Inpatient Peds Flashcards
1
Q
Barlow Test
A
First - adducting hip, applying posterior force, pressure on the knee
femoral head OUT of acetabulum
dislocating
2
Q
Ortolani Test
A
Abduct the hip, anterior force on femur
reducing
3
Q
Worrisome Signs of Sacral Dimples
A
cutaneous signs (hypertrichosis, hemiangioma, etc)
greater than 5mm in diameter
greater than 2.5cm above anus
4
Q
Ductal Steal
A
excessive blood flow through pulm circulation –> hypoperfusion of systemic
5
Q
Chlamydial conjunctivitis presents at age..
A
5-14d after birth
6
Q
Chlyamdia PNA presents at what age
A
4-12 weeks of age
7
Q
Cow Milk and IDA
A
Low Fe content of cow mlik
occult GI blood loss w/ CM in 40% of population
inhibition of non-heme iron absorption by casein and calcium
8
Q
TEN-4
A
any bruising less than four months
trunks/ears/neck older than 4m
9
Q
Types of HSV Infection in Neonates
A
Skin Eye Mucous Membranes
CNS/Meningitis
Disseminated
10
Q
Phototherapy works by
A
converting bilirubin to lumirubin (more water soluble)
11
Q
Bilirubin peaks on what day of life
A
three (5 if premature)
12
Q
Phototherapy will decrease bilirubin by what rate…
A
0.5 /hr
13
Q
Bilirubin in neonates accumulates in what part of brain
A
Basal ganglia
14
Q
Conjugated hyperbili definition
A
greater than 2 if less than 5
greater than 20%
15
Q
HSP Diagnosis
A
EULAR Criteria
have to have purpura/petechiae w predom on lower extremities
+ 1/4: abd pain, arthritis, arthralgia, histo, or renal
16
Q
Most common cause of hemoptysis in peds
A
cystic fibrosis
17
Q
Febrile seizures simple classification
A
less than 15 minutes
one in 24hr period
generalized, not focal
18
Q
Monospot/Heterophile Antibody
A
Good test in older kids (younger kids don’t make Ab, less than 4)
Good when symptoms present at least 5 days, more likely to be positive as time goes on
19
Q
CBC abnormality w/ EBV
A
atypical lymphoctes
20
Q
Mono- keep out of sports for
A
3 weeks
21
Q
EBV-NA (nuclear antigen)
A
positive 1-2 months after infection
22
Q
Rovsing sign
A
pain in the right lower quadrant with palpation of the left side
23
Q
Obturator sign
A
pain on flexion and internal rotation of the right hip,
which is seen when the inflamed appendix lies in the pelvis and causes irritation of the obturator internus muscle
24
Q
Iliopsoas Sign
A
pain on extension of the right hip, which is found in retrocecal appendicitis
25
Age range for typical intussception
6-36m
26
Intussception - most common location
ileocecal
27
Intussception - lead point
peyer patches > meckels, lyphoma
28
Intussception - imaging
US: target sign
XR: Crescent sign
29
intussception treatment
air enema
30
Ladd Bands
connect cecum to abdominal wall, cross duodenum
| present in malrotation pts
31
Malrotation imaging of choice
UGI with contrast
| shows corkscrew sign
32
Cholinergic Poisoning
SLUDGE
| Parasympathetic: Salivation, Lacrimation, Urination, Defecation, Gastric Upset, Emesis
33
Status epilepticus duration
Historically 30 minutes
| However, >5 minutes likely to be prolonged and lead to status, so treatment algorithms start here
34
Otitis Externa - Organisms to cover
Pseudomonas and Staphylcoccus
35
PID- Short term complications
tubo-ovarian abscess
perihepatitis (Fitz-Hugh-Curtis)
periappendicitis
36
PID Organisms
* STI- Gonorrhea, Chlamydia
* Ureaplasma, Mycoplasma
* Anaerobes/GI- E coli, Bacteroides, Gardenella, actinomyces, etc...
* Can be due to UTIs
37
PID Diagnosis
1) Cervical, Adenxal or Uterine Tenderness
and
2) Supportive findings including fever, discharge, +STD, elevated ESR/CRP
38
PID Oral Treatment
Ceftriaxone + Doxy +/- Flagyl
39
Lyme Treatment
doxy
amox
cefuroxime
40
Port Wine Stain
- capillary vascular malformation
- can be associated with Sturge Weber (seizures, glaucoma)
- typically in V1 distribution w/ SWS
41
Tick paralysis-
mimics GBS
| remove tick!
42
What common peds meds for chronic kids CAN"T be in solution
- levothyroxine
| - baclofen
43
Colic definition
3 hours of crying for 3 days a week for at least 3 weeks
| should resolve by 4-6 months
44
Gianotti Crosti syndrome
papular rash on legs, buttocks, arms
| hypersensitivity reaction to prior viral infection
45
Papular Urticaria
rxn to to insect bites
| red papules or vesicles on extremities, can be umbilicated
46
Edwards Syndrome
Trisomy 18
- rocker bottom feet (vertical talus)
- petite face (small mouth, micrognathia)
- clenched hands, 5th over 4th, 2nd over 3rd
- GI can be malrotation, meckels, omphalocele
47
Patau Syndrome
Trisomy 13
| - micro/anophthalmia, cleft lip and/or palate, and postaxial polydactyly
48
Apnea Definition
cessation of breathing for 20 seconds
| or shorter with bradycardia (HR <100, cyanosis or pallor)
49
Stridor
high pitch, upper airway obstruction
50
Wheezing
narrowing of airway
51
Rhonchi
rattling
larger airway
mucus obstruction
52
Williams Syndrome
- elfin face, friendly demeanor
- aortic stenosis, arterial stenosis
- hypercalcemia
53
Hepatomegaly in Newborns
greater than 3.5cm in newborns below costal margin
54
Hepatomegaly in Children
greater than 2cm in children below right costal margin
55
Noonan Syndrome
hypertelorism
short stature
webbed neck
pulmonary valve stenosis
56
Impetigo- organisms
```
Staph Aurues (MSSA, MRSA)
GAS
```
57
Adenovirus
commonly pharyngitis and conjunctivitis
58
TB treatment in children
Under 5 - receive prophylactic treatment
59
Pneumonia Organisms - Less than age 5
Viral: RSV most common, adeno, humanmeta
| Strep Pneumo, H flu > Mycoplasma
60
Pneumonia Organisms - Age 5 through 18
Mycoplasma > Strep Pneumo, H flu
61
Blood Cultures in Peds Pneumonia
low clinical utility
- fail to show clinical improvement
- moderate to severe
62
Effusions size in pediatrics
small - less than 1/4 of thorax
medium - less than 1/2
large - more than 1/2
63
Peds Pneumonia with Empyema - antibiotics
```
consider ceftriaxone (resistant s pneumo) +
clindamycin or vancomycin (MRSA coverage)
```
64
Nitrites vs LE in UAs
nitrite --> specific
| LE --> sensitive
65
Recommendations for Renal Ultrasound in Peds
2-24 months following first febrile UTI
66
Can use see VUR on renal ultrasounds?
only Grade III-IV
67
Recommendation for VCUG in Peds
```
2 or more febrile UTIs
1st febrile UTI w/
- abnormal u/s
- 39+ temp + organism other than E coli
- Poor growth or HTN
```
68
How does H flu get resistance to Amox
Beta lactamase
69
How does Strep give resistance to Amox
PCN binding proteins
70
HUS triad
anemia, thrombocytopenia, acute renal failure
71
McCune Albright Triad
precocious puberty
café-au-late spots
fibrous dysplasia
72
Cover Test
First eye covered for 1-2 seconds, observe uncovered eye
| Cover opposite ever for 1-2 seconds
73
congenital melanocytic nevi
transformation to melanoma in large CMN, >20cm
| grow as children grow
74
Phytophotodermatitis
rash following citrus exposure and then UV light
75
Measles- symptoms
cough, coryza, conjunctivitis
76
Koplik spots
white spots on buccal mucosa, occur before measles rash begins
77
Measles Complications
- ADEM
- Encephalitis
- Subacute sclerosing panencephalitis
78
Croup-
parainfluenza
| 6 months to 3 years
79
Croup Treatment
Dexamethasone even if mild symptoms
| Race epi if stridor at rest
80
Croup X ray
steeple sign on neck xray, subglottic tracheal narrowing
81
Racemic Epinephrine
reduce stridor in 30 minutes
lasts no longer than 2 hours
observe for 4 hours
82
Pleural TB
primary TB pleuritis in kids
reactivation TB pleuritis in adults
obtain pleural biopsy
83
ASA in Kawasaki Disease
preventing intracoronary thrombosis that could leading to MI in stenotic or aneurysmal coronary artery
84
Peutz-Jeghers Syndrome
AD
melanocytic macules of lips, buccal mucosa, digits
GI harmartomatous polyps (rectal bleeding, anemia)
85
DiGeorge Syndrome
```
CATCH-22 (chromosome 22)
C- cardiac abnormalities
A- abnormal facies
T- Thymic absence or T cell dysfunction
C- cleft palate
H- hypocalcemia
```
86
Raynold Phenomena- Triphasic
1) With vasospasm, the digit exhibits a distinctly demarcated distal pallor coolness (white)
2) cool dusky bluish phase and/or (blue)
3) a bright hyperemic flush (red)
87
Dermatomyositis MOA
small vessel vasculopathy
88
Dermatomyositis- muscle symptoms
proximal muscle weakness
89
proximal muscle weakness=
difficulty getting up out of chair/toilet
climbing stairs
getting on and off the floor
90
Muscle Enzymes =
CK
LDH
aldolase
AST
91
Classic KD Symptoms
5 days of fever
4/5 CRASH
Conjunctivitis, Rash, Adenopathy, Strawberry tongue/mucositis, Hands and feet
92
Incomplete KD Features
```
sterile pyuria
anemia
low albumin
thrombocytosis
elevated ALT
leukocytosis
or ECHO findings
```
93
JIA diagnosis
6 weeks of symptoms
| before 16th birthday
94
Torticollis on Exam
head tilted to one side
| chin in opposite direction
95
Klippel-Feil Syndrome
fusion of cervical vertebra (alantoaxial instability)
short neck
low posterior hair line
96
Atlantoaxial Rotary Subluxation
children, 6-12 after URI or trauma to neck
| head tilts AWAY from SCM muscle
97
NF1 Skin Lesions
café au lait spots
| freckling in axillary or inguinal areas
98
NF Associated Abnormalities
Lisch Nodules (harmatomas)
Neurofibromas
Optic gliomas
99
dyshidrotic eczema
acute, pruritic, vesicular lesions
| often on hands and feet
100
What does Bactrim NOT cover?
Streptococcus
101
Differential Symptoms for Preseptal versus Orbital Cellulitis
symptoms of increased intraorbital pressure
blurred visionopthlamopegia
proptosis
chemosis
102
Reasons for CT in Orbital Cellulitis
unable to perform exam due to edema
CNS involvement (seizures, AMS)
Clinical deterioration or no improvement in 24-48h
103
Correction Factor in T1DM
1800 by TDD
| how much 1 unit of insulin will drop glucose
104
Insulin to carbohydrate ratio in T1DM
500 divided by TDD
105
Hemophilia A
Factor VIII def
| X linked
106
Hemophilia B
Factor ix def
107
Bilirubin production before the liver
- degrade heme to biliveridin then to unconjugated bilirubin
- binds albumin to arrive to the liver
108
Bilirubin Metabolism in liver
- conjugated w/ glucuronic acids by BUGT
| - secreted into bile ducts
109
Enterohepatic Circulation =
deconjugated by bacteria or tissue B gluconuridase
110
Conjugation of Bilirubin in intestine
conjugated to urobilinogen
| 90% to feces
111
Jaundice of Face
4-8
112
Jaundice of Trunk
Upper 5-12
| Lower 8-16
113
Physiological Jaundice can due to
1) increased break down of RBCs
2) low BUGT enzyme activity
3) lack of intestinal flora to metabolize to urobilinogen
114
Unconjugated Hyperbilirubinemia Differential - Categories
increased production
Reduced uptake
Conjugation Defect
115
Conjugated Hyperbilirubinemia Differential - categories
biliary obstruction
impaired excretion
intrahepatic
116
Unconjugated Hyperbili: Increased Production
```
Physiologic
Hemolysis
Polycythemia
Cephalotoma
Infection
```
117
Unconjugated Hyperbili: Conjugation Defect
Gilbert
Crigler-Najjar
Physiologic
Hypothyroidism
118
Unconjugated Hyperbili: Impaired Excretion/Uptake
Prematurity
| G6PD Deficiency
119
Breastfeeding jaundice
inadequate milk intake and dehydration
120
Breastmilk jaundice
inhibition of BUGT enzyme
| increase enterohepatic circulation
121
Criger Najjar Type I
- absent BUGT
- liver transplant, prolonged phototherapy
- AD
122
Criger Najjar Type II
- decreased BUGT
| - may improve with phenobarbital
123
Drugs that can cause unconjugated hyperbilirubinemia in neonates
sulfonamides
cephalosporins
aspirin
124
Biliary Atresia
inflammation on intra and extra hepatic ducts
| can have absence of galbladder
125
Alagille Syndrome
- cholestatic jaundice
- butterfly vertebrae
- peripheral pulmonary stenosis
126
Pediatric CAP - Blood Culture
obtained when hospitalized w/ moderate or severe illness
complicated illness
empyema
127
Pediatric CAP - Length of Therapy
Not more than 7 days
128
Steroids in Pediatric CAP
Only with asthma, otherwise not studied
129
Recurrent Pneumonia
More than two in one year
| More than three in lifetime
130
Causes of CAP - Less than 3m
GBS, GN enteritis, listeria
| HSV, vital
131
Causes of CAP - Infants
Viruses!
| S pneumo > H flu > Mycoplasma
132
Causes of CAP - Kids Less than 5
Viruses! (viral pneumonitis)
| S pneumo > H flu > Moraxella, S aureus, GAS
133
Causes of CAP - Kids more than 5
S pneumo, Mycoplasma, Chlymadia
134
CAP Complications
parapneumonic effusion, empyema, lung abscess
135
Urinary Antigens for CAP in Peds
Not recommended, usually false positive
136
When to use Ceftriaxone in Peds CAP
- unimmunized
| - consideration with empyema
137
Failure to Thrive Definition
dropping two percentiles
OR
weight less than 3rd percentile
below 5th percentile for weight-for-length
138
FTT Broad Categories
Inadequate nutritional intake
Malabsorption
Increased metabolic demand
139
FTT Inadequate nutritional intake
- Neglect
- Emesis/Reflux
- Oromotor dysfunction
140
FTT Malabsorption
CF
Celiac Disease
Hepatobiliary disease
Food Protein Intolerance
141
FTT Increased Metabolic Demand
Cardiac, Renal, Endocrine
Congenital Infections
Syndrome
142
Types of HSV in Neonates
Disseminated Disease
CNS Disease
Skin, Eye, and Mouth Disease
143
Neonatal Disseminated HSV
- acquired perinatally
- 20% do not have vesicles
- hepatitis, pneumonitis, sepsis, DIC
144
BRUE Definition
younger than 1 year w/ brief episode associated w/
(1) cyanosis or pallor;
(2) absent, decreased, or irregular breathing;
(3) marked change in tone (hyper- or hypotonia); and
(4) altered level of responsiveness
145
Low Risk Brue Features
>60 days
>32 GA w/ >45 weeks PCA
less than 1 minute
no other concerning features
146
BRUE Interventions
Should: educate, often CPR
May: EKG, brief monitoring, pertussis
147
pRBCs raise the count by
1 for hemoglobin, 3% for hct
148
platelets raise the count by
20-25k
149
cryoprecipitate is mainly..
factor VIII and fibrinogen
| use for DIC
150
Kocher Criteria Septic Arthritis
```
non weight bearing
temp >101.3
ESR >40
WBC >12
2 criteria = 40%
```
151
Acute Hemolytic Transfusion Reactions
ABO Incompatibility
| fever, flank pain, hypotension
152
Delayed Hemolytic Transfusion Reactions
.minor antigens/non-ABO antigens
| fever, hemolysis 7-14 days after
153
TACO
transfusion associated circulatory overload
| respiratory distress within 6 hours of transfusion
154
TRALI
transfusion related acute lung injury
pulm edema w/in 6 hours of transfusion
more serious- usually fever, hypotension
155
Febrile Nonhemolytic Transfusion Reaction
temperature increase of 1 degree within 4 hours
| due to donor leukocyte cytokines
156
Bacteremia from transufions
yesrsinia
| babeosis
157
When do we see glucosuria (serum value)
serum 180-200
158
Ely's test (peds rheum)
lay flat on table and lift legs
| if hips come off table sign of muscle tightness
159
Thomas Test (peds rheum)
Knees to chest, release one leg and determine whether it relaxes straight or not
160
Early onset sepsis (neonatal)
before 7 days of life
| usually within first 24-72 hours
161
Late onset sepsis (neonatal)
7 days- 3 months
162
Late, Late onset sepsis (neonatal)
>3 months
163
Antibiotic Coverage for Septic Arthritis in Peds
Cover Staph + Strept
| Kingella coverage in preschool children
164
Rationale for 4 hours Tylenol Level
- absorption has already taken place and now distribution and clearance is occuring
165
ER Tylenol
Immediate release of 325, release of addition 325 in 4 hours (will need two nomograms)
166
Osteomyelitis Organisms - Pediatrics
Staph Aureus!!
- Kingella in school age
- GBS, E coli in neonates
- Salmonella in SCD
167
Serotonin Syndrome - Triad
- altered mental status
- autonomic hyperactivity
- neuromuscular abnormalities (tremor, clonus, hyperreactivity)
168
AOM less than 6 months
always treat
169
AOM 6m-2y
treat if bilateral, or severe unilateral
| observe if mild and unilateral
170
AOM >2 y
treat if toxic, otalgia, temp >102.2F
171
Ocular Clonus
seen with serotonin syndrome!
172
Treating Pertussis Timeline Pediatrics
within 6 weeks if <1
| within 3 weeks if >1
173
Klippel-Trénaunay syndrome
port wine stain
lymphatic anomalies
variable overgrowth of bones and soft tissue
174
Theory of D5 in Pediatric Patients with Nausea/Emesis
prevents ketone formation which can worsen nausea/emesis
175
Post Exposure Prophylaxis (PEP) - Time Course
Within 72 Hours
176
Nikolsky Sign
Skin sloughs off when touched (cleavage of the epidermis, not dermis)
Happens w/ SSSS
177
Varicella Lesions
pruritic vesicles on erythematous base
| become pustules, crusted papules
178
Treatment of Staph Scalded Skin Syndrome
Clindamycin (for toxin)
Oxacillin or Cefazolin or Vancomycin
(eh, maybe topical mupirocin)
179
Staph Scalded Skin Syndrome - Where to look for source
nasopharynx!!
| opposite of bullous impetigo where you can culture fluid
180
Aspirin Overdose Treatment
- activated charcoal
| - bicarbonate to alkalinize urine
181
Aspirin Acid Base Problems
Metabolic Acidosis
| Respiratory Alkalosis
182
Galactosemia
- first days after birth w/ milk or breast milk
| - liver dysfxn, anemia, acidosis, reducing substances in urine (galactosuria)
183
Random Things associated with Galactosemia
- cataracts
| - E coli sepsis
184
Zinc Deficiency
alopecia, skin lesions, diarrhea
185
TAR syndrome
thrombocytopenia and absent radius
186
Esophageal damage from ingestion caused by..
alkaline products --> drain cleaner
187
Infections associated with swimming pools
shigella
188
Preauricular Pits and further testing
only if other abnormalities are present
189
Mom's Blood Type for risk of hemolytic anemia
O blood types
| Rh negative
190
Hemolytic Anemia of Newborn and prior exposures
ABO - new prior pregnancy
| RH neg - required prior pregnancy
191
Varicella and Skin Infections
invasvie GAS
192
Turner Syndrome
45X
short stature, webbed neck, normal intelligence
streak ovaries/ovarian failure
193
Congenital vertebral anomalies associated with
renal anomalies!
194
Caput succedaneum
- localized superficial edema of the scalp most likely due to venous congestion from cervical pressure
- above the periosteum
- cross suture lines
195
Cephalohematoma
- sub periosteal hemorrhage localized to the surface of 1 cranial bone.
- sharply demarcated boundaries
- underlying linear skull fracture in small percent
196
Subgaleal hemorrhage
- collection of blood beneath the epicranial aponeurosis and above the periosteum of the skull,
- fluctuant mass that increases in size soon after birth
- vaccum deliveries
197
When do c diff colonization in infants become equivalent to adults
around 3 years of age
198
VWF function
actor that allows functional platelets to bind to connective tissue proteins to form a clot
199
Elevated PT associated with what pathway
extrinsic and common pathways
200
Elevated PTT associated with what pathway
intrinsic pathways (included VIII)
201
corneal abrasion treatment
topical antibiotics
202
double bubble
duodenal atresia
dilated stomach and dudodenum
often w/ scaphoid stomach
203
duodenal atresia associated with
trisomy 21
| vacterl
204
Potter Sequence
oligohydramnios, renal abnormalities
- pulmonary hypoplasia
- facial abnormalities
- club feet/hip dislocation
205
Jejunal and Ileal Atresia associated with
caused by impaired vascular flow/vasoconstriction
| i.e. cocaine, smoking
206
heat exhaustion versus heat stroke
mental status changes
207
Bell's Palsy Treatment
steroids
