Miscellaneous (Aquifer, Uworld) Flashcards
what is most sensitive measure of proper circulation?
A. Warmth of extremities B. Capillary refill time C. Blood pressure D. Heart rate E. Strength of peripheral pulses
D. Heart rate is a very sensitive measure of volume status. Tachycardia is the first and most subtle sign of possible inadequate perfusion. It is the most commonly missed finding in patients who have been sent home and return with serious illness.
Capillary refill time (B) and strength of peripheral pulses (E) are useful components of assessing circulation, but they are not as sensitive as heart rate.
Blood pressure (C) is not a sensitive measure of volume status or circulation. The body’s protective mechanisms maintain blood pressure, so hypotension is typically a late sign of shock. Note that pulse pressure (the difference between systolic BP and diastolic BP) may widen before systolic BP drops.
list specific CNS conditions that can lead to altered mental status (5)
Infection (sepsis, meningitis, or encephalitis)
Poisoning/Toxic ingestion
Increased intracranial pressure (e.g. CNS tumor, hemorrhage)
Trauma
Metabolic disturbance (e.g. diabetic ketoacidosis)
List causes of acute altered mental status that must be reversed quickly to prevent cellular damage
Hypoxia, shock, and hypoglycemia
chest x-ray is needed in all children with chronic cough. how long is considered chronic?
> 3 weeks
what kind of cough do asthmatic kids usually have?
nonproductive cough that is worse at night and exacerbated by exercise and cold air
The hallmark of _______ is non-thrombocytopenic purpura.
One-third of children with this have renal involvement,-> hematuria.
Arthritis or arthralgia, mainly of the knees and ankles, is seen in about 75%
Colicky abdominal pain is present in 65% of patients.
About 50% may develop intestinal bleeding, with guaiac positive stool.
Two-thirds of patients report a recent upper respiratory tract infection.
Henoch-Schönlein Purpura (HSP)
when a kid with henoch schonlein purpura develops severe abdominal pain, what do you need to do?
workup for intussussception. the inflammation can cause lead point for it.
also do fecal blood stool test bc a lot of HSP kids get intestinal bleeding
Kid is diagnosed with HSP. Which of the following is most important to monitor at this patient’s follow-up visit in two days?
A. BP and urinalysis B. Platelet count C. PT/PTT D. White blood cells and hemoglobin E. Signs of intracranial hemorrhage
A. BP and urinalysis
Given the incidence of renal disease, it is important to check the urine for signs of hematuria or proteinuria; sudden changes in blood pressure can potentially suggest a change in renal function. With abnormal findings, serum BUN and creatinine must be checked.
Hep B infection is a significant factor for having which kidney dz?
membranous nephropathy
An infant with bilious vomiting should be considered to have ______ until proven otherwise
volvulus
Mix and match. word bank: Infratentorial, supratentorial, brain stem, cerebellar hemispheric
_______ lesions usually present with cerebellar signs and signs of raised intracranial pressure (ICP).
_________lesions can cause changes in muscle tone and DTRs, but usually lead to hypotonia and hyporeflexia.
________ lesions more commonly lead to focal motor and sensory abnormalities on the side opposite to the lesion.
_______ lesions will often be associated with cranial nerve and gaze palsies.
Infratentorial lesions usually present with cerebellar signs and signs of raised intracranial pressure (ICP).
Cerebellar hemispheric lesions can cause changes in muscle tone and DTRs, but usually lead to hypotonia and hyporeflexia.
Supratentorial lesions more commonly lead to focal motor and sensory abnormalities on the side opposite to the lesion.
Brain stem tumors will often be associated with cranial nerve and gaze palsies.
A 10-year-old boy presents to his pediatrician with a history of hypopigmented non-pruritic “dots,” mostly located on his face and neck. His mother complains that lesions get worse during the summer when her son plays outside. On exam, they are slightly scaly, hypopigmented lesions approximately 0.5 cm in diameter. What is the most likely etiology of his rash?
A. A pox virus
B. Hyperproliferation of keratinocytes
C. S. pyogenes and S. aureus
D. Decreased number of active melanocytes and decreased number and size of melanosomes
E. Ingrown hairs with resultant inflammation
D. Decreased number of active melanocytes and decreased number and size of melanosomes
Pityriasis alba, common in children 3 to 16 years of age, presents as hypopigmented macules. They most often occur on the face, neck, trunk, and extremities. They have irregular borders, can vary in size, and may have a slight scale. Lesions may become more noticeable after sun exposure because of tanning of the surrounding skin. The etiology of this disorder is unknown, but ultrastructural examination of epidermal cells reveal decreased number of active melanocytes as well as decreased number and size of melanosomes.
name what these congenital heart defects are associated with (other conditions, teratogens, what have you)
- aorta coarctation (preductal aka infantile)
- ebstein anomaly
- PDA
- complete AV septal defect
- transposition of great arteries
- truncus arteriosis
- coarctation - PDA and Turner syndrome
- ebstein - lithium exposure
- PDA - congenital rubella
- AV septal - Down’s
- transposition - diabetic mother, DiGeorge
- truncus arteriosis - DiGeorge
treatment of choice for rhinosinusitis (ie upper resp tract requiring abx?) (hint: it’s a med combo)
due to increasing resistance to beta lactamase,
AMOXICILLIN-CLAVULANIC ACID is med of choice!
sickle cell dz patients are at risk for sepsis from what 3 organisms?
strep pneumo
haemophilus influenza
neisseria meningitidis
note: if vaccines are up to date, then strep pneumo is most likely cause of sepsis
note: different from osteomyelitis susceptibility in SCD patients, which are from staph aureus and salmonella
