Inpatient

Question 1

Dose insulin in peds T1DM… eg stable after PICU admit for DKA

Answer 1

.5 U/kg total daily dose

basal (lantus) 1/2 TDD

the rest split over corrections prandially:

• insulin:carbohydrate ratio is 1 U : 500/TDD carb
• additional prandial 1800/TDD q50>150…

Question 2

infant admitted for SIRS/SBI (serious bacterial infection)… dispo pending…?

Answer 2

dispo after 36-48hr stay pending negative Bcx, Ucx, CSFcx

…treat empirically with relevant abx if high enough suspicion until then

Question 3

most common pathogenesis of osteomyelitis in peds

Answer 3

hematogenous spread
-but bacteremia usually asymptomatic… don’t usually get positive blood cx

staph aureus most commonly
-adhesive, antiphagocytic

Question 4

labs in osteomyelitis

Answer 4

WBC up

CRP up before ESR, down before ESR

Question 5

dx osteomyelitis

Answer 5

WBC up
CRP up before ESR, down before ESR

MRI most sns and sp imaging

definitive dx w aspiration

Question 6

tx osteomyelitis in peds

Answer 6

empiric abx - vanc or clinda

clinda has better bone penetration and can transition to oral

3-4 wk course

Question 7

pancytopenia in kid with fever and bone pain think…

Answer 7

leukemia…

Question 8

high flow nasal cannula aka

Answer 8

HHFNC

humidified high flow nasal cannula

Question 9

when is high flow nasal cannula used in peds

Answer 9

labored breathing

eg
bronchiolitis
PNA
asthma

Question 10

progression of retractions in labored breathing

Answer 10

inferior to superior
aka
abdominal breathing
subcostal retractions
intercostal retractions
suprasternal retractions
supraclavicular retracitons

Question 11

what can you adjust in high flow nasal cannula and why do it

Answer 11

flow
-relieve labored work of breathing (retractions, nasal flaring, etc)

FiO2 for hypoxia
-adjust to SpO2 ^90 awake, want to see nap before leave, make sure not desatting in sleep

Question 12

Peds diet on high flow nadal cannula

Answer 12

NPO if tachypneic 60-90

Because tough to coordinate breathing and swallowing in v1sec

NGT if NPO for long

Question 13

diagnostic criteria for kawasaki

Answer 13

Burn and CRASH… also labs

Fever for 5 days, true, documented ^100.4
(most important)

Conjunctivitis - non-purulent, limbic (right around iris)
Rash - polymorphous, can be anything
Adenopathy …. cervical… ^1.5 cm…
Strawberry Tongue (oral mucosal involvement)
Hand Swelling

Labs
WBC^15
Anemia for age
Thrombocytosis (later in course)
CRP ^3
Alb v3
ALT elevated to...
Sterile Pyuria (WBC, no bact... urethral, so need clean catch not catheter)

Echo for coronary artery ectasia(dilation)/aneurysm

Question 14

ectasia vs atelectasis

Answer 14

ectasia = dilation or balooning = ectasis

atelectasis = collapse = absence of ectasis

Question 15

treat kawasaki

Answer 15

high dose aspirin (100mg/kg/day) (antiinflammatory at high doses)

IVIG once over 8 hours (antiinflammatory)

• document stop time, monitor for fever
• if fever v24 hours of stop, it’s an IVIG rxn
• if fever ^24 hours of stop, Kawasaki’s is persisting, consider STEROIDS or REMICAID

when 24 hours afebrile, transition high dose to low dose aspirin (3-5mg/kg/day)… more antiplatelet

can also get Tylenol but NOT motrin (counteracts aspirin antiplatelet effects)

Question 16

tf

Kawasaki’s is a medium vessel vasculitis

Answer 16

T