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My Clin Med 4 > Peds > Flashcards

Peds Flashcards

1
Q

How much weight is normal for a neonate to lose in the first 3-4 days of life and why

A

10% (Meconium)

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2
Q

how long should it take for a neonate to regain weight lost just after birth

A

By Day of Life 14

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3
Q

How much weight should children gain per month in first 3 months of Life

A

2 pounds per month

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4
Q

Why do we measure head circumference?

A

Reliable indicator of brain growth up to 2 years

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5
Q

What BMI is a significant risk factor for obesity in adulthood

A

BMI>95%

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6
Q

When should lead testing occur?

A

Between 9 -12 months
Age 2
Age 3

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7
Q

When should Iron be checked

A

annually starting at age 1 until age 6

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8
Q

Why do we do developmental screens (3)

A

Identify delays
Initiates Interventions for best outcomes
Support family

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9
Q

4 parts of development

A

Gross motor
Fine motor
Language
Social

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10
Q

When does Gross and fine motor skills develop

A

first 3 years of life

Rapid in 1st year

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11
Q

Kicks ball forward at what age

A

2 years

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12
Q

rolls back to stomach at what age

A

4-10 months

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13
Q

sits steadily at what age

A

6-9 months

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14
Q

pulls to standing at what age

A

7-12 months

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15
Q

Stands alone at what age

A

9-16 months

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16
Q

stoops and recovers at what age

A

15 months

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17
Q

walks pretty well at what age

A

13 months

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18
Q

Throws ball overhand at what age

A

3 years

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19
Q

balances on 1 foot 2 seconds, hops at what age

A

4 years

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20
Q

Catches ball at what age

A

5 years

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21
Q

Fine motor rake at what age

A

5-7 months

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22
Q

Fine motor lobster claw grasp at what age

A

8-10 months

Radial digital grasp between thumb and side of index finger

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23
Q

Perfection of pincher grasp at what age

A

10-12 months

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24
Q

Fine motor scribbles

A

15 months

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25
Q

Fine motor imitates vertical or circular strokes - towers 6 cubes

A

24 months

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26
Q

When do you ask parents if baby startles at loud sounds

A

0-3 months

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27
Q

When do you ask parents if baby turns eyes and head at the sound of your voice

A

4-6 months

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28
Q

When do you ask parents if baby makes strings of sounds

A

7-9 months

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29
Q

When do you refer to professional speech and or language assessment (5)

A 
No talking by age 2
unintelligible speech at age 3
no sentences by age 3
child embarrassed by speech (any age)
Known disorder (hearing loss, retardation, autism)
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30
Q

Vision assessments (3)

A

red reflex in infants (check for retinoblastoma)
Corneal light reflex (for misalignment)
Cover/uncover

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31
Q

What is the vision expectation of a (fullterm) newborn

A

focuses of face and briefly tracks objects

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32
Q

What is the vision expectation of a 2 month old

A

tracks across midline,
responsive to smile,
follows movement 6 feet away

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33
Q

social skill at 2 months

A

social smile

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34
Q

Social skill at 6 months

A

reaches for objects

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35
Q

social skill at 9 months

A

feeds self, passes objects from hand to hand

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36
Q

social skill at 12 months

A

plays appropriately with toys

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37
Q

Social skill at 18 months

A

drinks from cup

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38
Q

Social skilla t 2 years

A

Uses spoon

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39
Q

Social skill at 4 years

A

puts on t shirt

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40
Q

early adolescent concerns

A

rapid physical changes
concern if different from peers
concrete thinking

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41
Q

middle adolescent concerns

A 
Body comfort (or not)
Sense of omnipotence
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42
Q

late adolescence concerns

A

less self-centered

realistic future plans

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43
Q

Stridor is what diagnosis

A

Epiglotitis

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44
Q

cough and stridor is what diagnosis

A

Croup

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45
Q

Wheeze is what diagnosis

A

Bronchiolitis

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46
Q

who gets epiglottitis?

A

<6 months (due to not being fully immunized)

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47
Q

What bacteria causes Epiglotitis (3)

A

strep pyogenes,
Strep Pneumo
Staph
(H. Flu in adults)

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48
Q

Signs and symptoms of Epiglotitis (7)

A

Mild sore throat and fever to toxic in hours
Muffled voice,
drooling, pain, labored breathing (stridor)
tripoding

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49
Q

Diagnose Epiglotitis?

A

Clinical suspicion
(used to be xray)
(can directly visualize with intubation and endoscopy)

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50
Q

Treat epiglottitis (5)

A 
Anesthesia STAT - Intubation
O2 on blow by
KEEP CHILD CALM
2 IV if possible
Ceftriaxone or cefotaxime (x 7-10 days)
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51
Q

Who to prophylax with epiglottitis contacts?

What to give?

A

NOT CONTAGIOUS

immunosuppressed, or Child<6 months without HIB vax - give Rifampin

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52
Q

Croup cause

A

viral - 75%

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53
Q

age of croup

A

3 months - 5 years
(fall and spring)
10pm-4am

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54
Q

Croup Clinical course

A

Day 0-2 URI
Day 0-5 Barking cough - worse DAY 2and 3
Resolves by day 5-7

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55
Q

diagnostics with croup

A

rapid strep if sore throat

xray if foreign body concern

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56
Q

Croup (mild-moderate) Treatment

A

Decadron PO 0.6mg/kg max 10mg
Cold air,
humidified air

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57
Q

Croup (severe- with stridor) treatment (3)

A

ED
Decadron PO 0.6mg/kg max 10mg
Inhaled (racemic) Epi by nebulizer - repeat PRN
Admit if recurrence

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58
Q

Bacterial Tracheitis Signs and symptoms

A

thick purulent exudate within trachea - may obstruct airway

Urgent or emergent condition

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59
Q

Who gets bronchiolitis

A

<2 years

more common in boys, non-breastmilk, or smokers

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60
Q

Who is at greatest risk for Bronchiolitis complications

A

Underlying condition or

Kids <2 months

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61
Q

Cause of Bronchiolitis

A

> 50% Respiratory syncytial virus

Otherwise (usually still viral)

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62
Q

Presentation of Bronchiolitis

A

copious clear rhinorrhea,
low grade fever
wheezing with/w/out crackles
Late fall through winter

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63
Q

What is a bad sign in bronchiolitis pts

A

Decreased breath sound

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64
Q

Diagnostics for Bronchiolitis

A

if first episode of wheezing or pneumonia consideration - CXR
PCR for RSV if pt <2 months or risk factors, or plans to hospitalize pt

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65
Q

Bronchiolitis treatment

A 
Albuterol/racemic epi
Decadron PO
Fluids
Tylenol
If hospitalized - 
O2 to keep sat >94%
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66
Q

course of Bronchiolitis

A

Worse Day 2-5 of illness

Lasts 10-12 days

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67
Q

Is Bronchiolitis contagious

A

yes - bad cold (+wheezing)

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68
Q

who to vaccinate for bronchiolitis

A

premie, chronic lung disease, cerebral palsy, heart disease, immune compromise,

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69
Q

Signs of asthma

A

Wheezing over weeks, with instigating factor

Cough -(may be with or without wheezing)

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70
Q

First time wheezing what is the diagnosis

A

Reactive airway disease

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71
Q

Pertussis vaccine <11 years

A

dTap

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72
Q

Pertussis vaccine >11 years

A

tDaP

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73
Q

What causes Pertussis

A 
Bortadella pertussis
(gram - coccobaccilus colonizing ciliated epithelium)
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74
Q

Stage 1 of pertussis

A 
Catarral stage (most contagious) lasts 1-2 weeks
Cold symptoms
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75
Q

Pertussis incubation period

and contagious timeframe

A

3-12 days
and
during catarrhal period and first 2 weeks of cough (21 day average)

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76
Q

Stage 2 of pertussis

A

Paroxysmal stage
Lasts 1-6 weeks (up to 10)
paroxysms of uncontrollable coughing fits

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77
Q

Stage 3 of pertussis

A 
Convalescence stage (lasts for months)
paroxysms may recur if subsequent Respiratory infections
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78
Q

Diagnostic for Pertussis

A 
Nasal swab (takes days to weeks to return)
clinical diagnosis
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79
Q

Treatment for Pertussis

A

Zithromax 10mg/kg day 1
5mg/kg day 2-5
Supportive care

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80
Q

Most common cause of morbidity/ mortality under 2 years old

A

Foreign body aspiration

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81
Q

Where do most foreign bodies end up in kids

A

proximal main stem bronchus

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82
Q

Concern of Foreign body aspiration if…

A

1st episode of wheezing get CXR
formerly speaking- won’t speak
coughing without other URI symptoms

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83
Q

Classic triad for Foreign body presentation

A

Wheezing,
Decreased air entry - usually regionally
Cough

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84
Q

Treatment and diagnosis of Foreign body

A

Bronchoscopy

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85
Q

Most common population for Cystic fibrosis

A

Caucasian,

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86
Q

Cause of Cystic Fibrosis

A

Genetically driven chloride channel disruption

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87
Q

Features of Cystic fibrosis

A

Viscous secretions in lungs, liver, pancreas, intestine, reproductive tract

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88
Q

What bacteria colonize Cystic fibrosis patients

A

Staph and H flu in childhood

P. Aeruginosa in adulthood

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89
Q

Sinus symptoms of Cystic fibrosis (2)

A

Panopacification by age 8 months

Nasal polyposis in 20%

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90
Q

Pancreatic symptoms of Cystic fibrosis (3)

A

Insufficient digestive enzymes,
malabsorption
failure to thrive, electrolyte abnormalities, anemia

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91
Q

Important early clinical finding in Cystic fibrosis

A

Meconium ileus is Pathognomonic for CF

May have small bowel obstruction in Older children

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92
Q

Infertility in Cystic fibrosis

A

95% in Males

20% in females

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93
Q

Cystic fibrosis diagnosis

A

sweat chloride elevated on 2 occasions
2 disease causing mutations of the CFTR gene
[testes at birth with heel stick (50% are diagnosed at this stage)]

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94
Q

Cystic fibrosis treatment options (7)

A 
Ivacaftor (/tezacaftor)
Azithromycin - anti-inflammatory
Bronchodilators
Dnase
Inhaled hypertonic saline
Steroids - short term
Lung transplant
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95
Q

Respiratory Distress syndrome epidemiology

A

Premies <30weeks

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96
Q

Cause of RDS

A

Surfactant deficiency –>
Atelectasis –>
V/Q mismatch –>
Pulmonary response

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97
Q

Diangosis of RDS

A

Clinical

CXR - air bronchograms, low lung volume, ground glass appearance, pneumothorax

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98
Q

prevention of RDS (3)

A

antenatal corticosteroids
exogenous surfactant
assisted ventilation

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99
Q

What is most important in diagnostic feature of Child abuse

A

History that doesn’t make sense

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100
Q

Likely abuse signs and ages(3)

A

fractures in non-ambulatory children
less than 18 months (>80%)
Multiple fractures or multiple different stages of healing

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101
Q

When does inflammation, pain and swelling occur after a fracture

A

day 3-7

induction

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102
Q

When does soft callus bone formation occur after a fracture

A

infants 7-10 days

children 10-14 days

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103
Q

When does union at fracture site - hard callus- occur after a fracture

A

14-21 days

hard callus

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104
Q

When does woven to lamellar bone occur after a fracture

A

3 months to 1 year

remodeling

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105
Q

When to do skeletal surveys for child abuse (5)

A

<2 with obvious abuse
<2with possible abuse
infants with unexplained death
infants with unexpected intracranial injuries
infants and siblings <2 in abused child’s household

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106
Q

abuse fractures (8)

A 
metaphyseal lesions - bucket handle
rib fx
acromion
spinous processes
scapular fx
sternal and pelvic
hand and foot in infants
occipital impression fx
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107
Q

When does pyloric stenosis present

A

3-5 weeks of life

Rare after 12 weeks

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108
Q

Presentation of Pyloric stenosis

A

Projectile vomiting,
Wt loss,
Hungry after vomiting
Palpable Olive

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109
Q

Diagnostic for Pyloric Stenosis

A

Ultrasound
(or UGI)
(But also correct electrolytes and hydration - so CBC and CMP)

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110
Q

Treating Pyloric stenosis

A

Rehydrate and correct ‘lytes
then
Pyloromyotomy

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111
Q

When does intussusception occur most commonly?

A

3months - 5 years

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112
Q

What usually causes Intussusception?

A

Ideopathic (75%)

Viral, bacterial, underlying pathology

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113
Q

Presentation of Intussusception

A

15-20 minutes of Sudden severe crampy pain
Non-bilious vomiting
currant jelly stool

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114
Q

intussusception triad

A

Pain
Palpable mass
Current jelly stool
(only 15% present with all three)

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115
Q

Diagnosis of Intussusception

A

Clinical
Xray - crescent sign (+/- reliable)
Ultrasound (100% with good tech)

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116
Q

Treatment of intussusception

A

barium or pneumatic enema if stable and no perf

Surgical if enema fails or signs of perf

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117
Q

Phenylketonuria (PKU)definition

A

genetic deficit of phenylalanine hydroxylase - build up of phenylalanine leading to intellectual disability

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118
Q

Untreated PKU symptoms

A

mental retardation
epilepsy
pigment issues,
blood and urine smell “mousy”

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119
Q

Diagnosis of PKU

A

Screening done at birth

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120
Q

Treatment for PKU

A 
Initiate by 1st week of life
monitor Phenylalanine levels 
Weekly for first year
Twice monthly until 12 years of age
Monthly for life
Mon
121
Q

Pediatric appendicitis presentation

A

1month - 5 years

Limping, Hip pain, may just look ill,

122
Q

Treatment for Peds appendicitis

A 
FLuids, Pain control, NPO, Antibiotics,
(if perforated - triple Abx)
High risk goes straight to OR (6-8 hours if non-perf)
No radiation (CT) unless surgeon insist
Perf goes to OR after 24-48 hours of Abx
123
Q

Normal stooling frequency for 0-3 month old

A

3-4 stool/ day

124
Q

Normal stooling frequency for 3months - 2 years

A

1-2 stool per day

125
Q

What is an important dietary counsel point for children less than one (might cause Microbleeding)

A

Cow’s milk

126
Q

Treating Constipation

A

Infants: Glycerine suppository
Older children:
Suppository, MIRALAX, Enema, Laxative

127
Q

What is encopresis

A

Involuntary leakage of stool (+/- constipation)

128
Q

Who gets encopresis

A

3% of kids
Boys 6x more than girls
around the age of toilet training, and school

129
Q

What is the most common cause of Encopresis

A

constipation

130
Q

DSM-V criteria for Encopresis (4)

A
  1. passage of stool into underpants
  2. 1+ event per month
  3. older than 4 years
  4. not result of laxative or illness
131
Q

Encopresis treatment when caused by constipation

A

Miralax and water

132
Q

Hirshsprung disease is what

A

Genetic mutation of RET proto-oncogene causing a section of the colon to lack ganglion cells - no nerves

133
Q

Presentation of Hirshsprung disease

A

due to lack of peristalsis in affected colon, proximal piece fills with feces
Failure of newborn to stool completely
Or in Children - swollen belly, N/V/C/D, failure to thrive and fatigue

134
Q

Where is Hirshsprung disease usually located

A

Rectosigmoid (75%) but may comprised the whole colon (8%)

135
Q

Diagnostic of Hirshsprung disease

A

Xray
Barium enema,
Manometry of anorectum,
Biopsy of section of colon - gold Standard

136
Q

Treatment of Hirshsprung disease

A

Surgical excision of affected segment

137
Q

What is Meckels disease

A

Congenital diverticulum

the disease of 2’s

138
Q

Who gets Meckel’s

A 
2% of Pop
males 2:1
2 years old at presentation
2 feet proximal to ileocecal valve
2 inches in length
139
Q

Presentation of Meckel’s

A

70% asymptomatic

otherwise may present with GI bleed, Obstruction, Peritonitis, Divericulitis, appendicitis, bezoar

140
Q

Treatment of Meckel’s

A

Surgical excision

141
Q

What is malrotation

A

rotation of small intestines only (unlike situs inversus) twisting leads to volvulus

142
Q

Presentation of malrotation

A

may be asymptomatic

otherwise - infants present with Bilious vomiting, abdominal pain and distension, melena and/or mucoid stool

143
Q

Diagnose Malrotation

A

If clinical suspicion do Xray

UGI series if not emergent

144
Q

Treat malrotation

A

surgical fix

145
Q

What are the types of strabismus

A 
Esophoria
Exophoria
esotrophia
exotrophia
Intermittent
constant
monocular
alternating
146
Q

Can strabismus ever be normal

A

Yes - In the first few months of life

147
Q

What is hering’s law

A

when one eye moves, the other eye should move equally (muscle equality from side to side)

148
Q

What is Sherrington’s law

A

When the eye is pulled by a muscle the opposing muscle must relax to allow ocular movement

149
Q

Risk factors for strabismus

A

Family hx
Low birth weight
visual deprivation (retinopathy of prematurity)

150
Q

What can occur if Strabismus is not corrected

A

Amblyopia, Diplopia, Contracture of EOMs, psychosocial and vocational consequences

151
Q

treating strabismus

A

prescription glasses,
miotic drops, patching, training exercises
Surgical reposistioning

152
Q

When to refer strabismus

A 
Any age with esotropis
esodeviation after 4 months
deviation with cover test
asymmetry of appearance on Bruckner test
inexplicable torticollis
parental/provider concern
153
Q

impetigo Epidemiology

A

Kids 2-5
warm climates
spread by contacts,

154
Q

Impetigo causes

A 
Staph Aureus (not MRSA)
(less frequent beta hemolytic strep -A)
155
Q

Impetigo types

A

Non-Bullous - most common
Bullous
Ecthyma

156
Q

Describe non-bullous Impetigo

A

honey colored crusts
may have regional lymphadenitis
No Systemic symptoms

157
Q

Describe Bullous impetigo

A

flaccid bullae with clear yellow fluid

fluid darkens and ruptures

158
Q

Describe ecthyma impetigo

A

ulcerative punched out lesions with yellow crusts

relatively rare

159
Q

treat impetigo

A 
Clinical suspicion 
Antibiotics - 
topical - if few lesions
Mupirocin 
Oral - If bullous or many lesions
Diclox, Cephalexin
Clinda, Bactrim (if MRSA suspect)
160
Q

What causes pinworms

A

Eterobiasis

Enterobius Vermicularis

161
Q

Who gets Pinworms

A

5-14 year olds

162
Q

Diagnosis of Pinworms

A

Hx of anal itching at night and cellophane tape collection

163
Q

Treat Pinworm

A

Albendazole
400mg once
repeat in 2 weeks
(pyrantel Pamoate - OTC may work also)

164
Q

fifth disease AKA

A

Erythema Infectiousum

165
Q

Cause of 5th disease

A

Parvovirus B19

166
Q

Symptoms of 5th disease

A

Day 1-2 Fever, HA, N/D
Day 2-5 RASH - slapped cheek
reticulated on trunk
Rash may reappear or linger for weeks to months

167
Q

Incubation period for 5th disease

A

1-2 weeks

non-infectious when rash appears

168
Q

Treating 5th disease

A

Supportive

Unless there is a pregnant mother - MAY CAUSE FETAL HYDROPS

169
Q

Mono AKA

A

Epstein Barr

170
Q

Incubation for Mono

A

4-7 weeks

171
Q

Mono presentation (7)

A 
Fever
Pharyngitis
Adenopathy
Fatigue
Atypical Lymphocytes
Splenomegally
Rash - Maculopapular
172
Q

Diagnosis of Mono

A

Clinical
Monospot (high false negative and false positive rate)
EBV panel if Monospot is negative after 1 week

173
Q

Treat mono

A

Supportive - Hydrate
Antipyretics, REST (NO SPORTS)
Steroids if Airway is compromised (tonsillar hypertrophy)

174
Q

Rubeola incubation

A

7-21 days

175
Q

Rubeola symptoms

A 
fever, cough, coryza, conjunctivitis
Koplik Spots (Head --> toe) - Pathognomonic
176
Q

When is Rubeola contagious?

A

4 days before rash appears until 4 days after rash

HIGHLY CONTAGIOUS

177
Q

Complications of rubeola

A 
OM
Pneumonia
Croup
Diarrhea
Acute encephalitis
178
Q

Measles Prophylaxis

A

MMR vaccine w/in 72 hours of exposure

IG if administered w/in 6 days of exposure

179
Q

Measles Treatment

A

Vitamin A - Immediately and then again the next day

180
Q

What does Vitamin A prevent when given for measles treatment

A

Preventable blindness due to xerophthalmia (severe dry eye)

181
Q

Rubella symptoms

A

Rash and low grade fever, symptoms last for 2-3 days

May cause birth defects in pregnant women

182
Q

Roseola epidemiology

A

affects over 90% of children by age 2

183
Q

Roseola presentation

A

Sudden high fever

fever subsides –> rash appears (arms and legs) Asymptomatic rash

184
Q

Kawasaki disease presentation (7 + age range)

A 
Usually kids <5 years old
Fever>5 days
Conjunctivitis (non-exudative)
Mucositis (cracked red lips and strawberry tongue)
Rash (perineal- then desquamates)
Extremity changes (swelling of hands and feet)
Lymphadenopathy(single- large >1.5 cm)
Affects coronary arteries - tachycardia
185
Q

Diagnose Kawasaki’s

A

Clinical but get Echo to detect aneurysm -Repeat in 4-6 weeks

186
Q

Treat Kawasaki’s

A 
Admit all pts - Cardiology consult
Monitor for Cardiovascular function
IVIG -given w/in 7-10 days of illness onset - fever should abate w/in 36 hours
Aspirin 80-100mg/kg q6 hrs
may d/c when fever resolves
187
Q

Coxackie presentation

A

Apthous stomatitis
Rash on hands an feet
fever
( less common -Aseptic meningitis)

188
Q

Treating Coxackie

A

Tylenol or motrin
magic mouthwash
hydrate
prophylaxis for close contacts

189
Q

Varicella treatment

A

Motrin or Tylenol for fever

Benadryl and aveeeno for itching

190
Q

what is eneuresis

A

urinary incontinence in children

191
Q

treating nocturnal enuresis

A

DDAVP (Vasopressin)

192
Q

What causes UTI in infants (2)

A

E.coli and anatomical abnormalities

193
Q

How does a UTI present in Infants

A

URI symptoms

not UTI symptoms

194
Q

limping child eval diagnostics (4)

A

Xray
Labs (CBC, CRP, ESR, Blood Cx, CMP)
Joint aspiration
MRI/CT

195
Q

Concern with femur fractures in children less than 10 years

A

Overgrowth - may grow longer than other leg by 1-3 cms

Don’t put back into anatomical alignment

196
Q

toddler’s fracture

A

Minimal or undisplaced spiral fracture of the tibia (not fibula)
No Hx of trauma, pt age 1-6

197
Q

Treating a Bowing fracture

A

required lots of force (done in OR under general Anesthesia)

198
Q

Conservative treatment of a Supracondylar fracture

A

Long arm cast,
analgesics
serial radiographs q 2 weeks

199
Q

Surgical treatment of supracondylar fracture

A

Pinning done in OR - avoid injury to Ulnar nerve

200
Q

Galeazzi fracture

A

dislocation of distal radioulnar joint and distal fractured radius
muGR

201
Q

Monteggia fracture

A

Fracture to ulna
proximal dislocation of radial head
MUgr

202
Q

Developmental dysplasia of hip

A

screened on newborn eval
F 4x more than M
early Total hip replacement

203
Q

Identifying Developmental dysplasia of hip

A

toe walking
limb length inequality
waddling gate
swayback

204
Q

Tests for Developmental dysplasia of hip

A

Galeazzi - knee height difference

Barlow - trying to dislocate hip

205
Q

Treatment for Developmental dysplasia of hip

A

Pavlik Harness–>
Closed reduction–>
Open reduction–>
SPICA cast to hold hip in reduced position

206
Q

Legg-calve Perthes description and epidemiology

A

osteonecrosis of capital femoral epiphysis
ages 2-14
Boys 5x more than Girls

207
Q

4 stages of Legg-calve Perthes

A

Stage 1: necrosis
Stage 2: fragmentation
Stage 3: reossification
Stage 4: remodeling

208
Q

presentation of Legg-calve Perthes

A

limited hip Abduction and internal rotation
atrophy of quad,
leg length inequality

209
Q

tx for Legg-calve Perthes

A

Reduce activity,
crutches, walker, wheelchair,
refer to specialist
NSAIDS may help with bone regrowth

210
Q

Transient synovitis of hip diagnosis

A

diagnosis of exclusion

r/o septic arthritis

211
Q

tx for transient synovitis

A

bedrest until symptoms improve
NWB - 1-2 days
NSAIDS

212
Q

Apophysitis other names and description

A

Osgood-schlatter’s disease
pain over tibial tuberosity
Sever’s disease
pain in calcaneus at insertion of achilles

213
Q

treatment for apophysitis

A

RICE
NSAIDS
Reassurance

214
Q

Bow legged baby - non-pathologic - name

A

Physiologic genu varum

215
Q

concerning genu varum signs and symptoms

A

asymmetry,
atypical for age
worsening deformity

216
Q

what age to refer genu verum out

A

2 years

217
Q

Blount’s disease description

A

unilateral genu verum with lateral thrust during gait

218
Q

normal leg position ages 3-5

A

Physiologic genu valgus

219
Q

when to eval toe-walking - causes

A

older than 3 years,
cerebral palsy
tethered cord

220
Q

treating club foot

A

Serial casting

221
Q

Scoliosis -definition

A

COBB angle >10degrees

222
Q

What is the risser classification

A

used to grade skeletal maturity based on level of ossification and fusion of iliac crest
Stages 0-5
0= earliest
5 = latest

223
Q

<25 degree scoliosis treatment

A

observe regardless of risser scale

224
Q

25-45 degress of scoliosis treatment

A

Brace from Risser 0-2

Observe if in risser stage 3-5

225
Q

> 50 degrees of scoliosis treatment

A

Surgery

226
Q

meaning of RV heave pediatric

A

RV hypertrophy

227
Q

Differential pulses in pediatrics

A

Coarctation of aorta

228
Q

bounding pulses in peds

A

L–> R PDA shunt

229
Q

pulsus paradoxus in peds

A

exaggerated SBP drop with inspiration

May indicate tamponade or severe asthma

230
Q

Pulsus alternans in peds

A

alternating pulse strength -

LV mechanical dysfunction

231
Q

Mid systolic click

A

Mitral Valve Prolapse

232
Q

Loud S2 heart sound

A

Pulm HTN

233
Q

fixed split S2

A

ASD, Pulmonary stenosis

234
Q

S3 (gallop)

A

volume overload or cardiac dysfunction

235
Q

Holosystolic murmer

A

VSD,

Mitral regurg

236
Q

Continuous murmur

A

PDA

237
Q

Shunts in fetal circulation

A

Ductus venosus - bypasses liver
Foramen ovale -
ductus arteriosus

238
Q

Do umbilical arteries or vein carry oxygenated blood

A

Umbilical Vein (singular - there are 2 arteries that carry deoxygenated blood)

239
Q

What causes closing of shunts

A

Umbilical cord clamp causes changes to vascular resistance and greater L ventricular pressure closing FO
First breath decreases resistance in Pulmonary circulation

240
Q

How long does it take for ductus arteriosus to close (Functionally)

A

24-48 hrs (may be longer in premie or persistant hypoxia)

241
Q

When should the left ventricle be thicker than the right

A

By 1 month post partum

242
Q 
What do these structures become after birth: 
Foramen ovale
umbilical vein
ductus venosus
ductus arteriosum
A

Fossa ovale
ligamentum teres
ligamentum venosus
migamentum arteriosum

243
Q

murmur that changes with position (concern?)

A

Innocent murmur(Except HOCM)

244
Q

vibratory twangy systolic murmur at LSB and apex-
Age 3-5
loudest in supine –> Disapears upright

A

Still’s murmur (Innocent)

245
Q

Systolic ejection murmur over pulmonic area grade 1-2 increases insupine, decreases upright

A

Pulmonary flow murmur (innocent)

246
Q

Low pitched continuous murmur in infraclavicular area
loudest upright,
decreases supine

A

Venous hum (innocent)

247
Q

red flag murmurs (5)

A 
Diastolic (Venous hum ok)
Continuous murmurs
Loud murmur (with thrill)
constant with positional change
Symptomatic
248
Q

L–>R “Acyanotic” Shunts

A

VSD
PDA
ASD

249
Q

Holosystolic murmur at LSB with heave +

FFT, Tachypnea, Diaphoresis with feeding

A

VSD

250
Q

Systolic ejection murmur in pulmonic area

+/- Diastolic murmur at LSB

A

ASD

251
Q

Bounding pulse, Congestive heart failure

FFT and diaphoresis with feeding

A

PDA

252
Q

Treatment for PDA

A

Indomethacin

253
Q

Tetralogy of fallot

A

Rt ventricular outflow obstruction
VSD
Overriding aorta
RVH

254
Q

Tx for Tetralogy of fallot

A

systemic pulmonary artery shunt in early infancy

later relief of outflow tract, and VSD closure

255
Q

Skin can tolerate up to what temperature without burning

A

111 degrees

256
Q

deepest burn area with dead or dying cells necrosis and absent bloodflow

A

Zone of coagulation (3)

257
Q

red zone of burn - may blanch, becomes avascular and necrotic by day 3

A

zone of stasis (2)

258
Q

burn area blanches with pressure, healing by day 7

A

Zone of hyperemia (1)

259
Q

burns >30% of total body area - concern for what complication

A

Systemic inflammatory response
-hemolysis, and pulmonary bronchoconstriction
increased vascular permeability - hypovolemia End organ damage,

260
Q

2nd degree burn -superficial partial thickness- description

A

fluid filled blisters
soft - very tender to touch
healing over 2-3 weeks no scarring

261
Q

2nd degree burn -deep partial thickness- description

A

red and blanched white skin
thick-walled blisters
healing over 3-6 weeks with scarring

262
Q

3rd degree burn description

A

full thickness burn - white leathery area
no sensation
Burns >1cm require grafting

263
Q

4th degree burn treatment

A

surgical debridement and repair

264
Q

when counting TBSA burned rule of estimation

A

Count partial thickness and full thickness separately

1 palm is 1% body area

265
Q

circumferential burn around torso - treatment

A

Escharotomy - Longitudinal incisions
axial planes
In to normal skin
down to subcutaneous fat

266
Q

When does maximal

edema occur after burn

A

24-48 hours

267
Q

goal of fluid resuscitation for burn pts

A

Children urine output of 1-2ml/kg/hour
Adults
urine output of 40ml/hour

268
Q

Concern if over hydration with burns

A

ARDS 3-5 days post burn

269
Q

dressing on burns

A

2x daily,

partial thickness burns - topical anti-microbial and occlusive dressings

270
Q

concern with aspirin in peds

A

Reye’s syndrome

271
Q 
What % TBSA burns go to burn center:
Partial thick - adult
Partial thick - child
full thick 
other
A

Partial thick - adult: >25%
Partial thick - child: >20%
full thick: >10%
other - functional or cosmetic impairment (face, hands/feet, perineal)

272
Q

COncerns with Burns (2)

A

Infection

Burn shock - coagulation necrosis, fluid loss

273
Q

what type of electricity causes passes the “let-go current” barrier more easily

A

AC>DC

274
Q

Low voltage burns - cause in kids and treatment

A 
hand/mouth from exposed wire contact
Small deep burn - requires amputation/
graft
prolonged is significant injury
Monitor on EKG for 12 hours for arrhythmias
275
Q

oral burns in toddlers -presentation

A

Painless demarcation of viable/non-viable skin w/in 5-7 days

Labial artery bleeding risk at 2 weeks from dead tissue coming off

276
Q

what does contact with high voltage DC current cause

A

Single muscle contraction throwing victim from source (impact trauma)

277
Q

How does high voltage current travel in the body

A

Direct path through body from current source to ground

278
Q

How does low voltage current travel in the body

A

travels along path of least resistance along nerves and blood vessels

279
Q

Internal damage caused by electricity (5)

A 
necrosis 
periosteal melting
fluid leakage
rhabdomyolysis - muscle ischemia
cardiac - arrhythmias
280
Q

treating electrical burn pt (6)

A 
IVF + Foley
Labs + imaging
Tetanus
Splinting (after NV Eval)
Fetal monitoring and compartment pressure
281
Q

Symptoms of frostbite (5)

A

cold –> sting/burn/throb –>
Numbness/complete sensation loss –>
Loss of dexterity sm then large muscles–>
Severe joint pain

282
Q 
Frost bite:
1st 
2nd
3rd
4th degree
A

1st - cold ears in winter +/- peeling in weeks
2nd - clear blistering
3rd - hemorrhagic blister, pain for 5 weeks, ulceration, thick gangrenous eschar,
4th - involves muscle, bone and tendon, avascular, no pain on rewarming, demarcation of viability takes 1 month

283
Q

Trench foot

A

Pain, parasthesisas, pallor, pulselesnness, paralysis

reversible if treated early - better than frostbite

284
Q

Chilblains/ Pernio

A

chronic repeated exposure to non-freezing, cold/damp
capillary bed damage
resolves in 7-14 days

285
Q

what blisters should you treat/how to treat

A

Aspirate clear blister - do not aspirate hemorrhagic blister

286
Q

what controls body temperature

A

Hypothalamus
conserve heat via vasoconstriction
produce heat via shivering

287
Q

EKG findings in Hypothermia

A

J or Osborne waves

Arrhythmias

288
Q

Mild Hypothermia temperature

A

89.6-95 F
32-35 C
altered judgement,
ataxia, apathy

289
Q

Moderate hypothermia termperature

A

82.4-89.6 F
28-32 C
CNS Depression, paradoxical undressing

290
Q

Severe hyptothermia

A

82.4F
<28 C
V fib COMA

291
Q 
Lab changes in Hypothermia:
ABG
CBC
CMP
DIC
A

ABG - Falsely high O2, CO2 and low pH
CBC - HCT up 2%/1 degree C
CMP- K>10= low recovery
DIC- enzymes may be malfunctioning not accurately reflected in sample

292
Q

Slow rewarming technique

A

Warm IV Fluids - 45C,
Heated O2 mask
Warmed blankets

293
Q

Moderate rewarming technique

A

Warmed gastric lavage
warmed IV fluid -65 C
peritoneal lavage

294
Q

Rapid rewarming technique

A

thoracic lavage
Cardiopulmonary bypass
ECMO, AV Dialysis,
Warm water immersion

295
Q

What is catastrophic Hyperthermia

A

> 41.1C

>106 F

296
Q

Heat stroke temp

A

> 104.9

with anhydrosis and Altered Mentation

297
Q

Goal of hyperthermia therapy

A

Decrease Core temp to <40C within 30 minutes

298
Q

Malignant hyperthermia treamtment

A

Dandrolene

My Clin Med 4 (4 decks)

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