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Flashcards in peds3 Deck (146):
1

prophylactis for RSV bronchiolitis?

RSV monoclonal antibody called palivizumab

2

difference in sx of viral and bacterial pneumonia

viral sx begin with URI, whereas bacterial pneumonia has a more rapid onset with greater severity and not preceded by URI symptoms

3

difference in lab values between viral and bacterial pneumonia

for viral, WBC count is less than 20,000 cells/mm3 and for bacterial is more than that

4

common cause of afebrile pneumonia in 1-3 months of age

chlamydia

5

clinical clues that an infant with pneumonia has a chlamydia infection

a staccato-type cough, absence of fever, eosinophilia on WBC

6

management of chlamydia pneumonia

erythromycin or azithromycin

7

most common cause of bacterial pneumonia in older kids/adolescents

mycoplasma pneumonia and chlamydia

8

definitive dx of mycoplasma pneumonia

serum igM titers for mycoplasma

9

managmeent of mycoplasma pneumonia

oral erythromycin or azithromycin

10

pertussis aka

whooping cough

11

immunization for pertussis

beginning at 2 months

12

who is at greatest risk for pertussis?

infants less than 6 months

13

major source of pertussis

adolescents and adults whose immunity has waned

14

pertussis is characterized by what three stages

catarrhal stage, paroxysmal stage, convalescent stage

15

describe the cararrhal stage of pertussis

lasts 1-2 weeks; characterized by URI sx and low grade fever

16

describe the paroxysmal stage of pertussis

lasts 2-4 weeks; characterized by fits of forceful coughing; whoop= inspir gasp head at the very end of a coughing fit; post-tussive vomitting is common; between the fits, kids appear well and are afebrile

17

describe the convalescent stage of whooping cough

lasts weeks to months; recovery stage in which paroxysmal cough becomes less freq and less severe over time

18

definitive diagnosis of pertussis

direct fluorescent antibody tests of nasopharyngeal secretions

19

antibiotics and pertussis?

they don't alter the course of the disease but they are given to help prevent the spread; azithromycin and erythromycin are options; respiratory isolation is required until antibiotics have been given for 5 days!

20

how common is asthma?

50% of kids by 1 year and 90% by 5 years of age; 30-50% have remission by puberty

21

what may be the only sx of asthma?

chronic or recurrent cough

22

what does cxr show in an asthma patient?

hyperinflation, peribronchial thickening, and patchy atelectasis

23

what do PFTs show in a patient with asthma

obstructive disease, increased lung volumes, decreaed expiratory flow rate

24

differential for acute wheezing

asthma, hypersensitivity reaction, bronchiolitis, pneumonia, foreign body aspiration, acute aspiration of stomach contents, environmental irritants

25

6 types of drugs for asthma

sympathomimetics, cromolyn sodium and nedocromil sodium; corticosteroids; anticholinergic agents; leukotriene modifiers; methylxanthines (theophylline)

26

examples of sympathomimetics

b2 adrenergic agonists, short acting bronchodilators (albuterol), long acting bronchodilators

27

what are cromolyn sodium and nedocromil sodium?

anti-inflamm prophylaxis by inhibiting release of inflamm mediators

28

corticosteroids in asthma patient

can be systemic (for 5-10 days after acute exacerbation) or inhaled

29

good and bad of theophylline

has both anti-inflamm and bronchodilator properties but narrow therapeutic window

30

diff between intermittent, mild, moderate, and severe asthma

intermittent is daytime less than twice a week and nighttime less than twice a month; mild is less than once a day and nighttime greater than 2x per month; moderate is daily symptoms and nighttime greater than once per week; severe is continuous symptoms and frequent nighttime sx

31

how common is CF?

one in 2500 caucasians

32

what percent of caucasians are carriers?

five percent

33

what chrom is CF mutation on?

chrom 7

34

common infectious agents in CF

staph aureus and then pseudomonas

35

what nose thing is common in CF?

nasal polyps

36

what does dx of CF require?

one or more phenotypic features OR pos fam hx OR increased immunoreactive trypsinogen on newborn screen; AS WELL AS lab evidence of abnormal CFTR (two CF mutations or sweat chloride over 60 or characteristic ion transport abnormality across the nasal epithelium

37

chronic lung disease

aka bronchopulmonary dysplasia; it is defined as oxygen dependency past 28 days of life; causes both obstructive and restrictive lung disease

38

what causes CLD?

acute lung injury followed by not good healing; often in children born prematurely with RDS

39

what does cxr show for CLD?

atelectasis, hyperinflation, linear or cystic radiodensities

40

foreign body aspiration- what kids are at greatest risk?

3 months to 5 years

41

aspirated object usually ends up in which bronchus?

right

42

definition of apnea of infancy

unexplained cessation of breathing for at least 20 seconds or a shorter pause that leads to bad things like cyanosis

43

what is short central apnea?

less than 15 sec; interestingly, this is normal at all ages

44

definition of periodic breathing

three or more episodes of apnea lasting 3 sec each with no more than 20 sec in between

45

what is ALTE?

loss of breathing and tone and choking or gagging and baby needs to be resussitated

46

SIDS

death of an infant less than 1 year that cannot be explained

47

when is peak SIDS age

2-4 months, with like 95% happening before 6 months of age

48

drooling and neck hyperextension

think retropharyngeal abscess or croup (caused by staph or strep in a vaccinated infant)

49

how do you treat moderate exacerbation (10 days) of asthma?

systemic corticosteroids for 5 days

50

management of intermittent asthma

no daily medication; SA beta ag for sx

51

management of mild persistent asthma

SABA, low dose inhaled corticosteroid

52

management of moderate persistent asthma

SABA, medium dose inhaled corticosteroid

53

management of severe persistent asthma

SABA, high dose inhaled steroid and LABA, long term systemic if needed

54

difference between essential and non-essential nutrients

essential cannot be synthesized by the body so must be taken in

55

of the 20 Aas, how many are essential?

9

56

vit E def can cause

anemia/hemolysis, neuro deficits, altered prostaglandin synthesis

57

vit K def can cause

coagulopathy/prolonged prothrombin time, abnormal bone matrix synthesis

58

vit B1 (thiamine) def can cause

beriberi (cardiac failure, peripheral neuropathy, hoarseness, or aphonia, wenicke's encephalopathy)

59

vit B6 (pyroxidine) def can cause

dermatitis, cheilosis, glossitis, microcytic anemia, peripheral neuritis

60

vit B12 (cobalamin) def can cause

megaloblastic anemia, demyelination, methylmalonic acidemia

61

Vit c def can cause

scurvy

62

sx of scurvy

hematologic abnormalities, edema, spongy swelling of the gums, poor wound healing, impaired collagen synthesis

63

niacin def

pellagra (diarrhea, dermatitis, dementia), glossitis, stomatitis

64

zince def

skin lesions, poor wound healing, immune dysfunction, diarrhea, growth failure

65

marasmus

the most common energy depletion state; characterized by near starvation; patient is typically very thin from loss of bone and muscle

66

kwashiorkor

less common than marasmus; seen in parts of the world where starches are the main dietary staple; protein-deficient state; characterized by edema, abdominal distension, changes in skin pigmentation and thin sparse hair

67

how is malabsorption characterized

diarrhea, abdominal distension, and impaired growth

68

carbohydrate malabsorption

unabsorbed sugars draw water into the lumen; result is watery stool that is acidic (pH below 5.6); the unabsorbed sugars are detected as reducing agents by a positive Clinitin test

69

pos Clinitin test

unabsorbed sugars

70

congenital enterokinase def

rare cause of protein malabsorption; hypoproteinemia causes edema and growth impairment

71

inflamm disorders of the GI tract (crohn's disease) cause what kind of malabsorption

protein

72

how do you measure protein loss in the stool

fecal alpha 1 antitrypsin levels

73

steatorrhea

fat in stool

74

causes of exocrine pancreatic insuff (leads to decr lipid absorpt)

CF, Schwachman-Diamond syndrome, chronic pancreatitis

75

acanthocytosis of erythrocytes

seen in abetalipoproteinemia

76

Schwachman-Diamond syndrome

AR disorder characterized by pancreatic exocrine insufficiency, FTT, short stuature, neutropenia and sometimes pancytopenia

77

infection with what can caue malabsorption

Giardia; can be x with stool studies

78

most protein intolerance is caused by what protein?

cow's milk protein

79

what to expect in a kid with protein intolerance?

usually resolve by 1-2 years of age

80

celiac disease pathology?

intolerance to gluten, which causes mucosal damage

81

gold standard for dx of celiac

small bowel biopsy showing short, flat villi, deep crypts, and vacuolated epithelium with lymphocytes

82

serum screens for celiac disease

serum igA endomysial and serum tissue transglutaminase antibody testing (in patients with igA deficiency, check serum antigliadin igG)

83

what can non-compliance to a gluten free diet in adolescence in patients with celiac lead to?

growth failure and delayed sexual maturity

84

distal small bowel resecstion (ileum resection) leads to what?

vitamin b12 and bile acid absorption deficiency

85

predominant cause of GERD during childhood

transient lower esophageal sphincter relaxation

86

another cause of GERD in kids

gastric emptying delay

87

what to tell parents about their kid with emesis?

it is benign and usually resolves by a year old

88

most common sx of GERD in infants

emesis

89

Sandifer syndrome

torticollis with arching of the back caused by painful esophagitis

90

how does GERD present in older kids?

midepigastric pain ("heart burn")

91

how does GERD lead to airway disease?

acid refluxate causes bronchopulm constriction and can also lead to aspriation

92

who requires long term medical manaement of GERD

when infants have GERD past one year of age

93

scintigraphy

uses radioactive marker (technetium 99m) mixed into food to measure the rate of gastric emptyng. Radioactive tracer detected in the lung confirms aspiration

94

gold standard for diagnosis of GERD

pH probe in esophagus for 18 hours

95

metoclopramide

motility agents increase LES tone or increase gastric emptying;though metoclopramide has side effects

96

Nissen fundoplication

wraps the fundus of the stomach around the distal esophagus to reduce transient LES relaxation; works in 90% of kids; need gastrostomy tube for a short amt of time after this procedure

97

pyloric stenosis results in what sx?

vomitting of non-billious milky fluid during the 2nd or 3rd week of life; jaundice can occur in 5% of patients

98

who is affected most commonly by pyloric stenosi

caucasians and first born males

99

"olive" on physical exam

hypertrophied pyloric muscle palpable up and to right of umbilicus

100

what is acid/base and salt status of kid who has been vomitting due to pyloric stenosis

hypocalcemic, hypokalemic, metabolic alkalosis

101

diagnosis of pyloric stenosis

u/s that measures the pyloris muscle length and thickness

102

string sign on UGI

elongated, narrow pyloric channel due to stenosis

103

tx for pyloric steonosis

partial pyloromyotomy

104

malrotation

midgut twists around the mesenteric vessels (volvulus). Causes obstruction and infarction of the bowel

105

maltrotation more common in what gender

2:1 male predominance

106

Ladd's bands

peritoneal bands that result from the small bowel compressing the duodenum; happens in malrotation

107

presentation of malrotation/volvulis

billous vomitting and sudden onset of abdominal pain in an otherwise healthy infant; older kids might have crampy abdominal pain and vomitting

108

diagnosis of volvulus

upper intestinal contrast imaging; shows abnormal position of the ligament of treitz to the right of midline, partial or complete duodenal obstruction, jejunum to the right of the midline

109

management of volvulus

surgical emergency for the untwisting and removing any bowel that is dead; you also want to give fluid resuscitation (due to all the vomitting), and broad spectrum parenteral antibiotics

110

how does duodenal atresia happen?

failure of the duodenum to recanalize at 8-10 weeks gestation

111

most common cause of obstruction in the neonatal period

intestinal atresia

112

duod atresia more common in who?

males and babies with down syndrome

113

scaphoid abdomen with epigastric distension

duodenal atresia

114

double bubble on abdominal radiography

duodenal atresia

115

cause of jejunoileal atresia

caused by mesenteric vascular accident during fetal life

116

intussusception

proximal portion into distal

117

peak age of intussusception

5-9 months

118

most common cause of bowel obstruction after the neonatal period in infants less than 2

intussusception

119

most common location for intussuception

ileocolic

120

Meckel's diverticulum

diverticulum in the distal ileum

121

how does intussception present?

sudden onset of crampy pain that comes in intervals followed by periods of calm

122

currant jelly stools

intestinal ischemia and mucosal sloughing

123

sausage shaped mass in the RUQ

intussusception

124

gold standard dx for intussusception

air or contrast enema; both to reduce and diagnose the enema

125

"coil spring" sign on contrast enema

intussusception

126

management of intususception

contrast enema with air or hydrostatic pressure

127

risk of recurrence after contrast reduction and surgical repair of intussception

5% after contrast and 1% after surgical

128

acute abdomen

sudden onset of abdominal pain that requires urgent eval

129

most common pediatric surgery

appendectomy, peak age 10-12 years

130

appendix usually perforates by when

36 to 48 hours after onset of sx

131

tenderness at mcburney's point

appendicitis

132

most common cause of acute pancreatitis

blunt trauma, then idiopathic, then infection

133

presentation of acute pancreatitis

pain is periumbilical or epigastic and radiates to the back

134

gray-turner sigh

bluish discoloration of the flanks, sign of severe pancreatitis

135

cullen sign

bluish discoloration of of the periumbilica area, sign of pancreatitis

136

most specific blood sign of acute pancreatiits

serum lipase, but serum amylase is also elevated

137

other lab abnormalities in acute pancreatitis

interestingly, you see liver things go up; leukocytosis, hyperglycemia, hypocalcemia, elevated transaminases, and coagulopathy

138

most common method for diagnosis pancreatitis

u/s

139

management of pancreatitis

supportive care, TPN, antibiotics, and possibly surgery if there is lots of necrotic tissue around the pancreas

140

complications of acute pancreatitis

ARDS, renal failure, shock, GI bleeding; also a pseudocyst (collection of fluid rich in pancreatic enzymes that arises from pancreatic tissue) may develop

141

management of pseudocyst

small resolves on its own and large needs to be surgically removed

142

acute acalculous cholecystitis

cholecystitis that is not associated with gall stones (note that cholecystitis is usually associated with gall stones)

143

acute cholecystitis is uncommon in kids (as is pancreatitis), so if you see cholecystits, what should you think of?

sickle cell disease, or possibly CF or prolonged TPN

144

murphy's sign

palpation of RUQ during inspiraton elicits pain; sign of cholecystitis

145

gold standard dx for cholecystitis

u/s, can detect stones and thickened gall bladder wall

146

cholescintography

radioactive tracer goes through the biliary system; basically if it takes longer for the gall bladder to be visualized then there is inflamm