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Peds Block 2 Flashcards

1
Q

What are the three categories of fever?

A

Short duration- localized S/Sxs; dx w/ history and PE

W/out focus- often kids <3y/o; Hx or PE fail to show cause

Unknown origin- Fever >8 days w/out identifiable etiology despite PE, labs or after 1wk of hospitalization

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2
Q

Teething kids usually don’t have a fever higher than ?

What are two main causes of Fever Without Focus/Source?

A

100.4*

UTI and pneumonia

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3
Q

Serious bacterial infections in neonates/infants are usually due to ? 3 things

What is the most and second most common microbe?

A

Bacteremia UTI Meningitis

E Coli*, GBS

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4
Q

HSV induced virus is considered if PT is febrile and younger than ?

Peds who appear well but with fever are more likely to have ?

A

<28days

Virus

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5
Q

Peds under ? w/ fever need to be evaluated by the ER and NOT given ?

Tachypnea= ?
Tachycardia= ?
A

2mon, no antipyretics

> 60breaths pm
180bpm

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6
Q

How do you determine petechiae from other rashes?

All kids <1mon w/ fever w/out focus or source have what follow up step done

A

Petechiae= no blanching, more concerning

Admitted
CBC, culture, UA/culture, LP, CXR, stool WBC/culture if diarrhea is present
Post-labs: start ampicillin/gentamycin

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7
Q

Kids w/out fever but have toxic signs and are 1-36mon get

A 
Admitted
CBC, blood culture, UA/culture, LP (if 1-3mons and irritable*)
Stool WBC/culture if diarrhea
CXR if Temp >102.1 and WBC >20K
Empiric Ceftriaxone or Cefotaxime
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8
Q

What are 2 common bacterial infections in kids?

A

Acute Otitis Media- bulging, erythematous, and non-mobile TM

Strep Pharyngitis- seen late fall/winter, uncommon <3y/o
Prevent heart complications w/ PCN

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9
Q

What are the female risk factors for UTIs?

What re the risk factors for males?

A

White, <1yr, 102.2* or higher, Fever 2 days or longer

Uncircumcised, nonblack, temp 102.2 for more than 1 day

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10
Q

What are the two main types of bacteremia?

What are the more common agents?

A

Source: pneumonia, cellulitis
Occult: +culture in well appearing child

Pneumococcus
H Influenza Type B

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11
Q

Define Fever of Unknown Origin

What’s the difference between FOUO and Fever of Known source?

A

Fever >100.4 no origin +8 days

Duration

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12
Q

PT >6yo w/ fever is usually due to ? while adolescents w/ fever are more likely due to ?

Preterm infants less than <32wks have not received all maternal ?

Low birth weigh babies can summon ? type of immune reaction?

A

Respiratory/GU
TB autoimmune IBD lymphoma

IgG- cross placenta during second half of last trimester via active transport

IgM

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13
Q

Define Sepsis and Severe Sepsis

A

Systemic Inflammation Response Syndrome
Severe= end organ compromise

Temp >101.3
Tachy >2SD for age or,
Hypoxemia <70mm room air

HR >2SD for age or,
HOTN <2SD for age or,
Cap refill >3 sec

Lactic acidosis
Oliguria
AMS

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14
Q

Bacterial meningitis will present with what type of opening pressure?

What type of defect cause kids to be susceptible meningitis?

What two PT populations are more likely to get Strep Pneumo meningitis infections?

A

High

C5-8 defects w/ spleen issues

Functional asplenic- sickle cell
HIV

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15
Q

How is meningitis transmitted and what PT populations may be more susceptible?

What PT populations are more likely to get N Meningitidis infections?

What 4 serogroups are in the MCV4 vaccine?

A

Respiratory tract secretion/droplet
Native American/Eskimo

Younger than 5y/o, 15-24y/o

A C W Y X (verify)
B- has own vaccine
A: MC in Africa
B: MC in US

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16
Q

HIB infections more common during what part of life?

N Meningitidis has what 6 serogroups?

N Meningitidis mengingitis presents w/ what 2 S/Sxs?

A

70% of cases in first 5yrs of life
Peak at 6-9mon

A B C X Y W-135

Pruprua + non blanching

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17
Q

Since ABX are usually started prior to obtaining an LP, what lab results can be elevated for days later?

Traumatic LP taps are less likely to affect Gram stain, culture and glucose but can affect what two results?

A

Pleocytosis w/ neutrophils
Elevated protein
Red glucose

Leukocytes and Protein

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18
Q

What are 3 meningitis DDx?

A

Partially treated bacterial meningitis

Encephalitis- changes in mental status, greater risk for seizures, global neuro abnormalties

CNS abscess- focal neuro signs, Dx w/ CT

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19
Q

What ABX for meningitis is recommended for kids outside of neonatal period?

A

Vancomycin w/ 3rd gen Ceftriaxone
Meropenem- PCN/cephalosporin allergy
L monocytogenes suspected= ampicillin
Imm compromised/gram neg microbe- Cefepime/Meropenem

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20
Q

Three potential complications of meningitis Tx

Which microbe causes the survivors to have sequelaes of deaf, seizure, blind or learning disabilities?

A

SIADH
Hearing loss
Subdural effusion w/ S Pneumo and H Influenza

Pneumococcal infection

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21
Q

What part of a meningitis presentation indicates a poor prognosis?

Define Encephalitis and the 3 types

A 
Young
Long duration
Seizure/coma
Shock
Low/no CSF
ImmComp PT

Inflammation of brain parenchyma causing dysfunction (post infxn, chronic degeneration, viral)

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22
Q

What are the most common cause of viral meningoencephalitis?

A

Picornaviridae- neonate (functionally immcomp) and ImmComp PTs

Arbovirus: arthropod vector, most are zoonotic

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23
Q

What does HSV1 cause?

What does HSV2 cause?

A

Sporadic encephalitis
Coma/death in 70% of PTs

Neonatal encephalitis vix vertical transmission

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24
Q

What is a common Sx at presentation of acute infectious encephalitis

PTs w/ suspected acute infectious encephalitis get what serological studies?

A

Seizure

Cat scratch dz- from kitten
Lyme dz
Epstein-Barr
Arbovirus
Mycoplasma pneumo
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25
What test procedures is done for HSV, enterovirus and west nile during work ups? What is done for Tx of viral encephalitis
PCR No therapy except: HSV, Variclla, Cytomegalovirus, HIV
26
What viral CNS infection can have a severe sequelae if not Dx/Tx promptly? Rubeola= ?
HSV (Done w/ Lect 1) Measles: koplik, cough, coryza (runny nose), conjucitibits ( Fever and 3 C's)
27
Rubella= ? Roseola= ?
German measles Milder, Blueberry muffin baby Exanthem Subitum/6th Dz Fever, no fever, rash (Subitum= sudden)
28
Varicella= ? 5th Dz= ?
Chicken pox Dew drops on rose petals, itchy Erythema infectiosum
29
How long/how are infants protected from measles? What Dz can measles cause in Leukemia/HIV PTs?
Protected by transplacental maternal Ab until end of first year Giant cell pneumonia
30
What is the most common complication of measles? What is an acute but very late onset s/e?
Ottitis media ``` CNS: encephalomyelitis Sclerosing panencephalitis (8yrs later) ```
31
Humans are the only natural host for ? How is it transmitted and how long are PTs infectious?
Rubella Droplet 2 days before-7days after rash
32
Likelihood of Rubella infecting a fetus is highest at ? and lowest after ?
1st trimester | 16wks
33
PT w/ Rubella develop a rash first where? How does this rash spread?
Face/neck to torso but fades Face during progression lasting for 3 days
34
Lymphadenopathy is more prominent in Rubella PTs than other viral infections, primarily involving ? lymph nodes What oral finding will be seen?
Suboccipital Postauricular Anterior cervical Rose colored lesions
35
What finding can be seen in female PTs w/ rubella? What oral finding may be seen in Rubella PTs
Polyarthralgia of hands Forchheimer spots 3 days before rash
36
How is Rubella Dx? What unique finding is seen in CRS PTs?
Serological IgM, usually turns + 5 days after Sxs IgM at 3mon Stable/rises over 7-11mon
37
Rubella infecting babies creates CRS w/ ? issues? Why are these PTs dangerous?
Deaf Cataract CHDz (PDA) Secrete virus x 12mons
38
How is Rubella Tx? When is this vaccination c/i? How long after receiving MMR do females need to avoid getting pregnant?
Supportive ImmComp/Supressed Pregnant Received Immunoglobulin in past 11mon 28days
39
When can post-exposure prophylaxis be given for Rubella? What is the most common and accompanied Sxs of mumps
Within 3 days Orchitis Fever, Parotid swelling or tenderness
40
How is Mumps spread? How long are PTs contagious?
Respiratory droplet 7 days before - after parotid swelling
41
What causes 5th Dz Because this Dz has a high affinity for progenitor cells, what PT populations are at risk?
Parvovirus B19 Hemolytic anemias= aplastic crisis Fetal anemia Hydrops fetalis
42
How is 5th Dz transferred and what season is it seen in? Because this present with vague URI/flu like Sxs, what key finding is indicative?
Respiratory secretion Blood transfusions Spring Slapped cheek rash w/ circumoral pallor
43
What happens in each stage of development during 5th Dz? What areas of the body are not affected by this virus?
1: slapped cheek 2: erythematous truncal rash 3: central clearance leads to lacy reticulated rash leading to desquamination Palms/soles
44
How is 5th Dz Dx? How is it Tx?
IgM, PCR Hydration, antipyretic Transfusion if PT has aplastic crisis IV immunoglobulins if ImmComp w/ anemia or chronic infxn
45
What PT population will not develop a rash when infected w/ 5th Dz? What part of pregnancy is most susceptible to this infection and to whom? What two PT populations are at highest risk for 5th's?
Transient aplastic crisis PTs 2nd trimester Pregnant Deficient blood production d/o
46
6th Dz is AKA ? What causes this?
Exanthem Subitum Roseola HHV 6 and 7
47
When are most cases of Roseola seen? How does this present?
95% w/ HHV-6 by 2yrs, peak is 6-9mon Fever before rash Sudden/abrupt fever 103.5 Maculopapular rose colored rash w/ defervescence
48
What is the sequence of spreading of Roseola rash? What is the gold standard for Dx?
Trunk to face to extremities Viral culture
49
How is Roseola Tx? What complication can occur from this dz?
Hydration, antipyretic ImmComp= Ganciclovir/Foscarnet Encephalitis Virus associated hemophagocytosis syndrome
50
How does Varicella get transmitted and where does it reproduce? How long are these PTs infectious?
Airborne Contact w/ eye/resp tract Nasopharynx/UR tract Until all lesions are crusted over
51
How does Varicella rash spread? How does this rash look and what are the stages?
Trunk to head, face and extremities All lesions stages at once (all lesions in same stage= smallpox) Non-umbilicated oval tear drop vesicles w/ erythematous base and possibly on membranes Vesicular-pustules-scabs
52
What is the most common complication with Varicella? What other adverse events can occur?
Secondary skin infections from Staph/Strep Pneumonia Reye syndrome- avoid ASA and salicylates
53
What happens to neonates exposed to Varicella 5 days before/2 days after delivery? What is used for Tx?
Neonatal varicella, no shingles VZIG IV immunoglobulin
54
When do Varicella PT get an anti-viral Mortality from varicella increases if ? 2 things are present?
Acy/Valacyclovir Unvaccinated +12y/o Chronic skin/pulmonary dz CCS/salicylate therapy +20y/o ImmComp
55
When do kids get Varicella vaccine? What type of immunity does VZIG offer when used as post-exposure prophylaxis?
12-15mon 4-6yrs w/ MMR Passive- given within 96hrs of exposure
56
# Define Zoster Can mothers w/ this outbreak continue to breast feed?
Recurrence of latent VZV from direct contact Yes, but must cover and prevent skin on skin/direct transmission
57
Where does Zoster outbreaks usually occur? What is an adverse effect?
Thoracic/lumbar w/ unilateral lymphadenopathy CN7 Ramsay Hunt syndrome: facial paralysis and ear canal vesicles
58
What are two predisposing signs that a PT w/ zoster outbreak will have prolonged pain? What zoster vaccine has the CDCs recommendation as the strongest level of protection?
Advanced age Severity of pain at presentation Shingix Zostavax
59
How/what causes hand, foot and mouth? How do PTs present?
Coxsackie A16 via fecal/oral route Sore throat Lesions hand>feet Anorexia Mouth pain
60
Where do young kids present with Hand foot mouth Sxs? How is this Tx?
Diapered areas Pain control and hydration
61
What is a s/e of having hand, foot, mouth dz? What Sx do adults develop who get hand foot mouth?
Desquamation of nails, hands and feet weeks later Oral lesions
62
What causes Scarlet fever How does this rash start and spread
GAS Starts at neck, spreads to trunk/extremities that feels like sandpaper but blanches w/ pressure Peels like sunburn after resolution
63
PT presenting with Scarlet fever rash and a Pos GAS test gets ? med Define Herpes Gingivostomatitis
Amoxicillin Herpes of gingiva and vermillion border
64
# Define Herpes labialis How does this present?
Cold sore/fever blister Skin/membrane of vermillion border, most common form Erythematous papules progressing to groups of 2-4mm and fluid filled w/ erythematous base
65
# Define Viral Paronchia How can this be acquired
Herpetic whitlow Herpetic gingivostomatitis
66
# Define Herpes Gladiatorum How are they treated?
Unique to wrestler/rugby PO A/V/F-fyclovir
67
What is a rare but dangerous outcome from genital herpes? What causes pinworms?
Aseptic (viral) meningitis Enterbius Vermicularis- nematode/roundworm
68
How are pinworms Tx? What is the most effective prevention method?
Pyrantel pamoate (alt) Albendazole Mebendazole (alt) Hand hygiene
69
What causes scabies How does it present?
Mite: sarcoptes scabei Severe/paroxysmal itching Linear papules in axilae, umbiilicus, groin, webbed spaces w/ 1-2mm red pappules
70
What part of the body is not affected by scabies? What is the standard Tx and what is the most effective -cide agent?
Face Permethrin cream Heat
71
What is the most common chronic relapsing skin dz in infancy/children? What type of FamHx is this related to?
Atopic dermatitis/eczema Atopy (allergic rhinitis, asthma, eczema)
72
# Define Atopic March How does atopic dermatitis present?
Food allergy, Allergic rhinitis, Asthma Itch that rashes/Bricks w/out mortar Nocturnal pruritus and cutaneous reactivity= cardinal feature
73
How does atopic dermatitis present on infants? Where does is present on older kids or chronic cases?
Face, scalp, extensor surface (spares the diaper) Flexor folds, extremities
74
What finding is indicative a PT will have severe cases of eczema? How is this condition Tx?
Outbreaks crossing flexor folds ``` Avoid triggers Liberal bland emollients Topical anti-inflammatory (Cornerstone= CCS) Warm baths w/ rapid lotion Baths w/ 1/4 cup of bleach ```
75
When are Topical Calcineurin Inhibitors used for Atopic Dermatitis When are these sought out instead of earlier treatments?
Immune modulators for +2y/o Pimecrolimus- mild/mod Tacrolimus- mod/sev Parent w/ steroid phobia Face/neck dermatitis
76
What meds can be used as adjuncts for Tx of Atopic Dermatits?
1st Gen sedating anti-histamine (diphenhydramine, hydroxyzine) for sleep and reduced pruritus Systemic CCS- failed topical, anticipate rebound flare ups when d/c Derm referral: severe cases of UV therapy or Systemic Cyclosporine
77
Where does Secondary Impetigo come from? How is it Tx?
Atopic dermatitis- Staph A or GAS Topical localized- Mupirocin Widespread- PO 1st Gen cephalosporin (cephalexin)
78
# Define Eczema Herpeticum How do these PTs present?
Eczema/HSV overlapping dz (Kapsois Varecelliform) Punched out/crusted over appearance
79
What is the only two reasons to prevent infant from trying peanuts at home? What are the two sub-types of contact dermatitis and how are each Tx?
Egg allergy Severe eczema Irritant: remove agent (dirty diaper), Tx w/ CCS Allergic:
80
How does Diaper Dermatitis w/ Candida present? How is this Tx?
Secondary process causing beefy red/pink skin w/ numerous pustules and satellite papules Fist: Ointment/paste barrier w/ petroleum or zinc oxide Hydrocotisone (short term) Disposable diapers Anti fungals: Nystatin, Clotrimazole
81
Dry skin dermatitis is AKA ? How is it Tx?
Lip licker dermatitis Erythematous/fissured in area of exposure Stop offending action Moisturizer cream Steroids/topical ABX if refractory
82
# Define Juvenile plantar dermatosis How is it Tx?
Pre-puberty child w/ hyperhidrosis wearing occlusive foot wear Emolient after removing socks/swimming Severe: med/high topical steroids
83
# Define Allergic Contact Dermatitis How do they present
Cell mediated immune reaction, Type 4 or delayed/ type Pink w/ sharp margins in weird patterns that have clear vesicles/bullae in middle
84
What are the DDx of allergic contact dermatitis? What type of plants can cause allergic contact dermatitis?
HSV Dermatophytoses Impetigo Cellulitis Rhus (poison ivy/oak)
85
What causes Seborrheic Dermatitis How does it present
Malassezia yeast ASx PT w/ circumscribed w/ well defined borders of scales/hyperkeratosis on face, neck, diaper, ubilicus
86
Seborrheic in infants usually presents as ? How do adolescents present?
Craddle Cap Hair loss, blepharitis, brown scaly areas w/ yellow crust
87
What is the difference between Seborrheic dermatits and Acute Dermatitis How is infantile seborrheic cases Tx?
Seborrheic doesn't self resolve, chronic relapses Emolients/oil Persistent: low CCS and topical anti-fungal Ketonconazole shampoos
88
What is the first line Tx for seborrheic dermatitis in kids/adolescents? Define Pityriasis Rosea
1st: Antifungal shampoo, Topical CCS- Fluocinolone 2nd: topical calcineurin inhibs/keratolytic (urea) Once resolved, 1/wk antifungal shampoo wash Winter occurrence in adolescents as Herald Patch (on trunk/prox thigh), evolves into Christmas tree pattern parallel to skin tension lines
89
How is Pityriasis Rosea Tx Define Psoriasis
Menthol/Camphor lotion PO anti-histamine Phototherapy Papulosquamous rash, w/ plaque being most common Sharp demarcation, irregular borders that turn "mica" like if UnTx
90
Where does psoriasis present Define Auspitz sign
Scalp knees elbow Umbilicus Ear canal Kids- face, nail plate Pinpoint bleeding w/ scale removal
91
# Define Guttate Psoriasis What usually precedes this presentation?
Mostly in kids Eruption of oval/round papules on trunk, face, proximal limbs Wks after strep infection
92
What is the foundation of Psoriasis Tx? What can be used ad adjuncts?
Topical CCS Vit D analogs Salicyclic acid
93
What secondary therapy may help adolescents w/ Psoriasis? What is used if extensive skin involvement is present?
Phototherapy Immunosuppressives- Methotrexate, Cyclosporine, TNF antagonists
94
# Define Erythema Multiforme Who/when does this primarily affect?
First of several hypersensitivity syndromes Target lesion: Red, white, purple ring w/ plaque/bullae on hands, feet, elbow, knee Males in second decade
95
What are two predisposing factors that can cause Erythema Multiofrme This often is the first of what following two issues?
HSV infection Mycoplasma pneumoniae Steven Johnson Toxic epidermal necrolysis
96
Steven Johnson/Toxic epidermal necrolysis are most commonly caused by How is it Dx
Drugs- NSAIDs ABX sulfonamide anticonvulsant Infection- mycoplasma pneumo Nikolsky sign- rub skin and sloughing occurs
97
How does early cases of Steven Johnson/Toxic Epidermal present How is it Tx?
Swollen lips Bilateral conjunctiva erosion Genital mucus erosion Stop agent Support- feeding, fluid/E+ Burn unit Ophthalmology
98
What is the most common skin d/o in adolescents What are the 3 parts of this
Acne vulgaris Hyperkeratosis Inc sebum Propionbacterium increase
99
What are the two types of acne?
Non-inflammatory comedomes: Open/blackhead- open to air, superficial Closed/whitehead- closed to air, deeper Inflammatory comedomes: P. acnes colonization that ruptures, appearing as papules, pustules, cysts
100
What is the mildest form of acne? What area is most commonly involved in men/
Adolescent comedomes in central face Trunk
101
What are the stages of acne?
1: comedomal, minimal papules and occurs w/ puberty or 1wk prior to menses 2: papules on face only 3: pustules w/ scarring and possible cysts 4: nodulocystic acne, scarring and cysts
102
What topical agent is 1st line therapy for acne Tx? What drugs does this line of therapy encompass?
Comedolytic agent: Retinoid x 6-8wks, will worsen before it gets better Dec keratin/sebum/inflammatory MOST effective monotherapy ``` Tretinoin Adapalene Tazarotene Salicylic acid Azelaic acid ```
103
What are the major s/e of using retinoids for acne? When are PO ABX treatments used for acne?
Irritation Adapalene- minimal Tretinoin- red and scaling Taza- only irritation Mod/Sev/Inflammatory resistant to topicals Doxy, Mino>tetracycline
104
What is the s/e of taking PO ABX for acne? What med is used w/ systemic ABX and for maintenance after completing AB regime?
Pill esophagitis due to routine lasting for 3mon Benzoyl peroxide or retinoid
105
What education piece has to be done when prescribing Isotretinoin for acne? What OCPs can be used for acne?
Tetratogenic agent Triphasics- Orthotricyclen has FDA approval for acne
106
When using OCPs for acne, what do they have to be low in? What would be the benefit of prescribing Yasmin/Yaz?
Progestin (Norgestimate, Desogestrel, Levonorgestrel) Progestins that are spironoloactone analogs w/ antiandrogenic effects
107
Where are giant congenital pigmented nevi usually seen? What are two outcomes that need to be monitored for?
Posterior trunk Head/extremeties Neuromelanosis- melanocytes in CNS Malignant melanoma- cutaneous or neural
108
What is the most common type of cancer is kids? When are nodal metastases seen and what does that indicate?
Melanomas- white females 15-19y/o on extremities/heads of males More likely to occur in younger kids, not associated w/ decreased survival Adolescent w/ nodal dz- significant negative prognosis
109
What are the ABCDEs of pediatric derm? How do peds melanomas usually present?
``` Asymmetry Boders Color Diameter >6mm Evolving ``` Amelanotic More likely- regular borders and less than 6mm in diameter Papules/papulonodules
110
# Define Pyogenic Granuloma Where are they most commonly seen? What is the definitive Tx?
Pink/red popular lesion after trauma, grow rapidly in weeks Bleed a lot if damaged Head, neck, UE Surgery
111
How is Molluscum Contagiosum transmitted What type of microbe causes it? Where does it most commonly occur?
Direct contact vi autoinoculation Poxvirus- replicates in epithelial cells Neck, arm pit, thigh Rare- face
112
How are extensive cases of Molluscum Contagiosum Tx? What microbe causes the majority of cervical cancer?
Cryotherapy Topical Cantharidin but not on face HPV 16 and 18
113
What is the most common type of wart seen in kids? Define Verruca Plana and where they are seen?
Verruca Vulgaris from HPV 1 and 2 from direct contact/fomites HPV 3 and 10 <3mm on dorsal hand, knee, arm and face Painful when on soles of feet
114
# Define Condylomata Acuminata What type of wart Tx has topical Tx recommendation?
Genital warts- HPV 6 and 11 Most common STI Flat and Common Salicylic acid, Liquid N, Laser
115
How are anogenital warts Tx? HPV vaccine covers ? strands?
Topical Podophyllotoxin or Imiquimod Laser ablation/ImmTherapy w/ intralesion interferon 6 11 16 18 31 33 45 52 58
116
When are HPV vaccines given? What causes Impetigo and how does it present? What is a post-infection risk of Step Impetigo and what is NOT a post-infection risk?
2 doses 9-14y/o 3 doses if +15y/o Staph A/GAS Honey crusted lesion + Glomerulonephritis - ARF
117
How is Impetigo Tx Define Erysipelas
Topical 2% Mupirocin Superficial form of cellulitis from GAS Tx w/ 1st Gen Cephalosporin High MRSA= Clindamycin or Trimethoprim-sulfamethoxazole
118
What causes folliculits
Staph A causing dome shaped/erythematous papules Chlorhexadine wash Clindamycin wash Unresolved= PO ABX
119
What microbe causes hot tub folliculitis How is it Tx?
P aeruginosa Pruritic deep purple pustules on areas covered by swimsuit Self resolving in 1-2wks
120
# Define Furuncles Where do they usually occur How are they treated
AKA Bolis Deep hair follicle infection causing nodule w/ inflammaotry reaction Neck Trunk Arm pits Butt I and D, PO ABX
121
# Define Carbuncle How are they Tx?
Deepest hair follicle infection causing abscesses I and D, PO ABX
122
What causes Perianal dermatitis How does it present How is it Tx?
GAS Well demarcated, tender erythema 2cm around anus PO PCN or Amoxicillin
123
PTs w/ superficial fungal infections have a lifetime risk of developing ? How are these superficial infections Dx?
Dermatophytosis KOH exam and fungal culture
124
How are superficial fungal infections Tx? How is Onychomycosis Tx
Creams: Mico/Clot/Keton-azoles for body, foot, jock PO antifungal for Capitis (Grise, Terbin, Itracon) Tinea Unguium Confirm w/ KOH Tx: PO Terbinafine or Itraconazole x 12wks and monitor LFTs
125
What can cause neontral Kusmaul breaths? What can cause Cheyne-Stokes? What is and the causes of Biot respirations?
DKA, Metabolic acidosis CNS injury Depressants HF Uremia Breathing followed by apnea Brain stem injury Posterior Fossa mass
126
# Define Stridor Define Wheeze
Harsh sound from obstructed airway during inspriation Obstruction of lower airway during expiration Low- large/central airway High- small, peripheral
127
# Define Rhonchi Define Rales
Irregular rattling from secretion in intrathoracic airway Fluid secretions in small airways causing cellophane crumpling sound
128
What are four causes of decreased breath sounds? What is the narrowest part of children's and older/adult airway
Atelectasis Lobar consolidation Thoracic mass Pleural effusion Children: Cricoid ring Older/Adult: Glottis
129
# Define stridor and the cause Croup is AKA ?
``` Upper airway obstruction Infants laryngomalacia (floppy larynx) ``` Laryngotrachobronchitis
130
Croup is most commonly caused by ? What age does it effect?
Parainfluenza 1-4 Adenovirus Influenza RSV 6mon-3yrs, peak 2-3y/o
131
What x-ray sign is significant for croup? How is it Tx?
Steeple sign- subglottic narrowing Humidified air CCS- Dexamethasone Prednisolone Reacemic epinephrine- constrictor, reduces epiglottitis
132
When are Croup PTs admitted? What can be done at home to assist w/ Sxs?
<6mon Multiple ED visits in 24hrs Suspected bacteria infxn Stridor at rest Cool mist
133
If PT has croup, starts to get better but then gets sick again, what could it be? What microbes can cause epiglottitis?
Laryngomalacia GAS Staph A HIB/Diphtheria- if un-vaccinated
134
What is seen on PE for epiglottitis? How are they Tx?
Cherry red/swollen epiglottis ABX and intubation
135
What is seen on x-ray for Epiglottitis? What is the most common cause of infant airway obstruction?
Thumb sign Liquid
136
What are the most common foreign bodies seen in airways of toddlers/older kids? When so suspected airway obstruction PTs get an x-ray?
Grapes, Nuts, Hot dog, Candy First time unilateral wheezer
137
What is the most common chronic Dz in childhood in industrialized countries? What gender does it occur in more during childhood/adults?
Asthma Kids: B>G Adults: W>M
138
What are the 2 phases of asthma? How is asthma Dx?
Early: bronchospasm Late: inflammation Pulm function test <5y/o- trial of meds CXR
139
Asthma is a ? issue
Expiration
140
How is asthma classified?
Intermittent: 2 or less day time Sxs Inhaler use 2 or less/wk Persisitent: Mild- 2 or more days/ wk using inhaler +2 days/ wk and not more than 1/day; minor limitations on life Mod: daily Sxs and inhaler use; some limitations on life Sev: multiple Sxs during day and inhaler use; extreme limitation on life
141
How do you classify asthma control?
Well: <2 days wk, not more than 1 daily Sxs Not well: >2 days/wk or multiple times per day Poor: Sxs every day
142
What is the rules of 2 for Dx/Tx of asthma What is a known/identifiable cause of recurrent asthma and who is most susceptible?
Need for daily anti-inflammatory meds: 2 or more day Sxs or, 2 or more awakenings/mon Bronchopulmonary aspergillosis from A. Funigatus Steroid dependent asthma or CF
143
PT w/ uncontrolled asthma and GI Sxs needs to have ? test? What is the goal for Tx for asthma for inhaler use?
Cystic Fibrosis SABA albuterol 2 or less days/wk
144
What meds are used for acute asthma management? What is the benefit of using CCS and which ones are used?
Albuterol Ipatropium Burst therapy to shorten exacerbation Prednisone/solone
145
Why do we not leave asthma PTs on CCS therapy for long periods of time? After Dx asthma, what is the first line medication given and what are two common s/e?
HPA suppression= weight gain, suppressed growth, Cushings Inhaled CCS Thrush, dysphonia
146
What second class of medication can be added to asthma PTs w/ inhaled CCS? This is also especially effective for ?
Leukotriene antagonist- Montelukast Exercise induced asthma
147
What is the long acting B-agonist used for asthma? What is the risk of this med?
Salmeterol Black box- not for monotherapy, only in combo use w/ inhaled steroids
148
What medication can be used in PTs +12y/o w/ mod/sev asthma that can dec allergic exacerbation? What med is given for anaphylaxis or asthma unresponsive to short acting meds?
Omalizumab- aspergillosis PTs Epinephrine for PTs that present as "Status asthmaticus" (CO2 retention >40mmHg, tachy and normal pCO2)= impending respiratory arrest
149
MDIs w/ spacers are as effective for asthma as ? Why is pertussis so deadly in kids?
Nebeulizers Can't get DTAP until 2mon
150
What are the 3 stages of pertussis?
Catarrhal stage- low fever, rhinorrhea Paroxysmal- distinctive, violent coughing fits and post-tussive emesis Convalescent- dec Sxs, cough and whoop
151
Pertussis is AKA ? How do infants <3mon present with this Dz?
100 day cough Apnea/cyanosis after coughing Apnea alone- CNS damage
152
What do older PTs complain of who have pertussis? What is the gold standard lab test to Dx pertussis?
Strangulation feeling followed by coughing and emesis PCR of nasopharyngeal wash for early phase Serology for convalescent phase confirmation
153
How does pertussis change blood and visible on labs? What would be seen on CXR?
Lymphocyte dominant leukocytosis, not for Dx Atelectasis Peripheral infiltrates
154
How is pertussis Tx? When is the vaccine given?
<6mon, admit Azithromycin including for prophylaxis <1mon= Erythromycin, don't use Clarithromycin 2 4 6 15-18mon 4-6yrs Booster: 11-12yrs Pregnant w/ each pregnancy
155
What is the number once complication of pertussis? What is the number one cause of bronchiolitis?
Pneumonia RSV during 2-6mon
156
What are the risk factors for bronchiolitis What does this sound like on exam?
Male 2nd smoke exposure Not breast fed Smoked during pregnancy Mice squeaking on lungs Wheeze/crackles
157
How is bronchilitis Dx? What would be seen on CXR?
ELISA, PCR Hyperinflated lucency Flat diaphragm Atelectasis
158
When do Peds need additional oxygen w/ bronchiolitis? What method is used? What monitoring/Tx step needs to be followed?
90% Nasal cannula Dehydration monitoring
159
What vaccine is given to prevent RSV? What are the indicators to give the vaccine?
Palivizumab <29wks gestation Chronic lung dz of premature, <32wks at birth CHDz in 1st year of life
160
When is the influenza vaccine given? What happens during pneumonia that makes it problematic?
>6mons Airway and parachyma with consolidation of aveolar space
161
# Define Pneumonitis Define Atypical pneumonia
Lung inflammation +/- consolidation More diffuse than lobar pneumonia
162
# Define Bronchopneumonia Define interstitial pneumonia
Lung inflammation centered to bronchioles Inflammation of walls of aveoli
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What type of pneumonia is most common in kids? What are the most common etiologies of pneumonia?
Lobar Neonates: GBS, Ecoli, Strep pneumo Infant 1mon-5yrs: RSV, parainfluenza, influenza, Strep pneumo, HIB >5yrs: Mycoplasma, Strep pneumo, Chlamydia pneumo
164
How do neonates present w/ pneumonia? What are infants first presenting sign? What part of the VS will help with these Dx?
Fever, Hypoxia Apnea Pulse Ox
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What will be seen on labs for kids w/ pneumonia? How will this appear on CXR?
``` Viral= lymphocyte dominance Bacteria= leukocytosis, neutrophil predominance ``` Bacteria: lobar location Viral: diffuse
166
What are normal respiration rates for infants/toddlers?
0-2mon: >60 2-12mon: >50 1-5yr: >40 >5yr: >20
167
How are kids w/ pneumonia who have had vaccines Tx?
Amoxicillin Alt: Cefuroxime and Amox/Clavu 3rd Gen Cephalosporin or Amox/Clavu Alt: Clindamycin Allergy to alternate: Levofloxacin
168
How are kids >7y/o w/ pneumonia who have been vaccines Tx?
Azithromyin, Clarithromycin, Doxy Macrolide allergy= Levofloxacin Alt: 3rd Gen Ceph or Clindamycin
169
How is CAP in neonates Tx while inpatient?
Ampicillin/Gentamycin Or PCN G If Staph A concern- use Vancomycin HSV- use acyclovir
170
What is the most common life-limiting genetic Dz in Caucasians? What is the etiology of this?
CF Chrom7 mutation- cystic fibrosis transmembrane regulator gene, D-508
171
What organs are most likely affected by CF? PTs w/ CF and sinusitis will commonly grow ? What Sx is seen on their hands?
Lung Pancreas GI Testes Nasal polyposis Clubbing
172
Infants w/ CF can present w/ ? GI issue? What happens in CF PTs due to pancreas involvement?
Meconium ileus Steatorrhea and failure to thrive
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Infants need to be screened for CF if they present w/ ? 4 issues When do kids need to get screened?
FTT Cholestatic jaundice Chronic respiratory Sxs E+ abnormalities Resp/GI/clubbing Sxs Nasal polyps <12yrs/old All siblings of CF PTs
174
What criteria are needed for Dx CF
Clinical features or, Sibling w/ CF or, + newborn screening Plus Evidence of CFTR dysfunction (2 sweat Cl tests) or, Two CF mutations
175
What is the TOC for Dx CF? What can be given to CF Pts to reduce mucus viscosity?
Cl Sweat test: + >60mEq 72hr fecal fat Aerolized DNAse and 7% NS via nebulizer
176
Kids are not expected to reach normal vision of 20/20 until what age? What is legally blind What is the most common cause of vision impairment in kids?
6yrs old 20/200 or worse Retinopathy of prematurity
177
Define the Rule of 8
Determines need to refer childhood vision screening Age + vision distance w/ tens digit dropped= ? Equal 8, vision is great 9 or more, vision is poor
178
What is a baby's vision at birth? When do tears when crying develop? When are eye exams began and how often after?
20/400 1-3mon 6mon Annually
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Baby's eyes can move abnormally/independent and be called normal until they're ? old Fixation/tracking should occur by ? age
6mon 6wks
180
What are the 4 ways to test distance visual acuity? Define Hyperopia Define Myopia
Snellen letter/number Tumbling E HOTV Far sighted- most kids at birth Squints, rubs eyes, lack of interest in reading Near sighted- squints due to pin hole effect improving vision, rare except in prematures (ROP)
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# Define Strabisumus Define tropia and phoria Define Amblyopia
Eye misalignment, to squint or look obliquely Phoria + tropia Tropia: Constant strabismus Phoria: fixation of affected eye is interupted "letent strabismus" Central vision loss due to lack of development
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What are the 3 types of amblyopias What eye issue causes a misalignment of the visual axis
Strabismic- misalignment; brain ignores input from an eye, misalignment Refractive- blurry; my/hyperopic Deprivation- obstructed; retinopathy of prematurity, congenital cataract/glaucoma, retinoblastoma (usually w/ leukemia)
183
# Define Hirshberg test What is normal or what would be seen in a pseudostrabismus
Conrenal light test to assess alignment Norm- light reflex slightly nasal to center of pupil Pseudo: eye look misaligned, normal corneal light reflex
184
How is esotropias Tx? How are exotropias Tx?
Congenital= surgery 2-5y/o= patch/glasses After 5yrs= CNS dz Patch for persistent Surgery for extreme Under 3yrs- refer to ophthmologist
185
What is the cover test done to reveal? Lack of a red reflex can be indicative of ?
Reveals muscle imbalances Cover normal eye= affected eye moves in opposite direction of deviation ``` Leukocoria Cataract Tumor- retinoblastoma Chorioretinitis Retinopathy of prematurity ```
186
When are complete ophthalmologic exams warranted?
Premature birth Cerebral palsy/Downs Poor school performance ``` Nystagmus Strabismus Worse than 20/40 after 3yrs or 2 line difference Torticolis Abnormal red reflex ```
187
If PT has unilateral conjunctivitis, this rules out ? Dx What would be the difference in presentation of bacterial/viral conjunctivitis?
Allergies B: gunk, crusty from medial part throughout day V: watery
188
Conjunctivits does not touch what anatomical structure of the eye? What are the 3 most common causes of ophthalmia neonatorium?
Limbus Chlamydia E Coli Gonorrhea
189
What are the top 3 causes of viral conjunctivitis What is the etiology of the conjunctivitis if it is 1-3 days, 2-7, 3-21, or 4-19 days old
Adenovirus Coxsacie Enterovirus 1-3: chemical 2-7: Gonorrhea, Staph, Strep, Pseudomonas, E Coli 3-21: HSV 4-19: Trachomatis
190
How is neonatal conjunctivitis Dx What is used to prevent gonorrhea conjunctivitis during birth?
Gram stain, Culture HSV leaves dendritic lesion on cornea Erythromycin Tetracycline after birth
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What is used for Tx of neontal chlamydia conjunctivits? What is used for gonrorrhea What is used for pseudomonas conjunctivitis
Erythromycin Ceftriaxone Gentamycin w/ systemic ABX
192
What is used for neonatal HSV conjunctivitis What is used for Staph A conjunctivitis
Acyclovir Erythromycin or polysporin
193
What microbe is responsible for "pink eye"? What are the 3 microbes causing post-neonatal conjunctivits and how are they Tx?
Viral pink eye Adenovirus- use COLD compress H influenza Strep pneumo M catarrhallis Tx w/ Erythromycin* or Polymyxin B- trimethoprim
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What are the 4 ABX she wants us to know for conjunctivitis? What is the hallmark Sx of allergic conjunctiviits and how is it Tx
Polymyxin B and Trimethoprim Erythromycin- best for <1y/o Ciprofloxacin Moxifloxacin Pruritus, cobble stoning and bilateral onset Tx: vasoconstrictor antihistamin NSAID Cromolyn
195
# Define Bleb What is an important DDx for this?
Temporary blister associated w/ contact to allergen Ciliary flush- injection around limbus, same day refer asap Uveitis, Iritis, Iridocyclitis
196
# Define Bepharitis How do they present
Eyelid inflammation from Staph, Seborrhea and meibomian gland issue Photophobia, Burning, Irritation, foreign body sensation
197
How are blepharitis' Tx? Define dacryostenosis
Eyelid scrub, warm compress, topical ABX Lacrimal duct obstruction
198
# Define Dacryocystitis How are they Tx?
Bacterial infection of Staph A or Staph in lacrimal sac causing swelling and pain Massage, topical ABX,
199
# Define Hordeolum How are they Tx
Stye on external eye from infected gland of Zeis Internal= infected meibomian gland from Staph A causing pain and redness Warm compress NSAIDs
200
# Define Chalazion How are these Tx
Obstructed Meibomian gland causing nontender/non-erythematous swelling Steroid injection or Surgical removal
201
Periorbital cellulitis is AKA ? These PTs won't have ?
Preseptal cellulitis Proptosis Ophthalmoplegia
202
What microbe causes periorbital cellulitis? What meds are used for Tx on outpaitent basis?
Staph A/GAS Cephalexin, Clindamycin, Amox/Clavu MRSA: Trimeth/Clindamycin
203
What is a serious complication that can occur from sinusitis? What microbes can cause this
Orbital cellulitis Staph A Strep pneumo H influenza
204
How is orbital cellulitis Tx? What is a CN deficiency that can develop from this condition?
Admit w/ culture Cefazolin/clindamycin Cefuroxamine + metron MRSA= Vanc + Cefotax + Clinda Cavernous sinus thrombosis- CN 3, 4 V1, V2, 6 palsy from subperiosteal abscess
205
Acute ottitis media indicates ? microbe etiology What two ear issues can present w/ fluid in the middle ear and these present w/ ? PE finding
Viral Acute OM OM w/ effusion Conductive hearing loss
206
When are AOMs common and why? What is the most common operation performed in infants/young kids?
First 2yrs Ear canals are still flat, angle down w/ age Myringotomy
207
What is the most common cause of acquired hearing loss in kids? What bacteria cause this most commonly? What viruses cause this most commonly?
AOM H influenza Catarrhalis GAS Strep pneumo Rhino, influenza, RSV
208
AOM Dx requires ? 3 things What are the S/Sxs of two of these criteria
Acute onset of S/Sxs Middle ear effusion and inflammation ``` Effusion S/Sxs: Bulging Dec/no movement Air-fluid level Otorrhea- spontaneous after TM ruptures ``` Middle ear inflammation: TM erythema Otalgia
209
What is the most common sequela of AOM? How is AOM Tx?
OM w/ effusion or chronic OM ``` Acetaminophen/Ibuprofen ABX- all PTs 2yrs and under Over 2yrs- ABX, consider 24hr observation Amoxicillin Amox/Clavu Cefdinir/Ceftriaxone ```
210
When does a kid meet criteria for pressure equalization tube procedure? What AOM adverse development can be seen on PE?
Developmental risks Recurrent AOM +3mon effusion and bilateral hearing loss Mastoiditis Cholesteatoma Petrositis Intracranial extensions
211
How are recurrent cases of OM Tx? What vaccines can these PTs get?
<1mon since Tx: new ABX >1mon: same ABX >3 episodes in 6mon OR >4 episodes in 12mon, OR IM Ceftriaxone requirement= refer, atopic ABX Vaccinate- Strep Pneumo and annual influenza
212
# Define Ottitis Externa What causes it How do PTs present
Swimmers ear Pseudomonas or Staph A Pain, discharge, pinna tender to manipulation Tragus tenderness w/ chewing
213
What is the microbe if a kid presents w/ swimmer's ear but has tube? How is swimmers ear Tx?
Staph A Strep pneumo Catarrhalis Klebsiella Ofloxacin or Cipro w/ hydrocortisone or Dexameth Polymyxin B Fluoroquinolones safe for tympanostomy tubes
214
90% of epistaxis arise from what circulatory structure? What is the number one cause for this to bleed?
Kiesselbach's plexus Trauma/picking
215
What 2 meds can be used to help stop an epistaxis if not self resolving? What meds are not used for PTs w/ common colds?
Afrin Pheynlephrine Antihistamines if <6yrs No ABX No cough suppressants No expectorant
216
Babies are born with ? 2 sinuses? What age do others sinuses develop?
Maxiallary and Ethmoid Sphenoid- 5yrs Frontal- 7yrs
217
What is the hallmark finding of sinusitis? What meds are used to Tx?
Mucopurulent rhinorrhea 10-14 days after cold/URI First line: Amox/Clavu PCN Allergy- Levo, Clinda + 3rd Gen
218
What are the 2 phases of allergic rhinitis What are the 3 types of allergic rhinitis and what triggers them
Early: mast cell degranulation Late: eosinophl, basophil, CD4, monotcytes causing inflammation Seasonal- pollen Perennial- mites, dander, mold Episodic- pets
219
3 most common causes of meningitis? Parent education for controling peds eczema
Strep pneumo N Meningitidis H influenza ``` Cool temp Emolients Avoid herpes sores Avoid irritating clothes Avoid tobacco No limitation on vaccine, sun or sports Breast feed x4-6mon ```
220
Difference in DNA between Parvovirus B19 and HHV 6 or 7 Reactivation of HHV-6 after a bone marrow transport can lead to ?
B19: single stranded DNA 6/7: enveloped double strand DNA Rash Encephalitis Hepatitis Marrow suppression
221
Allergic rhinitis presents w/ ? atopic triad? What is the most potent pharmacological therapy for Tx of allergic/nonallergic rhinitis?
Eczema, asthma, allergic rhinitis Intranasal CCS- reduces inflammation, edema and mucus w/ no systemic effect MFT- one Budesonide
222
What class of meds are preferred for allergic rhinitis? What meds could be used if kid doesn't like spraying things up their nose?
2nd Gen anti-histamines- Cetir/Lorata/Fexofen/Deslo-dine Topical antihistamine: Azelastine Olopatadine
223
What drug can be used as second/third line therapy for allergic rhinitis This addition is best in ?
Montelukast Pre-existing asthma
224
What meds can be used for allergic rhinitis decongestants? What can be used for non-allergic rhinitis and rhinitis associated w/ viral URIs?
Pseduophedrine Phenylephrine Ipratropium
225
What are the two most common causes of pharngitis mono? What is the most common viral cause of pharyngitis/tonsilitis?
EBV, CMV Adenovirus
226
What is the most important Sx/lack of Sx when Dx pharyngitis/tonsillitis? What are the tonsil grading methods?
+ Fever - cough ``` 0-4 4= kissing 3= 50-75 2=25-50 1= <25% 0= not visible ```
227
What is the Centar criteria
``` No cough Anterior adenopathy Fever >100.4 Tonsil swelling/exudate 3-14y/o 45+= subtract 1 pt ``` 1-3: culture/rapid strep 4-5: probable, culture and ABX
228
What is the gold standard TOC for pharyngitis/tonsilitis? How is mono tested for is suspected?
Strep swab Monospot blood test
229
What meds are used for Strep throat? Why do we Tx this?
Amoxicillin PCN Allergy= Cephalexin, Cefadroxil, Clindamycin B-lactam allergy: Erythromycin ``` Shortens Dz Prevent ENT issue Prevents acute TF Prevents spread NO prevention of kidney issue ```
230
What does the PANDAS infection present w/ How is thrush Tx?
OCD, tics Ped autoimmune neuropsych w/ strep Nystatin Azole if fist line fails
231
When does GER peak and resolve? What are the 3 major concerns if a baby has GERD?
Peak @ 4mon Resolve by 2yrs Weight loss/FTT Esophagitis Pulmonitis
232
What are the risk outcomes of GERD? What is the best imaging study to assess for this?
Esophageal stricture Asthma Barrett's esophagus Upper endoscopy
233
What is the first line therapy for GERD? What is the TOC if Sxs are severe or aspiration?
PPIs Fundoplication- Nissen operation, prevents them from being able to throw up
234
How is esophagitis Dx How is it best Tx
Endoscopy NPO Viscous lidocaine, PPI, Metoclopramide, Sucralfate
235
How is eosinophilic esophagitis Dx How is it Tx
Endoscopy w/ biopsy EoE RAST panel Swallowed CCS
236
# Define Visceral pain Define somatic pain
Autonomic nerves sending sensation via nonmyelinated fibers of dull, slow onset/poorly localized pain (functional abdominal pain, IBS) Myelinated somatic fivers sending signals of well localized pain
237
What are the 4 types of IBS What criteria is needed for Dx
IBS-C IBS-D IBS D and C Unspecified IBS Pain 4 or more days/wk Pain doesn't stop after BM Sxs not better explained
238
What is the one time essential oils are used? How are the different stages of IBS Tx?
IBS- peppermint oil Mild: diet, antidepressants C: fiber, glycol D: loperamide
239
What PT population tends to have cyclic vomiting syndrome? What issue do they tend to develop later in life?
Caucasian female Migraine
240
What meds can be used to help w/ Cyclic Vomitting syndrome? What meds can be used for abdominal migraines?
Triptans Zofran Prophylaxis: Cyproheptadine, Propanolol, Amitriptyline Antimigraine for aborting episodes
241
What causes Functional Diarrhea What is a key component of making this Dx
Toddler Diarrhea Watery stool from excessive sweet liquids and low fat diets Painless No FTT
242
When is constipation dx? What life milestones can cause this?
2 or less stools/wk Hard pellets for 2wks Intro to solid foods Toilet training- functional constipation Start of school- social stress
243
What are four tests are ordered for constipation and what suspicions are they ordered for What 3 meds can be used?
Biospy- hirshprungs Barium enema- malformation X-ray: spina bifida Blood work: DM, thyroid, celiac Glycol Mg milk Mineral oil
244
# Define Encopresis What order is super helpful w/ this Dx
In/Voluntary passage of feces in inappropriate places 1/mon x 3mon Abdominal x-ray
245
Celiac dz is associated w/ ? What are some extraintestinal manifestations that can be seen?
DMT1, Thyroiditis, Turners, Trisomy 21 Osteopenia Arthritis Ataxia Elevated liver enzymes
246
How is Celiac Dz Dx? How is the Dx confirmed
IgA Antiendomysial Ab and IgA tissue transglutaminase Ab AND Total serum IgA Endoscopic small intestine biopsy
247
What can Celiac Pts eat? How does Allergic Collitis present
Rice Tapioca Corn Buckwheat Milk/Soy intolerant w/ blood streaked stool but no N/V/pain
248
What type of formulas do Allergic Collitis babies need to have? Define Acute Gastroenteritis
Hydrolyzed protein formula (casein hydrolysate) Sudden diarrhea illness
249
What is the leading cause of morbidity and common in US babies? How is this seen as a world-wide issue
AGE Childhood fatality in developing world
250
What microbe is the leading cause of AGE outbreaks in day cares?
Shigella, Cryptosporidium Blood= bacteria, intussusception ABX= C Diff
251
What is the only AGE microbe that causes microvilli damage What are the other 3 common microbes in this etiology
Rotavirus Astrovirus Calicivirus Enteric adenovirus: 40, 41
252
What microbe can cause AGE that is found in pre-heated food? What is the difference between secretory and mucosal invasion diarrhea
Campylobacter Secretory: watery, normal osmolality (cholera, EPEC, ETEC, C Diff Invasion: blood, WBCs in stool (bacteria etiology)
253
What medication can help reduce vomiting in AGE PTs in attempt to avoid IV fluid resuscitation? How is mild/mod dehydration Tx?
Ondansetron Mild: 50ml/kg over 4hrs Mod: 100mL/kg over 4hrs Ongoing: 10mL per stool Maintenance: 100mL over 24hrs until diarrhea stops
254
# Define Bezoar When does this presentation peak?
Accumulation of exogenous matter in GI, mostly food or fiber 2nd decade of life
255
What is the most common chest wall deformity in kids Infants w/ CHD often have no ? and instead present w/ ?
Pectus excavatum Murmur Baby exercise- sweat FTT
256
What heart sound is a normal variant in Peds? What type of S2 is normal and what type is indicative of a defect
S3 However, loud= dilated ventricle Physiological split- N Fixed split- ASD
257
What do cardiac clicks mean? What type of EKG finding is common
Abnormal valve Dilated great vessel Sinus arrhythmia- from immature cholinergic input
258
What is the most common Sx arrhythmia in Peds Functional murmurs are AKA
SVT- vagal and adenosine Benign, Innocent
259
Functional murmur includes what 4 and their location
Still's murmur: 3-6yrs, systolic, LLSB or apex, vibratory/muscial, dec w/ upright Hum: 3-6yrs; continuous, louder w/ upright, changes w/ jugular compression or head turns Carotid bruit: systolic, over carotid and at any age Ejection: 8-14yrs; systolic, LUSB, softer when upright and no radiation to back Peripheral PS: newborn-6mon; systolic, axilla and back, harsh and short
260
What part of a sickness process accentuates murmurs? How are murmurs graded?
Fevers- inc blood flow 1: very soft 2: easily heard 3: loud, no thrill 4: loud w/ thrill 5: loud, thrill, audible @ 45* 6: heard w/ no stethoscope
261
What atrial dysrhythmia is uncommon in Peds population
A-Fib/Flutter | Usually presents after surgical repair of CHDz or mycocarditis, drug toxicity
262
How does SVT present in Peds? How can it be managed?
220 or higher w/ sensation of pounding heart | Vagal, ice bag to face (dive reflex), blow through straw IV adenosine only do vagal/dive reflex in stable PTs
263
What Tx is done for V-Tach in peds? If mother has Lupus or Sjorden's, what heart abnormalities can be seen?
Conversion if Sx/unstable Lidocaine/amiodarone if conscious/ASx Congenital 3* block
264
Acyanotic lesion implies ? What is the first and second most common congenital heart defect of kids?
No shunt or L to R shunt VSD PDA
265
How do PTs w/ VSDs not responding to Tx present? How do VSD and ASD look on EKG?
FTT, PHTN VSD: LVH ASD: RAD, RVH
266
How do PDAs present on exam? What med is used to keep a PDA open?
Bounding wide PP Continuous machine murmur Prostaglandin E- used for cyanotic lesions
267
Tx of choice for coarctation? What is the first and second most common cyanotic heart defect?
Surgery Tetrology Transposition
268
What is the most common cause of cardiac defect deaths in the first month of life? Lesions that produce CHF or PHTN require ? stabilization meds?
Hypoplastic left heart syndrome Lasix +/- Digoxin
269
Acyanotic lesions are usually corrected before ? age If untreated, most lesions will result in what 3 issues?
2yrs PHTN CHF Subacute bacterial endocarditis
270
What causes RF What age does this present in
Group A B-hemolytic strep pharyngitis causing anti-strep Abs to cross react w/ cardiac Ags 6-15y/o
271
What lab work is done for RF and how is it Dx What are the minor criteria for Jones?
Anti-strep O titer 2 major or, 1 major, 2 minor ``` CAFE PAL CRP inc Arthralgia Fever 101-102 ESR inc Prolonged PR intercal Anamnesis of rheumatism Leukocytosis ```
272
What ABX are used for acute RF What age do annual BP checks begin?
Benzathine PCN Allergic- erythromycin ASA- for anti-inflammatory +3yrs
273
How long do kids need to be still prior to taking BP? What if the BP cuff is too narrow?
5min Artificially high
274
Criteria for White Coat Syndrome What is the most common cause of HTN in adolescent
95th or higher percentile but normal out of office Primary essential
275
What is the most common cause of secondary HTN in kids? How are kids placed into HTN categories?
Renal dz Normal: <90th percentile Pre: 90-95th; repeat in 6mon 1: 95th-99th + 5mmHg; repeat 1-2wks 2: >99th + 5mmHg; evaluate and refer
276
What BP is always abnormal in peds? Peds w/ HTN need to be evaluated for secondary cause if what 2 things exist?
+120/80 BMI +85th percentile +140/100

IPAP (212 decks)

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