pediatrics Flashcards
* master clinical principles
plain radiographic results …….. exclude foreign body aspiration
(can/cannot)
Cannot.
when there is an index of suspicion of foreign body aspiration in children, ……….. should be performed for definitive diagnosis and treatment
rigid bronchoscopy
what is the procedure of choice in the management of foreign body aspirations in children
rigid bronchoscopy under general anesthesia
what age of children are highest risk for aspiration of foreign objects?
ages1-3
why is rigid preferred over flexible bronchoscopy?
it provides a greater access to the subglottic airways and allows optimal passage and extraction while maintaining adequate oxygenation of the patient
what are some of the features of supraventricular tachycardia (SVT)
- HR typically between 180 and 360 bpm
- regular rhythm ( constant R-R interval)
- narrowed QRS complex
- usually no P wave can be seen
SVT is particularly associated with what congenital heart defect?
Ebstein anomaly
what are the features of Wolff-Parkinson-White syndrome?
- short P-R interval
* delta wave (slow curved upstroke of the R wave)
what is Ebstein anomaly?
This is due to the downward displacement of an abnormal tricuspid valve into the right ventricle thus dividing the ventricle into two parts ( atrialization of the right ventricle)
Describe the two parts the ventricle divides into in Ebstein anomaly
- Upper part is a thin-walled portion continuous with the right atrium
- the lower part is the small right ventricle
what are some of the causes of increased right atrium volume in the case of Ebstein anomaly?
- obstruction of the right ventricular outflow tract
- small right ventricle
- tricuspid regurgitation
Ebstein anomaly’s physical findings include:
quiet precordium,
holosystolic murmur due to tricuspid regurgitation
*gallop rhythm
what is the most common conduction pathway defect seen in Ebstein anomaly?
Wolff-Parkinson-Syndrome
In older children, conversion of SVT may be achieved by ……..
submerging the face in iced saline for several minute
In infants, conversion of SVT maybe achieved by …..
placing an ice bag over the face
If SVT is recurring, what do we do next?
teach older children vagotonic maneuvers
if vagal maneuvers fail acutely in a stable child, what is the next management?
rapid IV push of adenosine
if adenosine fails in treatment of SVT, what is the next step in management?
synchronized DC cardioversion
if a patient is hemodynamically compromised in a case of SVT, what is the initial management of this patient?
synchronized DC cardioversion
Ethylene glycol is found in ,,,,,,,,, and it is sweet (T/F)
antifreeze
True
what metabolizes ethylene glycol?
alcohol dehydrogenase
an example of a toxic metabolite of ethylene glycol
oxalate
presentation of ethylene glycol
confusion
stupor
coma
drukenness
treatment of ethylene glycol includes ……
fomepizole and ethanol and hemodialysis
what type of crystal is formed in ethylene glycol?
calcium oxalate crystals
calcium oxalate crystals leads to ………. and ………
renal tubular ischemia and renal failure
infants affected with transposition of great arteries present within minutes with ………
severe cyanosis and metabolic acidosis
what are the chest radiograph changes seen in transposition of great arteries?
- narrowed mediastinum
- narrow heart base
- absence of the pulmonary artery
what kind of murmur does aortic valve stenosis produce?
loud ejection murmur with a prominent systolic click
where is aortic valve stenosis best heard?
upper right sternal border
what are the ECG changes seen with tetralogy of fallot?
- right ventricular hypertrophy
* right axis deviation
what does chest radiograph show in tetralogy of fallot?
a small heart with a concave main pulmonary artery
what are the typical findings of streptococcal pharyngitis?
- mild anterior cervical lymphadenopathy
- posterior oropharyngeal exudates
- enlarged erythematous tonsils
- palatal petecchiae
what is the treatment of choice for strep pharyngitis?
oral penicillin V (phenoxyethylpenicillin) for 10 days
when patient is likely to be lost in follow up or compliance is questionable, what is the appropriate management of strep pharyngitis?
single dose benzathine penicillin G IM
what can be done to diminish local pain when administering benzathine?
shorter acting procaine penicillin (12hr low conc of penicillin)
what is the first step in management of a patient who has dehydration (moderate to severe)?
correction of the abnormally hemodynamic variables with 20mL/kg of normal saline or ringer’s lactate given rapidly
what sodium conc constitute hypernatremic or hypertonic dehydration
a serum sodium concentration >150 mEq/L
what constitute isonatremic or isotonic dehydration?
a serum sodium concentration between 130-150 mEq/L
what constitute hyponatremic or hypotonic dehydration?
a serum sodium concentration < 130 mEq/L
what is the management of a patient with hypernatremic or hypertonic dehydration?
administer maintenance therapy with solute and free-water deficit but correct sodium slowly over 48 hours.
why must serum sodium be corrected slowly in hypernatremic dehydration?
to avoid the danger of fluid shift causing cerebral edema
define failure to thrive
failure to gain weight or deceleration of weight growth
failure to thrive can be either …… or ……….
organic or inorganic
one of the most common causes of failure to thrive is …………
improper preparation of the formula
what and how should a 9 month-old be eating
4-6 times a day consisting of:
- chunky lumpy mashed food,
- finger food
- start cup drinking
fruit juice in a nine month old should never be ……….
> 4-6 oz/day
what are the clinical manifestations of pyloric stenosis?
- nonbilious projectile vomiting shortly after feeding
* palpable olive-sized mass in the epigastrium
when does symptom of pyloric stenosis typically present
3rd-4th week
what is the acid-base status of a symptomatic pyloric stenosis patient?
hypochloremic hypokalemic metabolic alkalosis
what is the study of choice for pyloric stenosis?
Ultrasound
describe what is seen on the study of choice for pyloric stenosis?
target sign on cross-sectional view: small amount of white air centrally surrounded by a large black ring- the hypertrophied tissue
what is the definitive treatment of pyloric stenosis
pyloromyotomy
what is the most common cause of neonatal seizure?
hypoxic-ishemic encephalopathy (HIE)
causes of neonatal seizure includes:
HIE, infections, hypoglycemia, hyponatremia
hyperbilirubinemia
neurofirbomatosis (NF) type 1 is caused by …….
a mutation of a gene (NF-1) on the long arm of chromosome 17
………….. should be suspected in children who develop isolated thrombocytopenia and petechiae after a viral infection.
Immune thrombocytopenia
What is the management of a child with immune thrombocytopenia with low platelet count
Observation
What is the management of a child with thrombocytopenia who is bleeding
Intravenous Immunoglobulin or glucocorticoids
What is the empirical treatment for children with meningitis after 1 month of age?
Vancomycin with a third generation cephalosporin
What is the most common insulin-related cardiac abnormality in infants of diabetic mother
Asymmetric septal hypertrophy
Diagnosis of DiGeorge syndrome is made with ______________
PCR-based genotyping
These three syndromes are known as the CATCH -22:
DiGeorge syndrome
Conotruncal face syndrome
Velocardiofacial syndrome
___________ presents in adolescent boys as a painful limp with limited abduction and external rotation on physical examination
Legg-Calvé-Perthes disease
____________ usually presents with a painful, swollen mass with limping between 10-12 years of age. Radiographic appearance is a “sunburst pattern”
Osteosarcoma
_______ is a malignant tumor of bone arising in medullary tissue. Occurs often in cylindrical bones. Radiographs have a primary lyric lesion with periosteal reaction
Ewing sarcoma
_________ affects the lower extremities and spine most commonly and patients present with pain which is worse at night and relieved with anti-inflammatory drugs.
Osteoid osteoma
An innocent murmur can never be diastolic. True/False
True
Neonatal abstinence syndrome reflects dysfunction in four domains which are:
Motor and tone
State control and attention
Sensory integration
Autonomic functioning
The most common initial event of pubertal development in girls is ___________
Thelarche (breast development )
The most common initial event of pubertal development in boys is _____________
Testicular growth then penile growth
what is the treatment for congenital hip dislocating?
Pavlik harness with splinting in an abducted fashion for approximately six months.
The most common complication of mumps in prepubertal children is ………………..
Meningoencephalomyelitis
The most common extrarenal manifestations are ____________ and __________
Sensorineural hearing loss and anterior lentoconus
breast feeding jaundice often shows symptoms of jaundice _________ of life
within 3-4 days of life
breast milk jaundice often shows symptoms of jaundice _________ of life
end of first week - beginning of second week
treatment of breast milk jaundice is ________
phototherapy
treatment of breast feeding jaundice is __________
hydration and education on breast feeding
_____ is both diagnostic and therapeutic for intussusception in treatment of choice of symptoms less than 48 hrs
contrast or air enema
