Peds Flashcards
How do you work up unilateral red eye and mucoid drainage?
visual acuity neonate or sexually active teenager: gram stain and culture for N. gonorrhea and PCR or antigen test for Chlamydia trachomatis
How do you treat bacterial conjunctivitis?
Topical abx drops (bactrum, polymixin-bacitracin, fluoroquinolone)
What is the most common cause of conjunctivitis in the first 24 hours of life?
chemical conjunctivitis from the silver nitrate or erythromycin
How do you treat neonatal conjunctivitis due to gonorrhea?
CTX IM x1 and cover oral chlamydia w/ erythromycin x14 days w/ eye irrigation
How do you treat neonatal conjunctivitis due to chlamydia?
oral erythromycin x14 days and eye irrigation
When does chlamydia conjunctivitis present in the neonate?
days 5-14
How does neonatal glaucoma present?
megalocornea, tearing, photophobia, blepharospasm refer to ophthalmologist
How do you treat chemical conjunctivitis?
irrigate and refer to ophtho
How do you treat foreign body in eye?
examine, irrigate if non-penetrating foreign body, otherwise refer to ophtho
How do you dx corneal abrasion?
put anesthesia on eye do fluorescein test w/ wood’s lamp
How do you tx corneal abrasion?
topical ophtho abx drops and f/u in 48 hours
How do you tx dacrycocystitis?
massage 3-4 times per day and warm compresses until resolves
How do you tx periorbital cellulitis?
oral abx
What are concerning signs of orbital cellulitis?
eye pain! Can not move eye or it is limited
How do you evaluate orbital cellulitis?
CT/MRI urgent ophtho surgery!
How do you tx impetigo and what is the causative organism?
usually strep pyogenes (group A strep) or staph aureus
tx: mupirocin x 7days
if wide spread - oral cephalexin or clindamycin
What is a complication of impetigo caused by strep?
post-strep glomerulonephritis
Ddx for respiratory distress in the newborn
Respiratory distress syndrome
Pneumonia
Meconium aspiration
Transient tachypnea of the newborn
Congenital heart disease
Diaphragmatic hernia
primary pulmonary hypertension of the newborn
Why do babies get RDS?
Surfactant immaturity and deficiency
What are the steps to stablize a newborn with respiratory distress?
Place baby on the warmer
place cardiac and respiratory monitors
start oxygen, place pulse ox
wean oxygen as able
order chest x-ray and echo
place UVC for IV fluids and meds and UAC for blood draws and ABGs
start D10 W, send ABG, CBC, glucose, electrolytes, blood culture
start nasal CPAP if indicated
start ampicillin and gentamicin (if worried about meningitis - cefotaxime and ampicillin)
How to evaluate for and treat pyloric stenosis?
Ultrasound and pyloromyotomy
IV fluids and manage electrolytes
What acid-base disturbance is seen with prolonged vomiting?
hypokalemic, hypochloremic metabolic acidosis
How to work up and treat concern for intussuception?
CBC, place IV and give bolus 20 cc/kg if dehydrated + IV hydration
ultrasound to dx
abdominal flat plate (look for perforation, if present cannot do air contrast enema)
air contrast enema to dx and tx
surgery if can’t reduce it
W/U of Gi bleed in child older than 3 months?
stool guaiac, CBC, PLTs, retic, PT/PTT, bleeding time, CMP, could do stool cultures if indicated
How to work up short stature?
- Look at parents height, if both short it’s likely familial short stature
- look at growth curve
- get bone age xray of wrist/hand, if younger than actual age = constitutional growth delay
What is the definition of short stature?
Growth below the 3rd percentile
What is the definition of tall stature?
Growth above the 97th percentile
How to w/u a dusky newborn with low o2 sat and abnormal cardiac exam?
pulse ox, oxygen
ABG on room air
start IV with D10W, start Prostaglandin E1 drip (to keep open PDA)
ABG on oxygen (if PaO2 doesn’t correct - probably a heart issue)
CBC, blood culture, urine culture, UA, serum glucose and ca
CXR, EKG
amp and gent
ECHO
What is the most common cyanotic congenital heart lesion?
Tetralogy of fallot (5-7%)
What is the most common overall congenital heart legion?
Ventricular septal defect (25-30%)
Diagnostic criteria for Kawasaki disease
Fever for five days and 4 of the following:
Conjunctival injection
Oral manifestations (cracked lips, strawberry tongue)
Skin rash
Adenopathy/adenitis
Hand findings including swelling or desquamation
How to diagnose and treat Kawasaki disease?
CBC, ESR, AMP, BUN, CMP, glucose, liver enzymes, UA
start IV fluids
begin IVIG and high dose aspirin
CXR
EKG
ECHO
*continue high dose aspirin until afebrile x48 hrs, then low dose for 4-6 wks
*cardiology follow ECHO at 2-3 wks, 4-6wks, then q2-3 monthsuntil normal
s/sx of lead poisoning?
abdominal pain, live in old building, behavioral issues, lethargy, pica
How to w/u lead poisoning?
CBC and smear (shows anemia and basophilic stipling)
serum lead level
When does lead poisoning require treatment?
44-70 give dimercaptosuccinic acid (oral)
>70 give EDTA (versenate) IV
How to evaluate minor head trauma?
if no LOC, observe with competent care provider at home
if LOC <1 min observe in hospital or do CT scan
What typical work up should be done in a child if concerned for NAT?
check coags (PT/PTT), CBC, skeletal survey if <2 yrs,
What is the ddx for painless abdominal mass/
wilms tumor
neuroblastoma
choledochal cyst
ectopic or horseshoe kindey
teratoma
poop
What is a Wilms tumor?
mixed embryonal tumor of the kidney
age 2-5 yrs
presents with painless mass and HTN
tx with surgery and chemo (if advanced or can’t resect)
What is neuroblastoma?
embryonal cancer of peripheral sympathetic nervous system
~2 yo
usually near adrenal glands, increased VMA and HVA
*if child <1 yo, usually regresses on own
*if older than 1, poor prognosis
How to tx fetal alcohol syndrome?
PT, OT, speech, psychosocial counseling
s/sx of CF in newborn?
FTT despite good intake
thick meconium and delayed production
bulky, greasy stools
repeated respiratory symptoms
salty
nasal polyps
How to w/u CF?
CXR, CMP
sweat chloride
How to manage CF?
bronchodilators (albuterol/saline)
antibiotics when sick
steroids
chest PT
pancreatic enzymes and ADEK vitamins
