Emma Holliday part 2 Flashcards
why rectal prolapse with cystic fibrosis?
chronic diarrhea
treat CF pt with pneumonia
must cover pseudomonas and b cepacia
pipearacillin + tobramycin
or
ceftazidime
what makes mild vs moderate asthma?
intermittent vs persistent?
PFTs normal vs abnormal
for mild vs moderate/severe
freq of sx for intermittent (v2&2 2 days/wk 2night/mo) vs
persistent
(2-6 days, daily, throughout the day… weekly nights)
infectious complication of chronic asthma….
allergic bronchopulmonary aspergillus
why add K+ to IVMF for T1 diabetic hospitalized kid with hyperglycemia and hypochloremic anion gap metabolic alkalosis from puking
because you are going to give insulin and that drives K+ into cells, don’t want serum to get hypokalemic
diagnostic criteria for diabetes
fasting gluc ^125 (twice)
any gluc ^200 with sx
2hr OFTT (75g) ^200
(any of the above I think..)
High fever, Then rash maculopapular erythematous on trunk
dx
bug
roseola
HHV6 human herpes virus 6
when do we worry about erythema infectiousum, slapped cheek, parvovirus B19
sickle cell kids - can cause aplastic crisis
pregnant women - fetus can get hydrops fetalis
2yo low grade fever, lacy reticular rash on cheeks and upper body that spares palms/soles
dx
who to worry about
erythema infectiousum, slapped cheek, parvovirus B19
worry about
sickle cell kids - can cause aplastic crisis
pregnant women - fetus can get hydrops fetalis
fine maculopapular desquamating rash begins on chest and spreads to neck, trunk, extremities
strawberry tongue
sore throat 1-2 weeks prior
dx
tx
scarlet fever
penicillin to prevent rheumatic fever (won’t prevent PSGN post strep glomerulonephritis)
how and why treat scarlet fever
penicillin to prevent rheumatic fever (won’t prevent PSGN post strep glomerulonephritis)
cough runny nose fever.. macular rash begins behind ears and spreads down, gray spots on buccal mucosa
dx
bug
tx
measles
paramyxovirus
vitamin A
sore throat, joint pain, fever… pinpoint rash on face spreads down, rose spots on palate
dx
bug
rubella
paramyxovirus
complications of lyme
arthritis, heart block, meningitis, bell’s palsy
treat lyme
doxy ^8yo
amox v8yo
iv ceftriaxone to penetrate csf if complicated by meningitis
tf
treatment of lyme and rocky mountain spotted fever is age dependent
lyme is age dependent
doxy ^8yo
amox v8yo
iv ceftriaxone to penetrate csf if complicated by meningitis
RMS is not age dependent
everyone gets doxy
kid went camping, got fever, myalgias, abdominal pain
dx
bug
tx
compx
rocky mountain spotted fever
rickettsia rickettsii
doxy for everyone every age
can be complicated by gangrene via vascular infection
treat impetigo
topical mupiricin
inflamed conjunctiva and multiple nikolsky positive blisters
dx
path
tx
staph scalded skin syndrome
from exfoliative toxin
iv abx
meningitis bug that gets young and immunosuppressed
tx
listeria
ampicillin
meningitis bug that gets brain surgery patients
staph aureus
tf
TB can cause meningitis
T
treat with RIPE and ‘roids
what to give dorm roommate of college kid who got bacterial meningitis and petechial rash
rifampin
for nisseria meningitidis ppx
most sensitive finding for otitis media
limited mobility on insufflation, or air-fluid level visualized
(may be erythematous and angry just from kid crying)
when to consider ear tube
bilateral effusion ^4mos or bilateral hearing loss
treat otitis externa
what bug to cover
topical ciprofloxacin
cover pseudomonas
complications of otitis media vs otitis externa
media - deafness, so place ear tubes if bilateral effusion ^4mos or bilateral hearing loss
externa - malignant external otitis - can invade temporal bone - facial paralysis, vertigo… so get CT and IV abx if concerned, surgery may be needed
muffled voice, stridor, stiff painful neck
dx
tx
bugs
compx
retropharyngeal abscess
IandD for culturs and sensitivities
3rd gen cephalosporin + amp or clinda… to cover GAS and anaerobes
mediastinitis
treat peritonsilar abscess
aspiration or IandD + abx
tonsillectomy if recurrent
indications for tonsillectomy
recurrent peritonsilar abscess
recurrent step throat
^5 strep/year for 2 years
^3 strep/year for 3 years
what happens if you give mono kid amp or amox,
why
maculopapular rash
immune mediated vasculitic
dx mono
blood smear with atypical lymphocytosis
heterophile antibody (monospot) test
treat mono
rest
no contact sports till splenomegaly resolved
most common epiglottitis bugs in vaccinated child
ga strep pyogenes
strep pneumo
staph aureus
epiglottitis
next step
next step
intubate IN THE OR (very sensitive airway, manipulation may inflame and cut off acutely)
anti-staph abx + 3rd gen cephalosporin
acute bronchitis
get cxr?
no
suspect pneumonia next step most common bugs in v1mo most common bugs in 1-3mo specific finding for chlamydia pna? most common bugs in 4mo-5yo most common bugs in ^5yo
cxr
v1mo GBS Ecoli Lysteria
(same as meningitis)
1-3mo strep pneumo, chlaymidia trachomatis, RSV, paraflu
chlamydia pna staccato cough, eosinophilia
4mo-5yo VIRAL (RSV) then strep pneumo (the only age that viral is most common)
^5yo mycoplasma and strep pneumo like adults
cxr findings in rsv bronchiolitis
hyperinflation with patchy atelectasis
who needs rsv vaccine
palivizumab for premies, congenital heart disease, lung disease (CF), immune disease
lab finding in pertussis
high lymphocytes
weird because it is a bacteria
treat family members and kids in daycare of pt with pertussis?
yes
with erythromycin, just like pt
(very contagious)
tf
cystitis can have fever
f
febrile uti is PYELONEPHRITIS
prophylactic tx for child with vsicoureteral reflux
ppx abx for recurrent uti risk
when get ultrasound for UTI
anytime uti is febrile
for anatomy, abscess, hydronephrosis
treat UTI
treat pyelo
uti - po tmpsmx or nitrofurantoin
pyelo - 14 days IV ceftriaxone or amp + gent
who needs VCUG in setting of UTI
any male at first UTI
any female v5yo
any female ^5yo with 2nd uti
any pyelo
best test for scarring in setting of pyelonephritis
Tc-labeled DMSA scan…
most common cause of limp in child
just trauma
not transient synovitis, septic joint, ddh, legg-calve perthes, scfe,
just trauma, ouchie, booboo
5yo boy with painless limp now has pain in thigh
legg calve perthes
AVN of hip
preteen female with 2wk hx daily fevers, random rash, joint pain and swelling
dx
good prognostic factor
bad prognostic factor
tx
JRA juvenile rheumatoid arthritis
+ANA actually good prognostic factor
+RF bad prognostic factor, also older age, multiple joints
1st line tx NSAID
2nd MTX
3rd steroids
best 1st test when kawasaki’s diagnosed
echo and ekg
for scary coronary artery aneurysms
treat kawasaki
high dose aspirin
IVIG
then aspirin and warfarin
treat kawasaki with high or low dose aspirin?
high dose aspirin
IVIG
then aspirin and warfarin
diffuse bone pain in peds pt w petechiae, pallor, and increased infections
top dx
leukemia
sickle cell pt w point tenderness over femur, fever, and malaise
top dx
osteomyelitis
salmonella
howell jolly bodies in sickle cell pt tells you…
autosplenectomy has occured
sickle cell pt, acute drop in HCT, with decreased retics
aplastic crisis
suspect parvovirus B19 slapped cheek erythema infectiousum
recurrent RUQ pain after meals in sickle cell pt think…
cholecystitis from pigment gallstones, do cholecystectomy
sickle cell pt in respiratory distress without fever cough chest pain chills think..
hyperplastic tonsils
(waldeyer ring)
get tonsillectomy
if fever cough chest pain chills sob think acute chest syndrome (pulmonary infarct) - get exchange transfuion to rid sickle cells
most common surgical procedures for sickle cellpatients
cholecystecomy for cholecystitis from pigment gallstones
tonsillectomy for waldeyer ring (hyperplastic lymphoid tissue… respiratory distress)
proteinuria and increased Cr and recurrent UTIs in sickle cell pt think..
kidney infarcts
most common cause of sepsis in sickle cell pt
strep pneumo
(not salmonella!)
because…encapsulated? post-autosplenectomy?
sickle cell pt in respiratory distress with fever cough chest pain chills think.. tx…
acute chest syndrome (pulmonary infarct)
get exchange transfuion to rid sickle cells
most common cause of death in sickle cell patient
acute chest syndrome (pulmonary infarct)
sickle cell pt in respiratory distress with fever cough chest pain chills
acute confusion and fnds in sickle cell pt
think. ..
tx. ..
stroke
exchange transfusion to rid sickle cells
not tPA!
can increase HbF in sickle cell baby with
hydroxyurea
vaccinations and ppx for sickle cell pt
strep pneumo
h flu
nisseria meningitidis
(encapsulated organisms, because autosplenectomy)
penicillin ppx till age 6…
sickle cell pt with fativue and megaloblastic anemia think.. why?
folate deficiency
because more RBC turnover, higher demand
treat baby with sickle cell
hydroxyurea to maintain HbF
manage pain
bone marrow transplant is curative but 10% postop mortality…
unconcerning anemia in kids
physiologic HandH drop v3mos old
immunosuppresion after viral infection - transient erythroblastopenia 3mos-6yo
lab tip for thalassemia
very low MCV (e.g. 60)
8mo irritable, glossitis, failure to thrive, drinks goats-milk formula, picky eater
top dx
tx
folate deficiency
supplement folate
pale baby, anemic, low retics, triphalangeal thumbs
top dx
tx
blackfan-diamond anemia
corticosterods, transfusions, stem cell bone marrow transplant
anemia
no thumbs
no radius
top dx
diagnostic tests
tx
complications
fanconi anemia
bone marrow shows bone marrow hypoplasia, chromosomal breaks on cytogenetic tests
corticosteroids, androgens, bone marrow transplant
increased cancer risk
baby with low WBC, anemia, low plts… cafe-au-lait spots, microcephaly, absent thumbs
top dx
diagnostic tests
tx
complications
fanconi anemia
bone marrow shows bone marrow hypoplasia, chromosomal breaks on cytogenetic tests
corticosteroids, androgens, bone marrow transplant
increased cancer risk
2yo hyperactivity, impaired growth, abdominal pain, constipation, basophilic stippling of RBCs on peripheral smear
top dx
dx test
tx
lead poisoning
led level in venous blood sample
- treat level ^45 with oral succimer (sucks to be a kid with lead poisoning)
- treat really high level ^70 with admission for EDTA and dimercaprol IV
lead poisoning screening
blood lead levels 12-24 mos age 1-2years
especially if low SES, old house from 1960s or earlier
15yo F recurrent epistaxis heavy menses petechiae, low platelets
top dx
tx
give platelets?
ITP
IVIG for 1-2 days
predisone
splenectomy
NO DON”T GIVE PLTS!…
15yo F recurrent epistaxis heavy menses petechiae, normal platelets, inc bleeding time and PTT
top dx
tx
von Willebrand disease (normal number but defective platelets)
DDAVP for bleeding or preop
replace factor VIII and vWF
7yo M with recurrent bruising, hematuria, hemarthroses, inc PTT
top dx
tx
hemophilia
if mild tx w DDAVP
otherwise replace factor VIII or IX depending on type of hemophilia
diathesis means
tendency to suffer from a particular medical condition
1wk newborn born at home now bleeding from umbilical stump and bleeding diathesis (tends to bleed)
top dx and pathophys
tx
Vitamin K deficiency
(dec factors II VIII IX X)
give FFP and vit K shot
risk factors for vit k deficiency
one healthcare related
one genetic
born at home without vitamin K shot
CF malabsorption
peds pt with wilson disease developed fulminant liver disease
1st factor depleted
1st coag abnormality
two factors not depleted
factor VII depleted first
PTT increased first
vWF and factor VIII are normal
toddler with petechiae, abdominal pain, vomiting, lethargy. bloody diarrhea 5 days ago after hamburgers at family picnic. labs thrombocytopenia and inc Cr
top dx rank most common causes tx give platelets? give abx?
HUS hemolytic uremic syndrome
ecoli O157H7
shigella
salmonella
campylobacter
aggressive TPN nutrition
early peritoneal dialysis
*don’t give platelets!! can inc HUS
*don’t give abx to treat bloody diarhea! can inc HUS
give abx for bloody diarrhea?
NO!
can inc risk of HUS
(toddler with petechiae, abdominal pain, vomiting, lethargy. bloody diarrhea 5 days ago after hamburgers at family picnic. labs thrombocytopenia and inc Cr)
IgA and __ deposited in skin in HSP
IgA and C3
peds new onset seizure, ataxia, headache worse in morning, vomiting, for a month
most common, prognosis
2nd most common, prognosis
most common brain tumor of childhood - pilocytic astrocytoma of cerebelllum, resect, 90% survive
2nd most common brain tumor of childhood - medulloblastoma.. very poor prognosis
adolescent 5% for height, bitemporal hemianopsia, calcifications in sella turcica
top dx
pathogenesis
craniopharyngioma
remnant of Rathke’s poutch
2yo hypertensive with asymptomatic abdominal mass noticed while mom bathing him
top dx
associations
best test
treatment
Wilm’s tumor
assoc Wilms tumor with aniridia, GU anomalies, hemihypertrophy, Beckwith-Weidemann syndrome
abdominal CT, CXR to check for lung mets
resect, chemo, radiation
4yo dancing eyes dancing legs bluish skin nodules and tender abdominal mass
top dx
diagnostic test
neuroblastoma
urine HVA and VMA
(homovanillic acid and vanillylmandelic acid… catecholamine metabolites… sympathetic chain ganglion / adrenal medulla tumor)
CALLA and TDT are markers of
ALL
best test for ALL
bone marrow biopsy with ^30% lymphoblasts
treat ALL
chemo
+
intrathecal methotrexate for CNS
poor prognostic factors for ALL
v1yo or ^10yo
lots of WBCs.. on bone marrow biopsy? ^30% lymphoblasts is diagnostic… a lot more than that means poor prognosis?
peds pt with large painless rubbery nodes, drenghing fevers, 10% weight loss, owl eyes on path
top dx
best test
next step
tx
Hodgkin lymphoma
best test excisional biopsy
next step staging CT
tx resection chemo radiation
peds pt with non-productive cough and large anterior mediastinal mass on cxr
top dx
best test
tx
non-hodkin lymphoma
biopsy mass
biopsy bone marrow for staging
resect if abdominal
anti-cd20 if bcell tumor
radation for some
