Pediatrics Flashcards
Management of HR <100bpm at 1 minute of life
PPV
NOTE: if hr<60, cardiac problem –> initiate CPR
APGAR scores
7-10 good
<7 bad
Appearance Pulse Grimace Activity Respirations
Transient tachypneic of the new born
most often seen in term babies delivered by c-section
CXR: lungs hyperextended and wet
Tx with ppv
spO2 goals at 0 minutes, 1 and 5 minutes
0: 60-65% (stimulate to overcome primary apnea)
1: 80-85%
5: 90-95%
Pneumatosis intestinalis =
necrotizing enterocolitis
NEC: TX
NPO, IV antibx
VACTERL
Vetebrak anomolies Anus (imperforate) dx on cross table xray Cardiac TE fistula Esophageal atresia Renal Limb hypoplasia
US sacrum, Echo, catheter xray, voiding cystourethrogram
Meconium ileus: TX
Diagnostic and therapeutic water enema
Malrotation vs duodenal atresia: imaging findings
Malrotation: xray showing double bubble and air distally (there has been time to swallow air)
Duodenal atresia: double bubble with no air
Double bubble d/os
duodenal atresia
annular pancreas
malrotation–>volvulous
NOTE: all cause bilious emesis
Double bubble d/os that are associated with downs
duodenal atresia
annular pancreas
Pyloric stenosis: Dx and Tx
Dx with US showing donut sign
get CMP (to find hypochloremic, hypokalemic metabolic alkylosis) and create electrolyte abnormalities before performing pyelorectomy
Physiologic vs pathologic jaundice
physiologic: onset after 72hrs, resolves w/in 2 weeks, unconj bili, rises <5/day
pathologic: onset w/in first day, resolves w/in 2 weeks, conj bili, rises >5/day
Work-up of physiologic jaundice
get coombs test:
if positive, mom was isoimmunized
if negative, get Hgb:
if Hgb low, cephalotoma
if high, twin-twin trasnfusion a possibility in multiple gestation
if normal, get reticulocyte count
If retic normal, breast milk or breast milk jaundice
Breast feeding vs breast milk jaundice
Breast feeding: product of not enough PO and bowl hypomotility
Breast milk: breast milk has enzyme that inhibits conjugation, give hydrolyzed formula
Baby with scaphoid abdomen and bowel in chest on xray
diaphragmatic hernia
NOTE: associated with hypoplastic lung
Hypospadia:associations
cryptochidism and inguinal hernias
Epispadia: associations
opening on dorsal surface
urinary incontinence and bladder exstrophy
Boot-shaped heart and decreased pulmonary vascular markings on CXR of child
tetrology of fallot
CXR of infant showing an egg on a string =
transposition
CXR of child showing globular-shaped heart with pulmonary edema =
hypoplastic left heart syndrome
CHARGE syndrome
Coloboma of the eye, CNS abnormalities Heart defects Atresia of the choanae Retardation of growth and/or development Genital or urinary defects (hypogonadism) Ear anomolies or deafness
Congenital defects associated with Downs syndrome
hirschsprung disease
imperforate anus
duodenal atresia
Prolonged QT: PPX
beta blockers with pacemaker placement
Postural neck deformity that presents with a sternocleidomastoid muscle mass, ipsilateral head tilt, and contralateral chin deviation =
congenital muscular torticollis
Congenital muscular torticollis: risk factors and tx
risk factors: multiple gesteation, breech position, oligohydraminos
Tx: increased tummy time, passive stretching, and PT. AVOID positional plagiocephally
Best initial diagnostic testing for laryngomalacia
direct laryngoscopy showing collapse of the supraglottic structures
TX severe hypovolemic hypernatremia in peds
0.9% saline
triple bubble sign and gasless colon =
jejunal atresia
Bilious vomiting and abdominal distension in newborn of mom who used cocaine
jejunal atresia
Specific test for lead toxicity
venous blood draw (can confirm positive capillary blood specimen)
Measles: transmission
airborne
Measles: clinical presentation
prodrome: cough, coryza, conjunctivitis, fever, koplik spots
Maculopapular exanthem: cephalocaudal and centrifugal spread, spares palsms and soles
NOTE: watch out for subacute sclerosing panencephalitis
Mullerian agenesis: clinical features
Karyotype: 46, XX
breast development, axillary and pubic hair, ovariess
No uterus or upper vagina
Doll-like face, thin extremities, short stature, hypoglycemia, lactic acidosis, and hyperlipidemia
glucose-6-phosphatase deficiency (type 1 glycogen storage disease, von Gierke)
Riboflavin deficiency
angular cheilitis stomatitis glossitis normocytic-normochromic anemia seborrheic dermatitis (erythematous scaly patchs on eyebrows, cheeks, and nose)
Nephrotic syndrome associated with what virus?
hep B
Roseola: clinical presentation
prodrome: high-spiking fever (over 104), which breaks when rash arises
Rash moves from trunk out
NOTE: watch out for febrile seizures
Rubella: clinical presentatio
Prodrome of generalized tender LDN (UNLIKE measles)
fever and rash (like measles)
rash moves cephalocaudal and centrifugal, does not involve palms and soles
Mumps: clinical presentation
pubertal male with parotid swelling and orchitis
Can lead to infertility
Hand, foot, mouth: clinical presentation
varicella zoster-like vesicles on hands, feet, and mouth
Meningitis: Tx peds vs adult
peds (kids less than 30 days): vancomycin, cefotoxine (bili doesnt get as high with this), ampicillin (covers listeria), steroids
adult: vanc, ceftriaxone, steroid
Polyps, pale/boggy mucosa, and cobblestonning
allergic rhinitus
Allergic rhinitus: TX
internasal steroids
Kid being fed with soy formula with FTT and a bloody bowel movement
Milk protein allergy
Conjunctivitis: TX
H2 blockers and leukotriene antagonists
Otitis media: pathogens
strep, H flu, moraxella
Otitis media: TX
1st time: amoxicillin
2nd time: amox-clav
if 3x/6months or 4x in a year: consider myringotomy
Otitis media vs externa
media: infection of middle ear (with URI bugs like strep)
externa: infection of outer ear and canal (with pseudomonas or staph)
Otitis externa: TX
Cipro and steroid drops
Air fluid levels on head xray and opacification on CT
bacterial sinusitis
TX indications for amox-clav in sinusitis
worsening OR 10days OR fever
Imaging for recurrent sinusitic
CT
CENTOR criteria for GAS
No Cough Exudates Nodes (anterior LDN) Temp (fever) OR age <14 (+1), older 44 (-1)
<1 viral, symptomatic tx
2-3, rapid strep
>4, tx with amox-clav
3yo with URI that progresses to barking cough and inspiratory stridor
Croup
Tx moderate cases with racemic epinephrine, steroids, and O2
Bacterial trachietis
Caused by staph aureus
Croup that does not improve with racemic epi and kid looks toxic
Do tracheal culture and initiate IV antibx
Epiglottis
rapid onset
fever
drooling (as swallowing hurts)
hot potato/muffled voice
Xray shows thumbprint sign
Imaging in retropharyngeal abscess
CT (peritonsillar abscess, which happens in older children, does not need)
Inrathoracic foreign body aspiration
expiratory wheeze
extrathoracic foreign body aspiration
Inspiratory stridor
Brionchiolitis: TX
O2 and IVF
Watch for any progression toward respiratory failure and ARDS
Chronic granulomatous disease: clinical features and dx
features: majority of cases are x-linked recessive, recurrent pulm and cutaneous infections, catalase positive organisms
CBC shows leukocytosis
Dx with neutrophil function testing (dihydrorhodamine 123 test or nitroblue tetrazolium test)
Trigeminal neuralgia: TX
carbamezepine
Simple febrile seizure criteria
(1) Only 1 in 24hours
(2) duration less than 15minutes
(3) generalized
If any of these absent, classify as complex
Simple vs complex seizure: TX
Simple: benzos to abort, otherwise acetominophen to keep fever down and no imaging
Complex: benzos to abort, consider EEG, LP, CT, initiate anti-epileptic meds
Infantile spasm: features and TX
less than 1 yo
symmetrical limb jerking, not generalized anad no fever
NOT A SEIZURE
EEG showing interictal hyparsthria
TX: ACTH
Tuberous Sclerosis: features and DX
Angiofibroma
Ash-leaf spot
Seizures (afebrile)
DX: Neuroimaging
Absence seizures: prognosis
good, will often resolve over time
pneumatosis intestinalis =
NEC
Age range for intussusception to occur
3months-3years
IDA in infant male
meckles diverticlum
Full term newborn with bloody stool with no red flags
could have swallowed mom;s blood
get Apt test
Left-to-right shunts
acyanotic, but can eventually lead to eisenmengers
ASD (fixed split S2)
VSD (FTT, CHF, asym)
PDA (continuous multiphasic/machine like murmur that was not present at birth)
Right-to-left shunts
cyanotic at day 0
Transposition of the great vessels (diabetic moms, use prostaglandins)
Tetralogy of Fallot (downs syndrome, boot shaped heart)
Congenital vs acquired strabsimus: TX
Congenital: surgery before 6mo
acquired: patch good eye
Imaging for intraventricular hemorrhage of newborn
US doppler
Newborn with oliguria and distended bladder
posterior urethral valve
Immunedeficiencies involving only B cells (4)
XLA (Brutons)
CVID
IgA def
Hyper IgM
Immunedeficiencies involving both B and T cells (3)
Wiscott-aldrich (affects boys, ezcema and low platlets and infections–> increased IgM and G)
Ataxia-telanctasia
SCID
Immunedeficiencies involving phagocytosis (3)
chronic granulomatous disease
LAD
CH
Immunedeficiencies involving complement (2)
C1-esterase def
C5-C9 attack complex def
XLA
Brutons
Affects young boys (6mo to 3yo)
recurrent sinopulmonary and ear infections as well as giardia
no Igs on quantitative panel
no B cells on flow cytometry
TX: schedule IgG, consider BM transplant
Common variable immunodeficiency
mild XLA in older boy
QIg show decrease in 2/3 Ig
TX: schedule Ig
IgA deficiency
Sinopulmonary infections and recurrent gastroenteritis
anaphylaxis after blood transfusion
QIg showing decreased levels of IgA but increased IgG and IgM
Hyper IgM
B cells cannot convert IgM to IgG
QIg shows decreased IgG and A but markedly elevated IgM
Delayed separation og cord with infections without pus
leukocyte adhesion deficiency
Chediak hedashi
AD
Giant granules in PMNS
albinism, neuropathy, and neutropenia
TX of angioedema
FFP acutely
Longterm management with androgens (danazol and stanazol)
Milk/soy protein induced colitis: clinical features
presents ages 2-8weeks
regurgitation or vomiting of feeds
+/- painless bloody stools
+/- eczema
Milk/soy protein induced colitis: TX
elimination of milk and soy from maternal diet of exclusively breast fed infants OR initiation of hyrolyzed formula in formula-fed infants
Child with fever, pharyngitis, and gray vesicles on the posterior oropharynx =
Herpangina (coxsackie A virus)
Henoch-Schonlein purpura
IgA-mediated vasculitis producing palpable purpura on lower extremities, abdominal pain, and renal disease
Developmental delay, eye problems, and a marfinoid habitus in s/o stroke/TIA =
Homocystinuria
Acute strep throat: DX
Get rapid streptococcal antigen testing (even if high CENTOR score). If positive, tx. if negative, f/u with culture
To confirm strep exposure with rheumatic heart disease
antistreptolysin O antibody testing
Strep throat: TX
Oral penicillin or amoxicillin
Freidrich ataxia: features
Cardiac (cardiomyopathy)
Neurologic (ataxia, dysarthria from spinocerebellar involvement)
Skeletal (scoliosis, feet deformities)
Most common causes of death are from cardiomyopathy and respiratory complications
Cancer associated with pernicious anemia
gastric cancer
Diagnostic testing of PCP in child
silver stain of bronchoalveolar fluid
12 hour old born to mom with untreated gestational diabetes who has generalized tonic clonic seizure, low tone, lethargy, and prolonged QT most likely has ____ in additon to low glucose
hypocalcemia
