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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
Acute Otitis Media
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)
26
Tympanostomy Tube Otorrhea
Fluoroquinolone drops | (e.g., ofloxacin and ciprofloxacin dexamethasone)
27
Otitis Media with Effusion
Resolves ≤ 3 mo w/o intervention | If no resolution in 3 mo → refer for tympanostomy tubes
28
Viral Rhinitis
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
29
Sinusitis
High dose amoxicillin If in day care or recent amox hx then use augmentin
30
Allergic Rhinitis
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
31
Mono
Symptomatic If treat with abx (amoxicillin) → rash
32
Streptococcal Pharyngitis
abx penicillin
33
Acure Rheymatic Fever
Anti-inflam, bed rest and cardio eval
34
Laryngotracheitis | Croup
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
35
Epiglottitis
ET intubation IV abx (ceftriazone or other cephalosporin) Extubation 24-48 hrs when ↓ swelling
36
JIA
Control pain and inflammation NSAIDs 1st line Hydroxychloroquine Methotrexate Biologics (etanercept, infliximab, adalimumab)
37
Juvenile Dermatomyositis (JDM)
Immunosuppressive Therapy Prednisone Steroid-sparing agents (Methotrexate) Stretching to maintain range of motion Continuation of activities
38
Henoch-Schonlein Purpura
Supportive NSAIDs for arthritis Corticosteroids (1mg/kg/day divided BID) for severe GI and renal dz
39
Kawasaki Disease
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
40
growing pains
Stretching and reassurance
41
Developmental Dysplasia of the Hip (DDH)
Pavlik harness (p to 6 mo- positioning redirects femoral head toward acetabulum Older children- closed/open reduction
42
Avascular Necrosis of Femoral Head | Legg-Calve-Perthes Disease
Follow by ortho Pain control and restoration of hip ROM Braces, surgury for containment of femoral head in acetabulum in kids >6 yo
43
Slipped Capital Femoral Epiphysis
Orthopedic Emergency Immediately be made non-weight bearing → urgent referral to ortho Surgery-internal fixation w/ cannulated screw
44
Osgood-Schlatter Disease
Rest and activity modification NSAIDS, Ice Lower extremity flexibility and strengthening exercises Course typically benign: may last 1-2 years
45
Torticollis
↑ ROM Strengthing exercises, PT
46
Polydactyly tx
type 1 litigation or electrocautery type 2/3 surgery
47
Nursemaid’s Elbow
Place thumb on prominence of radial head and apply gentle longitudinal traction → supinate forearm fully → flex elbow
48
Bronchiolitis (RSV)
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
Pertussis
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
Asthma tx
SABA PRN Low, med or high dose ICS ICS + LABA or monteleukast Oral systemic corticosteroids
51
Exercise Induced Asthma
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
Status Asthmatics
β agonist ICS Systemic corticoids IV Mg, aminophylline, or salbutamol Non-invasive ventilation IV ketamine infusion inhales anesthetics, ECMO
53
Tx for HA if more than 4/mo
topiramate
54
Febrile seizure
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
Status Epilepticus
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
When can child return to school after concussion
after can concentrate on a task and tolerate visual and auditory stimulation for 30 - 45 min
57
When can child return to play after concussion
after successful return to school, sx free and off med for concussion, normal neuro exam, back to baseline bal and cognitive performance
58
Hypothermia tx
Remove wet clothing & dry skin External rewarming: warm blankets, plumbed garments, heating pads, radiant heat, forced warm air Internal core rewarming
59
Antidote for opioid poisoning
Naloxone
60
Antidote for Acetaminophen poisoning
N-Acetylcysteine
61
Antidote for TCA poisoning
Sodium bicarbonate
62
Antidote for Insecticide poisoning
Atropine
63
Antidote for iron poisoning
Deferoxamine
64
What are Colloid solutions (5% albumin, hydroxyethyl starch) good to treat?
low intravascular oncotic pressure (e.g. nephrotic syndrome or severe sepsis)
65
When should you apply LET topical gel (Lidocaine-epinephrine-tetracaine)
30 min before procedure
66
Do not use lidocaine 1-2% +/- Epi for
fingers, toes, penis, nose
67
Bicarb in lido helps what
burning w/ inj
68
Drug of choice for min sedation
Midazolam [Versed] prior to procedure
69
Drug of choice for mod sedation
IV Ketamine Ortho reductions, Tongue lacerations, Extensive lacerations, MRI/CT
70
SE of ketamine
N/V, increased HR/BP, agitation, hallucinations, respiratory suppression
71
HTN w/ posioning
Benzos, nitroprusside
72
bradycardia w/ posioning
atropine
73
seizure w/ posioning
benzo then barb
74
When do you do primary closure
Cosmetically important (e.g. facial) Clinically uninfected <12 hours old, <24 hours on the face
75
When should you NOT close
Crush injuries or puncture wounds Hands or feet Cat or human bites (unless on the face) Immunocompromised
76
Prevent SIDS
Room-sharing, pacifier use, breastfeeding, fan use, immunization, firm mattress, education
77
ALL tx
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
AML tx
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
brain tumor tx
Surgery Radiation therapy Chemo Poor prognosis: low surg availabilty, infancy
80
neuroblastoma tx
Younger age better progniosis Low risk- surg only Intermed- surg + chemo High- surg, chemo, irradiation, autologous BMT< experimental therapies
81
Wilms tumor
Consult ped onc/surg Surgical excision, chemo, radiationif local spillage or higher stage
82
Osteosarcoma
Chemotherapy No Radiation-Tumors are radioresistant Older at time of Surgery-Amputation vs. Limb Sparing
83
Retinoblastoma
Chemo, local radiotherapy, enucleation Goals: save life, vision and avoid late tx sequelae Highly curabe when detected early Recommend genetic counseling
84
ABO Incompatibility tx
Fetal tx Intrauterine transfusion Induced early delivery ``` Postpartum therapy prevent kernicterus (acute bili encephalopathy caused bu deposition of direct bili in basal ganglia ```
85
Neonatal Acne
Self resolves but can use soaps or benzoyl perioxide to help it go away (more bothers parent than child)
86
Seborrheic Dermatitis
Ketoconazole 2% cream/shampoo or hydrocortisone 1% cream No tx necessary- doesn’t usually get infected and will resolve on own
87
Harlequin Color Change
Benign - associated w/ prematurity, use of Pf or certain types of anesthesia and meningitis
88
Mottling | cutis marmorata
Resolves with warming (if it doesn’t concern for shock)
89
Erythema Toxicum
spontaneously resolves - no tx necessary
90
Pustular Melanosis
Self resolves
91
Allergic Contact Dermatitis
Avoid irritant, keep skin dry Emollients (zinc oxide cream or petrolatum) Hydrocortisone 1% or 2.5% ointment (trunk/extremities)
92
Candida Diaper Dermatitis
Topical nystatin try to keep dry (avoid moist diaper for long periods of time)
93
Slate Grey Patch
Fade over years
94
Infantile Hemangioma
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
Port Wine Stain
Refer if concerned about association with genetic conditions
96
Congenital Melanocytic Nevus
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
Measles (Rubeola)
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
Mumps
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
Rubella
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
Erythema Infectiousum (Fifth Disease)
Supportive Complications- aplastic crisis, hydrops fetalis
101
Eczema herpeticum
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
Varicella Zoster
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
Molluscum Contagiosum
Cryotherapy, curettage or cantharidin to remove but no tx necessary
104
Neisseria Meningitis
IV Abx (IV ceftriaxone) x 7 days Abx should not be delayed > 30min
105
Lyme Disease
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
Fever in Infants <28 days old
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
Fever
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
Fever 28 days to 3 mo
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
Fever of unknown Origin
Avoid Abx- harder to figure out Antipyretics and fluids

Pediatrics (7 decks)

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