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Pediatrics AQ cases > 6 > Flashcards

6 Flashcards

1
Q

When do you consider failure to thrive?

A

< 5th for weight OR weight for length

crossing more than 2 major lines

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2
Q

Organic causes of failure to thrive

A 
Congenital heart defects
Cystic fibrosis
Gastroesophageal reflux
Neurologic disorders
Metabolic disease
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3
Q

Typical feeding pattern of a young infant

A

10-30 minutes every 1-2 hours; bottle-fed may be less frequent because takes more with each feed

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4
Q

What is a critical portion of the pediatric cardiac exam?

A

PULSES- brachial vs femoral pulses = rule out coarctation of the aorta

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5
Q

What grade murmur has a thrill?

A

4

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6
Q

What is the number one cyanotic congenital heart defect?

A

Tetrology of fallot

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7
Q

Why do we see hepatomegaly in congestive heart failure?

A

Decreased renal blood flow leads to fluid retention via RAAS = systemic venous congestion, and hepatomegaly.

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8
Q

On an abdominal exam of a newborn you appreciate the liver edge 3 cm below rib border. Is that normal? What is ddx for hepatomegaly?

A

Not normal - < 1 cm = normal

If > 1cm ddx =
Congestive heart failure
Congenital infections
Inborn errors of metabolism
Anemias, and (less commonly)
Tumors
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9
Q

You hear a systolic ejection murmur with widely split, fixed S2. What is this murmur and how old is the patient?

A

ASD, 3-5 most common age

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10
Q

How does coarctation fo the aorta present?

A
  • murmur
  • HTN in upper extremities
  • discrepancy between the upper and lower extremity pulses and BP
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11
Q

You are examining an infant in the nursery and detect a holosystolic murmur beginning with S1 with a blowing quality. What is it?

A

VSD

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12
Q

Describe physical exam of aortic stenosis

A

Systolic ejection murmur, radiating to the neck (and occasionally a thrill in the jugular notch), with an early systolic click

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13
Q

Continuous ‘machine-like’ murmur and bounding pulses (from a widened pulse pressure)

A

patent ductus arteriosus murmur

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14
Q

Why does tetralogy of fallot result in systolic ejection murmur?

A

RVOT obstruction

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15
Q

Why does ASD result in systolic murmur?

A

increased flow across a normal pulmonic valve

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16
Q

How does an innocent murmur sound?

A

Vibratory, low-pitched, louder when supine

Heard best at the left lower sternal border

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17
Q

Which heart murmurs present with signs of CHF in infancy?

A

VSD
Severe aortic stenosis
Coarctation of the aorta
Large patent ductus arteriosus

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18
Q

What are the three embryological components of the ventricular septum?

A

endocardial cushion
embryologic conotruncus
embryologic trabecular septum

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19
Q

What determines the magnitude of left to right shunt in VSD?

A

size of the defect and pulmonary vascular resistance

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20
Q

A child is diagnosed with VSD murmur. Why was it not detected in the nursery?

A

elevated pulmonary vascular resistance in a newborn

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21
Q

3 medications for CHF

A

Enalapril, furosemide, digoxin

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22
Q

What is a potential bleak outcome of untreated VSD?

A

Pulmonary vascular obstructive disease (Eisenmenger’s syndrome)

23
Q

What is an akinetic/atonic seizure?

A

Involves loss of motor tone

24
Q

Things a 16 month old should be able to do

A

Uses 4-6 words consistently
Uses a spoon and cup, spills some
Follows simple commands
Stoops and recovers

25
Q

Are febrile seizures hereditary?

A

YES

26
Q

vaccinations against which two bugs has contributed to bacteremia as a rare event?

A

Haemophilus influenzae type b and Streptococcus pneumoniae

27
Q

What is fever without a source?

A

no localizing symptoms or signs on physical exam

28
Q

What are some SBI to keep in mind?

A

bacteremia, meningitis, pyelonephritis, osteomyelitis, appendicitis, pneumonia, bacterial gastroenteritis, septic arthritis

29
Q

When is an EEG indicated?

A

in children who have focal, recurrent, or complex seizures

30
Q

EEG spike 3-Hz spike-and-wave pattern

A

Absence seizure

31
Q

What is a complex febrile seizure?

A

More than once in 24-hour period, > 15 minutes

32
Q

If a child has his first febrile seizure before age 12 months, the recurrence risk for a second febrile seizure is about ___

A

50%

33
Q

What are 6 types of seizure medications?

A 
Diazepam
Valproic acid
Phenobarbitol
Phenytoin
Primidone
Carbamazepine
34
Q

red lips, a strawberry tongue, and a light-red sandpaper rash

A

Scarlet fever

35
Q

A high fever (38.5 to 40.5 C) for 3-5 days in a typically fairly well-appearing child, followed by abrupt resolution of fever and development of a maculopapular rash

A

Roseola

36
Q

Primary HHV-6 infection is associated with approximately 20% to 30% of first _______

A

febrile seizure

37
Q

What questions can you ask to evaluate if organ perfusion is being maintained in sickness (evaluate severity of sickness)?

A

Brain (alert vs. lethargic)
Skin (well-perfused, flushed, cool/clammy?)
Kidneys (urine output)
Lungs (RR, work of breathing, cyanosis)

38
Q

What are some emergency conditions that cause AMS?

A

Hypoxia, shock, and hypoglycemia

39
Q

What are some CNS causes of AMS?

A 
Infection (sepsis, meningitis, or encephalitis)
Poisoning/Toxic ingestion
Increased ICP (CNS tumor, hemorrhage)
Trauma
Metabolic disturbance (DKA)
40
Q

Why the tachypnea in a child with shock?

A

Blow off CO2 to compensate for metabolic acidosis from decreased oxygen perfusion of the tissues and cells.

41
Q

Is hypotension a late sign on shock in children?

A

YES; can usually compensate with RR and HR

42
Q

What are the types of shock?

A

Distributive
Hypovolemic
Cardiogenic
Septic

43
Q

Patients with septic shock may intitially present in “warm” shock. What are the sx of warm shock?

A 
Warm extremities
Bounding pulses
Tachycardia
Tachypnea
Adequate urination
Mild metabolic acidosis
44
Q

A child presents in shock. What is an appropriate fluid resuscitation?

A

repeated boluses of isotonic fluids (20 ml/kg at a time, total of 60 mL/kg)
if still not adequately responding, start inotropic rx

45
Q

How do fluids administered through IO enter the blood stream?

A

Tibia blood flow = popliteal vein

Femur = femoral vein

46
Q

What are some PEx findings with meningitis?

A

AMS, fever, neck stiffness, kernig’s or brudzinski’s sign

47
Q

When does meningococcal disease happen?

A

Peak incidence occurs in children < 12 months of age, with another peak at age 16 through 21 years.

48
Q

What are risk factors for meningococcal disease?

A 
Close accommodations (dormitories, military)
Complement deficiency
Anatomic or functional asplenia
49
Q

Fever and petechiae - what do you need to rule out?

A

bacterial sepsis, meningococcal disease

50
Q

Does ceftriaxone treat disease and eliminate carrier state of n. meningidities?

A

YES

51
Q

Should IV abx be ordered on hourly terms?

A

YES

52
Q

What meds are given as n. meningitis ppx?

A 
Adults = Cipro
Children = Rifampin
53
Q

What vaccines protect against n. meningococcal disease?

A

MCV4 (first at 11-12, 2nd at 16)

MenB (first at 16, booster 6 mo following)

Pediatrics AQ cases (13 decks)

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