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)
2
Q
how long should it take for a neonate to regain weight lost just after birth
A
By Day of Life 14
3
Q
How much weight should children gain per month in first 3 months of Life
A
2 pounds per month
4
Q
Why do we measure head circumference?
A
Reliable indicator of brain growth up to 2 years
5
Q
What BMI is a significant risk factor for obesity in adulthood
A
BMI>95%
6
Q
When should lead testing occur?
A
Between 9 -12 months
Age 2
Age 3
7
Q
When should Iron be checked
A
annually starting at age 1 until age 6
8
Q
Why do we do developmental screens (3)
A
Identify delays
Initiates Interventions for best outcomes
Support family
9
Q
4 parts of development
A
Gross motor
Fine motor
Language
Social
10
Q
When does Gross and fine motor skills develop
A
first 3 years of life
Rapid in 1st year
11
Q
Kicks ball forward at what age
A
2 years
12
Q
rolls back to stomach at what age
A
4-10 months
13
Q
sits steadily at what age
A
6-9 months
14
Q
pulls to standing at what age
A
7-12 months
15
Q
Stands alone at what age
A
9-16 months
16
Q
stoops and recovers at what age
A
15 months
17
Q
walks pretty well at what age
A
13 months
18
Q
Throws ball overhand at what age
A
3 years
19
Q
balances on 1 foot 2 seconds, hops at what age
A
4 years
20
Q
Catches ball at what age
A
5 years
21
Q
Fine motor rake at what age
A
5-7 months
22
Q
Fine motor lobster claw grasp at what age
A
8-10 months
Radial digital grasp between thumb and side of index finger
23
Q
Perfection of pincher grasp at what age
A
10-12 months
24
Q
Fine motor scribbles
A
15 months
25
Fine motor imitates vertical or circular strokes - towers 6 cubes
24 months
26
When do you ask parents if baby startles at loud sounds
0-3 months
27
When do you ask parents if baby turns eyes and head at the sound of your voice
4-6 months
28
When do you ask parents if baby makes strings of sounds
7-9 months
29
When do you refer to professional speech and or language assessment (5)
```
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)
```
30
Vision assessments (3)
red reflex in infants (check for retinoblastoma)
Corneal light reflex (for misalignment)
Cover/uncover
31
What is the vision expectation of a (fullterm) newborn
focuses of face and briefly tracks objects
32
What is the vision expectation of a 2 month old
tracks across midline,
responsive to smile,
follows movement 6 feet away
33
social skill at 2 months
social smile
34
Social skill at 6 months
reaches for objects
35
social skill at 9 months
feeds self, passes objects from hand to hand
36
social skill at 12 months
plays appropriately with toys
37
Social skill at 18 months
drinks from cup
38
Social skilla t 2 years
Uses spoon
39
Social skill at 4 years
puts on t shirt
40
early adolescent concerns
rapid physical changes
concern if different from peers
concrete thinking
41
middle adolescent concerns
```
Body comfort (or not)
Sense of omnipotence
```
42
late adolescence concerns
less self-centered
| realistic future plans
43
Stridor is what diagnosis
Epiglotitis
44
cough and stridor is what diagnosis
Croup
45
Wheeze is what diagnosis
Bronchiolitis
46
who gets epiglottitis?
<6 months (due to not being fully immunized)
47
What bacteria causes Epiglotitis (3)
strep pyogenes,
Strep Pneumo
Staph
(H. Flu in adults)
48
Signs and symptoms of Epiglotitis (7)
Mild sore throat and fever to toxic in hours
Muffled voice,
drooling, pain, labored breathing (stridor)
tripoding
49
Diagnose Epiglotitis?
Clinical suspicion
(used to be xray)
(can directly visualize with intubation and endoscopy)
50
Treat epiglottitis (5)
```
Anesthesia STAT - Intubation
O2 on blow by
KEEP CHILD CALM
2 IV if possible
Ceftriaxone or cefotaxime (x 7-10 days)
```
51
Who to prophylax with epiglottitis contacts?
| What to give?
NOT CONTAGIOUS
| immunosuppressed, or Child<6 months without HIB vax - give Rifampin
52
Croup cause
viral - 75%
53
age of croup
3 months - 5 years
(fall and spring)
10pm-4am
54
Croup Clinical course
Day 0-2 URI
Day 0-5 Barking cough - worse DAY 2and 3
Resolves by day 5-7
55
diagnostics with croup
rapid strep if sore throat
| xray if foreign body concern
56
Croup (mild-moderate) Treatment
Decadron PO 0.6mg/kg max 10mg
Cold air,
humidified air
57
Croup (severe- with stridor) treatment (3)
ED
Decadron PO 0.6mg/kg max 10mg
Inhaled (racemic) Epi by nebulizer - repeat PRN
Admit if recurrence
58
Bacterial Tracheitis Signs and symptoms
thick purulent exudate within trachea - may obstruct airway
| Urgent or emergent condition
59
Who gets bronchiolitis
<2 years
| more common in boys, non-breastmilk, or smokers
60
Who is at greatest risk for Bronchiolitis complications
Underlying condition or
| Kids <2 months
61
Cause of Bronchiolitis
>50% Respiratory syncytial virus
| Otherwise (usually still viral)
62
Presentation of Bronchiolitis
copious clear rhinorrhea,
low grade fever
wheezing with/w/out crackles
Late fall through winter
63
What is a bad sign in bronchiolitis pts
Decreased breath sound
64
Diagnostics for Bronchiolitis
if first episode of wheezing or pneumonia consideration - CXR
PCR for RSV if pt <2 months or risk factors, or plans to hospitalize pt
65
Bronchiolitis treatment
```
Albuterol/racemic epi
Decadron PO
Fluids
Tylenol
If hospitalized -
O2 to keep sat >94%
```
66
course of Bronchiolitis
Worse Day 2-5 of illness
| Lasts 10-12 days
67
Is Bronchiolitis contagious
yes - bad cold (+wheezing)
68
who to vaccinate for bronchiolitis
premie, chronic lung disease, cerebral palsy, heart disease, immune compromise,
69
Signs of asthma
Wheezing over weeks, with instigating factor
| Cough -(may be with or without wheezing)
70
First time wheezing what is the diagnosis
Reactive airway disease
71
Pertussis vaccine <11 years
dTap
72
Pertussis vaccine >11 years
tDaP
73
What causes Pertussis
```
Bortadella pertussis
(gram - coccobaccilus colonizing ciliated epithelium)
```
74
Stage 1 of pertussis
```
Catarral stage (most contagious) lasts 1-2 weeks
Cold symptoms
```
75
Pertussis incubation period
| and contagious timeframe
3-12 days
and
during catarrhal period and first 2 weeks of cough (21 day average)
76
Stage 2 of pertussis
Paroxysmal stage
Lasts 1-6 weeks (up to 10)
paroxysms of uncontrollable coughing fits
77
Stage 3 of pertussis
```
Convalescence stage (lasts for months)
paroxysms may recur if subsequent Respiratory infections
```
78
Diagnostic for Pertussis
```
Nasal swab (takes days to weeks to return)
clinical diagnosis
```
79
Treatment for Pertussis
Zithromax 10mg/kg day 1
5mg/kg day 2-5
Supportive care
80
Most common cause of morbidity/ mortality under 2 years old
Foreign body aspiration
81
Where do most foreign bodies end up in kids
proximal main stem bronchus
82
Concern of Foreign body aspiration if...
1st episode of wheezing get CXR
formerly speaking- won't speak
coughing without other URI symptoms
83
Classic triad for Foreign body presentation
Wheezing,
Decreased air entry - usually regionally
Cough
84
Treatment and diagnosis of Foreign body
Bronchoscopy
85
Most common population for Cystic fibrosis
Caucasian,
86
Cause of Cystic Fibrosis
Genetically driven chloride channel disruption
87
Features of Cystic fibrosis
Viscous secretions in lungs, liver, pancreas, intestine, reproductive tract
88
What bacteria colonize Cystic fibrosis patients
Staph and H flu in childhood
| P. Aeruginosa in adulthood
89
Sinus symptoms of Cystic fibrosis (2)
Panopacification by age 8 months
| Nasal polyposis in 20%
90
Pancreatic symptoms of Cystic fibrosis (3)
Insufficient digestive enzymes,
malabsorption
failure to thrive, electrolyte abnormalities, anemia
91
Important early clinical finding in Cystic fibrosis
Meconium ileus is Pathognomonic for CF
| May have small bowel obstruction in Older children
92
Infertility in Cystic fibrosis
95% in Males
| 20% in females
93
Cystic fibrosis diagnosis
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)]
94
Cystic fibrosis treatment options (7)
```
Ivacaftor (/tezacaftor)
Azithromycin - anti-inflammatory
Bronchodilators
Dnase
Inhaled hypertonic saline
Steroids - short term
Lung transplant
```
95
Respiratory Distress syndrome epidemiology
Premies <30weeks
96
Cause of RDS
Surfactant deficiency -->
Atelectasis -->
V/Q mismatch -->
Pulmonary response
97
Diangosis of RDS
Clinical
| CXR - air bronchograms, low lung volume, ground glass appearance, pneumothorax
98
prevention of RDS (3)
antenatal corticosteroids
exogenous surfactant
assisted ventilation
99
What is most important in diagnostic feature of Child abuse
History that doesn't make sense
100
Likely abuse signs and ages(3)
fractures in non-ambulatory children
less than 18 months (>80%)
Multiple fractures or multiple different stages of healing
101
When does inflammation, pain and swelling occur after a fracture
day 3-7
| induction
102
When does soft callus bone formation occur after a fracture
infants 7-10 days
| children 10-14 days
103
When does union at fracture site - hard callus- occur after a fracture
14-21 days
| hard callus
104
When does woven to lamellar bone occur after a fracture
3 months to 1 year
| remodeling
105
When to do skeletal surveys for child abuse (5)
<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
106
abuse fractures (8)
```
metaphyseal lesions - bucket handle
rib fx
acromion
spinous processes
scapular fx
sternal and pelvic
hand and foot in infants
occipital impression fx
```
107
When does pyloric stenosis present
3-5 weeks of life
| Rare after 12 weeks
108
Presentation of Pyloric stenosis
Projectile vomiting,
Wt loss,
Hungry after vomiting
Palpable Olive
109
Diagnostic for Pyloric Stenosis
Ultrasound
(or UGI)
(But also correct electrolytes and hydration - so CBC and CMP)
110
Treating Pyloric stenosis
Rehydrate and correct 'lytes
then
Pyloromyotomy
111
When does intussusception occur most commonly?
3months - 5 years
112
What usually causes Intussusception?
Ideopathic (75%)
| Viral, bacterial, underlying pathology
113
Presentation of Intussusception
15-20 minutes of Sudden severe crampy pain
Non-bilious vomiting
currant jelly stool
114
intussusception triad
Pain
Palpable mass
Current jelly stool
(only 15% present with all three)
115
Diagnosis of Intussusception
Clinical
Xray - crescent sign (+/- reliable)
Ultrasound (100% with good tech)
116
Treatment of intussusception
barium or pneumatic enema if stable and no perf
| Surgical if enema fails or signs of perf
117
Phenylketonuria (PKU)definition
genetic deficit of phenylalanine hydroxylase - build up of phenylalanine leading to intellectual disability
118
Untreated PKU symptoms
mental retardation
epilepsy
pigment issues,
blood and urine smell "mousy"
119
Diagnosis of PKU
Screening done at birth
120
Treatment for PKU
```
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
Pediatric appendicitis presentation
1month - 5 years
| Limping, Hip pain, may just look ill,
122
Treatment for Peds appendicitis
```
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
Normal stooling frequency for 0-3 month old
3-4 stool/ day
124
Normal stooling frequency for 3months - 2 years
1-2 stool per day
125
What is an important dietary counsel point for children less than one (might cause Microbleeding)
Cow's milk
126
Treating Constipation
Infants: Glycerine suppository
Older children:
Suppository, MIRALAX, Enema, Laxative
127
What is encopresis
Involuntary leakage of stool (+/- constipation)
128
Who gets encopresis
3% of kids
Boys 6x more than girls
around the age of toilet training, and school
129
What is the most common cause of Encopresis
constipation
130
DSM-V criteria for Encopresis (4)
1. passage of stool into underpants
2. 1+ event per month
3. older than 4 years
4. not result of laxative or illness
131
Encopresis treatment when caused by constipation
Miralax and water
132
Hirshsprung disease is what
Genetic mutation of RET proto-oncogene causing a section of the colon to lack ganglion cells - no nerves
133
Presentation of Hirshsprung disease
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
Where is Hirshsprung disease usually located
Rectosigmoid (75%) but may comprised the whole colon (8%)
135
Diagnostic of Hirshsprung disease
Xray
Barium enema,
Manometry of anorectum,
Biopsy of section of colon - gold Standard
136
Treatment of Hirshsprung disease
Surgical excision of affected segment
137
What is Meckels disease
Congenital diverticulum
| the disease of 2's
138
Who gets Meckel's
```
2% of Pop
males 2:1
2 years old at presentation
2 feet proximal to ileocecal valve
2 inches in length
```
139
Presentation of Meckel's
70% asymptomatic
| otherwise may present with GI bleed, Obstruction, Peritonitis, Divericulitis, appendicitis, bezoar
140
Treatment of Meckel's
Surgical excision
141
What is malrotation
rotation of small intestines only (unlike situs inversus) twisting leads to volvulus
142
Presentation of malrotation
may be asymptomatic
| otherwise - infants present with Bilious vomiting, abdominal pain and distension, melena and/or mucoid stool
143
Diagnose Malrotation
If clinical suspicion do Xray
| UGI series if not emergent
144
Treat malrotation
surgical fix
145
What are the types of strabismus
```
Esophoria
Exophoria
esotrophia
exotrophia
Intermittent
constant
monocular
alternating
```
146
Can strabismus ever be normal
Yes - In the first few months of life
147
What is hering's law
when one eye moves, the other eye should move equally (muscle equality from side to side)
148
What is Sherrington's law
When the eye is pulled by a muscle the opposing muscle must relax to allow ocular movement
149
Risk factors for strabismus
Family hx
Low birth weight
visual deprivation (retinopathy of prematurity)
150
What can occur if Strabismus is not corrected
Amblyopia, Diplopia, Contracture of EOMs, psychosocial and vocational consequences
151
treating strabismus
prescription glasses,
miotic drops, patching, training exercises
Surgical reposistioning
152
When to refer strabismus
```
Any age with esotropis
esodeviation after 4 months
deviation with cover test
asymmetry of appearance on Bruckner test
inexplicable torticollis
parental/provider concern
```
153
impetigo Epidemiology
Kids 2-5
warm climates
spread by contacts,
154
Impetigo causes
```
Staph Aureus (not MRSA)
(less frequent beta hemolytic strep -A)
```
155
Impetigo types
Non-Bullous - most common
Bullous
Ecthyma
156
Describe non-bullous Impetigo
honey colored crusts
may have regional lymphadenitis
No Systemic symptoms
157
Describe Bullous impetigo
flaccid bullae with clear yellow fluid
| fluid darkens and ruptures
158
Describe ecthyma impetigo
ulcerative punched out lesions with yellow crusts
| relatively rare
159
treat impetigo
```
Clinical suspicion
Antibiotics -
topical - if few lesions
Mupirocin
Oral - If bullous or many lesions
Diclox, Cephalexin
Clinda, Bactrim (if MRSA suspect)
```
160
What causes pinworms
Eterobiasis
| Enterobius Vermicularis
161
Who gets Pinworms
5-14 year olds
162
Diagnosis of Pinworms
Hx of anal itching at night and cellophane tape collection
163
Treat Pinworm
Albendazole
400mg once
repeat in 2 weeks
(pyrantel Pamoate - OTC may work also)
164
fifth disease AKA
Erythema Infectiousum
165
Cause of 5th disease
Parvovirus B19
166
Symptoms of 5th disease
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
Incubation period for 5th disease
1-2 weeks
| non-infectious when rash appears
168
Treating 5th disease
Supportive
| Unless there is a pregnant mother - MAY CAUSE FETAL HYDROPS
169
Mono AKA
Epstein Barr
170
Incubation for Mono
4-7 weeks
171
Mono presentation (7)
```
Fever
Pharyngitis
Adenopathy
Fatigue
Atypical Lymphocytes
Splenomegally
Rash - Maculopapular
```
172
Diagnosis of Mono
Clinical
Monospot (high false negative and false positive rate)
EBV panel if Monospot is negative after 1 week
173
Treat mono
Supportive - Hydrate
Antipyretics, REST (NO SPORTS)
Steroids if Airway is compromised (tonsillar hypertrophy)
174
Rubeola incubation
7-21 days
175
Rubeola symptoms
```
fever, cough, coryza, conjunctivitis
Koplik Spots (Head --> toe) - Pathognomonic
```
176
When is Rubeola contagious?
4 days before rash appears until 4 days after rash
| HIGHLY CONTAGIOUS
177
Complications of rubeola
```
OM
Pneumonia
Croup
Diarrhea
Acute encephalitis
```
178
Measles Prophylaxis
MMR vaccine w/in 72 hours of exposure
| IG if administered w/in 6 days of exposure
179
Measles Treatment
Vitamin A - Immediately and then again the next day
180
What does Vitamin A prevent when given for measles treatment
Preventable blindness due to xerophthalmia (severe dry eye)
181
Rubella symptoms
Rash and low grade fever, symptoms last for 2-3 days
| May cause birth defects in pregnant women
182
Roseola epidemiology
affects over 90% of children by age 2
183
Roseola presentation
Sudden high fever
| fever subsides --> rash appears (arms and legs) Asymptomatic rash
184
Kawasaki disease presentation (7 + age range)
```
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
Diagnose Kawasaki's
Clinical but get Echo to detect aneurysm -Repeat in 4-6 weeks
186
Treat Kawasaki's
```
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
Coxackie presentation
Apthous stomatitis
Rash on hands an feet
fever
( less common -Aseptic meningitis)
188
Treating Coxackie
Tylenol or motrin
magic mouthwash
hydrate
prophylaxis for close contacts
189
Varicella treatment
Motrin or Tylenol for fever
| Benadryl and aveeeno for itching
190
what is eneuresis
urinary incontinence in children
191
treating nocturnal enuresis
DDAVP (Vasopressin)
192
What causes UTI in infants (2)
E.coli and anatomical abnormalities
193
How does a UTI present in Infants
URI symptoms
| not UTI symptoms
194
limping child eval diagnostics (4)
Xray
Labs (CBC, CRP, ESR, Blood Cx, CMP)
Joint aspiration
MRI/CT
195
Concern with femur fractures in children less than 10 years
Overgrowth - may grow longer than other leg by 1-3 cms
| Don't put back into anatomical alignment
196
toddler's fracture
Minimal or undisplaced spiral fracture of the tibia (not fibula)
No Hx of trauma, pt age 1-6
197
Treating a Bowing fracture
required lots of force (done in OR under general Anesthesia)
198
Conservative treatment of a Supracondylar fracture
Long arm cast,
analgesics
serial radiographs q 2 weeks
199
Surgical treatment of supracondylar fracture
Pinning done in OR - avoid injury to Ulnar nerve
200
Galeazzi fracture
dislocation of distal radioulnar joint and distal fractured radius
muGR
201
Monteggia fracture
Fracture to ulna
proximal dislocation of radial head
MUgr
202
Developmental dysplasia of hip
screened on newborn eval
F 4x more than M
early Total hip replacement
203
Identifying Developmental dysplasia of hip
toe walking
limb length inequality
waddling gate
swayback
204
Tests for Developmental dysplasia of hip
Galeazzi - knee height difference
| Barlow - trying to dislocate hip
205
Treatment for Developmental dysplasia of hip
Pavlik Harness-->
Closed reduction-->
Open reduction-->
SPICA cast to hold hip in reduced position
206
Legg-calve Perthes description and epidemiology
osteonecrosis of capital femoral epiphysis
ages 2-14
Boys 5x more than Girls
207
4 stages of Legg-calve Perthes
Stage 1: necrosis
Stage 2: fragmentation
Stage 3: reossification
Stage 4: remodeling
208
presentation of Legg-calve Perthes
limited hip Abduction and internal rotation
atrophy of quad,
leg length inequality
209
tx for Legg-calve Perthes
Reduce activity,
crutches, walker, wheelchair,
refer to specialist
NSAIDS may help with bone regrowth
210
Transient synovitis of hip diagnosis
diagnosis of exclusion
| r/o septic arthritis
211
tx for transient synovitis
bedrest until symptoms improve
NWB - 1-2 days
NSAIDS
212
Apophysitis other names and description
Osgood-schlatter's disease
pain over tibial tuberosity
Sever's disease
pain in calcaneus at insertion of achilles
213
treatment for apophysitis
RICE
NSAIDS
Reassurance
214
Bow legged baby - non-pathologic - name
Physiologic genu varum
215
concerning genu varum signs and symptoms
asymmetry,
atypical for age
worsening deformity
216
what age to refer genu verum out
2 years
217
Blount's disease description
unilateral genu verum with lateral thrust during gait
218
normal leg position ages 3-5
Physiologic genu valgus
219
when to eval toe-walking - causes
older than 3 years,
cerebral palsy
tethered cord
220
treating club foot
Serial casting
221
Scoliosis -definition
COBB angle >10degrees
222
What is the risser classification
used to grade skeletal maturity based on level of ossification and fusion of iliac crest
Stages 0-5
0= earliest
5 = latest
223
<25 degree scoliosis treatment
observe regardless of risser scale
224
25-45 degress of scoliosis treatment
Brace from Risser 0-2
| Observe if in risser stage 3-5
225
>50 degrees of scoliosis treatment
Surgery
226
meaning of RV heave pediatric
RV hypertrophy
227
Differential pulses in pediatrics
Coarctation of aorta
228
bounding pulses in peds
L--> R PDA shunt
229
pulsus paradoxus in peds
exaggerated SBP drop with inspiration
| May indicate tamponade or severe asthma
230
Pulsus alternans in peds
alternating pulse strength -
| LV mechanical dysfunction
231
Mid systolic click
Mitral Valve Prolapse
232
Loud S2 heart sound
Pulm HTN
233
fixed split S2
ASD, Pulmonary stenosis
234
S3 (gallop)
volume overload or cardiac dysfunction
235
Holosystolic murmer
VSD,
| Mitral regurg
236
Continuous murmur
PDA
237
Shunts in fetal circulation
Ductus venosus - bypasses liver
Foramen ovale -
ductus arteriosus
238
Do umbilical arteries or vein carry oxygenated blood
Umbilical Vein (singular - there are 2 arteries that carry deoxygenated blood)
239
What causes closing of shunts
Umbilical cord clamp causes changes to vascular resistance and greater L ventricular pressure closing FO
First breath decreases resistance in Pulmonary circulation
240
How long does it take for ductus arteriosus to close (Functionally)
24-48 hrs (may be longer in premie or persistant hypoxia)
241
When should the left ventricle be thicker than the right
By 1 month post partum
242
```
What do these structures become after birth:
Foramen ovale
umbilical vein
ductus venosus
ductus arteriosum
```
Fossa ovale
ligamentum teres
ligamentum venosus
migamentum arteriosum
243
murmur that changes with position (concern?)
Innocent murmur(Except HOCM)
244
vibratory twangy systolic murmur at LSB and apex-
Age 3-5
loudest in supine --> Disapears upright
Still's murmur (Innocent)
245
Systolic ejection murmur over pulmonic area grade 1-2 increases insupine, decreases upright
Pulmonary flow murmur (innocent)
246
Low pitched continuous murmur in infraclavicular area
loudest upright,
decreases supine
Venous hum (innocent)
247
red flag murmurs (5)
```
Diastolic (Venous hum ok)
Continuous murmurs
Loud murmur (with thrill)
constant with positional change
Symptomatic
```
248
L-->R "Acyanotic" Shunts
VSD
PDA
ASD
249
Holosystolic murmur at LSB with heave +
| FFT, Tachypnea, Diaphoresis with feeding
VSD
250
Systolic ejection murmur in pulmonic area
| +/- Diastolic murmur at LSB
ASD
251
Bounding pulse, Congestive heart failure
| FFT and diaphoresis with feeding
PDA
252
Treatment for PDA
Indomethacin
253
Tetralogy of fallot
Rt ventricular outflow obstruction
VSD
Overriding aorta
RVH
254
Tx for Tetralogy of fallot
systemic pulmonary artery shunt in early infancy
| later relief of outflow tract, and VSD closure
255
Skin can tolerate up to what temperature without burning
111 degrees
256
deepest burn area with dead or dying cells necrosis and absent bloodflow
Zone of coagulation (3)
257
red zone of burn - may blanch, becomes avascular and necrotic by day 3
zone of stasis (2)
258
burn area blanches with pressure, healing by day 7
Zone of hyperemia (1)
259
burns >30% of total body area - concern for what complication
Systemic inflammatory response
-hemolysis, and pulmonary bronchoconstriction
increased vascular permeability - hypovolemia End organ damage,
260
2nd degree burn -superficial partial thickness- description
fluid filled blisters
soft - very tender to touch
healing over 2-3 weeks no scarring
261
2nd degree burn -deep partial thickness- description
red and blanched white skin
thick-walled blisters
healing over 3-6 weeks with scarring
262
3rd degree burn description
full thickness burn - white leathery area
no sensation
Burns >1cm require grafting
263
4th degree burn treatment
surgical debridement and repair
264
when counting TBSA burned rule of estimation
Count partial thickness and full thickness separately
| 1 palm is 1% body area
265
circumferential burn around torso - treatment
Escharotomy - Longitudinal incisions
axial planes
In to normal skin
down to subcutaneous fat
266
When does maximal
| edema occur after burn
24-48 hours
267
goal of fluid resuscitation for burn pts
Children urine output of 1-2ml/kg/hour
Adults
urine output of 40ml/hour
268
Concern if over hydration with burns
ARDS 3-5 days post burn
269
dressing on burns
2x daily,
| partial thickness burns - topical anti-microbial and occlusive dressings
270
concern with aspirin in peds
Reye's syndrome
271
```
What % TBSA burns go to burn center:
Partial thick - adult
Partial thick - child
full thick
other
```
Partial thick - adult: >25%
Partial thick - child: >20%
full thick: >10%
other - functional or cosmetic impairment (face, hands/feet, perineal)
272
COncerns with Burns (2)
Infection
| Burn shock - coagulation necrosis, fluid loss
273
what type of electricity causes passes the "let-go current" barrier more easily
AC>DC
274
Low voltage burns - cause in kids and treatment
```
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
oral burns in toddlers -presentation
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
what does contact with high voltage DC current cause
Single muscle contraction throwing victim from source (impact trauma)
277
How does high voltage current travel in the body
Direct path through body from current source to ground
278
How does low voltage current travel in the body
travels along path of least resistance along nerves and blood vessels
279
Internal damage caused by electricity (5)
```
necrosis
periosteal melting
fluid leakage
rhabdomyolysis - muscle ischemia
cardiac - arrhythmias
```
280
treating electrical burn pt (6)
```
IVF + Foley
Labs + imaging
Tetanus
Splinting (after NV Eval)
Fetal monitoring and compartment pressure
```
281
Symptoms of frostbite (5)
cold --> sting/burn/throb -->
Numbness/complete sensation loss -->
Loss of dexterity sm then large muscles-->
Severe joint pain
282
```
Frost bite:
1st
2nd
3rd
4th degree
```
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
Trench foot
Pain, parasthesisas, pallor, pulselesnness, paralysis
| reversible if treated early - better than frostbite
284
Chilblains/ Pernio
chronic repeated exposure to non-freezing, cold/damp
capillary bed damage
resolves in 7-14 days
285
what blisters should you treat/how to treat
Aspirate clear blister - do not aspirate hemorrhagic blister
286
what controls body temperature
Hypothalamus
conserve heat via vasoconstriction
produce heat via shivering
287
EKG findings in Hypothermia
J or Osborne waves
| Arrhythmias
288
Mild Hypothermia temperature
89.6-95 F
32-35 C
altered judgement,
ataxia, apathy
289
Moderate hypothermia termperature
82.4-89.6 F
28-32 C
CNS Depression, paradoxical undressing
290
Severe hyptothermia
82.4F
<28 C
V fib COMA
291
```
Lab changes in Hypothermia:
ABG
CBC
CMP
DIC
```
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
Slow rewarming technique
Warm IV Fluids - 45C,
Heated O2 mask
Warmed blankets
293
Moderate rewarming technique
Warmed gastric lavage
warmed IV fluid -65 C
peritoneal lavage
294
Rapid rewarming technique
thoracic lavage
Cardiopulmonary bypass
ECMO, AV Dialysis,
Warm water immersion
295
What is catastrophic Hyperthermia
>41.1C
| >106 F
296
Heat stroke temp
>104.9
| with anhydrosis and Altered Mentation
297
Goal of hyperthermia therapy
Decrease Core temp to <40C within 30 minutes
298
Malignant hyperthermia treamtment
Dandrolene
