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Key Facts Flashcards

1
Q

RETROPHARYGEAL ABSCESS

A

-Widening of the retropharyngeal space on X-ray
-Kids, difficulty swallowing, refusal to feed
-Hyperextension of the neck w/ drooling
SURGICAL EMERGENCY
Tx: Clindamycin, Amp/salbactam

Etiology: Strep Viridans (A), Staph and Anaerobes

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2
Q

PERITONSILLAR ABSCESS

A 
Trismus, drooling, "hot Potato voice" 
Teen 
Unilat swelling around tonsil 
Dev of Uvula 
increased WBC 
Dx: CT 
Etiology : Group A strp and anaerobes 
Tx: Needle aspiration and drainage 
Amp/salb
Clindamycin
Augmentin
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3
Q

AOM PREVENTION

A
  • Breast feeding at least 6 months
  • Avoid bottle propping
  • decreased Pacifier Use
  • No smoking
  • PCV-13
  • Avoid Daycare
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4
Q

AOM TREATMENT OPTIONS

A

1st Amox 80-100mg/kg
2nd Augmentin
3rd Ceftriaxone
4th ENT

Penicillin allergy:
Type 1 Hypersensitivity:
1 Macrolide , 2 Bactrim/clinda

Non-Type 1
Cephalosporin (cefuroxime, cefdinir, cefpodoxim, ceftriaxone)

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5
Q

INDICATIONS FOR TYMPANOSTOMY TUBES AND RECURRENT AOM

A

> 4 AOM/ yr

>3AOM in 6 months

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6
Q

RISK FACTORS FOR AOM

A
  • immunodeficiency
  • Craniofacial abnormality
  • Age <6mo (risk for chronic otitis)
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7
Q

2ND MCC OF EXTRA-THORACIC AIRWAY OBSTRUCTION

CAUSE OF STRIDOR IN INFANCY

A

-VOCAL CORD PARALYSIS
-traumatic injury of recurrent laryngeal nerve
“weak” high pitched cry
-if Unilateral –> hoarseness
-

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8
Q

INDICATIONS FOR TONSILLECTOMY

A
  • REPEAT PERTONSILAR ABSCESS
  • MALIGNANCY
  • OSA
  • RECURRENT PHARYNGITIS
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9
Q

INDICATIONS FOR ADENOIDECTOMY

A
  • CHRONIC SINUSITIS
  • ADENOIDITIS
  • RECCURENT AOM
  • MOUTH BREATHING
  • ADENOID FACIES
  • OSA
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10
Q

KNOWLEDGE OF PATHOPHYSIOLOGY OF OM WITH EFFUSION

A
  • EUSTACHIAN TUBE DYSFUNCTION FOLLOWING URI, GERD, AR, CRANIOFACIAL ABNL (CLEFT PALATE)
  • RELATIVE NEGATIVE PRESSURE VACUUM IN MIDDLE EAR DRAWS SECRETIONS FROM NASOPHARYNX TO MIDDLE EAR
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11
Q

CLEFT LIP AND PALATE

A

-CLEFT LIP/PALATE > BOYS
-CLEFT LIP -MC CRANIOFACIAL CONGENITAL MALFORMATION
-CLEFT LIP/PALATE -MC THAN CLEFT PALATE ALONE
-CLEFT LIP/P CAN OCCUR AS A SINGLE GENE DEFECT OR IN CONJUNCTION WITH OTHER CHROM ABNL
-CLEFT P MORE LIKELY TO BE ASSOCIATED WITH OTHER ABNL
CLEFT PALATE ALONE MC IN GIRLS
-MIDDLE EAR EFFUSIONS COMMON IN KIDS WITH CLEFT PALATE

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12
Q

OM WITH EFFUSION

A

FLUID IN MIDDLE EAR WITHOUT SIGNS OF ACUTE INFECTION

–DECREASED MOBILITY, CLOUDY TM AND AIR FLUID LEVEL

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13
Q

DIAGNOSIS FOR AOM

A

-ACUTE ONSET OF S/S
(PAIN, IRRITABILITY, FEVER)

-MIDDLE EAR EFFUSION
(BULGING TM, DECREASED MOBILITY, AIRFLUID LEVEL)

-S/S OF MIDDLE EAR INFLAMMATION
(ERYTHEMA, OTALGIA THAT INTERFERES WITH SLEEP)

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14
Q

NEWBORN ANURIC WORKUP

A 
1 PE ABDM AND GENITALS
2 CHECK FLUID INTAKE 
3 OBTAIN CATH UA 
4 CHECK BUN/CR
5 RENAL US 
THEN CONSULT IF NOTHING POSITIVE
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15
Q

PHYSIOLOGIC ANEMIA

A

TIME NADIR RANGE

PT 1-2 MO 7-8

FT 2-3MO 9-11

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16
Q

CLINICAL PRESENTATION OF MUMPS

A

-INCUBATION: - 2-3WEEKS
-LATE WINTER/SPRING
-
MANIFESTATION: SALIVARY GLAND SWELLING FEVER

COMPLICATIONS: MENINGOENCEPHALITIS, SENSORINEURAL HEARING LOSS, ORCHITIS, PANCREATITIS

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17
Q

CONTRAINDICATIONS OF MMR VACCINE

A
  • SEVERE ALLERGIC RXN TO VACCINE COMPONENTS
  • PREGNANCY
  • SEVERELY IC
  • ANAPHYLAXIS TO NEOMYCIN OR GELATIN
NOT CONTRAINDICATIONS: 
\+tb TEST, 
tb TESTING, 
PREG MOM, 
BREAST FEEDING, 
IC HOUSEHOLD CONTACT, 
EGG ALLERGY, 
MILD HIV 
HX OF SZ
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18
Q

ADVERSE REACTION TO COMMON VACCINES

A

MMR- 15% FEVER >103 W/IN 12 DAYS (1-2D) (DUE TO MEASLES COMP)
-RASH IN 5% W/IN 12DAYS

VZV- RASH -5% WITHIN 1 MONTH

FLU - GB W/IN 6 WKS OF VACCINE

LIVE FLU - MILD URI SYMPTOMS

MMR (DUE TO RUBELLA COMPONENT)
MILD RASH, FEVER, LA, ARTHRALGIAS in 5-15%, 5-12 DAYS AFTER

MMR-V INCREASED RISK OF FEBRILE SZ

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19
Q

INDICATIONS FOR RABIES VACCINE (AFTER DOG BITE)

A

MAKE SURE TO UPDATE TETANUS AND HEPB IN CASE OF HUMAN BITE

HIGH RISK: BATS, RABID DOG , CAT OR FERRET, SKUNKS, RACOONS
ADMIN BOTH VACCINE and RIG

UNKNOWN RISK:
ESCAPED DOG/CAT
-CONSULT HEALTH OFFICIALS

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20
Q

MANAGEMENT OF POLYCYTHEMIA IN A NEONATE

A

DX: HCT OF 65 OR HIGHER
HCT> 70 –> PARTIAL EXCHANGE TRANSFUSION

ASSOCIATED WITH HYPERBILIRUBINEMIA, HYPOGLYCEMIA, AND THROMBOCYTOPENIA

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21
Q

RECOMMENDATIONS FOR CHILD AUTOMOBILE PASSENGER SAFETY

A

I @45 deg

I > 20lbs convertible back
w/ harness forward-f

school-a booster forward
up to 4-9 back

Older kids standard back
>/= 13yrs seatbelt

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22
Q

Risks associate with the prevention of handguns

A
  • guns present in 35% of homes
  • more than 90of suicide attempts are fatal, increased chances of suicide in those at risk
  • 75%of adol homicides attributed to guns
  • having a gun in the home increases the risk for adol suicide by 5 fold
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23
Q

PREVENTION OF DROWNING/SWIMMING POOL SAFETY

A 
*4 sided fence with locked gate 
Facts: 
-infants are more likely to drown in bathtub 
-kids < 5yrs -residential pool
-Adol "fresh water"

Above ground pools less dangerous

Drowning > AA males
MCC of death in kids with epilepsy
Males account for 75% of drowning
ratio of near drowning 1:1

24
Q

Knowledge of normal linear growth throughout childhood

A 
NB
- regain BW by 2-3 weeks 
-double by 4-6 months
Triple by 1 yr 
50% for wt @ birth is 3.25kg 
50% for Ht @birth is 50cm

Length:
1yr =1.5 x BL
4yr = x BL
13yr = 3 x BL

Normal rate is 5cm/yr til puberty

25
Q

AG of toddler discipline

A

Time out: > 1yr and up 1 min/yr , max of 5 min

Time in: Positive feedback, make non-verbal contact when being good
Ages 9mo-6yrs

Extinction: parent withdraws attention with misbehaving

Token Economy: ages 3-5yrs
Token for good behavior

Loss of privileges: >/= 5yrs

26
Q

Recognition and management of breath holding spells

A

Age: 6-18mo

Simple spell: child becomes pale/ cyanotic

Complex: child cries until passes out , can progress to hypoxic Sz with postictal state

There is an association between anemia and incidence of breath holding spells but no causation

27
Q

Tourette Syndrome

A

Continuum of Tic disorders

  • 2 motor tics + one vocal
  • changes over time

Co-occurrence w/ ADHD and OCD
-stimulant may unmask tic disorder

May treat with Clonidine or Guanefacine

28
Q

Management of Night Terrors

A
  • occurs in first 1/3 of night, rapidly
  • +Fhx , M>F
  • Deep breathing, agitation, inc HR/RR
  • moves around and can hurt themselves
  • will not remember, disoriented

Tx make sure child is safe

29
Q

Evaluation of Speech Delay

A
  • obtain hearing Eval
  • most important for language development in an infant with congenital hearing loss is a FAMILY INVOLVEMENT WITH BOTH VERBAL AND NON-VERBAL COMMUNICATION
30
Q

Interpretation of AFP screen

A

Increased: Incorrect dates, multiple gestation, NTD, Turner Syndrome, gastroschesis, omphalocele, GI obstruction, Sacrococcygeal teratoma
Decreased: incorrect dates, trisomies 13,18,21, IUGR, Fetal Demise

31
Q

Physiologic Consequences in A SGA NEONATE

A 
-Probs with temperature Maintenance 
Hypoglycemia
Poor feeding 
Hyperbilirubinemia 
increased risk for infection
32
Q

Affects of Polycythemia on a NB

A

Thrombocytopenia
Hyperbilirubinemia
Hypoglycemia

33
Q

MCC of Meconium Aspiration

A

Persistent Pulmonary Hypertension

34
Q

Erbs Palsy

A

Common with Clavicular fx
-C5-C7
Waiter’s tip, grasp preserved
Can also have phrenic Nerve involvement with Respiratory distress

35
Q

Klumpsky Palsy

A
  • C8-T1
  • Affects hand muscles -claw hand
  • associated with Horner’s syndrome
36
Q

Tobacco Use in Pregnancy

A
  • increased riske for low BW, miscarriage, IUGR, Prematurity
  • Increased risk for cleft lip/palate
  • Increased risk for SIDS
  • Increased risk for asthma and other resp ailments
37
Q

Causes and complications associated with Oligohydramnios

A

Amniotic Fluid Index: <5cm

Causes; Fetal Urinary tract abnormalities, U-P insufficiency,, Maternal dehydration

Complications:
Pulmonary hypoplasia
IUGR
Fetal musculo-skeletal abnormalities (club foot)

38
Q

Conditions associated with Polyhydramnios

A

AFI: > 20cm

Causes: 
Maternal; Diabetes 
Esophageal atesia in fetus 
Twin-twin Transfusion 
Idiopathic (60-65%)
39
Q

recognition of symptoms associated with Neonatal HYPOCALCEMIA

A

Ionized Calcium < 8.5

Signs of Jitteriness, CHVOSTEK’S SIGN + TROUSSEAU’S SIGN
-PROLONGED QT

Due to increased Phos load on kidneys for an infant given Cow’s milk too early

40
Q

Newborn Renal Physiology

A

-Na Wasters
-Hyperkalemia (especially preemies)
Increased Phos (decreased excretion, blunted response to PTH)
Decreased calcium reabsorption + mG
Decreased GFR

41
Q

PPHN Etiologies

A 
Syndrome with multiple Etiologies 
MEC ASPIRATION 
Pulm infection 
RDS 
Sepsis 
Pulmonary Hypoplasia 
Hyperviscosity/polycythemia 
Hypoglycemia 
Hypothermia
42
Q

PPHN Presentation

A

Severe Hypoxemia refractory to O2
Liable O2 requirements

Differential Cyanosis O2Arms> Legs
(2nd to R–>L Shunt through PDA)

Tx: Mechanical Vent -> decreased CO2 -> decreased Vasoconstriction –> decreased pulmonary pressures

43
Q

Risk for RDS increases with…

A

IDM
C-section
Birth asphyxia

44
Q

Risk For RDS decreases with …

A

Prolonged Rupture of Membranes

Steroids

45
Q

Knowledge of Blood gas criteria for intubation

A

pH 60

Maintain O2 between 50-70

46
Q

Knowledge of Complications with use of Umbilical Vessel Catheters

A

NEO CATH

Necrosis
Emobolization
Omphalitis

Compromised Femoral pulse
Accidental Hemorrhage
Traumatic Perforation Thrombosis (renal artery + Aorta)
Hepatic (dysfunction)

47
Q

management of an infant exposed to Mec delivery

A

DO NOT STIMULATE LIKE USUALLY
-if baby is vigorous do not intubate
-When floppy suction at oropharynx (@del)
THEN INTUBATE AND SUCTION BELOW CORDS

48
Q

Congenital Lobar Emphysema

A

-Usually unilateral
-MC LUL
10% associated w/ CHD
Usually due to partial bronchiomalacia obstruction

Clinical:

  • RD in NB
  • Ipsilateral Lobar atelectasis
  • mech Shift
  • Contralateral Lung atelectasis
49
Q

PATHOPHYSIOLOGY OF PULM EDEMA

A

INCREASED HYDROSTATIC PRESSURE ARDS

50
Q

management of Infant with Bronchiolitis

A

-ABG analysis in Bronchiolitis
Hypoxemia SaO2 < 94%
PCO2 50
Anion Gap = met acidosis

51
Q

Clinical findings in Pulmonary Abscess

A 
Cough 
Fever
Tachypnea 
Chest pain 
Hemoptysis
Wt Loss 
Common with Aspiration
52
Q

Conditions Associated with Congenital Hypoventilation Syndrome

A

Hirschsprung’s Disease
Ganglioneuroma
Hypothalamic Dysfunction
Sz (FOX2B Gene)

53
Q

Findings Associated with Idiopathic Pulmonary Hemosiderosis

A

Age < 6yrs

  • Recurrent Hemoptysis
  • cough, SOB
  • Hypoxemia
  • Anemia
  • Diffuse alveolar hemorrhage on CXR (LOOK AT ATLAS)

dX: BAL -HEMOSIDERIN LADEN MACROPHAGES

54
Q

Asthma Pathophysiology

A

Early Phase -Bronchoconstriction

Late Phase- 4-12hrs later due to airway hyperresponsiveness and inflammation

Irreversible obstruction potential increased 2nd to Airway remodeling if symptoms start < 3yr old

55
Q

Findings in a Pt with a defective function in Complement system

A

Early Components: Sinopulmonary with Encap Bacteria

Late components: Neisseria Infections

56
Q

Leukocyte Adhesion Deficiency

A

Decreased levels/mutation of CD11/CD18 complex (ß2-
integrin)
poor adhesion to vascular endothelium and impaired motility, chemotaxis,
and phagocytosis

CLINICAL MANIFESTATIONS:

  • Delayed umbilical cord separation
  • Recurrent Bacterial/fungal infections
  • ABSENCE OF PUS AND NEUTORPHILS AT WOUND SITE

DX: Delayed T-cell dependent antibody responses (IPV, DPT, tetanus)

Tx:Antibiotics, Bactrim, BMT

57
Q

Evaluation of T-cell Function

A

Initial Evaluation of T-Cell System
1. Quantitative:
CBC- look at absolute lymphocyte count
2. Qualitative:
DHT-Delayed Hypersensitivity skin Testing
used if > 1 y/o. Evaluates in vivo T cell function.
Eg. Candida, tetanus, Diphtheria, PPD, trichophytan

ABP (8 decks)

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