Peds ALL Flashcards
1
Q
Writhing for a POC suggests
A
Obstruction, ie colic or intussusception
2
Q
0-3 months, give 6 emergent reasons for abdominal pain
A
Necrotizing enterocolitis Volvulus Hirschsprung's disease Incarcerated hernia Testicular Torsion Nonaccidental trauma
3
Q
0-3 months, give 3 nonemergent reasons for abdominal pain
A
Constipation
Acute gastroenteritis
Colic
4
Q
3 months to 3 years, give 5 reasons for emergent abdominal pain
A
Intussusception Volvulus Testicular torsion Appendicitis Vaso-occlusive crisis
5
Q
3 months to 3 years, give 4 reasons for nonemergent abdominal pain
A
UTI
Constipation
Henoch-Shonlein purpura
Acute gastroenteritis
6
Q
3 years to adolescence, give 11 emergent reasons for abdominal pain
A
AppendicitisPancreatitisVaso-occlusive crisisEctopic pregnancyDKAOvarian TorsionTesticular TorsionUTITumorPNACholecystitis
7
Q
3 years to adolescence, give 10 nonemergent reasons for abdominal pain
A
PregnancyHenoch-Shonlein purpuraAcute gastroenteritisIBDRenal stonesOvarian cystConstipationNonspecific viral syndromePUD/gastritisStrep pharyngitis
8
Q
Intermittent, paroxysmal abd pain in 0-3 months suggests
A
IntussusceptionGastroenteritisColic
9
Q
Constant abdominal pain in 0-3 months suggests
A
Midgut rotation with volvulusNecrotizing enterocolotis
10
Q
Most common surgical emergency age 3-15 years
A
Appendicitis
11
Q
Dx that mimics appendicitis but includes upper respiratory sxs
A
Mesenteric adenitis
12
Q
First step in evaluating any ill-appearing child or in cases of persistent vomiting or poor oral intake
A
Bedside glucose
13
Q
Pathognomonic signs of necrotizing enterocolitis
A
penumatosis intestinalis (air in bowel wall)portal venous gas*Normal abd xray does not rule out
14
Q
Use of ampicillin in necrotizing enterocolitis
A
Cover gram +
15
Q
Use of gentamicin or cefotaxime in necrotizing enterocolitis
A
Cover gram -
16
Q
Use of metronidazole or clindamycin in necrotizing enterocolitis
A
Cover anaerobes
17
Q
Infant with abrupt onset of bilious vomiting, constant pain, abdominal distention;dx?
A
Volvulus
18
Q
Imaging signs of volvulus
A
Corkscrew bowl, bird’s beak contrast cutogg in duodenum
19
Q
Common location for intussusception
A
Ileum into colon
20
Q
Diagnosis of intussusception is made by
A
Immediate air contrast enema* If free air, skip this step and go straight to surgical consult
21
Q
U/S findings in intussusception
A
Target appearance of bowel within bowel
22
Q
Useful way to assess peritoneal signs in children
A
Walk, cough, jump
23
Q
Appendiceal U/S findings
A
Max diameter > 6mmWall thickness >or= 3mmLack of compressibilityHyperemia on color Doppler U/SSurrounding edema or fat strandingAppendicolith
24
Q
Appendicitis meds for nonperforated appendix
A
CefoxitinAmpicillin/sulbactam (Unasyn)
25
Appendicitis meds for perforated appendix
Piperacillin/tazobactam (Zosyn)
26
Triad of palpable purpuric rash, abdominal pain, arthritis;dx?
HSPGI bleeding in 50-75% of cases
27
Most significant long-term consequence of HSP
Renal: Hematuria/edema/proteinuria
28
Mgmt of incarcerated hernia
Manually reduceAdmit
29
Acute pancreatitis in children is defined by:
Lipase or amylase >3x normal or imaging
30
Complications of acute pancreatitis in children
Intra-abdominal third spacingShockMultiorgan system failure*Treat aggressively with NS or LR
31
Common reasons for cholelithiasis in kids
TPNSCD
32
Diagnostics in peds cholecystitis
LipaseLFTsUS*Tests can be normal, does not rule out
33
Charcot's triad is:
Cholangitis: RUQ pain, fever, jaundiceMedical emergency
34
Abx for peds cholecystitis
Ampicillin + gentamicin + clindamycin
35
Increased risk of _____ with use of azithromycin/erythrocmycin/cesarean/bottle feeding in babies?
Pyloric stenosisnon-bilious/string sign/olive shape/
36
Intercavernosum phenylephrine is the treatment modality for
Priapism
37
First step treatment for phimosis
Dorsal slit procedureTopical steroid creamPeriodic gentle retraction
38
What is the most common cause of external shunt infection?
Staph epidermidis
39
What is the most common reason for pediatric VP shunt failure?
Choroid plexus obstruction
40
When considering scrotal pain, what favors torsion over epididymitis?
Acute, severe painHigh riding testiclepain worsens with testicle elevationAbsent cremasteric reflexDecreased Doppler color flow
41
What is the most common way to de-torse a testicle?
Medial to lateral rotation for 1-1.5 rotations
42
What is Prehn sign?
Relief with elevation of the affected testicle
43
What is a complex febrile seizure?
Multiple seizures during the same illness (>1 in 24 hours), prolonged seizures (>15 min), focal seizures
44
What kind of vomiting is commonly seen in pyloric stenosis?
Non-bilious
45
What is the classic finding in pyloric stenosis seen on upper GI series?
String sign passage of contrast through narrow pyloric sphincter
46
What do the labs show in pyloric stenosis?
Hypokalemic metabolic alkalosis
47
What common viral infection is associated with intussusception?
Adenovirus
48
What medications are associated with the development of necrotizing enterocolitis?
IndomethacinVitamin E
49
The majority of shunt infections present when?
Within the first two weeks of placement, with 80% occurring by 6 months
50
Intravenous Ig is used to treat
Kawasaki diseaseITPGuillain-Barre
51
What is the diagnostic test of choice for suspected malrotation with volvulus?
Upper GI series
52
What type of intussusception occurs with HSP?
Ileoileal
53
What is the most commonly fractured bone in children <2?
Clavicle
54
The most common cause of acute onset altered consciousness in the pediatric population is
Toxic ingestion
55
Most common intra-abdominal injuries associated with Chance fractures of lumbar vertebrae
Pancreas and small bowel
56
What is the triad of "seat belt syndrome" in children?
Lumbar spine fractureIntra-abdominal injuryPelvic fracture
57
What is the most common cause of acquired heart disease in children?
Kawasaki disease
58
The most common causes of neonatal (<1 month) meningitis are
group B Streptococcus and Escherichia coli
59
The most common causes of meningitis in children (>1 month to 18 years) are:
Neisseria meningitidisStrep pneumoH. flu
60
Most common cause of death in sickle cell children
Strep pneumo sepsis
61
What is an appropriate adenosine dose in pediatrics?
0.1 mg/kg for the first dose followed by 0.2 mg/kg for the second dose (not to exceed 6 mg and 12 mg respectively)
62
Maltese cross sign is pathognomonic for
Nephrotic syndromeIndicates fatty casts in urine
63
Child with pink foamy urine, dx
PSGNDecreased serum C3 most specific finding
64
Lipid emulsion is the treatment for
Lidocaine toxicity
65
S/S lidocaine toxicity
Perioral numbnessTinglingArrythmia
66
IO inaccurate lab values
WBCKCaAST/ALTpO2
67
When to use oral rehydration therapy
Mild to moderate dehydration
68
Age range for croup
6 months to 3 years
69
Txs for croup
Racemic epiCool, humidified airDexamethasone
70
BP ranges
70 + 2x age to 90 + 2x age
71
Organs/cells that require glucose
braingut epitheliumnephronRBC
72
PCARN height cutoff >2years
5 ft
73
PCARN height cutoff <2 years
3 ft
74
NAVELIV for meds down ETT
NaloxoneAtropineValiumEpinephrineLidocaineIV or IO preferredUse 2-3x IV dose except epindephrine (10x the dose)
75
Resus amount of blood dose
10 ml/kg prbc
76
Narrowest portion of airway
Cricoid ring
77
How to calculate ETT size
(Age + 16)/4
78
breaths per minute for peds resus
8-10 per min
79
CPR compressions # in peds resus
100/min
80
Defib dose for peds resus
2 J/kg shock initialthen 4J/kg
81
Synchronized cardioversion dose peds resus
0.5-1 J/kg initialthen 2 J/kg
82
IVF bolus dose for peds
20 ml/kg NS
83
4-2-1 rule for IVF resus
4 cc/kg for the first 10 kgs of a patient's weight2 cc/kg for the next 10 kgs of a patient's weight1 cc/kg for the rest of the patient's weight
84
Inspiratory stridor suggests an obstruction where?
At or above the larynx
85
Newborn RR
<60
86
1-6 months old RR
24-35
87
6-12 months old RR
??
88
1-5 years old RR
20-30
89
6-12 years old RR
25-Dec
90
Signs of impending respiratory failure
Reduced LOC, lethargy, shallow or quiet breathing, apnea
91
Most common organism causing croup
Parainfluenza
92
Mgmt croup
SupportiveCool mist/O2 as necessary
93
When to use racemic epi in croup
Moderate to severe respiratory distress
94
Single dose of dexamethasone for croup peds
0.15 mg/kg as effective as higher doses, can give oral, iv, im
95
Tripoding, drooling, stridor, toxic appearing;dx
Epiglottitis
96
Mgmt epiglottits
Intubation by ENT in ORDo not upset child3rd gen cephalosporin
97
Peds pt has croup but gets sicker;dx?
Bacterial tracheitisSuperinfection - staph aureus
98
Findings in bacterial tracheitis
Pseudomembrane and purulent secretions
99
Mgmt unstable SVT in peds
0.5 J/kg synchronized cardioversion
100
Length of catarrhal stage of whooping cough
Up to 2 weeks
101
What is the first step in the evaluation of every child with difficulty breathing?
Identify wheezing vs stridor
102
Dose of epi in peds resus
0.01 mg/kg of 1:1,000
103
Dose of amio in peds resus
5 IV mg/kg bolus w/o pulse, 20-60 min with pulse
104
Dose of procainamide in peds resus
15 mg/kg IV
105
Dose of lidocaine in peds resus
1 mg/kg IV/IO
106
Dose of magnesium in peds resus
25-30 mg/kg IV/IO
107
Dose of glucose in peds resus
0.25-0.5 g/kgInfants: D10W 2.5-5 ml/kgChildren: D25W 1-2 ml/kgAdolescents D50W 1ml/kg
108
Why is D10 neonates/infants?
To prevent IC hemorrhage, vein damage
109
Virus that causes RSV
Parainfluenza
110
Mgmt RSV
SupportiveO2 monitoring, suction, antipyreticsRibavarin in high risk infants
111
5Ts of congenital heart issues
Tet of Fallot most commonTransposition of the great arteriesTotal anomalous pulmonary venous returnTricuspid atresiaTruncus Arteriosus
112
History of strep suggests
PSGN
113
Hx of bloody diarrhea suggests
HUS (CBC shows thrombocytopenia)
114
Organomegaly on PE in young children may suggest
Fluid overload
115
Hematuria, casts, proteinuria suggest
GN
116
Proteinuria alone suggests
Nephrotic syndrome
117
Hyaline casts may be seen in
ATN
118
Urine SG is often high (>1.025) in what renal failure?
Prerenal
119
CBC shows eosinophilia, what renal dx suggested?
Interstitial nephritis
120
In prerenal failure, treat dehydration and hypovolemia with a 10-20ml/kg bolus of
NS
121
How are RBC transfused in kids in the setting of hemorrhagic shock?
10 ml/kg
122
Diagnostics for Nephrotic syndrome
HypoproeteinemiaLow albuminProtein:Creatinine ratio >2 in 1st am voidHypercholesterolemiaGeneralized edemaPE to assess for pulmonary effusion, edema, facial swelling (anasarca)
123
Tx for volume overload in children
1-2 mg/kg furosemide
124
Children with nephrotic syndrome are at high risk for:
Bacterial peritonitis from strep pneumo
125
GN is often associated with
HTN
126
Most common serologic markers of PSGN in kids
Anti-streptolysin titerLow C3
127
Tx for PSGN
SupportiveRenal bx not indicatedF/U with Nephropathy
128
Tx for Berger's/IgA Nephropathy
Bx is diagnosticACE inhibitors or ARBs for HTN (esp w/ proteinuria)Refer to Outpt Nephropathy
129
Tx focuses for HSP
Rest, analgesics, hydrationConsult Nephrology
130
Triad of HUS
Microangeiopathic hemolytic anemiaAKIThrombocytopenia
131
Complications of E. Coli enteritis/Shiga toxin
HUSAcute gastroenteritisDMAcidosisColitisIntussusceptionHTNHeart failure
132
Peripheral smear in microangiopathic hemolytic anemia
SchistocytesHelmet cellsBurr cells
133
Diagnostic to do for HUS
Get stool sampleCBC w/ diffUA
134
Contraindications for tx of suspected HUS in peds
Do not give abxDo not give antiperistalticsDo not give platelets
135
Most common signs of primary HTN in children (4)
HASleep disturbancesChest painAbd pain
136
Medication causes of HTN in children
OCTSteroidsDrugs of abuse
137
Lower BP in legs vs arms, or left vs right suggests
Coarctation of the aorta
138
Diagnostics to order in children with HTN
CXREKG+/- head CT if neuro findings presentRenal U/S +/- CT/MRI+/- Echocardiogram
139
Tx hypertensive emergency peds
ABCsReduce MAP by 25% over 8 hours
140
Tx hypertensive urgency
Oral antihypertensivesD/C with outpatient F/U
141
Medication causes of hematuria
NSAIDsAnticonvulsantsWarfarinDiureticsPenicillinChlorpromazine
142
Imagine choice for macroscopic hematuria
US to rule out structural defects and malignancy
143
What is an avoidable risk factor for development of hemolytic uremic syndrome?
Antibiotic use during infection with E. Coli O157:H7
144
JONES criteria, major
Carditis (clinical and/or subclinical), arthritis (polyarthritis), Sydenham chorea, Erythema marginatum, and subcutaneous nodules
145
Which of the following congenital heart lesions shows increased pulmonary vascularity on CXR?
Transposition of the great arteries
146
Infants with noncyanotic heart disease can develop hypoxia through what mechanism?
Pulmonary edema
147
Pediatric Assessment Triangle
AppearanceWork of BreathingCirculation
148
PALS Dose of adenosine peds
0.1 mg/kg --> 0.2 mg/kgMax first dose 6 mg; max second dose 12 mg
149
PALS Dose of amiodarone peds
5 mg/kg IV - bolus for pulseless VT/Vfib;give over 20-60 min for VT w/ pulse or SVT
150
QRS length peds
0.09 s
151
SVT infant HR >
220
152
SVT child HR >
180
153
Differential diagnosis of AMS in pedsAEOIU TIPS
A - Alcohol, abuseE - Electrolytes, EncephalopathyI - InfectionO - OD, IngestionU - UremiaT - TraumaI - Insulin, Hyoglycemia, Intussusception, Inborn error of metabolismP - PsychogenicS - Shock, Stroke, Shunt, Seizure
154
Neonatal HR
100-160
155
1y HR
100-130
156
5y HR
80-110
157
10y HR
70-100
158
15y HR
60-80
159
Systolic BP peds
90 + 2(age) = 50th percentile
160
Best was to lower increased ICP peds
Mild hyperventilation
161
Morphine dose peds
0.1 to 0.2 mg/kg
162
The target PaCO2 for initial management of pediatric traumatic brain injury is
35 mm Hg (35-40)
163
Rectal bleeding and abdominal distention in a newborn;dx?
NEC
164
Femoral head slips posteriorly and inferiorly relative to the femoral neck, dx?
SCFECan present as hip, thigh, groin or knee pain
165
Mgmt septic arthritis children
IV abx and drain
166
The three most important vital signs to monitor during neonatal resuscitation are:
HRRRO2 sat
167
Where to put O2 monitor in neonate
Right hand bc pre-ductus
168
In an apneic and bradycardic newborn being resuscitated, the most immediate indicator of effective positive pressure ventilation is
Increase in HR
169
HR to start chest compressions in neonate
HR < 60
170
Contents of umbilical cord
Two umbilical arteries and one umbilical vein
171
Glucose bolus dose for newborn with hypoglycemia
2 ml/kg of 10% dextrose
172
ASA classification of pts with mild, systemic disease
Class II ie asthmaClass III - severe systemic disease
173
Discharge criteria after procedural sedation
Return to baseline respiratory status
174
Max dose of lidocaine with epi
7 mg/kg or 0.7 ml/kg of 1% lidocaine with epi
175
Sedative agent with longest acting duration
Chloral hydrate
176
Cushing triad
HypertensionIrregular respirationsBradycardia
177
Neonate RR
30-60
178
Infant RR
30-60
179
Toddler RR
24-40
180
School age RR
18-30
181
Preschool age RR
22-34
182
Adolescent RR
16-Dec
183
Kinds of shock
CardiogenicDistributive - Anaphalaxis, Sepsis, NeurogenicObstructive - Tamponade, Tension PTX, EmbolismHypovolemic - Hemorrhagic and Non-hemoorrhagic
184
When to add hydrocortisone for BP support
Adrenal insufficiency
185
PALS chest compression rate
> 100/min
186
T/F: AEDs can be used in infants
TRUE
187
CPR chest sequence
Chest compressions, airway, breathing
188
Peds survival rates for out of hospital arrest
10%
189
Most likely treatment for DKA to cause cerebral edema
Sodium bicarb
190
Mgmt SIADH
Fluid restriction unless pt is comatose or seizing
191
Most insidious onset and progressive worsening of IEMs
Lysosomal storage disorders
192
Fastest way to turn around hyperammonemia
Hemodialysis
193
Most common lab abnormalities of IEMs
Metabolic acidosis, hyperammonemia,hypoglycemia
194
Treatment of moderate hypothermia in infants
Warm air in ETT and warmed IVF
195
Why can ferrous sulfate not be absorbed by activated charcoal?
Iron ions are too small to be caught
196
Why should flumazenil not be used?
Can precipitate seizures in mixed drug toxicities
197
Most common EMS call in peds
Respiratory distress
198
Mediastinal widening and bilateral pleural effusions;bioterrorism dx?
Anthrax
199
Least vulnerable organ to radiation damage
The heart (or muscle)
200
Why do neonates have a right axis deviation on ekg?
The two ventricles are the same size at birth, and LV 2:1 to RV at approximately 2 months
201
PALS epinephrine dose
0.01 mg/kg of 1:10,000 --> 0.1 ml/kg IV or IO;a 10 kg child gets 1mL of crash cart epi
202
Dose blood products PALS
10 ml/kg prbc
203
PALS atropine dose
0.02 mg/kgMin dose 0.1mg to prevent paradoxic bradycardia;Max dose 1 mg
204
PALS procainamide dose
15 mg/kg IV
205
PALS lidocaine dose
1 mg/kg IV/IO
206
PALS magnesium dose
25-30 mg/kg IV/IO
207
PALS glucose dose
0.25-0.5 g/kgInfants D10W 2.5-5 ml/kgChildren D25W 1-2 ml/kgAdolescents D50W 1ml/kg
208
SHANE pneumonic for the critical neonate
S - SepsisH - Heart ie ductal dependent lesion, hyperoxia test, give prostaglandin E1A - AbdomenN - NATE - Errors of inborn metabolism, +/- withhold feedings, ammonia level, D10W
