Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PNP II > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Unchanged or decreased frequency of BMs
Pebbly or cracked stools
Straining/painful stooling

A

Constipation S/S

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Constipation Contributing Factors

A

Stool withholding
Slow transit
Sensory (taste, smell) abnormalities
Diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Laxatives (Dosing)

A

PEG (0.4-0.8 g/kg/day max 17g or 1 tsp/full year of age max 4)
Lactulose/Sorbitol 70% (1 mL/kg q12-24 max 60/30 mL/day)
Mineral Oil (1-3 mL/kg/day max 45)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Concomitant Symptoms of Abdominal Pain Suggesting Organic Etiology

A

Persistant vomiting, GI blood loss
Rashes, joint complaints, fever
Dysphagia, weight loss, stunting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Categorized by timing & content:
Acute watery - hours - days
Acute bloody/Dysentery
Prolonged (7-14 days) or Persistent (>14 days)

A

Diarrhea Presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Diarrhea Diagnostics & Management

A

Depends on Category:
Watery - rehydrate, observe
Bloody/Dysentery - Infection/allergy/autoimmune - get a stool sample
Persistent - Parasitic, bacterial, or enteroviral infection, or unmasking of a chronic condition
Malnutrition - refeed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Low-grade fever
Watery diarrhea; vomiting
Respiratory symptoms

A

Viral Gastroenteritis Presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Acute Gastroenteritis Management

Viral, Bacterial, or Malnutrition-related

A

Vaccination to prevent (Rotavirus); probiotics to shorten
Rehydration (low-os ORS)
Refeeding (2-4 hours post rehydration); zinc supplements (malnutrition-related diarrhea)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Bacterial gastroenteritis
May not be bloody
Vomiting

A

Salmonella Infection Presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Salmonella Infection Management

A

3 mo.+: Rehydration/refeeding

<3mo., imm. comp., SCD: Antibiotic dependent on susceptibility (PCNs, Bactrim, tetracyclines)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q 
Vomiting, poor feeding, poor growth, FTT,
Tooth erosion
Blood in the stools
Coughing, breathing problems
Irritability
A

GERD Presentation, Signs

“Disease” means complications/sequelae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

GERD Management

A

NUTRITION
Avoid upright position while feeding
<12mo: rice cereal
12mo+: H2RA (-tidines) or PPI (-prazoles)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Bacterial GE+
potential for HUS (Pallor, fatigue/SOB, hemophilia/hematuria)
Bloody, watery, and dysenteric OR
1. Bloody, solid diarrhea

A

E. Coli
Diarrhea quality important in differentiating type of e. coli infection:
1. Shiga toxin producing e. coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

E. Coli Management

A

Inpatient AGE therapy (aminoglycoside or 3rd-gen cephalosporin antibiotic –> susceptible antibiotic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q 
High Fever (>40); CNS involvement
Bloody Stool
Severe abdominal pain
A

Bacterial Gastroenteritis Presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Bacterial GE+
Malaise
Tenesmus
Cramping abd pain

A

Shigella Infection Presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

C Diff Infection Management

A

Discontinue antimicrobial agents if on them OR

IMMEDIATELY start PO metronidazole x 10-14 d if not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Feeding dysfunction/dysphagia, esophageal food impaction, heartburn/GERD symptoms
Esophageal stricture

A

Eosinophilic Esophagitis Presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Eosinphilic Esophagitis Management

A

Eliminate dietary allergens

Topical corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Painful swallowing, drooling, food refusal

Necrosis w/ ulceration, perforation, mediastinitis, or peritonitis

A

Caustic Esophageal Burns Presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Caustic Esophageal Burns Management

A

Inpatient steroids, then endoscopy (48-72 hours postingestion) and go from there

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Dysphagia, odynophagia, drooling

Regurgitation, chest/abdominal pain

A

Foreign Body Ingestion Presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Foreign Body Ingestion Management

A

Non-motile esophageal body - Removal in 24 hours
Button battery - emergent excision
Other - will pass spontaneously

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Recurrent pulmonary infections
Vomiting, dysphagia
Anemia, failure to thrive

A

Hiatal or Paraesophageal Hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Hiatal/Paraesophageal Hernia Management

A

Upper GI series or CT to confirm

Surgery to repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

12- wks: Nonbilious/projectile vomiting, dehydration

Avid nursing

A

Pyloric Stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Pyloric Stenosis Management

A

BMP (hypochloremic alkalosis) & US to confirm

Rehydration/electrolyte balance followed by pyloromyotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Epigastric pain, vomiting, and hematemesis/hematochezia/melena

A

Gastric/Duodenal Ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Gastric/Duodenal Ulcer Management

A

Upper GI endo to confirm

Culture to determine H. pylori involvement: treatment with amoxicillin, clarithromycin, & a PPI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Bile-stained vomiting

Overt SBO

A

Intestinal Malrotation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Intestinal Malrotation Management

A

Upper GI series to diagnose (DJJ/Jejunum R of spine)

Surgery; volvulus is emergent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Diarrhea, dehydration
Electrolyte or micronutrient deficiency states
Growth failure

A

Short Bowel Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Short Bowel Syndrome Management

A

Continuous formula through gastrostomy tube
Acid suppression, antimotility and antidiarrheal agents
Antibiotics to treat small bowel bacterial overgrowth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Recurring abdominal pain+screaming+knee-drawing
Vomiting, Diarrhea, Bloody stools
Tender, distended abdomen w/ sausage-shaped mass

A

Intussusception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Intussusception Dx & Tx

A

Confirm with abdominal ultrasound > AXR

GI referral - Air Enema Reduction or surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Painless swelling to small area of groin
May abate when the infant is active, cold,
frightened, or agitated
Singular, depressible

A

Inguinal hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Maroon/melanotic rectal bleeding

A

Meckel Diverticulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Meckel Diverticulum Management

A 
Meckel Scan (special nuclear dye) to confirm
Refer for surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Fever and periumbilical/RLQ abdominal pain
Anorexia, bilious post-pain vomiting
Constipation, diarrhea

A

Acute Appendicitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Acute Appendicitis Management

A

CRP & WBC elevation specific, not sensitive
Confirm with ex-lap
Refer for appendectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Newborn failing to pass meconium, emesis
Abdominal distention and reluctance to feed
Enterocolitis

A

Hirschsprung Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Hirschsprung Disease Management

A

Confirm with biopsy

Refer for surgical repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Crying with defecation; holding back stools

Red bleeding outside of stool following defecation

A

Anal fissure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Anal Fissure Management

A

Confirm visually
Stool softener
Sitz baths for comfort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Initiation of Antibiotic Treatment 1-14 days prior
Persistent Watery Diarrhea
Abdominal Pain, Fever

A

C. Diff infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Upper vs Lower GI Bleed Management

A

Saline gastric lavage vs not

EGD vs Colonoscopy: ID site of bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Three or more recurrent episodes of stereotypical vomiting in children usually older than 1 year; the
emesis is forceful and frequent, occurring up to six times per hour for up to 72 hours or more

A

Cyclic Vomiting Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Cyclic Vomiting Syndrome Management

A

Trigger avoidance (re: migraine triggers)
Sleep (Diphenhydramine, Lorazepam)
Antimigraine, antiemesis Rx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Recurrent attacks of abdominal pain or discomfort at least once per week for at least 2 months
Little relationship to bowel habits and physical activity

A

Functional Abdominal Pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Functional Abdominal Pain Management

A

Reassurance
Restriction of various sugars/sweeteners?
Peppermint Oil?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Diarrhea, vomiting
Failure to thrive, anorexia, poor weight gain
Abdominal pain, distention, edema, ascites
(bulky, foul, greasy, pale stools)
[Repeated infections]

A

Malabsorption Syndromes
(Fat malabsorption)
[Carbohydrate malabsorption]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Management of Malabsorption Syndromes

A 
Nutrition replacement (albumin, hi protein, low fat)
Diuretics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

6 - 24 mo
Chronic diarrhea, vomiting
Abdominal distention, irritability
Anorexia, poor weight gain

A

Celiac Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Celiac Disease Management

A

Strict dietary gluten restriction

Supplemental calories, vitamins, and minerals (acute)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Adolescents & Children
Delayed puberty/short stature/delayed menarche
Anemia, decreased bone density, arthritis
Epilepsy
Intensely pruritic rash (elbows, forearms, knees)

A

Celiac Disease

56
Q

6 - 24 mo
Rash on the extremities, around orifices, eczema
Profound FTT, immune deficiency
Fatty, greasy diarrhea

A

Acrodermatitis Enteropathica

6-24 mo: weaning from breast-feeding

57
Q

Acrodermatitis Enteropathica Management

A

Zinc supplment (symptoms are caused by zinc deficiency)

58
Q 
Uveitis
Recurrent oral aphthous ulcers, rash
Arthritis
Growth and pubertal delay
[Abdominal pain, diarrhea, bloody stools]
Fever
Anorexia, anemia, fatigue, weight loss
(Stricturing process, abscess)
A

Inflammatory Bowel Disease
[(Chron Disease)]
[Ulcerative Colitis]

59
Q

Inflammatory Disease Management
(Chron)
[UC]

A

5-ASA Derivatives: sulfasalazine 50 mg/kg/day
Corticosteroids
Moderate-Severe: adalimumab IM
Severe/steroid-dependent: immunomodulators - AZA, 6MP, (MTX)
(Enteral liquid formula –> High pro, high carb, even fat diet)
[Total Colectomy if other treatments are ineffective/contraindicated]

60
Q

Anaphylaxis Management

A

IM epinephrine: autoinjector kit prescribed after first incidence of anaphylaxis.
< 15 kg: 0.1 mg
15-30: .15
>30: .3

61
Q

Diarrhea, abdominal pain, vomiting, fever
Dehydration
Bloody stools
Seizures, meningismus (stiff neck, photophobia, confusion), encephalopathy

A 
Campylobacter Gastroenteritis
(Bacterial Gastroenteritis: high fever, CNS involvement, severe abdominal pain, bloody stools)
62
Q

Campylobacter Infection Management

A 
Supportive care (HYDRATION, nutrition)
Severe: azith 10 for 3, or eryth 40 for 5
63
Q 
From childhood: asymptomatic
Epigastric or stomach pain/tenderness
Nausea, vomiting
Bloody stool/vomit
Gas
A

H. Pylori Infection
Epigastric pain: PUD
Stomach pain, gas: gastritis

64
Q 
Vague GI symptoms with:
Dysphagia, odynophagia
Weight loss, linear growth deceleration
Delayed puberty
Family history of IBD, CD, PUD
A

Red flags for H. Pylori Infection: refer to GI

65
Q

H. Pylori Diagnosis & Management

A

Upper GI Endo (biopsy) to confirm (GI referral)

PPI w/ Amoxicillin (or Clarithromycin if PCN allergy) & Metronidazole until susceptibility is established

66
Q

voluminous, nonbloody, and watery diarrhea

1. malaise, N/V

A

cryptosporidiosis

1. C. hominis

67
Q

Cryptosporidiosis Management

A

Confirm with microscopic stool analysis (oocysts)
Supportive therapy, self-resolves in 2 weeks
Immunocompromised (suff. CD4 count): Nitazoxanide

68
Q

Watery, nonbloody, foul-smelling, greasy diarrhea
Abdominal distention
Anorexia, maybe fever

A

Giardiasis

69
Q

Giardiasis Diagnosis & Management

A

Trichrome stain to confirm
Metronidazole x 5-7d or
Tinidazole x 1 or
Nitazoxanide x 3 days

70
Q

Dysentery w/ any of

  1. Rectal bleeding, N/V, abdominal distention
  2. Tachycardia, fever, abd pain/distention, dehydration
  3. Fever, abdominal pain, hepatomegaly
A 
Amebiasis
90% of cases are asymptomatic
1. Necrotizing colitis
2. Toxic megacolon
3. Liver abscess
71
Q

Amebiasis Diagnosis & Management

A

Confirm with stool antigen test
Tinidazole (or metronidazole)
Followed by an intraluminal agent (Paromomycin*, Iodoquinol, or diloxanide furoate)

72
Q

Flulike illness
Nontender, nonsuppurative cervical lymphadenopathy
Up to 6 weeks
1. Eye pain, reduced vision, floaters, strabismus,
leukocoria
2. encephalitis, myocarditis, pneumonitis, hepatitis

A

Toxoplasmosis
1. Congenital/post-natal acquired
1 & 2. Immunocompromised/HIV

73
Q

Toxoplasmosis Diagnosis & Management

A

Confirm with PCR, isolation, histology
Observation if immunocompetent
Immunocompromised//pregnant w/ infected or 18+ week fetus: pyrimethamine, sulfadiazine, and leucovorin x 4-6 weeks after symptoms resolved –> prophylaxis
Pregnant w/ uninfected <18wk fetus: spiromycin

74
Q

Growth Stunting & Cognitive/Intellectual Deficits +

Pruritis Ani

A

Enterobiasis (pinworm)

75
Q

Enterbiasis (pinworm) Management

A 
Albendazole 400 (off label) OR
Mebendazole 100
76
Q

Patho/Etiology of GER/D

A

Relaxation of esophageal sphincter w/o swallowing

H. Pylori –> spontaneous increase of gastric acids/ulceration

Infantile contributory factors:
Small stomach capacity, large-volume feedings, short esophageal length, supine
positioning, slow swallowing response

77
Q

Best course of treatment for infant w/ GERD

A

Feeding techniques, volumes, frequency
Trial of hydrolyzed protein formula
Increase in calorie density if weight loss

78
Q

Etiology, patho of UTI/Pyelonephritis

A

Bacterial (e. coli) infection of:
urethra - asymptomatic bacteriuria
bladder - cystitis
kidneys - pyelonephritis - severe –> kidney damage

Most important risk factor in children: vesicoureteral reflux (VUR), also: congenital structural abnormalities, circumcision, sex, abuse, HTN, and hygeine/recurrent infection issues

79
Q
  1. Fever, irritability, vomiting
  2. Fever, bacteriuria, vomiting, flank pain
  3. Fever, toxicity, dehydration
A

Clinical manifestations of UTI

  1. In infant
  2. In children
  3. Severe or in infants under 6 months
80
Q

Diagnostic testing of UTI

A

Confirm with UA/UC:
- Opaque, foul, alkaline, proteinuria, bacteriuria,
hematuria, pyuria
> Blood cultures too if appears septic
> Hematuria & Proteinuria on dipstick: >1+ is abnormal
- 10k cells & symptoms or 100k cells & asymptomatic
> sensitivity study for toxic, pyelonephrotic, recurrent,
or unresponsive
-> Also a CBC, ESR, CRP, BUN/Cr for these & < 12mo

81
Q

Management of UTI

A

Antibiotics (Bactrim, amox, Augmentin, cepha, cefix, cefpodox, nitrofur) as appropriate
Asymptomatic bacteriuria w/ no luekocytes: observe

F/U UC after initiating treatment

Phenazopyridine for dysuria (> 6yo)

82
Q

Management of Pyelonephritis

A

Young children: cefix, ceftib, Augmentin
Adolescents: Augmentin, cipro

F/U UC after initiating treatment

83
Q

Hematuria cut-off and differential for

  1. Gross
  2. Asymptomatic w/ proteinuria
A

5+ RBC/HPF x 3

  1. Post-strep glomerulo, renal disease, UTI, IgA nephropathy
    Trauma, coagulopathy, HSP, SCD
    Crystalluria, nephrolithiasis
    Rhabdomyosarcoma
  2. Renal disease more likely
84
Q

Proteinuria cut-off and types

A

30+ mg/dL (4+ mg/m^2?)

Glomerular - high levels
Isolated - asymptomatic & persistant or orthostatic
Functional - Exercise/fever-induced
Tubular/interstitial - high levels

85
Q

Types of Enuresis

A

Primary (never potty-trained)
Secondary (6-12 mo of dryness)
Nocturnal/monosymptomatic nocturnal (MNE) - only at night

86
Q

Management of Enuresis

A

CBT
Enuresis Alarms
Desmopressin - antidiuretic
Education: supportive, proactive, positive reinforcement of child

87
Q
  1. Phimosis (Px & Tx)

2. Paraphimosis (Px & Tx)

A
  1. Cleanse/gently stretch to reduce; physiologic < 6 yo

2. Can be secondary to masterbation/sex; Lubricate to reduce, if unsuccessful, surgical emergency

88
Q

Testicular torsion diagnostics & management

A

Doppler US, pyuria, bacteriuria

SURGICAL EMERGENCY

89
Q

Inguinal hernia management

A

Attempt to reduce

If does not reduce, or continues to re-protrude after 1-2 weeks, refer to urology

90
Q

Concerning findings for the scrotum

  1. undescended, retractile, gliding
  2. painless, translucent swelling; tense/blue or reducable; no testis movement
  3. hard, painless, opaque mass
  4. Painful swelling, ecchymosis
A
  1. Cryptorchidism - risk for deterioration
  2. Hydrocele - low risk, refer > 1 year
  3. Malignant tumor
  4. Scrotal trauma - cool comp, NSAIDs, refer if grows
91
Q

Concerning findings for the testis

  1. sudden, ipsilateral, severe, unrelenting pain
  2. Gradual onset of pain; “Blue dot” sign on scrotum
  3. Painful scrotal swelling; hard, tender mass above testis (sexually active patient)
A
  1. Testicular torsion - ischemia after 6 hours
  2. Appendix testis
  3. Epididymitis (gonorrhea, trachomatic infection) - support, ceftri & doxy
92
Q

For what are chordee or torsion of the penis is concerning?

A

Hypospadias: assess urethral opening location

93
Q

Testicular torsion - patho

A

Twisting of spermatic cord – compromised blood supply

94
Q

Testicles feel like a “bag of worms” (Px, Dx, Tx)

A

Varicocele - Benign enlargement of testicular veins
Dx
– Ultrasonography to rule out malignancy if <10 years
– Serial US to measure size every 6-12 months
Tx
– No intervention if asymptomatic
– Refer to urologist if grade 2 or 3, painful, right-sided, or if testicular growth retarded

95
Q

Child fussy; abdomen distended; scrotal/labial swelling (Px, Dx, Tx)

A

Incarcerated Inguinal Hernia
Px
• Inguinal herniation including abdominal contents
• Incomplete closure of processus vaginalis
• Obese males/weight lifters with history of undescended testicles have increased risk
Dx
– radiograph, US
Tx
Reduce if possible, if not EMERGENT SURGERY

96
Q

Positive history for previous UTI, abnormal voiding
pattern/dysfunction, unexplained febrile illness, chronic
constipation, UTI symptoms (Px, Dx, Tx)

A 
Vesicoureteral Reflux (VUR)
Px: Regurgitation of urine from bladder into ureters and potentially to kidneys
Dx
• Ultrasonography – may be normal
• VCUG – presence of reflux
• DMSA – to look for renal scarring
Tx
– Prevent infection --> scarring
   > Prophylactic antibiotics?
   > Resolve obstructive processes
   > Interval UCs
   > Repeat VCUG/refer to urologist if not resolved in 
      12-18 months
97
Q

Cryptorchidism Management

A

Often resolves spontaneously (majority < 3 mo.)
Patient/family reassurance
Referral < 6 mo.

98
Q 
Absence of one or both testicles
Microphallus sometimes with hypospadias
Cliteromegaly
Labial fusion, masses within the fused labia
Px, Dx, Tx
A

Disorder of Sexual Differentiation or Ambiguous Genitalia

EMERGENT karyotype & lab eval of serum electrolytes, 17-OH progesterone, T, LH, & FSH levels required to rule out/emergently treat congenital adrenal hyperplasia (CAH)

99
Q 
Hematuria
Edema
Hypertension
(RBC casts in the urine)
(Px)
A

Acute Glomerulonephritis
Px
-“Post-infectious”
-Generally post-streptococcal, recent pharyngitis/impetigo supports Dx

100
Q

Nausea AND
Uncontrollable ipsilateral pain,
UTI, oliguria, OR
Inability to tolerate oral intake

A

Nephrolithiasis

EMERGENT urologic assessment needed

101
Q

Renal and bladder ultrasounds demonstrate fluid masses in/around bilateral kidneys, a solitary kidney, or thickened bladder wall (Name & Tx)

A

Antenatal hydronephrosis

EMERGENT inpatient assessment/treatment needed

102
Q

Parental AG: toilet training readiness

A 
2 hour dryness, dry after naps
Regular, predictable BMs
Follows simple instructions
Can help undress
Wants clean diapers
Asks to go
Asks for underwear
103
Q

Peanut allergy prevention

A

Early introduction of peanut at 4 to 6 months of age in children with severe eczema and/or egg allergy after being evaluated by sIgE or SPT to peanut

104
Q
  1. Pruritic hives & angioedema

Atopic dermatitis

A

Food allergy presentations typical of Children > Adults

1. “Acute Urticaria” & angioedema

105
Q

Pruritus and mild swelling of the lips, tongue, palate, and throat

A

Food allergy presentation typical of Adults > Children

“Pollen food syndrome”

106
Q

Anaphylaxis
Celiac Disease
1. EoE
2. EoG

A

Food allergy presentations typical of any age
1. Infants & young children: usually feeding disorders & FTT; older children: food impaction vomiting, abdominal pain, dysphagia
2. Mimics pyloric stenosis in infants; irritable bowel
syndrome in adolescents and adults

107
Q
  1. Profuse, repetitive vomiting and diarrhea, leading to dehydration and lethargy
  2. Passage of bloodtinged stools and mucus without anal fissure
  3. Recurrent pneumonia with pulmonary infiltrates, hemosiderosis, iron deficiency anemia
A

Food allergy presentations typical of infants

  1. “Food protein-induced enterocolitis syndrome”
  2. “Food protein-induced proct-/proctocolitis;” as early as 2 weeks old
  3. “Pulmonary hemosiderosis” also FTT
108
Q

Persistant pain to ipsilateral knee; spontaneous, or closely following injury or infection

A

Osgood-Schlatter Disease

109
Q

Osgood-Schlatter Disease (Px, Dx, Tx)

A

Osteochondrosis (necrosis of ossification center, and subsequent secondary bone growth/replacement) of the tibial tubercle
Typically seen at ages 11-13
Idiopathic lesions usually develop during periods of rapid growth of the epiphyses
Diagnostically apparent on x-ray
Treatment for most cases is supportive

110
Q

Persistent pain
limp or limitation of motion
Periarticular swelling

A

Legg-Calve-Perthes Disease (Avascular Necrosis of the Proximal Femur)

111
Q

Legg-Calve-Perthes Disease (Avascular Necrosis of the Proximal Femur) (Px, Dx, Tx)

A

Between 4 and 8 years of age; vascular supply to the proximal femur is interrupted
Necrosis visible on x-ray, but joint effusion is the early radiographic finding
Minimize impact. Casting/surgical approaches to contain femoral head w/in acetabulum, abduct hip

112
Q
  1. Plantar flexion of the foot at the ankle joint
  2. Inversion deformity of the heel
  3. Medial deviation of the forefoot
A

Talipes Equinovarus (Clubfoot)

  1. equinus
  2. varus
  3. adductus
113
Q

Talipes Equinovarus (Clubfoot) (Px, Dx, Tx)

A

Idiopathic, neurogenic, or syndromic (arthrogryposis, Larsen syndrome)
Diagnosed by 3 principle deformities (equinus, varus, adductus)
Manipulation to stretch contracted medial and posterior tissues, cast to hold correction

114
Q

Inward deviation of the forefoot

A

Metatarsus Adductus

115
Q

Metatarsus Adductus (Px, Dx, Tx)

A

Flexible: intrauterine positioning (flexible), resolve spontaneously; frequently concurrent with hip dysplaisa, close assessment required
Inflexible (past midline): idiopathic; serial casting to correct, 1- to 2-week intervals

116
Q

Outward directionality of femoral insertion which:
Persists after 2 yo
Increases in angle
Occurs in only one leg

A

Abnormal Genu Varum (Bow Legs)

117
Q

Abnormal Genu Varum (Bow Legs) (Px, Dx, Tx)

A

Normal: infancy-3 yo
Secondary to tibial rotation
The patient should be referred to an orthopedist: bracing may be appropriate, an osteotomy may be necessary for severe problems

118
Q

Medially oriented knees:

in association with short stature

A

Genu Valgus (Knock Knees)

119
Q

Genu Valgus (Knock Knees) (Px, Dx, Tx)

A

Normal: 3 yo-8 yo.
Skeletal dysplasia or rickets
If short stature, refer to orthopediatry

120
Q

In-toeing beyond age 2

More internal rotation of the hip than external rotation

A

Femoral Anteversion

121
Q

Femoral Anteversion (Px, Dx, Tx)

A

Apparent malformation
X-ray to confirm
Resolves spontaneously; may require osteotomy if hip/joint pain manifests

122
Q
  1. Post-injurious, sudden…
  2. Protracted, gradual onset of…
    Ipsi-/bilateral hip/thigh/medial knee pain, limitation of internal rotation of the hip, limp on which the patient…
  3. can
  4. cannot
    Bear weight
A

Slipped Capital Femoral Epiphysis

  1. acute (symptoms resolve in < 3w)
  2. chronic
  3. stable
  4. unstable
123
Q

Slipped Capital Femoral Epiphysis (Px, Dx, Tx)

A

Displacement of the proximal femoral epiphysis due to disruption of the growth plate; secondary to stress increase across proximal femoral physis or reduced resistance to shear; endocrine or renal disorders, obesity, coxa profunda, femoral/acetabular retroversion
AP, lateral pelvic X-Ray
Crutches and immediate referral to an orthopedic surgeon for internal fixation of femoral head to the neck

124
Q

Elbow fully pronated and painful
Elbow will not bend
Point tenderness over the radial head

A

Nursemaid’s Elbow

125
Q

Nursemaid’s Elbow (Px, Dx, Tx)

A

Physio x-ray
Reduce: from fully supinated/extended slowly to fully flexed; or elbow at 90, slowly hyperpronate wrist; click felt over radial head
Sling for a day or longer if pain persists
Sign of abuse, especially if recurrent

126
Q

Typically non-painful, lateral curvature of the spine

A

Scoliosis

127
Q

Scoliosis (Px, Dx, Tx)

A

Idiopathic, congenital, neuromuscular, syndromic
Lumbar or thoracic
PA, lateral x-rays to confirm
<20 degrees w/o progression: no treatment required
20-40: bracing (if skeletally immature)
40-60: surgery (instrumentation, fusion)

128
Q

Limping and hip pain
Limitation of motion, particularly internal rotation
Swelling apparent around joint
Temp < 38.4C

A

Toxic Synovitis

129
Q

Toxic Synovitis (Px, Dx, Tx)

A

Acute inflammatory reaction following upper respiratory/gastrointestinal infection
ESR, white blood cell count WDL (vs. septic arthritis)
Clear, yellowish fluid on aspiration (vs. purulent w/ SA)
Radiographic changes: nonspecific, DCE-MRI: definitive
Generally self-limited; rest and NSAIDs (vs. operative drainage followed by antibiotic treatment for SA)

130
Q

Internal rotation of the leg b/t knee and ankle

A

In-toeing

131
Q

In-toeing (Px, Tx)

A

20 deg is physio at birth, neutral by 16 months
Accentuated by laxity
Often resolves spontaneously, may require osteotomy if persists/becomes symptomatic (painful)

132
Q

Points of assessment/diagnostics for trauma, sprains, and strains

A 
Directed physical examination for swelling, tenderness, deformity, and instability
Radiographic examination (rule out physeal fracture)
133
Q

Treatment for most fractures, sprains, and strains

A

Rest, Ice, Compression, & Elevation (RICE) and NSAIDs for sprains
Early protected motion for sprains and stable strains (possibly after brief splinting)
Surgical repair for unstable strains
Closed reduction and immobilization for most fractures

134
Q

Epiphyseal fractures

A

Radiograph every dislocation to rule this out
Elbow epiphyseal fractures often require open reduction and fixation; closed reduction is typically sufficient for others, but if they fail, open reduction should be performed; all under anesthesia
Bony bridges may form that will cause premature cessation of growth even with adequate reduction

135
Q

Torus vs. Greenstick

A

Crushing compression of bone cortex
3w immobilization is typically all that is necessary: soft bandage/casting
vs.
Realignment, snugly fitting hard cast

136
Q

Clavicular Fracture

A

Sling for comfort; typically resolves in less than a year

137
Q

Supracondylar Fracture

A

Closed reduction and percutaneous pinning performed under general anesthesia

PNP II (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions