Pediatrics Flashcards
Distinguishing timing difference between epiglottitis and retropharyngeal infection
Epiglottitis - more acute
RPA or other infection - progresses more slowly over several days
Imaging of choice for suspected RPA?
CT of neck with contrast (even in peds!)
When is surgical draining indicated for for RPA?
Greater than 2.5 cm squared
First line abx choice for RPA?
Ampicillin-sulbactam or Clindamycin
What measurements of the retropharyngeal space on a lateral neck radiograph are considered abnormally widened and suggest abscess formation?
Greater than 7mm at C2 or greater than 14 mm at C6
What is pseudosubluxation?
Anterior displacement of the anterior border of C2 and C3
- Normal in children <8 years old (40% of children demonstrate this)
- picture Q7 Exam 1 (343744)
Pediatric Cervical Spine Injuries
- Upper injuries (C1-C3) > Lower injuries
- Pseudosubluxation between C2 and C3
- Common to have spinal cord injury without radiographic abnormality
- Hyperextension, hyperflexion injuries more common
Most common fracture involving the elbow in children < 8?
Supracondylar fracture
Supracondylar fractures are high risk for neurovascular injury to what?
Brachial artery and median nerve
Age of Ossification in children’s bones
CRITOE Capitellum - 1 y/o Radial head - 3 y/o Internal (medial) epicondyle - 5 y/o Trochlea - 7 y/o Olecranon - 9 y/o External (lateral) epicondyle - 11 y/o
Which branch of the median nerve is commonly injured in supracondylar fractures?
Anterior interosseous - check by strength of patient making “OK” sign
Clinical presentation of bacterial tracheitis
- Recent URI or croup improves initially, then worsens
- Will look like croup, but toxic
Definitive diagnosis of bacterial tracheitis
Direct visualization with bronchoscopy or laryngoscopy showing laryngotracheal erythema, edema, and thick purulent secretions
Q#447581
Bacteria implicated in bacterial tracheitis
- *Staph aureus
- H. flu
- Moraxella catarrhalis
- Strep pneumo
- beta-hemolytic strep
Tx for bacterial tracheitis
Third-generation cephalosporin combined with a penicillinase-resistant penicillin e.g. nafcillin. Vanc if MRSA prevalent
Major causes of lower GIB in children by age
Q#330394 graph
What is the most common cause of neonatal hemorrhage?
Failure to administer vitamin K in the immediate postpartum period (associated with home births)
Neonatal sepsis work up
- CBC
- UA and culture (obtained by cath or suprapubic aspiration)
- BCx
- LP
- CXR (only with respiratory sx)
- Stool analysis (only with diarrhea)
Abx for sepsis in < 4 weeks old
Ampicillin PLUS gentamicin or cefotaxime
ETT size for pediatrics formul
CUFFED: Age/4 + 3.5
UNCUFFED: Age/4 +4
What is single finding most closely associated with acute otitis media?
Bulging tympanic membrane
First line abx tx for uncomplicated acute otitis media?
High-dose amoxicillin at 80-90 mg/kg/day
Kocher criteria to determine risk for pediatric septic joint
- NWB on affected side
- ESR >40 mm/hr
- Fever >38.5 (101.3)
- WBC >12,000
4/4 = 99% 3/4 = 93% 2/4 = 40% 1/4 = 3%
Pediatric dextrose administration in hypoglycemia
By Age:
>8 - D50 1ml/kg
1-8y/o - D25 2ml/kg
<1 yr - D10 2-5 ml/kg
What is tracheomalacia?
Weak tracheal rings resulting in collapse of trachea during expiration
Can be congenital, but also a frequent complication of surgical repair of esophageal atresia and tracheoesophageal fistula
Clinical manifestations of tracheomalacia
- Brassy, barking cough
Severe: - Stridor at rest
- Biphasic stridor
- Dyspnea with feeding
- Expiratory wheezing with respiratory infections
- “Death spells” beginning after 2-3 months of age - associated with feeding, crying or coughing and characterized by cyanosis, apnea, bradycardia, hypotonia that requires resuscitation
Management of tracheomalacia
Most with close observation, but those with recurrent death spells require nasal CPAP temporarily and aortopexy or tracheostomy for long-term relief
At what age do most cases of isolated congenital tracheomalacia resolve by?
1 year of age
Which type of bacterial meningitis usually produces lower WBC counts in CSF?
Gram positive meningitis
Abx therapy for bacterial meningitis in neonates (<1 mo)
Ampicillin + Gentamicin
What is phimosis?
Benign condition caused by stenosis of distal foreskin which may cause the inability to retract the foreskin over the glans penis
Evaluation of phimosis
Confirm there are no signs of urinary obstruction or local infection such as balanitis -> topical steroid cream, good hygiene, periodic gentle retraction, pediatrician follow-up
If urinary obstruction, gentle dilation of foreskin should be attempted to relieve obstruction
If signs of ischemia of the glans -> dorsal slit procedure
What is paraphimosis?
Inability to reduce foreskin back to anatomic position -> urologic emergency
What are the locations of the dorsal penile nerves?
2 and 10 o’clock positions at the base of the penis, just deep to the Buck fascia
Low risk characteristics after brief resolved unexplained event
- > 60 days old
- Born >32 weeks gestation
- No CPR performed by trained medical provider
- Occurrence of only one BRUE
- Duration of BRUE <1 min
- No concerning historical or physical exam findings
Concerning historical features related to BRUE
- Social risk factors for child abuse
- Respiratory illness or exposure
- Recent injury or other sx in days preceding event (fever, fussiness, diarrhea, decreased intake)
- Administration or access to meds
- History of episodic vomiting or lethargy
- Developmental delay or congenital anomalies
- Family h/o BRUE or sudden unexplained death in a sibling
Concerning physical exam findings in BRUE
- Any signs of injury
- Bleeding or bruising (especially on scalp, trunk, face, or ears)
- Bulging anterior fontanel
- Altered sensorium
- Fever or toxic appearance
- Respiratory distress
- Abdominal distention or vomiting
What are the three most likely disorders that can be elicited on history or exam as a cause to an apparent life-threatening event, thus negating the dx of BRUE?
- Respiratory infection
- Gastroesophageal reflux leading to laryngospasm
- Seizure
Most common metabolic problem in neonates
Hypoglycemia
Etiology of SCFE
Thought to be due to physeal cartilage weakness associated with onset of puberty and growth spurt, but may be multifactorial, tends to be in obese adolescents
Clinical presentation of SCFE
Obese, adolescent with hip, thigh, or isolated knee pain
- limited range of motion of hip
- external rotation deformity
Tx of SCFE
Operative stabilization
Complications of SCFE
Avascular necrosis of hip and premature closure of the physis
Most common type of TE fistula?
Proximal esophageal atresia with distal anastomosis
Most common type diagnosed after newborn period: H-type
Clinical presentation of papular acrodermatitis (i.e. Gianotti-Crosti syndrome)
- Symmetric papular or papulovesicular rash usually beginning on face, buttocks, and extensor aspects of the arms and legs
- Pruritus is mild
- Mucosal lesions NOT present
- Usually occurs in children younger than 5 years
- Recent URI or GI illness
What can papular acrodermatitis (i.e. Gianotti-Crosti syndrome) be associated with?
Hepatitis B or EBV and less so with other viral pathogens
Reported to occur after vaccinations including influenza, measles-mumps-rubella, hepatitis A and B, and oral polio
What conditions become an indication to treat a fever?
- Shock
- Burns
- Post-op patients
- Major head trauma
- Post-cardiac arrest
- Underlying neurologic or cardiopulmonary disease
Clinical presentation of cat scratch disease
Primary inoculation papule followed by regional lymphadenopathy 1-3 weeks later
Tx for cat scratch disease
Azithromycin (first line)
Can also treat with rifampin, bactrim, ciprofloxacin
Clinical presentation of malrotation with midgut volvulus
- Bilious vomiting
- Abdominal distension
- Tenderness
- Palpable mass
33% present within 1st week of life; 50% within first month; 85% within first year
Congenital defects associated with midgut volvulus
- Congenital diaphragmatic hernia
- Congenital heart disease (herotaxy syndrome)
- Omphalocele
Dx of midgut volvulus
Plain film may show dilation of stomach and duodenum and a paucity of bowel gas distally
Upper GI series or ultrasound will confirm diagnosis
Tx for midgut volvulus
NG tube decompression and laparotomy
Most common cause of painful rectal bleeding in infants?
Anal fissure
What are infantile spasms?
- Clusters of myoclonic seizures on awakening
- flexor spasms, extensor spasms or mixed - Hypsarrhythmia pattern on EEG
- Developmental delay
What disease process is associated with infantile spasms?
Tuberous sclerosis
Tx for infantile spasms
ACTH
Steroids
Antiepileptic medications
Difference between gonococcal and chlamydia ophthalmia neonatorum
Gonococcal: 2-5 days old, purulent conjunctivitis, profuse exudate and swelling of eyelid, corneal involvement, can lead to corneal rupture, impaired vision
Chlamydia: 5d-5w old, minimal eyelid swelling, pneumonia is common complication
Tx for gonococcal ophthalmia neonatorum
Hospitalization
Cefotaxime preferred over ceftriaxone in hyperbilirubinemia
Clinical presentation of pediatric discitis
- Sudden onset of back pain and refusal to walk
- Radicular symptoms common
- Fever
- Neurologic deficits UNCOMMON
- Lumbar spine most commonly involved
- Avg age of patients is 7 y/o
Diagnostic study of choice when concerned for pediatric discitis
MRI
Most common etiologic agent of discitis?
Infection with staph aureus
Clinical presentation of neonatal abstinence syndrome
CNS DYSFUNCTION
- high-pitched cry
- restlessness
- hyperreflexia
- tremor
- myoclonic jerks
METABOLIC, VASOMOTOR, RESPIRATORY
- Diaphoresis
- Fever
- Yawning
- Tachypnea
GI DYSFUNCTION
- Excessive sucking or rooting
- Poor feeding
- Vomiting
- Loose stools
Distinguishing feature between acrocyanosis and true cyanosis?
Mucous membranes would be involved in true cyanosis
What is the name of the benign lacy, reddish, mottled skin appearance of the extremities that may be associated with acrocyanosis?
Cutis marmorata
At what age can kids start receiving ibuprofen?
Greater than 3 months of age
What is a severe complication of perioral electrical burn?
Delayed bleeding from labial artery 5-21 days after injury
Most common location for pediatric pseudosubluxation?
C2-C3
Normal (deviation <2mm) in children under 8 years old
Clinical picture of coarctation of aorta
Depends on how severe
Neonates: asymptomatic while PDA is open or if not severe - heart failure and shock when PDA closes
Older infant, children: most asymptomatic; BP in upper extremities > lower extremities; brachial-femoral pulse delay; hypertension
Adults: hypertension; rib notching
Coarctation of the aorta is associated with what genetic disease?
Turner syndrome
How long after birth does umbilical vein stay patent?
One week
What is the most common rhythm in pediatric cardiac arrest?
Asystole
Most common complication of acute mastoiditis
Facial nerve paralysis
Others: - Subperiosteal or deep neck abscess - Hearing loss - Labyrinthitis - Osteomyelitis Less common: - Epidural or subdural abscess - Meningitis - Sinus venous thrombosis
What infectious organism is associated with intussusception?
Rotavirus
