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Oral Boards > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Pressors

A

Dopamine if poor perfusion

Cold shock (hypotensive and vasocontricted) = epinephrine

Warm shock (hypotensive and vasodilator) = norepinephrine (levophed)

If catecholamine resistant = hydrocortisone

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2
Q

Intubation

A

Avoid etomidate in sepsis (adrenal insufficiency)

Have atropine available for bradycardia and secretions
PALS recommends everyone under 1 year gets atropine

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3
Q

PALS

A

Reversible causes of asystole/PEA

2-4 J/K in VT/VF

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4
Q

Jaundice

A 
Physiologic (2-3 days)
Breastfeeding (relative dehydration)
Breast Milk (inhibitor of bili conjugation)
Infection
Hemolysis

Bad = first 24h or conjugated biliribuin

Bilirubin nomogram

Tx = phototherapy, exchange transfusion

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5
Q

Crying Infant

A 
Hair Tourniquettes
Infection
Corneal abrasion
Testicular torsion
Nonaccidental Trauma (Frenulum)
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6
Q

Crashing neonate

A 
Sepsis
Cardiac 
Metabolic (check ammonia)
GI catastrophe (NEC, bilious vomiting)
NAT
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7
Q

Hypoglycemia

A

Rule of 50

D10W 5cc/kg neontes
D25W 2cc/kg young kids
D50W 1cc/kg older

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8
Q

Fever abx for neonates

A

Ampicillin/Cefotaxime (or Gent)
>1 month rocephin
Acyclovir
Vancomycin for UTI or sepsis

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9
Q

Pneumonia

A

Neonates: GBS, Listeria, Chalmydia, G- enterics
ABX: Tx for sepsis!

Infants/Toddlers: Viral, Strep pneumo, Haemophalus, Staph, atypicals, pertussis
ABX: Amoxicillin (high doses)

> 4-5 yrs: Mycoplasma
ABX: Macrolides

Afebile staccato cough = chlamydia, zithromax

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10
Q

Otitis Media

A

Treat if bilateral or >48h
High dose Amoxicillin

Augmentin if recent infection or associated bilateral conjunctivitis (H-flu)

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11
Q

Congenital Heart Disease

A

Bimodal, neonate (ductal dependent) and 2-6 months (CHF)

Ductal dependent
1. pulmonary blood flow = cyanosis/hypoxic
2. systemic blood flow = shock/acidotic
Tx = PGE 1 (intubate, MC side effect = apnea)
TRANSFER!!!

CHF = respiratory symptoms, looks like asthma, difficulty feeding, hepatomegaly

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12
Q

Arrythmias

A

SVT (>220 infant, >180 child)

Vagals (ice to face)

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13
Q

Acquired heart disease

A 
Myocarditis 
Pericarditis
Endocarditis
Kawasaki
Cardiomyopathy
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14
Q

Peds EKG

A

R heart dominant at birth
HR faster
Intervals shorter

Normal to have TWI in V1-3

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15
Q

Croup

A

Middle of night barky cough and respiratory distress

Steroids, single dose dexamethasone

If severe, epi neb (watch x2h)

DDx = bacterial tracheitis if sick appearing and no improvement with tax’s

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16
Q

Bronchiolitis

A

Suctioning, O2, PPV if needed

Maybe albuterol, hypertonic saline nebs, epi nebs

No role for steroids or abx

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17
Q

Status Epilepticus

A

FSBS? Check frequently - can become hypoglycemic

Benzo’s (0.1 mg/kg)

Dilantin/Cerebyx, Phenobarbitol, Keppra
(all 20 mg/kg)
Dilantin if >2 yo (20 mg/kg)

Secure airway if refractory
Versed, propofol, ketamine, pentobarbitol

Causes?
Hypoglycemia
Hyponatremia
Hypocalcemia (DiGeorge)
INH toxicity (Pyridoxine)
18
Q

Febrile Seizures

A

Simple:
6 months - 6 years
15 min, focal, or recur in 24h

19
Q

AMS

A 
FSBS
Low threshold to tx infection
Tox?
NAT
Intussusception
20
Q

Stroke in kids

A

50% hemorrhagic

Risk factors:
Infection
Arteriopathies
Cardiac disease
Hematologic disease (sickle cell - exchange transfusion)
Drugs
Chemo/rads

Management: controversial, officially don’t use TPA in kids

21
Q

Peds DKA

A

Less fluid resuscitation!
Cerebral edema

10mg/kg bolus over 1 hour
2nd bolus over hour 2 if circulation compromised
1.5-2x maintenance fluids

Have mannitol at bedside

Risk factors for cerebral edema:
Age
First time episode
Degree of acidosis

22
Q

Congenital Adrenal Hyperplasia

A

Hyperkalemic, Hyponatremic, Hypoglycemic

N/V/D
Arrythmias (due to elevated K)
Hypoglycemia can cause seizures

IVF, glucose, hydrocortisone

23
Q

Inborn Errors of Metabolism

A

Enzyme deficiency leads to toxic metabolite

Metabolic Acidosis
Hypoglycemia
**Hyperammonemia

Supportive, make NPO
Replete glucose
Control seizures
Correct electrolyte abnormalities

Tx for sepsis, these are higher risk

24
Q

Bilious Vomiting

A

Surgical emergency

Malrotation with midgut volvulus until proven otherwise

Call surgery, if stable may get upper GI as well.

25
Q

Hirschsprung’s Disease

A

No meconium in neonates

Lesser form: Infants/children with chronic constipation

26
Q

Pyloric Stenosis

A

Hypertrophy of gastric outlet, hungry but vomiting

US diagnostic
Olive mass at epigastrium

Correct dehydration or metabolic deficiency

27
Q

Intussusception

A

Abdominal pain
Palpable sausage mass
Red currant jelly stool

Lethargy, N/V, paroxysms of pain

3 months - 2 years
Surgical emergency

Diagnosed with US or air/barium enema (dx and therapeutic, but perf risk)

10% recurrence, usually early

28
Q

Meckel’s Diverticulum

A

Painless rectal bleeding

Can be nidus for volvulus or intussusception

29
Q

Hemolytic Uremic Syndrome

A 
Follows diarrhea (Ecoli, bloody)
Abx with bloody diarrhea increase risk of HUS

Acute Renal Failure
Thrombocytopenia
MAHA (schistocytes)

If neuro findings as well consider TTP

Tx = supportive, dialysis

30
Q

Leukemia

A 
Presents like viral syndrome
Fever
Petechiae
Bone pain, limp
HSM
Lymphadenopathy
31
Q

Lymphoma

A 
Night sweats
Fever
Pruritis
Respiratory distress (if mediastinal mass)
Lymphadenopathy
32
Q

Limping Kids

A

Fracture

Discitis

Abdominal pain

Transient Synovitis

Septic Joint (fever, elevated CRP/ESR/WBC, effusion on XR/US, decreased ROM)

AVN (Legg-Calve-Perthes) - NWB

SCFE - frog leg view, chubby 13 year old, Klein’s line - NWB

Malignancy

Arthritis (ANA&raquo_space; RF)

Apophysitis (overuse injuries)

33
Q

Nonaccidental Trauma

A 
Posterior rib fractures
Multiple injuries
Skull fractures
Serious injuries
Recurrent visits
Metaphyseal lesions (bucket fractures)
Frenulum tears
34
Q

5th’s disease

A

Parvovirus B19, slapped cheek

Worry in pregnancy (hydrops) and sickle cell (aplastic crisis)

35
Q

Varicella

A

Vesicles in different stages = varicella
Acyclovir, VZIG
Can happen in vaccinated kids

36
Q

Scarlet Fever

A

Scarlet Fever - pastia’s line, sandpaper, strawberry tongue, desquamation (toxin mediated)

37
Q

Staph Scaled Skin

A

Desquamination
More well defined than TEN
ABx
Nikolsky positive

38
Q

Henoch Schonlein Purpura

A

Palpable Purpura (dependent, symmetric, edema)
Arthritis/Arthralgias (>50%)
Abdominal pain (can lead to intussusception)
Renal disease

If normal urine dip can f/u outpatient with kids, all adults should have Cr checked as well

Supportive tx with NSAIDs

39
Q

Erythema Multiforme

A

Minor = no mucosal involvement

Major = mucosal involvement

Negative Nikolsky sign

90% a/w infection (HSV usually)

Symptomatic tx

40
Q

Stevens Jonhsons Syndrome

A

Postive Nikolsky

On TEN spectrum

Prior abx usually

Mucous membrane involvement

IVF, supportive care

41
Q

Kawasaki

A

5 days of fever PLUS 4/5 criteria

Mucosal changes
Conjunctivitis
Extremity changes
Cervical LAD
Polymorphous rash

ASA, IVIG
Concern for coronary artery aneurysm

42
Q

Neonatal Resuscitation

A

PPV if HR under 100
Compressions if HR under 60

120 bpm if intubated
Otherwise 3:1 with thumb compressions

With hold support if under 23wks or 400g

DC if after 10 min with no HR

Oral Boards (6 decks)

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