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IPAP > Peds: Block 3 > Flashcards

Peds: Block 3 Flashcards

1
Q

Define Hypochromic, Microcytic anemia

What diseases does this include?

A

Dec Hgb production

Chronic Dz
Lead
Iron deficiency
Thalassemia

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2
Q

Define Normocytic Anemia

What issues can cause macrocytic anemia?

A

Systemic illnesses impairing marrow RBC synthesis

B12/Folic acid deficiency*
Trisomy 21
Hypothyroid
Newborn

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3
Q

What are Sxs of acute anemia and which one is especially seen in infants?

What Sxs may be seen in Chronic Anemia

A

Murmur Exercise Intolerance Tachy HA Excessive sleeping*
Fatigue Irritable Poor feeding Syncope

Minimal tachy/flow murmurs

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4
Q

What findings dictate if a PT needs a transfusion or not?

What are the MC presenting S/Sxs of anemia

A

CV and functional impairment, not Hgb level

Pallor Jaundice Splenomegaly

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5
Q

PT w/ petechiae, purpura, deeper bleeds indicate a generalized ?

Infiltrative d/o or systemic illness induced anemia may present w/ ? PE findings?

A

Hemorrhage

Hepatosplenomegaly
Lymphadenopathy

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6
Q

What part of the CBC help differentiate the cause of the issue?

How are anemia categorized?

What does the RDW do?

A

WBC/Platelet count

RDW and Peripheral smear

Measures variation in RBC sizes/indicates abnormal sizes

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7
Q

Dec RBC production, norm RDW can be caused by ?

What are the etiologies of Macrocytic, Hypo Micro, Target cell and Schizocyte cells?

A

Marrow failure (pancytopenia)
Anemia, chronic dz (microcytic)
Transient erythroblastopenia

Macro: B12/Folic deficiency
Hypo Micro: Fe deficiency
Target: HbCC Dz
Schizocytes: hemolytic-uremic syndrome

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8
Q

Inc RBC destruction, high RDW can be due to ?

Peripheral smears asses ? parts of blood work?

A

G6PD deficiency
Sickle cell
Spherocytosis

RBC, WBC, Platelet morphology, Fe and Lead levels
Determines if anemia is due to erythroid line or marrow elements

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9
Q

What does it mean if a reticulocyte count is elevated, normal or dec?

This measurement can indicate severity of ?

A

E: normal response to blood loss

N: dec/ineffective production

D: body hasn’t reacted to blood loss yet, Ab mediated destruction or intrinsic marrow dz

Hemolysis

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10
Q

What lab results would be seen in Fe deficient anemia as a presumptive dx?

Breast fed babies need to receive Fe supplementation starting at ? age?

A

CBC w/ microcytic anemia
High RDW, Red RBC
Norm WBC, Platelet

4mon
Start Fe foods @ 6mon

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11
Q

How long are Fe Deficient anemias Tx?

A

48-72hrs: reticulocytes inc and peak in 5-7 days

4-30 days: inc in Hb, MCV, ferritin

1-3mon: replenished stores
Continue Tx for 2-3mon after values normalize

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12
Q

How is normocytic anemia suspected dx made and how is it confirmed?

What are the common DDx for Macrocytic Anemias

A

Hx to Dx of dec production
Peripheral smear- dx for destruction

Hypo BAFFLE
Hypothyroid
B12 deficiency
Aplastic anemia
Folate deficiency
Fanconi
Liver dz
ETOH
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13
Q

What labs are ordered to work up macrocytic anemia

What is done for Tx and for how long?

A

B12 LFTs Folate TSH/Thyroid

B12/Folate replacement
CBC improvement <1wk
Tx liver/thyroid issue

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14
Q

Aplastic anemia is most often ?

How is it Dx?

What is the criteria for a severe Dz Dx?

How is it Tx?

A

Idiopathic

Marrow biopsy

Reticulocyte count <50K
Platelets <20K
Neutrophil <500

Hematopoietic stem cell transplantation
ImmSupp therapy

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15
Q

Define Fanconi Anemia

How does it present

How is Fanconi anemia Tx?

A

Autosomal recessive form of aplastic anemia causing abnormal DNA repair, effects all cell lines
High MCV and Hgb F

Cafe au Lait spots
Horseshoe/one kidney
Absent thumbs
Microcephaly
Pancytopenia

Stem cell transplant
Androgenic therapy
CCS

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16
Q

What are the 6 types of hemolytic anemias

A

I RIMES
Intrinsic- thalassemia, sickle

RBC membrane defect- spherocytosis

Isolated site- vasculitis

Mechanical

Extrinsic- immune mediated

Systemic d/o- DIC, malignancy

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17
Q

What will be seen in lab results of hemolysis

Define Schistocytes seen in hemolytic anemia

What are two possible findings seen during this issue

A

Inc bilirubin/serum Hgb
Dec haptoglobin

Broken RBCs

Hemoglobinuria
HyperKalemia

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18
Q

Define Thalassemia

Normal Hgb is made of ?

A

Insufficient Hgb production from dec A/B-globulin production

HgA= A2B2
Four A genes= 4 A proteins
Two B genes= 2 B proteins

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19
Q

What are the 4 versions of Alpha Thalassemia

A

One= silent carrier; normal CBC/ASx; detected w/ genetics

Two= a-Thalassemia trait; microcytic, dec Hgb/Hct

Three= Hgb H Dz, microcytic anemia/mild hemolysis, not transfusion dependent

Four: Bart Hgb/Hydrops fetalis

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20
Q

Define Beta Thalassemia

A

One: thalassemia minor (heterozygous)- mild macrocytic anemia

Two: thalassemia intermeida (compound heterozygous) moderate hemolysis, splenomegaly, mod/sev anemia (not transfusions dependent)

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21
Q

Define Thalassemia Major

A

Cooley’s Anemia
2 gene deletion- homozygous
Severe hemolysis, ineffective erythropoiesis, inc Hgb F
Transfusion dependent, frequent crisis/hemachromatosis
Reqs stem cell transplantation

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22
Q

Define Sickle cell anemia

Define Sickle Cell Dz

A

HbSS homozygous
HbS >50% of Hgb

Heterozygotes w/ one B-globulin includes sickle cell mutation and 2nd: Hbc, Beta-thalassemia, HbD

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23
Q

What do PTs w/ Sickle Cell and a fever need?

By 5yrs they are functionally asplenic and vulnerable to what 3 microbes?

A

Medical emergency
+6mon- splenic dysfunction

HIB
N Meningitidis
Strep Pneumo

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24
Q

Sickle Cell PTs are at increased risk of infections by ? bacteria?

If PT w/ Sickle presents w/ osteomyelitis, suspect ? microbes?

PT w/ aplastic crisis, suspect ? microbe?

A

Encapsulated: Strep Pneumo, HiB, N Meningitidis

Salmonella
Staph A

Parvovirus B19

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25
Q

Sickle Cell PTs most often have avascular necrosis in ? location?

Define Dactylitis

What Sx is seen in males w/ sickle cell?

A

Femoral head

First manifestation of pain in kids, swelling of hands/feet

Priapism w/ stuttering

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26
Q

What regression of mile stones could be seen in Sickle PTs?

Define Pain Crisis in Sickle PTs

A

Enuresis

MC vasoocclusive event
2-7 days of arm/leg pain
Tx: fluids, pain, O2

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27
Q

What other adverse effects can occur due to Sickle Cell?

Define Acute Chest Syndrome in Sickle PTs

A

PHTN, Enuresis, Pain, Stroke

Occlusive crisis of lungs
CXR= new infiltrates
Tx: pain fluid transfusion O2 ABX dilators

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28
Q

What meds are used for Sickle Tx?

What meds can be used for prophylaxis

What procedure can be curative for sickle cell PTs?

A

Hydroxyurea at 9mon old- inc Hgb F production
Dec occlusive events

PO PCN at Dx
Vaccines- HiB, Influenza, HBV
Folate

Hematopoietic stem cell transplant from sibling donor

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29
Q

What unique lab finding is indicative of G6PD?

What is the clinical presentation of G6PD deficiency?

What Hx piece can precipitate a hemloysis presentation?

A

Heinz Bodies- RBC membrane fragility leads to hemolysis, phagocytosis by macrophages to make Bite Cells

Hemoglobinuria Anemia Jaundice

Serious infection

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30
Q

G6PD PTs that ingest ? compounds lead to issues

How is G6PD Dx?

A 
Fava beans
Naphthalene (mothballs)
Dapson
Quinidine
Primaquine
ASA
Infection
Nitrofurantoin
Sulfa drugs

Enzyme measurement, low NADPH/G6PD levels

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31
Q

Thrombocytopenia means platelet count below ?

Platelet levels below ? are not an issue unless surgery/major trauma occurs

Levels below ? have PTs at risk for spontaneous bleeds

A

<150K

> 80K

<20K

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32
Q

How does the most common childhood bleeding d/o present?

What type of d/o is this

A

ITP, 1-4wks post viral infection
Petechiae epistaxis purpura

IgG/IgM coats platelets causing destruction in spleen

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33
Q

What would be seen in lab results of ITP?

ITP Tx is not needed if platelets counts are above ?

A

Severe thrombocytopenia
Normal results elsewhere

> 30K, 80% resolve in 6mon

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34
Q

What med is used for ITP Tx?

What is the definitive Tx of Chronic ITP lasting more than 6mon?

A

IVIG, Prednisone
IV anti-D in Rh pos PTs

Splenectomy

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35
Q

Define Wiskott-Aldrich Syndrome

What are the three characteristics of this dz

A

X-linked cytoskeletal protein defected lymphocytes/platelets

Thrombocytopenia
Hypogammaglobinemia- defected Ab production due to defected lymphocytes
Eczema

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36
Q

How is Wiskott Syndrome Dx and Tx

What is the difference between Hemophila A and B

A

Peripheral smear- small platelets
Splenectomy improves thrombocytopenia

A: Factor 8 deficiency
B: Factor 9 deficiency

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37
Q

How is Hemophilia Dx?

What is used for Tx?

What is the most common congenital bleeding D/o

A

Coagulation studies: prolonged PTT, normal when mixed w/ normal serum

Desmopressin- increases Factor 8, vWF in Hem A
Recombinant Factor 8/9

Von Willebrand dz

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38
Q

What are the function of vWF in the blood?

What are the subtypes of this dz?

A

Bridges platelets and collagen
and protects Factor 8 from being removed from circulation

1: dec production, autosomal dom is MC
2: normal production, defective vWF (dyspoteinemia)
3: no production, rare

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39
Q

How is vWF measured by the lab during Dx studies?

What is done for Tx?

A

Ristocetin- ABX that induces vWF to bind to platelets

Desmopressin- Type 1 and 2
vWF concentration-Type 3

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40
Q

Define Henoch-Schonlein Purpura

Half of these presentations follow a ?

A

MC childhood systemic vasculitis before 6y/o
Inflamed small vessels w/ Leukocyte infiltrate, Hemorrhage, Ischemia

URI

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41
Q

What is a adverse issue from Henoch Purpura

What will be seen on PE?

What findings can be found but are less common?

A

IgA deposition= glomerulonephritis in adults

Palpable purpura* below waist
Arthralgia- no weight bearing
Abdominal pain- precedes rash
Renal involvement

Edema: Calves Scalp Feet Genitals
Encephalopathy, Pancreatitis, Orchitis

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42
Q

What peds hematological dz needs baseline blood work at Dx

What is the work up for this dz?

A

HSP

Platelet count- normal
WBC, ESR/CRP- elevated
Creatinine UA BUN
Stool occult

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43
Q

What criteria are needed to Dx HSP?

What education piece needs to happen after Dx?

A 
2 of 4:
Palpable purpura
Bowel angina
Diagnostic biopsy
Pediatric age <20y/o

Monophasic x 3-4wks
Rash can last 1yr
Arthritis not permanent

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44
Q

How is HSP Tx

What adverse outcomes are possible?

What is the prognosis of this Dz?

A

Monitor renal function
NSAIDs

Rash wax/wane x 12mon
Arthritis
Abnormal GI paristalsis

Excellent, rare renal failure

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45
Q

Define Kawasakis

What are the 3 phases

A

Vasculitis of unknown etiology
Arterial inflammation w/ aneurysm formation
2nd MC childhood vasculitis

Acute: Fever >40*C
Conjunctival erythema
Cracked lips/red tongue
Cervical lymphadenopathy

Subacute: Desquamination, Coronary artery aneurysm

Convalescent: from Sx resolution until ESR normalizes

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46
Q

What is the number 1 Sx of Kawasakis?

This can present similar to Scarlet Fever, how is it different?

A

Fever +5 days

Pos throat culture
No conjunctiva/lip findings

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47
Q

What f/u study needs to be done in Kawasaki PTs?

How is it Tx

A

Echo for coronary aneurysm @ 2-3wks and 6-8wks

IVIG*- to prevent aneurysms
ASA

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48
Q

Childhood malignancy are not associated to ? factors

What are warning signs of Ped Cancer?

A

Tobacco Alcohol Diet Sun

F/Ns/WL
Lymphadenopathy >4wks
Atraumatic limp
HA- AM, vomit, wakes at night

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49
Q

Peds with fevers due to CA can present as what type?

What two labs are best when working up a possible CA case?

A

Fever of Unknown Origin

CBC w/ diff
Peripheral blood smear

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50
Q

What lab results would be seen in Peds w/ fast growing tumors?

What is the exception to surgical resection of cancer tumors?

A

Inc LDH and Uric acid

Lymphoma- almost all are chemosensitive

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51
Q

What are the two methods of using chemo for CA Tx?

What is a medical emergency presentation of a PT w/ fever?

A

Adjuvant- chemo after surgical removal
Neoadjuvant- chemo while tumor is present

Sepsis- presents w/ severe neutropenia

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52
Q

When is Tumor Lysis Syndrome commonly seen

What are the 5 types of oncology emergencies?

A

Leukemia/lymphoma Tx

Sepsis- neutropenia
TLS- K, PO4, uric acid release
Anemia/Thrombocytopenia
Inc ICP
Airway obstruction
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53
Q

What are 5 rare but common infections seen in Peds undergoing CA Tx?

What is the most common and possible only presenting Sx?

A

Crypto meningitis
HSV
Aspergillosis
P Jiroveci- atypical pneumo

Fever

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54
Q

Peds w/ CA w/ ? two Sxs are admitted

What is the most common childhood cancer?

A

Fever + neutropenia

Leukemia

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55
Q

What are the 3 sub-types of leukemia seen in Peds?

What would be seen on lab results for Leukemia PTs?

A

ALL- 2-3y/o males
AML- neonate/adolescence
CML
JMML

Immature blast cells
Anemia
Thrombocytopenia

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56
Q

DDx of leukemia

What leukemia DDx is unique to the Trisomy 21 population that carries a certain risk?

A

MyPEC
Mycobacteria Pertussis EBV CMV

Transient Myeloproliferative D/o
30% chance of ALL or AML

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57
Q

How is leukemia definitively Dx?

What are the two types of ALL?

A

Flow cytometry and cytochemical stain patterns

T 12,21: more favorable, MC
T 9,22: less common, poor prognosis

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58
Q

What is the 3rd MC malignancy in children?

When is the MC new Dx?

A

Lymphoma

15-19y/o

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59
Q

Although not proven, what etiology is linked to lymphoma?

A

EBV

Hodgkin- MC lymphoma
Non-Hodgkin- male Caucasian that inc w/ age

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60
Q

What are the 3 sub-types of Non-Hogkin lymphoma?

When treating PTs w/ Non-Hodgkin’s what two adverse outcomes need to be monitored for?

A

B cell: sporadic (US) endemic (Africa)
T cell- lymphoblastic
Large cell- T or B cell origin

Superior mediastinal syndrome
TLS

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61
Q

What are B-Sxs of Hodgkins?

What findings will be present on PE?

A

Poor prognosis
Fever >38*C x 3 days
Drenched night sweats
>10% weight loss in 6mon of Dx

Cervical/Supraclavicular adenopathy

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62
Q

What lab result finding is indicative of Hodgkin Lymphoma?

What use do bone marrow biopsies have?

A

Reed Sternberg cells

Dz staging
25% or more are blasts, Dz is classified as acute leukemia

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63
Q

What is the prognosis of Hodgkins?

How is Non-Hodgkins Tx?

A

90% w/ chemo/rad

Chemo, rarely surgery/radiation used

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64
Q

What is the most common type of brain tumor?

What is the 2nd MC?

A

Astrocytoma- posterior fossa w/ good prognosis

Medulloblastoma- cerebellar vermis w/ variable prognosis

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65
Q

Never do an LP before ? due to herniation risk

What are 3 unique complications to Tx of Peds brain tumors?

A

Neuroimaging

Cerebellar mutism syndrome- dec speech/behavior changes

Posterior fossa syndrome- HA, aseptic meningitis

Somnolence syndrome- excessive fatigue/sleep

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66
Q

What is the MC solid neoplasm outside the CNS of kids?

Where are these neoplasms able to grow?

A

Neuroblastoma- made of neural crest cells from adrenal medulla and SNS formation

Anywhere SNS is found
Half in adrenal glands
Half in paraspinal ganglia

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67
Q

What is the MC presenting Sx of neuroblastoma development?

How else can these present?

A

Abdomen mass/pain

Horners
Paraneoplastic syndrome: sweating, diarrhea, opsoclonus/myoclonus

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68
Q

What labs are ordered when working a suspected neuroblastoma up?

What is a Wilms Tumor?

A

VMA/HMA UA for catecholamines

Nephroblastoma- MC primary malignant renal tumor of kids and 2nd MC abdominal tumor of kids

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69
Q

WIlms Tumors are associated w/ ? other anomalies

WIlms causes PT to have inc risk of developing ? syndrome?

A

Retardation
Aniridia
Genitourinary malformation

Beckwith Wiedmann- Macroglossal, Umbilical herniation, Omphalocele

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70
Q

What is the MC presenting Sx of a nephroblastoma

How is it Tx

This has a good prognosis as long as ? is not present

A

Abdominal mass w/ pain

Surgery, chemo
Rad if advanced stage

Anaplasia

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71
Q

What is the MC soft tissue sarcoma in kids?

What are the two MC bone tumors?

A

Rhabdomyosarcoma of skeletal muscle- small round and blue cell tumors

Osteosarcoma
Ewing- unless PT is <10y/o, then is more common

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72
Q

Osteosarcomas have a ? appearance on x-rays

Ewing Sarcomas MC affect what 2 bones?

Osteosarcoma MC affect ? bones?

A

Star burst

Femur, Pelvis

Distal femur, Proximal tibia, Prox humerus

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73
Q

How do Rhabdo and Ewing differ from Osteosarcoma on microscopy?

What words are used to describe x-rays of Ewing Sarcoma?

A

R/E: small round blue
O: osteoid substance

Onion skin
Moth eaten

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74
Q

What cytogenic analysis result is Dx of Ewing?

What are the two forms of Rhabdomyosarcoma and the variants

A

T 11,22= Ewings

Embryonal- young PT w/ head/neck/GU tumor
Alveolar- older PT w/ trunk/extremity tumor (t2,13 or t 1,13)

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75
Q

How are Rhabomyosarcoma, Osteosarcoma and Ewing sarcoma Tx?

A

Rhabdo- surgery w/ post-op chemo/rad

Osteo: neoadjuvant chemo then surgery and adjuvant chemo

Ewing- radiation sensitive

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76
Q

Define Consciousness and what controls it

Define Arousal and what controls it

A

Awareness of self and environment, controlled by cerebral cortex

Initiates and maintains consciousness, controlled by reticular activating system from mid pons to mid-brain/thalamus

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77
Q

Define Lethargic

Define Obtunded

A

Difficulty maintaining aroused state

Dec arousal but responsive to stimuli

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78
Q

Define Stupor

Define Coma

A

Responds only to pain stimuli

Unresponsive conciousness, dyfunction of hemispheres bilaterally, brainstem or both

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79
Q

What are the MC causes of comas

What is the MC cause of long term morbidity in PTs w/ depressed consciousness

A 
Seizure
Head trauma
Hypoxia-ischemia
Infection
Toxin

Hypoxia

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80
Q

Two-thirds of Peds who have syncope have ?

What are the 4 types of injuries that can occur during a TBI

A

Anoxic seizures

Skull Fx
Intracranial hemorrhage
Cerebral concussion
Cerebral contusion

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81
Q

Define Concussion

What Sxs can be present?

A

TBI from rapid/short neurologic impairment that self-resolves

Somatic- HA (MC)
Emotion- personality change
Cognitive- slows reaction time, confusion
LoC, Amnesia, Drowsiness

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82
Q

What adverse finding can accompany a concussion and correlate to the severity of the injury?

What is the name of the issue that develops when PTs suffers multiple concussions especially in ? period of time

A

Amnesia- retrograde (events leading to) or anterograde (no new memory)

Second Impact Syndrome
First 10 days after a concussion

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83
Q

Normally w/ a concussion, there are no ? deficits

What is the preferred imaging?

A

Focal neurological

Normal CT

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84
Q

If seizures occur due to a concussion, what time frames indicate an excellent, good or poor prognosis?

How long does it usually take for a concussion to resolve?

A

At injury= excellent
7 days: edema/contusion= good
After 7 days from glial scarring- lead to epilepsy

Sxs <72hrs
Resolve 7-10 days

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85
Q

What happens during Second Impact Syndrome

What are the protocol steps for returning to sports after a concussion

A

Repeat concussion during healing phase leading to rapid increase of ICP

24hrs between each:

1: complete rest
2: light aerobic, no resistance
3: sport specific exercise
4: resistance, drills
5: full contact after clearance
6: game play

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86
Q

Define Post Concussive Syndrome

What are the two primary HAs seen in Peds?

A

Altered mental capacity of sleep, school or thinking post concussion

Migraine
Tension

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87
Q

What are the secondary HAs seen in Peds?

What is the most recurrent pattern of Primary HAs?

A

Associated w/ minor illness
May be 1st Sx of serious conditions

Tension

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88
Q

What are the red flags of Peds HA that warrant imaging?

A

Worst HA of life- hemorrhage
Morning HA- tumor
Wakes at night
Chronic/progressive- most ominous pattern)
Change due to position- pseudotumor/migraine
Recurrent morning vomiting
No FamHx

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89
Q

Almost all Peds w/ migraines will have ? in their Hx

What imaging modality is preferred when working a Peds PT up for HAs

A

FamHx of migraines

MRI w/ or w/out contrast

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90
Q

What PT education piece goes to PTs when Tx HAs?

What other class of drug can be used and when are they c/i?

A

NSAID/ASA no more than 2-3x/wk to avoid rebound HAs

Triptans- SRAs
C/i- focal neuro deficit w/ migraine
Basilar migraine sign/syncope

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91
Q

Since there are no FDA approved migraine prophylaxis drugs, what drugs can be used and when

What drug is C/i in Peds w/ Hx of migraine w/ aura?

A 
If >1 HA/wk:
Propranolol
Ami/Amitriptyline
Valproic acid/Topiramate
Verapamil
Cyproheptadine (antihistamine)

OCPs

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92
Q

Define Epilepsy

What are the 4 types and what type are not classified here

A

Recurrent unprovoked seizures

Focal/partial- from one region of cortex
Unclassified
General- from both hemispheres simultaneously
Unknown

Febrile- separate category

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93
Q

Define Generalized seizure and the 3 types

Define Focal seizure and the 2 types

A

Begin diffusely
Febrile, Absence (petite), Tonic Clonic (grand)

Formerly partial seizures
Simple- no altered consciousness
Complex- altered consciousness

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94
Q

Imbalances in what 4 E+ can lead to seizures

What do PTs retain during focal seizures and what meds are used for these PTs?

A

Glucose Na Ca Mg

Consciousness preserved
Oxcarbezapine
Levetiracetem

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95
Q

What is different in Complex Partial Seizure

What two things may be seen during absence seizures and what med is different in this Tx?

A

Altered LoC
Automatisms- unconscious actions of drool, pupil dilation or color changes

Eye lid flutter/eye roll up
Hyperventilation
Ethosuximide

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96
Q

What is seen in PTs w/ Generalized Motor Seizures

What can be done as first aid for seizures?

A

Bilateral or Focal to Bilateral tonic-clonic
Incontinence
Postictal period

Place on side
Clear mouth if open
Loosen clothes/jewelry
Extend head

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97
Q

What is the MC type of seizure between 6mon-5y/o

What are the two types?

A

Febrile

Simple: <15min and once/24hrs
Complex/Atypical: >15min, repeats w/in 24hrs or PT has pre-existing neuro issues
Febrile status epilepticus >30min

98
Q

What med is used for Febrile Seizure management

What two drugs are not used?

What lab result needs to be checked?

A

Rectal Diazepam

Daily anticonvulsant
Antipyretic

Fe deficiency

99
Q

What is the myth associated w/ fevers and seizures?

What is the truth?

A

Higher temp is associated w/ increased chance of seizure

How rapidly body inc temp correlates to likelihood of seizure

100
Q

Define Status Epilepticus

What meds can be used in the immediate setting?

What labs are ordered?

A

Neuro emergency due to seizure lasting >30min w/out return of consciousness

D/M/Lorazepam

Glucose 
CBC, Platelet
BMP 
Anticonvulsant levels
Toxicology
101
Q

What issues of weakness/hypotonia are seen in the anterior horn, peripheral, junctions or muscle cells?

A

Anterior: spinal muscular atrophy, poliomyelitis

Peripheral: Guillain Barre, Charcot Marie, Tick paralysis

Junction: M Gravis, Botulism

Muscle: dystrophies

102
Q

What are the three types of Spinal Muscular Atrophy

A

1- Wernig Hoffman Dz: severe infant dz leading to death before 2y/o

2- Kugleberg Welander Syndrome: MC; late infantile Dz but PTs reach adulthood

3: chronic, juvenile form w/ normal life expectancy

103
Q

What would be seen in PTs w/ Spinal Muscular Atrophy

What is the mainstay of management to prevent death

A

Proximal atrophy/weakness
No DTRs
Tongue fasciculations

Respiratory infections

104
Q

Polio invades and destroys ? part of the nervous system?

This is an endemic in what 4 countries

A

Anterior horns

Pakistan Afghanistan Nigeria India

105
Q

What type of vaccine is used for Polio in the USA?

Guillain Barre Syndrome is AKA and MC cause of ?

A

IPV

Acute Inflammatory Demyelinating Polyradidiculoneuropathy
Acute flaccid paralysis in kids

106
Q

Guillain Barre usually follows ?

What are the characteristic features of this Dz

A

10 days post respiratory/GI infection of M Pneumonia, C Jejuni

Areflexia
Flaccid
Symmetrical ascending weakness

107
Q

How is Guillain Barre Tx

Charcot Marie Dz affects ? nerves first?

A

IVIG
Plasma exchange or ImmSuppression if IVIG fails/Dz progresses quickly

Motor then sensation and autonomic

108
Q

What is the MC form of Charcot Marie and where does it affect the most on the body

What kind of deformity does this create?

A

Type 1A, Peroneal/Tibial nerves

Pes Cavus deformity

109
Q

What is done for Charcot Marie Tx

Tick saliva toxin is similar to ? and it’s pattern mimics?

A

Supportive foot bracing
Physical therapy

Botulism
Guillain Barre

110
Q

What are the 3 types of M Gravis?

What muscles are affected?

A

Juvenile
Transient neonatal- have maternal anti-AChR
Congenital- genetic mutation of junctional components

Abs block ACh receptors causing fatigue in striated muscles

111
Q

How is MGravis Dx

What can be done for management

A

Tensilon/Edrophonium test causes improved ptosis/strength

Pyridostigmine- ACh inhibitors
Thymectomy- dec Abs
PO steroids/ImmSupp drugs
Severe- plasmaphoresis and respiratory support

112
Q

What two foods are not given to infants under 12mon due to risk of botulism?

What are the first Sxs if poisoning has occurred

How is it Tx?

A

Honey
Canned foods

Constipation
Poor feeding

IVIG, respiratory/support care

113
Q

How are muscular dystrophies characterized

What causes the weakness in these Pts?

A

Myofiber degeneration and replacement w/ fibrotic tissue

Dystrophin

114
Q

What are the two types of muscular dystrophy

Which one is ASx in infancy

A

Duchenne- x-linked
Beckers

Duchennes- delayed milestones or toe walkers

115
Q

What can be seen on PE of a PT w/ Duchennes

What ages are arms and legs useless?

A

Gower sign- climbing up own body to stand
Pseudohypertrophy of calves due to thigh atrophy

Arm weakness at 6y/o
Wheelchair at 12y/o

116
Q

Define Prader Willi Syndrome

What does this syndrome cause

A

Deletion of paternal chromosome 15q11q13

Neonatal hypotonia causing poor feeding and FTT

117
Q

What lab results would be elevated in muscular dystrophy work ups

What Dzs would cause an abnormal CSF result

A

CK

Polio, Guillan Barre

118
Q

How are muscle dystrophies Dx

Brain and skin share what common embryonic origin?

A

Muscle biopsy show inc CT in muscles

Ectoderm

119
Q

What is Neurofibromatosis Type 1

NF 1 gene encodes neurofibromin which makes these fibromas made up of ?

A

von Reckling Dz
Autosomal dominant on Chrom 17

Schwann cells

120
Q

What is the cardinal feature of Neurofibromatosis Type 1

How is NF Type 2 different?

A

Cafe au Lait spots
Axilla/Inguinal freckles
Iris hamartoma (Lisch nodules)

Auto Dom mutation of Chrom 22 which codes for merlin

121
Q

What would be seen on PE of NF Type 2

This Dz commonly affects ? CN

A

Posterior/Cortical cataracts
No axillary freckles

CN8

122
Q

What are the two types of Tuberous Sclerosis mutations

PT w/ this Dz present w/ ?

A

Chrom 9- makes hamartin
Chrom 21- makes tuberin

Hamartomas

123
Q

Tuberous Sclerosis is a common cause of ?

What are the cardinal features?

A

Infantile spasms

Mental retardation
Epilepsy
Facial angiofibromas (adenoma sebaceum)

124
Q

What can be seen on PE of Tuberous Sclerosis

What malignant manifestation can occur?

A

Cerebral cortex tubers
Adenoma sebaceum
Ash leaf spots
Shagreen patches on lumbar/glutes

Renal angiomyolipomas- MC cause of death

125
Q

How is Tuberous Sclerosis Dx and Tx

Define Sturge Weber Syndrome

A

Imaging/Skin biopsy
Anti-seizure meds

Angiomas overlying cerebral cortex associated w/ port-wine stains on trigeminal nerve and glaucoma

126
Q

What is the MC presenting feature of Sturge Weber Syndrome

Hos is this syndrome Tx?

A

Seizures

Laser surgery for nevus flammeus
Anti-convulsants
Hemispherectomy- difficult seizures

127
Q

Define Rachischisis

What are the 3 different forms

A

Spina bifida occulta

Meningocele- open meninges
Meningomyelocele- open meninges/cord
Myeloscisis- open skin/cord

128
Q

What are the 2 types of hydrocephalus

How is this Tx?

A

Communicating w/ subarachnoid
Non-communicating

Ventriculoperitoneal shunt

129
Q

Define Arnold Chiari Malformation Type 1

What do these PTs present complaining of?

A

Cerebellar tonsils protrude down through formen magnum

HA, neck pain, Inc urination urgency

130
Q

Define Arnold Chiari Type 2`

Define Dandy Walker Malformation

A

Hydrocephalus w/ myelomeningocele anomaly of hind brain due to elongated 4th ventricle

Cystic expansion of 4th ventricle in posterior fossa

131
Q

How do 90% of PTs w/ Dandy Walker present?

Define Craniosynostosis

A

Hydrocephalus

Premature closure of suture, Tx w/ surgery

132
Q

Pseudotumor Cerebri is AKA ?

What are the 3 origins of this issue?

A

Idiopathic Intracranial HTN

Idiopathic
Meds: TCA, Vit A, OCP
Thyroid, Addison

133
Q

What is a predisposing factor of Pseudotumor Cerebri

How is it Tx

A

Overweight

Azetazolamide/diuretic
Topiramate
CCS

134
Q

What are the REM sleep stages

How much sleep do Infants/Peds need?

A

NREM 1-3: lightest sleep to deep/slow wave
REM: awake like sleep pattern

Infant: 16-18hrs/day
1y/o: 10-11 w/ 2-3hrs of nap
12y/o: 9-10hrs

135
Q

How much sleep do bottle/breast fed babies sleep

When does the ability to self soothe develop?

A

Bottle: 2-5hrs
Breast: 1-3hrs

First 12wks of life

136
Q

When do night time fears develop?

What age group who has cosleeping pattern is associated w/ sleep problems

A

1-2yrs old

3-5yrs old

137
Q

Define sleep onset association subtype

Define Limi-setting subtype

A

Infant/kids w/ frequent awakenings in new/unfamiliar surroundings

Pre-school/older kids w/ bed time resistance due to night time fears

138
Q

When are parasomnias MC?

When is sleep walking more common?

A

Preschool kids

2x higher >5y/o w/ Hx of night terrors
10x higher if FamHx

139
Q

What is the difference of timing between night terrors and night mares?

What causes circadian rhythm d/o

A

Terror: First 1/3
Mares: last 1/3

Delayed sleep phase

140
Q

Although rarely warranted, what two meds can be used for Peds w/ sleep d/o

Kids should be able to walk w/ normal gait and walk in tandem by ? age

A

Melatonin
Clonidine

6y/o

141
Q

How are DTRs graded

When should babinski be gone?

A

0: absent
1: trace
2: normal
3: exaggerated
4: clonus

12-18mon

142
Q

What microbes are more likely to cause UTIs?

What are the two types?

A 
E Coli
Klebsiella
Proteus
Enterococcus
Pseudomonas

Pyelonephritis
Cystitis

143
Q

When do UTI prevalence peak?

What microbes can cause cystitis?

A

Infancy
Toilet training
Onset of sexual activity

E Coli
Adenovirus- MC in boys

144
Q

What is the MC serious bacterial infection in kids <24mon?

What UA findings are Dx for UTIs

A

Pyelonephritis

Bacteria/Pyuria +50K
Leukocyte esterase AND nitrite: 99% specific for UTI

145
Q

How are UA samples gathered for suspected UTIs?

What UA result is indicative of sample contamination?

A

Clean catch if toilet trained
Catheter if 2-24mon

> 3-5 epithelial cells

146
Q

What test is the gold standard for UTI Dx

What results are Dx?

A

UA culture

> 50K one pathogen + pyuria
100K in older kids/adolescents

147
Q

What parenteral ABX are used for UTIs

How long are they used for infant/adolescents

A

Ceftriaxone
Cefotaxime
Cefepime

Neonate: 10-14 days
Older: 7-14 days

148
Q

What ABX can be used PO for UTIs?

When are renal/bladder US conducted when investigating UTIs?

A

Cephalosporin
Amoxicillin
Nitrofuratoin- no febrile UTIs
Trimethoprim

1st UTI in infant or non-toilet trained kid

149
Q

When is a VCUG ordered for Peds UTIs?

What is the MC cause of this reflux?

A

1st UTI in 2-24mon kid w/ abnormal US or,
Recurrent febrile UTIs w/ normal US

Congenital ureterovesical junction incompetence

150
Q

What are the 5 grades of VUR dx tests?

Which ones are less likely to resolve by them self?

A

1: reflux into ureter
2: reflux into renal calyx, no dilation
3: dilation
4: dilation, no angle of fornices
5: loss of papillary impression in most calyces

Bilateral 3 or 4-5

151
Q

What is the key feature of Nephrotic Syndrome

What can happen during this issue

A

Proteinuria >3.5g/24hrs
Protein:creatinine ratio > 2
Hypoalbuminemia <2.5
Hyperlipidemia >200

Hyperlipidemia
Inc infection risk
Hypercoagulability
Edema: eye, LE

152
Q

Minimal Change Nephrotic Syndrom

A 
Does not progress to renal failure
Edema above eyes
Inc BUN
Normal complement levels
Remission after 8wks of steroid- 90%

No HTN

153
Q

Focal Segmental Glomerulosclerosis

A

Associated w/ HIV, Sickle, Heroine use, Reflux nephropathy

Remission: 15-20%

154
Q

Membranoproliferative Glomerulonephritis Type 1

Membranoproliferative Glomerulonephritis Type 2

A

Hematuria
Low complement

Normal complement

155
Q

What is the MC presenting issue of nephrotic syndrome

Define Transient/Postural proteinuria

A

Sudden onset of dependent pitting edema/ascites

Transient: post work out
Postural: significant proteinuria when upright
MC in tall, thin PTs
Not associated w/ renal Dz

156
Q

What would be seen in Tubular proteinuria

Define Fanconi Syndrome

A

LMW protein in urine

Tubular proteinuria
Tubular E+ wasting
Glycosuria

157
Q

Define Glomerular Proteinuria

When is this usually seen?

A

Large and small weight proteins in urine

Post Strep + Lupus

158
Q

Most Peds under 13y/o will have ? nephrotic syndrome

How is the edema in these PTs Tx?

A

Steroid responsive NS
May start steroid Tx w/out renal biopsy

Loop diuretics
Salt restriction

159
Q

PTs w/ nephrotic syndrome are at increased risk for bacteremia/peritonitis from ? microbes

If these PTs are responding to steroid therapy, they have little risk of developing ?

A

Strep pneumo
E coli
Klebsiella

Renal failure

160
Q

What are the cardinal features of glomerular injury in glomerulonephritis?

What can cause factitious hematuria

A 
HTN
Oliguria
Proteinuria
Edema
Renal insufficiency

Rifampin
Urate crystals
Beets

161
Q

What is the MC chronic glomerulonephritis

These PTs present w/ what other current issue

A

IgA Nephropathy- Bergers Nephropathy

URI/GI infection

162
Q

Define Hereditary Nephritis

What PE finding is pathgnomonic for Dx

A

Alport syndrome
X-chromosome mutation of Type 4 collagen, causes abnormal basement membrane leading to ASx hematuria

Anterior Lenticonus in the eye

163
Q

Males w/ ASx hematuria need to have ? test done

How does post-strep glomerulonephritis present

A

Audiogram- sensorinueral hearing loss

Post GAS infection
Sudden onset gross hematuria, HTN and renal dysfunction

164
Q

What is the MC type of hemolytic uremic syndrome

What 2 meds are not used during supportive Tx?

A

Prodromal diarrheal illness from contaminated meat/produce/water w/ E Coli O157:H7

ABX
Antidiarrheals

165
Q

What is the MC inherited kidney dz

What other issues will be seen in these PTs?

A

Auto Dominant Polycystic kidney Dz, Polycystin 1 or 2 defects

Cerebral aneurysm
Liver, spleen, brain, pancreatic cysts

166
Q

Auto Recessive form of PKD is defective in ?

What type of kidneys are Turners Syndrome likely to have

A

Fibrocystin

Horse shoe

167
Q

Unilateral Renal Agenesis is MC to be seen ?

This is associated w/ ? issues

A

Diabetic mothers
Black mothers

VUR, VACTERL, Turner’s

168
Q

Bilateral renal agenesis is associated w/

What are the 3 DDx of testicular torsions?

A

Potter syndrome- flat face, clubfoot, pulmonary hypoplasia

Epididymo-orchitis: abnormal UA, + Prehns

Appendiceal torsion: blue dot on scrotum

Incarcerated hernia- palpable hernia w/ valsalva

169
Q

Cryptorchidism is more common in ? PTs

Tx w/ ? procedure prior to ? age rarely causes testis tumor

Spontaneous descent is rare after ? age

A

Premature

Orchidopexy <2y/o

4-6mon

170
Q

Define hydrocele

What are the two types

A

Fluid collection in tunic vaginalis

Communicate: w/ peritoneal space
Non-Comm: MC; processus vaginalis obliterated

171
Q

When are hydroceles referred to Urology?

Define Hypospadias

A

Non-Comm: 18mon
Comm: smallest in AM, associated w/ inguinal hernia, refer

Failure of ventral urethral folds to fuse

172
Q

Hypospadias commonly also present w/ ? issue

When is surgical Tx preferred?

What must be told to the parents?

A

Undescended testes
Inguinal hernia

6-12mon, but before 18mon

No circumcision until correction surgery

173
Q

What type of enuresis has a strong FamHx link?

What can be the cause of Secondary enuresis?

A

Primary nocturnal

Constipation UTI DM/DI

174
Q

Due to development of the same time, eye issues can be related w/ ? other issues

What are neonatal surgery red flags?

A

Kidneys

Polyhydramnios
Delayed meconium
Abdominal distension
Perinatal vomiting

175
Q

What causes infant vomit to be bilous or non-bilous

What is the MC type of tracheoesophageal fistula

A 
Bilous= distal to ligament of triaz
Non= proximal to ligament

Esophageal atresia w/ distal TEF

176
Q

What causes polyhydramnios

How do they present

A

Fetus w/ atresia can’t swallow amniotic fluid

Drooling, Bubbling, Single umbilical artery

177
Q

If T/E fistula is suspected, what is avoided after birth?

T/Es have the strongest association w/ VACTERLs which stand for?

A

First feeding

Vertebral anomaly
Anal atresia
Cardiac anomaly
TEF 
Renal anomaly
Limb anomaly
178
Q

How are TEFs Dx

A

Failure to pass OG cath
CXR w/ tube in pouch of esophagus
Gastrografin swallow study

179
Q

What is the #1 cause of intestinal obstruction before 3mon of age?

What kind of issue is this and when is it MC?

A

Pyloric stenosis

Hypertrophy + spasm= obstruction prox to LoT
MC in male and first born

180
Q

How do PTs w/ pyloric stenosis present?

What will be seen on labs?

A

Non-bilous projectile vomit w/ FTT

Hypo calorie, potassium
Metabolic alkalosis
Elevated BUN

181
Q

What is seen on PE of Pyloric Stenosis

What is seen on US and barium imaging?

A

Olive sign
LUQ peristaltic waves

Elongated thick pylorus
String sign

182
Q

How are Pyloric Stenosis PTs managed?

What is the name of the Tx procedure

A

NS bolus
D5 w/ K+ to Tx alkalosis and make the candidate for surgery

Pyloromyotomy

183
Q

What are the 4 parts of the diaphragm that fuse during development?

Where is it innervated from?

A

Pleuroperitoneal Muscular Septum Dorsal

Wk 6: thoracic
Wk 8: 1st lumbar

184
Q

Congenital diaphragmatic hernia is usually on ? side causing defected development of ?

This defect leaves a hole in the diaphragm where?

A

L side
Pleuroperitoneal fusion

Posterolateral

185
Q

During a congenital diaphragmatic hernia, bowels herniate into the thoracic cavity through ? foramen?

This deformity causes what findings seen on PE?

How is it Dx?

A

Bochdalek foramen

Scaphoid abdomen
Bowel sounds in L chest

X-ray

186
Q

What is a common type of ventral hernia?

What are the predisposing risk factors for this development?

What tissues can be contained here?

A

Umbilical hernia- contents still covered by subcutaneous tissue and skin

African American
Low birth weight

Omentum, small intestine

187
Q

When are umbilical hernias Tx w/ surgery?

How do PTs w/ intestinal malrotation/volvulus present?

A

After 5y/o
Sx/Strangulation
Larger after 2y/o

Obstruction is distal to LoT= bilious vomiting in 1st mon of life

188
Q

What can cause vomiting in PTs w/ volvulus if there’s no malrotation?

What would be seen on a barium study?

A

Ladd’s Bands

Cecum in RUQ
Upper GI cork screw affect

189
Q

While correcting a malrotation/volvulus, what prophylactic procedure is done?

Intestinal atresias are associated w/ what abnormalities?

A

Appendectomy

Trisomy
Rotations
Annular pancreas
Meconium ileus w/ CF

190
Q

Infant w/ Dx of atresia needs to have / test?

How do intestinal atresias present?

A

CF

Polyhydramnios
Failure to feed
Bilious vomit
Abdominal distension
Jaundice
191
Q

What two conditions present w/ non-bilious vomit?

What is seen on imaging of PTs w/ intestinal atresia?

A

TEF
Pyloric stenosis

Duodenal atresia= Double bubble sign
Distal atresia- dilated/air filled bowel

192
Q

Define Gastroschisis

What is thought to be the cause?

A

Split/open stomach, split in abdominal wall w/out affecting umbilicus

Absence of omphalomesenteric artery

193
Q

Why are gastrochisis PTs hard to Tx w/ surgery?

What causes an omphalocele?

A

Intestines are exposed to amniotic fluids, develop thick covering

Muscle/skin growth dysfunction, bowel remains in umbilical ring and covered
No amniotic irritation

194
Q

Omphaloceles are associated w/ ? issues

Meckels contain ? tissues

These are remnants of ? duct

A

Cardiac
Beckwith Syndrome

Gastric, Pancreatic

Vitelline/omphalomesenteric

195
Q

Once discovering a anorectal malformation, what is the next step?

Why is this step important?

A

MRI of lumbrosacral spine

Tethered cord

196
Q

What type of issue is Hirschsprungs Dz

What part of the colon is usually involved

A

Absent motility and functional obstruction

Rectosigmoid

197
Q

How do most Hirschsprung PTs present?

What PTs usually have NEC?

A

No stool passing in first 24hrs of life

Premature: <1500g or <34wks

198
Q

What are the two types of lead points that can result in intussusception

What is an associated cause of this?

A

Lyphoid hyperplasia- peyers patches
Abnormal anatomy- ileocecal valve/Meckels

Rotavirus or old immunization

199
Q

How do intussusceptions present?

What can be seen on PE?

A

Paroxysmal abdomen cramping
Current jelly stool

Sausage shaped mass in RUQ

200
Q

What test is therapeutic and Dx of intussusceptions?

What can potentially cause a blocked appendix?

A

Air/Barium enema

Fecalith
Lymphoid hyperplasia
Neoplasms

201
Q

What PE landmark is used to assess for appendicitis?

What is the alvardo rule for scoring?

A

McBurney’s: 2/3 distance between umbilicus to ASIS

Migrating pain
Anorexia
N/V
Rebound tenderness
Fever
WBC shift >75%

RLQ tenderness
Leukocytosis >100K

202
Q

What image is more accurate for identifying appendicitis

After Dx of NEC, what is the next step?

A

CT w/ contrast

Stop enteral feedings

203
Q

Who is usually the reported perpetrator of abuse?

Who is more likely to cause serious injury?

A

Mother

Father/maternal boy friend

204
Q

What is the MC type of emotional abuse?

What is the MC type of abuse overall?

A

Verbal

Neglect

205
Q

What types of Fxs are suspicious for abuse?

What color bruise by what day of healing

A

Metaphyseal
Scapular
Vertebral

Red 0-2
Blue/purple 2-5
Green 5-7
Yellow 7-10
Brown 14-28
Hgb Bilveriden Bilirubin
206
Q

How can the age of a Fx be estimated?

What is the shaken baby trifecta

A

7-14: callus
14-21: loss of Fx line
21-42: callus inc w/ density

Subdermal hematoma
Retinal hemorrhage
Brain swelling

207
Q

What 3 STDs in kids are almost always due to abuse?

What PE finding can be seen in neglect abuse?

A

G/C/Syphilis

Type 1 growth deficiency- normal head/length, low weight

208
Q

What are the top 5 unintentional injuries in kids aged 9-18

What does a Primary Assessment include?

A 
MVC
Drowning
Burn
Falls
Toxins

ABCDE
Airway Breathing
Circulation Deformity Environment/exposure

209
Q

What adjuncts are available during a primary assessment?

Max, min and intubation scores on GCS

A 
Pulse ox
O2 
Labs/Rads
IV
VS

15, 3, less than 8

210
Q

GCS section mnemonic

A

ESSPN- 4
Eye Spont Sound Pain No

VOCAIN- 5
Verbal Orient Confuse Appropriate Incomp Nil

MY OLD BEN- 6
Obey Localize Draws Bends Extend Nil

211
Q

What types of fluids are used in Peds resuscitation?

What combo needs to be avoided?

A

Isotonic- NS, LR

LR w/ pRBCs= hemolysis

212
Q

What is the primary cause of cardiopulmonary arrest in kids?

What level is the definition of hypoxemia and hypercarbic

A

Respiratory arrest

PaO2 <60mm
PaCO2 >50mm

213
Q

What are the early and late signs of hypoxic respiratory failure

5 types of shock

A

Tachy/Tachy
Cyanosis/AMS

Hypovolemic
Distributive
Dissociative
Obstructive
Cardiogenic
214
Q

What is the MC type of shock in kids?

Define Distributive shock

A

Acute hypovolemic

MC caused by sepsis
Adequate volume, maldistributed blood flow

215
Q

Define Cardiogenic shock

Define Obstructive shock

A

Dec heart contractility

Mechanical obstruction to ventricular filling/outflow

216
Q

MC type of trauma in Ped

What’s the 2nd MC cause of trauma death?

What’s the 3rd cause?

A

Head

Thoracic trauma- rib fx, contusion, pneumothorax

Abdomen trauma

217
Q

What abdominal injury causes severe bleeding?

MC location of Fxs

A

Liver

Physeal: radius, tibia, fibula

218
Q

SALTR

MC type of Fx

A

Separated Above Lower Through Rammed

Complete- spiral, transverse, comminuted, oblique

219
Q

Define Greenstick Fx

Buckle Fx AKA and typically occur ?

A

Fx on tension side
Bend deformity on compression side

Torus, metaphysis

220
Q

What is a Gymnast’s wrist

Little Leaguers elbow

A

Distal radial physis Fx

Medial humerus epicondyle apophysitis

221
Q

Legg Calve Dz is associated w/ ?

What is the characteristic presentation

A

Favtor V Leiden

Child w/ atraumatic painless limp

222
Q

Define ALTE

What are the MC causes

A

Acute Life Threatening Event characterized by apnea, color change, limpness and choking

GERD
Laryngospasms

223
Q

What is the 3rd leading cause of injury related death in kids 1-9y/o

How is this injury classified

A

Burns

Percent
Location
Association w/ injuries
Depth

224
Q

What does underlying dermis look like after debrisment?

How are deep partial thickness burns classified?

A

Painful
Erythematous
Wet
Blanches

2nd degree- involved epidermis and deeper dermis

225
Q

How are 4th degree burns classified

Burns disrupt what 3 skin functions

A

All of 3rd w/ fascia, muscle or bone

Heat regulation
Fluid preservation
Infection barrier

226
Q

Burns cause a release of ?

Smoke inhalation may be associated w/ ?

A

Cytokines
Mediators inc permeability, dec plasma volume, dec CO

CO toxicity

227
Q

What does initial management of burns involve

Nutritional support is needed due to managing ?

A

20ml/kg LR bolus
Titrate to urine output of >1mL/kg/hr

Hyermetabolic state

228
Q

What meds are used for burn wound care?

What two Txs are avoided when Tx poisonings?

A

Silver sulfadiazine
Polymyxin B/Bacitracin

Syrup of Ipecac
Gastric lavages

229
Q

What does MUDPILES stand for

A 
Methanol
Uremia
DKA
Paraldehyde
Isoniazid
Lactic acidosis
Ethanol
Salicylates
230
Q

Triad of narcotic poisoning

What is a common source of Fe poisoning

A

Miosis
Dec mental status
Respiratory depression

Prenatal Fe tabs

231
Q

How does Fe poisoning present

What is the antidote and side effects of its use?

A

Hemorrhagic gastroenteritis
HOTN
Heptatitis

Deferoxamine
Not in renal failure
Predispose to Yersinia sepsis

232
Q

What is an early and late sign of salicylate poisoning

How can urine be forced into alkalinization

A

Tachypnea, respiratory alkalosis
Severe anion gap, metabolic acidosis

IV HCO3 and D5W

233
Q

How does lead poisoning present

How is it Tx

A

Alopecia
Seizure
Coma
Basophilic stippling

Edetate Ca disodium
Dimercaprol* peanut allergy
Succimer

234
Q

How does carbon monoxide poisoning present

Methanol poisoning leads to ?

Ethylene glycol poisoning leads to ?

A

Flu like Sxs
Cherry red
Groups of people

Optic/renal edema

Renal/CNS toxicity

235
Q

Both methanol and ethylene glycol poisoning present w/ ?

How is it Tx

A

Metabolic acidosis

D5W
Fomepizole
Thiamine and B6 (ethylene)
Folic acid (methanol)

236
Q

How does organophosphate poisoning present

How is this Tx

A

SLUDGE
Salivation Lacrimation Urination Defecation Gastroenteritis Emesis

Atropine
Pralidoxime

237
Q

When is urticaria acute or chronic

How is angioedema different and caused

A

+ or - 6wks

Below dermis
Mast cells, IgE mediated

238
Q

How is anaphylactoid different from anaphylaxis

When is this seen

A

Not IgE mediated
C3a and C5a anaphylatoxins

Serum sickness after blood transfusions

239
Q

Complications of SCFE

What type of shock is called Warm shock

A

Chondrolysis
Avascular necrosis

Distributive

240
Q

What type of shock can cause JVD in kids

Use caution when pushing fluids in ? type of shock?

A

Cardiogenic

Cardiogenic

IPAP (212 decks)

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