14 Peds Flashcards
You suspect child has immunodeficiency
-what tests first
Start with these 2:
CBC Ig panel (quantitative levels of Igs)
Newborn management: TTN vs RDS
- what is diff
- how to tx
TTN: delayed clearing of lung fluid, mainly in C/S
- hyperexpanded/wet lung on CXR
- give O2, possible CPAP/intubation
RDS: preemie, lack of surfactant
- hypoextended lungs, atelectasis on CXR
- give surfactant, possible CPAP/intubation
Leukocyte adhesion def,
Chediak higashi
LAD: massive leukocytosis but no pus. Baby has delayed cord separation. Tx with BMT
Chediak (think train tracks). impaired microtubule polymerization. Albino, neuropathy, neutropenia
Ataxia-telangiectasia
-what assocs to rememeber
telangiectasias, ataxia, DNA repair, lymphoma, leukemia
Bilious vomiting in neonate
-DDx, how to dx and tx
4 to know. KUB to dx, all have double-bubble and:
- normal gas beyond: Malrotation
2/3. double bubble only: Annular pancreas (no Down’s) and Duodenal atresia (Down’s)
- Air fluid levels: Intestinal atresia from cocaine
Malrotation: Barium enema if colonic (dx, might also tx), Upper GI series if not colonic. Surgery if dying bowel
Sickle cell dz:
-what see on blood smear, other than sickled cells
Howell Jolly bodies, if older and you assume spleen autoinfarcted.
Premature, BPD
-tx
surfactant, steroids in mom antenatal.
-lung protective strategy (try to keep FiO2 and pressures low)
DiGeorge
-how present?
CATCH 22
cardiac abnl facies thymic absence (no T cells) cleft palate hypoCa (no parathyroid)
Neonatal jaundice, you see elevated conjugated Bili
-DDx (3), how to workup
think:
- obstruction (biliary atresia)–HIDA scan, U/S
- sepsis–WBC, Cx
- metabolic inborn
CGD
- what infxns
- dx
- tx
macrophages not working (catalase bugs): Staph, Aspergillus
Dx: normal CBC and Ig’s (WBCs just don’t work), negative nitro blue.
Tx: Daily Bactrim, bone marrow trans
Bronchiolitis
-who gets admitted (4)
spO2 <92
premature <34wks
age<3 mo
cardiopulm abnormality
APGAR
- what are they
- when to do
1 and 5 min Appearance: blue, acrocyanosis, pink Pulse: 0, <100, 100+ Grimace: none, high stim, regular stim Activity: none, flexion, resists extension Resps: none, irregular, strong
VACTERL
-how to check
Vertebral–XR
Anal–visual
Cardiac–Echo
Tracheal–NG tube down throat
Esophageal–
Renal–VCUG
Limbs
rash that is blanching vs non-blanching
-think what
Blanching means blood is still inside vessels, so hypervascularization or vasodilation
non-blanching means extravasation of blood through vessel wall. This is worse. Non-blanching is purpura/petichiae. eg think meningococcus, HSP, etc.
Premature, NEC
- dx
- tx
Premature in ICU has bloody BM
- do XR, see pneumatosis intestinalis
- NPO, IV Abx, TPN
- Surgery
why never take 1st temp rectaly?
imperforate anus. found on visual inspection
- upside down XR (babygram) to find end of pouch
- can fix now or colostomy to later
Check VACTERL
Neonate, bilious vomiting, KUB shows “ground glass” apperance
Meconium ileus, CF
Dissolve plug with gastrograpin enema
Measles vs rubella
-how to tell diff
Different prodome:
Measles: 4 C's Coriza Conjunctivitis Cough Koplik spots
Rubella: not as sick, prodrome of tender LAD, esp postauricular
Coin sign
foreign body aspiration, object pushes posterior
see only on lateral film
SCID
-what do they need
Think ‘Mega-AIDS:’
PCP and MAC ppx (bactrim and azithro)
gastroschisis, omphaloecele, what else not to confuse?
also Bladder extrophy–red, shining, wet with urine
omphalo”sealed”
MCC immunodef?
IgA def, 1/500
Newborn management/resuscitation
-describe
Minute 1: Stimulate infant to breathe and suction (primary apnea).
30 sec: assess pulse and breathing. If <100 or resp difficulty, do PPV or intubate
Min 1-5: APGAR and pulse ox. make sure HR>100 and resps good.
If HR 60-100 or resps not good, continue PPV
If HR <60, do chest compressions
If no improvement, Epi into umbilical vein
Min 5+: APGAR, continue resus if necessary.
Premature infant, 4 problems
BPD
ROP
IVH
NEC
Newborn management:
Meconium
-what to do
If meconium present but infant vigorous (HR>100, good resps, etc), then simple mouth/nose suctioning.
If infant poor tone, HR<100, bad resps: ET suctioning.
If pulse <60, shift to ventilatory support
Neonatal jaundice, you see elevated unconjugated Bili
-DDx and Workup tests (3)
3 tests: Coombs, Hgb, Retic ct
- Isoimmunization? (Rh dz, ABO dz)–Coombs test
- Hgb high? Blood transfusion from Twin-twin or maternal-baby delayed cord clamping
- Hemolysis? Retic high, then think genetic: spherocytosis, Pyruvate k def, G6PD
- All-, then think Breast milk jaundice
Newborn head exam
-what to know
Caput succedaneum (Crosses Sutures) Cephalohematoma
Croup
-meds
Steroids
-if stridor at rest, do racemic epi
Premature, ROP
- tx
- what is complication long term
Caused by high O2
Laser ablation
future: early glaucoma
Breast feeding vs Breast milk jaundice
- diff by timing
- tx
Breast feeding (lack of): Not enough feeding, so low gut motility leads to more uptake of Bili <7days
Breast milk: enzyme inhibition
>10days
Both can tx with formula feeding. breast feeding–increase feeding
Devo milestones to know
- motor
- fine motor
- speech
- social
2,4,6mo. 1,2,3,4,5y
motor: lift head, lift body (roll), lift and stay (sit). then: walk.
fine motor: 3,4,5,–circle, cross, triangle
speech: 1,2,3,4,5: 1,2,3,4,5-word sentences
social: social smile (2mo), stranger anx (6mo), separation anx (1y)
Premature, IVH
- how it is dx
- tx
- long term complications
- asx screening with Cranial Doppler (also do if bulging fontanelle)
- tx with surgery–VP shunt, drains
-future mental retard, sz d/o
Febrile sz:
simple vs complicated
5 things
5mo-5y
Fever
not Focal
<15 min
not repeat in 24h
Crohn’s and UC:
-which has more diarrhea, which has more blood in stool
-if suspect IBD, what things to check on physical exam:
More likely:
UC: blood in stool
Crohn’s: diarrhea
- check oral ulcers (Crohn’s)
- eyes
- skin
- joints
BCG vaccine protects from what?
against disseminated TB, but NOT pulmonary TB
Bruton’s X-linked agammaglobulinemia
- presentation
- dx
- tx
Boy, repeated bacterial infxn (esp pseudomonas)
Dx: all Ig’s deficient. Confirm with low B cells.
Tx: ppx abx, monthly Ig’s
Baby: blue at rest, pink when crying
- think what, and what else
- dx, tx
Choanal atresia, also think Tet Fallot
-catheter doesn’t pass through nose. Get ENT to look surgery
RPA
-presentation
opposite of meningitis: pain with extension of neck
hot potato voice, drooling, etc
EEG shows “hypsarrythmia”
dx, tx
Infantile spasm (West) give ACTH (cosyntropin)
1yo boy presenting with ear infection. Also has rash and easy bruising. Think what
WAX TIE
Wiskott (upside down, low IgM)
Aldrich (high IgA)
X linked
Thrombocytopenia
Infxn, recurrent
Eczema (high IgE)
Tx: bone marrow trans
IgA def
-how presents (2)
- repeated GI/resp infxn (remember, IgA is mucosal)
2. Asx, but anaphylactic rxn to blood transfusion
Non-bilious vomiting, baby
- always think what
- what age
- dx, tx
Pyloric stenosis, 6 week baby (not day1)
Projectile vomit, olive mass
IVF to rehydrate, U/S donut, myomectomy
Child with recurrent PNA
-no immunodeficiency, think what?
CF with recurrent resp/lung infections
Croup that is not responding to steroids and racemic epi
-do what
possible Bacterial tracheitis (rare)
get tracheal cx to dx, abx
Lyme dz in peds
-what to know
Amox in kids<8 (if >8, Doxy.)
Disseminated Lyme (bell’s palsy, heart block, meningitis): Ceftriaxone, still.
What peds rash to keep away from pregnant mom?
B19 parvovirus.
danger Hydrops Fetalis!
Neonate with persistent jaundice at 6 weeks
-think what, do what
Biliary atresia. (also think inborn metab or CF)
Do HIDA scan after phenobarb x1 week. (phenobarb stim biliary tree) So, if HIDA reaches duodenum, then not biliary atresia
Why don’t give Azithromycin for sinusitis
resistance to Strep pneumo
What infxns:
CGD
complement def
thymic hypoplasia
Abnormal B-cell maturation
- catalase+ (staph, aspergillus)
- Gonorrhea, meningococcal (C5-C9 in Neisserias)
- Viral, fungal
- Giardia (IgA), encaps bact
Peds seizures
-3 weird ones to know, and what to remember about them
- Infantile spasm (West)–baby, afebrile, ‘clonus of UE’. EEG shows “hypsarrythmia”
- Lennox-Gastaut
Boy 2-6, recurrent sz, EEG shows ‘spike and wave.’ mental retard - Tuberous sclerosis
- toddler with afebrile sz or complicated febrile sz, gets CT, see tubers
peds immundeficiencies tend to appear what age, why?
6 month, mom’s Ab start wearing off. Keep drinking mom’s milk
ALTE/BRUE: possible causes (5 to know), what hx/physical clues?
- Sz: eye deviation/limb-jerking
- Infxn: fever, fussy baby
- cardiac: difficulty feeding, murmur, FTT
- Abuse: multiple injuries
- Reflux: after eating, food in mouth.
chronic sinusitis
- when to suspect
- how to workup (do what 3 things)
Sxs >8weeks duration, possible intermittent flareups. Get:
Sinus CT
endoscopy
allergy eval
consider rheum or immuno cause
Suspect Reye’s syndrome
- what lab to get
- what else to suspect
- get ammonia (this is hepatic encephalopahty)
- also suspect inborn errors of metabolism, can present similarly (vomiting, AMS)
BRUE definition
brief resolved unexplained event
<1y and <1 min, and any change in:
- color
- muscle tone
- resps
- responsiveness
Neonate, Failure to pass meconium:
DDx, when to suspect and how to dx/tx
3 to know:
- imperforate anus
- hirschsprungs
- CF–meconium ileus
- look at anus, no rectal 1st temp. KUB, fix now or later
- FTPM>48h. First KUB, then barium enema, confirm with full thickness bx, surgery
- FTPM>48h. KUB shows dilated loops, Gastrografin enema dx and dissolves
hydrolyzed formula
-what for
babies with milk-soy protein allegies (which can present with FTT and bloody diarrhea). Milk and soy protein can have cross reactivity.
So, give proteins that are broken down (hydrolyzed)
Child with melena
-think what, ask or do what 4 things
Remember, babies can swallow maternal blood, children can swallow own
Look for:
- hx epistaxis
- Fe supplement
- Beets diet
Apt test to diff maternal from neonatal blood
CVID
- how present
- what tx
Usu present in teenage, mild recurrent infxn (B and T cells combined)
-get regular IVIGs
Hirshsprungs
- presentation (2 ways)
- how is dx different
- FTPM neonate–Barium enema
2. child with chronic constipation, explosive BM after DRE–use anorectal manometry
Child with hematochezia
- think what if painful
- if painless
painful: intususseption
painless: think Meckel’s. Also food allergies, eg milk-soy
SIDS
-what to tell parents to prevent
- BACK to sleep
- remove blankets/stuff animals in crib
- no sharing beds
- smoking cess
Newborn presents with choking with feeds and excessive salivation
-do what
esophageal atresia
- attempt NG passage, will coil
- before surgery, look for VACTERL (esp cardiac and renal)
Adult pt with tracheostomy gets resp sxs, looks like PNA. But CXR shows no consolidation
think what, do what
Think: Bacterial tracheitis (in trach pts)
they get Zosyn
Infectious peds rashes: think what
- starts head, then spreads down body
- trunk, spreads to extremities
- palms, soles
- measles, rubella
- roseola, scarlet fever
- hand foot mouth, others
DiGeorge
- you dx’ed
- do what
- Most risk from fungi and PCP
- PPx abx from PCP (bactrim or dapsone)
- thymic transplant
- careful hypocalcemia
