PEDS Flashcards
Steeple sign
Narrowing of the subglottic airway on chest XR, often seen in Croup
17 yo w/ sore throat, difficulty swallowing, and faver. 1 week hc. Temp 103. Upon PE you find lateral deviation of the uvula. What does this raise concern for?
In an adolescent w/constitutional symptoms/signs of an acute infections, lateral deviation of the uvula should raise concern for a peritonsillar abscess. It is a sirgical emergency/urgent case as there is considerable risk for local swelling and obstruction of airway.
These are often caused by strep or staph.
What are possible causes of short stature?
constitutional growth delay, familial short stature, chronic steroid use, endocrine abnormalities like hypothyroidism or adrenal insufficiency, cardiopulmonary disease, genetic disorders likel downe or turner.
What are the most COMMON causes of short stature?
Constitutional growth delay and familial short stature
9 month old coming in for her annual wellness, she has conjunctival pallow and labs concerning for iron deficiency anemia. What is most likely cause?
9 month old=milk predominant diet
Whole mulk and breast milk are low in iron but note that the iron in breast milk has higher bioavailability while cow milk proteins can impair iron absoprtion in human infants, most infants and cow milk is associated w/increased risk of occult bleeding
4 yo boy comes in w/ 1day hx of limp and hip pain. Pt had cough and runny nose 10 days ago. Palpation of the hip reveals no tenderness, and hip is not erythematous or hot to the touch. What is the most likely dx?
Transient synovitis of the hip, post infection in young kiddos you can get synovitis on weight baring joints.
Tx w/ibuprofen
Painless left scrotal mass in 16 yo boy, mass decreases while supine and has a bag of worms sensation. This is likely ___________ but you can also consider _____________ on your differential
This is MOST likely a varicocele, they can be managed symptomatically or surgically
Hydrocele, this normally presents w/uniform enlargement and not isolated mass
Inguinal hernia
Epididymitis, this is more acute and seen w/tender swelling
Tx for otitis externa
Daily use of alcohol acetic ear drops
Most common pathogen is pseudomonas aeruginosa
Nonbloody nonbillious emesis adter feedings starting 3-6 weeks
likely pyloric stenosis, assess w/ abdominal US
Common/most likely organism to cause acute otitis media
strep pneumoe or haemophilus influenzae
First line ABX for acute otitis media
amoxicillin with or without clavulnate
Amoxicillin is a broad spectrum abx, beta lactam, ffram + and - bacteria. Its also commonly used for ped URI, sinus, and ear infections.
17 yo male w/ unilateral scrotlal pain and swollen tender mass over the posterior aspect of the testis. He also is sweating, endorses chills, and burning with urination. What is the likely dx?
Acute epididymitis, likely from an STI
17 yo male w/ unilateral scrotlal pain and swollen tender mass over the posterior aspect of the testis. He also is sweating, endorses chills, and burning with urination. What tx would you like to start and why?
Start ceftriaxone to cover gonnorhea and start doxy or azithro to cover chlamydial infection b/c this is likely acute epididymitis secondary to STI.
Levofloxacin or trimethoprim-sulfamethox for pts where STI is unlikely.
Preterm infant who spent time in the NICU and is exclusively breastfed is at greatest risk for what deficiency after 4 months?
IRON
Prematurity–> low iron stores at birth
NICU–> blood draws reduce iron stores
Breastfed–> iron poor diet
How might you differentiate viral from bacterial conjunctivitis?
Viral: bilateral
Bacterial: unilateral, purulent discharge
How do you treat viral conjunctivits?
You dont, its just symptom management
How do you treat bacterial conjunctivitis?
Topical antibiotics like sulfacetamide but this one has largely been supplanted by newer ones but regocnize this for exam purposes
Can you tx infectious mononucleosis with acyclovir?
No
General/typical newborn screens include…
newborn state screen, hearing, bilirubin, and congenital heart disease
WHen screening kids for hocum before spots physicals, what symptoms/hx/and PE findings would you look for?
Symptoms/Hx: personal hx of syncope and chest pain, fam hx of sudden young death
PE: left ventricular outflow obstruction–> systolic murmur that radiates along left sternum that worsens w/preload
note that innocent murmurs are often soft, systolic murmurs 2/6 w/out palpable thrill
Lens shaped hematoma
Epidural hematoma
crescent shaped hematoma
subdural hematoma
What might lead to a subdural hematoma in a kid?
Shaken baby or HIGH SPEED trauma
This will be a ‘crescent shaped’ hematoma
For burns in kids, how do we calc body surface area %?
Head - The head is 18%, 9% each for the front and back.
Arm - Each arm is 9% of the body surface area (front and back are 4.5% each)
Thorax - The front and back thorax are 18% each (36% for the whole thing).
Legs - The total surface area for the legs is 27% (so 13.5% for each leg).
there’s usually a nonspecific prodrome that gives rise to an erythematous rash. It’sisolated to the face bilaterally (slapped-cheek).You may see some spread to the trunk/limbs, which willbelacy or reticular in appearance.Thisdisease is benign on its own in a normal healthy baby andresolvesspontaneously
Erythema Infectiosum Caused by parvovirus B19
an obvious prodrome of low grade fever and the “four hard Cs” –cough, coryza (runny nose), conjunctivitis, and Coplik Spots (Koplik Spots, an enanthem,are small irregular spots with white centers on bright red buccal mucosa). The rash starts on the face, after the prodrome. As it spreads to the body, fever starts with the rash. The rash spreads and clears from head to toe. Later in lifea potentially lethal complication (subacute sclerosing panencephalitis) can occur
MeaslesCaused by a paramyxovirus RUBEOLA
It starts on the face, spreadsdownto the toes, and is likewise macular. The prodrome of tender generalized (periorbital, postauricular) lymphadenopathyprecedes the rash.Forchheimer spotson the palate (red enanthem)can be seen
Rubella(aka “German Measles”)Caused by thetogavirusnamedRubella
a prodrome of a high-fever (>40 C) that breaks as the rash starts. The rash is a macular rash that begins on trunk and spreads to the face. Febrile seizuresmay result from extreme fever during the prodrome.
RoseolaCaused by HHV-6,
A vague, nonspecific viralprodrome indicates contagion. What follows isa rash that starts on the trunkand headfollowed by outward spreadto extremities. Thevesicles are on anerythematous base andare in different stages(eruption, ulceration, crusting). Contagion ends with a final crust. Scarringand secondary infections(Staph and GAS) are two complications.
Varicella(aka “Chickenpox”)Thisiscaused by varicella zostervirus.
itcauses bilateral parotid swelling and orchitis in pubertal males.
Mumps
has a vague, nonspecific prodromebut may present with oral pain. Like varicella, it has a vesicle on an erythematous base, but will primarily involve only the hands, feet, and mouth (thus the name). It can also involvethe buttocks. Herpanginainvolves vesicular lesions on the soft palate, tonsils, and uvula.
Hand-Foot-MouthDisease (aka “HFMD”)Caused by coxsackie A virus,
Slapped cheek appearance
Erythema infectiosum
Cough, Coryza, Conjunctivitis, Coplik
Measles/rubeola
Aplastic anemia is a concern with what exanthem?
ParvoB19, “slapped cheek” or “fifth disease”, normally its benign but for people with sickle cell or a condition with increased cell turnover it can lead to aplastic crisis!
Subacute sclerosing panencephalitis is a concern in the sequelae of which examthem?
Measles
IgE mediated reaction
Type 1 Hypersensitivity
Unilateral ear pain, releif w/pulling of the pinna, dx’d w/pneumatic insufflation showing a tense immobile membrane
otitis media
How do we treat otitis media?
Amoxicillin!
If it recurs, amoxicillin-clauvanate
If penicillin allergy, try a cephalosporin like cefdinir
Anyphylaxis hx, try azithromycin
What tends to lead to otitis media?
URIs mostly caused by:
–s pneumoniae
–H influenzar
–M. cararrhalis
WHen is a tympanoplasty warranted?
3 infections in 6 months or 4 in a year
Two major causes of otitis externa?
Swimming–> psedomona
Digital–> staph
Pinna pulling increases pain!
otitis externa
How do we treat otitis externa?
Alcohol Acetate ear drops
Bad symptoms Cipro drops and steroid drops
When should mastoiditis be considered?
Acute otitis media and mastoid swelling! Its a clinical dx.
People w/ear tubes are at increased risk
How do we know when to test for strep?
Sore throat w/ CENTOR criteriaL
Cough+1
Exudates+1
Nodes+1
Temp over 38C+1
OR less than 14 yo +1 or over 44 yo -1
only 1=viral
2-3 get a swab it may be bacterial
how do we tx for strep a?
Amox-clav
When should you consider mono when you get a strep throat like presentation?
–SPLENOMEGALY or party with sharing cups and what not
There is purulent discharge. The illness has been going on for more than 7 days. There is a high fever and maxillary tenderness. All of these signs point to viral or bacterial sunusitis?
Bacterial! worsening symptoms, fever, over 7 days–> likely they had a cold that improved, then became superinfected with bacteria
persistence of a bony/mucosal membrane in the nasopharynx that obstructs air flow in babies
choanal atresia
Cyanosis while feeding should make you think of
choanal atresia, eval w/looking at nasopharynx/catheter
What are pts w/strep a infection at risk for even if you tx correctly?
Post-Streptococcal glomerulonephritis (PSGN) can happen whether or not the patient is adequately treated or not. Just the exposure to the antigen puts him at risk for the mimicry which can result in the renal disease. There is no protection from having treated the infection (unlike Rheumatic fever).
The patient will present with a viral prodrome for ~1-2 daysbefore the development of a barking,seal-like coughthat’sinterspersed with inspiratory stridor. The cough is worse at night. The diagnosis is clinicalbut an AP film will show clear lungs and a steeple sign (subglottic narrowing). If causing significant respiratory impairmentsupplement with oxygen and give racemic epinephrineand steroids(usually dexamethasone)
Croup (laryngotracheobronchitis)
Steeple sign can be indicative of…
CROUP!
or
Bacterial Tracheitis!
Thumb print sign
Epiglottitis
Drooling, tripoding, sudden onset dyspnea, high fever, sick as shit
Epiglottitis
caused by Hib, not as common due to vaccination
3month old-3 year olf w/barking cough improved w/racemic epi
croup
also remember croup and dexamethosone
How do you differentiate epiglottitis from retropharyngeal abscess?
Look for mass/abscess!
Both pts have rapid onset of dyspnea, drooling, hot potatoe voice, maybe tripoding
Uvular deviation in a kid
peritonsillar abscess
In an asthmatic who came to the ER for an exacerabtion, they have stopped wheezing. If you have rising CO2 in the setting of tachypnea you should strongly consider….
Intubation, this is respiratory failure!
If there is sufficient air trapping the wheezes “go away” because there is NO air movement. The respiratory acidosis tells you that ventilation is impaired.
Under 2 years of age + wheezing =
bronchiolitis. Most common etiology is RSV. For the love of all that is holy, do not treat with steroids.
