Pediatrics 8.9

Question 1

Sick patient big five

Answer 1

oxygen, pulse ox, Cardiac monitor, IV access, CXR/EKG

Question 2

ABCD

Answer 2

Airway, breathing, circulation, disability, environment

Question 3

Fluid resuscitation

Answer 3

Isotonic solutions (normal saline or LR), 20ml/kg bolus until improved perfusion, and resolution of tachycardia. Hemorrhagic–>2 boluses and then PRBC 10ml/kg

Question 4

AMPLE history

Answer 4

Allergies, Medications, PMHX, last meal, events surrounding visit

Question 5

Most common cause of death and disability in children

Answer 5

injury

Question 6

Leading cause of death in ped trauma

Answer 6

head injury

Question 7

“Jump Test”

Answer 7

jump three times= no appendicitis

Question 8

Abdominal Emergency warning signs

Answer 8

Bilious vomiting, vomiting and abdominal distention, pain before vomiting, blood in stool of ill appearing infant, focal abdominal pain, involuntary guarding

Question 9

1-2 months abd emergency

Answer 9

pyloric stenosis

Question 10

6-10 months abd emergency

Answer 10

intusseception

Question 11

pre-school/school age

Answer 11

appendicitis, intussesception, test/ovarian torsion, incarcerated hernia, NAT with blunt abdominal pain trauma

Question 12

adolescent females abd emergency

Answer 12

ectopic pregnancy, ovarian cyst, appendicitis, STD/PID, tuboovarian abscess

Question 13

Intestinal malrotation

Answer 13

hallmark= bilious emesis in a 1-2 week old. Surgical emergency because it can lead to bowel necrosis.
Study of choice is upper GI series. contrast passes in corkscrew formation and shows abnormal position of duodenum.
IV fluid resuscitation, NG tube, call surgeon, upper GI series, laparotomy

Question 14

Intussusception

Answer 14

most common early childhood abd emergency. 5-9 months
severe cramping belly pain in episodes. drawing knees up, blood stool.
Classic image is ultrasound bulls eye or coiled spring.
Manage with IVF, NGT, IV abx, surgery, abd xrays/ultrasound, air enema

Question 15

Classic intussusception triad

Answer 15

pain, palpable sausage shaped mass, currant jelly colored stool

Question 16

air enema contraindications

Answer 16

prolonged symptoms (>3 days), signs of peritonitis, evidence of free air on plain x-ray.

Question 17

Appendicitis

Answer 17

RLQ pain, rovsings, jump test, obturator, surgery! imaging not necessary in classic presentation

Question 18

Ovarian Torsion

Answer 18

sudden onset of unilateral lower abd pain right side > left, nausea and vomiting in 70-80%
most common during reproductive years
1 in 5 are pregnant when it's diagnosed
imaging- ultrasound
emergent operation

Question 19

causes of seizures in children

Answer 19

Fever (50%), congenital malformation, metabolic abnormalities, infections, trauma, vascular event, tumor, drugs, idopathic (35%)

Question 20

Types of seizures

Answer 20

Generalized- tonic clonic, tonic, clonic, absence, atonic, myoclonic
Partial- simple, complex partial, partial with secondary generalization

Question 21

seizure protocol

Answer 21

ABCs, place patient on side, O2, O2 sat, monitor, IV access, bedside glucose, Lorazepam, diazepam, midazolam.

Question 22

febrile seizure criteria

Answer 22

temp of >100.4,

Question 23

febrile seizure

Answer 23

12-18 months, viral or bacterial infection, vaccinations, familial

Question 24

complex febrile seizure

Answer 24

> 15 mins, focal features or postical paresis (todd’s paralysis), recurrence within 24 hrs

Question 25

factors that increase risk of recurrent febrile seizure

Answer 25

young age, family history, baseline developmental delay, complex febrile seizure

Question 26

indications for admission in febrile seizure

Answer 26

prolonged postictal phase, complex febrile seizure, age

Question 27

Absence epilepsy

Answer 27

absent staring w/ or w/o eyelide flutter

Question 28

Juvenile myoclonic epilepsy

Answer 28

AM, early adolescence, precipitated by stress, may have tonic-clonic or absence as well

Question 29

Benign epilepsy of Childhood with centrotermporal spikes

Answer 29

Somatosensory changes, speech arrest, facial twitching, drooling, may have tonic-clonic seizures at night. may not require therapy and is often out grown

Question 30

infantile spasms

Answer 30

sudden flexion, extension or mixed movements, of trunk and proximal muscles, more urgent

Question 31

lennox-gastaut

Answer 31

3-5 yrs, mixed seizure types, developmental delay

Question 32

DKA definition

Answer 32

hyperglycemia >200mg/dl AND

Acidosis- venous pH 7.3 and/or bicarb

Question 33

symptoms of acidosis

Answer 33

abd pain, vomiting, SOB, HA, confusion, altered mental status, kussmaul respirations

Question 34

symptoms of hyperglycemia

Answer 34

polyuria, polydipsia, urinary incontinence, weight loss, muscle cramps

Question 35

DKA physical exam findigs

Answer 35

kussmaul respirations, dehydration, tachycardia, delayed capillary refill, abdominal tenderness

Question 36

DKA precipitant “I’s”

Answer 36

insulin lack, indiscretion, infection, impregnation or other stressor

Question 37

treatment DKA

Answer 37

correct dehydration, correct acidosis, resotre normoglycemia, correct electrolyte imbalance, identify and treat precipitation event.

Question 38

Symptoms of cerebral edema

Answer 38

cushings triad- bradycardia, hypertension, irregular respirations
change in pupil size, decrease in LOC, HA