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Peds > peds66 > Flashcards

peds66 Flashcards

1
Q

clinical features of growing pains

A

kids awaken at night crying in pain; however, the physical exam is normal

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2
Q

management of growing pains

A

analgesics and reassurance

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3
Q

compression fracture

A

torus or buckle fracture; occurs if the soft bony cortex buckles under compressive force; occurs in metaphysis and requires only splinting 3-4 weeks

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4
Q

incomplete fracture

A

greenstick fracture; occurs if only one side of the cortex is fractured; reduction may include fracturing the other side

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5
Q

complete fracturs

A

transverse, oblique, spiral, communuted

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6
Q

spiral fracture

A

oblique fracture encircling the bone; occur with twisting injury; associated with child abuse

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7
Q

comminuted fracture

A

fracture that is composed of multiple fracture fragments

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8
Q

physeal fracture

A

involves the growth plate

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9
Q

Salter-harris classification

A

describes fracture involving the physis; GradeI-V; Same, Above, Low, through and through, crush

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10
Q

grade I salter-harris

A

fracture within the physis

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11
Q

grade II- salter harris

A

fracture in the metaphysis and the physis

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12
Q

grade III salter harris

A

fracture in the epiphysis and the physis

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13
Q

grade IV salter harris

A

fracure in the physis, metaphysis, and epipysis

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14
Q

grade V salter harris

A

crushing of the physis

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15
Q

metaphyseal fracture

A

involves the ends of the central shaft (between the epiphyses and diaphyses)

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16
Q

diaphyseal fractures

A

involve the central shaft of the bone

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17
Q

clavicular fractures

A

common in childhood

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18
Q

causes of clavicular fracture?

A

falling onto the shoulder

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19
Q

major cause of clavicular fracture in neonates

A

birth injury

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20
Q

clinical features of clavicular fracture

A

asymp or asymm moro reflex or pseudoparalyiss (refusal to move extremity); crepitus may be felt over the fracture

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21
Q

supracondylar fractures happen how?

A

when kid falls onto an outstretched arm or elbow

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22
Q

why is a supracondylar fracture a med emergency?

A

if the fracture is displaced and angulated, there is a risk of neurovascular injury and compartment syndrome

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23
Q

clinical features of supracondylar fracture

A

point tenderness, swelling, and deformity of the elbow;

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24
Q

supracondylar injury and pain with passive extension of the fingers suggests what?

A

compartment syndrome

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25
Q

“posterior fat pad sign”

A

triangular fat pad shadow posterior to the humerus may be observed if afracture is present

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26
Q

why should you never passively move the elbow if supracondylar fracture is suspected?

A

may increase the risk of further neurovascular injury

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27
Q

complications of supracondylar fracture

A

compartment syndrome; injury to the radial, median, or ulnar nerve; cubitus varus

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28
Q

compartment syndrome

A

pressure in the anterior fascial compartment is elevated, leading to ischemic injury and flexion deformity of the fingers and wrist

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29
Q

5P’s of compartment syndrome

A

palor, pulselessness, paralysis, pain, and paresthesia; this is a late sign

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30
Q

best sign of compartment syndrome

A

pain with passive extension of the fingers

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31
Q

cubitus varus

A

decreased or absent carrying angle of the arm as a result of poor positioning of the distal fragment

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32
Q

three common types of forearm fractures

A

colles fracture; monteggia fracture; galeazzi fracture

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33
Q

colles fracture

A

fracture of the distal radius

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34
Q

monteggia fracture

A

fracture of the proximal ulna with dislocation of the radial head

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35
Q

galeazzi fracture

A

fracture of the radius with distal radioulnar joint dislocation

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36
Q

management of forearm fractures

A

splint first until swelling goes down, then cast

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37
Q

toddler’s fracture

A

spiral fracture of the tibia; fibula remains intact

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38
Q

how do toddler’s fractures happen?

A

between 9 mos and 3 years; when toddler trips and falls while playing

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39
Q

what should make the clinician suspect child abuse?

A

metaphyseal fractures (corner or bucket handle fractures); posteror or first rib fractures; complex skull fractures; scapular, sternal, and vertebral spinous process fractures

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40
Q

most common cause of cardiac arrest in a child

A

lack of oxygen supply to the heart 2/2 pulmonary problem (choking, suffocation, lung dz), resp arrest, or shock

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41
Q

how to open the airway in a kid that is not responding

A

head-tilt method, which lifts the tongue from the back of the throat; or by the jaw-thrust method if the child has suspected neck or cervical spine injury

42
Q

how to assess for breathign

A

look, listen, and feel for exhaled airflow

43
Q

what is “circulation” all about in ABCs?

A

you need to assess the need for chest compressions; this need should be determined after two rescue breaths

44
Q

how to assess pulse (part of circulation)

A

in the brachial artery for infants; in the carotid artery for children

45
Q

when are chest compressions administored

A

for asystole or bradycardia

46
Q

shock

A

inadequate delivery of oxygen and metabolic substrates to met the metabolic demands of the tissues

47
Q

shock bp?

A

normal or decreased

48
Q

compensated shock

A

normal bp and CO with adequate tissue perfusion but maldistributed blood flow to essential organs

49
Q

decompensated shock

A

hypotension, low CO, and inadequate tissue perfusion

50
Q

irreversible shock

A

cell death and is refractory to medical treatment

51
Q

hypovolemic shock- how does your body respond?

A

endogenous catecholamine release to try to increase blood pressure

52
Q

two stages of septic shock

A

hyperdynamic stage (normal or high CO with bounding pulses, warm extremites and a wide pulse pressure) and decompensated stage

53
Q

distributive shock typically caused by what?

A

anaphylactic or neurogenic shock, or as a result of medications or toxins

54
Q

anaphylactic shock

A

acute angioedema of the upper airway, bronchospasm, pulm edema, urticaria, and hypotension because of extravasation of intravascular fluid from permeable capillaries

55
Q

neurogenic shock

A

typically secondary to spinal cord transection; characterized by total loss of distal sympathetic CV otone with hypotension resulting from pooling of blood wihin the vascular bed

56
Q

cardiogenic shock

A

when CO is limited because of primary cardiac dysfunction

57
Q

why is recognition of shock difficult?

A

compensatory mechanisms that prevent hypotension until 25% of intravasc volue is lost

58
Q

tachycardia almost always accompanies shock

A

and occurs before bp changes in children

59
Q

peripheral pulses bounding

A

in early septic shock

60
Q

capillary refill in shock

A

may be prolonged with cool and mottled extremites

61
Q

management of shock

A

supplemental oxygen, early endotracheal intubation to secure the airway and decr patient’s energy expenditure; vascular access with fluid resuscitation

62
Q

initial fluids in shock

A

20 mL/kg bolus of normal saline or lacted ringers solution

63
Q

when are inotropes indicated in shock?

A

if the blood pressure increase in response to fluids is insuff

64
Q

expamples of inoropes/vasopressors used in shock

A

dobutamine, dopamine, epinephrine

65
Q

treatment for DIC

A

fresh frozen plasma

66
Q

leading cause of death in kids greater than 1 year

A

trauma

67
Q

leading cause of trauma

A

MVA

68
Q

why are head injuries more common in kids than adults in trauma?

A

child’s head comprises a larger percentage of total body mass

69
Q

why are spleen and liver injuries more common in kids than adults during trauma?

A

rib cage is more pliable in kids

70
Q

prmary survey when a kid comes into the ER with trauma

A

ABCD (disability assessment with glasgow coma scale); and Exposure/environmental control in which patient is undressed to facilitate exam and then warmed

71
Q

adjuncts to primary survey when kid comes into ER from trauma

A

ECG monitoring, urinary catheter and NG tube, diagnostic studes (radiographs of bones and CT scans of brain and abdomen)

72
Q

pulseless electrical activity on ecg may indicate wat?

A

cardiac tamponade, tension pneumothorax, or profound hypovolemia

73
Q

why urinary catheter and NG tube in ER for trauma?

A

monitor ins and outs; and reduce abdominal distension

74
Q

secondary survey in trauma

A

the head to toe evaluation

75
Q

seizures after head trauma

A

common in kids and self-limited

76
Q

why are infants at risk for bleeding in the head after trauma?

A

at risk for bleeding in the subgaleal and epidural spaces because of open fontanelles and cranial sutures

77
Q

epidural hematoma

A

bleeding between the inner table of the skull and the dura; associated with tearng of the middle meningeal artery

78
Q

clinical features of epidural hematoma

A

increased ICP; dx by head CT which shows lenticular density representing blood in the epidural space

79
Q

management of epidural hematoma

A

immediate surgical drainage

80
Q

subdural hematoma

A

associated with tearing of the bridging meningeal veins by direct trauma or shaking

81
Q

which is more common- subdural or epidural hematoma

A

subdural

82
Q

clinical features of subdural hematoma

A

seizures and signs of incr ICP; bilateral in most cases; symptoms develop more gradually than epidural

83
Q

diagnosis of subdural hematoma

A

head CT which shows crescentic density representing blood in the subdural space

84
Q

management of subdural hematoma

A

neurosurgical consultation and usually surgical drainage; prognosis poor if underlying brain is also injured

85
Q

intracerebral hemorrhage

A

bleeding in the brain parenchyma; frontal and temporal lobes most often affected, usually on opp side of impact

86
Q

management of intracerebral hemorrhage

A

surgical drainage if the hematoma is accessible

87
Q

clinical features of ICP

A

headache, pupillary changes and altered mental status are the first signs and symptoms

88
Q

complications of incr ICP

A

cerebral herniation, most commonly trasntentorial or uncal herniation in which the temporal lobe or uncus is displaced into the infratentorial compartment

89
Q

clinical features of herniation

A

bradycardia (early sign of herniation in kids less than 4 yo); fixed and dilated ipsilateral pupil; contralateral hemiparesis; pupils will eventually become bilaterally fixed and dilated; cushing’s triad

90
Q

cushing’s triad

A

sign of herniation; bradycardia, hypertension, and irreg breathing

91
Q

signs of incr ICP

A

papilledema, CN palsy, stiff neck, head tilit, retinal hemorrhage, macewen’s sign, obtundation, unciousness, progressive hemiparesis

92
Q

macewen’s sign

A

hyperresonance of the skull on percussion; sign of elevated ICP

93
Q

managemnt of increased ICP

A

mild hyperventilation with 100% oxygen to lower PaCO2, which mildly vasoconstricts cerebral vessels; elevation of head to encourage venous drain; diuretics; neurosurg consult

94
Q

spinal cord injury without radiographic abnormality

A

SCIWORA; occurs more commonly in kids than adults

95
Q

tension pneumothorax

A

life threatening

96
Q

clinical signs of tension pneumothorax

A

distended neck veins, decreased breath sounds, hyperresonance to percussion, displaced trachea, pulseless electrical activity, and shock

97
Q

management of tension pneumothorax

A

emergent chest decompress by needle thoracotomy; don’t wait for radiographic confirmation- it may be too late!

98
Q

duodenal hematoma

A

often secondary to injury to the RUQ, commonly from a bicycle handle bar; abdom pain and vomitting; bowel obstruction is found on radiograph

99
Q

lap belt injury

A

chance fracture (flexion disruption of lumbar spine), liver, and spleen lacerations, and bowel perforations

100
Q

burns

A

second most common cause of accidental death in kids

Peds (99 decks)

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