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Pediatrics AQ cases > 5 > Flashcards

5 Flashcards

1
Q

What are some important physical exam findings for pneumonia?

A

tachypnea, dyspnea, crackles, decreased breath sounds.

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2
Q

When should sinusitis be considered in ddx?

A

symptoms > 10 days worsening, or severe

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3
Q

What should you look for in an ear exam (COMPT)?

A

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)

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4
Q

Rather than color, what two things are more important predictors of AOM?

A

Position and mobility - many things can cause TM to be red

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5
Q

What does a normal ear look like?

A

translucent TM that is in neutral or retracted position with normal mobility.

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6
Q

What are some risk factors for development of AOM?

A 
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
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7
Q

What are two common bugs in AOM?

A

S. pneumo and Haemophilus Influenza

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8
Q

Ear exam indicates AOM in L ear, temp has been < 39 and child is consolable. Are abx a must?

A

NO, specifically because unilateral and lower temp. Discuss with parent.

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9
Q

How do you categorize severe AOM?

A

Toxic-appearing, persistent pain for 48 hours, or Fever > 39 C

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10
Q

Who should get tympanostomy tube placement?

A

OME > 4 months + hearing loss, language or developmental delay, structural abnl of ear

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11
Q

What physical exam findings reflect hydration status?

A 
Weight
HR, BP
fontanel, eyes sunken, mucous membranes
Skin turgor, temperature, cap refill
Mental status/level of activity
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12
Q

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?

A

500/30000 = 1.7% = < 3% is MILDLY DEHYDRATED1

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13
Q

What percent dehydration is SEVERE?

A

> 9%

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14
Q

Kid is lethargic, has mottled skin, heart rate is bradycardic. How dehydrated is the kid?

A

Severely, >9% fluid weight lost

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15
Q

What is the regimen for ORT of mildly-moderately dehydrated children?

A

50-100mL/kg total volume over 2-4 hours in small aliquots

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16
Q

If bowel obstruction is above the ligament of treitz, will vomiting be billious?

A

NO

Pyloric stenosis = ABOVE = NON-bilious

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17
Q

What symptoms do you expect with intussesception?

A

bilious emesis, crampy/intermittent abdominal pain, bloody stool

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18
Q

In a vomiting child without fever, should you consider etiologies due to increased intracranial pressure?

A

YES - hydrocephalus, intracranial neoplasm, and trauma (accidental or non-accidental)

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19
Q

Are sx of UTI non specific in infants?

A

YES - fever, poor feeding and vomiting, leading to dehydration

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20
Q

What electrolyte abnormalities do you expect with pyloric stenosis?

A

metabolic alkalosis, hypochloremia, hypokalemia

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21
Q

What is the maintenance fluid algorithm for children?

A

For the first 10 kg, 4mL/kg/hour
For the second 10 kg, 2mL/kg/hour
For any additional kg, 1mL/kg/hour

22
Q

You are determining ongoing fluid losses for a child in the PICU. What should you take into account?

A

vomiting, diarrhea, NG output, and insensible losses (fever, tachypnea)

23
Q

What is the anion gap equation and what is a normal number?

A

(Na + K) - (Cl + HCO3)

Normal is < 11

24
Q

What is Cushing’s triad (signs of cerebral edema and increased ICP)?

A

Hypertension, bradycardia, irregular respirations

25
Q

What to do if you suspect cerebral edema?

A

STOP fluids, START mannitol

26
Q

A kid comes in with DKA. Should they be placed on continuous CV monitoring?

A

YES; electrolyte abnl = arrhythmia risk

27
Q

Why is creatinine elevated in DKA?

A

Hypovolemia

28
Q

Why hyponatremia in DKA?

A

DILUTIONAL - water to hyperosmolar extracellular space + increased renal sodium losses.

29
Q

What does MUDPILES stand for?

A

MUDPILES: methanol, uremia, DKA, paraldehyde, INH/Iron, lactic acidosis, ethanol/ethylene glycol, salicylates.

30
Q

Calculate corrected sodium level in DKA

A

Sodium decreases by 1.6 meq/L for each 100 mg/dL rise in glucose over 100mg/dL

31
Q

Why do children have a higher rate of dehydration as comopared to adults?

A

Higher:

  • surface area:body mass ratio
  • basal metabolic rates
  • water content
32
Q

You want to quickly bolus a dehydrate a child. What to do?

A

Bolus 20mL/kg of isotonic crystalloid solution

33
Q

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?”

A

2.4 L (22 kg is 90% normal weight; 1 kg = 1 L fluid equivalent) - ** remember deficit + maintenance = total fluids

34
Q

What are the diagnostic criteria of DKA?

A

Random glucose of > 200 mg/dL
A venous pH < 7.3 or serum bicarb < 15
Moderate/large ketonuria or ketonemia.

35
Q

What is your ddx for a kid who won’t walk?

A 
Osteomyelitis
Leukemia
Reactive Arthritis
Septic Arthritis
Transient Synovitis
Trauma
JIA
SCFE
Legg-Calves-Perthes Disease
36
Q

Fever, weight loss, bone pain

A

leukemia

37
Q

0-6 years old, high fever, constitutional symptoms, pain with walking

A

septic arthritis, bacterial

38
Q

3-8 year old, bone pain, recent URI

A

transient synovitis

39
Q

diagnostic criteria of JIA

A

< 16 years old, more than 6 weeks

40
Q

You order XR in kid with limp that you suspect SCFE. What will you see?

A

posterior displacement of the femoral head

41
Q

What is Legg-Calves-Perthes Disease?

A

avascular necrosis of the capital femoral epiphysis, typically presents with indolent pain in 4-10 year old boys

42
Q

What is developmental dysplasia fo the hip (DDH)?

A

femoral head not properly aligned with the acetabulum

43
Q

What are 3 physical exam findings you can expect to see with leukemia?

A

bruising, lymphadenopathy or hepatosplenomegaly

44
Q

Do people with septic arthritis typically appear ill/toxic?

A

YES

45
Q

Do people with osteomyelitis tend to have boney tenderness?

A

YES

46
Q

What are the most helpful labs in evaluating a painful hip?

A

CBC (look for infxn)
CRP
ESR

47
Q

What do you expect of synovial fluid in septic joint?

A

Turbid appearance
Increased WBCs
Gram stain positive for bacteria

48
Q

What is the treatment of transient synovitis?

A

Rest and ibuprofen.

49
Q

What is the pediatric dosing of ibuprofen?

A

10 mg/kg every 6-8 hrs PO

50
Q

posterior displacement of the femoral head

A

SCFE

51
Q

mnemonic for causes of high anion gap metabolic acidosis

A

MUDPILES

Pediatrics AQ cases (13 decks)

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