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Exam 2 > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Bilirubin-induced neurologic dysfunction (BIND)

A

occurs when unconjugated bilirubin, which is not bound to albumin (also referred to as “free” or “unbound bilirubin”, crosses the blood-brain barrier, enters the brain, and causes brain injury

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2
Q

Chronic bilirubin encephalopathy (CBE) / kernicterus

A

the progressive and extreme chronic form of BIND associated with permanent neurologic sequelae, such as choreo-athetoid cerebral palsy, upward gaze abnormalities, enamel dysplasia of deciduous teeth, and sensorineural impairment

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3
Q

Acute bilirubin encephalopathy (ABE)

A

In the early phase, clinical findings are subtle (sleepiness, mild hypotonia, and high-pitched cry) and without intervention progresses to an intermediate phase (fever, lethargy, irritability, shrill cry, and moderate hypertonia), and to an advanced stage (apnea, fever, seizures, severe hypertonia marked by persistent retrocollis and pisthotonos, and semicomatose state that progresses to coma). ABE may be reversible, or if not addressed, may result in permanent irreversible neurologic dysfunction: chronic bilirubin encephalopathy (CBE).

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4
Q

Most common cause of unconjugated hyperbilirubinemia

A

increased bilirubin production due to hemolytic processes

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5
Q

How bilirubin is created

A

It is produced when the liver breaks down old red blood cells
RBC breakdown = heme catabolism

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6
Q

Risk factors for severe hyperbilirubinemia and bilirubin toxicity

A
  • Prematurity (less than 36 weeks)
  • Jaundice at first 24 hours of life
  • Race: East Asian
  • Sibling who received phototherapy (family hx)
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7
Q

Jaundice appearance

A
  • Conjunctival icterus

- Yellowing of the skin

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8
Q

Iron Deficiency Anemia Threshold for Children

A
  • Under 5: hemoglobin less than 11
  • Ages 5-12: hemoglobin less than 11.5
  • Over 12: hemoglobin less than 12
  • Ferritin: less than 15
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9
Q

Iron Deficiency Anemia Risk factors

A
  • Prematurity (less than 36 weeks)
  • Low birth weight
  • Milk intake (transitioned to milk)
  • Childhood obesity
  • Race: Hispanic/Latin and Asian
  • NOT RELATED TO POVERTY LEVEL
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10
Q

Daily iron dose for infants and children:

A

In infants and children, 30 percent of daily iron needs must come from diet because of the rapid growth and increase in body (muscle) mass that occurs during this age range.

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11
Q

Iron homeostasis

A
  • regulated in the intestines (small and large)

- absorbed and excreted through the intestines

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12
Q

Patient education on iron supplements:

A
  • Can cause constipation
  • Stool can be dark and tarry
  • Take with Vitamin C
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13
Q

Anemia d/t lead toxicity appear on CBC

A
  • Hemolytic/normocytic (mild)
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14
Q

Anemia d/t iron deficiency appear on CBC:

A
  • Hypochromic/microcytic
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15
Q

Pediatric risk factors for atherosclerosis:

A 
Traditional risk factors:
o	Dyslipidemia
o	Obesity
o	Diabetes mellitus (type 1 or 2)
o	Hypertension
o	Family history of premature CVD
o	Smoke exposure

Other conditions with increased CVD risk:
o Familial hypercholesterolemia
o Chronic kidney disease
o Kawasaki disease
o Childhood cancer
o Transplant vasculopathy
o Congenital heart disease defects
o Cardiomyopathy
o Chronic inflammatory disorders (eg, SLE, systemic JIA)
o HIV infection
o Adolescent depressive and bipolar disorders

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16
Q

When to start screening for cholesterol:

A

Screenings without risk factors:
- First screening between ages 9-11
- Second screening between ages 17-21
If there are risk factors for CVD, can start as early as 2 years old
If abnormal –> Recheck annually
- Also assess for DM, hypothyroidism, pregnancy, nephrotic syndrome, hepatic disease, PCOS

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17
Q

Short stature:

A
  • 2 standard deviations off (defined as a length or height more than 2 standard deviations below the mean
  • Considerations:
  • Familial/genetic short stature?
  • Check height velocity*
  • Females –> Turner’s syndrome
  • Males –> Genital abnormalities
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18
Q

IgE-mediated food allergy

A

Sx = anaphylaxis: urticaria and angioedema, BP drops. Causes allergic reaction (less likely GI sx). Quick reaction!

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19
Q

Non-IgE mediated food allergy

A

Sx = celiac (diarrhea, nausea, malabsorption, FTT in kids). Do not appear immediately after ingestion of the food.

20
Q

Patient education on food allergies

A

Kids can outgrow allergy as they get older

21
Q

Most common food allergies

A

Egg and wheat –> cause atopic dermatitis

22
Q

Most deadly food allergy

A

Peanut butter

23
Q

Not suggested to do elimination diet

A

Taking food away and reintroducing it later can cause more severe reaction (vs mild symptoms) –> increased risk of death

24
Q

Assessing complaints of allergies

A

Most important tool = history and physical (not testing)

25
Q

In vitro allergy tests (blood testing):

A
  • Advantages: it poses no risk to the patient, is not affected by medications, and requires only a simple blood draw. In vitro testing may be superior to skin testing.
  • Immunoassays, in various forms, are the most commonly used in vitro tests for immunoglobulin E (IgE)-mediated allergy. These tests detect allergen-specific IgE in a patient’s serum by incubating the serum with the allergen in question.
  • The presence of allergen-specific IgE is correctly interpreted as evidence that the patient is sensitized to that allergen and may react upon exposure. Actual reactivity must be determined by history or supervised challenge.
26
Q

In vivo allergy tests (skin testing):

A
  • Skin testing is a bioassay that detects the presence of allergen-specific IgE on the surface of a patient’s cutaneous mast cells. Allergen is pricked into the skin and if allergen-specific IgE is present on the patient’s mast cells, the cells are activated and produce localized pruritus, swelling, and erythema.
  • Skin testing is contraindicated in patients who are at high risk for an anaphylactic reaction to testing, have experienced a recent anaphylactic event, are taking medications that may interfere with the treatment of anaphylaxis, or have certain skin conditions (eczema/atopic dermatitis okay to continue with skin testing). Such patients should undergo in vitro allergy testing instead.
  • The results of skin testing are influenced by medications, physiologic characteristics of the patient, the device used, and the allergen extract used. Antihistamines must be discontinued prior to testing.
  • There are two commonly used methods of skin testing for IgE-mediated disorders: prick/puncture and intradermal. Prick/puncture is performed first and is sensitive but not very specific. Intradermal testing is more sensitive, although false positives are common, and it carries a higher risk of inducing an allergic reaction.
  • Intradermal tests are usually performed following negative prick/puncture tests and are approximately 100- to 1000-fold more sensitive. Intradermal testing is not performed in the diagnosis of food or latex allergy, due to an unacceptably high rate of both false positives and systemic reactions to testing. In contrast, intradermal testing is important in the diagnosis of drug and insect venom allergies.
27
Q

Rectal thermometry contraindication:

A

Patients with neutropenia [low count of a type of white blood cell (neutrophils)]

28
Q

How old do you switch from rectal to oral temperature?

A

Age 4

29
Q

Calculating pediatric dose for ibuprofen

A

For children ≥6 months of age, the dose of ibuprofen is 10 mg/kg per dose (maximum dose 600 mg) orally every six hours with a maximum daily dose of 40 mg/kg up to 2.4 g/day.

30
Q

Calculating pediatric dose for APAP

A

The therapeutic dose of acetaminophen for children younger than 12 years is 10 to 15 mg/kg per dose (maximum dose 1 g) orally every four to six hours (with no more than five doses in a 24-hour period) with a maximum daily dose of 75 mg/kg per day up to 4 g/day.

31
Q

Most common cause of fever in infants

A

Viral infection

32
Q

Risk factors for invasive bacterial infections::

A
  • Age (under 28 days)
  • Rectal temp: >100.5
  • Gestational age/Prematurity
  • Immunizations/ Unimmunized
33
Q

Most common type of infection for children under 90 days:

A

UTI

34
Q

Abx treatment for UTI in a pediatric patient:

A
  • No fever = abx x 3-5 days
  • With fever > 101.5 = abx x 10 days
  • Abx first line tx = Cefdinir
35
Q

Calculate dose for Cefdinir

A

14 mg/kg by mouth once daily

36
Q

Sepsis workup

A
  • Blood cultures
  • Lumbar puncture
  • Urine
  • CBC w/dif [banded neutrophils = always bacterial]
  • Serum procalcitonin (PCT)
37
Q

Severe sepsis

A

associated with cardiovascular dysfunction, acute respiratory distress syndrome or dysfunction in two or more other organ systems

38
Q

Septic shock

A

refers to sepsis with cardiovascular dysfunction that persists despite the administration of ≥40 mL/kg of isotonic fluid in one hour

39
Q

Refractory septic shock

A

o Fluid-refractory septic shock exists when cardiovascular dysfunction persists despite at least 60 mL/kg of fluid resuscitation
o Catecholamine-resistant septic shock exists when shock persists despite therapy with dopamine ≥10 mcg/kg per minute and/or direct-acting catecholamines

40
Q

Multiple organ failure

A

Identify and quantify organ dysfunction

  • Cardiovascular
  • Respiratory
  • Neurologic
  • Hematologic
  • Renal
  • Hepatic
41
Q

Distributive (“warm”) shock

A

Distributive shock is characterized by hyperdynamic (or high output) physiology with decreased systemic vascular resistance and elevated cardiac output as manifested by the following findings:
o Flash capillary refill (<1 second)
o Bounding pulses
o Warm, dry extremities
o Wide pulse pressure (typically greater than 40 mmHg in older children and adults; lower pulse pressures may reflect widening in infants and neonates)

42
Q

Cold shock

A

Cold shock reflects increased systemic vascular resistance and decreased cardiac output as indicated by the following signs:
o Delayed capillary refill (>2 seconds)
o Diminished pulses
o Mottled or cool extremities

43
Q

Know how to read standard CBC:

A
  • MCV = Mean corpuscular volume. Measures the average size of your red blood cells
  • MCH = Mean corpuscular hemoglobin. Refers to the average quantity of hemoglobin present in a single red blood cell
  • MCHC = Mean corpuscular hemoglobin concentration. Measurement of the average amount of hemoglobin in the RBCs compared to the average size of the RBCs. MCHC is the ratio of the MCH to the MCV.
44
Q

Viral vs Bacterial on CBC

A

Bacterial:
high neutrophils, low lymphocytes
[banded neutrophils = always bacterial]

Viral:
low neutrophils, high lymphocytes

45
Q

Common causes of dysuria in children if NOT UTI

A

Consider constipation/dehydration/labial adhesions/chemical irritation from bubble baths

46
Q

Urine dipstick analysis:

A
  • Nitrites indicate gram negative bacteria (will not show if it is a gram pos bacteria). 80% of UTI is E.Coli (which is gram neg.). If no nitrites, does not mean there is no infection.
  • Leukocytes: if only leukocytes, concern for contamination (dirty urine)? Still treat if symptomatic.
  • Protein + low specific gravity  concern for renal disease
  • Glucose + high specific gravity  concern for DM

Exam 2 (3 decks)

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