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CCFP-EM > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Labs / Signs with increased risk for bacterial source

A

Procalcitonin
CRP
Fever > 38.5 C rectally
ANC > 4000 with elevated PCT or > 5200 without

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2
Q

Assessment of fever in 8-21 day old (well-appearing only)

A

urinalysis
lumbar puncture
labs (can include inflammatory markers)
Consider HSV risk

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3
Q

Assessment of fever in 22-28 day old (well-appearing only)

A

UA
Blood culture
Inflammatory markers
- If UA negative AND abnormal IMs - do LP
- If normal IMs, MAY do an LP
- If Normal CSF 1) Going home: give antibiotics/antivirals. Observe at home and reassess in 24 hrs.
2) In hospital: MAY give antimicrobials. Observe.
If no source identified, stop antimicrobials and d/c home.

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4
Q

Assessment of Fever in 29-60 day old, well appearing
If NOT CLINICAL RSV BRONCHIOLITIS

A

Urinalysis, blood cultures and IMs.
- If increased IMs, send urine culture. MAY perform LP.
- If IMs Normal: positive urine, treat. If negative urine, observe closely at home, f/u in 24-36 hours.

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5
Q

Most common bacteria for 0-28 days

A

Group B Strep
Klebsiella
E Coli
Listeria
Chlamydia
Gonorrhea

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6
Q

Most common bacteria 1-3 months

A

Strep Pneumo
Neisseria
E Coli
H Flu

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7
Q

Most common bacteria > 3 months

A

E Coli
Strep Pneumo
Neisseria

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8
Q

Empiric Treatment in the Infant

A

Ampicillin, Cefotaxime (or Gentamycin) + Acyclovir if concerns for HSV

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9
Q

Rochester Criteria for Low Risk infants

A

WBC 5-15
Abs bands < 1500
UA < 10 WBC/HPF
Stool < 5 WBC / HPF

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10
Q

Colic Definition (Wessel Criteria)

A

Crying > 3 hrs / day, 3 days / week for at least 3 weeks

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11
Q

Differential Dx for Colic

A

C - Corneal abrasion, constipation, congenital anomalies
A - Anal fissure, appendicitis
N - iNtussusception, iNfection
T - Tourniquet
F - Formula intolerance, foreign body eye
A - Abuse
R - Recent immunization (pertussis)
T - Testicular torsion

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12
Q

Jaundice Causes (<24 hours)

A

ABO incompatibility
Sepsis
Conginital TORCH infections
- Toxoplasmosis
- Other: Syphillis,Varicella and Parvo
- Rubella
- CMV
- HSV
Birth Trauma

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13
Q

Jaundice Causes 2-3 Days

A

Physiologic (most common cause)

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14
Q

Jaundice Cause 3 days - 1 week

A

Infection
Congenital Infections
Congenital disease in bilirubin metabolism

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15
Q

Jaundice Causes > 1 week

A

Breast milk
Breast feeding
Biliary Atresia
Congenital hepititis
Red cell diseases (G6PD, sickle, spherocytosis)
Hemolysis due to drugs
Hypothyroid
Metabolic abnormalities

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16
Q

Signs of Kernicterus

A

Extensor rigidity
Tremor
Loss of suck reflex
Lethargy
Seizures

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17
Q

Progression of Jaundice

A

Head
Torso
Lower
Generalized

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18
Q

Risk factors for phototherapy

A

Prematurity
ABO incompatible
Sepsis
Clinical instability

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19
Q

ALTE Def’n

A

Acute, otherwise unexplained change in breathing leading to apnea or pallor / cyanosis, limpness or rigidity or an episode of choking/gagging

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20
Q

ALTE Workup and Mgmt

A

Glucose
Electrolytes
ECG
Infectious w/u if indicated
Inpatient mgmt if:
- Recent ALTE in preceding 24 hrs
- Sick appearing
- Signs of abuse
- FMHx
- Congenital abnormalities

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21
Q

Bronchopulmonary Dysplasia

A

Receive O2 in first 28 days of life
Repeated injury/inflammation
Risk Factors: prematurity, PPV, genetic predisposition
Signs/Symptoms: Resp distress, hypoxia, tachypnea, adventitious sounds or decreased air entry
CXR: Hyperinflation with cystic areas or fibrosis.
Tx:
- Supportive, O2 and suctioning.
- Trial inhaled bronchodilators
- IV fluids
- Admit

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22
Q

Pleural Effusion DDx in Peds

A

Transudative:
-Cirrhosis
-Nephrotic Syndrome
-CHF
-hyponatremia
Exudative:
-Infection
-Neoplasm

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23
Q

Cystic Fibrosis Presentation

A

Frequent lung and sinus infections
Pancreatitis
FTT
CP - due to pleurisy, pneumonia, pneumothorax
SOB due to LRTI or aspergillosis
Constipation/obstruction/ppancreatitis, chole, GERD

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24
Q

Cystic Fibrosis Dx

A

Meconium Ileus in newborn
Sweat Chloride
For exacerbations:
- Antibiotics: Inhaled and oral
- Pulmonary hygiene
- Steroids for bronchospasm
- Pulmonology Consult

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25
Q

Asthma Risk Factors for Badness

A

Previous ICU, previous intubation, low SES, multiple admissions in last year, comorbidities

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26
Q

Wheezing Differential

A

Asthma
Anaphylaxis
Bronchiolitis
Pneumonia
Cardiac wheeze / pulmonary edema
Foreign body
Bronchiectasis
Neoplasm
Vocal cord dysfunction

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27
Q

PRAM Score

A

Wheeze
Scalene retractions
Suprasternal Retractions
Air entry
Oxygen saturation

Mild < 4
Moderate 4-7
Severe >7

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28
Q

Asthma Mgmt

A

Initial:
Mild (PRAM 1-3): Ventolin Q1
Moderate (4-7): Salbutamol 20 min x 3 then Q1H + Dex (up to 2 dose)
Severe (8-12)
- Dex 0.6 mg/kg to max 12 mg
- < 20 kg Salbutamol 5 puffs (2.5 mg neb) q20 x 3 and Ipratropium 4 puffs (250 mcg neb)
- >20 kg Salbutamol 10 puffs (or 5 mg neb), Atrovent 8 puffs (500 mcg nebs)
*Atrovent ONLY in the first 3 hrs.
- Assess perfusion. IV access as needed.
- If impending resp failure give MgSO4 50 mg/kg (max 2g over 20 mins) with IV bolus (20 mg/kg)
- High flow nasal canula
- CPAP 5 to max 10 cm H20
- IV hydrocort 8 mg/kg (max 400 mg)
- Can trial IV salbutamol or epi 0.01 mg/kg to max 0.5 mg IM.

Impending respiratory failure: PRAM 12 + lethargy, cyanosis, decreasing resp effort, with increasing pCO2

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29
Q

Asthma D/c

A

Discharge 4 hrs after dex if PRAM < 4 and not required puffers x 2 hrs.
On d/c 4 puffs Q4 hrs x 24 hrs
D/c with ICS

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30
Q

Croup (laryngotracheobronchitis)

A

Upper airway obstruciton
- most common by Parainfluenza (COVID)
- Children < 3 usually
Differential:
- FB, subglottic stenosis, bacterial tracheitis, epiglottitis
XR: steeple sign
Use Wesley Score
Tx: Oral dexamethasone, 0.6 mg/kg. Nebulized epinephrine
Humidified O2
- Trial Heliox
- If ETT required, 0.5 size smaller.
- Admit if ongoing stridor

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31
Q

Bacterial Tracheitis Features and Mgmt

A

Age < 3
Preceded by viral illness
Toxic appearing
XR: Tracheal narrowing with rough appearance
If can get IV without causing resp distress, the administer ceft + vanco

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32
Q

RPA features and mgmt

A

Children < 4. Potential space infection between esophagus and spine.
- Hoarse voice, drooling, neck pain, trismus
Dx: Lateral neck (in extension)
- C2: > 7mm
- C6: > 14mm at C6 (21 mm in adults)

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33
Q

Bronchiolitis features and mgmt

A

Virus: RSV, HMNV, COVID
Typical: 1-2 days URI then cough, wheeze, tachypnea
Hypoxia possible
Apnea possible in premature infants
Ddx: Pneumonia, asthma, FB
Dx: Clinical. RAT for admission cohorting only
CXR only if very sick / ICU
Tx: Suction, supplemental O2.
- Consider hypertonic saline nebs
- Admission for resp distress, hypoxia, comorbidities or apnea present
- Complications dehydration and acute respiratory failure

Age Criteria: < 2 yrs, really < 1 years.
NO Nebulized Ventolin
Can try Epinephrine

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34
Q

Risk Factors for severe bronchiolitis

A

Age < 7 weeks
< 34 week prem
Chronic cardiac / respiratory illness
HR > 180
RR > 80
O2 sat < 88%

D/c if:
Mild distress
Hydrated
Sats > 90%
Mom/Dad Happy

RSV usually peaks at 4-7 days.

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35
Q

Distal Radius Acceptable Angulation

A

Bayonet apposition acceptable if > 50% overlap

If < 5 yrs 20 degrees
5-10 yrs, 15 degrees
> 10 10 degrees? Review slide

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36
Q

Greenstick # Mgmt

A

Requires splinting and ortho follow-up

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37
Q

Bowing Fracture / Plastic Deformity MgMt

A

Requires reduction, will not remodel

38
Q

Elbow Injury - Supracondylar Features and Mgmt

A

Look for sail sign ant/post
Anterior humeral line should pass through the medial 1/3 of capitellum
Radio-capitalar line - done the radius bisects the capitellum in all views
Should not see a posterior fat pad ever!
Assess NV status in all
Median nerve (anterior interosseous branch) most commonly injured (Ok sign)
Can have radial nerve as well

Gartland Classifications
1 - undiscplaced
2 - Obvious # line with displaced distal fragment but intact posterior
3 - Complete displacement (no reduction unless hand is pulseless)

Mgmt: Posterior slab with ortho follow-up

39
Q

Elbow Injury - Ossification order

A

Capitellum
Radial head
Internal
Trochlea
Olecranon
External

40
Q

Toddler’s #

A

Stable #
Immobilize for comfort
Stable - no # line
REVIEW THIS

Fall, refusing to ambulate / limp

41
Q

Salter Harris I of fibula Mgmt

A

Ankle bracing alone is ok.

42
Q

Low Risk Ankle Fractures

A

Salter Harris I
Salter II
Avulsion
Weber A / Through malleoulus

43
Q

Tilleaux (Salter Harris III of distal tibia)

A

Transition fracture
Growth plate fuses medial to lateral
Ortho referral in ED.

+ posterior malleolus = triplane #

44
Q

Pelvic Avulsion #

A

Acute onset with forceful movement

Locations:
- Ischial tuberosity
- Greater trochanter
- Less Trochanter
- AIIS
- Symphysis Pubis
- Iliac Crest (abdo muscles)
- ASIS

45
Q

SIDS Risk Factors

A

Prone sleeping
Co-sleeping
Mother that smokes
Young maternal age
Soft surfaces sleeping
Prematurity
Too hot
Male
FMhx

46
Q

Management of Increased ICP

A

Elevated Head of Bed
Avoid hypotension / hypoxia / hypercarbia
MAP > 60
IV Mannitol (1 g/kg) or IV 3% NS (2-6 ml/kg)

47
Q

Pediatric Cervical Spine Injury - Indications for Imaging

A

Focal Neuro deficit
Torticollis with trauma hx
Altered Mental Status
High speed injury
Major torso injury concomitantly

Age < 8 - can use plain films as initial imaging.
Age > 8 more likely.
- NEXUS criteria can be applied to rule out.

48
Q

Pediatric Thoracic Trauma Signs

A

Tachypnea, tachycardia, hypotension, abnormal auscultation or external trauma

49
Q

Chance Fracture and Associated Injuries

A

Chance fracture is an unstable spine fracture that typically occurs at the thoracolumbar junction. It is a horizontal fracture extending from posterior to anterior through the spinous process, pedicles, and vertebral body

Mechanism - flexion/distraction

Associated with duodenal perforation, mesenteric injuries or bladder ruptrue.

50
Q

Pediatric Airway Normal Resp rate

A

10-60.
If < 20 in age < 6 then worry re: fatigue

51
Q

List 5 Reasons Infants Desaturate Rapidly Under Anesthesia

A

Increased O2 Consumption
Decreased number of alveoli
Decreased FRC
increased dead space ventilation
Increased ventilatory rate

52
Q

Risk of Anesthesia for Recent URI

A

Can result in airway hyperreactivity for up to 8 weeks
Increased rusk of perioperative complications including breath holding , desaturation, coughing, laryngospasm and bronchospasm

53
Q

Anesthesia considerations for peds OSA

A

20% increased in postop respiratory morbidity after T&A and blunted CO2 response with increased opioid sensitivity

54
Q

Laryngospasm mgmt

A

Jaw thrust and high flow 02 for partial
Succinylcholine 0.1 mg/kg + IV atropine 20 mcg/kg
- If no IV then 3-4 mg IM

55
Q

Biomarkers for SBI / IBI in peds

A

Procalcitonin
ANC > 4
Temp > 38.5
CRP

Procalcitonin + ANC OR CRP (If negative no LP, if + then LP)
Temp + ANC + CRP then LP

22-28 days: No LP required if markers negative. Can consider discharge
- If positive markers must do LP and admit

56
Q

Vitals in pediatrics

A

Memory aid:
1-3-5-7-9
6-5-4-3-2

Age RR HR
1 60 160
3 50 150
5 40 140
7 30 130
9 20 120

57
Q

Minimal BP

A

Neonates: 60 mmHg
1-12 months: 70 mmHg
>1 = 70 + 2x age in years.

58
Q

Pediatric Assessment Triangle

A

Appearance
- Tone, interactive/irritable, consolable, look/gaze, speech or cry
Breathing
- Head position, Bobbing, Nasal flaring, grunting, indrawing / retractions
Circulation
- Cap refill, pallor, petechiae, cyanosis, mottling

59
Q

Red flags for non-accidental trauma

A

Story inconsistent
Bruises in pre-cruising infants
Patterns injury or injury to ears, inner thighs, neck, groin
Posterior oropharynx bruising.
Posterior rib #
Fractures in non-ambulatory child
injury not in keeping with mechanism endorsed

60
Q

Simple vs Complex Febrile Seizure

A

Simple:
- < 15 mins
- Single in 24 hours
- No focality, GTC
- Between 6 months - 5 years

1/3 will have 2nd seizure, usually within the year.

Risk of epilepsy 1-2 vs 0.5-1% if seizure

61
Q

6 causes of fever and petechiae

A

1) N. Meningiditis
2) HSP
3) DIC
4) ITP
5) Toxic shock syndrome
6) Leukemia
7) Necrotizing fasciitis
8) VAsculitis - SLE
9) HIV
10) Pneumococcemia
11) Endocarditis

62
Q

Diagnostic criteria for Toxic Shock Syndrome

A

Fever > 38.9
Hypotension
Orthostatic syncope
Erythroderma
Desquamation (after 1-2 weeks, not helpful(
Multisystem involvement (3 or more):
- GI
- Muscular (elevated CK or myalgias)
- Mucous membranes
- Renal
- Hepatic
- Hematologic - thrombocytopenia
- CNS: Disorientation without focal findings
Negative cultures for other bacteria, rocky mountain spotted fever, measles, leptospirosis

63
Q

Differential for stridor

A

Supraglottic:
- Epiglottitis
- Myriad congenital with craniofacial abn
- Foreign body
- RPA
- Tonsillar hypertrophy

Glottic (biphasic)
- laryngomalacia
- vocal cord paralysis, cyst
- laryngeal web
- foreign body
- papillomas

Subglottic:
-subglottic stenosis
- tracheiitis
- mediastinal mass
- croup
- FB
- tracheomalacia

64
Q

XR findings in croup

A

Thumbprint sign
Thickened aryepiglotic folds
Lack of air in vallecula
Dilated hypopharynx
Normal

65
Q

How to do jet insufflation

A

14 G angiocath over needle into the cricoid membrane - directed caudally
- Attach to 3 cc syringe
- Connect adapter for 7.0 tube the bag

66
Q

Differential for pneumonia in peds

A

Bad XR . interpretation
Pulmonary disease:
- Dysplasia
- CF
- Bronchiectasis
- Atelectasis
- ARDS
Cardiac Disease
- CHF
Blood Vessels:
- AVM
- PE
- Sickle cell infarction / acute chest
Bronchi/oles:
- FB
- Aspiration
-Chemical exposure

67
Q

When to get XR in respiratory disease in child

A

Fever, unilateral lung findings, tachypnea, hypoxia

68
Q

CF complications

A

Pumonary infections and bronchiectasis
Pancreatic insufficiency
Malabsorption - vitamin deficiency and osteoporosis
Diabetes
Infertility

69
Q

Causes and stages of Whooping Cough

A

Bordetella Pertussis
Stages:
1) Catarrhal stage, 1-2 weeks of typical URTI symptoms
2) Paroxysmal Stage
- Severe paroxysms of staccato cough x 1-2 weeks
- 2 to 4 weeks
3) Convalescent stage
- Gradually resolving over 2-4 weeks

Mgmt: Azithromycin, Septra
- Does not treat infection / reduces transmission

70
Q

Tetralogy of Fallot anatomy

A

VSD
Low lying aorta
RV outflow obstruction
RVH

71
Q

Cyanotic and Acyanotic Heart Lesions

A

Cyanotic:

  • Increased Pulmonary Markings
    *Transposition of the great arteries
    *TAPVR
    *hypoplastic Left Heart
    *Truncus Arteriosus
  • Decreased Pulmonary Markings
    *Tetralogy of Fallot
  • Severe pulmonic stenosis
    *Tricuspid atresia
    *Pulmonary atresia
    *Hypoplastic RH

Acyanotic:

  • Increased Pulmonary Markings
    *VSD
    *ASD
    *Patent DA
  • Decreased Pulmonary Markings
    *Aortic Stenosis
    *Aortic Coarctation
  • Pulmonic Stenosis
72
Q

Ductal dependent cardiac lesions

A

Acyanotic: aortic stenosis, coarctation, HLHS
Cyanotic: Tetralogy, Pulmonic stenosis, Tricuspid atresia, HRHS, TGA, TA

73
Q

Complications of PGE1 - Prostaglandin

A

Apnea
Seizures
Bradycardia
Fever
Flushing
Decreased platelet aggregation

74
Q

Tet Spell Mgmt

A

Calm child
Knees to chest
Supplemental O2
Fentanyl / Morphine
IV Fluids / Bicarb

75
Q

HSP etiology and complications

A

IgA vasculitis, usually onset after a viral URTI
- Joint pain
- Painful, palpable purpura
- Hematuria
- AKI
Complications:
- Intussusception
- GI bleeding
- Renal failure
- Testicular torsion
- Hypertension
- Cellulitis / infection of purpura

76
Q

Causes of constipation in children

A

Drugs: opioids, anticholinergics, aluminum containing antacids
Neurogenic: Hirschsprungs, CP, spinal cord injury, duchenne MD
Endocrine / Metabolic: CF, hypoK, hyper or hypoCa2+, hypothyroid, DM
Anatomic: Atresia, volvulus, imperforate anus

77
Q

DDx Priapism

A

Low flow: Ischemic, painful, “limb” threatening”
- Drugs (cocaine)
- Sickle cell
- Malignancy - lymphoma, leukemia

High Flow (Non-ischemic, non-painful)
- Trauma, AVM

Neurogenic

78
Q

Testicular torsion assessment

A

Testicular or flank pain
Swelling
High Riding
Nausea and vomiting

Twist score
-Swelling (2 pts), hard (2 pts), high riding, loss of cremasteric reflex,

79
Q

UTIs in kids < 2 years

A

If < 2 month:
- Admit and IV abx with Amp and cefotxime
- Kleb and E.coli
2-24 months
- Assume all are upper tract disease
- PO cefixime is first line.
- tx 7-10 days
>2 yrs
- If no systemic symptoms, treat as simple with 3 day course of Abx.

80
Q

Types of HUS

A

Primary - atypical HUS
- Complement mediated

Secondary - typical HUS
- Usually associated with EHEC
- Renal failure, uremia, hemolyis, thrombocytopenia

81
Q

DDx for hematuria

A

Intrarenal:
- Stones
- PSGN
- AIN
- Pyelonephritis
- PCKD
- Renal vein or artery thrombosis
Extrarenal:
- Cystitis
- Trauma
- Meatal stenosis
- Exercise
- Mestruation / rectal bleeding
- Epididymitis

82
Q

6 causes of nephrotic syndrome

A

Renal failure with hypoalbuminemia and edema
- PSGN
- Lupus
- Scleroderma
- IgA nephropathy
- HUS
- HSP
- Goodpasture’s
- MPA
- Alport syndrome

Primary and most common is minimal change disease!

83
Q

Indication of surgical repair in clavicle fracture

A

Open
Skin tenting
NV injury
Fractures with > 100% displacement
Pathologic fracture

1-2-3 rules
1 and 3 pieces are odd fractures
2 - up to 2 cm of overlap allowed

84
Q

Approach to elbow XR

A

Effusion
Lines - anterior humeral and radiocapitellar
Boney Cortex
Ossification centres
Watch all 3 views.

Baumann’s angle: Angle between humeral axis and lateral physis

85
Q

Supracondylar Fracture complications

A

NV injury. AIN
Brachial artery
Volkmann’s Ischemic contracture:
- Fixed elbow flexion, forearm pronation, wrist flexion, MCP extension, IP flexion
Brachial artery thrombosis
Malunion: cubitus varus

86
Q

Monteggia vs Galleazzi

A

MUGGER
Monteggia: Fracture of ulna with dislocation of radial head
- Needs ORIF

Galeazzi: Fracture of distal 1.3 of radius with DRUJ injury

87
Q

Risks for DDH

A

Female
Breach presentation
Family Hx
First born
Oligohydramnios

88
Q

10 Causes of hip pain in child

A

Infection: Septic arthritis, osteomyelitis, myositis
Inflammatory: TS, JRA, Rheumatic fever
Trauma: Fracture or overuse
Metabolic: Hemophilia, sickle cell
Neoplasm: leukemia, osteogenic / sarcoma, metastatic disease
Miscellaneous: LCP, SCFE

89
Q

Septic arthritis vs Transient Synovitis

A

Septic - younger 6-24 months
- ++ pain with passive ROM
- Appear sick
- Limp or refusal to walk
- Erythema, warmth and swelling of joint. If hip, usually flexed, abduction and external rotation
Knee&raquo_space;> Hip incidence
- Most common cause if MSSA/MRSA
- Gonococcal
WBC > 50,000 ++ likely

TS: Older, age 3-9 years
- Dx of exclusion
- Limited pain with passive ROM

Kocher Criteria:
- Fever > 38.5
- Inability to WB
- ESR > 40 or CRP > 20
- WBC >12

90
Q

Pathogens for septic arthritis by age

A

< 2 months: GBS, s aureusm gram negatives bacilli or N gonorrhoeae
2 months -5 years: MSSA, MRSA, S. pneumonia, S. pyogenes, Kingella kingae, H Flu
>12 S aureus, N. gonorrheae

Sickle - Salmonella

91
Q
A

CCFP-EM (20 decks)

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