Pediatric Cases Flashcards
girl with high fever, strawberry tongue, sore hip, conjunctival injection without drainage, bright red cracked lips… labs? management?
CBC, urinalysis, LP, could check for lipoproteins
treatment of choice for kawasaki’s: admit to hospital, IV Ig, high dose aspirin. Perform echo now and in a few weeks
worst prognosis: coronary aneurysms (big morbidity)
Diagnostic criteria of Kawasakii
requires : the presence of fever lasting at least five days without any other explanation
Combined with at least four of the five following criteria:
- Bilateral bulbar conjunctival injection
- Oral mucous membrane changes, including injected or fissured lips, injected pharynx, or strawberry tongue
- Peripheral extremity changes, including erythema of palms or soles, edema of hands or feet (acute phase), and periungual desquamation (convalescent phase)
- Polymorphous rash
- Cervical lymphadenopathy (at least one lymph node >1.5 cm in diameter)
Infectious diseases that may mimic some of Kawasakii syndrome symptoms
Exudative conjunctivitis (eg, adenovirus)
●Exudative pharyngitis (eg, streptococcal pharyngitis)
●Discrete intraoral lesions (eg, Koplik spots in measles)
●Bullous or vesicular rash (eg, Stevens-Johnson syndrome)
●Generalized lymphadenopathy (eg, Epstein-Barr virus [EBV] infection)
Complications of Kawasaki Syndrome:
Coronary artery aneurysms, resultant MI.
Hydrops of the gallbladder.
Peeling of hands and feet.
Thrombocytosis with clot formation.
Treatment of Kawasakii Syndrome
IVIG, high dose aspirin until acute phase reactants decrease, then low dose aspirin until evidence of coronary aneurysms resolve
IVIG will mess up the sed rate, though.
Make sure kids get their flu shots in fall because no flu + aspirin!
5 months old with cough, bibasilar wheezes
pneumonia, bronchiolitis…
treated with albuterol–> unmasked heart murmur
CXR shows cardiomegaly
EKG shows ST elevation
LKAPPA- anomylous coronary artery coming from SVC or (?)- deoxygenated blood going to the heart
CHF in children- structurally normal heart
due to ventricular dysfunction in such things as ischemia, myocarditis, cardiomyopathy (dilated, hypertrophic or restrcictive) or arrhythmias, drugs or toxins (anthracyclines), sepsis (release of cytokines) fluid overload secondary to renal failure.
CHF in children in structurally abnormal hearts
with normal ventricular function due to volume overload such things as AV canal, large ASDs, VSDs, PDA. You can also see volume overload with normal ventricular function due to valvular issues such as aortic regurgitation, mitral regurgitation or pulmonary regurgitation. Noncradiac causes of volume overload include renal failure and a massive AV malformation.
Preserved ventricular function with pressure overload as an etiology of CHF
can be due to aortic stenosis, pulmonary stenosis, or coarctation of the aorta
2-year old crying, goes blue and falls down, 10 seconds tonic posturing, a few beats of jerking movement of both hands. Wakes up in your office.
Could consider EEG, CBC, etc. But his dx was a breath-holding spell.
16-year old boy syncope during exercise (rugby), no chest pain, other symptoms.
HOCM
could valsalva to get murmur of aortic stenosis
17 year old after 5 hour class gets up, sweating and nauseous, passes out. Wakes up, some juice, feeling better.
Could be orthostatic HypoTN, hypoglycemic, vaso vagal syncope, seizure, arrhythmia
labs- could get HCG, EKG, orthostatics,
for orthostatics, chips and gatorade
2 week old healthy girl, everything is fine but has heart rate of 230
dx- sinus tachycardia, volume depletion, sepsis, stress, CHF, respiratory stress… but in a happy baby, rules most of these out. LEft with atrial or ventricular arrhythmia
Paroxysmal Atrial Tachycardia
- use adenosine to drop the heart rate (if they’re stable) or a vagal maneuver like gagging, ice pack to face, rectal maneuver
Sick kids with SVT- cardiovert.
Could use digoxin unless WPW. Radioablation is another alternative.
