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Surgery > Emergency Medicine - Pediatrics > Flashcards

Emergency Medicine - Pediatrics Flashcards

0
Q

Fracture of distal radius

A

Buckle fx, aka torus fx?

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1
Q

Are fractures or sprains more common in kids? Why?

A

Fractures, because kids ligaments are stronger than their bones

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2
Q

Salter-Harris classication of fractures

A

S - straight across, type I
A - above growth plate, type II
L - lower or beLow growth plate, type III
T - two or through growth plate, type IV
ER - ERasure of growth place or cRush, type V
(I think)

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3
Q

What’s the proper hand alignment

A

When hand is flexed, all finger tips should point toward scaphoid and digits may overlap when flexed

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4
Q

Most common pediatric elbow fracture

A

Supracondylar fx

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5
Q

How do you treat gartland types I, II, III fractures?

A

Supracondylar fractures. Tx type I with elbow split, type II get ortho consult for open vs closed reduction with percutaneous pin placement, type III ortho consult

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6
Q

3yo limping and refusing to walk with normal exam and some pain when twist LE and tap heel? Tx?

A

Toddlers fx, spiral or oblique fx through distal 1/3 of tibia, nondisplaced, often unwitnessed fall or minor trauma, tx with short or long leg cast x3-4wks, ortho f/u in 1wk

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7
Q

12moM with barky cough and congestion at night, crying, upset with hoarse voice, inspiratory stridor, and clear lungs? Cause? Tests? Tx?

A

Croup. ALWAYS viral (RIPAM). Clinical dx, but CXR shows steeple sign (subglottic narrowing). Tx with cold mist/hot shower, DEXAMETHASONE, racemic Epi nebulized if audible stridor at rest

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8
Q

Causes of croup

A

Always viral. RIPAM: RSV, influenza, parainfluenza (>60%), adenovirus, mycoplasma

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9
Q

Reasons to admit patient with croup

A

If DX is questionable, continued audible stridor, toxic appearance, dehydration and V, very young (?, <3mo)

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10
Q

7yoM with cough, SOB, HX of wheezing, breathless with one word answers, inspiratory and expiratory wheeze, subcostal and intercostal retractions

A

Asthma

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11
Q

Describe mild asthma

A

Incr RR, No/mild accessory muscle use or retractions, moderate often end-expiratory wheeze

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12
Q

Describe moderate asthma

A

Incr RR, Moderate accessory muscle use and retractions, loud wheeze throughout exhalation

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13
Q

Describe severe asthma

A

Incr/Decr RR, Severe accessory muscle use or retractions, inspiratory and expiratory wheeze

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14
Q

Indications for X-ray in diagnosis of asthma in child. What do you see on CXR?

A

If exam is asymmetric, minimal improvement, chest pain, severe exacerbation or first time wheeze. See hyperinflation, peri bronchial thickening, atelectasis.

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15
Q

What labs do you need to get with asthma?

A

Labs not required. ABG is severe exacerbation. K if continuous beta agonists (push K into the cell).

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16
Q

Reasons to admit kid with asthma

A

O2 requirement, persistent resp distress with need for tx < every 4hrs, high risk, ED visit within last 24hrs

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17
Q

7wk old with fever, decr PO, fast breathing, cold Sx for a few days, diffuse wheezing and retractions

A

Bronchiolitis

18
Q

Tx of asthma

A

Bronchodilators, corticosteroids, supportive O2, hydration, ABx if concerned for bacterial inf (PNA)

19
Q

26moF with fever, V, RLQ and pain for 1d, T38.9, HR138, RR48, 92%RA, tachyon epic with diffuse crackles and diffuse abdominal pain R>L

A

PNA

20
Q

Cause of PNA in neonates

A

Group B Strep, GN enterics

21
Q

Cause of PNA in 2wk to 2mo old

A

Chlamydia, viruses, S. Pneumo, S. Aureus, H.flu

22
Q

Cause of PNA in 2mo to 3yrs

A

Viruses, S. Pneumo, S. Aureus, H.flu

23
Q

Cause of PNA in 3yrs to 19 hrs

A

Viruses, S. Pneumo, mycoplasma pneumo

24
Q

20moM coughing with fast breathing, active and playful, RR42, O2 sat 95%, mild R-sided wheezes and decr breath sounds

A

Foreign body aspiration

25
Q

Where is FBA most common?

A

Slightly more common on R

26
Q

CXR of kid with FBA

A

Foreign body, hyperinflation, infiltrates

27
Q

33 day old infant M with fever. Per mother, has been slightly cranky but no other sx. Brother has a cold. in ED, alert, vigorous, T 38.4, normal exam.

A

febrile infant (0-56d) with T>38C. Do Septic workup: CBC with diff, BCx, UA, UCx, LP, CXR if URI Sx, Stool Cx if Sx. Since pt 29-56d old, decide if high or low risk, admit and give Abx if high risk. withhold Abx if low risk.

28
Q

Philadelphia Criteria after septic workup.

A

If 0-28d, admit, immediate Abx, acylovir admit, immediate Abx. if 29-56d, low risk if PMHx nl, well appearing and nl labs -> option 1 outpt mgmt, 24hr f/u, withhold ABx or option 2 inpt obs, withhold ABx.

29
Q

11mo F with fever for 2 days. No other Sx. PE reveals a well-appearing, interactive infant. T 40.20C, but remainder of exam is normal.

A

2-36mo febrile young infant. T>/= 39C. if well appearing, <12mo Cath urine dipstick, UCx and tx if urine positive.

30
Q

2-36mo causes of fever >39C

A

occult bacteremia - Hflu B, Strep pneumo; fever without source - well appearing, no source, no tx; occult UTI - Ecoli, GN enterics, enterococci

31
Q

tx of occult UTI in 2-36mo

A

for GN enterics: cefixime, TMP-SMX, cephalexin

32
Q

9yo F with fever and sore throat for 3d. +V, -D, URI Sx, dyspnea, or dysuria. PE: T=40°C, well-appearing, + exudative, erythematous pharynx and anterior cervical adenopathy. What if she had dysuria? or tachypnea and crackles?

A

> 3yo, VIRAL -> no testing/tx needed, but use Sx as guide: pharyngitis do rapid strep test. Dysuria do UA, UCx. Tachypnea/crackles do CXR.

33
Q

A previously healthy 22 day old girl presents with a chief complaint of “feeling warm”. No vomiting, diarrhea, cough, or irritability. Alert, well-appearing, 38.6º

A

< 4 weeks old: admit, presumptive antibiotics

5-8 weeks old: may consider outpatient therapy without antibiotics, if low risk (philadelphia) criteria are met

34
Q

Philadelphia criteria

A 
Age: 	29-56 days; Fever:	> 38.2°
Low-risk Criteria: on PE no infection and well-appearing
Labs:	CSF < 8 (or 10?) wbc/hpf
			CSF profile wnl and negative Gram stain
			WBC < 15,000
			Band/neutrophil < 0.2
			UA < 10 wbc/hpf
			CXR: no infiltrate
Social: 	Good observer and car and phone
35
Q

A 47 day old presents with T = 38.6°. She is slightly fussy but consoles easily and has a normal exam. LP?

A

febrile young infants 29-56 days old who meet all other low risk criteria are highly unlikely to have bacterial meningitis. It is reasonable to omit the LP in this setting.

36
Q

A 38 day old presents with coughing and “trouble breathing”

On PE, T = 38.3º. He is well-appearing and noted to be wheezing.

A

For <29 days old, RSV infection doesn’t significantly alter rate of SBI
For 29-60 days old, Those with clinical bronchiolitis (with or without documented RSV inf) are at significantly lower risk for SBI compared to others. There is a clinically important rate of UTI among FYI with RSV and/or bronchiolitis

37
Q

An 11 day old presents with poor feeding, fussiness, and a tactile fever
On PE, T = 38.7º. He is irritable and slightly dehydrated. Plan? Cause of fever?

A

Full sepsis work-up, initiate antibiotics, and hospitalize. Ecoli, CGS, listeria (<21d with severe inf.

38
Q

when should we consider HSV inf in febrile infant? TX?

A

< 21 days old, Mum had active primary HSV at delivery, on PE: Vesicles, Seizure (27%), Lab studies show CSF pleocytosis (especially if CSF RBCs also), Increased liver enzymes

Consider empiric testing and acyclovir (60 mg/kg/day tid) if one of these criteria

39
Q

cause of fever 0-21d, tx

A

GBS, enterococcus, GNegs, HSV. Amp, cefotaxime, acyclovir

40
Q

cause of fever in 22-28d? Tx?

A

GBS, enterococcus, GNegs. Amp, cefotaxime, +Vanc if Gpos bugs in CSF or if septic.

41
Q

cause of fever in 29-56d? tx?

A

late GBS or pneumococcus. Cefotaxime.

42
Q

risks for occult UTI in 2-36mo

A

caucasian > latino > AA; /=39C; fever for >/=2d; no source of fever; uncircumcised

43
Q

what is considered a positive UA for occult UTI testing in 2-36mo with fever?

A

urine dipstick positive if +nitrites +/- moderate leukesterase or microscopic UA has >10-15 WBC/hpf. always send UCx bc of false negatives

Surgery (34 decks)

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