PEDIATRICS Flashcards
RED EYE
VIRAL: DENDRITIC DO NOT STEROID IT! BACTERIAL: SELF LIMITING - SALINE UVEITIS: PAIN - VA DIM - LAMP + CORNEAL ABRASION: PAIN - STAIN GLAUCOMA: PAIN - HEENT: ABN PUP RESP*
IM:
SCHNELLEN - VISUAL ACUITY*
FLUORESCEIN STAIN LAMP EXAM*
FM:
GRAM STAIN 4 BACT
GIEMSA STAIN 4 CLAM (RETIC OR ELEM BODIES)
OPHTHALMIA NEONATORUM
1-2 SILVER CHEMICAL
2-5 GONO
5-8 TRACHOMA WW1st - COB
FM:
SALINE
SALINE + IM CEFTRIAXONE
ORAL AZYTHROMICIN
IMPETIGO
DZX
CELLULITIS
ERYSIPELAS
VZ
IM:
DX VISUAL APPEARANCE*
CULTURE OF THE SKIN LESIONS
MILD: TOPICAL MUPIROCIN BACITRACIN GENTAMYCIN GENERALIZED: ORAL DICLOXACILLINA SEVERE INFECTIONS: OXACILLIN NAFCILLIN
ALLERGIES:
RASH: IM IV CEPHAZOLIN
ANGIOEDEMA: MILD PO CLYNDAMICIN SEVERE: IV VANCOMYCIN
RDS *
NASAL FLARING
CYANOSIS
GRUNTING
DZX
PNA
MECONIUM ASP SYNDROME
TTN
NON PULMONARY HYPOGLYCEMIA HYPOTHERMIA METABOLIC ACIDOSIS POLICYTHEMIA
MATERNAL AEROBIC CULTURES
UA
CBC
URINE TOXICOLOGY
CXR *
FETAL UMBILICAL ABG CBC D STICK CPAP BPAP ETI ENDOTRACHEAL INTUBATION MULTIPLE DOSE SURFACTANT THERAPY WEANING AS TOLERATED
GERD
PYLORIC
DUODENAL ATRESIA
ANTRAL WEB
VIRAL GASTROENTERITIS
IWU:
CBC SMA 7 UA US* LYTES IMBALANCE
FM:
PYLOROMYOTOMY
FEEDING SLOWLY AFTER SURGERY WITHIN 48 HRS OF SURGERY
VOMITING NEONATE 3 WK
DZX
GERD: THICK FEED + PROKINET
VIRAL
D ATRESIA - D BUBBLE
PYLORIC
IWU: CBC SMA7 UA US *
FM: NPO/TPN LYTES FIRST IF + PYLOROMYOTOMY FEEDING SLOW 48 H AFTER
CHILD ABD PAIN*
DZX
GASTROENTERITIS CONSTIPATION RLL PA MES ADENITIS UTI APPY PANCREATITIS
IWU:
CBC UA SMA7 AXR CXR AMYLASE- LIPASE ABD US*
FM:
IVF LYTES SURGERY* - APPY NGT-NPO PAIN MED ABX
5 YO* W/ UNKNOWN* IMMUNIZATION STATUS
GENERAL IMMUNIZATION
IPV = INACT POLIO VACC DPT= DTaP acelular pertussis
FIRST VISIT: DPT HBV MMR IPV HIB IF <5 YO FU INTERVAL 1 MO DPT 2MOS HBV-IPV 8 MOS HBV IPV 4-6 YRS ANOTHER DPT or DTaP BE4 ENTRY SCHOOL
IPV DOES NOT NEED 3RD DOSE AFTER 4 YO 11-12 YO MMR VZ SINGLE DOSE IF NOT IMMUNE Td RATHER THAN DPT IF > 7 YO Td EVERY 10 YRS
INSUSCEPTION
> 2YO
SEC: LYMPHOMMA FOREING B
MECKEL, POLYP
CBC
AXR
ABD US*
BARIUM ENEMA *
FM:
IF > 48 HR = PERF -SURGERY
8 YO O->
PAIN IN GROIN INNER THIGH
DZ X
SEPTIC ARTHRITIS SCFE O>, OVER WT, ENDOC : SPINNING HEAD JRA STRESS FRACTURE TUMOR CONVERSION REACTION
IWU:
IDP STANDING AP FROG LEG, LATERAL XR PELVIS*
CBC
ESR
FM:
PHYSICAL THERAPY
CONTAINMENT OF FEMORAL HEAD
LEG CALVE PERTHES > 6 YO POOR PROGNOSIS
FTT 5th PERCENTIL
EXTREME OF NORMAL EXCLUSION DZ*
PRIMARY SHORT STATURE
SECONDARY SHORT STATURE
HYPOTHYROIDISM: REPLACE T4, CORTISOL AND GH AS INDICATED.
CONSTITUTIONAL DELAY TESTOSTERONE IN SELECTED PATIENTS
FAMILY SHORT
CHRONIC CONDITIONS
DWARFISM
TURNER GH/OXANDROLONE SEX HRT.
IWU:
CBC
SMA 18
ESR
UA
TSH AND TRH
X RAY LEFT HAND WRIST ASK PARENT PATTERN CONSTITUTIONAL DELAYED GROWTH
IGF 1: CHRONIC ILLNESS + MALNUTRITION
FM:
REVIEW OLD RECORDS: NORMAL GROWTH VELOCITY
DROWN CROSSING THROUGH A NORMAL CURVE TO A LOW PERCENT IS GROWTH FAILURE*
GERD
VOMITTING
FTT
ATYPICAL SXS
IWU: SMA 18 UA CXR BARIUM* TE FISTULOGRAPHY HEM STOOL
FWU:
PH *
UPPER ENDOSCOPY
FM: FOOD: SMALL THICK FREQs POSITIONING ANTACIDS H2 BLOCKs PRO KIN CISAPRIDE PPIs SURGERY FUNDOPLICATION
AMS
FALL BED
NEURO: UNRESPONSIVE LETHARGY
PE: FUNDOSCOPY*
CHILD ABUSE DZ X MENINGITIS ACCIDENTAL SUBDURAL HEM AND RETINAL HEMO METABOLIC RICKETS IMMUNOLOGY ITP, SCHONLEIN HENOCH HEMATOLOGY HEMOPHILIA, WwD CONG MONGOLIAN SPOTS OSTEOGENESIS IMPERFECTA BLUE SCLERAE BRITTLE BONE DISEASE
IWU: CBC LFT AMYLASE LIPASE UA CK BLEEDING TIME SMA 7 CT SCAN HEAD* FM: SKELETAL SURVEY DRAINAGE OF SUBDURAL HEMATOMA DIVISION OF YOUTH AND FAMILY SERVICES
FEVER 5DYS AND RASH MCLN SYND.
4/5: CRASH AND BURN*
PE: WORRISOME TKC GALLOP
DZ X JRA INFANTILE PAN KAWASAKI MYOCARDITIS VIRAL LEPTOSPIROSIS POSTREPTOCOCCAL DISEASE DRUG TOXICITY SJS: Mycoplasm, Sulf, Phenit
IWU:
CBC WBC
UA PROT
FWU: 2D ECHO CUTOFF MORTALITY DIAM> 8 MM ESR CXR EKG + CRP A1 ANTITRYP HYPO ALBUMIN
TX:
IVIG FEBRILE LOWER CAD
HIGH DOSE 100 mg/kg SALICILATES
IF PERSISTENT LARGE ANEURYSM WARFARIN HEPARIN
FU:
STRESS TESTING AND ECHO CARD IF PERSISTENT CAD
OMA
MOPS
COMPLICATIONS MASTOIDS EFFUSION MENINGITIS HEARING LOSS SLOWED SPEECH LEARNING DISORDER
INSUFFLATION* TYMPANOMETRY AMOXICILLIN FIRST LINE W/ BETA LACTAMASE INHIB > 24 HRS IF PERSIST FEVER ANALGESIC
FU 2 WKS TUBE TYMPANOSTOMY IF LEARNING OR SPEECH EFFUSION 4WK
PICA MOVED OLD HOUSE* COGNITIVE OR MS IMPAIRED* IQ TO MEMORY TOP READING DISABILITY PE: PALLOR AND II/VI M
LEAD POISONING
FANCONI SYND PERIPHERAL NEUROPATHY LATE: INTRACTABLE SEIZURES ENCEPHALITIC PERMANENT DISABILITY
DZ X
IRON DEF DZ X BASOPHILIA + FE STUDIES
HEPATITIS A AMS = LIVER DAMAGE = PT PROLONG HOSPITALIZE HIM + EXCLUDE SCHOOL FOR 1 WK
HYPOGLIC AMS = COCKTAIL D10%-50% BOL FB D5% INF OLDER DIAZOXIDE OR OCTEOTRIDE
THYROID
IWU:
CBC BLOOD LEAD LEVEL* LYTES TSH GLUCOSE LFTs PERIPHERAL SMEAR * SERUM FERRITIN BASICALLY Ca Na EDTA CHELATION TEST 4 RESPONSE EVAL
TX:
IVA
HYDRATE - NSS
Ca Na EDTA
15-19 SCREEN EVERY 3-4 MOS >20 REMOVE FROM + LEAD ABATE AGENCY >45 URGENT MEDICAL ATTENTION ADD DIMECAPROL IF LEAD > 50 FOR RAPID CHELATION 59-69 EDTA or SUCCIMER >70 INPATIENT
ASTHMA
CROUP
EPIGLOTTIS FOREIGN BODY ASPIRATION ALLERGIC REACTION BRONCHIOLITIS PNEUMONIA
IM :
OXYMETRY
PEAK FLOW 70%
FM: OXY BY CATH ALBUTEROL NEBULIZER ORAL PREDNISONE ABG NOT ROUTINE IF OXY <95
FM:
CXR
OUTPATIENT MGMT
AVOID TRIGGERS
MILD INTERMITTENT SABA - LESS 2/WK 1/DY
MILD PERSISTENT SABA + LOW DOSE ANTINFLAMMATORY ICS OR CROMOLYN - MORE 2/WK LESS 1/DY
DAILY SXS
MODERATE PERSISTENT SABA + ICS MEDIUM TO HIGH DX + LABA
SEVERE PERSISTENT: FREQ HOSPIT + PO STEROID
FBA
> 4YO
RIGHT MAINSTEM
CXR
RIGID SCOPE
EPIGLOTTIS
3D: DROOLING DYSPHAGIA DISTRESS RESP
Hib 2 -7 YO
TRIPOD
IWU: L- NXR: THUMBPRINT* AIRWAY CONTROLLED CONDITIONS BLOOD CS EPIGLOTIS CS* ABx 3rd G CEPHALOSPORIN -AMOXICILLIN SULBACTAM
CROUP
3 MOS TO 5 YO
PARAINFLUENZA
IWU AP NXR: STEEPLE* FM: MILD: CONT HUMIDIFICATION HOT OR COLD SEVERE: RACEMIC EPI + DEXAMETHASONE BOLUS SINGLE IM OBSEVE 4 TO 6 HRS NO REBOUND = DISCHARGE
PAINLESS ABDOMINAL MASS
HBP
WILMS NEUROBLASTOMA
DZ X
RENAL VEIN THROMBOSIS CHOLEDOCAL CYST ECTOPIC KIDNEY OR HORSESHOE PANCREATIC CYST FECAL MATERIA TERATOMA RENAL VEIN THROMBOSIS
ASOCIATIONS
WAGR 11 seq
BECKWITH WIDEMAN
OVERALL 5Y SV R
80% LOCAL
50% WIDESPREAD
IWU:
CBC UA* ABD US* U CATHECOLAMINES VMA-HOMO VMA R/O NB SMA 6 LFT
FDP: MRI: RENAL VEIN, CONTRALATERAL KIDNEY AND LIVER. CT CHEST ECHO CARDIOGRAM: R/O T IN THE RA BX: SURGICAL SPECIMEN 4 11p13 del COAGULATION STUDIES R/O Adq VwD LAPAROTOMY
CHEM X 15 MOS
ACTINOMYCIN D + VINCRISTINE
RASH JOINT PAIN HANDS* MISSING 11-12 YO MMR BOOST PE: LAD RETRO AURICULAR MILD CONJUNCT RASH CONFLUENT ENTIRE FACE BEHIND EARS ERITHEMA PAPULES ENTIRE TRUNK
RNA TOGA VIRIDAE
DZX
RUBELLA 3 DYS MEASLES ROSEOLA INFANTUM MEASLES CONJUNCT & FEVER HIGHER SCARLET FEVER INFECTIOUS MONONUCLEOSIS
IWU:
CBC
FWU:
RUBELLA SPECIFIC IgM TITER*
IgG TITER*
SERUM EBV ANTIBODIES
FM:
INCUB 14 -21 DYS
CONTAG 2 DYS BE4 RASH LASTS 3 DYS
EXCLUDE FROM SCHOOL 7 DYS AFTER RASH APPEARS
ROSEOLA INFANTUM(EXANTHEMA SUBITO)
HHV6
6-15 MOS
FEVERFOR 3 TO 4 DYS
POST OCC LAD
5-6 DYS
SCARLET FEVER PE: AXILA GROIN NECK THE GENERALIZES STRAWBERRY TONGUE -SANDPAPER LIKE RASH PASTIA LINES - CIRCUMORAL PALOR MILIARIA SUDAMINA
IM: RAPID STREPT TEST: STREP BETA HEM G A PHARYNX TITER's STREPTOLISIN SERIC - O .... OFF DAY CARE OR SCHOOL 24 HRS OF APPROPRIATE TX PENICILINE G ALLERGIES: ERITHROMICINE FIRST GENERATION CEPHALOSPORINE CLINDAMICINA
VZ*
RESP - PHARYNX - VIREMIA
DZ X
IMPETIGO BULLOUS OR STAPH
FOLLICULITIS
HFM SYND
DISEMINATED HSV
IM:
SUPPORTIVE
NON ASPIRIN COUNSEL REYES SYND
ACYCLOVIR: HIGH RISK CASES
PEP IVIG:
NEWBORNS EXPOSED MATERNAL VZ
INMUNOCOMP CHILDREN
PREGNANT WOMEN
FU:
RETURN TO DAY CARE WHEN AL LESIONS HAVE DRIED AND CRUSTED
DISEMINATED HSV
ECZEMA HERPETICORUM
IM: TZANCK PCR 4 HSV ACYCLOVIR COVER LESION TO ATTEND DAYCARE OR SCHOOL
HFM - SYND COXSACKIE A 16
PE:
ULCERS OROPHARYNX
LESIONS HAND FEET AND BUTTOCKS
SUPPORTIVE
CAN ATTEND SCHOOL
CAREFUL WASHING AND HYGIENE
RSV*
BRONCHIOLITIS
2 % HOSP MORTALITY
SMALL AIRWAY AAA
DZ X
CHLAMYDIA
BACTERIAL PNA
ASTHMA
RSV
IWU:
CXR AAT + INTERSTITIAL
NASO SWAB RAPID Ag DETECTION TEST
PCR OR VIRAL CS SMEAR URT 4 SRV
SYMPTOMATIC TX
ADMIT 4 OBSERV
INPATIENT: RR> 60 OR < 3MOS, CHD, NEUROMUSC, IMMUNE, CHRONIC LUNG DISEASE - CLD
IM:
OXYGEN
ALL CHILD WHEEZING: AEROSOL ALBUTEROL TRIAL AND MOVE THE CLOCK’ AND UPDATE NURSE NOTE
AEROZOLIZED RACEMIC EPINEPHRINE
FM:
HIGH RISK TOO SICK PTS:
RIBAVIRIN SMALL PARTICLE AEROSOL
OXYGEN X 24 HRS X 3-5 DYS ADMIN EARLY
RSV IVIG PALIVIZUMAB: ALL <2 MOS, PRETERM, CLD
DO NOT USE IN CONGENITAL HEART DISEASE CHD
BACT PNA*
TRIAD:
FEVER COUGH TACHIPNEA
BIRTH TO 2 MOS
GROUP B STREP
E. COLI
LISTERIA
IWU: CBC CXR* ABG OXYG/M
FM:
COMPLETE SEPTIC WORK UP INCLUDE CSF*
TX:
AMPICILLIN + AMINOGLUCOSIDE
AMPICILLIN 3 rdG + CEPHALOSP
CLAMIDIA 6 MO TO 6 YO “STACCATO COUGH”
ERYTHROM X 14 DYS
MYCOPLASMA: AZYTHROMYCIN + CLARITHROMYCIN
HSP W/ ACUTE ABDOMEN
PE PURPURA* + EDEMA 25%
SCROTAL EDEMA TORSION TESTICULAR BOWEL INTUSUSCEPTION OR PERFORATION* RENAL ACTIVITY 1% CHRONIC ARTHRITIS SEIZURES
PATH
IgA MEDIATED VASCULITIS
NON THROMBOCITOPENIC BUT LEUCOCYTOKLASTIC PURPURA
DZ X
ITP BUT PLATELETS
SEL ANA SMIDTH C3 C4
RMSF 3 HA FEVER PALE ROSE RASH INDIRECT IF Ab ASSAY DELAY + DEATH TX: TETRACYCLINE OR DOXICYCLINE
KD CRASH BURN - IVIG + HD ASA - ECHO FU
MENINGO PETECHIA PURPURA FUMINANS 16 %
JRA EXTRARTIC INITIAL: FEVER FEW MOS
SALMON PINK EVANESCENT RASH
FIRST LINE: NSAIDS
IWU:
FOBT
CBC
ESR
UA*
OUTPATIENT POSSIBLE: DIET BLAND STEROID SUPPORT ACETAMINOPHEN
FM: ADMIT 4 COMPLICATIONS ADB PAIN OR NEPHROTIC SURGERY CONSULT INSUSCEPTION BE CONSEQUENT : AXR,NPO,NGT,TPN .....
FU:
RENAL FUNCTION
ACNE VULGARIS
DZ X
SEBORRHEA GREASY ERYTHEMA YELLOW SALMON COLORED PLAQUES FROM DIAPER TO FACE TRUNK NECK SEBACEOUS RICH AREAS
MALAR RASH
ROSACEA >30 YO NOSE FOREHEAD CHIN NO COMEDONIAN
TOPICAL METRO OR PO TETRA
TELANGIECTASIA ERYTHEMA PAPULES PUSTULES
TOP NON GLUCOCORT
IA:
CAREFUL HX
FACTORS THAT INFLUENCE FLARES OF SKIN CHANGES
DIET, STRESS, MENSES, TOPICAL MED, FACE CARE, COSMETICS, ANTIBACTERIAL SOAPS, LOTIONS.
FM:
BENZYL PEROXIDE TOPICAL TOPICAL (PREFERED) CLYNDAMICIN/ ERYTHROMYCIN PO DOXICYCLINE TETRACYCLINE PLAIN SOAPS
U BHCG
CONTRACEPTION 1 MO AFTER AND BE 4 ISOTREONIN
ISOTREONIN: SEVER NODULO CYSTIC
LOW DOSE INTRACYSTIC MID POTENCY GLUCOCORTICOID INJECTIONS
KNEE PAIN - DISCOLORATION TX W RICE
TRAUMA INDUCED DELAYED BLEEDING IN DEEP TISSUE*
DZ X HEMARTHROSIS
VwD: TXX - FFP, CRYOPRECIPTATE OR DDAVD
HEMOPHILIA
INFECTIOUS ARTHRITIS
TRAUMATIC INJURY/LIGAMENT TEAR
LONG TERM COMP:
PRONE TO FACTOR V III Ab RESISTANCE
CRYPRECIP ARE POOLED FROM MULT DONORS AIDS AND HEP C
DDZ:
MILD TO MODERATE HEMOPHILIA
IWU:
CBC
PT NORMAL!!! EXTRINSIC F II V VII X LIVER
PTT PROLONGED!!! INTRINSIC F VIII IX XI XII HEMOPHILIA*
INR
FIBRINOGEN
ASPIRATION OF KNEE
CLINICAL THINKING:
YOUNG MALE X LINKED RECESSIVE
MILD HEMOPHILIA OR FACTOR INHIBITOR
TO BE OR NOT TO BE
FWU:
MIXING STUDIES: DOES CORRECT *
BLEEDING TIME
FACTOR LEVELS 5% OF NORMAL FACTOR VIII
FM:
INFUSION OF FACTOR VIII CONCENTRATE OR CRYO PRECIPITATED TO RAISE FACTOR VIII TO 25 % OF NORMAL
IMMOBILIZATION OF THE JOIN
ORTHOPEDIC AND PHYSICAL THERAPY FOLLOW UP
ROTAVIRUS WATERY STOOLS ES FOBT POS
WINTER
CAN CAUSE DEATH
DZ X
SHIGELA WBC PMN BANDS APPY VIRAL ENTERITIS PROTOZOA: ENTAMOEBA, GIARDIA, CRIPTOSPORIDIUM INTUSUSCEPTION
IWU:
CBC WBC LYMPHO
LYTES, BUN - CREA, GLUCOSE Na 133 K 3.5 Cl 100 BIC 15 BUN 20 CREA 0.7 A GAP 18
FOBT + BUT FECAL LEUKOCYTES NO DZX SHIGELLA
UA GRAVIDITY >1030
FM:
ENZYME IMMUNOASSAY 4 ROTAVIRUS*
STOOL CULTURE
LEADING CAUSE OF DEATH BIRTH TO 10 YO
CONDITIONS ORIGINATING IN PERINATAL PERIOD
CONGENITAL ANOMALIES
SUDDEN INFANT DEATH SYNDROME UNINTENTIONAL NON MVA
MVA
INTERVENTIONS CONSIDERED FOR THE PERIODIC HEALTH EXAMINATION
SCREENING
HT and WT BP VISION SCREEN AT AGE 3-4 AT BIRTH ELECTROPHORESIS Hgb Phe LEVEL T4, TSH
INTERVENTIONS CONSIDERED FOR THE PERIODIC HEALTH EXAMINATION
COUNSELING
SAFETY CAR SEATS < 5 YO LAD SHOULDER BELTS > 5 YO BICYCLE HELMET BICYCLING NEAR TRAFFIC SMOKE DETECTOR FLAME RETARDANT SLEEPWEAR HOT WATER HEATER TEMPERATURE <120-130F WINDOWS/STAIRS GUARDS POOL FENCE SAFE STORAGE FIREARMS MATCHES TOXINS DRUGS SYRUP IPECAC POISON CONTROL PHONE NUMBER LIMIT FAT AND CHOLESTEROL MAINTAIN CALORIC BALANCE EMPHASIZE FRUITS GRAINS VEGETABLES AGE >2 YO REGULAR PHYSICAL ACTIVITY CPR FOR CAREGIVERS/PARENTS
VACCINES
DTP OPV MMR Hib CONJUGATE HB VZ PCV OCULAR PROF AT BIRTH
HIGH RISK POPULATION
PRETERM LOW INCOME IMMIGRANTS INFANTS OF MOTHERS AT RISK OF HIV TB CONTACTS NATIVE AMERICAN/ ALASKA NATIVE TRAVELLING TO DEVELOPING COUNTRIES LONG TERM CARE FACILITIES RESIDENTS CERTAIN CHRONIC MEDICAL CONDITIONS INCREASE INDIVIDUALS OR COMMUNITY LEAD EXPOSURE INADEQUATE WATER FLUORIDATION FAMILY HISTORY OF SKIN CANCER NEVI FAIR SKIN EYES HAIR
POTENTIAL INTERVENTION FOR HIGH RISK
POPULATION
Hb Hto HIV TESTING PPD HEP A PCV INFLUENZA BLOOD LEAD LEVEL DAILY FLUORIDE SUPPLEMENT AVOID EXCESSIVE MID DAY SUN - SUN PROTECTIVE CLOTHES
