Pediatrics Flashcards

Question

Pediatric Fractures - Bowing

Answer 1

Longitudinal force directed along the shaft of the bone exceeds the bone’s ability to recoiled to its normal position If the curvature is less than than 20 degrees or if the injury occurs in children < 4 years of age, these fractures typically spontaneously resolve

Answer 2

Classification system grades fractures Severity increases as the grade scale increases S: Type I; straight across the growth plate A: Type II; above the growth plate L: Type III; lower or below the growth plate T: Type IV; through the growth plate ER: Type V; erasure of the growth plate or crush

Answer 3

Long bone fractures in non-ambulatory children Metaphyseal corner and bucket-handle fractures Rib fractures Fractures of the sternum, scapula or spinous processes Multiple fractures in various stages of healing Bilateral acute long-bone fractures Vertebral fractures and subluxations in the absence of a history of high force trauma Digital fractures in children younger than 36 months of age or without a corresponding history Displaced physeal fractures, especially transphyseal distal humerus fractures in non-ambulatory children Complex skull fractures in children

Answer 4

Presentation: - Effortless regurgitation in an otherwise healthy infant - Typically resolves over the first year of life - Can trial removing cows milk as this may mimic GER - Symptoms of cows milk protea in are intolerance, poor weight gain (Family history of atopy increases risk) Treatment: - Keep infant upright after feedings - Avoid smoking around infant

Answer 5

Hypertrophy of the pyloric sphincter causes an obstruction Occurs between 3 and 6 weeks Presentation: - Projectile, non-billous vomiting, that occurs immediately after being fed followed by an infant demanding to be fed again as they lost all their nutrients - May see dehydration and weight loss - May be able to palpate and “olive-shaped mass” in the RUQ, easier to palpitate immediately after infant vomits. Diagnosis: - Made by Ultrasound - Refer for surgical correction Treatment: - Refer to ER if the symptoms of dehydration are present

Answer 6

Intestine “telescopes” in on itself causing sudden, intermittent and severed abdominal cramping Most commonly occurs between 6 and 36 months Presentation: - Inconsolable crying, may suddenly draw legs towards abdomen. - “Jelly like stools” - As obstruction worsens vomiting may occur, that can turn bilious Diagnosis: - Confirm with ultrasound (may show “coiled spring” appearance)

Answer 7

A testes that does not descend by 4 months of age Presentation: - Empty, poorly righted scrotum - If testes does not descend by 4 months, this generally requires surgical intervention - Cryptorchidism increases the risk for testicular cancer in the future if not corrected early on Diagnosis: - Refer to pediatric urology

Answer 8

Most common renal malignancy in children and one of the most common malignancies in childhood Occurs < 10 years old… 75% before 5 years old Presentation: - Abdominal mass palpated that rarely crosses the midline. May be asymptomatic, may also present with abdominal pain, hematuria and hypertension. - Once a Wilms tumor is suspected, do NOT palpate as it may result in rupturing the capsule and spilling contents from the tumor Diagnosis: - Ultrasound is the initial diagnostic tool… Biopsy to confirm Treatment: - Refer to pediatric cancer center

Answer 9

Heart murmurs are common findings in infants and children and are generally benign - Murmurs detected in the first 6 hours of life are typically a result from a valve complication - Murmurs auscultated after 6 hours of life are more likely to represent shunt lesions (atrial or ventricular septal defects, patent dictum arteriosus or peripheral pulmonary stenosis. - Murmurs identified after 1 year of age are typically benign.

Answer 10

Grade 3 or higher Holosystolic timing Maximum intensity at the left upper sternal border Harsh or blowing qualities Systolic click Diastolic murmur Increases in intensity with upright position Most benign murmurs decrease in intensity in the upright position Gallop rhythm Friction rub (Occurs with pericarditis)

Answer 11

Parent or sibling with congenital heart disease Abnormal prenatal ultrasound or fetal echocardiogram Age < 1 year old Symptoms of heart disease Abnormal vital signs Abnormal pulses Abnormal ECG

Answer 12

Most common congenital anomaly Risk Factors: - Prematurity, pregnant with multiples, in-utero infection with rubella or influenza, preeclampsia, phenylketonuria, diabetes, HTN, obesity, thyroid dysfunction, 40 years and older, alcohol or substance abuse, tobacco smoking in the first trimester, use of NSAIDs or lithium during pregnancy, family history of CHD. Presentation: - Early presentation usually involves symptoms of shock, cyanosis, and/or respiratory symptoms. - Late presentation may occur and usually presents with symptoms such as poor feeding, irritability, excessive sweating, poor weight gain and delayed milestones. Diagnosis: - Evidence shows that universal screening with pulse oximetry improves the detection of critical CHD and should be done after the first 24 hours of life, before discharge. - Positive screening test results: - SpO2 < 90% in either extremity. - SpO2 90 - 94% in both the right hand and a lower extremity on two to three measurements, each separated by one hour. - SpO2 difference >4% between the upper and lower extremities on two to three measurements, each separate by one hour. Treatment: - Infants with a positive pulse oximetry screening should have an echo and be referred to cardiology if CHD is identified on the echo or if clinical suspicion for CHD.

Answer 13

Streptococcus pneumonia is the most common cause for a typical bacterial pneumonia Presentation: - Bacterial pneumonia: Fever (>101.3), tachypnea, non-productive cough, malaise, anorexia, decrease in breath sounds or crackles. - Viral pneumonia: Gradual onset, preceded by URI symptoms (Nasal congestion), non toxic appearing, diffuse auscultation findings. Diagnosis: - Radiographs are not required for diagnosis, for mild cases of pneumonia that will be managed outpatient - Lack of tachypnea helps to rule out pneumonia Treatment for BACTERIAL PNEUMONIA: High dose amoxicillin (90mg/kg/day) Indications for hospitalization: - Presence of severe illness, confirming or excluding a pneumonia diagnosis when clinical findings are inconclusive, if the patient is hospitalized, if they have a history of recurrent pneumonia, excluding an alternative diagnosis and assessing for complications. - Hypoxemia, dehydration, signs of respiratory distress, toxic appearing, immunocompromised, failure of outpatient treatment - Signs of respiratory distress: Nasal flaring, intercostal retractions, head bobbing, abdominal breathing, tachypnea, decrease respirations.

Answer 14

Life shortening, autosomal recessive disease caused by mutations in the CFTR Gene Thick, viscous secretions accumulate in the lungs, pancreas, liver, intestines and reproductive tract. Presentation: - Productive cough, wheezing, or breathing difficulties, a meconium ileus (which is a blockage of the small intestine d/t an abnormally thick and sticky first meconium BM), failure to thrice. - CF patients often suffer from many health complications as a result of the build up of thick mucus through out the body. Diagnosis: - A: Symptoms consistent with CF, or a positive newborn screen, or patient has a sibilig who has CF. - B: Evidence of CFTR dysfunction by one of the following - Elevated sweat chloride test of >60 mmol/L (most important diagnostic test) - Presence of 2 disease causing mutations in the CFTR gene, one from each parental allele - Abnormal nasal potential difference Treatment: - Managed by CF specialist/Pulmonologist - CFTR Modulators - Chest physiotherapy

Answer 15

A respiratory illness that occurs from inflammation to the larynx and subglottic airway Presentation: - Inspiratory strider, cough (“bark-like”), and hoarseness - Generally viral, occurring mostly in children <6 years of age, however predominately between 6 months and 3 years of age. Diagnosis: - Made clinically in the presence of cough and strider Treatment: - Mild croup treated in clinical setting should be given a single dose of dexamethasone or prednisone - Moderate to severe croup should be managed in the ER (Stridor at rest, retraction, distress) - Nebulized epinephrine and a single dose of dexamethasone (Preferred glucocorticoid)

Answer 16

Presentation: - Cough and wheeze are the most common asthmatic symptoms in pediatrics. - Precipitating factors are animals, tobacco smoke, perfume, physical activity Diagnosis: - Symptoms of asthma and wheezing on exam strongly suggest asthma - Demonstration of reversible airflow obstruction, with spirometers after administration of a bronchodilator, confirms the diagnosis of asthma and helps define the severity of the disease. - FEV1/FVC <0.85 indicates airflow obstruction - Reversibility is indicated by an increase in FEV! Of 12% or greater (However, some studies suggest a smaller number of an 8% increase in FEV1 is a better indicator for children) - If unable to perform spirometers, appropriate to treat with asthma medications if patient has symptoms of asthma and evaluate for improvement.

Answer 17

Daytime symptoms < or = 2days/week without nocturnal waking. No interference with daily activities and 1 or less exacerbations treated with glucocorticoids per year. Treatment: - SABA PRN or Low-dose ICS whenever SABA is used

Answer 18

Daytime asthma symptoms 3 to 6 days a week, up to 4 nocturnal wakings per month / but not more than 1x a week, Minimal interference with daily activities and 2 or more exacerbations requiring glucocorticoids per year. Treatment: - Daily low-dose ICS with SABA PRN or - Daily low-dose ICS with a low-dose ICS anytime a SABA is used.

Answer 19

Daily symptoms of asthma, nocturnal wakings more than 1x a week but not every nights. Some limitations to normal activities and evidence of airway obstruction are not d/t an exacerbation (as evidence by an FEV1 between 60% - 80%) Treatment: - Daily lo-dose ICS-Formoterol as a reliever and maintenance therapy OR - Daily low-dose ICS-LABA with SABA PRN or - Daily medium dose ICS with SABA PRN

Answer 20

Severe asthma restricted by their symptoms, nightly wakings, FEV1 <60% Treatment: - Daily medium-dose ICS-Formoterol as reliever and maintenance therapy - Daily medium-dose ICS-LABA with SABA PRN or - Daily High-dose ICS with SABA PRN

Answer 21

Most cases occur in individuals who are younger than 2 years old (peak between 7 months to 13 months) Presentation: - 3 to 5 days of high fever - As the fever resolved a non pruritic, blanch able, macular/maculopapular rash develops - Rash typically begins on the neck and trunk and then spreads t o face and limbs Treatment: - Supportive case and manage fever ***Remember: RoSeola causes a super high fever, Secondary rash Starting on the Stem (neck) and Stomach before the Second year.

Answer 22

Complication of streptococcal tonsillopharyngitis Presentation: - The rash is diffusely erythematous and blanchable with popular elevations usually beginning in ancillary or pelvic region - Papular elevations may cause skin to have “sandpaper” quality - other symptoms include circumoral pallor and a strawberry tongue Treatment: - Antibiotics for strep infection and antipyretics for fevers

Answer 23

This viral exanthema normally affects school aged children, though adults can be affected Caused by the Parvovirus B19 Presentation: - Generally presents as a mild fever and nonspecific prodromal symptoms followed by a rash 2-5 days later that is often described as a “slapped cheek” rash - Several days after the “slapped cheek” rash develops a “lace-like” rash on the trunk and limbs ***Remember: Fifths disease = 5 fingers on a hand = slapped cheek rash***

Answer 24

Highly contagious virus Approximately 90% of susceptible indicates who have been exposed to measles with contract measles Person believed to be contagious from 5 days before the development of the rash and 4 days afterwards Presentation: - Prodrome includes 2 to 4 days of fatigue, cough, coryza and conjunctivitis - Rash typically presents 2 to 4 days after onset of fever and is an erythematous maculopapular rash - Rash typically begins on the head and spreads downward (cephalocaudally), palms and soles rarely involved. - Initially rash is blanchable, however at the end rash is not blanchable - “Koplik spots” are seen (small white/blueish/grayish dots) in the mouth approximately 48 hours before the rash appears Treatment: - Supportive - All children with acute measles may be treated with Vitamin ! As a deficiency in Vitamin A can delay recovery ***Remember: RuBeola = Bad virus, with Blueish/white Bumps on the Buccal mucosa, then rash Begins at the Ball cap (head)***

Answer 25

Any questions regarding vaccine administration - REFER TO CDC Administration of a vaccine 4 days before a dose is due is acceptable… >4 days before it is due is considered invalid Live vaccines must be either given on the same day or a minimum of 28 days apart No live vaccines before 12 months old, in pregnant patients or the immunocompromised (Varicella and MMR) Monitor minimum 15 minutes after administering a vaccine to observe for allergic reaction Egg allergy is NOT a contraindication to the influenza vaccine