Peds Flashcards
What is Respiratory Syncytial Virus?
Under 2 years of age + wheezing = bronchiolitis (Inflammation of the bronchioles)
Increase in mucus production and the sloughing of airway epithelial cells from the viral illness–> wheezing
Tx: none (supportive)
When should circumcision be delayed?
Epispadias (epi, on top of) or hypospadias (hypo, below)
leave the foreskin on for reconstruction at a later date
Kid with strep gets hives on penicillin… What do you do?
Discontinue penicillin, start cephalexin, and start 2nd gen H1 antagonist (cetirizine)
Baby with diarrhea due to milk products.. Next step?
Milk-soy protein often presents with failure to thrive and hematochezia. Switch to hydrolyzed formula to solve the problem.
There is only one true indication for soy formula - galactosemia
What is Tetralogy of Fallot?
Cyanotic Heart + Diagnosis not at birth (the baby lived) = Tetralogy
What is the treatment for otitis media?
Tugging on the ear without producing pain in the setting of febrile ear pain sounds like otitis media
Bulging tympanic membrane with pneumatic insufflation being positive
Tx: Oral amoxicillin
Epidural hematome facts
unconscious–>Lucid period before becoming unconscious
Injury to the middle meningeal artery from skull trauma causes bleeding between the dura and the skull.
Lens-shaped () hematoma (biconvex shape)
C5-C9 complement deficiency?
If a kid has infections with Neisseria they prob have terminal complement deficiency (C5-C9)
What is intestinal atresia?
intrauterine vascular accident (maternal cociane use, cold meds)
Projectile vomiting of bilious contents in newborn
Multiple air-fluid levels on xray
Child with fever and UTI… Next step?
First febrile UTI–> renal ultrasound
2nd febrile UTI or abnormal ultrasound–> VCUG to look for vesiculoureteral reflux (reflux of urine from bladder up into the ureters (and sometimes kidneys)
Teen confidentiality laws
Confidentiality is conditional and should only be broken if there is concern for abuse, suicidal ideations, homicidal ideations, or any behaviors that would put the life of the patient or others in jeopardy.
Testing for Tb in kids
When evaluating for tuberculosis, use the tuberculin skin testing (TST) in patients under 5 years of age. The interferon gamma release assay (IGRA) can be used in those 5 years of age or older.
How is coarctation of the aorta diagnosed?
Coarctation of the aorta has a variable clinical presentation but should be considered whenever there is a difference in perfusion or blood pressure between upper and lower extremities. Echocardiogram is the next (and often times only) test you will need.
Foreign body aspiration?
With acute onset dyspnea and an unsupervised child, you should think of foreign body aspiration. Suspect upper airway if stridor and lower airway if wheezing. Plain films can be diagnostic. Bronchoscopy will be therapeutic (and can be diagnostic as well).
Treatment for Lyme disease
Use Doxycycline to treat Lyme disease in adults and in children 8 years of age and up
<8 use amoxicillin
Ceftriaxone is used to treat Lyme disease that has disseminated. you would expect to see Bell’s palsy, heart block, or Lyme meningitis
Treatment for infantile spasms (west Syndrome)?
West syndrome (infantile spasms) should be treated with cosyntropin (ACTH). Look for hypsarrhythmia on EEG.
2 year old boy with GI bleeding?
Painless bleeding in a patient who meets the rule of 2s should be evaluated for Meckel’s diverticulum via a technetium-99m scan.
How will xrays for duodenal atresia and annular pancreas present?
Double bubble sign (gas in stomach and duodenum) and no gas pattern beyond
Both cause a bowel obstruction at the level of the duodenum
Both associated Down syndrome
How will xray for malrotation present?
Double-bubble WITH distal air is indicative of malrotation.
What is breast milk jaundice?
Breast milk jaundice is a “quality” issue with breast milk. Enzymes in the milk result in decreased conjugation of enteral contents and result in unconjugated hyperbilirubinemia.
What is VACTERL syndrome?
VACTERL stands for (V)ertebral anomalies, (A)nal atresia, (C)ardiac defects, (T)racheoesophageal fistula, (E)sophageal fistula, (R)enal anomalies, and (L)imb defects
At least 3 of them need to be present for diagnosis
what is the treatment for imperforate anus?
Imperforate anus can either be directly reanastomsed or require a colostomy depending if the lesion is “low” or “high”, respectively. However, evaluate for VACTERL before any surgical intervention is done so that a full understanding of the infant’s anatomy is obtained.
How is osteosarcoma diagnosed?
Bone destruction (alkaline phosphatase and LDH are elevated) Mass with a sunburst pattern on x-ray that is proximal Bone cancer + child + proximal long bone = Osteosarcoma
How is Ewing sarcoma diagnosed?
Fever, leukocytosis, anemia, and an elevated ESR
Onion-skinning with a lytic appearance plus periosteal elevation
Ewing sarcoma is bone cancer + shaft + in a child
What is leukocyte adhesion deficiency?
Large leukocytosis
Recurrent abscesses with non-purulent drainage
Positive nitro blue test (oxidative burst)
Delayed umbilical cord separation.
LAD = leukocytes can burst but cannot get where they need to go
What is chronic granulomatous disease?
Large leukocytosis
Recurrent abscesses with Purulent drainage
Negative nitro blue test (no oxidative burst)
CGD = leukocytes can get where they need to go but cannot burst
What are some conditions associated with Tuberous sclerosis?
Ash- leaf lesion sebaceous adenoma angiofibromas of the face mental retardation (usually mild) seizure
What is the effect of sickle cell on the spleen?
Since the spleen auto-infarcts by age 5, red blood cells that are prematurely released do not have the nucleated component removed (which is done by the spleen). This leads to Howell-Jolly bodies on a peripheral smear.
Look for sickled cells and howell jolly bodies
what is an example of a holosystolic murmur?
Mitral regurgitation and ventricular septal defect are the only two possible diagnoses.
Kids- VSD
Adults- MR
What is peritonsillar abscess?
Tonsillar shift in the setting of a febrile illness
Incision, drainage, and antibiotics that cover Group A Strep, anaerobes, and Staph aureus are sufficient. There is a normal x-ray
What is epiglottitis?
Thumb print sign (swollen epi)
tripoding child who is unvaccinated and toxic
What is the treatment for intussusception?
Can be diagnosed with an abdominal ultrasound
Air enema (both diagnostic and therapeutic) is the preferred treatment of intussusception when the bowel isn’t dead
Intussusception can progress and lead to ischemic bowel. Surgical intervention is needed.
What is low implantation of ureter?
One of the ureters has implanted (likely) in the proximal urethra which can cause continuous leakage as the sphincter is bypassed. Urine generated by the kidney goes straight to the urethra and out the door. The fact that she has the urge to void and can void on her own control at times shows the other ureter is properly implanted.
When should someone with concussion be sent to ER?
A GCS <15
focal neurological deficits
loss of consciousness >30-60 seconds
progressively worsening symptoms should prompt brain imaging
CT preferred over MRI
What is Mongolian Spot/congenital dermal melanocytosis?
Mongolian spots are commonly mistaken as ecchymosis, raising concern for abuse and hemophilia. If present at birth, they are not ecchymosis.
blue spots on buttocks
What is an absolute contraindication to DTap?
Absolute contraindications to future DTaP administrations include anaphylaxis and encephalopathy after receiving previous dose.
What is apnea of prematurity?
Apnea of prematurity is typically seen in neonates < 35 weeks. Diagnose with apnea episodes greater than 20 seconds (drop in O2 sats and heart rate). Treat with caffeine (and additional respiratory support if needed).
Transposition of the Great Arteries
diagnosed at birth. If not, baby dies as the ductus closes. “Endomethacin Ends the ductus (Indomethacin is an NSAID) and so prostaglandins prolong the ductus and are required to support life. Mom will have a history of diabetes (NOT gestational diabetes) when becoming pregnant.
Treatment for acute chest syndrome?
1) treat any underlying infection
2) achieve adequate hemoglobin levels
3) maintain adequate oxygenation
4) aggressively treat pain
try regular transfusion, if no improvement then do exchange transfusion
Treatment for gonococcal conjunctivitis?
ceftriaxone IM/IV Topical therapies (silver nitrate) are for prophylaxis only.
A newborn baby is being evaluated at 24 hours for the absence of urinary output. Next step?
Newborns should have urine output within the first 24 hours of life. Posterior urethral valves is a common cause of obstructive uropathy in newborn males. Relieve obstruction with urinary catheterization (which will also give you diagnosis).
Will see Mild degree of oligohydramnios in a male w/ posterior valves
Can also do renal ultrasound but this ^ kills 2 birds with 1 stone
What is Osgood-Schlatter disease?
Osgood-Schlatter disease is apophysitis (inflammation/nodule) of the tibial tubercle.
There is tenderness and swelling over the tibial tubercle.
Conservative management (NSAID and rest) is the mainstay of therapy.
How will xray for Osgood-Schlatter disease look?
X-rays show irregularities and a haziness over the metaphyseal border of the proximal tibia.
What is reye syndrome?
In the setting of a viral illness, aspirin use in children and adolescents can precipitate Reye syndrome (hepatic encephalopathy)
Check with ammonia and BUN
What is the treatment for retinopathy of prematurity?
Abnormal blood vessel development
Laser photocoagulation treatment of the affected eye(s)
Treatment for strabismus?
Alternate eye patching
Treatment for acute otitis media?
In children 2 years and older without severe symptoms, antibiotics (oral amoxicillin) or observation
Tugging at ear relieves pain
What is treatment for otitis externa?
Ciprofloxacin drops or steroid drops
Tugging on otitis externa is painful
How should transient proteinuria after viral illness be treated/ followed up?
Transient proteinuria can be caused by a febrile illness.
It should be followed-up (dipstick) to ensure there is no other underlying process.
Who should receive tetanus immunoglobulins?
For patients who have received at least 3 lifetime doses, no tetanus immunoglobulin is needed
Whoo should receive tetanus booster?
Tetanus booster is needed for 1) clean wounds with 10 or more years since booster and 2) dirty wounds with 5 or more years since booster.
For a patient who has not received at least 3 lifetime doses to Tetanus vaccine, how should wound be treated?
clean wounds receive tetanus vaccine only
Dirty wounds receive both vaccine and tetanus immunoglobulin.
Kid has transposition of great arteries, what should be done immediately?
Prostaglandins Prolong the ductus, Endomethacin (Indomethacin) ends the ductus.
use prostaglandin infusion to keep the PDA open and prevent death
What are the congenital cyanotic diseases?
Truncus Arteriosus Tricuspid Atresia Total Anomalous Pulmonary Venous Return Tetralogy of Fallot (can survive past the neonatal period undiagnosed) Transposition of the Great Vessels
What is choanal atresia?
failed recanalization of the nasal fossae
Cyanosis during feedings, pinking up when crying
1st step in diagnosis: Pass a flexible catheter through the nose
What is esophageal atresia?
Esophagus doesn’t develop properly
Feeds are regurgitated
Secretions are aerated or aspirated into the lungs, thus the gurgling and bubbling between feeds
Confirm diagnosis with NG tube and see (with xray) that it coils in the esophagus (or even goes into the lung) rather than into the stomach
How can sepsis be prevented in a patient with sickle cell disease?
There is a higher risk of infection with encapsulated organisms in the setting of sickle cell disease.
Penicillin prophylaxis can be used up to the age of 5 years but ultimately immunization (conjugate CAPSULAR polysaccharide (Strep pneumo vaccine)) is the best prevention of severe pneumococcal infections (which can be fatal).
What is croup and treatment for it?
Caused mainly by Parainfluenzae
Inspiratory stridor and a seal-like cough
Racemic epinephrine and dexamethasone are your first line therapies.
Meningitis in infant?
Lethargy, fever, irritability, nausea and vomiting, rigid muscles
In a pediatric patient with meningitis who has contraindication to lumbar puncture (i.e has increased ICP/ bulging fontanelles), obtain blood cultures then administer antibiotics then get a CT scan of the head ( needed due to increased intracranial pressures).
Treatment for hypoglycemic baby?
Ideal glucose levels in a neonate should be at least 40 mg/dL
You can allow the infant to feed but since this is symptomatic hypoglycemia (jittery, agitated, obtunded, seizing) he needs the good stuff via IV.
IV administration of D10 bolus is the correct answer.
A continuous dextrose infusion may be needed if hypoglycemia persists, but not yet.
Treatment of Kawasaki disease
Kawasaki’s Disease may be complicated by the development of coronary artery aneurysm. Intravenous immunoglobulin and aspirin significant reduce the incidence of coronary artery aneurysm formation and improve overall morbidity and mortality.
WAGR syndrome
Loss of part of the short arm of chromosome 11 that contains the Wilms tumor gene (causes GU abnormalities and increasing the likelihood of Wilms tumor) and PAX6 (causes aniridia and is one possible cause of mental retardation).
Wilms tumor, Aniridia, GU abnormalities, and mental Retardation.
Scoliosis treatment
20º or less- home exercises, OMT
20º- 45º- Spinal bracing
> 45°- Surgical correction
Pregnant female with HIV
If viral load less than 1000 then normal delivery can occur V or C
If viral load >1000 than scheduled C section at 38 weeks with 3 hours of zidovidune before delivery
staph infection treatment
Cephalexin is the most appropriate choice of antibiotics for methicillin-SENSITIVE Staphylococcus aureus infections.
Henoch-Schonlein purpura
Henoch-Schonlein purpura is a vasculitis caused by IgA and C3 deposition in the small vessels. It primarily affects children and is classically characterized by palpable purpura, abdominal pain, joint pain, and hematuria.
Cephalohematoma
Birth trauma injury that consists of bleeding under the periosteum and is limited by the suture lines
caput succedaneum and subgaleal hemorrhage
likely to cross suture lines
Developmental dysplasia of the hip (DDH)
Abnormal development or dislocation of the hip due to capsular laxity and improper uterine packing.
asymmetric gluteal (and/or thigh) folds, a positive Galeazzi sign (apparently shortened femur when comparing knee heights)
Diagnosis of Developmental dysplasia of the hip (DDH)
Ultrasonography is the first-line imaging modality for the diagnosis of DDH in patients age 4-6 months.
After age 6 months, plain radiographs of the hips consisting of AP (anteroposterior) and frog-leg views are used for evaluation of DDH.
Duchenne muscular dystrophy
Caused by a mutation in the dystrophin protein
Muscle breakdown with normal muscle usage (Gower sign)
Dx: Serum creatine kinase can be used to rule out muscular dystrophy because all patients with the disease have muscle breakdown that liberates creatine kinase into the bloodstream
When foaming at the mouth is mentioned in a baby less than 24 hours of age, think
Esophageal atresia
Other feeding difficulties can be noted with esophageal atresia, including gagging, coughing, and frank aspiration. Emesis should never be bilious.
patients with a tracheoesophageal fistula should have a
Renal ultrasound, echocardiogram, and x-ray of the spine, to evaluate for associated anomalies (VACTERL)
Treatment for Acute epiglottitis
Vancomycin and ceftriaxone
Causes of acute epiglottitis
Haemophilus influenzae type B (HIB)
Fever, sore throat, stridor (audible inspiratory sound), muffled voice, and difficulty breathing that worsens when lying supine
Tripoding”, and drooling
Most appropriate diagnostic test for duodenal atresia?
Abdominal Xray
Double bubble sign
Bilious emesis and gastric distension in the first 24 hours of life
1/3 infants with duodenal atresia have Trisomy 21 (Down’s)
Diagnosis of intussusception
Barium enema can diagnose and treat intussusception
Sausage-shaped abdominal mass
“target sign” on Abdominal ultrasound
Diagnosis of Hirschsprung disease
Failure to pass meconium, generally after 24 hours of life
Abdominal distension and nonbilious emesis
Rectal biopsy revealing a lack of ganglionic cells in the submucosa
Bacterial meningitis in neonates
In newborns, meningitis is most commonly caused by Group B Streptococci, Escherichia coli, and Listeria monocytogenes.
The combination of ampicillin and an aminoglycoside (gentamicin) provides coverage against these bacteria.
Laryngotracheobronchitis (croup)
High-pitched whooping sound (characteristic barking cough)
inspiratory stridor
Croup vs Epiglottitis
Croup- no position preference. Onset is slow with 1-7 day prodrome of URI
Epiglottitis- Extended neck, tripod position. Onset is acute within 4-12 hrs
Otitis externa
Pain with traction of the tragus
If not responding to initial empiric therapy would warrant further investigation with ear culture.
X-linked agammaglobulinemia
Deficiency of humoral immunity caused by a mutation in the Bruton’s tyrosine kinase
Without the activity of this Bruton’s tyrosine kinase, B cells do not mature properly. This leads to the low production of IgG and low numbers of mature B cells. leads to infections with encapsulated organisms (strep pneumo, H flu, N menin)
Tx: antibiotic prophylaxis and IVIG.
Chediak-Higashi syndrome
Microtubular dysfunction
ocular albinism and neutropenia
ADHD treatment
1st- amphetamine and methylphenidate compounds
2nd- Atomoxetine, Bupropion
Alpha-2 agonists (guanfacine and clonidine)
Treatment for painful diabetic neuropathy
Pregabalin or gabapentin
Amitriptyline, venlafaxine, and duloxetine
Most common area for berry aneurysm
anterior circulation of the circle of Willis. The most common sites include the branch point of the anterior communicating artery with the anterior cerebral artery, the junction of the posterior communicating artery and the internal carotid artery, and the bifurcation of the middle cerebral artery.
Beckwith-Wiedemann syndrome
Presents with hemihypertrophy
Asscoiated with omphalocele, macroglossia, polyhydramnios
