Peds Flashcards
abx for OM (decreasing order)
amoxicillin augmentin cefdinir (PCN allergic) azithromycin (last resort) r/o mastoiditis, tx with surgical decompression
OE tx
abx drops: cipro
steroid drops
r/o mastoiditis, tx with surgical decompression
sinusitis tx
typically VIRAL
if clearly bacterial: give augmentin
consider foreign body
pharyngitis tx
augmentin
what to do if bug in ear
Lidocaine to paralyze, don’t shine light! bug will go deeper
blue with feeding, pink with crying + childhood snore
choanal atresia
dx: catheter fails to pass, or fiber-optic
tx: surgical
if see croup that does not improve with racemic epi, think?
bacterial tracheitis may be toxic appearing dx: tracheal culture tx: IV abx f/u: ENT scope
epiglottitis vs retropharyngeal abscess
both extend necks, will see tender u/l neck mass with abscess and LAD
dx: CT scan
tx: I/D or aspiration + IV abx
how is peritonsillar abscess different
older kids (10+)
see uvular deviation
dx: clinical
tx: drain + abx
extrathoracic vs intrathoracic FB
intrathoracic: expiratory wheeze
extrathoracic: inspiratory stridor
FB XR
look for “coin sign”
if in trachea, will be A-P oriented, so see face of coin on lateral
if esophagus will be lateral
bronchiolitis tx
O2, IVF
peaks 3-4
may not be able to eat so keep in hospital
f/u: hypoxemic resp. failure, ARDS
seizure tx
levetiracitam (keppra)
phenytoin
valproate
lamotrigine
simple febrile seizure
3/3 of the following
tx?
1x in 24 hrs less than 15 minutes generalized tx: benzos, acetaminophen if less than 3/3 it's complex, w/u with EEG, LP or MRI and tx: AEDs
infantile spasms
less than 1 yr, not generalized, no fever, symmetric jerking dx: EEG shows hypsarrhythmia tx: ACTH f/u: MR associated with tuberous sclerosis
tuberous sclerosis
angiofibromas, ash-leaf, afebrile seizures
dx: neuroimaging
intussusception dx
KUB: will see perf or obstruction
U/S next: sn, track resolution, “target sign”
dx/tx: air enema, need surgery if fails or peritonitis or perforation
“colon cancer” presentation in adult, think?
Meckel's i.e. painless hematochezia or FOBT+ or iron-def. anemia dx: technicium-99 scan tx: resection f/u: teenager: CT scan is better
GI bleed distractors
babies swallow moms blood (Apt test)
epistaxis
iron pills, beets, medications
give reassurance
other GIB stuff
IBD (UC more bloody) infectious colitis (stool cx) milk-protein allergy (change to hydrolyzed formula)
dev. dysplasia of hip
dx: U/S after no resolution for 4 wks
LCP (avascular necrosis)
6 yo
dx: XR, tx: cast
SCFE
13 yo
frog-leg XR tx: surgery
transient synovitis
hip pain after viral illness
+/- inability to bear weight
tx: supportive, ddx from septic joint with Kocher criteria (fever, ^WBC, ^ESR, (^CRP), non-weight bearing)
bone cancer
Ewing vs Osteosarcoma
Ewing: mid-shaft
Osteosarcoma: distal femur (Rb association)
dx: XR then MRI and biopsy to confirm
take peds fractures to OR for ORIF if ?
open, commuted, or involves growth plate
strabismus tx
congenital: surgery before 6 mo
acquired: patch good eye, give glasses
congenital cataracts
at birth: TORCH
after birth: galactosemia
diseases of prematurity (if you see one look for the others)
retinopathy of prematurity
bronchopulmonary dysplasia
intracranial hemorrhage
NEC
conjunctivitis
chemical: <24 hrs
gonorrhea: day 2-7, tx: ceftriaxone
chlamydia: days 5-14, u/l becomes b/l, mucopurulent, PO erythromycin
others: HSV, bacterial (d 5-14)
w/u for macroscopic non-glomerular (no RBC casts) hematuria
U/S: shows +/- hydro VCUG: shows +/- reflux CT: trauma (use contrast) or stone (non contrast) cystoscopy: intraluminal lesions IVP, renal bx (not usually)
Posterior urethra valves
“kid with BPH”
No UOP + distended bladder +/- oligohydramnios, ^CR
dx: U/S (hydro), VCUG (r/o reflux)
tx: catheter, sx
hypo/epispadias
do NOT do circumcision, need that tissue for reconstruction
Uteropelvic Junction Obstruction
presents with colicky abdominal pain with ^urinary flow (i.e. binge drinking)
dx: U/S: hydro, (NO hydro in ureter) VCUG: r/o reflux
tx: sx +/- stent
ectopic ureter
girl with “fistula”
boys: asymptomatic (above urinary sphincter)
girls: constant leak (below urinary sphincter)
dx: U/S: no hydro, VCUG: r/o reflux, radionucleotide (renal function)
tx: reimplant
vesiculouretural reflux
retrograde flow usually found on antenatal U/S + hydro may present with recurrent UTIs +/- pyelo dx: U/S: hydro, VCUG: +reflux tx: abx, surgery
labs in HgbSS
Hgb: 7-9, ^Bili, ^retic
may need transfusion which may result in iron overload (tx: deferoxamine)
may need folate supplementation
SCD osteomyelitis org
still most likely S. aureus!
Salmonella is commen in SCD
avascular necrosis tx
initially conservative, may need sx
SCD acute problems
stroke: FND, AMS
ACS: CP, SOB
tx: exchange transfusion (CVC)
priaprism: drainage before exchange transfusion
vasoocclusive crisis tx
IVF, O2, IV opiates
compare to baseline Hgb, retic, bili
+/- abx
f/u: psychosocial stressors if no ^labs
vasooclusive ppx
hydroxyurea, ^HbF
reduce # of crises
BM transplant not yet an option
HgbSC
low Hgb (around 11)
hematuria
usually do not get crises
others: SB+, SBo
recurrent sinopulmonary infections at 6 mos, low B-cells, NO IgG, IgA, IgM
X-linked Bruton’s agammaglobulinemia
confirm with RTK gene
tx: IVIG (scheduled), +/- BM transplant
recurrent sinopulmonary infections in teenager, low B-cells, low of 2/3: IgG, IgA, IgM
CVID (“mild Bruton’s”)
tx: IVIG
sinopulmonary or GI infections AND/OR anaphylaxis after blood transfusion
IgA deficiency
^IgG, ^IgM
tx: none
f/u: take IgA out of donor blood, EPI for anaphylaxis
non specific immune deficiency, low B cells, low IgG, low IgA, ^IgM
hyper IgM
tx: none
fungi and PCP infections, low absolute lymphocytes
DiGeorge
22q11.2 deletion, 3rd pharyngeal pouch
wide eyes, low ears, small face, no thymus
tx: TMP-SMX, IVIG bridge to thymic transplant
f/u: hypocalcemia (absent PTH)
eczema, low platelets, low WBC, normal infections, ^IgM, ^IgG (trying to compensate)
Wiskott-Aldrich (X-linked)
tx: BM transplant
Ataxia telangectasia associations
low Igs
DNA repair, leukemia, lymphoma
immediate immunodeficiency, NO B/T cells, low WBCs, NO IgG/M/A, adenosine deaminase deficiency
SCID
“mega-AIDS”
tx: isolate, TMP-SMX, BM transplant
S. aureus abscesses, ^WBC, ^IgG/M think?
Chronic granulomatous disease
catalase + infections
immune system trying to “ramp up”
tx: BM transplant
^fever, ^WBC, NO pus, delayed cord seperation
LAD: WBC can’t leave blood
tx: BM transplant
giant granules in PMNs, +partial albinism, neuropathy, neutropenia
Chediak Hegashi
if has C1 esterase deficiency and get angioedema give ?
FFP
who should not get egg containing vaccines
yellow fever
MMRV IS SAFE TO GIVE
influenza may/may not contain eggs
Treatment for tetanus
Intubate, sedate, muscle relaxers, metronidazole IV
Wound management if less than 3 lifetime doses of Tdap
If clean, just give Tdap
If dirty, Tdap + TIG
Wound management if more than 3 lifetime doses of Tdap
Clean wound: if more than 10 years since Tdap, give Tdap
If less than 10 years, no treatment
Dirty wound: if more than 5 years since Tdap, give Tdap
If less than 5 years, no treatment
Diphtheria treatment
Antitoxin, erythromycin or penicillin G, possible intubation, droplet precautions
