrotizing enterocolitis managmenet
stop enteral feeds
bowel rest
NG decompression
blood cultures and antibiotics
infant feeding
0-6 mo:
at 1 yr:
supplement with iron and vitamin D in exclusively breast fed
bilious emesis –> x ray normal, next step?
Upper GI series
cerebral edema, elevated LFT’s and hyperammoniemia in child
Reyes syndrome
Hirschprungs management
painful vesicular rash in the setting of atopic dermatitis (eczema)
eczema herpeticum
tx: systemic acyclovir
bright red sharply defined rash that extends 2. cm circumferentially around the anus
dx
bug
tx
bullous
high BP in upper extremities vs lower extremities with pulmonary edema and elevated lactic acidosis, cardiomegaly
coarctation of aorta
tx: systemic blood flow via right to left ductal shunting (keep PDA open)
will see increased left ventricular afterload d/t aortic art narrowing increased pressure
Di george
routine newborn care
pulse oximetry
single S2, crescendo decrescendo systolic murmur WITH tet spell hypercyanotic hypoxic, squats gets better
increases systemic vascular resistance
tetralogy of fallot
RVOT obstruction ( pulmonary steonsis or atresia) – why you only hear single S2 pulmonic part is absent
Right ventricualr hypertrophy
overriding aorta
VSD
decresendo diastolic murmur at LSB that increases with inspiration
Pulmonary regurgitation
turners
aoritic dissection
biphasic stridor that improves with next extension
vascular ring
neonate born premature, cxr diffuse ground glass appearance, decreased lung volumes, pulse ox is still low even after positive airway presure given
due to?
little kid with seizures and hypo-pigmented macules on body, brain mri: subendymal nodules
premature baby with LBW, head size increased
intraventricular hemorrhage
11 boy with CF, recurrent sinusitis and lung infections, labs: eosinophilia and igE elevated
18mo old with recurrent sinusitis pnemonia, heart maximal impulse on Right side of chest
2 yo barking like a dog, inspiratory stridor at rest
next step
tachypnea shortly after birth
resolves by day 2 of life
prematurity severe resp disterss and cyanosis
tachypnea and severe cyanosis
