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OME > Pediatrics > Flashcards

Pediatrics Flashcards

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

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

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
Q

Encephalitis

A

Inflamation of brain parenchyma

26
Q

Meningitis

A

Inflamation of meningis
-Kernig / brudzinski signs
-

27
Q

FAILS

A

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
Q

CSF findings

A

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
Q

Fever:
Under 1 month
1-3months
3months - 3 years

A

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
Q

TX for anaphalaxis

A

Epinephrine
H1/H2 blockers
Epi pen at D/C

31
Q

Urticaria

WHat is it

What do you see

TX

A

Mast cell degranulation - causes
erythema and wheals

TX
2n gen H1 antihistamines (ranitidine, fexofenadine)
Avoid agent

32
Q

Angioedema

WHat is it

TX

A

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
Q

Allergic Rhinitis
Difference between seasonal and perenial

PE findings

TX

A

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
Q

ALlergic conjunctivitis

Exam:

TX

A

PE
Ocular prurutus
Conjuctival redness discharge

TX
Avoid triggers
artificial tears (barrier)
Medicated eye drops (mast cell stabalzierz / h1 blockers)

35
Q

Atopic dermatitis (eczema)

What is it
What causes it
Who gets it 
What do you worry about 
TX
A

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
Q

Food allergies

Which are often outgrown?

Which ar persistant?

Presentation

TX

Note: breast feeding

A

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
Q

Baby emisis

Usually is

Something to keep in mind

Must find out if ____

A

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
Q

Causes of billious vomiting

First step in workup

A 
DDX
Duodenal atresia 
annular pancrease 
Malrotation / volvulus 
Intestinal atresia

First step
Babygram

39
Q

Causes of non billious vomiting

A

Pyloric stenosis

TE fistula

40
Q

BRUE: what does it stand for

What is it

TX

A

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
Q

Otitis Media

What is it

What causes it

Exam finding/
DX

TX

A

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
Q

Mastoiditis
What is it

inc risk of:

Look for:

What to do:

A

Mastioid air cell infection

Inc risk with tympanoplasty (for pseudomonas)

Look for swelling behind the ear, and anteriorly rotated ear

Get surgical eval

43
Q

Otitis Externa

What is it

Causes

Common bug

TX
Education

A

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
Q

Sinusitis

What is it

Presentation

When to presume bacterial?

When to get XR?

TX if bacterial

A

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
Q

Cold
main cause
How long to wait

A

Rhinovirus

do nothing unless over 10 days

46
Q

Pharyngitis

HX

Exam findings

Centor cirteria?

If pharyngitis + enlarged spleen
conjunctivities
rash on palms and souls

IF GAS (group A strep)

TX

A

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
Q

What are the CENTOR criteria

Acronym

A

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
Q

Epistaxis

Most common cause

Normal nosebleed will:

TX:

Exam once it clears

A

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
Q

failure to pass meconium

TImeline

Causes of FTPM (failure to pass meconium)

First step

A

Timeline : over 48 hours

Causes :
Imperforate Anus
Meconium Illius
Hrischsprungs

Get X ray

50
Q

Constipation in baby / todler

Causes
two high, two low

A 
Causes: 
Voluntary constipation 
duodenal atresia 
Voluvulus 
Intestinal atresia

Medication induced
Mg, opiates

Metabolic induced
(Hypercalcimia, hypermagnesemia,
Hypoglycemia, hypokalemia)

51
Q

Describe each:

Epidural Hematoma
Subdural Hematoma
Cerebral contussion

A

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
Q

When to use:

Rear facing seat in the back seat

Booster seat

A

Read facing in back - o-2

Booster - after 2, untill 4’9” - usually 8-12 years old

53
Q

Concussions

things to ask about

Mild vs Severe

A

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
Q

SIDS

How to prevent

A

Children under 1 year, highest incidence in first 3 months.

Sleep on back
Dont share bed
Stop smoking

55
Q

Failure To Thrive

What is it. What goes first.

DDX
Organic
non organic

A

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
Q

Important things to discuss to prevent trauma

A 
Car seat (back backwrds till 2, then booster untill 4'9")
Then seatbelts 
Trampolines
Guns 
Fence pools 
Swimming

OME (11 decks)

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