160. General peds

Question 1

Lower 5% of SBP by age

Answer 1

0-28d : 60
1-12m: 70
1-10y: 70 + (2xage)

Question 2

RR by age

Answer 2

<1 - 30-60
1-2 - 24-40
2-5 - 22-34
6-12 - 18-30
>12 -12-16

Question 3

5 airway differences

Answer 3

• more anterior and cephalad
• large, floppy epiglottis
• large occiput
• large tongues
• smaller airways and more easily obstructed

Question 4

main diff in CV system

Answer 4

• can maintain BP much longer

- hypoT is late finding

Question 5

3 differences in MSK system

Answer 5

• ligaments stronger, so more likely to break bones than tear/sprain ligaments
• weak physis of bone
• can accept greater angulation

Question 6

3 contraindicated meds and age

Answer 6

• no ceftriaxone for under 28 days
  o displacement of bili from albumin
• no ibuprofen under 6 months
• no ASA for reyes

Question 7

SAMPLE Hx

Answer 7

Signs and Sx
Allergies
Medications
PMH
Last food
Events around injury

Question 8

4 age specific issues to ask about on Hx

Answer 8

o	especially in infants
	need to get birth Hx
o	urine output in diapers
o	vaccine status
o	drug and sex in adol

Question 9

3 parts of peds assessment triangle

Answer 9

Tone/Appearance
Breathing
Circ

Question 10

5 things to assess on appearance

Answer 10

TICLS 
1. tone
2. irritable
3. consolable
4. look/gaze
5 speech/cry

Question 11

6 signs to look for on breathing

Answer 11

• tripoding ominous
• quality of voice and cry may give clue to airway
• signs of compromise
  o stridor, wheeze, retractions, grunting, snoring
• nasal flaring
• head bobbing
• RR is inversely tied to age

Question 12

3 signs to look for in circ

Answer 12

-	early compensated shock
o	pale but warm
o	delayed cap refill
-	later 
o	mottled
-	cyanosis

Question 13

feeding concerns

Answer 13

o should be q2-3h
o can lose up to 10% in first week
 should be back by day 10
o small amounts of regurg are okay as long as gaining weight

Question 14

4 Hx concerning for abuse

Answer 14

1. Hx lacks detail
2. inconsistent
3. Hx inconsistent with dev status
4. mech not consistent with injury

Question 15

PHx finding concerning for abuse

Answer 15

1. bruising in pre-cruisers
2. patterned injury
3. bruises on ears, trunk, innner thigh, neck, groin
4. posterior oropharynx injury
5. posterior rib #
6. classic metaphyseal injury
7. Any # in non-ambulatory
8. # in different stages of healing