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Pediatrics > Exam 2 Treatment > Flashcards

Exam 2 Treatment Flashcards

1
Q

Colic tx

A

Benign, self limiting condition

Parental support and reassurance

5 S’s → Swaddle, Shush, Swing, Suck, Side or stomach position

Sx resolve by 3-6 mo

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2
Q

Temper tantrums tx

A

Parent edu → tantrums are nrml

Prevent hunger, fatigue, lonliness, hyperstim

ID and remove underlying stress factors

Positive reinforcement for good behavior

Will get worse before it gets better

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3
Q

Breath Holding Spells tx

A

Usually no treatment

Plenty of rest

Help child feel secure

Reassure parent that this is temporary ( most stop by 3-4 yo)

Counseling on proper disciplining techniques

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4
Q

Night Terrors tx

A

Just barely wake the child just prior to the usual time the night terrors occur can sometimes help to “reset” the cycle

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5
Q

Nightmares tx

A

Provide comfort, reassurance, efforts during the day to feel safe (check closets, under the bed)

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6
Q

ASD tx

A

Referral for services/medical home

Manage co-morbidities- behavioral, sleep prob, feeding/GI prob

Applied behavioral analysis (ABA)- applied early and intensely, associated with gains in IQ, adaptive behavior, language, academic performance and social behavior

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7
Q

ADHD stimulant med tx

A

mixed amphetamine salts, dextroamphetamine, lisdexamfetamine, methylphenidate, dexmethylphenidate

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8
Q

ADHD non-stimulant med tx

A

atomoxetine, LA alpha agonists (guanfacine, clonidine)

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9
Q

Estimated insulin requirement for:

Infants (0-2 yrs)

Pre-pubertal

Adolescents (Pubertal)

A

Infants (0-2 yrs): <0.5 units/kg/day

Pre-pubertal: 0.5-1 units/kg/day

Adolescents (Pubertal): ~ 1units/kg/day

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10
Q

What is rule of 500

A

500/TDD= the number of carbs for every 1 unit of insulin

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11
Q

What is rule of 1800

A

how much 1 unit of insulin should drop the blood glucose levels

1800/TDD

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12
Q

What is the Honeymoon period and how do you have to adjust tx?

A

Recovery of remaining endogenous insulin production after initiating exogenous insulin therapy

Should lower insulin

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13
Q

When do insulin req decrease?

A

honeymoon period

exercise

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14
Q

When do insulin req increase?

A

DKA or recent resolution of DKA
Illness
Puberty

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15
Q

What is insulin injection site rotation impt?

A

to prevent lipohypertrophy which interferes with insulin absorption

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16
Q

What happens if a diabetic patient is sick?

A

Body’s response to acute illness tends to trigger stress hormones that increase glucose so need to monitor closely and give correction factor of rapid acting insulin based on BG check

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17
Q

Describe fluid intake for sick diabetic pt

A

1 oz per year of age per hour in small frequent sips

glucose >200 mg/dL, sugar-free fluids

glucose <200 mg/dl, sugar containing fluids should be included

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18
Q

Indications for tracheostomy tubes

A

≥ 3 episodes of AOM w/in 6 mo
or
4 w/in 1 yr

<6 mo old may need aggressive mgmt

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19
Q

Criteria for tonsillectomy

A

Minimum 7 or more episodes of sore throat in the preceding year, OR

5 or more episodes in each of the preceding 2 years, OR

3 or more episodes in each of the preceding 3 years

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20
Q

Strabismus tx

A

Correct visual impairment

Correct alignment- patch therapy (cover good eye) or surgery

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21
Q

Chemical Conjunctivitis

A

Sx resolve in days → no tx necessary

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22
Q

Neisseria gonorrhoeae

A

Ceftriaxone

Ophtho Referral

Screen and treat parents

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23
Q

Chlamydia Trachomatis

A

Erythromycin

Often treat empirically for gonorrhea co-infection

Screen and treat parents

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24
Q

Dacryostenosis

A

Clean, warm cloth and lacrimal sac massage

Referral to ophthalmology if not resolved by 6 mo (for poss lacrimal duct probing surg)

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25
Q

Acute Otitis Media

A

High dose Amoxicillin 90-90 mg/kg/day divided in 2 daily doses*1st line

Augmentin if purulent conjunctivitis bc suspect H. flu or amox failurein last 30 d

Ibuprofen or ace

F/u 48-72 hrs if obs only (1/3 will need abx)

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26
Q

Tympanostomy Tube Otorrhea

A

Fluoroquinolone drops

(e.g., ofloxacin and ciprofloxacin dexamethasone)

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27
Q

Otitis Media with Effusion

A

Resolves ≤ 3 mo w/o intervention

If no resolution in 3 mo → refer for tympanostomy tubes

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28
Q

Viral Rhinitis

A

Supportive

↑ fluids, rest, col mist humidifier

Nasal saline spray for younger children and saline drops for infants (help congestion)

NO OTC cold/cough preps < 4 yo (caution <6 yo)

Honey for cough if >1 yo

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29
Q

Sinusitis

A

High dose amoxicillin

If in day care or recent amox hx then use augmentin

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30
Q

Allergic Rhinitis

A

Antihistamines-nasal itching/sneezing

Intranasal steroid spray (nasonex)- best for congestion and post nasal drop

Leukotriene Modifiers-good for asthma and allergies

Immunotherapy- refractory sx despite med mgmt

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31
Q

Mono

A

Symptomatic

If treat with abx (amoxicillin) → rash

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32
Q

Streptococcal Pharyngitis

A

abx penicillin

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33
Q

Acure Rheymatic Fever

A

Anti-inflam, bed rest and cardio eval

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34
Q

Laryngotracheitis

Croup

A

Mild- supportive, fluids and mist therapy

Glucocorticoids
Single dose dexamethasone 0.6mg/kg IM (improves sx, ↓ hospital duration and earlier d/c)

Oral dexamethasone 0.15 mg/kg (for mild-mod)

Nebulized racemic epi in ED

O2 for desat

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35
Q

Epiglottitis

A

ET intubation

IV abx (ceftriazone or other cephalosporin)

Extubation 24-48 hrs when ↓ swelling

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36
Q

JIA

A

Control pain and inflammation

NSAIDs 1st line

Hydroxychloroquine
Methotrexate
Biologics (etanercept, infliximab, adalimumab)

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37
Q

Juvenile Dermatomyositis (JDM)

A

Immunosuppressive Therapy
Prednisone
Steroid-sparing agents (Methotrexate)

Stretching to maintain range of motion

Continuation of activities

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38
Q

Henoch-Schonlein Purpura

A

Supportive

NSAIDs for arthritis

Corticosteroids (1mg/kg/day divided BID) for severe GI and renal dz

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39
Q

Kawasaki Disease

A

Full doses of intravenous immunoglobulin (IVIG) are the mainstay of tx to ↓ inflammation of the bv

Aspirin (high-dose for a variable period, followed by low-dose) to help ↓ the pain, fever and ↓ the risk of blood clots

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40
Q

growing pains

A

Stretching and reassurance

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41
Q

Developmental Dysplasia of the Hip (DDH)

A

Pavlik harness (p to 6 mo- positioning redirects femoral head toward acetabulum

Older children- closed/open reduction

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42
Q

Avascular Necrosis of Femoral Head

Legg-Calve-Perthes Disease

A

Follow by ortho

Pain control and restoration of hip ROM

Braces, surgury for containment of femoral head in acetabulum in kids >6 yo

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43
Q

Slipped Capital Femoral Epiphysis

A

Orthopedic Emergency

Immediately be made non-weight bearing → urgent referral to ortho

Surgery-internal fixation w/ cannulated screw

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44
Q

Osgood-Schlatter Disease

A

Rest and activity modification

NSAIDS, Ice

Lower extremity flexibility and strengthening exercises

Course typically benign: may last 1-2 years

45
Q

Torticollis

A

↑ ROM

Strengthing exercises, PT

46
Q

Polydactyly tx

A

type 1 litigation or electrocautery

type 2/3 surgery

47
Q

Nursemaid’s Elbow

A

Place thumb on prominence of radial head and apply gentle longitudinal traction
→ supinate forearm fully
→ flex elbow

48
Q

Bronchiolitis (RSV)

A

Supportive care: nasal suctioning, hydration, supp O2, β2 agonist or racemic epi, nebulized 3% hypertonic saline

No benefit from corticosteroids or chest percussion

Palivizumab (Synagis) 15 mg/kg IM admin monthly during RSV season for RSV pphx for at risk pts

49
Q

Pertussis

A

Macrolides- Azithromycin x 5 day (preferred <1 mo or pregnant)

Alt: erythromycin x 14 d, clarithryomcin x 7 days, TMP-SMX x 14 d

50
Q

Asthma tx

A

SABA PRN

Low, med or high dose ICS

ICS + LABA or monteleukast

Oral systemic corticosteroids

51
Q

Exercise Induced Asthma

A

Pre-treatment with albuterol 2 puffs with spacer at least 15 minutes before exercise

Brief warm-up period might help

Well controlled if sx ≤ 2 days/ wk

52
Q

Status Asthmatics

A

β agonist
ICS
Systemic corticoids

IV Mg, aminophylline, or salbutamol

Non-invasive ventilation

IV ketamine infusion inhales anesthetics, ECMO

53
Q

Tx for HA if more than 4/mo

A

topiramate

54
Q

Febrile seizure

A

Antipyretics do NOT help

Rectal diazepam can be used in ST for chld w/ recurrent/prolonged febrile seizures

Daily pphx antiepileptic med not routinely recommended

55
Q

Status Epilepticus

A

Benzos 1st line
Lorazepam* (Ativan) preferred due to rapid onset and long HL

Repeat every 5 min for max of 3 doses if still seizing
→
Phenytoin (Dilantin) is next drug o chouce -give slowly to avoid cardiac dysrhythmia & hypotension
→
Phenobarbitol added if 3rd med is needed (risk of resp depression-be prepared ot intubate)

56
Q

When can child return to school after concussion

A

after can concentrate on a task and tolerate visual and auditory stimulation for 30 - 45 min

57
Q

When can child return to play after concussion

A

after successful return to school, sx free and off med for concussion, normal neuro exam, back to baseline bal and cognitive performance

58
Q

Hypothermia tx

A

Remove wet clothing & dry skin

External rewarming: warm blankets, plumbed garments, heating pads, radiant heat, forced warm air

Internal core rewarming

59
Q

Antidote for opioid poisoning

A

Naloxone

60
Q

Antidote for Acetaminophen poisoning

A

N-Acetylcysteine

61
Q

Antidote for TCA poisoning

A

Sodium bicarbonate

62
Q

Antidote for Insecticide poisoning

A

Atropine

63
Q

Antidote for iron poisoning

A

Deferoxamine

64
Q

What are Colloid solutions (5% albumin, hydroxyethyl starch) good to treat?

A

low intravascular oncotic pressure (e.g. nephrotic syndrome or severe sepsis)

65
Q

When should you apply LET topical gel (Lidocaine-epinephrine-tetracaine)

A

30 min before procedure

66
Q

Do not use lidocaine 1-2% +/- Epi for

A

fingers, toes, penis, nose

67
Q

Bicarb in lido helps what

A

burning w/ inj

68
Q

Drug of choice for min sedation

A

Midazolam [Versed]

prior to procedure

69
Q

Drug of choice for mod sedation

A

IV Ketamine

Ortho reductions, Tongue lacerations, Extensive lacerations, MRI/CT

70
Q

SE of ketamine

A

N/V, increased HR/BP, agitation, hallucinations, respiratory suppression

71
Q

HTN w/ posioning

A

Benzos, nitroprusside

72
Q

bradycardia w/ posioning

A

atropine

73
Q

seizure w/ posioning

A

benzo then barb

74
Q

When do you do primary closure

A

Cosmetically important (e.g. facial)

Clinically uninfected

<12 hours old, <24 hours on the face

75
Q

When should you NOT close

A

Crush injuries or puncture wounds

Hands or feet

Cat or human bites (unless on the face)
Immunocompromised

76
Q

Prevent SIDS

A

Room-sharing, pacifier use, breastfeeding, fan use, immunization, firm mattress, education

77
Q

ALL tx

A

Intensive multi-agent chemotherapy induction
→
Less intensive maintenance (2.5 – 3.0 years), mostly
outpatient after induction

Bone marrow transplantation (5%)

99% pts obtain remission w/ 10-20% relapse

78
Q

AML tx

A

Duration 6 months, inpatient.

More intensive & toxic than
ALL treatment

Bone marrow transplantation (30%) → 1st choice for many patients once in remission

85% pts obtain remission w/ 40-50% relapse

79
Q

brain tumor tx

A

Surgery

Radiation therapy

Chemo

Poor prognosis: low surg availabilty, infancy

80
Q

neuroblastoma tx

A

Younger age better progniosis

Low risk- surg only

Intermed- surg + chemo

High- surg, chemo, irradiation, autologous BMT< experimental therapies

81
Q

Wilms tumor

A

Consult ped onc/surg

Surgical excision, chemo, radiationif local spillage or higher stage

82
Q

Osteosarcoma

A

Chemotherapy

No Radiation-Tumors are radioresistant Older at time of

Surgery-Amputation vs. Limb Sparing

83
Q

Retinoblastoma

A

Chemo, local radiotherapy, enucleation

Goals: save life, vision and avoid late tx sequelae

Highly curabe when detected early

Recommend genetic counseling

84
Q

ABO Incompatibility tx

A

Fetal tx
Intrauterine transfusion

Induced early delivery

Postpartum therapy
prevent kernicterus (acute bili encephalopathy caused bu deposition of direct bili in basal ganglia
85
Q

Neonatal Acne

A

Self resolves but can use soaps or benzoyl perioxide to help it go away (more bothers parent than child)

86
Q

Seborrheic Dermatitis

A

Ketoconazole 2% cream/shampoo or hydrocortisone 1% cream

No tx necessary- doesn’t usually get infected and will resolve on own

87
Q

Harlequin Color Change

A

Benign - associated w/ prematurity, use of Pf or certain types of anesthesia and meningitis

88
Q

Mottling

cutis marmorata

A

Resolves with warming (if it doesn’t concern for shock)

89
Q

Erythema Toxicum

A

spontaneously resolves - no tx necessary

90
Q

Pustular Melanosis

A

Self resolves

91
Q

Allergic Contact Dermatitis

A

Avoid irritant, keep skin dry

Emollients (zinc oxide cream or petrolatum)

Hydrocortisone 1% or 2.5% ointment
(trunk/extremities)

92
Q

Candida Diaper Dermatitis

A

Topical nystatin try to keep dry (avoid moist diaper for long periods of time)

93
Q

Slate Grey Patch

A

Fade over years

94
Q

Infantile Hemangioma

A

Usually self resolve - cosmetic so no tx

If location to grow to affect vision, breathing or feeding, large, over sacrum midline - treat with propanolol (oral), steroids and laser therapy

95
Q

Port Wine Stain

A

Refer if concerned about association with genetic conditions

96
Q

Congenital Melanocytic Nevus

A

If large- 3-5% chance of MM and may require excision and grafting so refer to Derm

Small or med- recommend rte monitoring by derm and fam for MM potential (1% occurs after puberty)

97
Q

Measles (Rubeola)

A

Inspect place in airborne isolation room and call health dept.
Tx - supportive care , vit A (2 doses) for children will DEC mortality for children under 2 yo

Best tx is prevention w/ vaccine at 1 and 4 yo
Complications: secondary infections (PNA, diarrhea, enchephalitis), SSPE (7-10 yrs later)

98
Q

Mumps

A

Recommend isolation for at least 5 days after sx onset supportive care is only tx
vaccinate at 1 and 4 yo or if exposed and only have received 1 dose

Complications: orchitis (unilateral pain and swelling of testicle), SNHL, encephalitis, aseptic meningitis

99
Q

Rubella

A

Supportive care and prevent w/ vaccine
complications: encephalitis (rare, if pregnant woman transmits to babe can get cataract,S, cardiac defects, deafness, hepatosplenomegaly jaundice, blueberry muffin lesions (purpura), microcephalic and sometimes meningoencephalitis

Concern if near pregnant woman because mother can not get vaccine due to it being a live virus

100
Q

Erythema Infectiousum (Fifth Disease)

A

Supportive

Complications- aplastic crisis, hydrops fetalis

101
Q

Eczema herpeticum

A

PO acyclovir (unless ill appearing or im,unk LMP- use IV)

Anti-staph abx (clindamycin)

Can have significant morbidity /mortality due to bacterial superinfection

102
Q

Varicella Zoster

A

Airbourne isolation and pregnant pts avoid contact
PO acyclovir or valcyclvir for children >12 yo or immunocomp
Complications: bacterial superinfection, PNA, can be fatal in immunocomp
Nonxaspirin antipyretics , oatmeal baths, careful hygiene

103
Q

Molluscum Contagiosum

A

Cryotherapy, curettage or cantharidin to remove but no tx necessary

104
Q

Neisseria Meningitis

A

IV Abx (IV ceftriaxone) x 7 days

Abx should not be delayed > 30min

105
Q

Lyme Disease

A

Basically
<8yo: Amoxicillin (or Cefuroxime) PO if early disease or IV
Ceftriaxone if arthritis or severe cardiac/neuro manifestations.

For >8yo can use Doxycycline instead of Amox

106
Q

Fever in Infants <28 days old

A

ALL febrile infants <28 days of age should be admitted to hospital, get a work up and be treated with broad spectrum IV abx

107
Q

Fever

A

Acetaminophen (Tylenol) 15 mg/kg every 4-6 hours PO, PR (Max 90 mg/kg q 24 hrs)

Ibuprofen (Motrin) 10mg/kg q 6-8 hours (Max 40mg/kg q 24 hrs) - avoid in children <6 mo due to nephrotoxicity risk with dehydration

108
Q

Fever 28 days to 3 mo

A

Any ill appearing, febrile infant should be admitted to hospital, get a work up, and be treated with broad spectrum abx

IM/IV ceftriaxone or observation alone and re-eval in 24 hrs

109
Q

Fever of unknown Origin

A

Avoid Abx- harder to figure out

Antipyretics and fluids

Pediatrics (7 decks)

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