Pediatrics Flashcards
APGAR
Appearance Pulse Grimace Activity Respiration
Delivery Room Resuscitation
ABC
Infant with scaphoid abdomen, cyanosis, respiratory distress, heart sounds on right, breath sounds diminished on left =
diaphragmatic hernia (herniated bowel in chest) –> pulmonary hypoplasia
TX: diaphragmatic hernia
DON’T USE BVM (will cause accumulation of bowel gas); intubate!
Neonatal Resuscitation: If HR <60 and compressions aren’t working, give…
epinephrine
Infant has respiratory distress when she stops crying =
choanal atresia
TX: choanal atresia
Intubate –> surgery
Maternal ingestion of phenobarbital during pregnancy can…
decrease the risk of neurologic damage in a jaundiced newborn
8-day-old jaundiced infant (noted on day 2 of life) with normal labs, Coombs, and smear…
Gilbert Syndrome
12-day-old infant with jaundice, above birth weight, exclusively breast-fed…
Breast Milk Jaundice
Physiologic jaundice in the first week of life in the majority of infants results from…
- higher bilirubin production rates
2. limited ability for excretion
R/F for neonatal sepsis (5)
- Young maternal age
- Small gestational size
- APGAR < 5
- > 18 hours ROM
- Young gestational age (premature)
TX: early onset sepsis
amp + gent
TX: late onset sepsis
amp + cefotax
Most common neonatal sepsis pathogen from 0-3 months:
GBS
Organisms associated with EOS
- GBS
- E. Coli
- Listeria
- H. influenzae
Late onset neonatal sepsis is caused by organisms found…
…in the environment.
DX: fever, irritability, erythema, blisters, epidermal shedding
Staphylococcal scalded skin syndrome (SSSS)
Pathophysiology of SSSS
Staph aureus strains that produce exfoliative toxins, which disrupt keritoncyte adhesion in the superficial epidermis
Blisters + honey colored crust
Bullous impetigo
Well demarcated, warm, tender area of erythema + constitutional sx
Erysipelas
Targetoid lesions; central bullae; Nikolsky sign is negative
Erythema multiforme
Fine, pink, sandpaper-like rash following an episode of pharyngitis
Scarlet fever
Extensive skin blistering and erosion; triggered by medication; Nikolsky sign is + with mucous membrane involvement
Toxic epidermal necrolysis
Pathogenesis: Croup
Parainfluenza viral infection of the larynx & trachea
Epidemiology: Croup
6 months - 3 years
Fall/Early Winter
Clinical Features: Croup
Inspiratory Stridor
Barking Cough
Hoarseness
Tx: Croup
Mild - humidified air +/- corticosteroids
Moderate/Severe (stridor at rest) - corticosteroids + nebulized epinephrine
Another name for croup…
Laryngotracheitis
In croup, stridor will worsen with…
crying, laughter
Steeple sign =
Croup
Acute onset of high fever, stridor, significant respiratory distress; often unvaccinated –> tripod position
Epiglottitis
Lower respiratory tract illness most commonly caused by RSV
Bronchiolitis
Sudden-onset respiratory distress/stridor…
Foreign body aspiration
Collapse of supraglottic structures during inspiration; chronic inspiratory stridor that begins in neonatal period; worse in supine position
Laryngomalacia
Cyanosis within 24 hours of life + single S2 + egg on a string CXR =
Transposition of the great vessels
Immediate Tx for TGV
Prostaglandins (keeps PDA open!)
Chronic oligoarthritis + daily fever + rash =
Systemic-onset juvenile idiopathic arthritis
TX: sJIA
NSAIDs
glucocorticoids
biologic agents
Surge of this hormone leads to refeeding syndrome…
insulin
In refeeding syndrome, insulin stimulates cellular uptake of…
phosphorus
potassium
magnesium
Clinical manifestations of refeeding syndrome
arrhythmias
cardiopulmonary failure
4 anomalies of TOF
- R ventricular outflow tract obstruction
- R ventricular hypertrophy
- Overriding aorta
- Ventricular septal defect
Tet spell
Increase in PVR shunts deoxygenated blood from the right ventricle across the VSD into the aorta
Tx: tet spell
knee-chest positioning (kinks the femoral arteries, increases systemic vascular resistance, and reduces the degree of right-to-left shunting)
Pale stool + hepatomegaly + direct hyperbilirubinemia =
biliary atresia
Pathophysiology of biliary atresia
progressive obliteration of the extrahepatic biliary ducts connecting the liver to the small bowel
Tx: biliary atresia
Kasai procedure (hepatoportoenterostomy); all patients will require a liver transplant at some point
Jaundice in second week of life; unconjugated
Breast milk jaundice
Pathophysiology of Crigler-Najjar
Absent UDP; early symptoms, need liver transplant; unconjugated
Pathophysiology of Gilbert
Mild lack of UDP; mild symptoms; unconjugated
unconjugated hyperbilirubinemia + positive coombs =
alloimmune hemolytic disease (erythroblastosis fetalis)
Most common congenital heart defect in patients with Down syndrome
Complete atrioventricular septal defect
diminished or absent lower-extremity pulses and upper-extremity HTN; associated with Turner syndrome
coarctation of the aorta
triple or quadruple gallop (widely split s1 and s2 + loud s3 and/or s4) + holosystolic/early systolic murmur at LLSB
symptomatic Ebstein anomaly
continuous, machine like murmur
PDA
cyanosis + single s2 + harsh crescendo-decrescendo murmur
TOF
neonatal cyanosis + tachypnea + single s2 + associated with DiGeorge syndrome =
TGA
Pleural fluid analysis demonstrates milky-white fluid with elevated triglycerides
chylothorax/exudative
Exudative effusion due to disruption of lymphatic flow within thoracic duct…
chylothorax
In patients with apparent subcutaneous emphysema secondary to sever coughing paroxysms, ____ must be obtained to r/o _____.
CXR
pneumothorax
Allergic reaction to blood transfusion…
selective IgA deficiency
Lots of infections + GIARDIA
Common Variable Immunodeficiency (IgA, M, G low)
3-5 weeks old, nonbilious emesis…
pyloric stenosis
Mild mental delay, eunuchoid habitus, gynecomastia, long arms, long legs, hypogonadism…
Klinefelter (XXY)
Explosive anger, weakness with fine motor control, accelerated growth, large teeth, asymmetrical ears, severe acne…
XYY Syndrome
Girls with short stature, amenorrhea, excessive nuchal skin, low posterior hairline, broad chest, coarctation of the aorta…
Turner’s (45, XO)
Primarily in boys; ID, macroencephaly, long face, high arched palate, large ears, macroorchidism…
Fragile X (fragile site at X gene)
Beta thalassemia blood findings…
microcytic, nonimmune, hemolytic anemia (normocytic w/ high reticulocytes)
MCHC = decreased
presents >6 months
Hereditary spherocytosis blood findings…
hemolytic anemia (normocytic w/ high reticulocytes)
MCHC = elevated
Young patient in distress, sitting in tripod position with chin thrust forward…
epiglottitis
Pathogen: epiglottitis
H. influenzae B
R/F for epiglottitis
no vaccinations
XR findings for epiglottitis:
thumb sign
Tx: epiglottitis
intubation
antibiotics
McCune-Albright Syndrome (3)
irregular cafe-au-lait
precocious puberty
fibrous dysplasia of bones
McCune-Albright Syndrome Gene
GNAS
Peutz-Jeghers Syndrome (2)
GI tract hamartomatous polyposis; skin lesions (small, perioral, mucocutaneous pigmented macules)
Sturge-Weber (4)
ID
seizures
visual impairment
Port Wine Stain (trigeminal nerve)
Tuberous Sclerosis (2)
Ash-leaf spots
Shagreen patches
Hand, Foot, Mouth (virus, sx)
Coxsackievirus
Sx: fever, oral sores, rash on palms/soles
Measles (sx, rash distribution)
sx: cough, coryza, conjunctivitis
rash: cephalocaudal
Scarlet Fever (sx)
sx: fever, strawberry tongue, sandpaper rash, exudative pharyngitis
Complications of Kawasaki Disease (2)
- Coronary Artery Aneurysms
2. Myocardial Infarction & Ischemia
Severe Combined Immunodeficiency (Etiology)
Gene defect leading to failure of T cell development, B cell dysfunction due to absent T cells
SCID (inheritance)
x-linked recessive
autosomal recessive
SCID (tx)
Stem Cell transplant
CD19 =
B Cells
CD3 =
T Cells
Down Syndrome Features
epicanthic folds upslanting palpebral fissues low set, small ears flat facial profile short neck w/ excess skin furrowed tongue brushfield spots single, transverse palmar crease sandal-toe deformity