Pediatrics

Question 1

1 cause of mortality in children? over 1

Answer 1

trauma

Question 2

what is important to find out about head injury?

Answer 2

IF IT IS:
Minor
IC injury
Neurological defect
Mortality

Question 3

Scalp injury - what is important to look for?

Answer 3

Foreign bodies
Underlying skull fractures
Bleeding (can lead to Hypotension and shock)

Question 4

caput succedaneum

Answer 4

Swelling of the scalp in a newborn. It is most often brought on by pressure from the uterus or vaginal wall during a head-first (vertex) delivery. crosses suture lines

Question 5

Cephalohematoma

Answer 5

Accumulation of blood under the scalp, specifically in the sub-periosteal space. During the birthing shearing forces on the skull and scalp result in the separation of the periosteum from the underlying calvarium resulting in the subsequent rupture of blood vessels. Does not cross suture lines

Question 6

Linear fracture

Answer 6

There is a break in the bone, but it does not move the bone.
– most common
– typically occur over temporal bone, in area of middle meningeal artery (commonest cause of
epidural hematoma)

Question 7

Comminuted fracture

Answer 7

a bone that is broken in at least two places.

Question 8

Depressed fracture

Answer 8

broken bones displace inward with more than 1 thickness of the bone

Question 9

most common fracture in children?

Answer 9

90% are linear

Question 10

open fracture

Answer 10

fracture overlayed by laceration

Question 11

basilar skull fracture

Answer 11

multiple blows to the bones composing the base of the skull
◆ generally a clinical diagnosis (poorly visualized on CT)

Question 12

Signs of basilar skull factures

Answer 12

battle sign - brusing over mastoid process
Raccoon eyes
CSF otorrhea and rhinorrhea

Question 13

Concussion

Answer 13

◆ transient alteration in mental status that may involve loss of consciousness
◆ hallmarks: confusion and amnesia, which may occur immediately after trauma or minutes later
◆ loss of consciousness (if present) must be less than 30 min, initial GCS must be between 13-15,
and post-traumatic amnesia must be less than 24h

Question 14

subdural andepidural hematoma

Answer 14

Question 15

EDH: times for presentation

Answer 15

Arterial: peak 6-8h
Venous: peak 24h or more

Question 16

causes of subdural hematoma in peds

Answer 16

Birth trauma:
- presents within 12h
- seizures
- full fontanel
- anisocoria
- respiratory distress
Shaken baby syndrom
- new-onset seizures
- inc hear subconference
- poorly thriving infant
- tense fontanel

Question 17

subarachnoid hemorrhage

Answer 17

bleeding into subarachnoid space (intracranial vessel between arachnoid and pia)

Question 18

Shaken baby syndrom
(Diffuse axonal injury)

Answer 18

Absence of external signs of abuse with
respiratory arrest, seizures, or coma.
Ocular exam findings are important
diagnostically for Shaken Baby Syndrome.
These findings include extensive retinal and
vitreous hemorrhages that occur during the
shaking process and are extremely rare in
accidental trauma. A detailed fundoscopic
exam or an ophthalmology referral should
be conducted for all infants in whom abuse
is suspected

Question 19

Classify severity of head trauma is based on GCS,

Answer 19

14-15 is mild head trauma
8-13 is moderate head trauma
< 8 is severe head trauma.
In non-verbal children: pediatric GCS, rather than an adult GCS

Question 20

why is E for exposure in primary survey so important in pediatrics?

Answer 20

Because a child may not be able to
tell you about other sites of injury, either because they are too young or because of level of consciousness has deteriorated. Be sure to check the whole body.

Question 21

Summarize the primary survey

Answer 21

Do the ABCs, and also D and E where D is a quick neuro exam and E is ensuring you have exposed every potential site of injury

Question 22

Alarming features indicating that they need to be seen by a neurosurgeon ASAP

Answer 22

• Hypotension, suggesting hemodynamic instability;
• Unilaterally fixed and dilated pupils suggesting mass effect from raised ICP
• Bilaterally fixed and dilated pupils, suggesting substantial mass effect and possible herniation
• Any other signs of increased ICP including apneic spells, hypoventilation, and Cushing’s triad
  of low heart rate, high blood pressure, and irregular breathing.

Question 23

type og history in cases where patient is unconscious and unstable

Answer 23

SAMPLE history:
Signs and Symptoms;
Allergies;
Medications;
Past illness;
Last Meal;
Events related to illness or injury.

Question 24

2 rules used in peds imaging

Answer 24

CATCH: minor head injury but need a head CT
PECARN: low risk of intracranial injury in, CT should be avoided

Question 25

2 parts of our immune system?

Answer 25

Innate: first defense - fast
Adaptive: second defense - slow (cellular and humoral)

Question 26

when to suspect immunodeficiency

Answer 26

infections that are severe, persistent, unusual, or
recurrent (mnemonic SPUR).

Question 27

typical for severe persistent infection infections?

Answer 27

§ two or more months of antibiotics with little effect
§ sepsis in the absence of a known risk
§ bacterial meningitis
§ pneumonia with empyema

Question 28

typical for recurrent infections?

Answer 28

§ six or more new infections in one-year
§ recurrent tissue or organ abscesses
§ two or more serious sinus infections in one year
§ two or more pneumonias in one year.

Question 29

when is the onset of clinical features of immunodeficiency?

Answer 29

after 6 months of life because mom provides Ab (or 3 months of severe)