Pediatrics Flashcards
Provide a DDx for acute testicular pain.
Testicular torsion (intermittent or persistent)
Torsion of the testicular appendix
Epididymitis
Epididymo-orchitis
Cellulitis of the scrotal skin
Hernia (incarceration/strangulation can cause pain)
Nephrolithiasis
In a boy with acute testicular pain, what features should raise your concern for testicular torsion?
Hemiscrotal redness and swelling
Nausea and emesis
Severe intensity of pain
Sudden onset
In evaluating a boy for testicular torsion, it’s important to note that if the ultrasound is negative it could ___________________.
be that he has intermittent torsion/detorsion
The reason this is important to know is that if it is detorsing then surgical correction is still warranted.
Describe the evaluation and management of epididymo-orchitis.
The presentation of epididymo-orchitis appears like torsion, so an US must be ordered. This will show findings of EO.
If the UA is positive for UTI, treat with antibiotics. In sexually active men, swab for G/C.
If it is negative (which is often the case in children), then supportive care is all that is needed because it is likely viral. Advise NSAIDs, supportive underwear, and ice packs.
- Epididymo-orchitis looks like torsion w/ a gradual onset and no nausea/vomiting.
In a fingernail injury, what should you assess?
First, look for nerve damage by assessing for sensation and movement.
Second, look for subungual hematomas. If there is a hematoma > 50% of the nail, trephination is indicated for relief of pain and protection of the nail.
Third, look for gross instability of the nail. If it is near to falling off, then the nail should be removed.
Fourth, if there is a laceration through the nail that is actively bleeding or there is a concern for foreign body, then remove the nail to stop bleeding and/or remove the foreign body.
In manipulating a nail, you need to be careful not to ______________.
remove any of the underlying nail matrix. If you do, the nail may not grow back effectively
Sterile foil for nail folds can be found in _________________.
suture packaging
Meconium ileus with a ground glass opacity in the right hemiabdomen is pathognomonic for __________.
CF
The mass is the meconium plug at the ileocecal junction.
A child who was born at 35 weeks gestation presents at 9 months. He is cognitively normal. He is noted to be missing gross motor milestones and has LE hypertonia. What diagnostic test should you order next?
MRI of the brain (looking for signs of cerebral palsy such as periventricular leukomalacia, ischemia, or other anomaly)
Describe the “scissoring of the legs” physical exam that can be seen in young kids with cerebral palsy.
If you hold a hypertonic young, nonambulatory child up by the axillae, the legs might remain stuck crossed (as opposed to dangling freely with spontaneous movement like they should).
A newborn screens positive for congenital hypothyroidism. TSH is elevated and T4 is mildly low. What should you do?
Begin levothyroxine immediately.
Congenital hypothyroidism can lead to intellectual disability if untreated. Treat and refer to endocrinology.
What is an easy formula for volume of feeds in the first few months of life?
Age in months +2
Review the types of formula and the brand names of each.
Milk-based: Enfamil, Similac Advance
Soy-based: Soy Isomil, ProSorbee
Hydrolyzed: Nutramigen, Alimentum, Progestimil
Elemental: Elecare, Neocate, Nutramigen AA
In addition to asking about how many diapers in the last 24 hours, you should also ask what?
When was the last diaper?
A baby should have a wet diaper every six hours.
Review the differential for hematochezia in an infant.
- Anal fissure or excoriation from diaper rash or diarrhea (most common)
- Milk protein allergy
- Malrotation
- Infectious diarrhea
What bruising patterns are concerning for NAT?
- Atypical locations: sides of the head (anterior and posterior are more typical), buttocks, cheeks, hands, ears
- Bruises on a non-ambulatory child
- Bruises in the shape of an object.
Intussusception usually happens in what age group?
6 months to 3 years
What concerning feature do you need to ask about in infants (younger than 3 months) with coughing episodes?
Apneic periods
The Broselow tape should always be in what orientation (color-wise)?
“Red to head”
The Broselow goes from the tip of the head to ___________.
the heel (not the toes!)
How are pediatric code carts different than adult code carts?
They are organized by color to match the Broselow.
Looking at the Broselow tape, how it is it organized?
PALS drugs in the left column, RSI and sedation drugs in the right column
