Pediatrics Flashcards
Transient Tachypnea of the newborn Presentation, Dx, Tx
Self- limiting mostly c-sections Pt: Term or near-term Grunting Dx: CXR=hyperextended/hyperinflation Tx: positive pressure ventilation
Respiratory Distress Syndrome presentation, Dx. Tx
Premature, Perinatal distress Dx: CXR=Hypoextended Atelectasis Tx: Intubation Surfactant
Hypoglycemia in a baby presentation, Dx, Tx
Jittery, Tremors, Seizures, lethargy Dx: rule out causes of infections Tx: Asx-Feed Sx- IV D50 Recurrent set up drip with D5/D10
Bronchopulmonary dysplasia Presentation, Dx, Tx
Pt: Increased O2 demand increase FIO2 Dx: CXR-ground glass opacities Tx: Surfactant (post natal) Steroids (ante natal)
Intraventriculr Hemorrhage
Presentation, Dx, Tx
Premature Asx Bulging Fontanelles Dx: Cranial Doppler Tx: VP Shunts or drains
Retinopathy of prematurity
Presentation, Dx, Tx
Premature baby on a ventilator (complication of too much oxygen)
Dx: Eye exam
Tx: Photoablation
Necrotizing Enterocolitis
Presentation, Dx, Tx
Premature baby with a bloody bowel movement
Dx: X-ray=Pneumotisis intestinalis
Tx: NPO. IV Abx, TPN
Imperforate Anus
Presentation, Dx, Tx
Possible Associated syndrome-VACTERL
Pt: No Hole
Tx: Mild=Fix now
Severe=colostomy first then fix later
VACTERL meaning, Associated with?
Vertebral Anomalies US Sacrum Anus X-ray Cardiac Echo TE Fistula Catheter Esophageal Atresia X-ray Renal Limb
Meconium Ileus
Presentation, Dx, Tx
Associated with Cystic Fibrosis Pt: FTPM and will be premature Dx: X-ray=transition zone gas filled plug Tx: Water enema F/u with sweat chloride test make sure they get ADEK and pancreatic enzymes
Hirschsprung
Presentation, Dx, Tx
Failure of migration, Auerbach/meissner plexus Pt: FTPM in 48 hours palpable colon Explosive diarrhea on DRE OR Chronic diarrhea with overflow incontinence Dx: x-ray good-dilated bad-normal best is Bx Tx: Resect bad colon
When you have baby emesis what do you consider?
bilious or non-bilious
if bilious consider double bubble and uterine course
Malrotation
presentation, Dx, Tx
Bilious emesis Pt: Normal pregnancy no polyhydramnios, no downs Dx: X-ray=double bubble Normal gas pattern Upper GI series Tx: NGT for decompression Surgery
Duodenal Atresia
presentation, Dx, Tx
Pt: Polyhydramnios, Down syndrome
Dx: X-ray= double bubble
no gas beyond
Tx: Surgery
Annular Pancreas
Presentation, Dx, Tx
Bilious Emesis Pt: Polyhydramnios, down syndrome Dx: X-ray=double bubble No gas Tx: Surgery
Intestinal Atresia
Presentation, Dx, Tx
"Vascular Accident in utero" Pt: mom taking some sort of vasconstrictor (cocaine) \+/- polyhydramnios negative for Downs Dx: X-ray=Double bubble with multiple air fluid levels Tx: Surgery
Tracheoesophageal fistula
Presentation, Dx, Tx
Pt: Non-biliary emesis Gurgling and bubbling Dx: NGT that coils on x-ray Tx: TPN Surgery
Pyloric Stenosis
Presentation, Dx, Tx
causes Gastric outlet obstruction Pt: Usually male 2-8 weeks Normal to projectile vomiting Olive shaped mass Visible peristaltic waves Dx: CMP= decreased Cl, potassium, increased CO2 US= Donut sign Tx: IVF to replete electrolytes then Surgery
Causes of Conjugated neonatal jaundice
Atresia
Sepsis
Metabolic
Causes of Unconjugated Neonatal Jaundice
Hemolysis or hemorrhage
Physiologic Jaundice (indirect) Findings
Onset >72 hours Resolution <1 wk Preme (<2 wk) Bili unconjugated Increase <5/day
Pathologic Jaundice (Direct) Findings
Onset <24 hr Resolution >1 wk preme >2 wk Bili Conjugated Increase >5/day
Diagnostic workup unconjugated neonatal Jaundice
Coombs (-)
Hgb
Reticulocyte count
Breast Feeding Jaundice
Presentation, Dx, Tx
Quantity, Not feeding enough decrease bowel movements increased reabsorption presents <7 days unconjugated, feed more
Breast Milk Jaundice
Presentation, Dx, Tx
Quality of milk
presents after day 7
unconjugated, change to hydrolyzed milk
Biliary Atresis
Presentation. Dx, Tx
Worsening Jaundice day 7-14 Direct Hyperbilirubinemia Dx: US=no ducts HIDA SCAN 5-7 days give phenobarbital first Tx: REsect
Neural tube defects Presentation
increased AFP
Tuft of hair on exam
Occulta
Tuft of hair with skin covering
Meningocele
CSF Outpouching sack
Meningomyelocele
CSF and nerves in outpouching
vaccine contraindicated with egg allergy
yellow fever
vaccine contraindicated with immunocompromised patients
MMRV
Intranasal Flu
if a patient is sick can you vaccinate?
yes
Tetanus treatment, <3 lifetime doses, clean wound
Tdap
Tetanus treatment <3 lifetime doses, dirty wound
Tdap +Ig
Tetanus treatment >3 lifetime doses, Clean wound,
> 10 years since last dose= Tdap
< 10 years since last dose= go home
Tetanus treatment >3 lifetime doses, dirty wound
> 5 years since last dose=Tdap
<5 years since last dose= go home
Epidural Hematoma
Presenation, Dx, Tx
Strike to the head, most likely sports injury (Ball), Skiiing Walk, Talk, Die - LOC lens shaped Middle Meningeal artery
Subdural Hematoma
Presentation, Dx, Hx
Pedestrain struck MVA Shaken Baby Syndrome \+ LOC then COMA Crescent shaped
Erythema Infectiousum Presentation, Tx
Parvo B19
Slapped cheek appearance, There is a fever and rash
Tx: Supportive
f/u with aplastic crisis with sickle cell
Roseola
Presentation
HHV6 Prodrome Very high fever >104 Fever first then rash moves from trunk to extremities
Measles
Presentation
Prodrome-
Conjunctivitis, Coryza, Cough, Koplik Spots
Fever and rash at the same time
moves from Face to trunk
Rubella “German measles”
Presentation
Prodrome
Generalized
Tender Lymphadenopathy
Fever and rash moves from face to trunk
Mumps
Presentation
Pubertal males, Parotid swelling, Orchitis
Can lead to infertility
Varicella zoster
Presentation
Rash without fever
Diffuse rash
Vesicles on an erythematous base in different stages of healing
Hand foot mouth disease
Presentation
Cocksackie A
Rash Features of varicella on the hand feet and mouth
Otitis Media
Presentation
Tx
unilateral ear pain
relieved with pulling on the pinna, bulging TM
Tx: Amxociliin, if allergic ceftanir or azithromycin
Otitis Externa
Presentation
Tx
Swimmers ear Pseudomonnas
Unilateral ear pain, worse by pulling pinna
Tx: Spontaneous resolution
Malignant Otitis Externa
Presentation
Like Otitis externa with involvement of the bone
Tx: Ciprofloxacin or steroid drops
Sinusitis
Presentation
Tx
Bilateral purulent discharge
Facial tap=pain
if Temp >38C, Dur >10D
give AMOX-CLAV
Pharyngitis
Tx
Amoxicillin
Croup
Presentation
Dx
Tx
3months - 3 years Viral prodrome, Barking/seal like cough Dx: Racemic Epinephrine (Steeple) Tx: Mild: Mist Moderate: Racemic Epi, Steroids, O2
Bacterial Tracheitis
Presentation
Dx, Tx
Staph Aureus
5- 7 year old, Croup that does not improve-Patient is toxic
Dx: not better with racemic epi, Tracheal Cx
Tx: IV Abx
Retropharyngeal Abscess
Presentation
Dx, Tx
Very sick patient, Abrupt Onset, High Fever, Drooling, hot potato voice Anterior chain unilateral LN Mass=Abscess Dx: CT scan Tx: Incision and drainage IV Antibiotics
Peritonsillar Abscess
Presentation
Dx, Tx
Hot potato voice, Sore throat, Drooling Dysphagia, Uvular deviation
Tx: Drain and IV Abx
Epiglottitis
Presentation
Dx, Tx
Very Sick child, Rapid onset high fever, Tripoding, drooling, Accessory muscle use, Hot potato voice Dx: x-ray-thumb sign Secure airway Cherry red epiglottis Tx: ET Tube in the OR IV Abx
Cystic Fibrosis
Presentation
Autosomal Recessive, CFTR gene Meconium Ileus Recurrent Pulm. Infection Failure to thrive "Salty" baby
Cystic Fibrosis
Dx, Tx
Sweat Chloride test >40 infant >60 for older Tx: Pulmonary toilet Replace pancreatic enzymes and give ADEK
Grand Mal Seizure features
+ LOC, generalized
Partial-Complex Seizure features
+ LOC, Focal (partial)
Partial, simple Seizure features
- LOC, Focal
Trigeminal neuralgia Tx
Carbamazepine
Absence Seizure Tx
Ethosuximide
Criteria for Simple Febrile Seizure
1 in 24 hours
Duration <15 mins
Generalized
Necrotizing enterocolitis
Presentation
Dx, Tx
Premature baby with a GI bleed
Dx: X-ray-Pneumatosis intertinalis
Tx: NPO, IVF, TPN, IV Abx
Meckles Diverticulum
Presentation
Dx, Tx
Painless, intermittent hematochezia
Rule of 2s
Dx: Technicium-99
Tx: Resection
Meckles, rules of 2s
<2 years old <2% of population 2x more likely in males 2 ft from ileocecal valve 2 inches
Intussusception
Presentation
Abrupt sudden onset colicky abdominal pain Knee to chest relief *currant jelly diarrhea* *sausage shaped mass* 3mo-3years
Intussusception Dx, Tx
KUB=perforation/obstruction U/S=track resolution Air enema Tx: Air enema Surgery, if there is signs of peritonitis, perforation, or failure of air enema
What are the Left to right shunts
ASD, VSD, PDA, non-cyanotic
ASD
presentation
Dx, Tx
> 1 year old most common congenital defect
Fixed Split S2
Dx: Ech
Tx: Surgery
VSD
Presentation
Dx, Tx
Associated with Downs Most common <1 year old Asx Murmur Failure to thrive, CHF Dx: Echo Tx: Asx=wait 1 year old CHF=Surgery
PDA
Presentation
Dx, Tx
Continuous machine like murmur Multiphasic murmur Dx: Echo Tx: Indomethacin=closure Prostaglandin=keep open
Transposition of the great arteries
Presentation
Dx, Tx
Moms that have DM Failure to twist Blue baby on day 1 Tx: Prostaglandin Surgery
Tetralogy of Fallot
Presentation
Dx, Tx
Associated with down syndrome VSD Overriding aorta Pulmonic stenosis Right ventricular hypertrophy TET spells-Kids will squat Dx: CXR-boot shaped heart echo Tx: Surgery
Coarctation of the aorta
Presentation
Dx, Tx
Descending aorta HTN in UE Hypotension in LE Dx: Echo Tx: Surgical
Developmental Dysplasia of the hip
Presentation
Dx, Tx
Newborn
Clicky Hip
Dx: U/s @ 4 weeks
Tx: harness
Legg-Calve Perthes Disease
Presentation
Dx, Tx
6 Years old
Insidious onset, analgesic Gait
Dx: X-ray
Tx: Cast
Sliped Capital Femoral Epiphysis
Presentation
Dx, Tx
Age 13 Growth Spurt or Obese Non-Traumatic Joint pain Dx: Frog Leg, x-ray Tx: Surgery
Septic gait
Presentation
Dx, Tx
Any age
Fever, leukocytosis, increased ESR/CRP, cannot bear weight
Dx: Arthrocentesis, >50k WBC
Tx: Drain, Abx
Transient synovitis
Presentation
Dx, Tx
Any age hip pain after viral illness cannot bear weight Dx: Clx Tx: Supportive F/u 2 days
Osgood Schlatter
Presentation
Dx, Tx
Osteochondrosis Teenage atheletes Knee pain+Tibial Swelling Dx: Clx Tx: Sit it out=curative or Work through it
Scoliosis
Presentation
Dx, Tx
Spinal deformity Teenage girl Shoulders at different levels Dx: Adams test (touch toes) X-ray Tx: Brace to slow progression Rods: Reverse
Ewing Sarcoma
Presentation
Dx, Tx
Midshaft, Onion skin appearance
11,22
Osteosarcoma
Presentation
Dx, Tx
associated with the retinoblastoma gene
Sunburst pattern
Bone pain- then x-ray- MRI then Bx
Tx: Surgery
Retinoblastoma
Presentation
Dx, Tx
All White retina
Clx
Surgical
f/u for osteosarcoma
Strabismus
Presentation
Dx, Tx
Lazy eye
if it is congenital surgery in 6 months
Acquired patch the goodeye and use glasses
Amblyopia
Presentation
Dx, Tx
Cortical Blindness Strabismus, Cataracts Dx: Clx Tx: none PPX: correct the underlying illness
Retinopathy of prematurity
Presentation
Dx, Tx
Premature baby high levels of O2, growths on the retina Dx: Clx Tx: Photoablation F/u-Bronchopulmonary dysplasia intraventricular hemorrhage Necrotizing enterocolitis
Congenital Cataracts
Presentation
Dx, Tx
Present at birth=due to TORCH infection not at birth=Galactosemia Pt: Cloudy/Milky white Front of the eye Dx: Clx Tx: Resection
Conjunctivitis due to Gonorrhea
onset 2-7 days
Bilateral Purulent discharge
Tx: Ceftriaxone
Conjunctivitis due to Chlamydia
Onset 5-14 days
starts unilateral mucoid discharge then converts to bilateral purulent discharge
Tx: Erythromycin
Psoterior Urethral Valves
Presentation
Dx, Tx
No urine out of the bladder post-obstructive Pt: no urinary output and distended bladder \+/- oligohydramnios \+/- Hydro on Prenatal u/s \+/- increased Creatinine Dx: u/s=hydro VCUG=r/o reflux Insert Catheter Tx: Catheter Surgery
Epispadias
Dorsal
Hypospadias
Ventral
Uretopelvic junction obstruction
presentation
Dx, Tx
Normal at normal Obstruction with increased flow Dx: u/s=hydronephrosis VCUG=r/o reflux Tx: Surgery
Ectopic ureter
Presentation
Dx, Tx
males usually Asx females have normal function with a constant leak, have never been dry Dx: u/s= non hydro VCUG=r/o reflux Radionucleotide Tx: Reimplant
Vesicoureteral reflux
presentation
Dx, Tx
Retrograde flow Prenatal u/s-Hydro Recurrent UTI +/- Pyelonephritis Dx: u/s = hydro VCUG=shows reflux Tx: Abx Surgery
What is the most common cause of ostemyelitis?
Staph Aureus
HgbSS-Salmonella
Chronic complications of Sickle cell
Osteomyelitis
splenic Autoinfarct Avascular necrosis of the hip
Sickle cell
presentation
Dx, Tx
Pt: decreased HgB increased reticulocyte, bilirubin Chronic pain Dx: CBC=sickled cells HgB electrophoresis Tx: Vasocclusive crisis=IVF, O2, Pain control \+/- infxn= Abx PPX: Hydroxyurea increases HgbF
