Falcon Review Pediatrics 2 Flashcards
Activated charcoals is ineffective against what type of poisonings
Hydrocarbons cyanide metals Li acids and bases
What are the stages of acetaminophen toxicity
Stage 1: 1st 24 hours
- Nausea, vomiting, diaphoresis
Stage 2: 24-48 hours
- clinical improvement
Stage 3: 72-96 hours
- peak liver functional abnormalities
Stage 4: 4 days - 2 weeks
- hepatitis resolves
How do you diagnose acetaminophen tox
measure plasma level 4 hours after ingestion.
Use Rumack-matthew Nomogram to plot level and predict hepatoxicity
What is the treatment for acetaminophen tox
Consider activated charcoal with in 1 hour of ingestion
Antidote: N-acetylcysteine (mucomyst)
What are the signs and symptoms of amphetamine toxicity
Diarrhea, palpitations, arrhythmia, syncope, hyper pyrexia, hyperreflexia, may progress to convulsions
What are the signs and symptoms of anti-histamine toxicity
It ranges from drowsiness to restlessness and seizures
anticholinergic effects such as hot as here; blind as a bat; reticent beat; dries the bone; mad as a Hatter.
What is the treatment for antihistamine overdose
Consider activated charcoal within the first hour
What is the most common cause of drug poisoning
Aspirin overdose
Where the signs and symptoms of aspirin overdose
mild: vomiting, fever, lethargy, mental confusion, hyperpnea
Severe: convulsions, coma, respiratory / cardiovascular collapse
chronic: hyperventilation, dehydration, bleeding disorders, seizures, coma
What are the three phases of aspirin toxicity
Phase 1 for 12 hours.
Respiratory alkalosis, sodium and potassium excretion urine.
Phase II within 12 to 24 hours.
Paradoxical acid urea.
Phase III
Metabolic acidosis with dehydration and hypokalemia.
How is salicylate toxicity level determined
Clinical course is predicted by measuring salicylate levels at six hours after ingestion
What is the treatment for salicylate toxicity
Alkalinization of urine to increase excretion
What is the affinity of carbon monoxide
250 times that of oxygen
Greater than what percentage of carbon monoxide is lethal
70%
How effective is using a pulse ox symmetry to determine carbon monoxide poisoning
Poor
Pulse oximetry just measures saturation of hemoglobin whether it is oxygen or carbon monoxide
What are the complications of carbon monoxide poisoning
Behavior change.
Memory loss.
Blindness may occur in 10 to 30% of cases
What are the signs and symptoms of caustics ingestion
burns of mucous membranes and drooling often refusing to swallow
What are the steps to diagnose caustic ingestion
First ensure airway patency then endoscopy to evaluate the extent of damage
Should you treat the caustic ingestion with
No
The burns on the way down then it will burn on the way back up
What are the signs and symptoms of cocaine use
Perforated nasal septum.
Euphoria,
CNS stimulation.
Myocardial infarction
How long may the symptoms be delayed for hydrocarbon ingestion
Up to six hours
What are the signs and symptoms of iron toxicity
Stage one: 30 minutes to six hours.
-After ingestion nausea vomiting diarrhea abdominal pain hemorrhagic gastroenteritis.
Stage II: six to 12 hours.
The honeymoon phase shows improvement.
Stage III.
24 to 48 hours progressive circulatory collapse, hepatorenal failure, bleeding, metabolic acidosis, Coma
Stage IV
1-2 months with G.I. scoring in obstruction
What level of serum iron is considered severe
Greater than 500 mcg/dL
What is the anecdote for iron toxicity
Deferoxamine
What will a peripheral blood smear show for lead toxicity
anemia with basophilic stippling
What is the treatment for lead toxicity
Mild: decrease environmental exposure
Moderate: oral succimer
Severe: intravenous calcium EDTA
What are the signs and symptoms of opiates
Respiratory depression, constricted pupils, bradycardia, hypertension, hypothermia, hyperreflexia, coma
What are the signs and symptoms of organophosphate ingestion
Multi system affect
Muscarinic
Salvation, lacrimation, urination defecation
Nicotinic
Cramps, fasciculations, twitching, weakness, areflexia, paralysis of voluntary muscles
CNS
Anxiety, ataxia, dizziness, headache, convulsions, coma
What is the treatment for organophosphate ingestion
Atropine
Pralidoxime
The signs and symptoms of tricyclic antidepressant overdose
Drowsiness, delirium, was nation, seizure coma, hypertension, arrhythmias including QRS widening and QTc prolongation
What are the treatment options for tricyclic antidepressant overdose
Consider activated charcoal within the first hour
Sodium bicarbonates decreased cardiac toxicity by decreasing free fraction of drug
The most common causes of non-organic failure to thrive
P. A. I. D.
Poverty
Abuse
Ignorance
Depression
What IQ was determined mental retardation
IQ of 70 or less
Defined learning disorder
Academic functioning below what would be appropriate for age, IQ and education
Discrepancy between achievement test and cognitive test
What is the difference between conduct disorder and oppositional defiant disorder
A conduct disorder is more associated with actions; show aggressive behavior towards others, animals, and property
Oppositional defiant disorder is more associated with the attitude they lose control they have negativity, hostility, defiance
What is required to diagnose Tourette’s syndrome
Disorder of multiple severe tics both vocal and motor
Must be before the age of 18 for one year nearly daily without a tic free period Greater than three months
Highly associated with ADHD
What are the signs and symptoms of depression
SIG E CAPS
S leep I nterest (loss): G uilt (worthless): E nergy (lack): C ognition/C oncentration: A ppetite (wt. loss); P sychomotor: agitation (anxiety) or retardations (lethargic) S uicide/death preocp.
What are the signs and symptoms of schizophrenia
Positive symptoms which are treatable include delusions, hallucinations, disorganized speech and behavior
Negative symptoms which are difficult to treat include flat affect, apathy, anhedonia
What is anorexia nervosa
Condition of weight loss resulting from disturbed body image and fear of obesity
What are the signs and symptoms of anorexia nervosa
Weight loss, amenorrhea, bradycardia, hypotension, hypothermia, lanugo hair growth, cardiac fluid and electrolyte disturbances
What is bulimia
Eating disorder characterized by binge eating, induced vomiting, laxative abuse
What are the signs and symptoms of ADHD
Inattention, hyperactivity, impulsivity, symptoms must be present by age 7 and last for six months and occur in more than one setting and impair function
What is autism
Impaired social, communication language, and behavior
Develops before 30 months
What is aspergbers syndrome
Type of autism with more communication and appear more socially aware
What is Rett syndrome
Neurodegenerative disorder affecting females. X-linked dominant
What are the signs and symptoms of Rett syndrome
Loss of milestones.
Acquired microcephaly onset of one year of age
What is Munchhausen by proxy
Patient fabricates or induces an illness in the child. They may be in the healthcare profession or regarded as a model parent
What is strabismus
Misalignment of the eyes “lazy eye”
Transient strabismus is common up to what age
Four months
How is strabismus diagnosed
- Hirschberg test: look for asymmetric corneal reflex
2. covered test: movement of affected eye. With strabismus the eye will wonder when the cover is removed
What is amblyopia
Decreased visual acuity resulting from an unclear image falling on the retina
What are the risk factors for amblyopia
Strabismus or deprivation (opacity in visual axis) such as congenital cataract
What is the treatment for amblyopia
Put a patch over the good to strengthen the bad
Surgery for congenital cataract
What are concerning signs and symptoms of pediatric headache
Awakens the patient from sleep or early-morning headaches, focal neurologic findings
What is the most common cause of recurrent headaches in childhood
Migraines
What are the risk factors for migraines
Stress, exercise, head trauma, food, menstruation
What are the signs and symptoms of migraine
Throbbing headache, photophobia, photophobia, aura, nausea and vomiting
What is the first-line treatment for pediatric migraines
NSAIDs
What is a pseudotumor cerebri
Also known as idiopathic intracranial hypertension
Is increased intracranial pressure in the absence of intracranial lesion or infection
Where the signs and symptoms of a pseudotumor cerebri
Headache,
diplopia,
nausea vomiting
papilledema
What is the treatment for a pseudotumor cerebri
Therapeutic lumbar puncture to decreased fluid levels.
Acetazolamide
What are the major types of neural tube defects
Spina bifida occulta
Meningocele
Myelomeningocele
What are the signs and symptoms of spina bifida occulta.
May have sinus dental or hair over the defects often asymptomatic
May develop bladder incontinence to the tethering of the cord
One of the signs and symptoms meningocele
The meninges herniate through defective posterior vertebral arches
Fluctuant Midline mass along the vertebral column does not contain spinal cord
Highly associated with hydrocephalus
What is used for definitive diagnosis of meningocele
MRIs definitive but ultrasounds maybe use first in the newborn
What is a myelomeningocele
Note to defect with protrusion of the spinal cord usually in the lumbosacral region
What are the risk factors to a myelomeningocele
Inadequate folate intake during pregnancy
Celiac disease
Is the biochemical marker for a myelomeningocele
AFP is a Biochemical Marker
What is a complication of a myelomeningocele
80% will have hydrocephalus. May require a VP shunt
What is the most common seizure disorder pediatrics
Febrile seizures
What are the signs and symptoms of febrile seizures
Generally occur from six months to five years of age. Generalized, tonic clonic, less than 15 minutes, normal neuro exam and return to baseline
Atypical seizures: are focal, greater than 15 minutes, or multiple seizures, and have an abnormal neuro exam
What are the signs and symptoms of an infantile spasm
Brief symmetric contractions of the neck, talk and extremities in infancy
Associated with tuberous sclerosis.
What will an EEG show for infantile spasms
hypsarrhythmia (bilateral asynchronous slow wave activity)
What are absence seizures
Sudden cessation of motor activity, blank staring, no aura or postictal state, occurring for less than 30 seconds.
Greater than five years, maybe provoked with hyperventilation
Want to limit EEG reveal for absence seizures
3 Hz spike and wave pattern
What is the treatment for absence seizures
ethosuximide
What are the signs and symptoms of a generalized tonic clonic seizure
Tonic clonic movements with loss of consciousness
Associated with aura
Postictal period
What is the treatment for generalized tonic clonic seizures
Phenytoin
Valproic acid
Phenobarbital
What are pseudoseizures
They are not true seizures.
It’s thrashing. Consider sexual abuse
What is myoclonic epilepsy
Brief symmetric contractions with loss of tone.
patients will often slump or fall forward
What is the treatment for myoclonic epilepsy
Valproic acid
What are signs and symptoms of partial seizures
Simple
- 10 to 20 seconds maybe conducive text
- Motor activity
- consciousness not impaired
Complex
-May have auras, automatism, EEG- temporal lobe waves and spikes
What is cerebral palsy
Static and nonprogressive impairment of motor function and posture.
Prenatal complications are the most common cause
What are the types of cerebral palsy
- Spastic diplegia
- Spastic quadriplegia
- Spastic hemiplegia
- Extrapyramidal
- Ataxia
What is spastic diplegia cerebral palsy
Increased muscle tone, increase DTR, contractures, lower extremities worse, may have seizures
What is spastic quadriplegia cerebral palsy
4 extremities are equally involved: scoliosis is more common
What is spastic hemiplegia cerebral palsy
-Involves one side of the body
What is extrapyramidal cerebral palsy
-Hypotonia, choreoathetosis, dystonia
What is ataxic cerebral palsy
-Hypotonia, brisk reflexes, cognitive delays
What is an Arnold Chiari type I malformation
Displacement of the cerebellar tonsils below the foramen magnum causing obstruction of caudal portion of the fourth ventricle.
What is an Arnold-Chiari type II malformation
Displacement of cerebellar tissue below the foramen magnum
- progressive hydrocephalus
What is Friedrichs ataxia
Is a defect in Alpha tocopherol transfer protein causing intracellular deficiency of vitamin E
Autosomal recessive is more common.
What are the signs and symptoms of Friedrichs ataxia
Neurologically: ataxia before 10 years, explosive dysarthria and nystagmus, absent DTRs, loss of vibration and position sense.
Skeletal: scoliosis and foot deformities
What is a major complication of Friedrich ataxia
Hypertrophic cardiomyopathy in 90%
What is leukodystrophy
Abnormal white matter or abnormal myelin
What is Krabbe leukodystrophy
Deficiency of lysosomal hydrolase galactosylceramide beta-galactosidase (GALC) resulting in myelin destruction
What causes the pathology of Krabbé leukodystrophy
Buildup of galctosylceramides
What are the signs and symptoms of Krabbé leukodystrophy
Will present in the first few months of life
Irritability, hypertonia, feeding problems, opisthotonus-followed quickly by rapid deterioration
What is opisthotonus
Hyperextension or specificity of the head and neck for me and arching position
What is adrenoleukodystrophy
X-linked
Adrenocortical insufficiency and demyelination the presents later in life typically between five and 15 years
Will develop abnormal skin pigmentation from adrenocortical insufficiency
What is the treatment of adrenoleukodystrophy
Mixture of MCG’s or Lorenzo’s oil to prevent body’s production of VLCFAs
What is the problem of having a buildup of VLCFAs
Buildup of VLCFAs leads to demyelination
What is mucopolysaccharidoses
Deficiency of lysosomal enzymes needed for the degradation of glycosaminoglycans resulting in accumulations of GAGS
What are three major types of mucopolysaccharidoses
Hurler
SanFillippo
Hunter (X-linked)
What are the signs and symptoms of mucopolysaccharidoses
Course facies is the biggest clue
Skeletal abnormalities, mental retardation, visceromegaly
Hurlers and Sanfilippo will have corneal clouding. Not seen with hunters
What is the pathology behind Tay-Sachs disease
Lysosomal accumulation of GM2 gangliosides in the nervous system due to a deficiency of hexoseamidase A
What are the signs and symptoms of Tay-Sachs disease
Developmental regression at six months, seizures, hypotonia, blindness (macular cherry red spot)
What is the prognosis for Tay-Sachs disease
Death between three and four years of age
What is Werdnig Hoffman disease
Infantile spinal muscular atrophy
A degenerative disease of motor neurons causing atrophy of the anterior horn cells
What are the signs and symptoms of Werdnig Hoffman disease
On set before two years
Generalized weakness hypertonia, Frog leg position, tongue fasciculations, normal IQ
What is the prognosis of Werdnig Hoffman disease
Death by two
What’s kind of pediatric patient history would be suggestive of hypotonia due to botulism
Recent ingestion of honey
Associated with spores in the soil that can be dug up a new construction site
Constipation
What is Guillain Barre
Postinfection polyneuropathy with demyelination usually associated with a viral infection or Campylobacter or Mycoplasma
What are the signs and symptoms of Guillain Barre
Ascending weakness or paralysis 10 days after nonspecific viral infection, absent DTRs, may compromise cardiorespiratory status
What’s for a lumbar puncture demonstrate suggested of Guillain Barre
CSF protein elevated,
CSF WBC less than 10
Normal glucose
What is the treatment Guillain Barre
Supportive care only follow the negative inspiratory force to determine the time or need for intubation
What is the area affected for Guillain Barre
Peripheral neuron is the most often affected
What are the signs and symptoms of Duchenne muscular dystrophy
The most common hereditary neuromuscular disease, X-linked
Dystrophin absent
Proximal muscle weakness and depressed reflexes
Pseudohypertrophy of the calf
Positive Gower sign
How’s Duchenne muscular dystrophy diagnosed
The gold standard is genetic testing
What inheritance pattern is suggested if the mothers brother is affected
Consider X-linked
What is needed to diagnose type I neurofibromatosis
Need to of the following seven
- Greater than six café au lait spots greater than 5 mm prepubertal or six café au lait spots greater than 15 mm post pubertal
- Axillary / inguinal freckling
- Greater than two iris lisch nodules
- Greater than 2 neurofibromas
- First-degree relative with NF 1
- Optic Glioma
- Osseous lesion
What is needed to diagnose type II neurofibromatosis
Need one of the following
- Bilateral acoustic neuromas
- Positive family history and unilateral acoustic neuroma
What is a hamartoma
Tissue that is in the correct location but growing in a disorganized fashion
Type one neurofibromatosis are at a greater risk for developing what
Optic glioma
Pheochromocytoma
What is tuberous sclerosis
Neurocutaneous syndromes of Facial fibroangiomas, hypopigmentation, seizures/infantile spasms and high incidence of MR
One of the classic cutaneous findings of tuberous sclerosis
Ash leaf spots
Shagreen patches
Sebaceous adenomas
What are the clinical features of tuberous sclerosis
Benign CNS tumors (tubers)
Angiomyolipoma’s kidneys
Rhabdomyomas myocardium
Depigmented nevi
What are the signs and symptoms of Sturge-Weber
Portwine stain facial nevus on trigeminal region (V1) of the face
MR and seizures possible
Glaucoma on ipsilateral side
