Pediatric Presentations Flashcards
What pathogen is associated with bronchiolitis?
RSV
What pathogen is associated with croup?
Parainfluenza
What pathogen is associated with exacerbations of asthma?
Rhinovirus
Prodrome of cold, hoarseness and barking cough, minimal to severe inspiratory stridor, not toxic appearing, stridor best heard over neck with clear lung fields, low grade fever, Steeple sign (subglotting narrowing on CXR)
Croup (viral) (laryngotracheobronchitis)
Prodrome of URI, hoarseness and barking, inspiratory stridor, toxic appearing, high grade fever, subglottic narrowing
Bacterial tracheitis (typically s. aureus)
What pathogen is associated with pertussis?
Bordatella pertussis or bordatella parpapertussis
GNRs
Coughing spells, post-tussive whooping, vomiting, no fever, elevated WBC, cough lasting more than 7-14 days
Pertussis
Edema, increased mucus secretion and eventual necrosis of small airways, rhinitis, cough, *tachypnea, wheezing and crackles
Bronchiolitis
Cough, grunting, chest pain, tachypnea, nasal flaring and retractions, cyanosis, dullness to percussion, decreased breath sounds, bronchial breath sounds, abrupt onset, high fever, toxic appearance
Bacterial pneumonia
Prominent URI symptoms, low grade or absent fever, diffuse findings or wheezes on exam, possible diffuse infiltrates
Viral pneumonia
Tachypnea, mild hypoxemia, lack of fever, wheezing, interstitial infiltrates
Atypical pneumonia - infancy (<3 mos) Chlamydia trachomatis (also look for conjunctivitis at 10 days)
Gradual onset, low grade fever, diffuse eam findings, diffuse infiltrates
Atypical pneumonia - older children (>5 yrs)
Mycoplasma
How long can an abnormal appearance on CXR continue in bacterial pneumonia?
6 weeks
When should CF be suspected in a child?
Recurrent episodes of cough, pneumonia, or sinusitis
Unexplained poor weight gain or FTT
Nasal polyps, rectal prolapse, hypochloremic alkalosis or FH of CF
What tests can be used to diagnose CF?
Immunoreactive trypsinogen (IRT) - pancreatic enzymes elevated in CF, used in the newborn screen
Sweat chloride test - gold standard - >60 is positive
DNA analysis to identify CTFR mutations
Bowlegs
Genu varum
Pathologic if asymmetric, unilateral, painful, or if progression different from expected
Knock knees
Genu valgum
Metatarsal bones of foot adducted
Metatarsus adductus
What further work up is needed for metatarsus adductus?
Needs correction
Stretching exercise of foot straightens with gentle pressure, casting or bracing if rigid
Medial malleolus is posterior to lateral malleolus
Tibial torsion - noticeable when child begins to walk
No treatment needed
Twist in femur between hip and knee, kid sits in W position, kissing knees upon standing
Femoral anteversion or medial femoral torsion (MFT) - no treatment needed
Pain and disuse of arm, no distress but arm guarding, slight flexion and pronation of elbow
Radial head subluxation = nursemaid s elbow
Treatment is manipulation back into place
Radiographs usually normal and not indicated unless history of fall and concern for fracture
Pain and swelling around elbow, decreased range of motion, possible gross deformity
Supracondylar humerus fracture
Must ensure neurologic and vascular status of arm - if concerning it is a surgical emergency - lots of arteries and nerves run through
Knee pain during puberty, gradual pain localized at tibial tuberous it’s, relieved by rest, worse with activity
Osgood-schlatter disease - rest, ice, NSAIDs, compression, stretching
Resolves after growth spurt
What is often the cause of knee pain?
Pain referred from pathology at the hips
What lab values suggest an infectious process?
WBC >12, ESR >20, CRP >1, fever >38
More than 2 of 4 positive
9 month to 3 year old, refusal to bear weight, point tenderness over tibia
Toddlers fracture
Immobilize until healed
Initial radiographs often negative, follow up shows callus
Hip pain, child up to 10 years (boys 4-8), confirmed hip effusion and exclusion of other conditions, negative hip tap
Transient synovitis
NSAIDs, resolves on its own
Fever >38, cannot bear weight, ESR>40 in first hour, WBC>12
Septic arthritis - urgent need for surgical washout and antibiotics
Most commonly staph aureus
Group b strep in neonates
4-8 year old boy, active with insidious onset of limp, possible pain, pain can be referred to thigh or knee, limited abduction and internal rotation at hip, smashed ice cream of femoral head
Legg-calve-perthes disease - mostly not weight bearing treatment
Female, first born, breech, family history, galeazzi, Barlow test, ortolani test
DDH
Bracing or casting to hold in abduction, flexion, external rotation
Possible surgery
Radiographs useful only after 4-6 months of age
Insidious or acute pain or limp, may be referred to thigh or knee, early pubertal age, obese, preferred position is foot externally rotated with flexion at the hip, limited internal rotation with pain, ice cream falling off cone
Slipped capital femoral epiphysis (SCFE) - surgical emergency - can stunt growth
