Peds and IV

Question 1

dehydration tonicity

Answer 1

look at salt

Na 15 - hyper

Question 2

normal saline

Answer 2

154 mEq Na/L

Question 3

D5W

Answer 3

dextrose in water

Question 4

lactated ringers

Answer 4

NaCl, KCl, CaCl, Na lactate in water

Question 5

deficit

Answer 5

half given over 8 hours

half given over next 16 hours

Question 6

deficit Na and K

Answer 6

important in hypo or hypernatremic dehydration

Question 7

bolus therapy

Answer 7

isotonic
20mL/kg
normal saline or LR

Question 8

vomiting

Answer 8

no lactated ringers

exacerbates metabolic alkalosis

Question 9

maintenance

Answer 9

daily water needs based on energy expenditure

Question 10

holliday segar method

Answer 10

for maintenance

hourly calc - 4-2-1
4 mL/kg/hr - first 10kg
2 - 11-20kg
1 - >21kg

24 hour calc
100 mL/kg/day - first 10 kg
50 - 11-20kg
20 - >21 kg

Question 11

fluid deficit

Answer 11

%dehydration of pre-illness weight x 1000mL/kg

child mild to severe
-3/6/9%

infant mild to severe
-5/10/15%

Question 12

clammy skin

Answer 12

severe dehydration

Question 13

tenting skin

Answer 13

moderate dehydration

Question 14

sunken fontanelle

Answer 14

severe dehydration

Question 15

<2sec cap refill

Answer 15

mild dehydration

Question 16

maintenance of Na and K

Answer 16

3Na x 100mL of water
2K x 100mL of water

Na - extracellular
K - intracellular

Question 17

illness < 3 days

Answer 17

80% ECF deficit

20% ICF

Question 18

illness > 3 days

Answer 18

60% ECF deficit

40% ICF

Question 19

Na deficit

Answer 19

fluid deficit X
proportion from ECF X
Na concentration in ECF

Question 20

K deficit

Answer 20

fluid deficit X
proportion fro ICF X
K concentration in ICF

Question 21

K

Answer 21

150

Question 22

Na

Answer 22

145

Question 23

less than 10kg

Answer 23

give 0.25 NS

Question 24

10-20kg

Answer 24

give 0.3 NS

Question 25

> 20kg

Answer 25

give 0.5 NS

Question 26

little kid maintenance

Answer 26

D1/4 NS with 20-30 mEq KCl or K acetate added per liter

Question 27

bigger kid maintenance

Answer 27

D1/2 NS with 20-20 mEq KCl or K acetate added per liter

Question 28

pre-illness weight calculation

Answer 28

determine weight loss - and replace with bolus of that much

20mL/kg

Question 29

double bubble X-ray

Answer 29

duodenal atresia

congenital obstruction of 2nd portion duodenum

failure of recanalization of bowel segment

below ampulla of vater

with polyhydramnios, down syndrome, CHD

Question 30

type 1 duondenal atresia

Answer 30

mucosal web with normal muscular wall - most common

type 2 - short fibrous cord connecting two atretic ends of duodenum

type 3 - complete separation of atretic ends

Question 31

oral rehydration therapy

Answer 31

5cc every 2 minutes

Question 32

dose timing for 24 hour day

Answer 32

first 8 hours

• 1/3 maintenance
• 1/2 total deficit

next 8 hours

• 1/3 maintenance
• 1/4 deficit

next 8 hours
-1/3 maintenance
1/4 deficit

Question 33

gastroenteritis

Answer 33

viral

• rotavirus
• norovirus - 50% cases in developed cases

Question 34

watery diarrhea

Answer 34

viral

Question 35

bloody bowel movements, cramping, fecal leukocytes

Answer 35

bacterial

Question 36

GERD

Answer 36

most common esophageal disorder in children

Question 37

recurrent regurgitation with or without vomiting

Answer 37

GERD

esophagitis
recurrent pneumonia
dental erosion
sandifer syndrome

Question 38

weird neck posture

Answer 38

sandifers syndrome

Question 39

CN IX

Answer 39

glossopharyngeal

altered tone - increased salvation

Question 40

occipital condylar release

Answer 40

MFR to free up vagus, hypoglossal, accesory nerves

Question 41

forceful vomiting

Answer 41

pyloric stenosis

olive like mass in RUQ abdomen

Question 42

bilious vomiting

Answer 42

green vomit

think obstruction - atresia, hirschsprung, malrotation, ileus