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Family Health Practicum 833P > Acute Disease in Children > Flashcards

Acute Disease in Children Flashcards

1
Q

Unconjugated bilirubin is a direct result of

A

hemoglobin breakdown

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2
Q

Bilirubin binds to ______ which brings it to the _____

A

albumin, liver

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3
Q

the liver turns unconjugated bilirubin into?

A

conjugated

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4
Q

conjugated bilirubin is excreted how?

A

through the stool

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5
Q

Babies with immature livers contain on ____% of the enzymes needed to convert unconjugated to conjugated

A

1%

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6
Q

Pre term Babies livers contain on ____% of the enzymes needed to convert unconjugated to conjugated

A

10

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7
Q

In the first week of life, ____ of full term and ____ of preterm infants have jaundice

A

60%, 80%

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8
Q

physiologic jaundice

A

normal breakdown of RBC that releases bilirubin, and an immature liver

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9
Q

Pathologic jaundice

A

any jaundice within the first 24 hours after birth

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10
Q

If TSB rises more than ____mg/dl/day or is higher than ____mg/dl in full term infant or ___-____ for preterm, they need further eval

A

5
12
10-14

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11
Q

etiology of pathologic jaundice

A

breast feeding difficulties, dehydration, weight loss, hemolytic anemia, RH incompatibility, certain maternal drugs, metabolic and endocrine disorders

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12
Q

Breast milk jaundice mechanism

A

unknown, thought that it may be a component of breast milk that blocks the protein in infant livers from breaking down bilirubin

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13
Q

Bilirubin induced neurologic dysfunction

A 
Severe TSB >25mg/dl
unconjugated bilirubin (unbound to albumin) crosses the blood brain barrier and binds to brain tissue resulting in brain injuries
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14
Q

results of bilirubin induced neurologic dysfunction

A

disorders in visuocortical pathways causing alteration in sensorineural hearing, proprioception, speech, and language deficits

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15
Q

Acute Bilirubin encephalopathy

A

may be reversible, three phases: drowsy, high pitched cry and hypotonic, hypertonicity, fever, apnea, twitching, seizures, respiratory failure, death

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16
Q

Chronic bilirubin encephalopathy

A

chronic, severe, progressive; permanent neuro sequelae such as choreo-athetoid cerebral palsy; upward gaze abnormalities, enamel dysplasia, sensorineural impairement

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17
Q

risk factors of jaundice

A

GA <36 weeks, low birth weight, suboptimal breast feeding, male infant, delayed cord clamping, birth trauma
maternal: age >25, maternal diabetes, drug use

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18
Q

genetic disease risk factor for jaundice

A

gilberts syndrome, galactosemia; family history of liver disease and hemolytic disorders
abx, metabolic acidosis

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19
Q

major risk factors for jaundice

A

predischarge TB in the high risk zone, jaundice observed in first 24 hours, blood group incompatibility, GA 35-36 weeks, siblings receiving phototherapy, cephalohematoma, poor breast feeding, East Asian race

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20
Q

clinical manifestations of hyperbilirubinemia

A

jaundice on entire body including palm and soles, loss of stool color, weight loss, drowsy infant, pallor, enclosed hemorrhage, bruising, hepatosplenomegaly

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21
Q

Physical exam with hyperbilirubinemia

A

visible in face, forehead, mucus membranes, appears on the trunk, hypotonia (mild), hepatosplenomegaly, petechiae, microcephaly

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22
Q

jaundice below ____ ___ is indicative of high bilirubin level

A

nipple line; indicates bilirubin over 12

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23
Q

DD for infant jaundice

A

breast milk jaundice, cholestasis, Dubin-Johnson syndrome, glacatosemia, hemolytic disease in newborn, hep B, biliary atresia, duodenal atresia, hypothyroidism

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24
Q

What do you use to determine the risk for jaundice?

A

bilitool; based on how old they are in hours and what their serum total bili is; helps direct next steps

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25
Q

lab work for jaundice

A

transcutaneous bilirubinometry, TSB, conjugated vs unconjugated if hepatomegaly, TSH, Rh, albumin, H&H, carbon monoxide, retic, LFT, parasites. ABG, ultrasound

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26
Q

treatment for jaundice

A

phototherapy, bili-blanket, exchange transfusion, phenobarbitol, IVIG

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27
Q

how does phototherapy work?

A

configurational isomerization makes bilirubin water soluble so it can be excreted-needs to cover eyes

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28
Q

thrush is caused by

A

candida albicans-white coating in mouths

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29
Q

what percent of infants develop thrush?

A

37

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30
Q

thrush is most common in?

A

infants or neonates on abx or steroids, immune diseases, polyendocrine disorders, mother with active yeast infection at birth, colonized breasts

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31
Q

thrush appearance

A

white plaques, unable to scrape off with a tongue blade, irritability in child, painful nipples in mother

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32
Q

DD for thrush

A

cytomegalovirus, diphtheria, echovirus, enteroviral infections, esophagitis, HSV, HIV, pharyngitis, syphilis

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33
Q

how to diagnose thrush

A

gram stain, KOH wet prep (pseudohyphae)

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34
Q

Thrush treatment

A

decolonize pacifiers and nipples
nystatin-0.5ml each cheek qidx10 days for neonates; 1-2 ml each cheek qidx10 days >1month old
if immunocompromised; fluconazole 3-6mg/kg

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35
Q

treatment for diaper dermatitis fungal infection

A

nystatin, miconazole, or clotrimazole cream

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36
Q

is reflux normal in babies?

A

yes

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37
Q

happy spittier

A

still growing and thriving, just spit up a lot

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38
Q

usual spit up volume

A

10-20ml

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39
Q

how do you know if their spitting up is problematic

A

esophagitis, losing weight, refusing to eat

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40
Q

What is rumination

A

voluntary regurgitation of stomach contents into the mouth for self-stimulation

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41
Q

what is BRUE

A

brief resolved unexplained event

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42
Q

Signs and symptoms of GERD

A

typical crying or irritability, apnea/bradycardia, poor appetite, vomiting, wheezing, stridor, abdominal pain, recurrent pneumonitis, sore throat, chronic cough, arching back

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43
Q

warning signs for obstruction or disease

A

bilious vomiting, GI bleeding, projectile vomiting, onset of vomiting after 6 months of life, constipation, diarrhea, abd tenderness, recurrent pneumonia, aspiration

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44
Q

usual causes of of GERD

A

immaturity of LES

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45
Q

Aggravating factors for GERD

A

eating habits, caregiver/child interaction, sleep habits, milk or soy protein intolerance

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46
Q

Secondary causes of GERD

A

asthma, obstruction, trachealmalacia

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47
Q

when does GERD disappear by?

A

9-12 months as patient sits up more with gravity and their sphincter strengthens

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48
Q

signs of a floppy airways

A

weakness, stridor, increased risk of aspiration

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49
Q

concerning Gerd if:

A

failure to thrive, intractable hiccups, crying and irritability, sleep disturbances, projectile vomiting, wheezing, recurrent pneumonia-likely related to aspiration

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50
Q

Concerning Gerd at child age if

A

dental problems, heartburn, retrosternal pain, dysphagia, odynophagia, esophagitis, herpes, candida, cytomegalovirus

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51
Q

when to do lab testing for GERD

A

if symptomatic and changes in feeding, positioning, and hypoallergenic diet failure

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52
Q

Labwork for GERD

A

CBC, electrolytes, review of newborn screening tests, celiac testing in older children exposed to wheat products

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53
Q

are thickened feeds supported by evidence?

A

no

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54
Q

procedures for GERD diagnosis

A

pyloric US, manometry, EGD, biopsy, UGI, swallow study!, pH testing probe

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55
Q

management of gerd in infants

A

can try thickening milk with oatmeal-doesnt really work; upright positioning, elevating head of bed, prone position in children >6months

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56
Q

management of GERD in older children

A

avoid tomatoes and citrus products, chocolate, peppermint, and caffeine; smaller more frequent meals, lower fat diet, proper eating habits, weight loss, avoidance of alcohol and tobacco

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57
Q

pharmacotherapy for GERD

A

antacids, H2 blockers (famotidine), PPI, nissan fundiplication

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58
Q

do PPI’s work in children

A

yes-but cause a lot of rebound GERD when stopped and long term complications such as bone growth stunting

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59
Q

when to test for celiacs?

A

when you see failure to thrive and stooling problems (late pre-school, early elementary school)

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60
Q

mode of infection for RSV

A

direct contact, also aerosol and droplet

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61
Q

RSV lives on fomites for how long?

A

up to 30 hours

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62
Q

Peak illness for RSV

A

3-7 days; usually day 5.

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63
Q

what percent of children require RSV hospitalization?

A

3%

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64
Q

incubation period for RSV

A

4-6 days

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65
Q

RSV virus sheds for how long?

A

10 days

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66
Q

if you have had RSV, are you immune?

A

no-previous infection does not preclude future infection even in children with high antibody titers

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67
Q

When to admit for RSV illness?

A

if it is day 2 of illness and they are quite sick, it is likely they will still get worse until day 5 and they probably need to go to hospital

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68
Q

how long with children cough after RSV?

A

3 weeks

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69
Q

RSV deaths occur in?

A

older adults with co-morbidities and children with underlying cardiac/respiratory issues

70
Q

rsv is the leading cause of?

A

respiratory infections in infants and young children (nearly all children by 5 years of age)

71
Q

risk factors for RSV

A

crowded spaces, infants younger than 6months, premature infants, congenital heart disease, chronic lung disease, respiratory diseases, asthma, CF, weakened immune systems

72
Q

prevention of RSV

A

avoid daycare, avoid second hand smoke, hand washing and cough hygiene, isolate infants/children in the hospital with RSV infection

73
Q

Palivizumab prophylaxis for RSV

A

monoclonal antibody against RSV F glycoprotein

can be used for infants and children <24 months at risk IM ; very expensive and difficult to get approval from insurance

74
Q

RSV symptoms

A

presents as bronchiolitis, pneumonia, nasal congestion/runny nose, low grade fever, barking cough, tachypnea, intercostal and subcostal retractions, nasal flaring, decreased appetite, rhonchi

75
Q

What should you encourage parents to use for children with RSV

A

bulb syringe or frieda nose cleaner; also saline nasal spray and humidifier help to keep mucus thin

76
Q

if patients are hospitalized for RSV, how long are they usually there for?

A

3-4 days

77
Q

mortality rate for RSV

A

<1% normal newborn

3-5% in kids with lung disease, congenital heart disease, or prematurity

78
Q

criteria to meet prior to hospital discharge for RSV

A

showing signs of improvement, on RA, and have good oral intake
do not send them home until the virus has peaked

79
Q

RSV DDX

A

bronchiolitis, croup, human metapneumovirus, influenza, neonatal sepsis, parainfluenza virus, bronchitis, pneumonia

80
Q

do you test for RSV

A

No as it will not change the treatment plan; more likely to test for influenza as there is medication you can give for that (tamiflu)

81
Q

Lab work/diagnostics for RSV

A

CBC, electrolytes, O2 sats, PCR assay, CXR if concerned for pneumonia

82
Q

AAP recommendations for RSV

A

purely supportive; no CXR, no steroids, no bronchodilator, no viral testing,

83
Q

should hypertonic saline nebs be done at home?

A

no, they can cause bronchospasm and need to be done with resources available; helps to loosen secretions for deep suctioning though

84
Q

Treatment for RSV

A

symptom management and supportive care;

85
Q

constipation is defined as

A

a period of 8 weeks with stool <3x/week, fecal incontinence, large stool that clogs toilet, palpable fecal mass, stool withholding, or painful defecation

86
Q

functional constipations

A

no underlying medical problem; acquired megacolon, chronic constipation and rectal distention can cause loss of rectal sensitivity and urge to defecate; may lead to encopresis

87
Q

organic neurogenic constipation

A

DMD, spina bifida, CP, hirschsprungs

88
Q

organic endocrine or metabolic

A

hypokalemia, DM, vitamin D toxicity, hypothyroid, immune diseases, CF, lead poisoning

89
Q

organic anatomic constipation

A

anorectal anomalies (imperforate anus, small left colon syndrome, obstruction)

90
Q

organic constipation other

A

celiac, meds

91
Q

what exam technique is helpful for locating stool in the colon

A

percussion

92
Q

fecal incontinence

A

is it loose stool or are they constipated so minimal amounts of stool are leaking around the impaction

93
Q

Physical exam in constipation

A

palpate, percuss, auscultate, assess anus for fistulas, imperforate anus
rectum should allow for a pink finger to enter

94
Q

constipation DDX

A

functional, anorexia, neurofibromatosis type 1 and 2, hirshsprung, hypercalcemia, hypokalemia, hypothyroidism, imperforate anus

95
Q

anorexia and constipation

A

if they do not have a lot of intake, they will not poop a lot; also anorexia slows down their GI tract so even if they increase their intake, they may have difficulty

96
Q

criteria for assessing constipation in children

A

Rome IV criteria

97
Q

work up for constipation

A

abdominal xray not indicated; TSH, celiac, UA/UC, electrolytes, calcium, lead level

98
Q

Treatment and management of constipation

A

evacuation of colon, remove impaction, laxatives (miralax), stool softeners, enema, lidocaine ointment, dietary modification, pediatric GI referral

99
Q

if miralax helpful yes

A

for initial treatment and maintenance

100
Q

is lactulose helpful in kids

A

no

101
Q

enema conconction

A

pink elephant; mag citrate and senna- usually helps to clean things out

102
Q

initial cleanout regimen

A

3-5 yo: 4 caps of miralax in 20oz and 5 dulcolax before and after
6-11: 6 caps of miralax in 32 ox gatorade with 5 dulcolax before and after
12+ 10 caps of miralax in 32 oz gatorade and 10mg dulcolax before and after

103
Q

1 thing to improve comstipation

A

diet

104
Q

how much water per day?

A

40-60 oz

105
Q

BRAT diet

A

bananas, rice, applesauce, tea: these foods are constipating-avoid them!

106
Q

how often can breast fed babies poop without concern

A

1x every 10 days

107
Q

what other foods can be constipating

A

milk and dairy foods

108
Q

when using maintenance protocol for constipation-how do you titrate

A

based on stool-if it is very loose, give less, if not pooping enough give more
do not use PRN; needs to be daily

109
Q

Goal for constipation regimen

A

train the bowel to go at the same time every day; develop a toileting schedule and use miralax to train the bowel; goal is for miralax use for 6 months-1year and then the bowel should be trained by then

110
Q

is constipation or diarrhea more common?

A

constipation

111
Q

time frame for diagnosis if diarrhea?

A

increased frequency or loose or watery stools for greater than 1 week

112
Q

causes of diarrhea

A

diet, viruses, bacteria, parasites, abx associated

113
Q

what is one of the main causes of diarrhea?

A

viruses

114
Q

how to differentiate between virus and bacteria diarrhea?

A

virus-fever, cramps, lack of appetite, headache, 12hours to 5 days after rotavirus exposure
bacteria- use history to try and trace back to ecoli or poultry food contamination or lake water

115
Q

diarrhea treatment

A

hydration, complex carbs, probiotics, avoid high fat food, half strength apple juice, prevent spread, immunize for rotavirus

116
Q

can clear liquids help with diarrhea?

A

no-can make it worse, also avoid sports drinks

117
Q

if having diarrhea: beware of these signs

A

bloody diarrhea, refusal to eat, dehydration, abdominal pain, behavioral change, lethargy

118
Q

Average colds per year for kids?

A

<6;8 colds/year

toddlers: 10-12/year

119
Q

transmission of cold viruses

A

direct contact, inhaled viral particles from person to person

120
Q

how long is a person contagious

A

2-4 days; usually 1 day before symptoms start

121
Q

how many different strains of rhinovirus are there?

A

100

122
Q

other viruses that cause colds?

A

enterovirus, coronavirus

123
Q

cold symptoms

A

nasal congestion, nasal discharge, fever >100.4 for first 3 days, sore throat, irritability, difficulty sleeping, decreased appetite, swollen glands

124
Q

when to be concerned of sinus infection

A

if the cold has been going on for 10 days or more

125
Q

complications of colds

A

ear infection (5-19%), asthma symptoms worsen, sinusitis, pneumonia

126
Q

can you use antihistamines and cough medicine in children?

A

NO-they have not been studied and have high alcohol content

127
Q

treatment for pain related to colds

A

tylenol and ibuprofen (only if >6months)

128
Q

can you give ASA to kids?

A

NO!!!

129
Q

other treatment modalities for common cold

A

honey if >12months, nasal saline sprays, fluids, vitamin c, wash hands, cover cough

130
Q

when to seek help for colds

A

refusing to drink, behavior changes, difficulty breathing, fever >101 for more than 3 days, nasal congestion longer than 14 days, eyes red or jaundice, s/sx of ear infection

131
Q

fever is considered when it is?

A

> 100.4

132
Q

types of temperatures to take

A

rectal only for trauma and newborns or neuro issues; axillary and infrared and appropriate

133
Q

does teething cause fevers?

A

no evidence of that

134
Q

most common cause of fevers

A

bacterial or viral infections

135
Q

red flags when associated with fevers

A

difficulty breathing, cyanosis, pallor, lethargy, poor tone, altered LOC, infants less than 60 days old (more prone to sepsis)

136
Q

antipyretics are advised for fever greater than?

A

103-104

137
Q

do antipyretics helps prevent febrile seizures

A

no; they do not decrease the incidence

138
Q

acetaminophen dosing

A

10-15mg/kg q 6 hours

139
Q

ibuprofen dosing

A

10mg/kg every 6 hours

140
Q

alternate or give ibuprofen and tylenol together

A

can do either: it appears that they have a synergistic effect when given together that makes them work better, and easier for parents to bundle them and give that at once

141
Q

cool baths for fevers?

A

body temperature baths are better to prevent hypothermia or temperature shock

142
Q

how to rehydrate with fluids?

A

a medicine cup full every 10 minutes; do not need to give a lot at once

143
Q

most common virus to cause conjunctivitis

A

adenovirus

144
Q

symptoms of viral conjunctivitis

A

watery discharge, FB sensation, redness, URI symptoms, usually bilateral, preauricular lymph node enlargement

145
Q

exam for conjunctivities

A

assess acuity and vision, look for foreign body, observe type of discharge, assess ears, nose, throat, lymph

146
Q

treatment for viral conjunctivitis

A

symptomatic; cool compress, hand washing-do not need to stay home if viral

147
Q

common pathogens for bacterial conjunctivitis

A

staph aureus, strep pneumo, H flu., GC

148
Q

symptoms of bacterial conjunctivitis

A

thick/yellow discharge, diffuse injection, unilateral onset, normal fundus and eye movement

149
Q

treatment for bacterial conjunctivitis

A

warm compress, antimicrobials for 5-7 days, steroids not necessary, hand hygiene, need to see optometrist immediately for vision changes

150
Q

antibiotic choices for bacterial conjunctivitis

A

trimethoprim polymixin B. azithromycin, gentamycin, tobramycin, neomycin, ciprofloxin, ofloxacin, gatifloxacin, erythromycin

151
Q

chlamydia conjunctivitis treatment in neonate

A

erythromycin 50mg/dkg/d for 2 weeks

GC IV aqueous penicillin G 100units/kg/day

152
Q

is erythromycin ointment or drops better?

A

ointment can be easier to apply and seems to stay longer and coats the eye; children cannot blink it away

153
Q

symptoms of allergic conjunctivitis

A

injected conjunctivitis, allergic shiners, allergic creases, stringy or watery discharge

154
Q

treatment for allergic conjunctivitis

A

topical or oral antihistamines, topical steroid optivar (rarely used), vasoconstrictors such as oxymetazoline, mast cell stabilizer (patanal-OTC), NSAID ketorolac

155
Q

when should you consider foreign body?

A

always

156
Q

s/s of foreign body in eye

A

conjunctiva and sclera injected, clear/watery discharge, light sensitivity, pain, sensation of something in the eye

157
Q

eye exam for foreign body

A

visual acuity, woods lamp, fluorescein stain, turn eyelid inside out

158
Q

treatment for foreign body

A

remove the FB, rust rung, eye rest, moisture

159
Q

what is the most common pediatric illness that causes stridor in 6-36 months?

A

croup

160
Q

what is croup caused by

A

a virus in children RSV, parainfluenza types 1, 2, and 3, rhinovirus

161
Q

croup symptoms start with

A

nasal discharge and coryza

162
Q

croup symptoms progress to include

A

fever, hoarseness, barking cough, stridor, prolonged respiratory phase with tachypnea

163
Q

how long does croup cough last?

A

3 days- other symptoms can last up to 7 days

164
Q

croup DDX

A

adenovirus, RSV, enterovirus, human bocavirus, coronavirus, rhinovirus, echovirus, reovirus, metapneumovirus, influenza A and B, measles, herpes, varicella

165
Q

croup complications

A

rare, death in 0.5%, 2% hospitalized, pneumonia and tracheitis can occur

166
Q

croup physical exam findings

A

cherry red epiglottis, unilateral swelling petechiae strep, diphtheria membrane, excessive drooling, lymphadenopathy

167
Q

lab work for croup

A

WBC (may be high or low), increased lymphocytes or neutrophils, influenza testing, lateral neck xray for steeple sign, rarely need CXR

168
Q

croup treatment

A

dexamethasone 0.15mg/kg to 0.6mg/kg or oral prednisone and nebulized racemic epi

169
Q

if rebound stridor 3 hours after racemic epi, then?

A

give more racemic epi and admit to hospital

170
Q

other croup treatments

A

cool mist, increased oral intake of warm clear fluids, frozen popsicles, elevate head, oxygen and helium mix

Family Health Practicum 833P (3 decks)

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