Pediatrics Flashcards
Consent for treatment of minors, categories (3)(1,5,3)
- Life / limb-threatening emergency
- State-protected right to treatment: Child abuse, Pregnancy, Sexually transmitted disease, Substance abuse, Outpatient mental health (some states)
- State-defined “emancipated minor” status: Married, Member of armed forces, Self-supporting and living on own
Inconsolable crying, most common cause, other categories (3)
vomiting infant clues to cause
Jaundice
hypoglycemia, metabolic acidosis
Billious emesis
projectile vomiting
abdominal exam with
Colic; trauma (abuse, hair tourniquet, corneal abrasion), infections (move all the joints), surgical (incarcerated hernia, testicular torsion, anal fissure, volvulus/intuss)
Jaundice - hepatobiliary disease
hypoglycemia, metabolic acidosis - inborn errors of metabolism
Billious emesis - malrotation of gut
projectile vomiting - pyloric stenosis
abdominal exam with incarcerated hernia
intussusception
diarrhea
Viral diarrhea with vaccine
high fevers, seizures - cause
bacterial diarrhea, season
metabolic cause
infant blood in stool, most common cause, tx
Viral diarrhea with vaccine - rotavirus
high fevers, seizures - cause - Shigella due to neurotoxin
bacterial diarrhea, season - summer
metabolic cause - secondary lactase deficiency
infant blood-idiopathic, observe
note, swallowed maternal blood seems unlikely when color is red
Necrotizing enteritis - what? Cause?
Timing
major risk factor
TX (2)
what? Cause? Sloughing of intestinal lining due to ischemia precipitated by unclear causes with infection possible
Timing - 3 to 10 days old
major risk factor - prematurity 50 to 80% incidence
TX (2) - antibiotics, surgery consult
Pictured entity, features
Necrotizing enterocolitis
- Intramural air
- Double density layering of the abdominal wall
- Generalized bowel dilation
- Loss of haustrations
- Gas lucencies over the liver (intraportal gas)
- Intramural bowel gas
Neonatal jaundice, cause categories (3)
_____ hyperbilirubinemia always requires admission
lab tests (2)
Glucuronyl transferase inhibitors in breast milk implies
Categories: physiologic 50%, sepsis related, breastmilk 10%
direct hyperbilirubinemia always requires admission
CBC, Coombs which indicates hemolytic antibodies
implies breastmilk jaundice
Physiologic jaundice, etiology
peaks during
breastmilk jaundice, treatment
phototherapy thresholds
etiology - rate of hemolysis of fetal RBCs > liver can handle
peaks during day to today for
tx: only stop breast-feeding if bilirubin > 20; peaks days 10-20
thresholds: days 1-2: 15, 2-3: 18, 3+: 20
Pictured entity
best test
common location
ALTE: definition (4)
peak age
able to diagnose in ?%
best test: US
common location: vertically oriented mass in epigastric or RUQ, 66%
some combination of color change, apnea, choking, change in muscle tone
1 to 3 months
70%
- CNS infections – ? LP / septic eval
- Seizures – (10%) ? chemistries, glucose
- Gastroesoph. reflux (laryngeal stimulation)(20-54%)
- Intracranial hemorrhage, increased ICP – ? CT
- Botulism – ? stool for clostridial cult. / botulinum
- Lower respiratory tract infection (8%) (RSV), obstruction, pneumonia, pertussis? CXR
- Low glucose, low calcium – ? test
- Dysrhythmia, cardiomyopathy, congenital heart disease – EKG
- Sepsis – septic eval with pan cultures / SBI 2.7%
- Non-accidental (battering [3%], OD, Munchausen)
- Idiopathic (apnea of infancy)
Review ALTE treatment algorithm - period of monitoring?
ALTE high risk (6)
24 hours
greater than 10 seconds, occurred during sleep, seizures, marked hypotonia, feeding associated, suspected abuse
Most common cause of death, one month to one year
associated with ALTE?
Risk factors (4)
risk reduction (3)
SIDS
no
advanced maternal age, increasing parity, maternal drug abuse, sibling with SIDS
risk reduction: sleep on back, pacifier, firm bedding
Neonatal pneumonia - causes, most common + 3
staccato cough =
paroxysmal cough, posttussive emesis
treatment
Group B strep, strep pneumo, H flu, chlamydia
staccato = chlamydia; also afebrile, conjunctivitis
pertussis - can also lead to rectal prolapse, hernias
erythromycin or Septra
Bronchiolitis - agent
indication for admission
complications
tx (3+)
RSV 60%
oxygen saturation < 92
apnea
tx: humidified oxygen, nebulized epinephrine, heliox, +/- steroids (not current)
NO albuterol/ipratropium
Febrile seizure, complex definition (4)
pediatric hypoglycemia tx
Arnold-chiari malformation leads to
Duration > 15 minutes, >1 in 24 hours, focal, age < 6 mo or > 6 years
tx D10
leads to non-communicating cerebellar hydrocephalus
sx/Signs of Hydrocephalus (4)
shunt obstruction sign and tx
infection most commonly occurs within
tx (2)
Irritability, Sixth cranial nerve weakness, strabismus, increase lower extremity tone
valve reservoir on scalp will not compress; consider emergency tap if severe symptoms
within six months of insertion, skin flora
tx: ceftaz and vanco
Pulsatile tinnitus can suggest
meningitis
< 2 mo causes (3) + tx (2)
> 2 mo causes (2+1) tx (2-3)
Idiopathic intracranial hypertension
E. coli, strep, listeria; ampicillin (listeria), cefotaxime
strep pneumo, Neisseria, H flu (rare); ceftriaxone/cefotaxime, vanc?, steroids
Pictured entity
unifying underlying pathophysiology
criteria (5)
treatment
Autoimmune vasculitis of small to medium vessels
4/5: measles like rash, oral signs, limb signs (including desquamating hand/foot rash), lymphadenopathy, conjunctivitis
IV gamma globulin
Recurrent respiratory infections, hypochloremic alkalosis?
Other major system affected
pictured entity
primary other symptom
other organ system involved
treatment
Cystic fibrosis
G.I.: pancreatic exocrine dysfunction, obstruction, intussusception
HSP
abdominal pain
renal dysfunction
steroids
Apgar pneumonic
infants are obligate ?
Bradycardia often due to ?
UA for all febrile children up to ?
How ready is the child: heart rate (>100 BPM), respiratory effort
irritability (more = better), tone, color
obligate nose breathers
due to hypoxia
UA -> two years (1 year for circumcised boys)
