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Therapeutics III > Pediatric Diseases - Block 4 > Flashcards

Pediatric Diseases - Block 4 Flashcards

1
Q

Describe the categories of pre-term neonates?

A

Late: 34-37 W
Moderate: 32-34 W
Very: 28-32 W
Extremely: less than 28 W

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2
Q

What is gestational age?

A

Time between last mentrual period and day of birth

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3
Q

What is postnatal age?

A

Time sinse birth

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4
Q

What is postmenstrual age?

A

GA plus chronological age

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5
Q

What is very low BW? extremely?

A

1500 g

1000 g

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6
Q

Examples of preterm complications?

A
  1. Respiratory distress
  2. Congenital heart defects
  3. Intraventricular hemorrhage
  4. SZ
  5. Necrotizing entercolitis
  6. Hypoglycemia
  7. Jaundice
  8. Sepsis
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7
Q

How do assess neonatal cardiopulmonary resuscitation?

A

Tone, RR, cry, HR

Target lungs not heart

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8
Q

How do you treat Neonatal cardiopulmonary Resuscitation?

A
  1. Initiation of positive pressure ventilation, positioning airway, clearing secretions, intubation
  2. Chest compression if HR <60
  3. Epinephrine <60 for 30 seconds
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9
Q

Routes of epinephrine use?

A

IV (umbilical)
IO/endotracheal (longer onset)

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10
Q

What is the difference between EOS and LOS?

A

EOS: withing 3 days of birth and risk factors originate from mother
LOS: after 3 days of life and risk factors from hospitalization, NEC

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11
Q

What are the sites of infection?

A
  1. Pneumonia
  2. UTI/pyelonephritis
  3. Menangitis
  4. Bacteriemia
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12
Q

What are the clincal prensentations of spesis in neonates?

A

Temp instability, feeding intolerance, lethargy, grunting, flaring, retractions, apnea

Meningitis -> bulging fontanelle and sz

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13
Q

What are the clincal prensentations of spesis in children?

A

Fever, loos of appetite, emesis, myalgia

Meningitis -> Nuchal, back pain, Kernig, Bruzinski, HA, photophobia, sz, altered mental status

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14
Q

Recommend temperature route for <4YO?

A

Rectall

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15
Q

Low grade fever?

A

100-102

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16
Q

High fever?

A

104

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17
Q

Normal body temp?

A

98.6

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18
Q

Temperature that qualifies for antipyretics?

A

101

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19
Q

What is the diagnosis for infection?

A

In serum:
↓ WBC
↓ ANC
↑ I:T
↑ CRP

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20
Q

Diagnosis for meningitis?

A

In CSF:
↑ WBC
↑ Protein
↓ Glucose

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21
Q

What is the tx for sepsis?

A

Abx based on culture

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22
Q

What are the types of congenital heart defects?

A

Acyanotic: artial and ventricular septum defects, patent ductus arteriosus

Cyanotic: tetralogy of fallots, hypoplastic left heart syndrome, transposition of the great arteries

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23
Q

What is paten ductus arteriosus?

A

High prostaglandin -> failure of ductus closure -> right to left shunt

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24
Q

Tx for patent ductus arteriosus

A

Prophylaxisis (24H of birth)
Eary sx (1-3 days)
Late sx (7-10 days) - surgery

Indomethacin
Ibuprofen
APAP

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25
Q

Monitoring for Indomethacin and IBU?

A

UO

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26
Q

Monitoring for APAP?

A

LFTs

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27
Q

WHo are more prone to patency?

A

Preterm infants who have:
1. Incomplete metabolism of PG
2. Increased sensitivity of PG
3. Increased ductus tone
4. Decreased muscle fibers of the ductus

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28
Q

What are the alterations of tetralogy of fallots?

A
  1. Override of aorta
  2. Hypertrophy of right ventricle
  3. Pulmonary stenosis
  4. Intraventricular septal defect (right to left shunt)
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29
Q

What are the alteration of hypoplastic left heart syndrome?

A
  1. Hypoplastic left ventricle
  2. Hypoplastic ascending aorta
  3. ASD
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30
Q

What are the alterations of transposisition of great arteries

A

Pulmonary arteries and aorta are switched

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31
Q

What is the tx for cyanotic heart defects?

A

PG E1 (aprostadil) IV infusion 0.05-0.1 mcg/kg/min

32
Q

What is the definition of neonatal hypotention?

A
  1. Below 5th-10th percentile
  2. Loss of autoregulation of organ blood flow
  3. MAP below GA of the infant
33
Q

What are the labs associated with neonatal hypotention?

A
  1. Capillary refill times >3 secs
  2. HR >160 bpm
  3. Weak pulse
  4. Mottled skin
  5. Lethargy
  6. Metabolic acidosis
  7. Decreased UO
34
Q

What is the tx for neonatal hypotention?

A
  1. Fluid bolus 10-20 mL/kg IV
  2. Dopamine
  3. Epinephrine
  4. DObutamine
35
Q

Medications for adult hypotention and refractory neonates?

A
  1. NE
  2. Vasopression
36
Q

Uses of hydrocortisone in hypotension?

A

Not recommneded for routine uses

37
Q

What is the difference between under and oversedation?

A

Under: accidental displacement of tube and catheter
* Ax and stress

Over: Increased hospital cost
* Longer hospitalization
* Prolonged need of mechanical ventilation

38
Q

Tx for pain and sedation?

A
  1. Sucrose
  2. APAP
  3. Morphine
  4. Fentanyl
  5. Midazolam
  6. Dexmedatomidine
39
Q

What are the non pharm for pain?

A
  1. Swaddling
  2. Pacifier
  3. Skin to skin
  4. Massage
  5. Feeding
  6. Reduce pain interventions
  7. Bundled bed care
40
Q

What are you upper respiratory infection?

A
  1. Otis media
  2. Acute bacterial rhinosinusitis
  3. Acute pharyngitis
41
Q

What is AOM?

A

Middle ear effusion: bulging tympanic membrane and fluid

Middle ear inflammation: erythema, otalgia

42
Q

What is OME?

A

Fluid in middle ear with no infection

43
Q

What is recurrent AOM?

A

3+ episodes of acute otis within 6 months or 4+/yr

44
Q

What is the most common RF of AOM?

A

Day care attendance

45
Q

Common pathogens that cause AOM?

A
  1. Viral
  2. S pneumonia
  3. H influenzae
  4. Moraxella catarrhalis
46
Q

Describe the tx for AOM?

47
Q

When should OME get Abx?

A

Bilateral effusions for 3 months

48
Q

What is given during delayed abx prescribing?

A

APAP 10-15 mg/kg Q4-6H
IBU 5-10 mg/kg Q6-8

For infants ≥ 6 months

49
Q

What are the types of lower respiratory tract infections?

A
  1. Bronchiolitis
  2. Pertussis
  3. Acute bronchitis
  4. Influenza
  5. Community acquired pneumonia
50
Q

What is pertussis?

A

Whooping cough:
Contagious 102 weeks or 2 weeks of onset of cough

51
Q

What are the phases of pertusis?

A

Catarrhal: 1-2 wk of cold sx
Paroxymal: 1-6 wk pf cough and whoop
Convalescent: weeks to months of slow resolution

52
Q

What is the tx for pertusis?

A

Macrolides:
1. Azithromycin PO QD for 5 days
2. Erythromycin
3. Clarithromycin

Alt is allergic to macrolides: Bactrim x 14 days
* Not for <2 months due to ↑ bilirubin and kernicterus

53
Q

What are the presentation of RSV?

A

Neonates: lower respiratory sx, wheezing, lethargy, fever
Children: upper respiratory tract sx

54
Q

What products are used for RSV prophylaxis?

A

Non pharm: Avoid crowds during season, handwashing

Pharm: Palivizumab 15 mg/kg durign season
*Beyfortus IM

55
Q

How is Beyfortus dosed?

A

<5kg -> 50 mg
>5kg -> 100 mg
2nd season and severe risk -> 200 mg

56
Q

What is the tx for active RSV?

A

Supportive care: O2 supplementation, mechanical ventilation, hydration

Ribavirin: acitve RSV for high risk patients

  1. Inhaled beta2 agonist
  2. CS
  3. Antibiotics (only for concurrent bacterial infection)
57
Q

What are acute viral gastroenteritis?

A
  1. Rotavirus
  2. Enteric adenovirus
  3. Norovirus
58
Q

What are the sx of rotavirus?

A

Intubation: 1-3 day (vomiting, low grade fever, water diarrhea)

Diarrhea lasts 4-8 days

59
Q

How do you prevetn Rotavirus?

A
  1. Good hygiene
  2. Prevention of fecal-oral contamination
  3. Vaccination
60
Q

What is the tx for rotavirus?

A
  1. Supportive to prevent dehydration and malnutrition

*DO NOT USE ANTIDIARRHEAL

61
Q

What is ProQuad?

A

MMR and varicella -> ↑ febrile sz

62
Q

Interchangability of DTap?

A

Must use same the brand for first 3 doses of 5

63
Q

Interchangeability if Tdap?

A

Boostrix or Adacel may be used for booster dose

64
Q

Interchangeability of HepB?

A

Engerix-B and Recombivax HB is Interchangeable

65
Q

Interchangeability of Polio

A

Not recommended

66
Q

Interchangeability of Hib?

67
Q

Interchangeability of HPV?

A

Gardasil products against 4 types (6, 11, 16, 18) and Cervarix 2 types (16 & 18)

68
Q

CI for immunization?

A
  1. Anaphylaxis
  2. Febrile illness
  3. Immunodef and pregnancy
  4. Intussusception (rotavirus)
  5. Admin of immune globulin (MMR, Varicella)
69
Q

Preterm infants vaccinations?

A
  1. Immunize according to chronologic age
  2. Do not lower vaccine doses
  3. If birth weight < 2 kg, delay HepB until neonate is 30 days old or at hospital discharge
70
Q

Immunocoprimised immunization?

A
  1. No live vaccines
  2. Household contacts should not receive oral polio vaccine
71
Q

Corticosteroid patients immunization?

A

Live vaccines for topicals, maintenance, low-mode but not high doses

72
Q

HIV immunizations?

A

Live vaccines are not recommneded due to immunocompromised

73
Q

What are the culture-proven sepsis ranges? For meningitis?

A

10-14 days
Meningitis: 14 days from G+, 21 days for G-

74
Q

How do you do with negative cultures?

A

Abx should be discontinued by 36-48 hr or as soon as clinicla imporvement is seen

75
Q

What are factors to consider for Abx selection?

A
  1. EOS vs LOS
  2. Empiric vs known bug
  3. Location of infection
76
Q

What is the tx for empiric Abx for EOS?

A

Ampicillin + AMG (or cefotaxime)

77
Q

What is the tx for empiric abx for LOS?

A

Vancomycin + gentamycin (or amikacin)

Therapeutics III (40 decks)

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