8 Flashcards
Children younger than 5 years are at a greater risk for lead toxicity and its sequela because of ?
increased GI absorption, more frequent hand-to-mouth activity, and a susceptible developing CNS
s/s at high blood lead levels (BLLs)
Anorexia, hyperirritability, altered sleep pattern, and decreased play, abdominal pain, vomiting, constipation, Developmental regression, especially with speech,
signs of encephalopathy in lead poisoning
Persistent vomiting, ataxia, altered consciousness, coma, and seizures
Permanent, long-term consequences of lead poisoning
learning and cognitive deficits and aggressive behavior
lead chelation in an asymptomatic child may consist of ?
IM calcium disodium ethylenediaminetetraacetic acid (CaEDTA) or more commonly oral meso-2,3-dimercaptosuccinic acid (DMSA, succimer)
Hospitalized symptomatic patients with lead poisoning are often treated with
2,3-dimercaptopropanol (British anti-Lewisite [BAL]) and CaEDTA
the CDC identifies children with lead levels above ? as having an elevated lead level and requiring further investigation
5 μg/dL
Chelation therapy is currently advised for patients with a blood lead level of ? and above Environmental investigation is recommended in patients with a blood lead level of ? and above
45 μg/dL
20 μg/dL
Although medications are the most common cause of SJS overall, ? typically account for a higher percentage of cases in children than in adults
infections related to viruses and atypical bacteria, such as M pneumoniae, Herpes viridae
management of SJS
Stop offending agent and admit to the hospital for close observation lab tests (CMP, CBC, blood culture), IV hydration, broad-spectrum antibiotics for typical (pneumococcus, Staphylococcus aureus) and atypical (Mycoplasma pneumoniae) (CAP). (ceftriaxone, azithromycin) Ophthalmology should be consulted, and ICU monitoring may be necessary
synechiae
Adhesions of the iris to either the cornea or lens; complication of ocular trauma or inflammation of the iris; identified by ophthalmoscope or on slit-lamp examination
SCORTEN: Score of TEN
Scores the severity of bullous conditions; initially developed for TEN, but also utilized in patients with thermal burns or SJS
CU placement should be considered for any patient with a SCORTEN score 2 or greater.
SCORTEN
http://casefiles.mhmedical.com.mwu.idm.oclc.org/ViewLarge.aspx?figid=105347083&gbosContainerID=75&gbosid=219800
extent of epidermal detachment differentiates the SJS and TEN
SJS less than 10%, SJS/TEN overlap syndrome 10%-30%, TEN more than 30%
Common inciting agents of SJS/TEN
antibiotics (sulfonamides, PCN, cephs), NSAIDs, allopurinol, and antiepileptics (carbamazepine, phenytoin, lamotrigine, phenobarbital)
-first occur about 2 weeks after a new med exposure
increased risk for SJS in these pts
HIV: TMP-SMX
select human leucocyte antigen types (HLA-B 1502): aromatic anti epileptics (carbamazepine, phenytoin, and phenobarbital)
“slow acetylators”
polymorphism in IL-4 receptor gene
SJS prodrome
ever and flu-like illness, burning sensation or other skin paresthesias, erythroderma, tongue swelling, facial edema, and palpable purpura
SJS lesions
ill-defined or target-shaped erythematous macules with purpuric centers
symmetrical and typically begins on the face and thorax, before extending to other areas (palms and soles typically spared)
SJS mucous membrane involvement
most common site?
other complications?
eyes, mouth, upper airway, esophagus, GI tract, anogenital mucosa
Ocular lesions, can lead to corneal ulceration, synechiae, and eventual blindness
-stomatitis, urethritis, and pulmonary involvement (cough, dyspnea)
SJS serious complications
sepsis, acute respiratory distress syndrome (ARDS) and multiple organ dysfunction
controversial treatments of SJS
corticosteroids, IVIG
pityriasis alba
hypopigmented macules on face, neck, trunk, and extremities with irregular borders, can varying size, and slight scale. more noticeable after sun exposure because of tanning of the surrounding skin.
decreased number of active melanocytes and decreased number and size of melanosomes.
pyloric stenosis dimensions on U/S
cross-sectional single muscle thickness greater than 3 mm and length greater than 17 mm
imaging for bilious vomiting
KUB (abd. XR), Upper GI series
CXR in RSV bronchiolitis
hyperinflation and increased perivascular markings
Salter Harris fractures mnemonic: SALTER
I – S = Straight across. Fracture of the cartilage of the physis (growth plate)
II – A = Above. The fracture lies above the physis, or Away from the joint.
III – L = Lower. The fracture is below the physis in the epiphysis.
IV – TE = Through Everything. The fracture is through the metaphysis, physis, and epiphysis.
V – R = Rammed (crushed). The physis has been crushed.
metaphyseal corner fracture (bucket-handle fracture) occurs when a small piece of bone is avulsed due to shearing on the growth plate, mechanism?
acceleration/deceleration force during shaking or grabbing, implies child abuse
Screen infants for DDH with a history of ? is usually performed at four to six weeks, after the newborn laxity has resolved
what imaging?
a click, breech position or positive family history
ultrasound
imaging for intussusception
Abdominal radiographs (KUB) Air enema Ultrasound of the abdomen and pelvis
complications of meningitis
Deafness, cranial nerve palsies, and, rarely, hemiparesis or global brain injury, seizures, cerebral infarction, cerebral or cerebellar herniation, venous sinus thrombosis, subdural effusions, SIADH secretion with hyponatremia, and central diabetes insipidus
most common causes of meningitis in neonate
GBS, E. coli, Listeria
meningitis symptoms in an infant are typically atypical
thermal instability (often hypothermia), poor feeding, emesis, seizures, irritability, and apnea, +/-bulging fontanelle, hyper/hypotonicity
bacterial meningitis orgs in older kids
S. pneumo and N. meningitidis
more rare: Pseudomonas, S.aureus, Staphylococcus epidermidis, Salmonella sp, and Listeria
classic symptoms of meningitis seen in older children and adults
mental status changes, N/V, lethargy, restlessness, ataxia, back pain, Kernig and Brudzinski signs, and cranial nerve palsies
CSF analysis
Gram stain and culture, RBC/WBC counts, and protein and glucose analysis
vaccination schedule
http://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf
Typical bacterial meningitis CSF findings
an elevated opening pressure, several hundred to thousands of WBCs with PMN cell predominance, and elevated protein and decreased glucose levels
neonatal meningitis antibiotics
ampicillin often is combined with a third-generation cephalosporin or an amino glycoside (GBS, E.coli, List)
antibiotics in suspected pneumococcal meningitis
third-generation cephalosporin combined with vancomycin
most common long-term sequela of meningitis
hearing loss (up to 30% of patients with pneumococcus)
less common complications of meningitis
Mental retardation, neuropsychiatric and learning problems, epilepsy, behavioral problems, vision loss, and hydrocephalus
Nuchal rigidity is not a reliable finding of meningitis until ?
12 to 18 months of age
how many patients with meningitis have a seizure?
1/3
how to describe clubfoot
(talipes equinovarus) plantar-flexed high-arched metatarsus addductus foot curved inward more...
vitamin D level to check
25-D not 1,25-D
at how many months would you expect conjugate gaze?
4 months
