Pediatric Psychiatry Flashcards
Methemoglobinemia is associated with […] O2 saturation on pulse oximetry and […] PaO2.
Methemoglobinemia is associated with decreased O2 saturation on pulse oximetry and normal PaO2.
short explanation: standard pulse oximetry is unable to detect methemoglobin, thus creating a falsely low oxygen saturation (versus co-oximetry, which can detect hemoglobin, methemoglobin, and carboxyhemoglobin)
long explanation: methemoglobin is characterized by hemoglobin where 1 of 4 iron molecules is oxidized to Fe3+, which has decreased O2 affinity. The remaining three Fe2+ molecules have increased O2 affinity, thus decreasing O2 delivery to peripheral tissues. Methemoglobin is not detected on standard pulse oximetry, therefore O2 saturation is slightly decreased (~85%). Arterial blood gas (ABG) detects free, unbound O2, which is not affected by methemoglobin.
Methemoglobinemia is typically treated with […].
Methemoglobinemia is typically treated with methylene blue.
methylene blue reduces methemoglobin (Fe3+) back to hemoglobin (Fe2+); high-dose vitamin C is ocassionally used as well
Methemoglobinemia often presents with cyanosis and […]-colored blood.
Methemoglobinemia often presents with cyanosis and chocolate-colored blood.
Neonatal abstinence syndrome occurs due to exposure to […] drugs while in the mother’s womb.
Neonatal abstinence syndrome occurs due to exposure to opiate drugs while in the mother’s womb.
usually presents in the first few days of life with irritability, sweating, and tachypnea
Patients who survive acute iron toxicity are at risk of developing […] stenosis within 2 - 8 weeks after ingestion.
Patients who survive acute iron toxicity are at risk of developing pyloric stenosis within 2 - 8 weeks after ingestion.
Risk factors for lead poisoning include homes built before 1978 under renovation or with peeling […].
Risk factors for lead poisoning include homes built before 1978 under renovation or with peeling paint.
Symptoms of neonatal abstinence syndrome include diarrhea, sweating, irritability, and […]. (respiratory rate)
Symptoms of neonatal abstinence syndrome include diarrhea, sweating, irritability, and tachypnea. (respiratory rate)
other possible symptoms include high-pitched cry, poor sleeping, tremors, sneezing, and vomiting
What acid-base disturbance is associated with acute iron toxicity?
Anion gap metabolic acidosis
What is the diagnostic test of choice to evaluate the extent of injury following caustic ingestion?
Upper GI endoscopy
should be performed within 24 hours of ingestion if there is no evidence of perforation or severe respiratory distress (after assessment of ABCs and decontamination)
What is the likely diagnosis in a child that ingested an unknown bottle of pills several hours ago and now presents with abdominal pain, hematemesis, hypotension, and metabolic acidosis?
Iron poisoning
iron tablets are radiopaque and may be visible on X-ray; diagnosis is confirmed by measuring serum iron levels
What is the likely diagnosis in a child that is verbal and talkative at home but refuses to speak in specific social settings (e.g. school) for > 1 month?
Selective mutism
considered an anxiety disorder (frequently comorbid with social anxiety disorder) and should be treated accordingly (i.e. CBT and/or SSRIs)
What is the likely diagnosis in a child that presents with cyanosis and decreased O2 saturation after using an oral topical anesthetic (e.g. benzocaine)?
Methemoglobinemia
other oxidizing agents that may induce methemoglobinemia include dapsone, nitrites, sulfa drugs
What is the next step in management for a child that has an elevated lead level on capillary blood testing?
Measure venous lead level
capillary blood testing is a good initial screen but false-positive results are common
What is the next step in management of caustic ingestion, after airway, breathing, and circulation have been assessed?
Decontamination (e.g. remove contaminated clothing, irrigate exposed skin)
What is the recommended management for children with mild lead poisoning (5 - 44 mcg/dL on venous blood testing)?
Removal from lead-containing environment; repeat level in < 1 month
no medication is needed for lead levels < 45 mcg/dL
What is the recommended management for children with moderate lead poisoning (45 - 69 mcg/dL on venous blood testing)?
DMSA (succimer)
What is the recommended management for children with severe lead poisoning (> 70 mcg/dL on venous blood testing)?
Dimercaprol plus EDTA
What is the recommended treatment for severely ill patients with iron toxicity?
Deferoxamine (an iron chelator)
mildly ill patients may be managed with whole bowel irrigation
What psychiatric condition is characterized by intentional and repeated fire setting with no obvious motive?
What psychiatric condition is characterized by intentional and repeated fire setting with no obvious motive?
Pyromania
What psychiatric condition is characterized by recurrent hair pulling resulting in hair loss with significant distress/impairment?
Trichotillomania
hair loss is characterized by patchy alopecia with broken hairs of varying lengths
What two drug classes are often associated with methemoglobinemia?
Nitrates (and nitrites) & Sulfa drugs
nitrites may also come from dietary intake or polluted/high altitude H2O
[…] is a local anesthetic that may cause methemoglobinemia in toxic doses.
Benzocaine is a local anesthetic that may cause methemoglobinemia in toxic doses.
