Pediatrics Flashcards
Workup for constitutional growth delay
IGF1, thyroid, kidney, wrist XR
Laryngomalacia
Floppy larynx, presents with squeaking stridor
No need for treatment unless severe/resulting in breathing difficulty
Normal weight gain at two weeks
1 ounce per day, 25-30g per day
Three most common causes of ear infections/sinus infeections/PNA in children
Strep pneumoniae
H. Flu
Moraxella catarrhalis
First line treatment for ear infections
Amoxicillin (90mg/kg) or cephalexin
Pink, bubblegum flavor
-If using to treat strep throat, dose is 50mg/kg
First line treatment for bacterial sinus infection
Augment (amoxicillin + clavulonic acid) or ceftanir
-ceftanir is better tasting
Treatment for croup
Dexamethasone 0.6mg/kg for one dose, oral of injectable because has no flavor
-prednisolone if the above is not available
Symptoms of pediatric sinus infection
ALWAYS has cough
- Cold-like sxs that fail to get better after 10 days
- Cold-like sxs that get better for a day or two and then get way worse
- Typical adult sinusitis symptoms (HA, sinus tenderness, drainage)
What are characteristics of bad lymph nodes?
Firm, nonmobile, nontender, and subclavicular are the worst
Treatment of colds
NO COUGH MEDICINE UNDER THE AGE OF SIX! Only treat the fever if it’s bothersome
Failure to thrive
<2% and decreased velocity of weight gain, disproportionate to length
Familial short stature
Parent’s height is short and so is patient’s adult height but young growth pattern is normal
Constitutional growth delay
Parental height is normal, patient has delayed puberty and slow growth
Anorexia
Short stature from poor nutrition
Turner’s syndrome
- Mild growth retardation in utero
- Slow growth during infancy
- Delayed onset of childhood component of growth
- Slow growth during childhood
Cause of anemia in infants
Can be Vitamin A deficiency
Milestone categories
Communication
Gross motor
Fine motor
Other (object permanence, etc)
Appointment schedule
Newborn, 2 weeks, 2 months, 4 months, 6 months, 9 months, 12 months, 14 months, 16 months, 18 months, 2 yeras, 2.5 years, every year
Hip exam
Ortolani, Barlow & Galeazzi maneuvers
Encopresis
Severe constipation that causes stretching of the bowel wall and hardening of old stool - new stool gets liquefied and slides around stool - presents as leakage in the underwear
Red flags of HA
worst headache of life thunderclap headache woke from sleep LOC with an injury early morning onset with vomiting
Exam for headache
Full neuro, including:
- ophthalmoscope to look for papilledema
- cranial bruits on head and orbits
- visual fields
- rapid alternating hand movements
- back for scoliosis
Treatment for conjunctivitis
Fluoroquinolones, such as oflaxacin
Systematic approach for differential diagnoses
Vascular Infectious Neoplasm Drugs Inflammatory/idiopathic Congenital Autoimmune Trauma Endocrine/metabolic
When to do post-partum depression screening
2 months
4 months
6 months
Pediatric physical exam
Ears
Eye exam if not seeing eye doctor (light reflex, EOM, visual fields). Starting at age 5-6, do fundoscopic if no eye doctor
Quick neuro (eyes shut and open, cheek puff, upper extremity strength)
Neck
Heart sitting and lying down
Lung
Belly
GU (at age 5-6 for girls, ask about hair. always check testes for boys)
Leg mobility lying down
Sitting up, check knee reflexes
Standing up: squat, duck walk, toe walk, heel, walk, scoliosis check
1 month milestones
Lift head, track with eyes, coo, recognizes parents
6 month milestones
Sit up, raking grasp, babbles, stranger anxiety
9 month milestones
Walk with assistance, 3 finger grasp, maybe mama/dada?, wave bye/patacake
12 month milestones
Walk without assistance, pincer grasp, imitate parents, mama/dada
24 month milestones
2 steps, 2 word sentences, 2 step commands, 6 blocks
3 year milestones
Tricycle, 3 word sentences, brush teeth, circle, know colors and maybe 123
4 year milestones
Hops, copy cross, plays with kids
What is paronychia?
Bacterial infection along lateral nail fold
What is herpetic whitlow?
Viral infection of HSV of the finger. Bimodal: <10years, 20-30 years, vesicles that appear purulent
Treatment of depression in children
Fluoxetine
Bronchopulmonary dysplasis
Decreased surfactant, increased oxygen demands
XR shows ground glass
Tx: surfactant postnatal and steroids prenatal
Becomes diffuse parenchymal lung disease
Retinopathy of prematurity
Due to premature, increased O2 demands
Dx: eye exam
Tx: Laser
Can lead to glaucoma
Intraventricular hemorrhage
Babies susceptible given highly vascular ventricles
Be careful of blood pressures!
Premie, have increased ICP
Dx: Cranial doppler
Tx: Decrease ICP with VP shunts and drains
Can lead to seizure, mental retardation
Necrotizing enterocolitis
Dead gut Premie with bloody bowel movement XR: pneumotosis intestinal (air in the wall of the gut) Tx: NPO, IV antibiotics, TPN Need surgery
Failure to pass meconium
Nothing comes out within 48 hours!
- Imperforate anus- no hole. Get cross table XR (determine severity). Mild: fix now. Severe: colostomy now, fix later.
- Vertebral anomaly (US sacral)
- Imperforate anus
- Cardiac issues (echo)
- Tracheoesophageal fistula
- Esophageal atresia (catheter with XR)
- Renal (voiding cystourethrogram)
- Limb (XR of the wrist) - Meconium ileus: CF (not enough water in the lumen so get meconium plug)
- Should be screened for CF
- XR shows transition point and possibly gas-filled plug
- Tx: water enema to dx and dissolve the plug
- Confirm CF with chloride test
- If CF: give vitamins ADEK, pancreatic enzymes, pulmonary toilet (prevent pulmonary infection) - Hirschprungs: (failure of migration of inhibitory neurons of distal colon - muscle can’t relax so stool can not get through)
Palpable colon because distended
-Explosive diarrhea on DRE
-Patients can present with chronic constipation with overflow diarrhea
XR; good colon dilated, bad colon looks normal
TX: if at birth: do contrast enema like barium to see transition point
If later in life, do anal-rectal manometry - increased tone due to lack of inhibition
BEST TEST is biopsy that shows no Auerbach plexus -
Tx: surgically resect bad colon (looks normal but biopsies abnormal)
constipation
- Hirschprungs
- Voluntary holding
-Cognitive impairment are at a higher risk
-Usually when they begin toilet training or when they begin school for the first time
-Starts as voluntary but may become involuntary
-LIkely to see overflow incontinence and encopresis (stooling in the bed)
Dx: clinical
Tx: Bowel regimen - stool softeners and motility agents and behavior (tell kid it’s ok to poop), disimpaction (under anesthesia) - Medication
- Diet
- Anatomy
Emesis
Normal feeds: formula colored, non-projectile, occurs after eating.
- Bilious: (
- projectile
- green
- XR shows double bubble
a. malrotation: failure to rotate appropriately - could have strangulation of bowel. Normal uterine course (no polyhydramnios, no Down syndrome)
Dx: XR shows double bubble but normal gas pattern beyond. Can be confirmed with upper GI series
Tx: NG tube, intermittent suction, decompress. Will need surgery (especially if with volvulus)
b. Duodenal atresia: Failure to recanalize - leads to SBO. Can’t absorb amniotic fluid so have polyhydramnios
-Associated with downs
-XR with double bubble with NO gas beyond
Tx: surgery
c. Annular pancreas: failure of apoptosis of pancreas - squeezes down on bowel
-Polyhydramnios, associated with Downs
-XR: double bubble with no gas beyond
Tx: surgery
d. Intestinal atresia: Caused by vascular accidents en utero such as cocaine
-Doesn’t always have polyhydramnios
-NOT associated with downs
-XR: double bubble and multiple air fluid levels
Tx: surgery
Worried about short gut syndrome - malabsorption syndrome
Confront mom about medical issue or substance use
- Non-billious:
- non-projectile
- not green
a. Tracheoesophageal fistula (5 different types)
- Gurgling/bubbling because breathing through gastric secretions
- Dx: NG tube that coils on XR because of blind pouch
- Tx: TPN, surgery
b. Pyloric stenosis
Neonatal Jaundice causes
Prehepatic (unconjugated): hemolysis or hemorrhage
Intrahepatic (mixed):
-Crigler Nigar - look like pre
-Gaillvair - looks like pre
-Dubin-Johnson - excretion - looks like post
-Rotars: excretiion - looks like post
-hepatitis
Posthepatic(conjugated, direct): biliary atresia, sepsis, metabolic derangements
Kernicterus
Conjugated bilirubin cannot cross BBB and is water soluble - easily excreted in urine
Indirect/unconjugated is fat soluble - can pass membranes easily. Not excreted in urine and CAN cause BBB and lead to kernicterus
Physiologic jaundice
Onset: after 72 hours Resolution: <1 week Bili: Unconjugated Rise: <5 units/day Workup: Coombs test -if positive - treat with isoimmunization -if negative - look at hemoglobin
If hemoglobin low - indication of hemorrhage which could be cephalohematoma. If elevated, there is some transfusion (twin-twin transfusion, delayed clamping, maternal)
-if normal - check reticulocyte.
If reticulocyte count elevated then there is hemolysis (G6PD deficiency, pyruvate kinase, or Hgb SS disease). If normal - reabsorption issue (breast milk and breast-feeding)