Pediatric Flashcards
(164 cards)
1
Q
Investigations for eating disorders
A
CBC, lytes, extended lytes, thyroid, LH/FSH, estradiol, prolactin, BHCG, ECG if abnormal lytes, bone density (family MD)
2
Q
Hospitalization requirements for anorexia nervosa
A
< 75% ideal body weight or ongoing weight loss despite intensive MGMT, refusal to eat, body fat < 10%, HR < 50 at daytime, < 45 at night, sBP < 90, orthostatic change in pulse > 20 or > 10 in sBP, T < 35.6, arrhythmia
3
Q
Hospitalization requirements in bulimia nervosa
A
syncope, K+ < 3.2, esophageal tears/hematemesis, arrhythmias, suicide risk, intractable vomiting
4
Q
SSRI of choice for children
A
fluoxetine
5
Q
Chlamydia treatment ABx
A
azithromycin 1 g PO or doxycycline 100 mg BID x 7 days
6
Q
Complications of chlamydia
A
chronic pelvic pain due to PID, ectopic pregnancy, infertility, reactive arthritis, epididymo-orchitis
7
Q
To r/o in bartholian cysts
A
malignancy, STI (gonorrhea)
8
Q
Abx of choice for gonorrhea
A
ceftriaxone 250 mg IM or cefixime 400 mg PO x 1 an azithromycin 1g PO x 1
9
Q
MGMT of gonorrhea
A
Abx, sexual abstinence for 7 days, f/u cultures within 4 - 5 days post-tx, repeat screening after 3 months (not done with chlamydia)
10
Q
Causes of Cyanosis with 1st hours
A
ToF, ebstein’s, pulmonary atresia
11
Q
Definition of Ebstein’s anomaly
A
tricuspid valve is displaced towards apex of RV
12
Q
Causes of cyanotic congenital heart disease
A
ToF, ebstein’s anomaly, TGA, trucus arteriosis, tricuspid atresia, total anomalous pulmonary venous return (TAPVR)
13
Q
5Ts of cyanotic congenital heart defects
A
ToF (overriding aorta, VSD, PA stenosis, RV hypertrophy), truncus arteriosus (single trunk for aortic arch, pulm arteries and coronary arteries), TGA (RV –> aorta and LV to PA), tircuspid atresia (forces systemic venous return across ASD –> mixing of pulmonic venous return), TAPVR: PV not connected to LA
14
Q
definition of patent ductus arteriosus
A
persistent patency of structure between L pulmonary artery and descending aorta
15
Q
Signs of CHF in pediatric patients
A
2Ts and megalies: tachycardia, tachypnea, cardiomegaly, hepatomegaly
16
Q
Pathological/Abnormal fractures in children
A
< 18 months, non-ambulatory children, metaphyseal, rib, scapula, vertebrae, sternum
17
Q
Disorders to r/o in child abuse
A
birth injuries, osteomalacia, congenital syphilis, bone disorders (ricket’s, osteogenesis imperfecta, NM disorders, copper deficiency)
18
Q
Definition of macule
A
flat, circumscribed area of colour change, < 1 cm; if greater, patch
19
Q
Definition of papule
A
elevated palpable lesion, if > 1 cm plaque
20
Q
Definition of vesicle
A
fluid-filled elevation (i.e., pus), If > 1 cm = bullae
21
Q
Definition of pustule
A
circumscribed elevation of skin containing purulent exudate
22
Q
Definition of nodule
A
palpable solid lesion, if > 1 cm tumour
23
Q
Key skin disorders in newborns (5)
A
acne neonatorum, erythema toxicum neonatoroum, infantile hemangioma, milia, transient neonatal pustular melanosis
24
Q
Acne neonatorum
A
closed comedones on corehead, nose and cheeks, resolves with 4 months without scarring
25
erythema toxicum neonatorum
pustular eruption on face/trunk/proximal extremities, sparing palms and soles. flea-bitten appearance. resolves over 5 - 7 days usually but up to several weeks
26
infantile hemangioma
benign vascular tumour, red appearance, may grow rapidly but ultimately resolves by age 12 at the latest, 50% by age 5
27
milia
1-2 mm pearly white or yellow papules often seen on forehead, cheeks, nose and chin, self-resolving with 3 months of life
28
transient neonatal pustular melanosis
vesiculopustular rash, seen in black newborns, can involve palms and soles; self limiting
29
diaper rash definition
beefy red plaques and confluent erosions, + fine scales, +painful, satellite papules and pustules on thigh/abdomen, involving skin folds; MGMT: topical antifuncal 1% clotrimazole
30
contact dermatitis definition
shiny erythematous rash, macerations and erosions, skin folds are NOT involved (the line of the diaper); MGMT: barrier cream
31
Skin disorders of childhood (5)
scabies, impetigo, tinea, urticaria, molluscum contagiosum
32
Definition of exanthem
skin eruption + fever, always involves the mucosa (check the mouth)
33
Measles Presentation
morbiliform rash starting from hairline down (face/neck/trunk), 3Cs (conjunctiva, coryza, cough), koplik spots on buccal mucosa; infectious 4 days before and after rash requiring respiratory isolation, MGMT: vitamin A, Ig +MMR vaccine for contacts. complications: pneumonia, OM, encephalitis, myocarditis
34
Rubella presentation
pink maculopapular rash on face/neck/trunk, occipital and retroauricular nodes, low grade fever; MGMT: symptoms. complications: STAR - sore throat, arthritis, rash, congenital anomalites if during pregnancy (TORCH)
35
Roseola presentation
pink maculopapular rash (HHV-6), MGMT: symptoms. complications: febrile seizures
36
Erythema infectiosum presentation
parvovirus B19; slapped cheeks, can be provoked with exercise or sun exposure. MGMT: STAR, glove & stocking distribution, aplastic crisis in SCD
37
Chicken pox presentation
incubation is 21 days, ithcy vesiculobullous rash with crusts, dew drops on rose pedals; MGMT: symptoms, Complications: bacterial super-infections, necrotizing faschiitis, CNS: encephalitis, cerebellar ataxia, hepatitis, DIC
38
Herpes Simplex presentation
grouped vesicles with erythematous base; MGMT: topical or oral antivirals; Complications: encephalitis, hepatitis, skin infections, keratitis, gingivostomatitis, DIC
39
Hand-foot-mouth disease presentation
Coxsackie disease; vesicles and pustules with eruthematous base involving tongue, posterior pharynx. MGMT: symptoms. Complications: dehydration
40
Gianotti-Crosti syndrome
associated with EBV/HBV/coxsackie/parvovirus; acrodermatitis (involving hands and feet) papular, preceeding viral prodrome; MGMT: self-limiting
41
Scarlet Fever presentation
GAS: generalized red papules with sand-paper texture, flexural accentuation (pastia's lines), desquamation, strawberry tongue, petechie on palate; MGMT: penicillin V/ampicillin/amoxicillin; complications: pneumonia, pericarditis, meningitis, hepatitis, glomerulonephritis, rheumatic fever
42
Kawasaki disease presentation
fever 5+ days and 4/5 of: unilateral LN, red/cracked lip/strawberry tongue, edema, erythema of palms and soles, generalized maculopapular rash, non-purulent bilateral conjunctivitis; MGMT: aspirin high-dose, IVIG, baseline ECHO and repeat in 6 months; complications: coronary artery aneursym
43
Dermatitis definition
red, inflammatory skin changes with poorly demarcated borders
44
Common types of dermatitis in pediatric patients (4)
contact dermaitits, atopic dermatitis (eczema), seborrheic dermatitis, nummular dermatitis, scabies
45
Eczema definition & MGMT
papules/plaques of edema and erythema +/- excoriation/lichenification, dry skin, pruritus; MGMT: skincare (emollients and moisturizers), topical corticosteroids for flare control (mid to high potency), lower potency for maintenace, topical calcineurin inhibitors
46
Distribution of eczema as per age group
infants: face + extensors
toddlers: flexural surfaces
adults: face, dorsum of feet, hands and eyelids
47
Eczema herpeticum definition & MGMT
severe and lethal complication of atopic dermatitis (eczema) due to superimposed HSV infection; Complications: blindness, mortality Sx: fever + grouped punched-out erosions; MGMT: high-dose systemic antiviral therapy, optho consult
48
Papulosquamous Disorders definition + common types in pediatric patients (4)
red, itchy, scaly lesions with well-defined borders, hyperkeratotic and well-demarcated; psoriasis, pityriasis rosea, tinea, corporis, drug eruptions
49
Psoriasis definition + MGMT
papulosquamous plaques with silvery scale; Auspitz sign: bleeding with removal of scales; nail involvement, arthritis, pruritus, involving extensor surfaces, scalp, genitalia, gluteal folds
50
Night terrors vs. nightmares
Night terrors: 1st third of the night, +autonomic agitation, high arousal threshold, agitated if awakened, no daytime sleepiness or recall of event; Nightmares: lasts 3rd of sleep (REM), +/- autonomic agitation, low arousal threshold, agitated after event, can have daytime sleepiness and frequent vivd recollection of event
51
Primitive Reflexes:
Root (0-4 months), Suck (0 - persists), Hand-toe grasp (0 - 3 months), Moro (0 - 6 months), asymmetric tonic neck reflex (2wks - 6 months), protective equilibrium (4 mos - persistent), parachute rection (8 months - persistent)
52
Pediatric hypoglycemia DDx
endocrine vs. non-endocrine; Endocrine ketosis, GH deficiency, panhypopituitarism, ACTH deficiency, addison's disease, excess exogenous insulin; Non-endocrine: sepsis/shock, liver disease, ingestion, inborn error
53
signs and sx of hypoglycemia
tremors, sweating, weakness, tachycardia, nervousness, hunger, neuroglycopenic - lethargy, irritability, confusion, hypothermia, seizures, coma
54
Inv for hypoglycemia NYD
CBC+lytes, VBG, GH, cortisol, FFAs, beta-hydroxybutyrate, lactate, NH4, etc. ketones, substances
55
MGMT of hypoglycemia in infants:
treat if < 3.3 + symptoms or < 2.8 mmol/L; 5 mL/kg of D10W or 2ml?kg of D25W bolus, continuous dextrose to maintain glucose, if no IV access, glucagon IM or SC (0.03 - 0.5 mg/dose for children < 20 kg; 1mg/dose for > 20 kgs) q20 mins
56
SVT vs sinus tachy in pediatric patients
SVT: >220 BPM if < 1 yo; > 180 if > 1 yo
57
Definition of shock
inadequate blood flow and oxygen delivery to meet tissue metabolic demands
58
Signs of Compensated shock vs. Decompensated shock
Compensated: normal sBP, tachycardia, cool and pale distal extremities, delayed cap refill, weak peripheral pulses vs. central; decompensated: hypotension + depressed mental status, decreased U/O, metabolic acidosis, tachypnea, weak central pulses, colour changes (mottling)
59
Initial MGMT of Shock
ABCs: position the patient, optimize oxygen content, support ventilation, establish lines; frequent assessment of vitals, ancillary tests, specific treatments; INV: CBC, lytes, curea, Cr, glucose, CRP, lactate, ABG, VBG, blood cx, imaging
60
Trendelenburg improves circulation in shock: T or F?
false (CJEM 2004; Johnson et co): does not improve circulation, detrimental effects on RVEF, head injuries and IOP, aspiration, pulmonary disorders
61
Glucose MGMT for pediatric patients
**in all critically ill or injured children perform rapid glucose test to r/o hypoglycemia as a cause or contributing factor to poor clinical status: MGMT: newborns: D10W 5 - 10 mL/kg; infants and children: D25W 2 - 4 mL/kg; Adolescents: D50W 1-2 mL/kg
62
Hypoglycemia MGMT for pediatric patients: rule of 50s
D10W x 5ml/kg; D25W x 2 ml/kg; D50W 1 ml/kg
63
DDx for tachypnea in the newborn(9)
respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), pneumothorax, meconium aspiration, hypoglycemia, hypothermia, cardiac abnormalities (cyanotic vs. noncyanotic), neonatal sepsis, congenital diaphragmatic hernia
64
H&P for respiratory distress in newborn
Birth history: C/S vs. SPV, maternal health factors, GBS, drug use, ROM prolonged?, maternal fever/infections, meconisum in amniotic fluid, birth weight, APGAR score
65
APGAR score
normal: 8+; A:appearance (pale, pink), Pulse (absent, below or over 100), grimace (floppy, responding to stimulation), activity (muscle tone), respiration (crying, slow, etc.)
66
Fluid resuscitation in neonates
4-2-1 rule does NOT apply to neonates; use D10W until second day of life (inability to concentrate fluids)
67
Fluid resuscitation in infants + children
maintenance fluid: D5W0.9%NaCl + K
68
Severity of dehydration: mild
<5%; HR is slightly elevated, normal sBP, UO is slightly decreased, mucous membrane is slightly dry, thirst is slightly increased; normal LOC, normal anterior fontanelle, normal eyes and skin turgor
69
Severity of dehydration: moderate
elevated HR, can have normal sBP, decreased UO, dry mucous membranes, sunken anterior fontanelle, sunken eyes, decreased skin turgor, moderately increased thirst
70
Severity of dehydration: severe
++tachycardia, hypotensive, marked decreased UO/anuria, very dry mucous membranes, very sunken anterior fontalle, very sunken eyes, tenting of skin, greatly increased thirst, lethargy or coma
71
MGMT of mild dehydration
1. rehydrate 50 mL/kg ORT over 4 hours; 2. replace ongoing losses
72
MGMT of moderate dehydration (5 - 10%)
1. rehydrate with 100 mL/kg ORT over 4 hours; 2. replace ongoing losses
73
MGMT of severe dehydration
1. resuscitate with NS 20 mL/kg IV bolus; 2. reassess and repeat if necessary; 3. rehydration once patient is stable; 4. replace ongoing losses
74
Contraindications for ORF
severe vomiting, severe dehydration, hemodynamic instability, impaired LOC, ileus,
75
Fluid choice for resuscitation in pediatric patients
NS first. no D5W or K+ (only for maintenance; add K+ once voiding)
76
Gastroenteritis Sx and MGMT
rotavirus; duration 3 - 7 days, viral --> bacterial after 2+ yo; Inv: stool analysis, cultures, C.Diff; MGMT: fluid replacement, ORF, nausea control; Complications: hypovolemia, electrolyte imbalance, shock, tissue acidosis, cerebral edema from hyponatremia, pontine myelinolysis due to rapid correction
77
DDx for vomiting in newborns
newborn: meconium ileus, malrotation with midgut volvulus, intestinal atresia, necrotizing enterocolitis, inborn errors
78
DDx for vomiting in infants (0 - 3 months)
pyloric stenosis, GERD, milk/soy allergy, malrotation
79
DDx for vomiting in children (3+ months)
intussusception, intracranial mass, gastroenteritis
80
Definition of chronic diarrhea
2+ weeks of stool frequency, consistency, volume and duration of symptoms
81
Types of diarrhea:
osmotic, secretory, dysmotility, inflammatory, infectious
82
DDx of diarrhea without FTT
infectious, malabsoprtion (toddler's diarrhea up to 3 years of life), IBS, medications
83
DDx of diarrhea with FTT
autoimmune (celiac disease, allergic, eosinophilic gastro, IBD), immune deficieincy (HIV), malabsorption (CF, pancreatic insufficienc), GI protein loss (lymphatic obstruction, mucosal), bowel obstruction/dysmotility (Hirschsprung's disease), neuroendocrine tumours
84
DDx of RUQ abdo mass
liver mass
85
DDx of RLQ abdo mass
appendix, abscess, lymphoma, ectopic kidney, ovarian/testicular mass
86
DDx of LUQ mass
kidney (MCD, polycystic, hydronephrosis, renal vein thrombosis), neuroblastoma, Wilm's tumour, adrenal hemorrhage
87
DDx of periumbilical
GI duplication, mesenteric cyst, omental cyst, urachal cyst, meconium pseudocyst, pancreatic cyst
88
DDx of chronic abdo pain
GI: constipation, IBS, lactose intolerance, esophagitits/gastritis, celiacl disease, PUD, IBD, parasitic infection, recurrent pancreatitis; GU: dysmenorrhea, endometriosis, ovarian cyst; Neuro: migraine/abdo migraines; ENDO: hyperparathyroidism (hypercalcemia), addison's disease; CVS: superior mesenteric artery syndrome; HEME: SCD, leukemia/lymphoma, porphyria; Other: recurrent abdominal pain of childhood
89
DDx of Constipation
functional vs. organic; organic causes: hypothyroidism, DM, hypercalcemia, Hirschsprung's, SCI, CF, celiac disease, bowel obstruction, anal abnormalities, drugs
90
Hirschsprung's disease signs and symptoms
passage of meconium > 48 hrs after delivery, FTT, small stools, bilious vomiting, tight anal sphincter
91
Recurrent Abdo Pain of Childhood Dx and MGMT
Dx: rule of 3s - 3+ attacks for ages 3+ over 3+ months; r/o constipation, abdo migraine, PUD, IBD, biliary colic, UPJ/renal colic, ovarian cyst celiac disease, parasitic infections, conversion reactions; MGMT: support
92
Red Flags of Abdo Pain for pediatric patients
FTT, weight loss/growth delay, fever, joint pain, oral lesion, rash, rectal bleeding, localized pain away from umbilicus, rebound tenderness, radiation to back/shoulder/leg, nocturnal pain, N/V, diarrhea, encoperesis
93
Pyloric Stenosis Dx and MGMT
3weeks - 3 months; M>>F, associated with erythromycin use in first 2 weeks; Sx: projectile vomiting, nonbilious, dehydration, hungry, weight loss; +palpable olive-like mass at RUQ; Inv: US abdo, electrolytes (hypochloremic hypokalemic metabolic alkalosis from excessive vomiting); MGMT: NPO, NG tube, rehydration with IV NS, surgery
94
Malrotation Dx and MGMT
due to abnormal embryological development at week 4 GA; Dx: any rotation < 270 degrees counterclockwise; Complications: volvulus, bowel ischemia; Sx: bilious vomiting, crampy abdo pain, abdo distension, mucous and blood in stool; Inv: AXR - gastric outlet obstruction: large gastric bubbles; duodenal obstruction: double-bubble sign, multiple air fluid levels, dilated bowel loops; Inv: upper gI series, contrast enema, abdo US; MGMT: NPO, NGT, fluid resuscitation, broad-spectrum antbiotics, urgent surgical intervention; Complications: short bowel syndrome
95
Causes of Respiratory Distress in a Newborn
sepsis, RDS, TTN, meconium aspiration congenital pneumonia, air leak/PTX, structural abnormality, cardiac
96
Definition of transient tachypnea of newborn
"wet lung" appearance on CXR; respiratory distress that resolves within 3- 5 days; delayed reabsorption of lung fluid; MGMT: ventilatory support and oxygentation, antibiotic coverage and gavage feeds; risk of air leak
97
Definition of Meconium Aspiration Syndrome
in utero passage of meconium with aspiration --> airway obstruction and chemical pneumonitis; MGMT: ventilation, oxygenation, antibiotics, surfactant
98
CXR finding for Tetraology of Fallot
boot-shaped heart
99
Respiratory Causes of Cyanosis in the Newborn
RDS, TTN, MAS, PNA, congenital lung disease
100
Cardiac causes of cyanosis in the newborn
TGA, TOF, TA, TAPVD, trucus arteriosus, pulmonary atresia, ebstein's anomaly of teh tricuspid valve
101
Non-resp/cardiac causes of cyanosis in the newborn
sepsis, polycythemia, methylhemoglobinemia, meningitis, ICH, drugs, hypothermia, hypoglycemia
102
Hyperoxic test method
baseline pO2 in RA then 100% oxygen for 10-15 mins then ABG; failed hyperoxic test: PaO2 < 150 in 100% O2. if > 100, likely lung; 50 - 100: heart or lung, < 50: likely heart
103
Method and reasoning behind pre-post ductal sat
Pre duct: R arm and head; post ductal: lower limbs or umbilical artery
104
Bilirubin level where jaundice is visible
85 - 120 umol/L
105
Opisthotonos definition
seen in kernicterus - tetanic spasm where spine and extremities are bent, back arched body is resting on heads and heels
106
Clinical sx of kernicterus
poor sucking, stupor, hypotonia, seizures --> hypertonis, opisthotonus, retrocollis, fever, hypertonia
107
Causes of conjugated hyperbilirubinemia
TORCH, sepsis, hepatitis, metabolic (alpha1 antitrypsin, galactosemia, hypothyroidism, CF), drugs, TPN, idiopathic, biliary atresia, choledochal cyst
108
MGMT of jaundice
phototherapy, IVIG, exchange transfusion
109
Hypoglycemia in infants RF
DM, LGA infants (hyperinsulism), prematurity, SGA
110
Sx of hypoglycemia in infants
apnea, cyanosis, lethargy, seizures
111
Definition of neonatal hypoglycemia
2.6 mmol/L or less
112
MGMT of neonatal hypoglycemia
< 2.0 immediately after feeds or < 1.8 mmol/L at 2 hours post feed = IV dextrose; if persistently < 2.6 mmol/L despite multiple feeds = IV dextrose
113
Definition of hemolytic uremic syndrome
triad of MAHA, thrombocytopenia, AKI; most common cause of renal failure in pediatric patients; Typical (D+HUS e.coli toxin, assocaited with abdo pain, diarrhea, bloody diarrhea) vs. Atypical (S.pneumo, drugs, collagen disease, genetics)
114
Inv for HUS
CBC+diff, Cr, BUN, haptoglobin, LDH. coomb's, UA
115
MGMT of HUS
supportive, dialysis, transfusions, plasmapheresis, do not give antibiotics
116
When to do a rectal temperature?
anyone < 3 yo
117
Temperature associated with brain damage
>41.5 degrees celsius
118
Correlation between bacteremia and temperature
duration (number of days) vs. actual degrees
119
T or F: child with tactile fevers correlates well with true fever
Yes! be sure to do a thorough assessment, ask about antipyretics
120
Pediatric doses of tylenol
15 mg/kg q6hrs
121
Pediatric doses of of advil
10 mg/kg q8hrs
122
Vital Sign Changes to fever for every 1 degree
RR +5 for 1 degree; HR by 10 for 1 degree above 38
123
Normal vital signs for Infant (0 - 6 mo)
HR: 100 - 160; RR: 30 - 60; BP: 65 - 90 sBP
124
Normal vital signs for 6 - 12 months
HR 100 - 160; RR: 24- 30; sBP 80 - 100
125
Normal vital signs for 1 - 5 yo
HR: 70 - 120; RR 20 - 30; sBP: 90 - 110
126
Normal vital signs for 6 - 11 yo
HR: 70 - 120; RR: 12 - 20; sBP: 90 - 110
127
DDx for abnormal vital signs after fever correction
dehydration, early compensated shock, early sepsis; ask about perfusion, mentation and urine output
128
Difference between fever without a source vs. fever of unknown origin
Fever without source: no identifiable source after complete H&P; unknown origin: 2+ weeks of fever without identifiable source despite investigations
129
Types of Serious Bacterial Infections
UTI, PNA, bacteremia, meningitis
130
(5) most common sources of fever/infection
"LUCAS" - lungs, urine, CNS, abdo, skin
131
UTI RF in pediatric patients
< 24 months F; < 24 M uncircumsized, < 6 mo M circumsized, fever for 2+ days, fever > 39 degrees, +hx of UTI
132
T or F; urine dipstick in not toilet-trained kids is accurate
F: these patients can be urinating too often and not let the urine incubate
133
Indications for admission for UTI
< 2 months, dehydration, sepsis
134
F/u for UTI in < 2 yo
outpatient ultrasound to look for vesico-ureteral reflux and structural anomalies
135
Abx of choice for UTI
outpt: cephalexin; in hospital: IV amp + gent
136
Signs and Sx of PNA in pediatric patients
URTI several days then fever, fever > 5 days, cough > 10 days, temp > 40 degrees, increased WOB, tachypnea, WBC: >20 000
137
Indications for BW in pediatric patients:
if patient is well and immunized, no BW needed.
138
FSWU Definition:
CBC, blood cx, UA, urine cx, CSF (cell, culture, stain, protein, glucose, viral studies)
139
HSV meningitis indications
if meningitis, start IV acyclovir; highest risk if < !4 days old; can cause hepatitis and pneumonitis
140
Low risk criteria for 1 - 3 months febrile infants
no obvious source, no complex history, WBC 5 - 15, normal UA, normal stool WBC, normal CXR; if all these criteria met, 1.5 % chance of SBI
141
age group for croup
6mo - 3yo
142
Sx for croup
stridor, sore throat, seal/barky cough, rhinorrhea, low grade fever, sx worse at night
143
most common pathogen for croup
parainfluenza, influenza, RSv, adenovirus
144
invesgtigations for croup
clinical, CXR shows steeple sign from subglottic narrowing
145
anatomy involved in croup
laryngotracheobronchitis; supglottic laryngitis
146
MGMT for croup
stridor at rest = EMERGENCY! no evidence for humidified O2; dexamethasone PO 1 dose, racemic epi, neb 1-3 doses q1-3 hr if unwell/resp distress, intubation if not responding to treatment
147
epiglottitis affected anatomy
supraglottic laryngitis
148
pathogens invovled in epiglottitis
h.flu, beta hemolytic strep
149
age range for epiglottitis
2yo - 6yo
150
sx and signs for epiglottitis
very sick!! rapid progressions, 4Ds - drooling, dysphagia, dysphonia, distress; stridor, tripod position,
151
investigation for epiglottitis
avoid examining throat to prevent further exacerbation; it is clinical! CXR thumbprint sign
152
MGMT of epiglottitis
intubation, antbiotics, Hib vaccine
153
bacterial tracheiitis age
all ages!
154
pathogen for bacterial tracheiitis
strep, s.aureus, GAS, M catarrhalis
155
sx for bacterial tracheiitis
more rapid deterioration than group, high fever, toxic
156
investigation for tracheiitis
endoscopy for definitive diagnosis, clinical otherwise
157
anatomy involved for bacterial tracheiitis
subglottic tracheitis
158
MGMT for tracheitis
Abx, intubation
159
HSP Definition
IgA vasculitis seen in ages 4- 6 yo
160
HSP Sx
"ARENA" - abdo pain, rash, edema, nephritis, arthritis/arthralgias
161
DDx for HSP
DIC, acute abdomen, testicular torsion, systemic vasculitis/rheum, ITP, TTP, HUS, endocarditis, meningococcemia
162
HSP abdo complication
intussussception
163
HSP rash distribution
lower extremities/pressure dependent areas (gravity)
164
Investigations for HSP
CBC, lytes, coag, ESR/CRP, stool guaiac
