Cardiac, Pulmonary and Renal Pediatric Pearls Flashcards
What is the most common cyanotic congenital heart disease?
Tetrology of Fallot
Cardiac arrest in kids- most likely from__________t that begins with a variable period of systemic ______, ______, and ______ and progresses to _______ and ______–>cardiac arrest
Cardiac arrest in kids- most likely from asphyxial arrest that begins with a variable period of systemic hypoxemia, hypercapnea, and acidosis and progresses to bradycardia and hypotension–>cardiac arrest
Well controlled asthma looks like ______ asthma in the table above
Poorly-controlled asthma looks like _____ asthma in the table above
intermittant
severe
List the mainstays of treating a patient suffering an acute asthma exacerbation
SABA (albuterol)
O2
Steroids (systemic); prednisone, prednisolon, methylprenisolone
Diagnose acute post-streptococcal glomerulonephritis
Recent strep throat followed by:
- Gross hematuria consistent with glomerular involvement
- HTN: mainly due to Na+ and water retention
- Swelling/edema: due to Na+ and water retention
What labs will you see in a patient in with post-strep GN?
- UA: hematuria and proteinuria of varying degrees
- ↑ ASO titer
- ↓ serum complement C3
How is post-strep glomerulonephritis treated?
Supportive care, usually kids are fine
What is the mechanism of post-strep glomerulonephritis?
Deposition of immune complexes in the glomeruli.
Henoch-Schonlein purpura is also called __________.
Immunoglobin A vasculitis
Name the prognostic indicator of long-term renal damage in children with Henoch-Schonlein Purpura.
Development of PROTEINURIA, along with hematuria
Henoch-Schonlein Purpura is ______ to diagnose
How long do children with Henoch-Schonlein Purpura feel shitty for
- hard
- kid feels really bad for a long time
In HSP, follow up with regard to _____________ is important–> follow until clear.
Follow up with regard to UA’s for RBC’s and protein is important–> follow until clear
List the signs and symptoms of urinary tract infections (UTIs) in children
- Fever (with no identifiable cause on PE)
- ↓ intake
- Dark, strong smelling urine
- Stomach pain
- ↑ frequency and urgency
- Dysuria
- Loss of control
- Sometimes emesis, sometimes diarrhea
When can a clean-catch urine be obtained?
- If the child can void on command
If the child cannot void on command, what are other methods of urine collection when sending a urine sample for culture and sensitivity?
- Catheterization
- Suprapubic aspiration (usually done in NICU)
_________ are only helpful if NEGATIVE and are NOT appropriate for culture.
Bag urine samples
If a child is acutely ill, febrile and empiric ABX are going to be given, how and when should a urine sample be obtained?
- Via catheterization or suprapubic aspiration
- BEFORE meds are given
Describe the criteria for the diagnosis of a UTI in a child if the urine is obtained via
- - clean catch
- - catheterization
- - by SPA
-
Clean catch: prescence of both:
- pyuria
- at least 50,000 colonies/mL of a single uropathogenic organism in an appropriately collected specimen of urine (child has to be potty trained)
-
Catheter:
- pyuria &
- colony count of 50,000 CPM or 10,000-50,000 CPM confirmed by repeat meets criteria
-
SPA:
- pyuria and ANY growth on culture
What is leukocyte esterase and what is it used for?
-
Enzyme present in most WBC and if in urine, indicative of a bacterial infection.
- (-) test when few WBC in urine in NL
- (+) test when number of WBC ↑ significantly.
↑ WBC count in urine (leukocyturia) =
Inflammation/infection in the kidney or UT
- bacterial infection-
What can contaiminate a leukocyte esterase test?
Vaginal secretions
Urine nitrate testing screens for what _______.
prescence of UTI;
bacteria that convert nitrate => nitrite,** which can cause a **UTI
Most common cause of UTI in pediatrics (57-67%)?
Escherichia coli (E. coli)
What are the other most common urinary pathogens in children?
Gram (-) pathogens:
- Klebsiella
- Proteus
- Enterococcus
- Pseudomonas
Gram (+) pathogens:
- Staph saprophyticus
- Enterococcus (esp of indwelling cather or post-intstrumentation
- Stap aureus (rare)
If you are going to treat pediatric patients empirically for a UTI, what should you choose?
-
Not acutely ill & tolerating (po);ORAL ABX.
- Cephalosporins (cefixime or cefdinir)
- Resistance to amoxicillin-clav and TMP/SMX is ↑
-
Acutely ill & not tolerating PO; Parenteral
- 3rd generation cephalosporin (cefriaxone)
How long should you treat a UTI in pediatrics?
Depends on if fever is present with UTI.
- No fever + UTI: 3-4 days
- Fever + UTI: 10 14 days
When treating UTI in pediatrics, you should see improvement in __________.
Always modify ABX choice depending on _________.
28-48 hours
results of culture
When do you image a childs Urinary tract?
- Boys: after first UTI
- Girls: after 2nd (sometimes 3rd)
How do we image a child UT?
-
1. Renal and bladder US
- Anatomic abnormalities
- Obstruction with secondary dilation
- Duplication of collecting system/ureters
- Conduct a VCUG if
* Abnormal RBUS
* Temp > 39C + pathogen other than E.coli
* Pt has poor growth & HTN
- Conduct a VCUG if
After a 2nd UTI, what is done to image childs UT and why?
-
VCUG
- to look for eviedence of VUR
- Grade 1-5
- Notorious for causing renal scarring
What is renal scarring?
Loss of renal parenchyma between calyces and capsule.
Long term complications of renal scarring is ?
1. HTN
2. Decreased renal function
3. Proteinuria
4. ESRD
Explain the significance of the different grades of VUR in pediatric pts
- Grade I- kidneys not affected
- Grade II- renal pelvis affected
- Grade III-dilatation of calyces and ureter
- Grade IV- worse dilatation of all structures
- Grave V- extreme dilatation
Grade 3 or less usually goes away on its own
Notorious for causing renal scarring
List the most common causes of obstructive uropathy children
- Anatomic:
- Neurologic
- Functional
-
Anatomic
- UPJ obstruction
- Posterior urethral valves (PUV); only in boys
- Duplex kidney; 2 ureters come out of 1 kidney
-
Neurologic
- Myelomeningocele with neurogenic bladder
-
Functional
- Bladder or bowel obstruction
When do suspect that a child has urinary obstruction?
- When a patient has problems voiding
- Family hx of urinary problems,
- GU exam revels abnormalities ****
- Sx dont respond to therapy
When does a PCP refer to a specialist, in a child with a UTI? (6)
- Grades 3-5 of VUR
- Obstructive uropathy is preesnt
- Renal abnormlaities
- Impairment of kidney fx
- Pt is HTN
- Bowerl and bladder dysfunction is cannot be managed by PCP
Develop a DDx for a newborn w/ tachypnea
Most indicative of a cardiac abnormality**** but can also be ARDS.
What are the ONLY acyanotic congenital heart defects, meaning that all others are cyanotic?
- ASD
- VSD
- PDA
- Coarctation of the aorta (CoA)
- Truncus arteriosus
- Transposition of great vessels
- Tricuspid atresia
- Tetralogy of Fallot
- VSD
- Total anomalous pulmonary vascular return
- Hypoplastic left heart syndrome
- ASD
- Double outlet R ventricle
- Ebstein’s anomaly
- PDA
- Coartication of the aorta
- Pulmonary atresia
- Single ventricle
- Total anomalous pulmonary return
- Truncus arteriosus: C
- Transposition of great vessels: C
- Tricuspid atresia: C
- Tetralogy of Fallot: C
- VSD: A
- Total anomalous pulmonary vascular return: C
- Hypoplastic left heart syndrome: C
- ASD: A
- Double outlet R ventricle: C
- Ebstein’s anomaly: C
- PDA: A
- Coarctation of the aorta: A
- Pulmonary atresia: C
- Single ventricle: C
- Total anomalous pulmonary return: C
- List the criteria for referring a pt with a heart murmur to a cardiologist
- Grade 4 murmur or above
- Diastolic murmur
- Increased intensity when pt stands
- Anytime a murmur is symptomatic
- Heart sounds are obscured
- Femoral pulses are weak
- Clicks
- Hyperactive precordium
- History of sudden death at a young age in family
- Abnormal or extra heart sounds (except S3 in children or young adults)
- Conditions (congenital or prenatal) predisposing pt to congenital heart lesions
- If you get “that feeling”
If you hear S3 in children or young adults, do you refer them do a cardiologst?
No, refer to cardiologist for abnormal or extra heart sounds, EXCEPT S3
What test is done to detect critical congenital HD in newborms before discharge from nursey
Pulse ox screening test
5T’s and 1-5 mneumonic
Tells us which CHD are cyanotic.
1. Truncus arterious
2. Transpotiion of great vessels
3. Tricuspid atresia
4. Tet of Fallot
6. Total anomalous pulmonary vascular return
What happens if a baby fails screening test for Critical CHD?
ITS JUST A SCREEN!
if it fails, a more thorough assessment is needed to find out the cause of ↓ O2 sat.
When do we conduct pulse ox screening in newborns to look for critical CHD?
- BB is in nursey 24 or more hours old
- Right before discharge, if bb is less than 24 hours old
Screen baby.
What inidicates if the baby fails screen, needs to repeat in 1 hour or passes?
- Fails: Pulse Ox is <90% in right hand or foot
-
Repeat: 90-95% in right hand and foot or if there is a >3% difference between right hand and foot
- repeat up to 2x
- Pass: 95% or greater in right hand or foot and 3% or less differance between right hand and foot.
Study of choice of CHD is _________, ____ is helful in initial work up.
Echo
CXR
BP cuff that is too small => artificially _____ BP
BP cuff that is too large => artificially _____ BP
- Small => high BP
- Large => low BP
- Locate electronically and be able to use the following
- A. Clinical practice guidelines for screening and management of High blood pressure in children and adolescents, pediatrics. 2017;140(3)
- B. Fourth report (January 2004);
- Diagnosis, Evaluation and Tx of HBP
refer to them for scpeicifc guidelines and numbers
