Peds Flashcards
hypoglycemia threshold in newborns
< 2.8 up to 48 hrs
then 3.3 on third day of life
then 4-8
febrile infant 0-28 days CPS algo
febrile infant CPS 29-60 days algo
empiric abx for febrile infant
what qualifies as fever in infant
RECTAL temperature >= 38 at home or in hosp
SBI and IBI
SBI: serious bact infection = UTI, bacteremia, meningitis, pneumonia,
IBI: invasive bact infection = bacteremia & meningitis
who do the CPS algorithms apply to?
well-appearing infants ≤90 days old with a documented history of fever, defined as any rectal temperature ≥38.0°C, taken
by a caregiver or HCP at home or in a clinical setting
risk factors that increase liklihood of SBI/IBI in febrile infants?
Commonly accepted risk factors
* History of prematurity (gestational age <37 weeks)
* Prior hospitalization or prolonged newborn nursery course
* Chronic medical conditions, chromosomal abnormality, or
technology dependence
* Known or suspected immunodeficiency
* Recent antibiotic exposure
* Any focal bacterial infection (e.g., cellulitis, omphalitis,
osteoarticular infection)
febrile infants < 90 days with which virus are actually more likely to have concomitant bact infection?
rhinovirus
how to handle viral symptoms or confirmed viral infection in young febrile infants?
even in the presence
of respiratory symptoms or a documented viral pathogen,
the initial diagnostic evaluation should follow the age-based
recommendations above
when to definitely think of HSV in febrile infants?
seizure, ELEVATED ALT, maternal HSV
basically, if covering for meningitis, cover for HSV with IV acyclovir
how to think of infants with hypothermia?
basically, any temp < 36 should be treated the same as a fever in infants <90 days
why is rectal temp the standard?
Axillary, oral, or tympanic measurements are inaccurate for core temperature in infants
definition of colic
rule of 3’s. crying 3 hours, 3 days per week for 3 weeks
2 times neonatal jaundice is always pathologic
in first 24 hrs of life and conjugated
Ddx of colic
NNJ: causes of conjugated hyperbili
BILIARY OBSTRUCTION, sepsis, TORCH infections (look them up), genetic/metabolic abn
NNJ: causes of unconjugated hyperbili
physiologic, breastmilk, hemolysis, trauma from birth
why order DAT in NNJ
r/o hemolysis in an unconjugated hyperbili
most common viral cause of diarrhea?
norovirus
bilious emesis in young infant is _____________ until proven otherwise
malrotation with volvulus
Levels of dehydration chart
dx and mgmt of malrotation/volvulus?
dx: abdo xray (cannot exclude and so still need to consult if suspicious)
mgmt: IVF, NGT, emergent surgical consult
Hirschsprung disease:
congen or acquired:
pathphys:
age group:
s/s:
dx:
mgmt:
Tracheoesophageal fistula:
congen or acquired:
pathphys:
age group:
s/s:
dx:
mgmt:
Meckel’s Diverticulum:
congen or acquired:
pathphys:
age group:
s/s:
dx:
mgmt:
Malrotation with volvulus:
congen or acquired:
pathphys:
age group:
s/s:
dx:
mgmt:
pyloric stenosis:
congen or acquired:
pathphys:
age group:
s/s:
dx:
mgmt:
Necrotizing eneterocolitis:
congen or acquired:
pathphys:
age group:
s/s:
dx:
mgmt:
Intussusception:
congen or acquired:
pathphys:
age group:
s/s:
dx:
mgmt:
peak age of incidence of wilms tumor
3-4 years
presenting s/s wilms tumor?
how to dx?
-painless abdo or mass effect when large
-hematuria
-hypertension
dx on u/s
pediatric UTI RF?
female, uncircumcised male, Caucasian, infants, sexually active
s/s of UTI based on age: neonates, 1-2, >2
neonate: sepsis, fever
1-2: vomiting, fever, irritable
>2: more typical UTI symptoms: LUTS, suprapubic pain, fever and vomiting with pyelo
how to interpret bag urine sample?
useful if negative as r/o UTI,
if + need to confirm with cath or midstream; generally if < 2 need to be cath’d
midstream usually can be done if child is potty trained
peak ages of peds testicular torsion?
NEONATES and adolescents
all male children with abdo pain or isolated vomiting need what exam?
GU to r/o torsion
primary vs secondary vs communicating hydroceles
primary: congenital excess fluid in scrotum, resolves by 1 yoa
secondary: reactive fluid collection secondary to infection, trauma, tumor, torsion –> treat underlying problem
communicating: excess scrotal fluid as a result of inguinal hernia –> refer for elective gen surg
most common cause of acquired peds renal failure?
glomerulonephritis
causes of peds
post infectious, especially strep (throat or skin); HSP, HUS, SLE
when does glomerulonephritis after infection, how does it present?
1-2 weeks after infection, presents as painless hematuria, HTN, +/- edema (if it causes nephrotic syndrome)
what is, what causes nephrotic syndrome
excessive proteinuria
can be primary (eg MCD) or secondary (HSP, SLE, HIV, GN)
how does nephrotic syndrome present?
most commonly age 2-6, presents as bilateral edema (periorbital, pedal etc), add to dx in eye puffiness
HUS triad
MAHA; thrombocytopenia; anemia
HUS most common cause
E coli O157
HUS vs DIC on lab work
coag studies will be normal in HUS
how does HUS present?
prodrome of bloody diarrhea,
Most kids with urololithiasis have one of two abn?
Anatomic gu abn
Metabolic abn leading to hypercalcemia
how do neonates and small children increase CO?
HR only, cannot really increase SV
when do ductus arteriosus and foramen ovale close functionally?
15 hours and 3 months respectively
age and characteristics of Still’s murmur
age 2-6, 1/6-3/6, early systolic murmur LLSB/apex, louder when supine
what is the basic mechanisms of cyanotic heart lesions?
R –> L shunt, which mixes deO2 with O2 blood
Cyanotic heart lesions - the 5 Ts
tricuspid atresia
truncus arteriosus
total anomalous pulmonary venous return
Tetrology of Fallot
transposition of great arteries
4 components of tetrology of Fallot
3 presentations phenotypes of CHD
which ones generally benefit from prostaglandins?
shock (grey), CHF (pink), cyanotic (blue)
grey for sure, as usually duct dependent systemic circulation
blue usually, as duct dependent pulmonary cirulation
when to give prostaglandin in crashing neonate?
initial mgmt of crumping neonate
3 heart lesions that are definitely duct dependent?
critical AS, coarctation, hypoplastic left heart syndrome
what is dose of prostaglandin? what do you need to be ready to do?
dose = 0.05 mcg/kg/min
need to be ready to intubate
what are tet spells? how to manage them?
= rt sided outflow obstruction leading to R->L shunt through a VSD, lead to hypoxia and acidosis. present like tachypnea, cyanosis
treatment is to increase pulmonary blood flow by increasing preload.
admin 100% o2, calm the child by placing in parents arms and flex the childs knee to chest to increase venous return,
if this doesnt work give morphine to act as pulm vasodilator
Cyanotic lesion, name a few, name clinical presentation and general mgmt
Shock lesion, name a few, name clinical presentation and general mgmt
HF lesions, name a few, name clinical presentation and general mgmt
basic mechanism of shock lesions?
poor left sided CO
basic mechanism of CHF lesions?
L –> R shunt
what are the cardiac complications of kawasaki?
coronary aneurysms, myocarditis, pericarditis , pericardial effusion, valve disease, arrhythmias
concerning historical features for pediatric chest pain?
exertional
syncope
famhx SCD
famhx/pmhx marfasns
pmhx kawasaki
lupus
cocaine use
recent URI
pericarditis vs myocarditis, ecg and trop, in peds (similar to adult)
peri: normal trop, classic ECG findings (same as adults, name them)
myo: often trop elevated, ECG –> low voltage or non-specific ST changes,
Ddx peds CP,
Note peds specific considerations
RF for serious cause of pediatric syncope
-mid exertion
-absence of prodrome
-triggered by loud noise or while swimmign (?long QT)
-famhx cardiac dz
what are breath holding spells
typicall 6-18 months, intense crying, then holds breath, becoems cyanotic and loses conciousness, can have ome myoclonic jerking, episodes resovle rapidly and require no intervention
most common cause of pediatric bradycardia? other causes
hypoxia
other: cardiac abn, hypothermia, raised ICP, meds
ECG characteristic of SVT
narrow complex, regular
no beat to beat variation,
rate > 220 in infant and >180 in children
discuss PALS brady algo
discuss PALS tachy algo
causes of pediatric SVT?
50% idiopathic, then accessory pathway (AVRT/AVNRT), then WPW syndrome and CHD can happen
what age do duct dependent lesions typically present?
second week of life
how does congenital adrenal hyperplasia present?
females: ambiguous genitalia
males: normal genitals, salt wasting (loss of sodium)
lethargy, vomiting, poor feeding, poor weight gain, hypovolemic shock
usually present around 2 weeks
stress dosing glucocorticoids? who and how?
for pts on chronic steroids. give 2-3X their daily dose when infection or stress from illness
one life threatening cause of persistent new born hypoglycemia?
CAH, give hydrocort 25 mg IV stat
when to suspect inborn errors of metabolism?
vomiting, lethargy, encephalopathic, acidosis or alkalosis, hypoglycemia.
these can present at any age, depending on the specific issue
what is eczema herpeticum?
eczema with superimposed HSV infection, vesicular rash in area of previous eczema
measles clinical picture and tx?
fever and rash with 3 C’s (cough, coryza and conjunctivitis) AND koplik spots (white pin point spots on white background)
tx: supportive
what is german measles
AKA rubella, immunity conferred by MMR
sx: low grade fever, rash, postauricular adenopathy,
mild course, except very severe if congenital infection which often leads to fetal viremia and birth defects
Roseola. Age and clinical presentation
6m to two years
High fever for 3-5 days, then rash when fever leave for 1-2 days
Roseola. Age and clinical presentation
6m to two years
High fever for 3-5 days, then rash when fever leave for 1-2 days
Erythema infectiosum
Parvovirus B19
4-15 years of age
3 day prodrome: Coryza, fever, HA then slapped cheek rash
Who should be concerned about parvovirus B19
Pregnant women, should see pregnancy dr if exposed
Chicken pox: virus, and symptoms
Varicella zoster
Fever precedes rash 2 days
Rash starts at hairline, often involves MM, dew drops on a rose petal at various stages of healing
Chickenpox treatment
Healthy, less than 12 supportive
Healthy older than 12 - oral antivirals
Immunocompromised- IV acyclovir
Pregnant- VZIG (note can cause severe fetal complications at birth or during pregnancy )
molluscum: presentation, virus, mgmt
virus: poxvirus
presentation: asymptomatic, flesh coloured, umbilicated papules
mgmt: ntohing
HFMD: presentation, virus, mgmt
cocksackie
usually kids <5, fever, painful lesion on mouth, buttocks, hands/soles
mgmt: supportive usually, can give magic mouthwash (not lidocaine conaining)
2 possible complications of HFMD?
myocarditis (2%)?? seems high
dehydration
scarlet fever presentation? mgmt?
sore throat and fever, then strawberry tongue, sandpaper rash and pastia lines (non blanching, linear erythema in skin folds)
anti staph abx for 10 days (PREVENTS RHEUMATIC FEVER, NOT GOMERULONEPRHRITIS)
staph scalded skin syndrome: presentation? mgmt?
usually under 5 yrs,
general erythema, no MM involement, + Nikolsky sign (although it is NOT SJS/TEN);
tx with anti staph abx
toxic shock syndrome: 2 organisms and mechanism
strep and staph
mech= colonization by a pathogen that produces endotoxins
general vibe of Juvenile Idopahthic arthritis
-joint pain and swelling longer than 6 weeks
-elevated crp, sometimes mild white count
-NSAIDs for first line tx
HSP presentation, prodrome?
prodrome = URI
palpable purpura, joint pain, abdo pain, hematuria
HSP mgmt and complications
mgmt = supportive, unless severe abdo pain, GIB or nephritis
complications: intussusception, nephrotic syndrome
what is the leading cause of acquired peds heart dz?
kawasaki
how does kawasaki cause heart issues?
it is a vasculitis, affects all small and med vessels, including coronary arteries which can elad to aneursym
diagnostic criteria for Kawasaki
5 or more days of fever
AND 4/5:
conjunctivitis
rash
erythema/edema
adenopathy (cervical)
mucous membrane involvement
treatment for kawasaki?
admission, IVIG, high dose ASA
caveat to diagnostic criteria for kawasaki?
not all pts will meet the criteria, consider the dx in anyone with fever for 5 or more days and two of the criteria
When do rheumatic fever symptoms develop in relation to GAS infection?
Within 2-3 weeks
5 major criteria (Jones) for rheumatic fever?
Carditis
Polyarthritis
Chorea
Erythema migranatum
Subcutaneous nodules
Causes of seizures in kids
Simple vs complex febrile seizure
Causes of seizure by age: neonatal, <6 yrs, <6 yrs
1st, 2nd and 3rd line meds in peds seizures
1st: lorazepam 0.1mg/kg, midaz 0.1 mg/kg IV or 0.2 mg/kg IM, diazepam 0.5 mg/kg PR
2nd: keppra 60mg/kg or fosphenytoin 20mg/kg
3rd: propofol, ketamine etc
In neonates: phenobarbital 20mg/kg
Peds headache causes: serious vs benign, list a bunch
Ddx of limp in peds
what is klein sign?
looks for SCFE, draw a line along superior border of fem neck and it should intersect fem head)
Salter-Harris classification
S: straight across = 1
A: Above the physis =2
L: beLow the physis =3
T: through and through =4
R: ruined physis = 5
ossification of peds elbow, by age
CRITOE, starts at 1 yoa and then counts up by two
Ddx of BRUE- think of common benign and serious pathologies
Think through BRUE algorithm
Anatomic consideration in peds airway and bow to deal with them
Name 6
Peds vent settings: tidal volume, peep, RR
xray finding of croup
steeple sign on soft tissue neck xray
xray finding in RPA, how to get xray specifically?
lateral neck xray in extension/inspiration. looking for soft tissue widening anterior to the cervical vertebrae (1/3rd the size of the vert)… if + or unsure get CT
bronchiolitis tx
supp o2, nasal suctioning, intermittently check o2. +/- epi neb or hypertonic neb
HFNC or NPPV are good to try and avoid mech vent
Pma organisms vibe, by age
peds pma abx
also consider azithro or doxy if suspicion for atypicals, ie suggestive xray or non-response to initial tx
RF for sides
run through peds primary survey
pecarn: over 2 and under 2
Pecarn blunt abdo trauma ct rule, 5 criteria a gate need for CT
Reasons to get a CT in blunt abdo trauma in peds
peds anaphylaxis algo? include doses
peds anaphylaxis dispo
peds astma tx according to PRAM score, include doses and dispo
PRAM score
peds asthma dispo
generally observe for 2 hours from initial therapy (also another slide on this)
treatments do’s and don’ts of bronchiolitis? what one med can you try?
bronchiolitis dispo
croup grading and mangement and dispo
croup criteria for d/c and admission
peds DKA mgmt (doses, monitoring etc)
signs of cerebral edema in peds DKA, mgmt of cerebral edema in peds DKA
signs and mgmt of severe gastro?
also can do NG rehydration if cant get IV access
mgmt of mild to mod dehydration in pesd gasto
general presentation of intusseception
most common age 5-10 months, most cases under 2 yrs
CSF interpretation in peds ?meningitis
ABCD’s of critical neonate resus
after ABCDs, what 5 body systems to think of in critical neonate
list 10 red flags for NAI in peds
peds severe sepsis resus algo?
peds status epi algo?
