Pediatrics

Question 1

Physiological differences - head

Answer 1

More surface area for heat loss

More mass relative to body

Question 2

Physiological differences - neck/airway

Answer 2

Airway is more anterior
Narrowest portion of airway is at cricoid cartilage
Epiglottis large, long and floppy
Use 2x as much oxygen as adults

Question 3

Physiological differences - brain/nervous system

Answer 3

Heavy skulls and weak muscles mean more head injuries

More room for the brain to move increasing susceptibility to head injuries

Question 4

Physiological differences - chest/lungs

Answer 4

Chest wall is thin
Less musculature/subcutaneous fat
Diagram as muscle of respiration (belly breathing)
Rib cage more compliant
Easy to hear lung sounds

Question 5

Physiological differences - heart

Answer 5

Large right sided forces on ECG
Cardiac output is rate dependent (chronotropic)
Poor ability to increase stroke volume

Question 6

Physiological differences - abdomen

Answer 6

Distension
Weak abdominal muscles, less protection of internal organs
Liver/spleen extends below rib cage
Liver function immature, fewer glucose stores, prolonged clotting time, decreased drug elimination time

Question 7

Physiological differences - renal

Answer 7

More prone to dehydration

More prone to electrolyte loss

Question 8

Physiological differences - musculoskeletal

Answer 8

Active bone growth; growth plate
Bones weaker than ligaments, so dislocations rare
If ribs are fractured suspect a large amount of energy

Question 9

Croup

Answer 9

Viral infection of upper airway causing edema/inflammation below the larynx and glottis

Most common upper airway emergency in children
Transmitted by respiratory secretions
S/S: stridor and barking cough, low grad fever, cold symptoms, gradual respiratory distress

Question 10

Epiglottitis/bacterial infection

Answer 10

Inflammation of the supraglottic structures

Rare with vaccines
Symptoms progress rapidly
S/S: drooling, painful swallowing, fever (102-104), occasional stridor

Question 11

Asthma

Answer 11

Most common chronic childhood illness

Three components to obstruction/poor gas exchange:

• Bronchospasm
• Inflammation
• Mucous production

Question 12

Bronchiolitis

Answer 12

Inflammation of small airways in lower respiratory tract, commonly caused by respiratory syncytial virus

Primarily in children < 2 years during fall/winter
Difficult to distinguish from asthma

Question 13

Pediatric assessment triangle (cardiovascular emergencies)

Answer 13

Appearance, work of breathing, circulation to skin

Question 14

Progress of hyperglycemia in children

Answer 14

Decreased insulin prevents sugar from entering the cells
Liver produces glucose and breaks down glycogen
Blood sugar increases
Fat metabolism produces ketones and metabolic acidosis (DKA)
Potassium moves intracellular and is excreted in urine causing fluid loss (polyurea)

Question 15

Signs and symptoms of hyperglycemia

Answer 15

Mild: vomiting, anorexia, low grade fever, polyurea, hypovolemia/dehydration, altered LOC

Severe: weight loss, polyurea, polydipsia (excessive thirst), general malaise, vomiting, abdo pain, fruity/acetone breath, kussmaul respirations, altered LOC

Question 16

Meningitis

Answer 16

Inflammation of the meninges

Viral less serious; bacterial can rapidly become life threatening
Petechial or purpuric rash (non-blanching) - hemorrhagic condition including tissue necrosis, small vessel thrombosis, decreased intervascular coagulation

Question 17

Signs and symptoms of meningitis

Answer 17

Less than 1 year: fever, jaundice, lethargy, irritability, poor feeding, bulging fontanelle, hypoglycemia, unchallenged rigidity (rare)

Over a year: nuchal rigidity, HA, irritability, N/V, photophobia, ALOC, seizures
Bruzinski sign - knees automatically pull in toward body when the neck is flexed forward (infant will still have babinski sign)
Kerrigan sign - when legs are up and bent and 90 degrees, any attempt to straighten the leg upwards will raise the head

Question 18

Pediatric seizures

Answer 18

Generalized 
Atonic (drop)
Tonic-clonic
Absence
Simple
Complex