pediatrics Flashcards
at what age is a fever of 100.4 most concerning?
less than 3 months
at what age is a fever of 100.4 most concerning?
HR starts ___ and gets ____ as a child grows
higher and gets lower
how to observe respiratory rate inkids
abdominal excursions, stethoscope in front of mouth, listen to chest
respiratory rate starts __ and gets ___ throughout childhood
higher and gets lwoer
blood pressure starts __ and gets __ throughout childhood
low and gets higher
when can we do a standing heigh for a kid?
> 2 years old
stuff to look for at 2 months:
Gross motor Holds head steady while sitting Raises head to 45 degrees prone Fine motor Grasps objects put in hand Hands to midline Social Social smile Language Cooing, vowel sounds “eh” Visual Fixes and follows
what age does pincer grasp start?
9 months
what age does stranger anxiety start?
9 months
when to start screening for lipids if family history?
5 years!
• Interruption of the normal progression of retinal vascularization
retinopathy of prematurity (premies at risk of retina not developing–need dilated fundoycopic exams0
weight, length (laying down) and head circumference
increased risk of ear infections
First episode at
stuff to look for at 2 months:
Gross motor Holds head steady while sitting Raises head to 45 degrees prone Fine motor Grasps objects put in hand Hands to midline Social Social smile Language Cooing, vowel sounds “eh” Visual Fixes and follows
what age does pincer grasp start?
9 months
what age does stranger anxiety start?
9 months
when to start screening for lipids if family history?
5 years!
• Interruption of the normal progression of retinal vascularization
retinopathy of prematurity (premies at risk of retina not developing–need dilated fundoycopic exams0
ddx of wheeze in kids
Functional • GERD • Cystic Fibrosis • Immune Def. • Vocal cord dysfunction • Aspiration • BPD • primary ciliary disease Chronic • Anatomic • Vascular compression • Cardiomegaly • Chronic lung disease • Congenital Heart disease Acute • asthma • Infectiousbronchiolitis • FB • Esophageal FB • Bacterial tracheitis • Anaphylaxis • Acute respiratory distress syndrome
increased risk of ear infections
First episode at
concomitant ear infection and conjunctivitis is usu d/t?
h flu, start amox/clav first
3 main RFs of CDH
female, first born, family history
what test do you use for a baby 4 mos old with suspected CDH?
US and look at angles, or can use barlow (disc locatable?) or ortolanis test (reducible?) also “fresh” position
• Insidious onset of limping and pain in groin, hip, thigh, knee regions in a kid makes you think of what?
perthes
ddx of limping in kid or pain in knee, groin, hip thigh
• perthes Transient synovitis • Osteonecrosis-septic arthritis • Sickle cell disease • Corticosteroid therapy • Skeletal dysplasias mucopolysaccharidoses
are SCFEs most often unilateral or bilateral?
usually unilateral but still get bilateral anyway b/c other things that can cause hip pain can be bilateral
causes of SCFE
- Weakened or compromised physis and physiologic forces and vice versa
- Endocrinopathies: thyroid, Growth hormone, hypogonadism, parathyroid hormone
- Renal osteodystrophy
- Prior radiation therapy
- Mechanical: obesity, increased femoral retroversion (angle of head of femur is toward spine, ours are usually anteverted or more angled toward front of body), decreased neck shaft angle, increased physeal obliquity
how long does genu varum (bow legged) last for? after that what do you work it up for?
usually 2 years, after that work up for Bone dysplasias, rickets, blounts disease
when do you become concerned about genu valgum (knocked knees)
after age 7
juvenile arthritis with poorest pg
systemic
work up of juvenile arthritis
multiple painful, swollen joints, ESR, CRP, RF, ANA
which marker for JIA is most associated with uveitis?
ANA
4 types of jIA
systemic, oligarticular, polyarticular (>5 joints), and seronegative (i..e reiters, etc)
ddx of cough in kids (not d/t lung disease)
- GERD
- Aspiraton d/t suck and swallow fcn
- CNS disease/hypotonia leading to GERD and/or aspiration
- Cardiac
- Psych/habit
- Anatomic
- Med induced (ACEI?)
ddx of stridor in kids
- Foreign body aspiration
- Anaphylaxis
- Viral induced (croup?)
- Post-intubation complications
- Retropharyngeal abscess
- Laryngomalacia (floppy larynx that doesn’t create tight seal)
- Tracheomalacia (trachea collapses)
- Inhalational injury
- Blunt tracheal disruption
- Epiglottitis?
which group of kids always gets antibiotics for ear infections?
which sinus is least likely to be infected in a 2 or 3 year old?which are most likely?
frontal, doesn’t develop until 3-9 years, ethmoid and maxillary develop earlier and are more likely
which disease has sx of: • Low grade fever • Malaise • HA • Myalgias • Anorexia • Parotitis and potential complications of • Meningitis • Encephalitis • Orchitis
mumps
what physical exam techniques do you need to do for pediatric cardiology every time?
mumur pulses (ue AND le) BP HR location of pMI newborn pulse ox screen growth pattern other abnormalities: cyanosis, retractions, clubbing, diaphoresis, mottling,
types of q
Atrial septal defect Ventricular septal defect Patent ductus arteriosus Coarctation of the Aorta Tetralogy of Fallot Ebstein’s Anomaly Hypoplastic Left Heart Syndrome Atrioventricular Septal Defect Transposition of the Great Arteries Vascular Ring
what will the EKG of an ASD show?
Right axis deviation, right ventricular hypertrophy +/- RBBB
what complications can develop from a ASD/
CVA (stroke), untx’d adults: pulm HOTN, CHF and RV dysfcn
harsh holocystic murmur at LLSB +/- thrill means what?
ventricular septal defect (both small and moderate)
what kind of sx can occur with moderate to large
Sx of CHF at 6-8 wks: tachypnea, poor feeding/weight gain, sweating, irritability, hepatomegaly, increased pulmonary infections
what is diagnostic for congenital heart disease?
echocardiogram
what can an EKG show in VSD?
normal (small VSD), LVH, or BVH
what can CXR show in VSD/
cardiomegaly, increased pulmonary vascular markings, enlarged MPA shadow
Postnatal communication between main pulmonary trunk & descending aorta
patent ductus arteriosis
what is a very common heart problem in premature babies?
80% have patent ductus arteriorsis
continuous systolic “machinery” murmur heard at LUSB/left infraclavicular area +/- thrill +/- apical diastolic rumble
patent ductus arteriorsis
tx of pPDA in preterm babies
indomethacin (prostaglandin inhibitor)
tx of PDA in term babies
surgery (ligation +/- division), cath lab (device closure)
Narrowing of aortic arch, usually at ductal insertion (juxtaductal)
coarctation of aorta
what syndromes are assoc with coarc of aorta?
turner syndrome and trisomy 13 and 18
Systolic ejection murmur left sternal border (absent in 50%), > in back (left subscapular area)
Thrill in suprasternal notch
Ejection click (if bicuspid AV or hypertension)
Diminished/absent peripheral pulses (LE)
Hypertension (UE)
CHF: Hepatomegaly, gallop
coarctation of the aorta
in a neonate:
Diminished lower body perfusion as PDA closes
Signs of shock (severe acidosis, renal/hepatic failure, NEC, death)
infant: tachypnea, heart failure, FTT
coarc of aorta
which disease? EKG: LVH in children, normal, RBBB
CXR: “rib notching” (rare
coarc of aorta
treatment of critical coA
keep PDA open with prostaglandins
what do these four criteria indicate? Ventricular Septal Defect 2.Pulmonary Stenosis (Subvalvar, Valvar, Supravalvar) Infundibular stenosis 45% Infundibular + PV stenosis 30% Pulmonary atresia 10% 3.Right Ventricular Hypertrophy 4.Overriding Aorta
tetralogy of fallot
signs and sx of tetralogy of fallot
murmur of VSD and PS, pulmonary stenosis: cyanosis
which dx? EKG: RAD, RVH CXR: boot shaped heart (main PA segment has an upturned apex)
tetralogy of ballot
Downward displacement of septal & posterior leaflets of TV into RV cavity (portion of RV is incorporated into RA) (atrialized RV)
ebstein’s anomaly
most frequent syndrome causing CHD
down syndrome
tx of hypertrophic cardiomyopathy?
Tx: Beta-blocker 1st line, surgery if severe (septal myotomy), ICD placement, avoid strenuous exercise, screen family, transplant
lymes disease can present as what kind of heart problem?
AV block
causes of sudden cardiac death in kids
Coronary abnormalities (anomalous origin, aneurysm-Kawasaki’s disease), arrhythmia, myocarditis, HCM, Long QT syndrome
challenges in pediatric prescribin
lack of adequate studies or suitable pediatric dosage forms, optimal dose is hard to know, adherence is hard
neonates don’t feel pain T or F
F: they may feel it even more
T or F: distraction is better with painful procedures than empathy or reassuranc
T!
black box warning in pedaitrics
no codeine or tramadol after tonsillectomy or adenoidectomy because of risk of OSA and higher breathing problems
which pain killer is best to use for tonsillectomy or adenoidectomy?
morphine
which ethnicities are more likely to be ultra rapid metabolizers of codeine, tramadol, hydrocodone and oxycodone?
n. african and arabs (30% are ultra rapid metabolizers) and 5% of AA and whites
what should be noted about how pediatric drugs are dose?
mg/kg and look closely for PER DAY OR PER DOSE
how should a drug be dosed for a child
weight based
how should a drug be dosed for children >40 kg?
weight based unless patients dose >adult dose or specific medication labeling notes a diff dose max for kids
ways to reduce dosing errors in kids
Always double-check calculations
Computerized dose checking programs can reduce errors
Always use a leading zero before a decimal point (0.1 vs .1)
Never use a trailing zero after a decimal point (1 vs. 1.0)
Use current reference books
Use a small personal formulary
Include use for drug on prescription
medications that taste good
Ceclor, Suprax, Lorabid, Omnicef, Cefzil taste pretty good
medications that taste bad
Prednisone intensol, dicloxacillin, KCl, Biaxin, Vantin taste pretty bad
identifying measles
koplik spots and rash while fever, rash coalesces
identifying rubella
tender LAD, low grade fever, swollen glands, discreet pink spots that don’t coalesce
identifying roseola
under 2, high fever that stops and rash breaks out, mildly maculopapualr
identifying erythema infectiosum
elementary schooler,
what is tx for inguinal hernias in babies/
ALWAYS SURGERY
what is tx for umbilical hernia?
reduce it, reassure it most likely goes away
what else can get trapped in hernias in babies?
ovaries, intestines, etc
red, moist thing in belly button of baby is what? how do you treat it?
umbilical granuloma. treat topically with silver nitrate, unless really big then can do surgery
• Embryologic connection to urinary bladder from umbilicus
urachus
baby presents with vomiting, abdominal distention (bowel obstruction) but has no signs of incarcerated hernia. what do you think of?
patent omphalomesenteric duct
meckel’s diverticulum rule of 2s
- 2% of population
- 2 years, age at common presentation
- 2 feet from ileocecal valve(ileum)
- 2 inches long
3 ways a meckel’s diverticulum can present or cause problems
bleeding, obstruction, diverticulitis
Bleeding per rectum (>1/3)- Dark red blood, painless, decrease hemoglobin substantially, what do you think of?
bleeding meckel’s diverticulum from heterotypic gastric mucosa that is causing ulceration into blood vessels
what condition can cause peritonitis and bowel pain and can look like appendicitis?
meckel’s diverticulitis
what do these sx make you think of? • Cramping episodes, pulling up the legs
• Interspersed lethargy, Vomiting
• Bloody mucoid stools - “currant jelly”-
intussusception
tx of intussusception
hydrostatic/pneumatic reduction by radiologist
• Concentric hypertrophy of pyloric muscle
pyloric stenosis
string sign or palpable “olive” in epigastric region makes you think of?
pyloric stenosis
lump at level of hyoid cartilage makes you think of what?
thyroglossal duct cysts
• Anterior border sternocleidomastoid muscle +/- hole or drainge in neck of kids makes you think of?
branchial cleft cyst
• Fibrotic mass in midportion of sternocleidomastoid and turning of neck
torticollis
soft spongy cystic ballotable mass in kids
lymphangioma
if a baby is born with down syndrome what do you want to do?
get a karyotype–if d/t translocation that has huge repercussions for reproduction of parents
gold standard test for newborns with CF: what result does it show?
sweat test: elevated chloride is diagnostic
is pulm disease and pancreatic insufficiency leading to malnutrition and FTT is suggestive of what?
cystic fibrosis
if a newborn has a positive CF screen, does that mean they have CF?
no–it could be just a carrier–send off for sweat test
if newborn has negative CF test does that mean they don’t have CF?
no–it could be the mutation they have is not covered in the panel
history questions for diarreha
- Ask- how many times?
- Color?
- Watery? blood; mucus?
history qs for vomiting
- How many episodes?
- Last time?
- Fluids since then? • Related to foods?
- Forceful? (key element) Color? Yellow is stomach secretions, green is bile (farther down obstruction) Blood?
- Smell? feces smell means even lower blockage
- Still drinking?
- How’s he acting?
- Apparent pain? • Urinary changes?
- Cough/cold symptoms?
- Fever? Rash?
- Ill contacts? Day care? Water source, food source?
- Recent travel or “just got off the boat”?
- Lots of antibiotics recently? C. diff
- Past medical history: “normal” child? Or, chronic GI issues? UTIs? •
PMH, SX, FMHX, ETC for kids with vomiting
ROS: not as important in this case. Sore throat? Scrotal swelling? Swellings of extremities? Skin pallor? Decreased mental status?
• Social history: not as important here. Many office/ED visits?
• Family history: not as important here. In infant, pyloric stenosis, In older child: appendicitis, IBD, celiac disease
life threatening causes of vomiting by age
- Newborn: anatomic problems, central nervous system infection, inborn errors of metabolism
- Older infant: obstruction (intussusception, pyloric stenosis, incarcerated hernia, malrotation with volvulus), gastroenteritis with dehydration, occult head trauma
- Older child: GI (intussusception, appendicitis), neurologic (mass lesions), renal (uremia), infectious, metabolic (DKA, adrenal insufficiency, inborn errors), toxins/drugs
definition of severe dehydration in kids (by weight)
• 15% loss of weight in infant, 9% loss in older child
most dehydration is usually isotonic, isonatremic T or F?
T
why are children more susceptible to dehydration than adults?
- The smaller the child, the more susceptible- Higher surface area-to-volume ratio
- Higher metabolic rate • Behavioral: “won’t drink”
- Depend on adults for care
are most cases of gastroenteritis viral or bacterial/
viral
in which case do you suspect salmonella in gastroenteritis?
food born outbreaks
in which case do you suspect s type in gastroenteritis?
typhoid fever
in which case do you suspect shigella in gastroenteritis?
usually mild; if severe, causes fever, abdominal pain, stools with blood and mucus; toxin may irritate CNS, seizures possible; antibiotic treatment is recommended
in which case do you suspect yersinia and campylobacter in gastroenteritis?
abdominal pain prominent
in which case do you suspect c diff in gastroenteritis?
pseudomembranous colitis; associated with antibiotic use
what are the results of hemolytic uremic syndrome from e coli 0157:h7?
hemolytic anemia, thrombocytopenia, acute renal failure; usually in children under 5 y/o
signs of bacterial infection in gastroenteritis
- More than 10 stools/day or more than 4 days diarrhea
- Blood in stool
- Temp 39.5
- Clinical toxicity
- PMNs in stool
• Antibiotics in E coli O157:H7 might increase incidence of what?
HUS
approach to vomiting and diarrhea–questions to ask?
- Does vomiting OR diarrhea predominate?
- What age and sex is the child?
- Is pain a significant part?
- Fever or other systemic sx?
- Blood?
- On exam, degree of dehydration and toxicity
what should topical abx always be used with to avoid resistance when txing acne?
BPO
cause of infantile acne, tx
maternal androgens. can do BPO. reassure.
identifying miliaria rubra, tx
covered areas, flexural areas. papules/vesicles on erythematous base. reassure. avoid over clothing
identiyfing milia, tx
white or yellow (sebaceous) bumps on newborn. really common. superficial epithelial cysts. reassure.
identifying erythema toxicum, tx
local immune response to new skin flora (most likely) 50% of newborns have it in first 24-48 hours. reassure
how do you distinguish between irritant and candidate diaper rashes?
irritant will have flaky confluent erythema and will not be in intertriginous areas, candidate will be in intertriginous areas and will have satellite lesions
distinguishing points of measles
starts on face, starts with prodrome persisting through rash, dark and red rash that coalesces, koplik spots
distinguishing rubella from measles
both start on face, though rash of rubella does not coalesce (is more discreet) isn’t as red as measles, and the kid doesn’t look as sick. it also spreads faster than measles and can have arthralgia.also + tender LAD
distinguishing roseola from other rashes
starts with high fever that goes away then rash. rash usually ends up mostly on trunk. coalescing pink maculopapules. kid will be happy. no URI. also kids will usually be under 2.
distinguishing erythema infectious from other diseases
“slapped cheeks’ + mild URI. cheeks distinguishes from measles and rubella, URI distinguishes from roseola + lack of high fever.+ lacy appearance on rest of body also adults may have arthralgia. and rash can recur with stimuli like sunlight.
virus in erythema infectiosum
parvovirus b19
can kids with erythema infectious go back to daycare?
yes, not contagious once rash starts.
sandpaper rash after strep throat that looks like a sunburn
scarlet fever
features of down syndrome
(1)Dysmorphic features •Upslanting palpebral fissures • Epicanthal folds • Flatnasalbridge • Low set small ears • Brachycephaly • Protruding tongue • Short neck/excessive skin at back of neck • Short stature (2) Extremities • Short broad hands • Curved fifth finger • Transverse palmar crease (single) • Sandal gap (wide space between first & second toes • Hypermobile joints CHD, VISION AND HEARING LOSS, LEUKEMIA, IMMUNODEFICIENCY, ENDOCRINE, INTELLECTUAL DISABILITY AND GI probs
required test to confirm down syndrome
karyotype
which congenital genetic disorder i x linked dominant?
fragile x syndrome
gene of fragile x syndrome, what goes wrong?
FMR1, CGG repeats
if someone comes in with new onset tremor or ataxia, or premature ovarian insufficiency what should you consider in your ddx?
fragile x syndrome carrier
tx of fragile x syndrome
tx of mental health issues
autosomal dominant syndrome with CHD, bleeding problems, delayed puberty and vision and hearing problems
noonan syndrome
causes of spina bifida
folate deficiency, AEDs, genetics
disorder of motor or postural abnormalities noted during development
cerebral palsy
is familial CP common or uncommon?
uncommon
sx of CP
low muscle tone, muscle spassms/stiff, feeding/swallowing difficulties, delayed mile stones, late to walk or speech
T OR F there is great variability between adolescents
T!
average age of height spurt for girls and guys
guys 11-13.5, girls 9-12
characteristics of psychosocial development for 10-14 yo
rapid growth, concerns about deviations from normal, curiosity about sexuality, reliant on friends, independence/dependence struggle
characteristics of psychosocial development for 15-17 yo
less precipitation with physical changes, formal operational thinking, less family influence, highly influenced by peer subculture
characteristics of psychosocial development for 18-21 yo
emotional stability, individuality, willing to seek parental advice, formalized sense of values, perspecgive
important points of adolescent history taking: HEADSSS
home, education/employment, activities, drugs/etoh/tobacco, sexuality, suicide, safety
anticipatory guidleines for parents of teens; PANTSED
physical changes, alcohol/drugs/substances, need for privacy, talk, sex, emotional changes, diet/exercise
causes of ADHD
genetics, environmental :lead, etoh, tobacco, diet, nutritional deficiencies, Parenting and Society
• Fast paced, high stimulus
• Instant gratification
components of ADHD diagnosis
- Symptoms lasting at least 6 months
- Impairment in two or more settings
- Significant impairment in social, academic, and occupational functioning all need to be affected • Some of symptoms present before age of 12- changed from age 7, more accurate for adult diagnosis, adults with new onset sx prob not ADHD
- Symptoms not due to another mental disorder or oppositional behavior or failure to understand tasks or instructions
- Has 6 or more of either Inattentive or Hyperactive-Impulsive symptoms
examples of inattention sx
Six (or more) of the following symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level (for individuals ≥ 17 only 5 symptoms needed):
• Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
• Often has difficulty sustaining attention in tasks or play activities need to not be able to pay attention in all areas whether you like it or not
• Often does not seem to listen when spoken to directly
• Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
• Often has difficulty organizing tasks and activities • Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
• Often loses things necessary for tasks or activities (eg, toys, school assignments, pencils, books, or tools)
• Is often easily distracted by extraneous stimuli
• Is often forgetful in daily activities
when is inattentive type of ADHD usually diagnosed?
9-10 (later b/c not causing behavioral problems in class)
ddx of ADHD
Developmental
• Normal variation
• ASD
• Giftedness
• Learning disorders Emotional/Behavioral
• Mood disorders
• Anxiety (PTSD or OCD)
• ODD
• Conduct disorder Environmental
• Child abuse/neglect- not completing homework
• Poor parenting
• Sociocultural differences
• Inappropriate school setting
Medical
• Fetal Alcohol Syndrome negative response to stimulant
• Fragile X
• Lead Poisoning
• Neurodegenerative d/o • Tourette syndrome
• Iron deficiency anemia
• Thyroid abnormalities
• Diabetes mellitus • Substance abuse- in older children and adults
• Medication side effects: Bronchodilators, Corticosteroids, Neuroleptics, isoniazid
what is req’d for a dx of ADHD?
meeting DSM-V criteria, must be verified by parents and teachers, need to assess for coexisting conditions
2 categories of drugs for ADHD
methylphenidate (ritalin and concerta) and amphetamines (dexedrine and vyvanse, adderall)
does autism cause intellectual disability?
no–they go together but they are separate entities
etiology and risks of autism
etiology: no one knows, vaccinations don’t cause it
risks: • Very nonspecific
• Older parental age
• Low birth weight
• Fetal exposure to Depakote only specific med that shows slight increase, don’t know why this is yet
early characteristics of autism
may appear deaf–doesn’t turn when you enter room, may seldom cry, or may be really fussy, fussy eater, no anticipatory response, avoids looking at people, tunes out, delayed speech, doesn’t like changes, don’t imitate friends or peers, sensory sensitivity
when are medications appropriate for autism?
for sx of − Aggression
− Hyperactivity and inattention may have ADHD but can’t tx it the same way
− Behavioral rigidity
− Perseveration and/or stereotyped behaviors
− Depression and/or anxiety
Is an isolated hydrocele or one with a communicating hernia most likely to persist?
one with a communicating hernia, isolated hydroceles are more likely to spontaneously reduce
tx of a hernia and hydrocele in infant
hernia: always needs surgery: elective if reducible and immediate if incarcerated; hydrocele wait to see if spontaneously resolves after 1 year and if it doesn’t then surgery b/c most likely
do umbilical hernias usually incarcerate?
no–just observe, may take years
what does this make you think of: substantial drainage of meconium from belly button + visible sinus. how to treat?
patent omphalomesenteric duct: tx with surgery
patent urachus
connection between umbilicus and urinary bladder, may be filled with fluid or may be flat with a hole in it: needs surgery
rule of 2s for meckel’s diverticulum (remnant of omphalomesenteric duct)
- 2% of population
- 2 years, age at common presentation
- 2 feet proximal to ileocecal valve(ileum)
- 2 inches long
what portions of intestines are involved in most intussusception cases
ileo-colic
projective vomiting, non bilious in a 3-6 wk yo
pyloric stenosis
what areas are rare to have bruises on for kids?
upper arms, genitalia, trunk, face, buttocks, ears, neck
currant jelly + cramping and vomiting makes you think of what?
intussusception
tx of intussusception
hydrostatic/pneumatic reduction/enema
palpable “olive’ and string sign mean what?
pyloric stenosis
Vasculitis of unknown etiology in kids
kawasakis disease
dx of kawasakis must include?
fever for 5 days + 4/5: changes in extremities, rash, oropharyngeal changes, bulbar conjuctival injection, cervical lymphadenopathy
coronary artery aneursym in kid on echo makes you think of what?
kawaskaki’s dz
immunoglobulin A deposition
dz
HSP
most common cause of acute renal failure in young children
HUS
Classic triad of what dz?
Microangiopathic hemolytic anemia
Thrombocytopenia
Renal insufficiency/injury
HUS
when a kid has UTI, what cause do you have to think about?
vesicoureteral reflux
how can we try to prevent vesicoureteral reflux?
prenatal ultrasounds looking for hydronephrosis
UTI sx in kids
Clinical symptoms: fever, vomiting, diarrhea, irritability, poor feeding, jaundice (nonspecific findings)
Failure to Thrive
Malodorous urine
Fever without source (5% have UTI) UA part of any fever work up
what test should be done in everyone
voiding cystourethrogram or radionuclide cystogram
T OR F: you should work up every kid with UTI
T!
indications for sending kids to pediatric trauma center
Multi-system trauma Unstable vital signs NEVER reassure yourself that their abnml vital sign (HR) is b/c they are crying Axial skeleton # Neurovascular injury Acute cord injury Complicated TBI Low trauma score
signs of hypoxemia in kids
Cyanosis
Agitation
Poor capillary refill fingers, head, neck
Bradycardia esp bad if started tachy then went brady—about to go into respiratory arrest, may still have to start compressions even if really low but not gone
Desaturation measured by pulse oximetry
Signs of inadequate ventilation
Stridor (croup? Epiglottitis?) or wheezing (asthma?)
Tachypnea not normal
Nasal flaring
Grunting
Retractions
indications for CT scan in kids
abdominal tenderness abdominal distention abdominal bruising hematuria vomiting, neurologic obtundation falling or low hematocrit absent bowel sounds
