7 Flashcards
(46 cards)
Meckel diverticulum
A 3- to 6-cm pouch off the ileum and is a remnant of the omphalomesenteric duct. It is often lined with an endothelium that can secrete acid similar to gastric mucosa, causing ulceration of the adjacent ileal mucosa. It causes half of the lower GI bleeds in children aged 2 years or older. It can have a chronic presentation with only occult blood detected in the stool by FOBT, or it can present with acute large volume hematochezia and a child in shock.
if suspect Meckel’s diverticulum, what diagnostic tests?
Meckel radionucleotide scan, if negative and still suspect, diagnostic laparoscopy
the most common cause of hematochezia in infants, children, and adolescents
anal fissures
surgical procedure involving TM incision and placement of tubes to ventilate the middle ear and help prevent reaccumulation of middle ear fluid
myringotomy and placement of pressure equalization (PE) tubes
An examination that measures the transfer of acoustic energy at varying levels of ear canal pressures, which will reflect TM mobility.
tympanometry
A minor surgical procedure in which a small incision is made into the TM to drain pus and fluid from the middle ear space (typically done by a specialist)
tympanocentesis
most common bac OM pathogens
Streptococcus pneumoniae, nontypeable Haemophilus influenzae, and Moraxella catarrhalis
other OM orgs seen in neonates and immunocompromised
Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa
Acute OM is diagnosed in a child with ?
fever (usually less than 104°F [40°C]), ear pain (often nocturnal, awakening child from sleep), and generalized malaise,
red, bulging TM with middle ear effusion and decreased mobility
“watchful waiting” is appropriate in who with OM?
a child older than 6 months with mild symptoms (ie, mild otalgia for less than 48 hours, temperature less than 39°C)
1st line treatment for AOM
amoxicillin at doses up to 80 to 90 mg/kg/d for 7 to 10 days
when to add B-lactamase (i.e. augmentin) coverage for AOM
recurrent AOM unresponsive to amoxicillin or has concurrent purulent conjunctivitis
In the AOM child begun on amoxicillin who demonstrates clinical failure after 3 treatment days, change to ?
amoxicillin-clavulanate, cefuroxime axetil, cefdinir, azithromycin, ceftriaxone, or tympanocentesis
when to consider myringotomy with PE tubes
when the fluid does not resolve or recurrent episodes of AOM occur (3+ in the previous 6 months or 4+ in the previous year with 1 in the previous 6 months), especially if hearing loss is noted
rare but serious AOM complications
mastoiditis, temporal bone osteomyelitis, facial nerve paralysis, epidural and subdural abscess formation, meningitis, lateral sinus thrombosis, and otitic hydrocephalus (evidence of increased intracranial pressure with OM)
ddx asthma exacerbation
anaphylaxis, cystic fibrosis, foreign-body aspiration, and CHF
classification of asthma severity
http://casefiles.mhmedical.com.mwu.idm.oclc.org/ViewLarge.aspx?figid=140631109&gbosContainerID=75&gbosid=219794
asthma exacerbation triad
acute, progressively worsening bronchoconstriction, airway inflammation, and mucus plugging
A variance of systolic BP greater than 10 mm Hg between inspiration and expiration (pulses paradoxus) suggests ?
severe obstructive airway disease, pericardial tamponade, or constrictive pericarditis.
Airway inflammation in asthma (immediate and late)
immediate IgE response to environmental triggers occurs within 15 to 30, late-phase reaction (LPR) is characterized by infiltration of inflammatory cells into the airway parenchyma (2-4 hrs after allergen exposure, causes chronic inflammation)
other long-term asthma medications (besides B-agonists, anticholinergics, steroids)
mast cell stabilizers (cromolyn, nedocromil) and leukotriene modifiers (montelukast), which act by reducing the immune response to allergen exposure. They become effective after 2 to 4 weeks of therapy
management of truncus arteriosis
meds to reduce the CHF: digoxin, diuretics to reduce preload (furosemide, chlorothiazide), afterload reducers (ACE- inhibitors), and inotropes (dopamine, dobutamine). Ultimately surgical correction is needed.
Clinically apparent cyanosis and heart failure from truncus arteriosus may not be present until after the first weeks of life, why?
pulmonary vascular resistance is high after birth but drops to normal levels by 2 to 6 months of age. when it drops below systemic pressure, more blood flows to the pulm. system, leading to pulmonary congestion, increased myocardial work, and subsequent heart failure
conotruncal heart defects
Malformations of the cardiac outflow tracts (aorta and main pulmonary artery).
- truncus arteriosus, tetralogy of Fallot (TOF), pulmonary atresia, and interrupted aortic arch
- commonly seen in chromosome 22q11.2 deletions such as DiGeorge syndrome.
