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Collège Royal 2019 > Ped > Flashcards

Ped Flashcards

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1
Q

TA minimale en ped selon l’âge

A

0–28 days: 60 mm Hg

1–12 months: 70 mm Hg

1–10 years: 70 mm Hg + (2 × age in years)

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2
Q

TA maximale en ped selon l’âge

A

1 an: 100

5 ans: 110

10 ans: 120

15 ans: 130

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3
Q

Cible de développement selon l’âge de 1 à 24 mois

A
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4
Q

Quel est l’utilité du PAT (pediatric assessment triangle) et décrivez-le.

A
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5
Q

Étiologies de régurgitations excessives en néonat ad 1-2 mois

A

Sténose pylore

Volvulus

Intusussception

Maltraitance

Infection SNC

Maladie métabolique

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6
Q

4 éléments à l’histoire et 8 éléments à l’examen physique orientant vers de l’abus/trauma non accidentel chez l’enfant

A

History lacking in details

Inconsistency—details change with repeated questioning

History inconsistent with child’s developmental status

Reported mechanism inconsistent with injury

Any bruises in young precruising infants

Patterned ecchymosis, burns, or skin marks (abrasions, lacerations)

Bruises on the ears, trunk, inner thighs, neck, or groin

Posterior oropharynx bruising or lacerations

Posterior rib fractures

Classic metaphyseal fractures

Any fracture in a nonambulatory child

Fractures in different stages of healing

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7
Q

8 différences anatomiques entre le airway ped et adulte

A
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8
Q

Corps vertébral qui est adjacent aux cordes/glotte chez bébé vs enfants vs ado

A

Bébé: C1

Enfants 7 ans: C3-C5

Ado: C6

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9
Q

En dessous de quel âge l’intubation nasotrachéale à l’aveugle est-elle contre-indiquée?

A

10 ans

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10
Q

Différences physiologiques entre le airway/intubation ped et adulte

A

Métabolisme plus élevé

Volume résiduel fonctionnel diminué

donc désat + vite - utiliser oxygénation apnéique 15L/min pour enfant/ado, 5L / min pour bébé

Volume de distribution des médicaments augmenté, donc dose/kg plus élevée

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11
Q

Formule pour taille du tube et profondeur du tube

A

Taille pour enfant de plus de 1 an:( âge / 4) + 4, pour tube avec ballonnet, soustraire 0.5

Profondeur: 3 x taille tube

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12
Q

Effets secondaires de la kétamine

A

Vo

Myoclonies

Laryngospasme

Phénomène d’émergence

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13
Q

Cut-off approximatif pour faire une crico à l’aiguille plutôt que chirurgicale en ped

A

Chez les moins de 6 ans, favoriser à l’aiguille

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14
Q

5 classes d’ASA pour évaluer le risque de sédation procédurale

A
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15
Q

Truc mnémotechnique pour se rappeler de la préparation ped en sédation procédurale: SOAP ME

A

Size-appropriate suction catheters

Oxygen supply

Airway: Size-appropriate airway equipment

Pharmacy: Advanced life support medications and antagonists

Monitors: Size-appropriate oximeter

Equipment or drugs for a particular case

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16
Q

Quel est la durée minimale de jeûne avant une sédation procédurale au département d’urgence?

A

Le jeûn pré-sédation procédurale ne réduit pas le nombre de vo/aspiration, il n’y a donc pas de jeûne nécessaire.

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17
Q

Quels sont les 2 types de douleur? et les 2 sous-types du 1er type?

A

Nociceptive (viscérale et somatique) et neuropathique

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18
Q

Dose maximale de lidocaine, lidocaine avec épi et bupivacaine. Quelle famille lidocaine vs tetracaine?

A

xylo: 5mg/kg

Xylo avec épi: 7mg/kg

marcaine: 3 mg/kg
tetracaine: 1,5 mg/kg = ester (aussi benzocaine)
autres: amides (i de amide avec lido et bupi)

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19
Q

Nommez 8 trucs pour minimiser la douleur lors de l’injection d’anesthésiques locaux

A
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20
Q

Nom du préservatif dans xylo qui peut induire une allergie:

(pcq allergie aux amides très rare, pas de réaction croisée avec esters)

Autres substances pouvant être utilisées comme anesthésiques locaux

A

méthylparabène

  • Diphenhydramine, alcool benzylique
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21
Q

signes et sx d’une intox aux anesthésiques locaux

A

Early signs of toxicity include numbness or tingling of the lips, metallic taste, muffled hearing, and tinnitus. These symptoms often portend the onset of drowsiness, seizures, status epilepticus, and coma

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22
Q

3 rythmes les plus fréquents en arrêt cardiaque ped

A

Asystolie, PEA, brady

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23
Q

Algorithme arrêt cardiaque en ped avec 6H6T

A

Embolie pulmonaire/SCA

PTX sous tension/tamponnade

Hypoglycémie/hyperkaliémie/Acidose

Toxine/hypovolémie

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24
Q

Définition/présentation d’un ALTE. Âge d’apparition.

A

combination of apnea, color change, change in tone, choking, or gagging. Typically these children are younger than 1 year old with the most common presenting age between 2 to 4 months old.

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25
Q

Facteurs de risque d’étiologies graves d’un ALTE à l’histoire, l’examen physique et aux ATCD

A

ATCD: prématurité, comorbidités, moins d’un mois, ATCD de ALTE

Histoire: changement de couleur vers bleu, absence de choking, absence de IVRS, plus d’un événement en 24hr

EP: examen physique anormal

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26
Q

Comment estimer la TAM d’un nouveau-né?

A

TAM = âge gestationnel en semaines

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27
Q

Quelles sont les indications d’aspiration méconiale du nouveau-né?

A

Indications for intubation in newborns born through MSAF are the same as those for all neonates; meconium aspiration should only be performed if indicated for signs of airway obstruction secondary to meconium that do not improve despite standard resuscitative measures, including warming and drying and initiation of effective positive-pressure ventilation (PPV)

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28
Q

Situations où on peut s’abstenir de réanimer un nouveau-né. Quand cesser la réanimation d’un nné?

A

Resuscitation is not currently recommended for neonates with a confirmed gestational age less than 23 weeks, those with birth weight less than 400 g, and those with confirmed anencephaly, trisomy 13, or trisomy 18.

Après 10 minutes sans ROSC

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29
Q

Signes et sx d’une hernie diaphragmatique à la naissance

A

diaphragmatic hernia include barrel chest, ipsilateral absence of breath sounds, tracheal or point of maximum cardiac impulse displacement, and scaphoid abdomen

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30
Q

6 lésions cardiaques congénitales canal-dépendantes

A

Ductal-Dependent Pulmonary Blood Flow:

Critical pulmonary stenosis, atresia

Severe tricuspid stenosis, atresia

Severe tetralogy of Fallot

Ductal-Dependent Systemic Blood Flow:

Hypoplastic left heart syndrome

Critical aortic stenosis

Interrupted aortic arch

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31
Q

Algorithme NRP

A
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32
Q

Décrire l’APGAR

A
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33
Q

2 trucs mnémotechniques pour la détérioration d’une ventilation ou intubation chez un nné

A

MR SOPA

M: Mask adjustment

R: Reposition airway

S: Suction mouth and nose

O: Open mouth

P: Pressure increase

A: Airway alternative

DOPE

D: Displacement of ETT

O: Obstruction of ETT

P: Pneumothorax

E: Equipment failure

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34
Q

6 différences anatomiques ayant de l’importance dans la prise en charge d’un trauma ped

A
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35
Q

taille des tubes en ped

  • TET et profondeur
  • DT
  • TOG, TNG, foley
  • ligne fémorale
A
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36
Q

Critères de drainage en SOP pour un hémothorax ped après installation du DT

A

SOP si >15mL/kg initialement ou > 2mL/kg/hr

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37
Q

HTIC ped:

dose de mannitol

dose de NaCl 3%

Cible de PPC

A

With signs of herniation, consider 3% hypertonic saline 6.5–10 mL/kg IV (or mannitol 0.25 to 0.5 g/kg IV), if possible elevate the head of the bed, keep the facing forward, and hyperventilate to a PCO2 of 30 to 35 mm Hg.

Maintain CPP of at least 50 mm Hg in children and 70 mm Hg in adults.

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38
Q

Décrire le glasgow modifié ped

A
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39
Q

Différences anatomiques ayant des implications dans le trauma ped

A
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40
Q

Critères de SOP pour un hémothorax

A

drainage supérieur à 15mL/kg initialement ou 2cc/kg/hr

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41
Q

dose de :

salin 3%

mannitol

cibles de PPC en trauma crânien ped

A
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42
Q

Définition d’une transfusion massive en ped et ratio suggéré

A

Transfusion massive si >40cc/kg de sang

Ratio 1:1:1

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43
Q

Décrire CT head rule pour ped

A
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44
Q
A
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45
Q

décrire les couches du scalp et les saignements possibles

A
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46
Q

dfn d’un kyste leptoméningé

A

après une fx du crâne, déchirure de la couche durale avec protusion des leptoméninges

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47
Q

Nommer des milions de différences entre la colonne ped et adulte

A
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48
Q

Quand peut-on se permettre de ne pas de faire de RX cervical chez un enfant de plus de 3 ans

A

Patients older than 3 years old do not require imaging if they are alert, have no midline tenderness, neurological deficit, painful distracting injury, unexplained hypotension, or intoxication. In addition to the aforementioned criteria, children younger than 3 years old generally do not require cervical spine imaging if their mechanism of injury is not a MVC, suspected nonaccidental trauma, or a fall from a height of more than 10 feet. Cervical spine imaging should be performed for children not meeting the aforementioned criteria

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49
Q

Comment distinguer une subluxation vs pseudosubluxation C2 sur C3

A
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50
Q

Comment détermine-t-on radiographiquement une dislocation atlanto-occipital

A

Ratio Power sup 1 (AB/CD) suggère lésion ligamentaire

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51
Q

Au-dessus de quel niveau pouvons-nous avoir un choc spinal et un choc neurogénique

A

Choc spinal > D1

Choc neurogénique > D6

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52
Q

Nommer les bactéries et virus responsables de la fièvre chez l’enfant selon le groupe d’age

A
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53
Q

Nommer les critères de choc toxique

A
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54
Q

Nommez les critères majeurs et mineurs de l’endocardite bactérienne

A

BE FIVE PM

Blood cultures

Echo +

Mineurs:

Condition prédisposante: valve, UDIV

Fièvre

Immuno (osler, roth)

vasculaire (janeway

Echo anormale sans critère majeur

Microbio evidence

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55
Q

Nommez les causes de stridor supra/glottique et sous-glottique en les divisant en causes congénitales et acquises

A
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56
Q

Critères d’admission pour laryngite virale

A
  • Détresse respiratoire importante
  • Sx inhabituels
  • Persistance de stridor au repos après cortico et épi

ATCD maladie pulmonaire/cardiaque/immuno

Déshydratation

Tachycardie ou tachypnée persistantes

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57
Q

Nommer les différences entre laryngite / épiglottite et laryngite bactérienne

A
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58
Q

Nommer les doses de médication pour l’asthme

A
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59
Q

critères qui orientent vers un souffle cardiaque d’allure non fonctionnelle

A
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60
Q

Nommer les foyers d’écoute pour les différents souffles possibles

A
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61
Q

Comment fait-on un test d’hyperoxie?

A

This test consists of assessment of the rise in arterial oxygenation with the administration of 100% oxygen. An arterial blood gas is measured after several minutes on high-flow oxygen (100% oxygen). When the child is breathing high-flow oxygen, an arterial oxygen partial pressure (PaO2) of more than 250 mm Hg virtually excludes hypoxia due to CHD—a “passed” hyperoxia test.5 An arterial oxygen reading of less than 100 mm Hg (in a child without obvious pulmonary disease) is consistent with a right-to-left shunt and is highly predictive of CHD—a “failed” hyperoxia test. Values between 100 and 250 mm Hg may indicate lesions with intracardiac mixing

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62
Q

Nommer les 3 formes classiques de silhouette cardiaque avec leur malformation associée

A

The three classic cardiac silhouettes seen in patients with congenital heart defects are the “boot-shaped heart” of tetralogy of Fallot lot (Fig. 170.4), the “egg-on-a-string” silhouette of transposition of the great arteries, and the “snowman-shaped” or “figure-of-eight” heart of total anomalous pulmonary venous return.

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63
Q

Nommer les cardiopathies congénitales et le moment de leur diagnostic initial usuel

A
64
Q

Dites pour chacune des cardiopathies congénitales si le blood flow pulmonaire est augmenté ou diminué

A
65
Q

Nommer les cardiopathies canal dépendantes

A
66
Q

Classer les cardiopathies non cyanogènes

A
67
Q

Classer les cardiopathies cyanogènes

A
68
Q

Nommer 10 facteurs de risques d’arythmies en ped

A
69
Q

Nommer les chirurgies et les pathologies où la prophylaxie de l’endocardite est indiquée

A
70
Q

Nommer les 2 germes les plus fréquemment impliqués dans l’endocardite bactérienne ped

A

Strep viridans et staph aureus

71
Q

Nommer les facteurs de risques d’anévrismes coronariens en Kawasaki

A

Significant risk factors for coronary aneurysmal formation include male gender, age younger than 1 year old, or older than 8 years old, prolonged febrile period longer than 10 to 14 days, early myocarditis, anemia (hemoglobin <10 g/dL), white blood cell count more than 30 × 103/hpf, increased band count, elevated ESR, elevated CRP level, low serum albumin levels, aneurysms involving other arteries (renal, axillary, or iliac), and giant coronary aneurysms (>8 mm in diameter)

72
Q

critères de jones (RAA)

A
73
Q

Nommer les causes d’hyperbilirubinémie non conjuguée chez l’enfant

A

Physiologic jaundice of the newborn

Breast milk jaundice

ABO incompatibility

Physiologic breakdown of birth trauma hematoma (cephalhematoma)

Intracranial/intraventricular hemorrhage

Spherocytosis, elliptocytosis

Sickle cell anemia

Thalassemia

Glucose-6-phosphate dehydrogenase deficiency

Pyruvate kinase deficiency

TORCHS infections

Urinary tract infection

Sepsis

Meconium ileus

Hirschsprung’s disease

Duodenal atresia

Pyloric stenosis

Galactosemia

Congenital hypothyroidism

Crigler-Najjar syndrome

Gilbert’s syndrome

74
Q

Cause d’hyperbilirubinémie conjuguée

A

TORCHS infections

Urinary tract infection

Gram-negative sepsis

Listeriosis

Tuberculosis

Hepatitis B

Varicella

Coxsackievirus infection

Echovirus infection

HIV infection

Biliary atresia

Choledochal cyst

Bile duct strictures

Inspissated bile syndrome

Neonatal hepatitis

Alagille syndrome

Byler’s disease

Congenital hepatic fibrosis

Galactosemia

Tyrosinemia

Glycogen storage disease type IV

Niemann-Pick disease

Wolman’s disease

Gaucher’s disease

Cholesterol ester storage disease

α1-Antitrypsin deficiency

Cystic fibrosis

Dubin-Johnson syndrome

Neonatal hypopituitarism

Zellweger’s syndrome

Donohue syndrome (leprechaunism)

Rotor syndrome

Rx/toxins

HAIV

75
Q

hyperbilirubinémie chez l’enfant plus vieux

A
76
Q

Nommer le dxd des vomissements selon l’âge de l’enfant

A
77
Q

Nommer les causes de sgmt digestif bas selon l’age

A
78
Q

Nommer les rétrécissements naturels où les CE ont tendance à se coincer a/n système digestif

A

one of three areas of normal physiologic narrowing—upper esophageal sphincter (cricopharyngeus muscle), thoracic inlet (C6-T1); aortic arch, tracheal bifurcation (T4-6); and lower esophageal sphincter, diaphragmatic hiatus (T10-11)

79
Q

Indications de retrait urgent de CE a/n GI

A
80
Q

Gastroentérite bactérienne

A

cf 2153

81
Q

Nommer les différents signes/sx reliés à la déshydratation lég, mod, sévère

A
82
Q

Nommer la classification de Gartland pour les fractures suscondyliennes

A
83
Q

Nommer la séquence d’ossification du coude chez l’enfant

A
84
Q

Décrire l’angle de Baumann

A
85
Q

Qu’est-ce qu’une fracture de Monteggia

A

Monteggia’s fracture-dislocations are characterized by a fracture of the proximal third of the ulna plus dislocation of the radial head

86
Q

dxd de douleur à la hanche chez l’enfant

A
87
Q

Nommer les critères de Kocher dans l’arthrite de la hanche

A

Four independent multivariate predictors of septic arthritis have been found (Kocher criteria)—fever, inability to bear weight, ESR of 40 mm/hr or higher, and serum WBC count higher than 12,000 cells/µL. Patients with three of the four predictors had a 93% chance of having septic arthritis, and those with all four had a 99% likelihood.

88
Q

Nommer les germes retrouvés dans l’arthrite septique ped

A

Couverture gram + : cloxa ou vanco, vanco si suspicion SARM

couverture gram - : ceftri, tazo si suspicion pseudo

kingela kingae couvert par ceftri

89
Q

Indications de drainage d’une arthrite septique en ped

A

Surgical options range from needle aspiration to open surgical drainage. Indications for surgical drainage in children with septic arthritis include involvement of the hip joint, presence of large amounts of pus or debris in the joint, loculated fluid, recurrence of joint fluid after four or five aspirations, and lack of clinical improvement within 3 days of the initiation of appropriate therapy.

90
Q

Nommer les facteurs qui influencent l’incidence de la nécrose avasculaire de la hanche en ped

A

The cause remains unclear; theories are myriad and research results conflicting. It usually occurs in those between the ages of 3 and 12 years, with the peak incidence between the ages of 5 and 7 years. Legg-Calvé-Perthes disease has been reported in teenagers as well as in children as young as 2 years. Boys are affected more frequently than girls, it is bilateral in up to 20% of cases, and it is familial approximately 10% of the time. It is least common in African Americans and East Asians and most common in whites. There is increased incidence at higher latitudes

91
Q

Nommer des modifications à la radiographie lors d’une nécrose avasculaire ped

A

Radiographic findings in the initial stage include a femoral head that appears smaller than the opposite unaffected femoral head, widening of the medial joint space, subchondral lucent zone, subchondral collapse causing the crescent sign (Caffey’s sign; Fig. 175.24), irregular physeal plate, and blurry and radiolucent metaphysis. In the fragmentation phase, the repair aspects of the disease become more prominent. The epiphysis begins to fragment, and there are areas of radiolucency and radiodensity as new bone forms. During the reossification stage, the repair process continues as normal bone density returns, radiodensities replace radiolucencies, and alterations in the shape of the femoral head and neck become apparent. The healed stage is the final radiographic stage of Legg-Calvé-Perthes disease, and radiographs of the proximal third of the femur will demonstrate residual deformities.

92
Q

Nommer les facteurs influencant l’incidence de glissement épiphysaire

A

rates affected by several factors: (1) race—higher prevalence in African Americans, Hispanics, and Pacific Islanders than whites; (2) geography—higher rates north of 40-degree latitude and in the northeastern and western United States; (3) gender—boys are affected twice as frequently as girls; and (4) underlying medical conditions—more frequent with endocrinopathies, renal osteodystrophy, and radiation therapy.30,31 The peak incidence is during the adolescent growth spurt, boys between 12 and 16 years of age (mean, 13.5 years) and girls between 10 and 14 years of age (mean, 11.5 years). The age at diagnosis decreases with increasing obesity. Most children with SCFE have delayed skeletal maturation. SCFE is bilateral in up to 80% of cases, although 30% to 40% of these cases are asymptomatic and discovered only on screening radiographs. In unilateral cases, the left hip is affected twice as often as the right.

93
Q

Décrire le Drehmann’s sign

A

Drehmann’s sign: rotation externe de la hanche lors de la flexion passive, indication d’un glissement épiphysaire de la tête fémorale

94
Q

Describe the metaphyseal blanch sign - Steel sign

and the Klein’s line

A

metaphyseal blanch sign - Steel sign: In the early stage of slipping of the capital femoral epiphysis, the epiphysis slips posteriorly in relation to the neck of the femur. When this occurs, the posterior portion of the femoral head is seen on the anteroposterior radiograph as a crescent-shaped area of increased density overlying the metaphysis adjacent to the epiphyseal plate

The modified Klein’s line is a comparison of the amount of epiphysis lateral to the Klein line on the symptomatic side compared with the same measurement on the asymptomatic side, with a difference of 2 mm being significant.33 Even with the modified Klein’s line, 13% of SCFEs were missed, highlighting the need for a lateral film

95
Q
A
96
Q

Comment mesurer la gravité du glissement épiphysaire; décrire la ligne de southwick

A
97
Q

Décrire le syndrome de sever

A

Apophysite du calcanéum

Sever’s disease can be associated with growth or tight heel cords. Impact sports, especially those that involve running, and sports in which cleats are worn are implicated in the development of Sever’s disease.

Treatment of Sever’s disease consists of ice, massage, stretching of the plantar fascia and involved muscles (gastrocnemius-soleus complex and ankle invertors and evertors), NSAIDs, and shock-absorbing shoe inserts.

98
Q

Nommer des causes de priapisme chez l’enfant et l’adulte

A

Anémie falciforme, néoplasie, maladie immunitaire, médication, drogues, toxines

Adulte: Penile erection from sexual arousal, erectile dysfunction medication, urethral foreign bodies, Peyronie’s disease, spinal cord injury, and penile implants occur more commonly in adults than children.

99
Q

Nommer les 3 mécanismes possibles de priapisme

A
100
Q

Tx priapisme à bas débit

A

Soulagement douleur, hydratation, analgésie locale (bloc), levée de l’obstruction urinaire, tx condition sous jacente.

To perform aspiration, place an 18-gauge angiocatheter (smaller in young children) percutaneously into the lateral aspect of the penile shaft entering the corpus cavernosum. Aspirate and evacuate blood from the corpora cavernosa. Next, irrigate with normal saline (NS) or in combination with an ICI of an α-adrenergic sympathomimetic agent. Instill 1 mL of dilute phenylephrine (100–500 µg phenylephrine/mL of NS) into the corpus cavernosum every 3 to 5 minutes for up to 1 hour. If these measures fail to resolve the priapism, emergent urologic consultation should be obtained for possible surgical shunt placement. Prolonged episodes (>48 hours) are associated with a high likelihood of erectile dysfunction, irrespective of clinical management

101
Q

De quel côté se forme habituellement un varicocèle et que suspecter lorsqu’il se développe de l’autre côté?

A

Patients with varicoceles that are sudden in onset, right-sided, or do not diminish in the supine position should undergo imaging (eg, ultrasonography, computed tomography [CT], or MRI) to evaluate for a retroperitoneal neoplasm. Surgical correction may be required if the patient becomes symptomatic or has bilateral varicoceles

102
Q

Qu’est-ce qu’un hydrocèle?

A

Patients with varicoceles that are sudden in onset, right-sided, or do not diminish in the supine position should undergo imaging (eg, ultrasonography, computed tomography [CT], or MRI) to evaluate for a retroperitoneal neoplasm. Surgical correction may be required if the patient becomes symptomatic or has bilateral varicoceles

103
Q

Nommer des types de tumeurs testiculaires

A

Tumor types include teratomas, embryonal carcinomas, yolk sac tumors, choriocarcinomas, Leydig cell tumors, and Sertoli cell tumors. Lymphoma and leukemia can also metastasize to the testicle.

104
Q

DxD de dysurie chez l’enfant

A
105
Q

dxd hématurie en ped

A
106
Q

DxD de protéinurie en ped

A

Causes of proteinuria can be glomerular or tubular. Glomerular causes include nephrotic syndrome, glomerulonephritis, and posttransplantation rejection. Transient causes of altered glomerular function include exercise, extreme cold or heat, fever, seizures, and stress. Tubular causes of proteinuria include heavy metal poisoning, urinary tract infections, and diabetes, as well as an asymptomatic tubular proteinuria

107
Q

DxD glomérulonéphrite en ped

A

post strep

Néphropathie à IgA

Wegener

Goodpasture

Henoch Schonlein

SHU

Alport

Lupus

108
Q

Qu’est-ce qu’une protéinurie de type néphrotique

A

Nephrotic-range proteinuria is a daily excretion of more than 3.5 g of protein/1.73 m2 ormore than 50 mg/kg, corresponding to 3+ or 4+ on the urine dipstick.

109
Q

dxd IRA ped

A
110
Q

DxD hyperTA ped

A

Primary

Essential hypertension

Secondary

Renal

Glomerulonephritis

Henoch-Schönlein purpura

Pyelonephritis

Obstruction or reflux

Polycystic kidney disease

Diabetic nephropathy

Trauma

Renal transplant or hemodialysis

Tuberous sclerosis

Systemic lupus nephritis

Endocrine

Pheochromocytoma

Cushing’s syndrome

Congenital adrenal hyperplasia

Corticosteroid treatment

Hyperthyroidism

Neuroblastoma

Ovarian tumor

Cardiac

Congestive heart failure

Coarctation of the aorta

Vascular

Hemolytic-uremic syndrome

Kawasaki syndrome

Renal artery thrombosis or stenosis

Neurologic

Central nervous system tumor or infection

Central nervous system trauma or abuse

Increased intracranial pressure

Guillain-Barré syndrome

Neoplastic

Neuroblastoma

Wilms’ tumor

Pheochromocytoma

Adrenal carcinoma

Drugs

Corticosteroids

Cocaine

Sympathomimetics

Oral contraceptives

Phencyclidine

Beta-blocker or clonidine withdrawal

Lead, mercury

Others

Iatrogenic fluid overload

Volume overload from end-stage renal disease

111
Q

tx HTA ped

A
112
Q

Nommer des précipitants fréquents du henoch schonlein

A

Approximately 50% of affected children have a history of previous upper respiratory tract infection, and as many as 75% have group A beta-hemolytic streptococci cultured from the oropharynx. Other theorized predisposing factors include exposure to cold weather, certain foods, drugs, and insect bites. Other possible precipitants include varicella-zoster virus, Mycoplasma species, parvovirus, Campylobacter enteritidis,parvovirus B19, and Epstein-Barr virus

113
Q

Décrire la différence entre le SHU typique et atypique

A

HUS can be classified as primary (or atypical) HUS, caused by compliment dysregulation, and secondary HUS, caused by infections (eg, STEC, Shigella organisms, S. pneumoniae, Aeromonas, or HIV), drugs (eg, chemotherapeutic or transplant antirejection drugs), or other idiopathic causes (eg, pregnancy, lupus). UTIs have also been implicated.

114
Q

dxd de AEC chez l’enfant

A

aeioutips

115
Q

Indications de décadron lors d’une suspicion de méningite

A

limit the use of dexamethasone to the presumptive treatment of pneumococcal meningitis in infants older than 6 weeks after consideration of the potential benefits and risks. The AAP has suggested that dexamethasone may also be beneficial for infants and children with Haemophilus influenzae meningitis to decrease the risk of neurologic sequelae, including hearing loss, if is given before or concurrently with the first dose of an antimicrobial agent

116
Q

Germes impliqués dans la méningite ped et les traitements antibio recommandés

A
117
Q

DxD de convulsions néonatales

A

hypoxic-ischemic encephalopathy, intracranial infection, congenital brain malformation, cerebrovascular events, electrolyte disturbances, metabolic derangements, and nonaccidental trauma.

118
Q

dxd épilepsie ped

A
119
Q

dxd de ce qui peut mimer une convulsion

A
120
Q

Traitement du SE post intox à INH

A

Toxic ingestions are treated based on the specific toxin involved. Seizures caused by isoniazid (INH) poisoning are particularly resistant to standard seizure treatment, yet respond to pyridoxine. The dose of pyridoxine is 1 g IV for every gram of INH ingested. When the quantity of INH ingested is unknown, 5 g IV may be administered to an adult and 70 mg/kg (maximum, 5 g) to a child.

121
Q

Quel anticonvulsivant est CI en maladie métabolique

A

Acide valproique et propofol

122
Q

Associer l’anticonvulsivant au type de convulsion

A

* La carbamazépine et la phénytoine peuvent exacerber les absences et convulsions myocloniques

123
Q

Définition de céphalées migraineuses

A

migraine, is the most frequent type of pediatric and adolescent migraine and includes the following criteria—more than five attacks that last 2 to 72 hours (untreated or unsuccessfully treated), accompanied by nausea, vomiting, photophobia or phonophobia—and including a minimum of two of the following criteria—unilateral or bilateral location, pulsing quality, moderate to severe intensity, and aggravated by routine physical activities.

124
Q

Ataxie en ped

A
125
Q

dxd vertige ped

A
126
Q

dxd stroke ped

A

Cardiac

Congenital heart defects

Valvular heart disease

Right-to-left shunts

Cardiomyopathy

Endocarditis, myocarditis

Arrhythmia

Cardiac tumors

Cardiac surgery

Hematologic Disorders and Coagulopathies

Anemia

Sickle cell disease

Dehydration

Idiopathic thrombocytopenia purpura (ITP)

Thrombotic thrombocytopenic purpura (TTP)

Hemolytic uremic syndrome (HUS)

Thrombocytosis

Polycythemia

Disseminated intravascular coagulation

Leukemia or other neoplasm

Congenital and acquired coagulation disorders

Pregnancy and the postpartum period

Vasculitis, vasculopathies

Systemic lupus erythematosus

Polyarteritis nodosa

Takayasu arteritis

Kawasaki disease

Moyamoya syndrome, disease

Infection

Meningitis, encephalitis

Mastoiditis, otitis media

HIV

Varicella

Syphilis

Tuberculosis

Systemic infection

Metabolic, Miscellaneous

Homocystinuria

Fabry disease

Organic acidemia

Hyperlipidemia

Mitochondrial encephalopathy with lactic acidosis and strokelike episodes syndrome

Menkes disease

Other Vascular

Vasospasm (subarachnoid hemorrhage)

Migraine

Carotid ligation (eg, extracorporeal membrane oxygenation)

Fibromuscular dysplasia

Cervicocephalic arterial dissection

Arteriovenous malformation

Arteriography

Hereditary hemorrhagic telangiectasia

Sturge-Weber syndrome

Intracranial aneurysm

Trauma (Including Nonaccidental)

Blunt and penetrating cervical trauma

Brain Tumor

DRUGS

Cocaine

Amphetamines

Oral contraceptives

L-asparaginase

127
Q

Nommer des considérations pharmacocinétiques en ped

A
128
Q

Nommer 5 médicaments avec toxicité en ped

A
129
Q

Nommer des éléments favorisant un bon usage des opioides en ped

A
130
Q

truc mnémotechnique pour retenir ecchmoses atypiques en ped

A

TEN-4 rule

Torse/ ear / neck / anywhere under 4 months

131
Q

Investigation recommandée en cas d’abus physique

A
132
Q

Nommer des trouvailles N vs abus sexuel

A
133
Q

investigation recommandée abus sexuel

A
134
Q

Critères de ALTE et BRUE

A

ALTE critères

Épisode inquiètant + 2/4 :

  • étouffement
  • changement de tonus
  • changement de couleur
  • étouffement

BRUE

Inf 1 an, inf 1 min, auto résolutif et comportant :

  • cyanose centrale ou paleur
  • Respiration irrégulière, diminuée ou absente
  • Hypo ou hypertonie
  • Changement de la réactivité
135
Q

haut risque de brue

A

Age inf 2 mois

age gestationnel inf 32 sem

récidive de brue

” stress parental”

136
Q

bas risque de brue

A

age sup 60 jours

age gestationnel sup 32 semaines

premier épisode de brue

durée épisode inf 1 minute

absence de RCR

histoire et E/P rassurant

137
Q

Quand couper le cordon

A

apres 30-60 sec

138
Q

Changements 2016 NRP

A

On se concentre sur le travail d’équipe, la communication et les compétences en leadership.

On insiste sur la réunion préparatoire avant l’accouchement.

Si le nouveau-né à terme ou prématuré est vigoureux, on recommande de reporter le clampage du cordon de 30 à 60 secondes.

En présence de méconium chez un nouveau-né hypotonique dont les respirations ne sont pas efficaces, l’intubation systématique n’est plus recommandée pour l’aspiration trachéale. On entreprend les étapes initiales de la réanimation et on administre une VPP, au besoin. Puisque le méconium demeure un facteur de risque de transition anormale, une équipe possédant les habiletés nécessaires pour procéder à une réanimation complexe doit être sur place.

L’administration de gaz : Si le nouveau-né est à terme, on utilise de l’oxygène à 21 % pour entreprendre la réanimation. Si le nouveau-né prématuré a moins de 35 semaines d’AG, on privilégie plutôt une concentration en oxygène de 21 % à 30 %.

Au bout de 15 secondes de VPP, on évalue la FC. Si celle-ci n’augmente pas, on évalue l’excursion thoracique. En présence d’une excursion thoracique, on poursuit la VPP pendant 15 secondes avant de réévaluer la FC. En l’absence d’excursion thoracique, on amorce les mesures correctives (MR SOPA). On réévalue la FC après avoir administré pendant 30 secondes une VPP qui provoque une excursion thoracique.

Pour déterminer la profondeur d’insertion de la ST, on respecte les lignes directrices liées à l’AG ou la méthode de la distance entre le nez et le tragus.

Il faut obtenir une VPP efficace pendant 30 secondes par une autre méthode de ventilation avant d’entreprendre les compressions.

La technique à deux pouces est recommandée pour effectuer les compressions thoraciques. La personne qui les effectue doit se placer à la tête du lit une fois les voies respiratoires ouvertes. On réévalue la FC 60 secondes après le début des compressions thoraciques. Le moniteur cardiaque est privilégié pour évaluer la FC pendant les compressions thoraciques, mais l’auscultation ou la saturométrie sont également acceptables.

Le lactate Ringer n’est plus recommandé pour la réanimation liquidienne. De même, il n’est plus recommandé d’administrer de la naloxone au nouveau-né qui présente une dépression respiratoire parce que sa mère a reçu des narcotiques pendant l’accouchement, car les données sont insuffisantes pour évaluer la sécurité et l’efficacité de cette pratique.

Si le nouveau-né a moins de 32 semaines d’AG, on recommande un ensemble d’interventions pour optimiser la thermorégulation, y compris le maintien de la température ambiante à 23 °C, la préparation de l’unité chauffante, l’utilisation d’un bonnet, l’installation d’un matelas thermique sous l’unité chauffante et l’utilisation d’une pellicule de polyéthylène.

Si le nouveau-né prématuré respire spontanément, mais que sa respiration est laborieuse, on envisage la PPC. S’il faut amorcer la VPP, la PEP est plutôt recommandée.

139
Q

installation CVO

A

couper 1 cm à la base du cordon, CVO dans veine à 4 cm, attacher au pourtour

140
Q

Quel germe pour pneumonie avec épanchement pleural

A

Strep pneumoniae, ceftri/clinda

141
Q

phases de la coqueluche

A

catarrhale: 7-10 jours

Paroxystique: 1-6 sem, ad 10 sem

convalescence 7-14 jours

hospit si moins 6 mois

142
Q

3 classes hyperbilirubinémie conjuguée chez nné

A

obstructif, infectieux, métabolique

143
Q

bilan avec sténose pylore

A

alcalose métabolique hypochlorémique hypokaliémique

144
Q

2 pathologies associées au double bubble sign

A

atrésie duodénale et malrotation de l’intestin, tx ampi-tobra-flagyl

145
Q

Anomalies au RX abdo à l’invagination iléo-colique

A
  • dilatation anses grêles (obstruction)
  • target sign a/n hépatique (masse HCD sans air)
  • air libre
  • signe du ménisque
    tx: iléo-colique - lavement à l’air +/- chx si perfo ou échec

Tx: iléo-iléale: réassurance

146
Q

Hernie inguinale ped : traitement

A

dx: écho

Tx gars: tenter réduction

Tx fille: ne pas tenter réduction avant écho car pourrait contenir un ovaire et alors il faut éviter de pousser

inf 6 sem: chx ped d’emblée, pas réduction , risque perforation

147
Q

Nom salter 3 cheville ado

A

Tillaux

148
Q

critères de fx clavicule chirurgicale

A

compromis neurovasculaire

ouverte

déplacement 100%

étirement peau

distal ou proximal

déplacement de plus de 2 cm

Athlète de haut niveau

149
Q

critoe

A

1-3-5-7-9-11

150
Q

fx suscondylienne type 2-3, quel nerf et artère les plus touchés?

A

médian

artère brachiale

151
Q

Kocher

A

dans la dernière semaine:

t 38.5

CRP sup 20

VS sup 40

GB sup 12

pas MEC

152
Q

Acronyme pour préparation de la sédation pédiatrique

A

SOAP-ME

Suctions

oxygène

Airway - matériel de la bonne grandeur

Pharmacie

Moniteur

Equipment

153
Q

tx hypoxic spell (TOF)

A
154
Q

Algorithme kawasaki incomplet

A

Critères labo supplémentaires

  • Albumine < 30
  • Élévation ALT
  • pyurie, > 10 GB/champ
  • Anémie pour l’âge
  • Plaquettes > 450 000
  • Leucocytes > 15
155
Q

Nommer 10 indices au RX d’abus

A

Metaphyseal corner (or bucket handle) fractures (image 1 and image 2 and figure 4)

●Rib fractures (image 3)

●Fractures of the sternum, scapula, or spinous processes

●Long bone fracture in a nonambulatory infant

●Multiple fractures in various stages of healing (image 4)

●Bilateral acute long bone fractures

●Vertebral body fractures and subluxations in the absence of a history of high force trauma

●Digital fractures in children younger than 36 months of age or without a corresponding history

●Epiphyseal separations

●Severe skull fractures (eg, multiple, stellate, or depressed) in children younger than 18 months of age

156
Q
A

Collège Royal 2019 (23 decks)

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