Peds 1 Flashcards
Appropriate mode of action with caustive chemical burns
Wash away w. massive irrigation
Consider pituitary adenoma w. neurological symptoms like:
Bitemporal loss of vision
Headaches
Overproduction of prolactin
Underproduction of LH
LH deficiency is characterized by:
Decreased serum androgen concentration, energy, & libido
Loss of axillary hair
Amenorrhea
Breast atrophy in chronic cases
Commonly presents w. staccato cough & low-grade fever or no fever.
Often a/w history of eye infection acquired during birth.
CXR shows hyperinflation or ground-glass appearance
Chlamydia pneumonia
CXR shows localized or bilateral alveolar & reticular infiltrates
Aspiration of food
Commonly presents w. cough, high fever, & SOB
CXR shows lobar consolidation
Increased WBC & neutrophilia
Can be complicated by emphyema in infants
Pneumococcal or Staphylococcal pneumonia
Deep pain in lower legs & knees that shows up at bedtime in children b/w 3-10 yrs. & a/w to familial predisposition
“Growing” pains
Relieved by massage, heat, & analgesics
Common cause of vaginitis that presents w. inflammation & erythema of labio majora compounded by excoriations
Foreign body
Remove by gentle irrigation w. saline or examination under anesthesia
Treat inflammtion of vulva & vaginal mucosa w. topical estrogen cream for 1 week
Always consider sarcoma botryoides (malignant embryonal rhabdomyosarcoma) w. vaginal tag in young girl
Friable, grapelike masses that protrude the urethra or vagina
Presents w. bloody vaginal discharge
A 3 yof w. normal development of motor skills, head circumference, growth & social interaction unitl 5 mon. of age develops progressive encephalopathy & decline in motor & social skills
Often a/w hypotonia, hand wringing, seizures, & irregulat respiratory patterns
Inherited by X-linked & seen mostly in females as males typically die before birth
Rett syndrome
Complication of antenatal steroid & early prophylactic surfactant therapy seen in infants < 28 weeks GA & <1000g BW w. absolute O2 requirement for first 28 days of life
Present w. tachypnea, increase AP diameter, intercoastal retractions, baseline wheezing, fine crackles w. fluid overload, & poor growth
Can cause cor pulmonale, focal emphysema, widespread fibrocystic disease & separation of capillaires for alveolar epithelium
Bronchopulmonary dysplasia
Due to early volume trauma, oxygen free radials, & inflammatory mediators
End result: Obliterative fibroproliferative bronchiolitis w. widespread bronchiolar & bronchial mucosal hyperplasia & metaplasia w. interstitial edema
Lower track obstruction responds to bronchodilators
Goal is to keep oxygen levels over 90%, decrease risk of cor pulmonale, increase rate of growth, & improve neurodevelopmental outcome
Fluid restriction w. use of furosemide to decrease lung fluid overload can cause fluid/electrolyte abnormalities if used long-term.
Mechanism of long-term use of furosemide in treating lung fluid overload
Volume depletion w. loss of Cl- in urine
Secretion of ATII & aldosterone
Increased Na+ delivery to distal nephron
Increased acid secretion - Metabolic alkalosis
No loss of HCO3 - Contraction alkalosis
Low intravascular volume leads to maintenance of compensatory alkalosis.
Renal retention of Cl- in response to volume depletion
Compensatory increase in PaCO2 w. hypoventilation
Increased urinary Ca2+ leading to nephrolithiasis & nephrocalcinosis
Alkalosis
Increases K+ loss
Shifts K+ extracellularly
Acidosis
Decreases K+ loss
Shifts K+ intracellularly
Bartter syndrome
Defective Na+ & Cl- in loop of Henle
Volume depletion
Hypokalemia
Metabolic alkalosis
Chronic use of furosemide
Hypo-natremia, -chloremia, -kalemia, -calcemia
Chloride-responsive metabolic alkalosis
Mild salicylate poisoning
Metabolic acidosis w. respiratory compensation in infants Metabolic alkalosis in adolescents Vomiting Hyperpnea Fever Lethargy Mental confusion Treat w. IV bicarbonate to raise pH to 7.0-7.5 or hemodialysis if salicylate level >100mg/dL
Severe salicylate poisoning
Convulsion
Coma
Respiratory & CV collapse
Chronic salicylate ingestion
Hyperventilation Dehydration Bleeding disorders Seizures Coma
Management of salicylate poisoning
Gastric lavage w. airway protection up to 24 hrs. after ingestion
Give activated charcoal
Aggressive IV bicarbonate to alkalize urine & excrete salicylates
Treatment of acute pulmonary exacerbations in CF patients
Antibiotics:
Given IV w. severe exacerbation w. bacterial resistance ot oral therapy or failure of oral therapy to work
Most commonly: Tobramycin + 3rd cephalosporin
~Tobramycin + Penicillin
~Tobramycin + Carbapenem
Only complication of strept throat that cannot be prevented by early antibiotic treatment
Latency lasts 1-2 wks.
Immune-mediated glomerulonephritis
Clinical diagnosis of whooping cough (a reportable disease)
>2 wks. of cough w. paroxysms of cough Posttussive vomiting Confirmed w. nasopharygneal swab Treated w. macrolides If allergic, use bactrim, fluoroquinolones, or doxycycline
Varicella in immunocompromised patients
Varicella pneumonia
Poor prognosis w. ALL
Treat w. IV acyclovir
With varicella, crusting of all the lesions is completed:
At 7-10 days
Highly pruritic
High risk of superinfection
Common cause of SVT in infants
Re-entry w. accessory pathway characterized by abrupt onset & cessation
Narrow QRS complex & absent P waves w. unwarying HR
Treat w. rapid infusion adenosine if IV access
Treat w. synchronized DC cardioversion if emergency & no IV access
Once at sinus tachycardia, maintain w. digoxin or propranolol
Vagal stimulation may be used if patient is hemodynamically stable
Sequence of management of recurrent UTI’s
Ultrasound
VCUG
Renal scan w. DMSA
Onset of nephrotic syndrome b/w 1-8 yrs. responds to
Oral prednisone w/o need for renal biopsy
Treat within 4-6 wks. & taper slowy over 2-3 mon.
Work-up for nephrotic syndrome in children
24hr urine collection
Oral prednisone
Most common cause of pneumonia in children >5yrs.
Treated w. macrolides
Mycoplasma pneumoniae
Significant bilateral interstitial pneumonia
Initial treatment for acne vulgaris
Topical comedolytics Oral isotretinoin, if severe Oral antibiotics (tetracyclines or erythromycin), if refractory, severe inflammatory acne
First line therapy for acute CHF
IV furosemide
Most common cause of ophthalmia neomatorum
Chlamydia trachomatis
Eye infection that can occur at birth or after 5 days of age w. topical antibiotic prophylaxis at birth
Treated w. systemic ceftraixone
Gonococcal conjunctivitis
Eye infection that can occur after 5-23 days after birth
Treated w. systemic erythromycin
Chlamydial conjunctivitis
Treatment for HSV conjunctivitis & keratitis
IV acyclovir for 14-21 days
Most common complication of mumps in prepubertal children
Meningoencephalomyelitis
Condition a/w elevated IgE levels & development of allergic rhinitis & asthma
Present w. pruritic skin & excoriated skin lesions worsened by application of water
Atopic dermatitis
Initial: Erythematous papules w. excoriations & serous exudate on face & extensor surfaces
Subacute: Scaling papules on flexural areas
Chronic: Thickened, discolored skin w. accentuated surface markings and fibrotic papules
Treat w. constant skin hydration using emollients & topical steroids for acute flare-ups
Significant route of HIV transmission along w. vertical transmission
Breastfeeding
Vertical HIV transmission can be reduced with:
C-section
Prenatal, intrapartum, & neonatal zidovudine therapy
Type of sedation indicated in children that have not fasted prior to procedure & do not requires deep level
Conscious sedation
For minor surgical procedures, administration of ______ by oral or rectal route is sufficient for sedation.
Short/long acting benzodiazepines such as midazolam/diazepam
IV can be used for procedures involving intense pain
Type of sedation that can be used for fasted, stable children
Deep sedation
IV propofol or ketamine
Avascular necrosis of the femoral head seen in patients b/w 4-12 yrs. that present w. limping
Self-healing process managed close observation, bracing w. orthoses, or surgical osteotomies
Most common complication: OA
Legg-Clave-Perthes disease
