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pediatrics Flashcards

1
Q

why are common PMHx not present in pediatric patients?

A

pediatric patients will have different common PMHxs than adults as they have not had the time for damage accumulation that causes many chronic condition and comorbidities to develop

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2
Q

what factors comprise pediatric SHx?

A

living circumstances, daycare/school, care-taker, secondhand smoke exposure, tobacco, alcohol, or drug use, immunization status

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3
Q

what kind specific questions would the provider ask to help understand a pt’s SHx?

A
  1. who is the patient’s caregiver? (mom, dad, foster, parents, etc)
  2. any known ill contacts? (do they attend daycare or school? do they have any siblings?)
  3. other questions for teenagers? (tobacco use, ETOH, drug use, sexually active)
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4
Q

what are the age/grade groupings?

A

neonate: <4 w/o; infant: 1-12 mo; toddler: 1-4 y/o; pre-schooler: 3-5 y/o; kindergartener: age 5; 1st grade: age 6; 2nd grade: age 7; 3rd grade: age 8; middle schooler: 11-13 y/o; high schooler: 14-18 y/o

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5
Q

what part of the patient history is immunization status?

A

social history

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6
Q

why do children need so many vaccines?

A

infants are born with very little immunity and are particularly susceptible to severe infections. vaccines offer some additional protection by teaching the immune system early on to recognize and respond to some specific types of infections that children are very prone to catching

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7
Q

why do children need so many vaccines?

A

infants are born with very little immunity and are particularly susceptible to severe infections. vaccines offer some additional protection by teaching the immune system early on to recognize and respond to some specific types of infections that children are very prone to catching

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8
Q

toxic

A

toxic-appearing, infants and children are pale or cyanotic, lethargic, or inconsolably irritable, may have tachypnea and tachycardia w poor capillary refill

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9
Q

lethargic

A

poor or absent eye contact; failure of child to recognize parents or to interact w persons or objects in the environment - ONLY DOCUMENT AFTER CONFIRMING TO DO SO

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10
Q

febrile

A

state of having a fever

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11
Q

inconsolable

A

pts w constant high levels of irritability that are not able to be comforted

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12
Q

turgor

A

elasticity of the skin; poor skin turgor is an indication of dehydration

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13
Q

describe dehydration

A

a shortage of fluids commonly caused by vomiting or diarrhea

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14
Q

what is the CC of a pt with dehydration

A

lethargic/listless, sunken eyes, poor urine output (PUO)

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15
Q

describe kawasaki disease

A

inflammation of and extensive damage to the blood vessels, unknown cause

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16
Q

what is the chief complaint of a person with kawasaki disease

A

constant fevers (for many days)

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17
Q

what are the associated symptoms of kawasaki disease

A

cervical lymphadenopathy, red, dry, cracked lips, swollen tongue, erthyematous palms and soles, rash to the mid-section of the body and genitals

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18
Q

how is dehydration diagnosed

A

clinically, or based on the Na+ levels from a BMP

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19
Q

what PE findings would be observed in a pt with dehydration

A

dry mucous membranes, crying w/out tears, poor skin turgor/tenting

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20
Q

why is it important to always document fevers as intermittent?

A

kawasaki disease, which consists of constant fevers. guardians will carelessly say their children has had a fever “constantly for 4 days” when the fever has actually improved after motrin. DO NOT document a constant fever for more than 24 hours unless told to do so by your physician

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21
Q

the physician performs a PE on a pt and finds that the pt is febrile, tachycardic, has “strawberry tongue”, and has a red rash on the palms of hands and soles of feet. what is a potential ddx?

A

kawasaki disease

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22
Q

how is kawasaki disease diagnosed

A

clinically

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23
Q

what is hand, foot, and mouth disease

A

viral infection (coxsackie) that can cause sores to the palms, soles, and w/in mouth, commonly seen in children who attend daycare/school

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24
Q

what is the CC for HFM disease

A

blisters on the hands, feet, and mouth

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25
Q

what is a major concern of HFM disease?

A

dehydration given the pain experienced with PO intake. be aware of signs of dehydration such as decreased UOP, dry mucous membranes, crying without tears

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26
Q

what are the associated sx of HFM disease

A

lowered PO intake

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27
Q

describe tachycardia

A

fast HR caused by a large variety of conditions, most commonly fever. the definition of tachycardia varies between pediatric age groups
diagnosed by: bedside telemetry or if tachycardia noted during exam

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28
Q

what is considered tachycardia for a newborn?

A

> 160 bpm

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29
Q

what could a physician potentially find during a PE on a pt with HFM disease?

A

lesions on the tongue, posterior pharynx, buccal mucosa, and gingiva

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30
Q

what is considered tachycardic for a less than 6 month old?

A

> 180 bpm

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31
Q

what is tachycardic for a 1-2 y/o?

A

> 160 bpm

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32
Q

what is tachycardic for children ages 3-10 y/o?

A

> 140 bpm

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33
Q

what is tachycardic for children 11-15?

A

> 120 bpm

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34
Q

what is considered tachycardic for adults?

A

> 100 bpm

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35
Q

describe myocarditis

A

infection of the myocardium, usually viral, that causes CP in older children

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36
Q

what is the chief complaint for myocarditis

A

chest pain

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37
Q

what are the most common causes of chest pain in children?

A

very rare for CP in children to be cardiac-related. common causes are musculoskeletal pain, costochondritis, pleurisy (inflammation of pleura), reflux, asthma, pneumonia

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38
Q

what are the associated sx of myocarditis

A

lethargic/listless, irritable, low grade fever

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39
Q

what are some PE findings of myocarditis

A

tachycardia, decreased capillary refill, gallop

40
Q

describe asthma

A

constricting of the airways due to inflammation and muscular contractions of the bronchioles
CC: SOB/wheezing, improved w bronchodilators
assoc. sx: hoarseness of voice, labored breath, fever
PE: wheezes
diagnosed by: clinically

41
Q

what are some associated sx of asthma

A

hoarseness of voice, labored breath, fever

42
Q

what are some associated medications used for asthma?

A

-short-acting beta agonist (SABA): used acutely via inhalers and nebulizers [albuterol or atrovent]
- long acting beta agonist (LABA): always w/ corticosteroid combination, used as daily controller medication via inhaler [symbicort]
-glucocorticoid: prednisone, prednisolone, decadron

43
Q

describe pertussis (whooping cough)

A

infection of the respiratory tract causes a dry harsh cough that can last up to 100 days (“100 days cough”)
CC: cough
assoc. sx: post-tussive emesis
PE: often unremarkable, may exhibit cough during exam
diagnosed: clinically, likely w/ negative CXR and maybe sputum culture

44
Q

what is the chief complaint of pertussis

A

cough

45
Q

what is post-tussive emesis

A

harmless type of vomiting that occurs after long coughing spells, not GI related. be sure to differentiate it from normal vomiting

46
Q

what medication can be used to treat pertussis

A

abx such as azithromycin

47
Q

what is the assoc. sx of whooping cough

A

post-tussive emesis

48
Q

describe bronchiolitis (RSV)

A

infection of the lower branches of the lungs leads to difficulty breathing

49
Q

what is the chief complaint of RSV (bronchiolitis)

A

SOB, grunting

50
Q

what are some assoc. sx of RSV

A

fever, cough, wheezing, poor feeding, irritability

51
Q

what is especially important to document for respiratory pt and bronchiolitis

A

oxygen saturation

52
Q

what are the signs of respiratory distress

A

retractions, tachypnea, accessory muscle use, belly breathing, nasal flaring

53
Q

what are some PE findings consistent with RSV

A

inspiratory rales and expiratory wheezes, signs of respiratory distress

54
Q

how is RSV diagnosed

A

CXR or RSV panel

55
Q

describe croup

A

viral infection caused by the parainfluenza virus, causing swelling of the upper airway leading to a “bark-like” cough

56
Q

what is the CC for croup

A

barking cough

57
Q

what is the main concern with croup?

A

respiratory distress, should be treated with corticosteriods if showing signs

58
Q

what is the main difference between asthma and croup?

A

same assoc. sx (fever, hoarseness, labored breath). asthma–> cc = sob/wheezing
croup–> cc = bark cough

59
Q

what would a physician find in the PE of a pt who has croup

A

stridor, bark cough, retractions, signs of respiratory distress

60
Q

what is stridor

A

noisy breathing that occurs due to obstructed air flow through a narrowed airway

61
Q

how is croup diagnosed

A

clinically, likely with a negative CXR and potentially sputum culture

62
Q

describe influenza

A

common viral upper respiratory infection that can deadly, especially in high risk groups
CC = dry, persistent cough, fever (>100.4F)
assoc. sx: fatigue, myalgia (muscle aches), headaches, nasal congestion, sore throat
assoc. med: tamiflu
PE: fever, nasal drainage
diagnosed by: rapid flu test

63
Q

what is the CC of influenza

A

dry, persistent cough, fever

64
Q

what are the assoc. sx of influenza

A

fatigue, myalgia, headaches, nasal congestion, sore throat

65
Q

what age group is at high risk of developing flu complications

A

<5yr, especially <2yr

66
Q

describe febrile seizure

A

seizure that results from rapid change in body temperature from fever (height of fever itself is not the cause)
CC: seizure like activity
assoc. sx: fever
PE: absence of postictal state
diagnosed: clinically

67
Q

describe pyloric stenosis

A

enlargement of tissue surrounding the pyloric valve causes obstruction of the stomach
risk factors: >3months old
CC: vomiting (projectile)
assoc. sx: poor appetite, poor feeding, poor weight gain, poor satisfaction after meals
PE: firm, non-tender, mobile mass in RUQ, “olive-like”
diagnosed: clinically or by US of RUQ

68
Q

describe intussusception

A

a section of bowel telescopes into an adjacent section, putting the pt at risk for blockage and gut-ischemia
risk fx: >2y/o
CC: sudden onset, episodic abd pain OR vomiting w/out diarrhea
assoc. sx: mucous or currant-jelly-like tools, pt appears completely well between episodes, potentially lethargy
PE: abd tenderness, abd distention, Guaiac positive stools
diagnosed by: contrast edema (not in ED) or AAS

69
Q

describe constipation

A

difficulty having bowel movements (many causes) and subsequent buildup of stool w/in the lower GI tract
risk factors: dehydration, weak GI mobility, infants, chronic constipation issues
CC: absence of/difficulty w BM, no BM in 2-3 days
assoc. sx: pain w BM, abd pain, loss of appetite, encopresis (fecal incontinence)
pert. neg: no blood in stool, emesis, or loss of ability to pass gas
PE: rectal exam may be performed to assess stool burden in rectal vault, may be tenderness or distention, as well as an appreciable stool burden on abd exam
diagnosed by: AAS or situationally CT a/p w IV contrast (if concern for potential SBO)

70
Q

what procedure can be done to relieve pt if determined they cannot pass the stool burden?

A

bowel disimpaction procedure, be sure to document

71
Q

describe a toddler’s fracture

A

tripping/twisting of leg causing a spiral fracture of the tibia, pain and limitation of use
CC: non-weight bearing on affected extremity
assoc. sx: will no put foot down, significant TTP, may still crawl
pert. neg: no focal weakness, no sensory deficits, no other injuries
PE: will not bear weight, point tenderness over distal tibia, CSMT intact distally
diagnosed by: XR of extremity

72
Q

what is important to note in most extremity injuries

A

splint application procedure, if one was done

73
Q

describe nursemaid’s elbow

A

(radial head subluxation[partial dislocation]) pulling motion on child’s wrist/forearm causes a subluxation of the radial head, causing pain and limitation of use
CC: child not using affected arm
assoc. sx: child holding their arm at their side, crying that is made worse w attempted use of arm
pert. neg: no motor weakness, no bruising/swelling
PE: child holding arm at side, no focal point tenderness, CSM intact distally
diagnosed: clinically

74
Q

what procedure will physicians typically do to treat nursemaid’s elbow

A

physician’s will often reduce joint by hyperpronation and/or supination w/ flexion

75
Q

describe the presentation of foreign bodies

A

foreign objects can become lodged in the body such as ear canal, nose, eye or throat
CC: ingestion/choking or “something stuck in nose/ear”
PE: describe the foreign body; size, shape, location
diagnosed by: direct visualization of the foreign body on exam or XR

76
Q

what should you always document in regards to foreign bodies?

A

document respiratory status (no SOB, airway patent, breathing easily, etc) as well as FB removal procedure for anything that is removed by the physician

77
Q

describe otitis media

A

middle ear infection, viral or bacterial infection of TM causing ear pain and pressure
CC: ear pain, ear pulling
Assoc. sx: fever, sore throat, dry cough, congestion
PE: erythema, effusion, bulging, or dullness of the TM
diagnosed: clinically

78
Q

what would a pt with a bite c/o

A

a break in the skin caused by the teeth of either an animal or another person; bite/wound, be sure to document the pt’s vaccination status including rabies and tetanus

79
Q

what is tinea corporis and capitis

A

ringworm; a fungal infection of the skin (corporis) or hair follicles of scalp (capitis); CC: erythematous and circular rash, alopecia also coming as the fungus permeated the follicle

80
Q

what is scabies

A

a mite that burrows and lives just below the surface of the skin
CC: itchy rash, commonly to hands, feet, waistline, or specifically for babies on the back

81
Q

describe atopic dermatitis (eczema)

A

several types, all share the feature of irritated skin that generally involves inflammation, erythema, itching, and flaking
CC: rash, FHx of eczema, history of eczema flares

82
Q

what is candidiasis

A

yeast infection of the skin that forms in dark, damp areas such as the inguinal folds or between fat rolls on the babies neck
CC: rash w skin breakdown at rash site

83
Q

what is important to include in the pediatric HPI

A

must include who the pt presented w/, generally parents

84
Q

what are the HPI buzz-words

A

lethargic, inconsolable, listless. these should not be used in the HPI unless instructed by the provider

85
Q

what should you use instead of lethargic

A

generally tired

86
Q

what should you use instead of inconsolable

A

crying slightly more often

87
Q

what should you use instead of listless

A

playing less often

88
Q

t/f: you should always pair positive findings with other related negatives

A

true
“mildy generally tired…but still active”
“crying slightly more often…but has been consolable”
“playing less often…but still eating and drinking well”

89
Q

what are the 3 major concerns to pay attention to for the peds ED? how would you document this?

A

changes in appetite, changes in activity, changes in alertness. if one of these three areas is changed, be sure to document the areas that are not affected

90
Q

what are some common febrile illnesses

A

febrile seizures, strep pharyngitis, OM, viral illness, UTI

91
Q

what are some serious febrile illnesses

A

meningitis, kawasaki disease, appendicitis, pneumonia

92
Q

what are the 5 important details to document for pt w/ fevers

A
  1. onset - any constant fever lasting >1-2 days is a concern
  2. timing - all fevers are documented as intermittent until proven constant
  3. T-max - max temp
  4. measurement - any fever w/out an actual temp document must be documented as “subjective fever” meaning no temp has been taken
  5. medications: any antipyretic, medication, or herbal remedy given and when they received their last dose
93
Q

when and where should birth history be recorded

A

for any pt > 12 month old, recorded at the end of HPI

94
Q

what type of questions would be included in the BHx

A

how many weeks pregnancy carried? vaginal delivery or C-section (and why)? did pt stay in NICU (why)? circumcised? was the mother treated w Group B Strep at delivery? did mom have an STD or UTI which was treated? did pt leave w the mother after birth?

95
Q

what is the single most important section of the PE for peds?

A

the general/constitutional section

96
Q

what are some normal and abnormal findings of the constitutional section of PE

A

-normal: NAD, alert, attentive, interactive, completely non-toxic, smiling, playful, well-hydrated, well perfused, cries normally w/ tears during exam, but is easily consolable, vigorous
-abnormal: fussy/irritable but consolable, mildly ill appearing but non-toxic

97
Q

what is the chief complaint for myocarditis

A

chest pain

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