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Pediatrics Flashcards

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1
Q

Newborn Management

First 30 seconds

A

First 30 seconds stimulating

  • rub with towel, suction MOUTH then NOSE
  • At thirty check pulse and breathing
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2
Q

Indications for PPV

A

Pulse under 100 or breathing difficulties (gasping, apnea)

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3
Q

Primary apnea

A

no breathing but is corrected by stimulation in first 30 seconds

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4
Q

Secondary apnea

A

not corrected in the first thirty seconds, treated by PPV

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5
Q

APGAR

A 
1, 5, 10? 
Appearance
Pulse
Grimace 
Activity 
Respiration
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6
Q

TX for Pulse below 100? Below 60?

A

<100: PPV

<60: Chest compressions 3:1 with breaths, check at 60 seconds, then epinephrine through umbilical vein catheter

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7
Q

Meconium Aspiration Syndrome, when to worry

A

Meconium passed in utero

Meconium present but vigorous (pulse >100) : simple suction

Patient not vigorous, endotracheal suctioning / ventilatory support

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8
Q

Newborn Exam

A

Head - fontanells open, ok for some molding, look for cephalohematoma/caput succedaneum

Ears / eyes - red reflex

Nose / mouth - cleft lip / palat

Clavicles - breaks

Chest - heart / lung sounds. PDA not heard right away

Abdomen - masses

GU - Male / femal genitalia. Patent anus, sacral dimple

Extremities - ortalani / barlow maneuvers

Neuro - reflexes

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9
Q

Umbilical cord

A

2 arteries, 1 vein

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10
Q

Maternal Labs that could change post partem care

A

GBS
HIV
Hep B

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11
Q

Transient tachypnia of the Newborn

A

Delayed clearance of lung fluid
Often seen with C sections
Wet hyperexpanded CXR

can last 24-48 hours

Treat with O2 or CPAP

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12
Q

Respiratory Distress Syndrome

A

Usually surfactant def causing atelectasis
Usually in premature babies / those with perinatal distress

CXR shows low lung volumes with granular pattern
If severe: give surfactant and mechanical ventialtion

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13
Q

Infectious Etiologies by Age

A

Under three months:
Ecoli
GBS
Listeria

3months - 5years
Hflu
Niseria
S Pneumo

6year - Adult
Niseria
S Pneumo

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14
Q

Antibiotics for < 1month vs >1month

A

<1 month:
Cefotaxime
ampicillin

> 1 month:
Ceftriaxone
Vancomycin

CTX - hyperbilirubinemia <1m

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15
Q

How to dx Asthma

A

PFT showing dec FEV1 over FEV that improves with bronchodilator OR
Normal PFT that is reduced with methacholine challenge

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16
Q

Asthma Management - initial and order of addition

A

Remove pets, mold, dust mites, cigarrets, mold other allergen triggers from house.

LTA can be added anytime.

SABA
ICS (low then high)
LABA
Oral steroids

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17
Q

Asthma; acute exacerbation tx

A

Albuterol / Iprotropium (duonebs)
IV steroids

Epi and Magnesium if escalation

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18
Q

Bronchiolitis

A

usually under 2
Viral infec (usu RSV)
Looks like asthma BUT no help from bronchodialator
Obstruction is from sloughed epithelial cells

DX with rapid antigen / nasopharingeal swab

under 3 months, under 90% spo2, immunodef all get hosp

Give Palivuzumab for prevention

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19
Q

CF

A

Prenatal screening

How it may present: Failure to thrive, meconium illius, freq resp infections, infertile, malnourished

Manage with pancreatic enzyems and agressive tx of psuedomonas with lung infections.

life expec is 40 years

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20
Q

Lung diseases in pedatric patient DDX

A

Forign body aspiration

Viral URI 
bacterial URI 
Bronchiloitis (under 2) 
PNA 
asthma
Consider CF
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21
Q

Physiologic vs Pathologic Jaundice

A

Physiologic

  • onset first week
  • < 10% direct (conjugated)
  • not elevating more than 5/day
  • resolves by day 10

Pathologic

  • onset under 24 hours
  • > 10% direct (Conjugated)
  • lasts over 2 weks
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22
Q

Workup for yellow baby

A

First check Bili
-direct (>10% conjugated) —-> HIDA scan/Hepatic US, Sepsis / metabolic eval

-indirect (<10% conjugated) —–>
Coombs test (Rh or ABO incompat)
Hgb (if high could be late cord clamping)
Retic count ( High in hemolysis / hemmorhage)
Reabsorbtion ( hemmorhage vs breasmilk jaundice vs breastfeeding jaundice)

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23
Q

Breast FEEDING Jaudice vs Breast MILK jaundice

Study These Flashcards
A

Breast feeding Jaundice

  • under 7 days
  • slow transit, increased reabsorbtion
  • unconj (indirect)
  • increase feeds

Breast milk jaundice

  • over 7 days
  • Milk inhibits an enzyme
  • Conjugated (direct)
  • temporary substitute formula
24
Q

Asthma DX with Frequency

Study These Flashcards
A

Intermittant - Under 2dayyime sxs/wk or nightime/2month

Mild Persistant - 2-6/wk or over 2 nightime sxs /month

Moderate Persistant - daily or >1 nightime / month

Severe - multiple daily or frequent nocturnal sxs

Refractory - PO steroids

25
Encephalitis
Inflamation of brain parenchyma
26
Meningitis
Inflamation of meningis -Kernig / brudzinski signs -
27
FAILS
Pneumonic used to decide if LP is safe ``` FND AMS Immunodef Lesion Seizure ``` If they fail, get BCX, ABX and a CT scan If no, do LP, then ABX and CT if CT shows mass - HIV or TOXO (get Abs / test for each)
28
CSF findings
Lymphocytes - viral. Get HSV PCR , IV acyclovir Polys (inc prot, low sug) - Bacterial - give Vanc, CTX, steroids +/- amp Inc prot, normal sug = Guillon barre? Not bacterial - Crypto, RMSF, Lyme, TB, Syphilis
29
Fever: Under 1 month 1-3months 3months - 3 years
Under 1 month -CBC, BCX, UCX, LP with chest radiogrpah and admit Urine Bcx, Lumbar px 1-3months -same, LP is a maybe , CXR is a maybe 3months - 3 years -LP not needed
30
TX for anaphalaxis
Epinephrine H1/H2 blockers Epi pen at D/C
31
Urticaria WHat is it What do you see TX
Mast cell degranulation - causes erythema and wheals TX 2n gen H1 antihistamines (ranitidine, fexofenadine) Avoid agent
32
Angioedema WHat is it TX
Mast cell degranulation (same as urticaria but deeper)- causes swelling in lip airway and GI tract INtubate if needed FFP given if C1 esterase inhib defect suspected
33
Allergic Rhinitis Difference between seasonal and perenial PE findings TX
PE venous congestion under eyes (allergic shiners) Nasal Mucosa will be pale and bogy. maby polyps Oropharynx may have cobblestoning TX Identify and avoid triggers Intranasal - (antihistamins, steroids) Oral meds : antihistamines, leukotriene antagonisnts
34
ALlergic conjunctivitis Exam: TX
PE Ocular prurutus Conjuctival redness discharge TX Avoid triggers artificial tears (barrier) Medicated eye drops (mast cell stabalzierz / h1 blockers)
35
Atopic dermatitis (eczema) ``` What is it What causes it Who gets it What do you worry about TX ```
Scaley skin Who typically gets it? younger children on extensor surfaces (flexors on adults) Cause - environmental / food exposure Worry; Can become infected if severely excoriated Emollients / moisterizers. steroids for exacerbations
36
Food allergies Which are often outgrown? Which ar persistant? Presentation TX Note: breast feeding
Grown out of: wheat, eggs, soy and milk Persistant - nuts / fish Presentation: could be pruritis or Vomiting/diarrhea OR anaphalaxys TX - epi pen Stop mom from eating offending food while breast feeding
37
Baby emisis Usually is Something to keep in mind Must find out if ____
Usually "Spitting up" - smaller vome, non projectile, formula colored Always keep head trauma from abuse as casue in mind If it is billious vomiting or not
38
Causes of billious vomiting First step in workup
``` DDX Duodenal atresia annular pancrease Malrotation / volvulus Intestinal atresia ``` First step Babygram
39
Causes of non billious vomiting
Pyloric stenosis | TE fistula
40
BRUE: what does it stand for What is it TX
Brief Resolved Unexplained Event ``` Definition: < 1year old and <1 min duration with any change in: color tone breathing responsiveness. ``` TX: If over in any any of these catagories, do work up
41
Otitis Media What is it What causes it Exam finding/ DX TX
inf of middle ear Cuased by resp bugs (S pnumo, H flu, Moroxella Catarhalis) Exam findings: Tense immobile membrane relief with puling the pinna TX - Amoixicillin recure: amoxicillin + clavulonic acid. Penicillin allergic: ceffdinir if no anaphalctic hx, azithro if there is
42
Mastoiditis What is it inc risk of: Look for: What to do:
Mastioid air cell infection Inc risk with tympanoplasty (for pseudomonas) Look for swelling behind the ear, and anteriorly rotated ear Get surgical eval
43
Otitis Externa What is it Causes Common bug TX Education
Infection of skin in ear canal Swimmer (pseudomonas) Casued by trauma, Staph aurius TX - topical abx and steroids Education - dry ears after swimming and showering
44
Sinusitis What is it Presentation When to presume bacterial? When to get XR? TX if bacterial
What is it : Infection of nose and sinuses Presentation: Purulent nasal discharge, sensitive sinuses When to presume bacterial? - above 10 days - Fever above 39 - Purulent / facial pain for 3-4 days When to get XR? if - - -refractory or recurrent to look for anatomical cause - -Eval for forign body if young* TX caused by URI bugs, so give Amoxicillin / clavulonic acid NO AZITHRO (why?)
45
Cold main cause How long to wait
Rhinovirus | do nothing unless over 10 days
46
Pharyngitis HX Exam findings Centor cirteria? If pharyngitis + enlarged spleen conjunctivities rash on palms and souls IF GAS (group A strep) TX
Causes HX - Sore throat pain on swallowing Exam findings Centor cirteria - to decide on next step for patient. Definitly swab someone 5-15 years old. Do not swab under three years old. If pharyngitis + enlarged spleen, get EBV panel If pharyngitis + conjunctivitis - adenovirus Pharyngitis + rash on palms and souls - cocksackie If GAS- could cause reumatic fever. Must treat. Wont stop PSGN TX - amoxicillin / clavulonic
47
What are the CENTOR criteria | Acronym
When you see sxs of step pharingitis, it is to see if a swab is needed CENTOR! Cough absent +1 Exudate or swelling on tonsils + 1 Nodes: Tender/ swollen anterior nodes + 1 Temp >38 +1 OR Age +1 if 3-14 OR -1 if over 45 2 - maybe 3 or more: strep test with culture
48
Epistaxis Most common cause Normal nosebleed will: TX: Exam once it clears
Most common cause- digital trauma Normal nosebleed will: be unilateral, last under 30 min TX: Cold compress, lean forward, pressure Consider cauterizing with silver nitrate Exam once it clears: look for forEign body / something anatomical
49
failure to pass meconium TImeline Causes of FTPM (failure to pass meconium) First step
Timeline : over 48 hours Causes : Imperforate Anus Meconium Illius Hrischsprungs Get X ray
50
Constipation in baby / todler | Causes two high, two low
``` Causes: Voluntary constipation duodenal atresia Voluvulus Intestinal atresia ``` Medication induced Mg, opiates Metabolic induced (Hypercalcimia, hypermagnesemia, Hypoglycemia, hypokalemia)
51
Describe each: Epidural Hematoma Subdural Hematoma Cerebral contussion
Epidural Hematoma - trauma to side of head, LOC, lucid interval, coma. CT - lense shape Subdural Hematoma- trauma or shaken baby. Coma, child stas in it. Concave or crescent shaped Cerebral contussion - desceleration injuries, LOC - CT shows puncteate intracerebral hemmohrages
52
When to use: Rear facing seat in the back seat Booster seat
Read facing in back - o-2 Booster - after 2, untill 4'9" - usually 8-12 years old
53
Concussions things to ask about Mild vs Severe
Any tingling, numbness, weakness? any LOC? How long? Any headache? Worse or better? Can you remember everything? Mild concussion - No FND - under 60 sec LOC - None/ improving headache - No amnesia -Observe / send home Severe concucssion - FND - over 60 seconds passed out - retrograde / anterograde amnesia CT / admit Always stepwise return to play, stop playing current game
54
SIDS | How to prevent
Children under 1 year, highest incidence in first 3 months. Sleep on back Dont share bed Stop smoking
55
Failure To Thrive What is it. What goes first. DDX Organic non organic
Kid falls off growth curve. Weight first, then hight, then head circ. DDX Organic - Genetic (CF) - cardiac dz - pyloric stenosis - GERD Non-organic (more common) -wrong formula -improper feeding technique CHECK Formula, Feeding, Frequency
56
Important things to discuss to prevent trauma
``` Car seat (back backwrds till 2, then booster untill 4'9") Then seatbelts Trampolines Guns Fence pools Swimming ```

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