5 Flashcards
What are some important physical exam findings for pneumonia?
tachypnea, dyspnea, crackles, decreased breath sounds.
When should sinusitis be considered in ddx?
symptoms > 10 days worsening, or severe
What should you look for in an ear exam (COMPT)?
C = Color (gray, white, red or yellow)
O = Other (bubbles, air-fluid interface, scarring, or perforation)
M = Mobility (absent, reduced, normal, or hypermobile)
P = Position (normal, retracted, or bulging)
T = Translucency (opaque or translucent)
Rather than color, what two things are more important predictors of AOM?
Position and mobility - many things can cause TM to be red
What does a normal ear look like?
translucent TM that is in neutral or retracted position with normal mobility.
What are some risk factors for development of AOM?
Day care attendance Tobacco exposure Allergies Bottle propping at bedtime Pacifier use Drinking formula from a bottle rather than breastfeeding Significant family history of AOM Male gender Lower socioeconomic status Respiratory allergies
What are two common bugs in AOM?
S. pneumo and Haemophilus Influenza
Ear exam indicates AOM in L ear, temp has been < 39 and child is consolable. Are abx a must?
NO, specifically because unilateral and lower temp. Discuss with parent.
How do you categorize severe AOM?
Toxic-appearing, persistent pain for 48 hours, or Fever > 39 C
Who should get tympanostomy tube placement?
OME > 4 months + hearing loss, language or developmental delay, structural abnl of ear
What physical exam findings reflect hydration status?
Weight HR, BP fontanel, eyes sunken, mucous membranes Skin turgor, temperature, cap refill Mental status/level of activity
A kid ways 30000 g last week and repeat weight is 29500 this week after viral gastroenteritis. What percent of weight has he lost? How dehydrated is he?
500/30000 = 1.7% = < 3% is MILDLY DEHYDRATED1
What percent dehydration is SEVERE?
> 9%
Kid is lethargic, has mottled skin, heart rate is bradycardic. How dehydrated is the kid?
Severely, >9% fluid weight lost
What is the regimen for ORT of mildly-moderately dehydrated children?
50-100mL/kg total volume over 2-4 hours in small aliquots
If bowel obstruction is above the ligament of treitz, will vomiting be billious?
NO
Pyloric stenosis = ABOVE = NON-bilious
What symptoms do you expect with intussesception?
bilious emesis, crampy/intermittent abdominal pain, bloody stool
In a vomiting child without fever, should you consider etiologies due to increased intracranial pressure?
YES - hydrocephalus, intracranial neoplasm, and trauma (accidental or non-accidental)
Are sx of UTI non specific in infants?
YES - fever, poor feeding and vomiting, leading to dehydration
What electrolyte abnormalities do you expect with pyloric stenosis?
metabolic alkalosis, hypochloremia, hypokalemia
What is the maintenance fluid algorithm for children?
For the first 10 kg, 4mL/kg/hour
For the second 10 kg, 2mL/kg/hour
For any additional kg, 1mL/kg/hour
You are determining ongoing fluid losses for a child in the PICU. What should you take into account?
vomiting, diarrhea, NG output, and insensible losses (fever, tachypnea)
What is the anion gap equation and what is a normal number?
(Na + K) - (Cl + HCO3)
Normal is < 11
What is Cushing’s triad (signs of cerebral edema and increased ICP)?
Hypertension, bradycardia, irregular respirations
What to do if you suspect cerebral edema?
STOP fluids, START mannitol
A kid comes in with DKA. Should they be placed on continuous CV monitoring?
YES; electrolyte abnl = arrhythmia risk
Why is creatinine elevated in DKA?
Hypovolemia
Why hyponatremia in DKA?
DILUTIONAL - water to hyperosmolar extracellular space + increased renal sodium losses.
What does MUDPILES stand for?
MUDPILES: methanol, uremia, DKA, paraldehyde, INH/Iron, lactic acidosis, ethanol/ethylene glycol, salicylates.
Calculate corrected sodium level in DKA
Sodium decreases by 1.6 meq/L for each 100 mg/dL rise in glucose over 100mg/dL
Why do children have a higher rate of dehydration as comopared to adults?
Higher:
- surface area:body mass ratio
- basal metabolic rates
- water content
You want to quickly bolus a dehydrate a child. What to do?
Bolus 20mL/kg of isotonic crystalloid solution
A pt with DKA weighs 22 kg and is approximately 10% dehydrated. How much fluid will she need over the next 24-48 hours in order to replace her current fluid deficit?”
2.4 L (22 kg is 90% normal weight; 1 kg = 1 L fluid equivalent) - ** remember deficit + maintenance = total fluids
What are the diagnostic criteria of DKA?
Random glucose of > 200 mg/dL
A venous pH < 7.3 or serum bicarb < 15
Moderate/large ketonuria or ketonemia.
What is your ddx for a kid who won’t walk?
Osteomyelitis Leukemia Reactive Arthritis Septic Arthritis Transient Synovitis Trauma JIA SCFE Legg-Calves-Perthes Disease
Fever, weight loss, bone pain
leukemia
0-6 years old, high fever, constitutional symptoms, pain with walking
septic arthritis, bacterial
3-8 year old, bone pain, recent URI
transient synovitis
diagnostic criteria of JIA
< 16 years old, more than 6 weeks
You order XR in kid with limp that you suspect SCFE. What will you see?
posterior displacement of the femoral head
What is Legg-Calves-Perthes Disease?
avascular necrosis of the capital femoral epiphysis, typically presents with indolent pain in 4-10 year old boys
What is developmental dysplasia fo the hip (DDH)?
femoral head not properly aligned with the acetabulum
What are 3 physical exam findings you can expect to see with leukemia?
bruising, lymphadenopathy or hepatosplenomegaly
Do people with septic arthritis typically appear ill/toxic?
YES
Do people with osteomyelitis tend to have boney tenderness?
YES
What are the most helpful labs in evaluating a painful hip?
CBC (look for infxn)
CRP
ESR
What do you expect of synovial fluid in septic joint?
Turbid appearance
Increased WBCs
Gram stain positive for bacteria
What is the treatment of transient synovitis?
Rest and ibuprofen.
What is the pediatric dosing of ibuprofen?
10 mg/kg every 6-8 hrs PO
posterior displacement of the femoral head
SCFE
mnemonic for causes of high anion gap metabolic acidosis
MUDPILES
