Peds Flashcards
5 categories of things to cover in well-child visit
vaccinations growth development safety abuse/neglect
evaluate growth at well-child visit
weight
height
head circumference
trend, if fall off growth curve, or in bottom 5th percentile, work up further
e.g. CF, heart disease, pyloric stenosis, GERD
malnutrition
in failure to thrive and malnutrition, which aspects of child growth suffer first?
1 weight
2 height
3 head circumference
well-child fell off growth curve into bottom 5%, what do you look for now
failure to thrive
(e.g. genetic (CF), heart disease, pyloric stenosis, GERD)
malnutrition
(formula, feed, frequency – do mom and dad know what they are doing? type, amount, freq?)
bare bones child development timeline
2mo - lift head, social smile
4mo - roll over
6mo - sit up, stranger danger (anxiety
bare bones child development timeline
2mo - lift head, social smile 4mo - roll over 6mo - sit up, stranger danger (anxiety) 1y - walk, separation anxiety, 1 word 2y - stairs, 2 words 3y - tricycle, 3 words, circle 4y - hop, 4 words, cross 5y - skip, 5 words, triangle
bare bones motor milestones
2mo, 4mo, 6mo, 1y, 2y, 3y, 4y, 5y
lift head roll over sit up walk stairs tricycle circle hop cross skip triangle
bare bones social/language milesones
2mo, 4mo, 6mo, 1y, 2y, 3y, 4y, 5y
social smile - stranger danger anxiety separation anxiety 1 word 2 word sentences 3 word sentences 4 word sentences 5 word sentences
tf
you will die from a tetanus toxin dose lower than can be recognized by immune system
t
that is why we vaccinate w tetanus toxoid
when does maternal immunity typically wear off in a newborn
~6mos
reactions to watch out for when administering vaccines
made w egg CI egg allergy
-yellow fever vac
-some flu vacs but changing
x can now give MMRV
live attenuated CI immunocompromise aids chemo transplant biologics careful w pregnancy
-MMRV
-intranasal flu vac
x IM flu ok
MMRV vaccine stands for
measles
mumps
rubella
varicella
vaccs CI w egg allergy
yellow fever vac
some flu vacs but changing
MMRV ok now
vaccs CI w immunocompromise
live attenuated
-MMRV
-intranasal flu vac
IM flu ok
vaccine reactions considered normal
temp v104F (babies only?)
erythema
baby consolable
vaccine reactions considered abnormal
temp ^104F (babies only?)
anaphylaxis
baby inconsolable
normal vs abnormal vaccine rxns
temp v104 vs ^104
erythema vs anaphylaxis
consolable vs inconsolable baby
tf
acute illness is CI to vaccine
f
give vaccine
tf
family hx of abnormal rxn to vaccine is CI to vaccine
f
only personal hx of abnormal rxn to THAT specific vaccine
when does baby get Hep B vaccine
mom + baby hep b ivig and hep b vacc asap
mom - baby hep b vacc w/in 2mos
mom ? baby hep b vacc now, check mom’s HBsAg
so baby always gets hep b vaccine, but if mom negative can wait v2mos
what will hep b infection at birth from carrier mom mean for baby
chronic carrier state for baby
DTaP/TdaP vacc schedule
kids get 5 doses DTAP
- 3 doses yr 1
- 2 doses yrs 1-4
Td age 11 and q10y after or q5y if wound
this bug causes epiglottitis
Hib
tf
Hib exposure v2yo confers immunity
f
so give Hib vaccine
tf
Hib vacc covers non-typeable Hib
f
MMRV vacc demo
everyone vacc and booster before school
not for immunocompromised because live attenuated
pneumococcal vacc demo
13 valent as infant
+ 23 valent if risk factors such as immunocompromise or asplenia
meningococcal vacc demo
everyone should get it
espec close quarters dorms barracks
HPV vacc demo
all boys and girls 9-26
how many doses
hep A vacc
hep B vacc
and what to do if pt re-presents after falling off dosing schedule
2 for A
3 for B
pick up where you left off
flu vacc demo
everyone unless CI
healthcare workers before winter mos
what do cap vs lowercase letters mean in DTaP Tdap and Td ?
large dose vs small dose
DTaP Tdap Td demos
DTaP x5 for kids
Tdap x 1 for all adults incl pregnant( every pregnancy!) and elderly… at least once age 11 and up
Td booster
tetanus
ppx
dx
tx
DTaPx5 kids
Tdap x1 adults + Td booster q10y x2
tetanus ivig
dx clinically
puncture metal rust mud
lockjaw spastic paralysis
support intubate sedate muscle relaxants as needed to get through acute phase
-iv metronidazole
tetanus
ppx
dx
tx
DTaPx5 kids
Tdap x1 adults + Td booster q10y x2
tetanus ivig
dx clinically
puncture metal rust mud saliva feces
lockjaw spastic paralysis
support intubate sedate muscle relaxants as needed to get through acute phase
-iv metronidazole
treat wound for possible tetanus exposure
if v 3 lifetime doses (DTaP Tdap Td whatever)
- Tdap if wound clean
- Tdap + tetanus IVIG if wound dirty
if 3 or more lifetime doses
- Tdap clean wound ^10y since last dose
- Tdap dirty wound ^5y since last dose
- send home if wound clean v10y since last; if wound dirty v5y since last
tf
give tetanus ivig if last vaccine dose was ^5 years ago but 3 lifetime doses
f
no tet ivig if ^ 3 lifetime doses
only give tet ivig fewer than 3 lifetime doses and wound dirty
diptheria
dx
tx
clinical dx fever, dysphagia, dyspnea, psudomembrane
inubate
antitoxin
ivabx
phases of pertussis infection
I catarrhal = infectious, nonspecific symx
II paroxysmal = cough/woop
III resolution
pertussis
dx
tx
clinical dx nonspecific infectious sympx, cough,woop, resolution
airway support, erythromycin
ppx w vaccine!
tf
prefererred immunity to varicella is obtained at pox parties
f
used to play w chicken pox kid so everyone would get it
now MMRV preferred, prevent disfiguration, shingles later in life
route of rotavirus vacc and CI
oral
intussusception CI
mnemonic for whether LP is unsafe
FAILS positive, increased icp FND AMS Immunocompromised Lesion Seizure
workup meningitis
FAILS positive
fnd ams immunocompromised lesion seizure
-blood cx, abx, ct, LP
FAILS negative
-LP, abx
Meningitis
FAILS positive
Fnd ams immunocompromised lesion seizure
CT or abx first?
abx before CT – want patient to live through ct
Fails positive - blood cx, anx, ct, lp
in peds meningitis, signs of ICP
bulging fontanelles
FAILS
fnd ams immunocompromised lesion seizure
Tx meningitis in adult vs peds
Adult
Vanc
Ceftriaxone
Steroids (plus minus)
Newborn v30 days old Vanc Cefotaxime(ceftriaxone causes hyperbilirubinemia in newborns) Ampicillin (Listeria coverage) Steroids
Meningitis with rash think this bug
Nisseria Meningitis
HIV baby How does baby get it How to prevent How to diagnose How to treat
Vertical transmission from Mom
- HAART best case, mom knows and viral load is zero
- AZT otherwise
PCR, skip ELIZA because baby v18mos not making their own antibodies yet, will just see mom’s
HAART FOR EVERYONE with HIV, including babies
Ppx cd4 (just know these, but cutoffs a little different in 6mos old)
v200 pcp - tmpsmx, dapsone, atovaquone
v100 toxo - tmpsmx, atovaquone
v50 mac - azythromycin
Osteomyelitis in peds
Dx
Tx
Same as in adults
But if see salmonella, think sickle cell
If toxic, give abx then continue workup
If not toxic
-xr, bx, abx
-mri if xr neg
Abx course 4-6 wks
Most often STAPH AUREUS any age
Most common bug in peds osteomyelitis
STAPH AUREUS most common in peds adults any age
If salmonella in kid think sickle cell
TF
Bone scan to dx osteomyelitis
F
Tough to tell cellulitis from deeper infection on bone scan
Abx fast if toxic
If not toxic, xr, mri, bx in there
Septic joint in peds Path Pres Dx Tx
Ghonnorhea sexually active
teen
Staph aureus direct inoculation stab wound
Aspirate ^50,000 wbc
Abx
