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Rosh Review > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Distinguishing timing difference between epiglottitis and retropharyngeal infection

A

Epiglottitis - more acute

RPA or other infection - progresses more slowly over several days

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2
Q

Imaging of choice for suspected RPA?

A

CT of neck with contrast (even in peds!)

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3
Q

When is surgical draining indicated for for RPA?

A

Greater than 2.5 cm squared

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4
Q

First line abx choice for RPA?

A

Ampicillin-sulbactam or Clindamycin

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5
Q

What measurements of the retropharyngeal space on a lateral neck radiograph are considered abnormally widened and suggest abscess formation?

A

Greater than 7mm at C2 or greater than 14 mm at C6

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6
Q

What is pseudosubluxation?

A

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)
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7
Q

Pediatric Cervical Spine Injuries

A
  • 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
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8
Q

Most common fracture involving the elbow in children < 8?

A

Supracondylar fracture

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9
Q

Supracondylar fractures are high risk for neurovascular injury to what?

A

Brachial artery and median nerve

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10
Q

Age of Ossification in children’s bones

A 
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
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11
Q

Which branch of the median nerve is commonly injured in supracondylar fractures?

A

Anterior interosseous - check by strength of patient making “OK” sign

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12
Q

Clinical presentation of bacterial tracheitis

A
  • Recent URI or croup improves initially, then worsens

- Will look like croup, but toxic

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13
Q

Definitive diagnosis of bacterial tracheitis

A

Direct visualization with bronchoscopy or laryngoscopy showing laryngotracheal erythema, edema, and thick purulent secretions
Q#447581

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14
Q

Bacteria implicated in bacterial tracheitis

A
  • *Staph aureus
  • H. flu
  • Moraxella catarrhalis
  • Strep pneumo
  • beta-hemolytic strep
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15
Q

Tx for bacterial tracheitis

A

Third-generation cephalosporin combined with a penicillinase-resistant penicillin e.g. nafcillin. Vanc if MRSA prevalent

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16
Q

Major causes of lower GIB in children by age

A

Q#330394 graph

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17
Q

What is the most common cause of neonatal hemorrhage?

A

Failure to administer vitamin K in the immediate postpartum period (associated with home births)

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18
Q

Neonatal sepsis work up

A
  • CBC
  • UA and culture (obtained by cath or suprapubic aspiration)
  • BCx
  • LP
  • CXR (only with respiratory sx)
  • Stool analysis (only with diarrhea)
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19
Q

Abx for sepsis in < 4 weeks old

A

Ampicillin PLUS gentamicin or cefotaxime

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20
Q

ETT size for pediatrics formul

A

CUFFED: Age/4 + 3.5
UNCUFFED: Age/4 +4

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21
Q

What is single finding most closely associated with acute otitis media?

A

Bulging tympanic membrane

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22
Q

First line abx tx for uncomplicated acute otitis media?

A

High-dose amoxicillin at 80-90 mg/kg/day

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23
Q

Kocher criteria to determine risk for pediatric septic joint

A
  • 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%
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24
Q

Pediatric dextrose administration in hypoglycemia

A

By Age:
>8 - D50 1ml/kg
1-8y/o - D25 2ml/kg
<1 yr - D10 2-5 ml/kg

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25
Q

What is tracheomalacia?

A

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

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26
Q

Clinical manifestations of tracheomalacia

A
  • 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
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27
Q

Management of tracheomalacia

A

Most with close observation, but those with recurrent death spells require nasal CPAP temporarily and aortopexy or tracheostomy for long-term relief

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28
Q

At what age do most cases of isolated congenital tracheomalacia resolve by?

A

1 year of age

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29
Q

Which type of bacterial meningitis usually produces lower WBC counts in CSF?

A

Gram positive meningitis

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30
Q

Abx therapy for bacterial meningitis in neonates (<1 mo)

A

Ampicillin + Gentamicin

31
Q

What is phimosis?

A

Benign condition caused by stenosis of distal foreskin which may cause the inability to retract the foreskin over the glans penis

32
Q

Evaluation of phimosis

A

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

33
Q

What is paraphimosis?

A

Inability to reduce foreskin back to anatomic position -> urologic emergency

34
Q

What are the locations of the dorsal penile nerves?

A

2 and 10 o’clock positions at the base of the penis, just deep to the Buck fascia

35
Q

Low risk characteristics after brief resolved unexplained event

A
  • > 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
36
Q

Concerning historical features related to BRUE

A
  • 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
37
Q

Concerning physical exam findings in BRUE

A
  • 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
38
Q

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?

A
  1. Respiratory infection
  2. Gastroesophageal reflux leading to laryngospasm
  3. Seizure
39
Q

Most common metabolic problem in neonates

A

Hypoglycemia

40
Q

Etiology of SCFE

A

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

41
Q

Clinical presentation of SCFE

A

Obese, adolescent with hip, thigh, or isolated knee pain

  • limited range of motion of hip
  • external rotation deformity
42
Q

Tx of SCFE

A

Operative stabilization

43
Q

Complications of SCFE

A

Avascular necrosis of hip and premature closure of the physis

44
Q

Most common type of TE fistula?

A

Proximal esophageal atresia with distal anastomosis

Most common type diagnosed after newborn period: H-type

45
Q

Clinical presentation of papular acrodermatitis (i.e. Gianotti-Crosti syndrome)

A
  • 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
46
Q

What can papular acrodermatitis (i.e. Gianotti-Crosti syndrome) be associated with?

A

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

47
Q

What conditions become an indication to treat a fever?

A
  • Shock
  • Burns
  • Post-op patients
  • Major head trauma
  • Post-cardiac arrest
  • Underlying neurologic or cardiopulmonary disease
48
Q

Clinical presentation of cat scratch disease

A

Primary inoculation papule followed by regional lymphadenopathy 1-3 weeks later

49
Q

Tx for cat scratch disease

A

Azithromycin (first line)

Can also treat with rifampin, bactrim, ciprofloxacin

50
Q

Clinical presentation of malrotation with midgut volvulus

A
  • Bilious vomiting
  • Abdominal distension
  • Tenderness
  • Palpable mass
    33% present within 1st week of life; 50% within first month; 85% within first year
51
Q

Congenital defects associated with midgut volvulus

A
  • Congenital diaphragmatic hernia
  • Congenital heart disease (herotaxy syndrome)
  • Omphalocele
52
Q

Dx of midgut volvulus

A

Plain film may show dilation of stomach and duodenum and a paucity of bowel gas distally

Upper GI series or ultrasound will confirm diagnosis

53
Q

Tx for midgut volvulus

A

NG tube decompression and laparotomy

54
Q

Most common cause of painful rectal bleeding in infants?

A

Anal fissure

55
Q

What are infantile spasms?

A
  1. Clusters of myoclonic seizures on awakening
    - flexor spasms, extensor spasms or mixed
  2. Hypsarrhythmia pattern on EEG
  3. Developmental delay
56
Q

What disease process is associated with infantile spasms?

A

Tuberous sclerosis

57
Q

Tx for infantile spasms

A

ACTH
Steroids
Antiepileptic medications

58
Q

Difference between gonococcal and chlamydia ophthalmia neonatorum

A

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

59
Q

Tx for gonococcal ophthalmia neonatorum

A

Hospitalization

Cefotaxime preferred over ceftriaxone in hyperbilirubinemia

60
Q

Clinical presentation of pediatric discitis

A
  • 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
61
Q

Diagnostic study of choice when concerned for pediatric discitis

A

MRI

62
Q

Most common etiologic agent of discitis?

A

Infection with staph aureus

63
Q

Clinical presentation of neonatal abstinence syndrome

A

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
64
Q

Distinguishing feature between acrocyanosis and true cyanosis?

A

Mucous membranes would be involved in true cyanosis

65
Q

What is the name of the benign lacy, reddish, mottled skin appearance of the extremities that may be associated with acrocyanosis?

A

Cutis marmorata

66
Q

At what age can kids start receiving ibuprofen?

A

Greater than 3 months of age

67
Q

What is a severe complication of perioral electrical burn?

A

Delayed bleeding from labial artery 5-21 days after injury

68
Q

Most common location for pediatric pseudosubluxation?

A

C2-C3

Normal (deviation <2mm) in children under 8 years old

69
Q

Clinical picture of coarctation of aorta

A

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

70
Q

Coarctation of the aorta is associated with what genetic disease?

A

Turner syndrome

71
Q

How long after birth does umbilical vein stay patent?

A

One week

72
Q

What is the most common rhythm in pediatric cardiac arrest?

A

Asystole

73
Q

Most common complication of acute mastoiditis

A

Facial nerve paralysis

Others:
- Subperiosteal or deep neck abscess
- Hearing loss
- Labyrinthitis
- Osteomyelitis
Less common:
- Epidural or subdural abscess
- Meningitis
- Sinus venous thrombosis
74
Q

What infectious organism is associated with intussusception?

A

Rotavirus

Rosh Review (22 decks)

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