Newman Flashcards
Step 1 tx
SABA prn
Asthma (etiology and findings)
- Triggers = infection, exercise, irritants, stress, GERD
- Sudden worsening of sx can occur (d/t atelectasis or alveolar dz)
- Inflammation, bronchospasm, edema, mucus production
- Wheeze/prolonged expiration
When to refer to specialist for UTI?
- Dilating VUR (Grades 3-6)
- Obstructive uropathy is present
- Renal abnormalities identified
- Kidney function impaired
- HTN
- Bowel/bladder dysfunction refractory to PCP measures
Quick relief asthma meds?
- SABA (albuterol)
- Anticholinergics (ipratropium)
- Systemic corticosteroids
MCC of UTI in children
E coli (followed by Klebsiella, Proteus, enterococcus, pseudomonas)
BP cuff too small?
BP falsely elevated
3 components of pediatric assessment triangle
Appearance
Breathing
Circulation
MCC of obstructive uropathy in children
- VUR
- Posterior urethral valves (boys)
- Cysts/ureteroceles
Tx of UTI
2nd or 3rd gen cephalosporin (cefixime or cefdinir), fluoroquinolone can also be used (empiric tx)
*Modify if culture dicates
What to look for in circulatory?
- Skin exam good to assess perfusion (decreased perfusion may be d/t decreased PVR to maintain BP) via cap refill
- HR changes (tachy, then brady w/ increasing severity)
- Cyanosis
Long-term asthma meds?
- Inhaled corticosteroid
- Leukotriene modifers
- LABA
- Anticholinergic (tiotroprium)
Pneumonia (etiology and findings)
- Bacterial (strep pneumoniae) usually gives lobar
- Can be viral or atypical (usually gives interstitial, but can be lobar)
- high fever, ill-appearance
Signs of pt w/ respiratory arrest imminent?
- Breathless @ rest
- Silent
- Drowsy/confused
- RR > 30
- Unable to recline
- Rocking respirations
- No wheeze
- Bradycardia
Describe VCD curve?
Truncated inspiratory loop and straight diagonal line
Step 4 tx
Medium dose ICS + LABA
Appropriate tx for anaphylaxis
Epinephrine
O2
Steroids
DDx for newborn w/ tacypnea
- Cardiac in nature
- ARDS
- Fever
What is possible dx for chronic rhinorrhea and sinusitis
CF
What are some nonspecific irritants for asthma triggering?
- Exercise
- URI
- Aspiration
- Pollution
- NSAID
- GERD
- Temperature change (cold air)
How to obtain urine sample?
Clean catch if they can void on demand
How to obtain urine sample when they cannot void on demand?
- Catheterization
- Suprapubic aspiration
- Bag samples
Common asthma triggers
- Exposure to inhaled allergens (dust mites, cockroaches, pollens)
- Nonspecific irritants
3 groups (inflammatory, irritants, other)
When to image for girls?
- After 2nd or 3rd
What type of curve is seen w/ asthma?
Scooped out curve
How is albuterol inhaler used?
Up to 2 tx 20 mins apart (2-6 puffs each) and measure response
What is possible dx for coughing/choking when eating?
oropharyngeal dysphagia w/ aspiration
What to look for in appearance?
- Overall demeanor
- Tone
- Interaction
- Consolability
- Look/gaze
- Speech/cry
What is especially dangerous to swallow?
Button batteries b/c they eat through mucosa
How is level of severity determined?
Assessment of impairment and risk
What is possible dx for poor growth/low BMI?
CF, immunodeficiency
Anaphylaxis (etiology and findings)
- Allergy to food or meds
- Retropharyngeal edema
- Bronchospasm in lower airway
- *WHAT HAPPENS when exposed?
When to image for boys? and what to get?
- After 1st UTI
- Renal/bladder US (anatomic abnormalities, obstruction or duplication)
What is possible dx for FH of sterile males
CF
What is the prognostic indicator of long-term renal damage w/ Henoch-Scholein Purpura
Development of proteinuria alongside hematuria
What is possible dx for > 2 pneumonia episodes
Immunodeficiency
Bronchiolitis (etiology and findings)
- RSV, influenza, parainfluenza, adenovirus, others
- Children < 2 yo
- URI sx w/ progressive/productive cough
- wheezing/atelectasis
Step 3 tx
Low dose ICS + LABA
OR medium dose ICS
What to look for in breathing?
- Tachypnea usually seen initially
- Development of slow/irregular breathing indicates worsening state
- Nasal flaring, grunting, retractions, stridor, rocking resp all may be seen on PE
Pathophys of asthma
- Episodic/chronic sx of airway obstruction
- Reversibility of sx either spontaneously or via bronchodilator
- Sx worse @ night or early am
- prolonged expirations and diffuse wheezing
Which congenital malformations are CYANOTIC?
- Tetrology of Fallot
- Truncus Arteriosis
- Tricuspid atresia
- Transposition of great vessels
- Total anomalous pulmonary vascular return
Dx criteria for catheter
BOTH pyuria and 50,000 colonies OR 10-50,000 colonies on repeat
Wheezing
Air passing through narrowed airways
d/t inflammation/bronchoconstriction
Epiglottitis (etiology and findings)
- Haemophilus influenzae type B
- Vax available now (so its rare)
- Airway obstruction possible
What is possible dx for chronic wet cough
Bronchiectasis
What is going on if there’s no audible speech, cry or cough?
Foreign body aspiration, angioedema from anaphylaxis or epiglottitis
Newborn pulse ox screening test
- Used to detect possible ductal dependent lesions prior to leaving hospital
- See notes for details
Asthma vs COPD?
Asthma sx are reversible, whereas COPD isn’t
PSGN description
- Gross hematuria w/ glomerular involvement
- HTN
- Swelling/edema
- ELEVATED ASO titers
- Low serum C3
Supportive care usually fine
What is possible dx for sudden onset of sx?
foreign body
When to get VCUG?
- any anomalies seen on RBUS
- Temp > 39*C and pathogen other than E coli
- Poor growth and HTN present
Signs and sx of UTI in children
- fever (unattributable to another cause)
- Decreased intake
- Increased urinary frequency, dysuria, urgency
- dark/strong-smelling urine
- loss of control
Foreign Body aspiration (etiology and findings)
@ trachea - sudden dramatic coughing w/ stridor, drooling and choking
@ lower tract - coughing, choking @ first, then recurrent pneumonia and cough
@ esophagus - drooling, swallowing problems
Diagnostic criteria for clean catch
BOTH pyuria and > 50,000 colonies of single organism
3 components of CP arrest?
Respiratory (O2)
Circulatory (pump, perfusion, BP)
Circulatory volume (perfusion, BP)
What is VCUG looking for?
Evidence of vesicoureteral reflux
Step 5 tx
High dose ICS + LABA
AND omalizumab
Croup (etiology and findings)
AKA acute laryngeotracheobronchitis MCC of infectious airway obstruction (6-36 m) - Parainfluenza virus or allergic - Steeple sign on CXR - Fast onset
Dx criteria for suprapubic aspiration
BOTH pyuria and any growth on culture
When are bag samples helpful?
Only when negative, and should never be used for cultures
What is possible dx for acute onset w/o hx of asthma in teenager?
VCD
Rales
Moist sounds d/t air passing through narrowed airways
d/t airway inflammation and thick mucus
Grunting
Expiratory sound in an attempt to maintain airway patency
d/t breathing out of a partially closed glottis and desire for decreased chest wall expansion
When to refer to cardiologist?
- Grade 4 murmur and above
- Diastolic murmur
- Increased intensity w/ standing
- Sx murmur
- Obscured heart sounds
- Weak femoral pulses
- Clicks
- Hyperactive precordium
- FH of sudden cardiac death
- Extra heart sounds
- Conditions predisposing to heart conditions (Downs)
Signs/sx of asthma
- Cough
- Wheezing
- Chest tightness
- Prolonged expiration
- SoB
BP cuff too large?
BP falsely lowered
Step 2 tx
Low dose ICS
Different grades of VUR?
See website link
https://www.chop.edu/conditions-diseases/vesicoureteral-reflux-vur
Step 6 tx
High dose ICS + LABA + OCS
AND omalizumab
Well controlled asthma vs poorly controlled?
- Less sx frequency
- Less nighttime awakenings
- No interference w/ daily activities
- SABA use <2/week
- FEV1 > 80% expected
- 0-1 exacberations/yr requiring OCS
Stridor
Prominent w/ inspiration
Laryngeal or tracheal narrowing
