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Peds > Peds CLIPP > Flashcards

Peds CLIPP Flashcards

1
Q

3 types of dehydration

A

Isotonic/natremic ( Na = 130-150)
Hypotonic/natremic (Na<130)
Hypertonic/natremic (Na>150)

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2
Q

Most common type of dehydration in children, i.e. acute gastroentertitis and diarrhea

A

Isotonic…Na and H20 losses are balanced

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3
Q

Deficit in ____ dehydration can be replaced over ____ hours:

A

Isotonic - 12
Hypotonic - 24
Hypertonic - 48

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4
Q

In a patient that is Z% dehydrated, how do you calculate pre-illness weight?

A

Current weight/((100-%dehydrated)x.01)

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5
Q

When DKA pt is dehydrated, how much fluid needs to be given over next 24-48 hours (DKA pt, we specify 48 hours)

A

kg deficit x 1000mL/kg = #mL fluid deficit (and thus amount needed to be given)

Deficit = Pre-illness weight - current weight = # kg deficit;

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6
Q

For maintenance fluids in a dehydrated patient, are calculations based off current weight or pre-illness wt?

A

Pre-illness weight!

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7
Q

Signs of Cerebral Edema

A
  • headache
  • recurrent vomiting
  • bradycardia
  • hypertension
  • hypoxia
  • restlessness/irritability
  • lethargy
  • CN palsies
  • Abnormal pupillary responses
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8
Q

Tx of cerebral edema

A
  1. Slow rate of fluid admin
  2. IV mannitol
  3. ICU
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9
Q

Components of admission orders

A

A dmit
D x
C ondition

V itals
A ctivity
N ursing
D iet
I V fluids 
S tudies
M eds
A llergies
L abs
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10
Q

Why do you need to do hourly neuro checks on DKA pt?

A

Cerebral edema = most serious

complication of DKA

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11
Q

Children with new-onset T1DM should also be screened for:

A 
Autoimmune thyroid disease (thyroid Ab)
and Celiac (endomysial/tissue transglutaminase)
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12
Q

Screening recommendations for T2DM in children

A

Fasting plasma glucose @ 10yo or @onset of puberty, then q3 years after that (for children overweight + 2 risk factors)

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13
Q

When would you expect fever as an adverse rxn from vaccines?

A

within 24-48 hours

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14
Q

Temp>101F for at least 2 weeks with failure to reach dx after 1 week evaluation

A

Fever of Unknown Origin

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15
Q

Fever without an identified etiology after a complete H and P performed

A

Fever without source

usually viral

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16
Q

Almost all children with elevated wbc represent:

A

FALSE POSITIVES…bacteremia rates are really low now due to vaccines

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17
Q

WBC<15,000 is ____ at ruling out bacteremia

A

Excellent

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18
Q

T/F: Majority of immunized, immunocompetent 3-36 mo chidren with fever should get empiric therapy with ceftriaxone or other antibiotics

A

False…most will not have bacteremia so this is not appropriate

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19
Q

Kernig and Brudzinski signs test for:

A

meningitis (if +, do LP)

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20
Q

Flexion of one of the legs 90 deg @ hip and knee in resposne to flexion of neck =

A

Brudzinski’s sign (meningitis)

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21
Q

Resistance to extension of the knee =

A

Kernig’s sign

meningitis

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22
Q

define occult bacteremia

A

+blood culture in a well-appearing child (most will not develop a serious bacterial illness)

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23
Q

Is a red TM + fever enough for AOM dx?

A

Nope. Need poor mobility and at least mild bulging of TM

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24
Q

Commonly caused by enterovirus; presents with fever; may have loose stools, rashes, or URI sxs

A

Viral meningitis

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25
Q

What’s more worrisome, bacterial or viral meningitis?

A

Bacterial

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26
Q

T/F: Basically always put UTI on the ddx in a young infant/child with fever without source, even if common UTI sxs not present

A

TRUE….get UA AND Urine culture (when antimicrobial therapy initiated, need a catheterized specimen, not bagged urine)

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27
Q

T/F: Nitrofurantoin is first line for cystitis and pyelo

A

False, only for cystitis. Only concentrates well in urine, not in blood.

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28
Q

Best choice antibiotic for pyelo

A

Keflex (cephalexin)

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29
Q

Follow up studies after 1st episode Pyelo:

A

Ultrasound of Kidneys and Bladder (better than the IVP)

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30
Q

FU studies after 2nd ep of febrile pyelo

A

do a Voiding Cystourethrogram (VCUG) –> demonstrates presence of Vesicourethral Reflux

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31
Q

Infant is expected to regain his birth weight by ______ age

A

2 weeks of age

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32
Q

Failure to regain birth weight by ____ weeks of age, or continous weight loss after _____ days = FTT

A

3 weeks; 10 days

Failure to Thrive

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33
Q

An infant is considered adequately nourished in the first few weeks if they receive ____ feedings per day (you expect at least ____ wet diapers/day)

A

6; 6

should encourage 8-12 feedings though

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34
Q

How much vit D supp do breast fed infants need?

A

400 IU daily beg. w/in first few days

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35
Q

Infant feeds should be approximately every:

A

2-3 hours. (4 hours is probably too long of intervals) for 10-15 min

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36
Q
  • poor/absent eye movements

- or, failure of child to recognize parents or objects in environ.

A

Lethargy def.

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37
Q

Normal size of anterior fontanelle…do ((length +width)/2)

A
  1. 1cm
  2. 6-3.6 = 2 SDs (95%)

Posterior usually

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38
Q

Conditions causing large fontanels

A
  • skeletal disorders (rickets, Osteo Imperfecta)
  • Chromosomal (Downs)
  • Hypothyroid
  • Malnutrition
  • Increase ICP
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39
Q

Conditions causing small fontanels

A
  • Microcephaly
  • Hyperthyroidism
  • Craniosynostosis
  • Normal variant
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40
Q

Conditions causing sunken fontanels

A

Dehydration

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41
Q

Conditions causing bulging fontanels

A
  • Meningitis
  • Hydrocephalus
  • Subdural hematoma
  • Lead poisoning
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42
Q

Hypotonia, large fontanels, umbilical hernia, and jaundice

A

Congenital Hypothyroidism

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43
Q

Poor feeding, vomiting, lethargy that occurs after about 2 days of life

A

Inborn error of metabolism. Symptomatic aftr few days due to protein load in breast milk/formula

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44
Q

Na and K levels in CAH?

A

Low sodium, high potassium

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45
Q

Where does majority of bilirubin in newborn come from?

A

Physiologic breakdown of red blood cells

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46
Q

Where and how is bilirubin conjugated?

A

Liver; bilirubin conjugated to glucuronide by UDP Glucuronyl transferase (UDPGT)

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47
Q

How is bilirubin excreted?

A

Conjugation in the hepatocytes makes it awter soluble; excreted into the bile and then intestines (stool)

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48
Q

Why do newborns absorb so much more of bilirubin from stool (meconium)?

A

Lack GI flora to metabolize bile; b-glucuronidase in meconium converts CB –> UCB –>reabsorbed into blood stream –>binds albumin

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49
Q

What are some sequelae of kernicterus (staining of BG and CN by bilirubin)?

A
  • Lose suck reflex
  • lethargy
  • hyperirritability
  • seizures
  • death

if survive:

  • opisthotonus
  • rigidity
  • oculomotor paralysis
  • tremors
  • hearing loss
  • ataxia
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50
Q

Why have rates of kernicterus in newborns decreased?

A

Screening for Rh incompatibility and use of Rhogham

(erythroblastosis fetalis)…its a hemolytic rxn. Also, tx of UCBemia with phototherapy

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51
Q

Who is at higher risk of jaundice, breastfed or formula-fed infants?

A

Breast

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52
Q

Physiologic jaundice = total bilirubin < ____ mg/dL

A

15

seen in almost all newborn infants

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53
Q

What factors promote physiologic jaundice

A

Increased enterohepatic circulation:

  1. increased bili production (breakdown of fetal rbc)
  2. Def of hepatocyte proteins/UDPGT
  3. Lack of intestinal flora to metab bile
  4. High b-glucuronidase in meconium
  5. low PO first few days life = slow excretion of mec (esp. breastfed)
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54
Q

Breast_____ jaundice occurs early in 1st week, when milk supply is low

A

breastFEEDING

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55
Q

Why does breastfeeding jaundice occur?

A

Low milk = dec. GI motility = retention of meconium, which has beta glucornidase = deconjugation of bili = reabsorbed via enterohepatic circ = elevated serum

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56
Q

T/F: Breast-milk jaundice is because of low breast milk volume

A

FALSE, this describes breastfeeding jaundice

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57
Q

What is ABO incompatibility?

A

Mother is Type O, baby is type A or B

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58
Q

T/F: Infants gain 1oz/day after birth for the first 2 months

A

False; they lose up to 10% during first 5 days, regain it by 2 weeks

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59
Q

T/F: Maternal infections can cause IUGR and newborn SGA with hyperbilirubinemia

A

True

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60
Q

Breast milk jaundice begins 4-7 days and may be caused by _______ present in breast milk which does what?

A

B-glucuronidase –> deconjugaes bilirubin the GI tract, and the UCB reabsorbed via enterohepatic circulation

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61
Q

T/F: Breastfeeding jaundice is because the feeding isn’t sufficient enough, whereas breastmilk is due to something in the milk

A

True…with feeding, not enough milk being made. With milk, b-glucuronidase in the milk deconjugates.

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62
Q

When should stool start becoming yellow (no more meconium)?

A

day 3

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63
Q

Healthy-appearing infant who develops jaundice, dark urine, and acholic (pale) stools btwn 3-6 weeks of age

A

Possibly biliary atresia

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64
Q

How do you evaluate jaundice in infant that’s >2 weeks old?

A

Fractionated bilirubin (total and direct)

65
Q

Kasai procedure when is it indicated?

A

Used to restore bile flow/prevent liver damage in pt with biliary atresia (if done early)

66
Q

Kasai procedure

what is it?

A

Anastomosis of the intrahepatic bile ducts to a loop of intestine to allow bile to drain directly into the intestine

67
Q

Who has higher incidence of jaundice, breastfed or formula-fed?

A

Breastfed…however, usually not an indication to stop breast feeding

68
Q

List some major risks for adverse outcomes of neonatal hyperbilirubinemia

A
  • Jaundice in first 24 hrs
    • Coombs
  • gest. age 35-36wk
  • Previous sibling had phototherapy
  • Cephalohematoma
  • East Asian
69
Q

causes of congenital hypothyroidism

A
  • Thyroid dysgenesis (aplasia, hypoplasia, ectopic gland) = #1 US
  • iodine def #1 world
  • Mother with Graves tx with antithyroid (transient in infant)
70
Q

Signs of infant hypothyroidism

A
  • feeding problems
  • low activity
  • constipation
  • prolonged jaundice
  • skin mottling
  • umbilical hernia
71
Q

Why is early detection fo sickle cell disease important in newborn screening?

A

Early penicillin prophylaxis can prevent sepsis secondary to Strep pneumo infection

72
Q

What is the follow-up protocol after treating congenital hypothyroidism?

A

TSH and T4 measured at 2 and 4 weeks post initiating therapy, then:

  • q1-2mo until age 1
  • q2-3mo until age 3
  • q3-12mo until growth completed
73
Q

Approximate bili level when jaundice on face vs jaundice past the knees

A

5 mg/dL

10 mg/dL

74
Q

Which of the following physical findings could contribute to hyperbilirubinemia: Cephalohematoma, Caput Succedaneum, Bruisng

A

Cephalohematoma (localized to cranial bone traumatized during delivery)

Bruising –> bleeding can = increased bili production b/c blood extravasated into tissues is broken down and converted to bili

(Caput swelling consists of serum so does not)

75
Q

What is Developmental Dysplasia of the Hip

A

aka congenital dislocation of hip…partial or complete dislocation and instability of femoral head

76
Q

Risk factors for developmental dysplasia of the hip

A

Breech position; Female gender; FHx

77
Q

When do you order urine for reducing substances?

A

When suspecting Galactosemia (galactose = reducing substance)

78
Q

Father is Greek and possibly has G6PD def. When do you test the daughter?

A

You don’t need to…its an X-linked recessive, so you would only test son or if mom is also greek

79
Q

When would you test urine for bilirubin?

A

When suspecting Cholestasis (so NOT whenever there is jaundice…for this, total serum bilirubin)

80
Q

Total serum bilirubin vs Direct bili/urine dipstick bili

A

Total serum bili: If jaundice in 1st 24 hours or w/significant jaundice

Direct/urine: Infant has dark urine/light stools ( atresia), infant is ill (sepsis)

81
Q

When is the optimal time for neonatal screen?

A

Testing >24hrs after birth. If obtained before, need second specimen

82
Q

T/F: Bronchodilators and steroids are generally not helpful in tx of wheezing in infants with viral respiratory illness

A

True

83
Q

How does responsiveness to bronchodilators/steroids in a wheezing child help with dx?

A

Points to asthma

84
Q

When do we use the phrase “Reactive Airway Disease”?

A

Controversial…appropriate for younger children with chronic wheezing without a dx of asthma yet (i.e. many kids will not continue to wheeze beyond 2-3 years)

85
Q

How can you assess depth/degree of effort for Tachypnea?

A
  1. Hyperpnea (increased depth of resp): suggests non-pulm condition (fever/acidosis/anxiety) if no resp distress
  2. Hypopnea (reduced tidal V): may have hypoventilation in the setting of normal/elevated RR
86
Q

What do nasal flaring and head bobbing indicate?

A

Both indicated significant resp distress and that accessory muscles are being used for respiration

87
Q

What does grunting indicate?

A

Resp distress…forced expiration against partially closed GLOTTIS…help generate POSITIVE PRESSURE to stent airways open

88
Q

Which is most severe indicator: Tachypnea, Grunting, Head Bobbing, Nasal Flaring, or Paradoxical Breathing?

A

Paradoxical breathing

89
Q

What is paradoxical breathing?

A
  • Sign of sig. resp. distress
  • Force of contraction generated by diaphragm>ability of chest wall mm. to expand rib cage
  • chest drawn in w/inspiration, abdomen rises
90
Q

Respiratory muscle fatigue can reduce signs of respiratory distress, even though pt’s condition is worsening. How can you assess status?

A

Get blood gas –> may show elevated PCO2 = hypoventilation

91
Q

Wet cough vs dry cough

A

Dry is typical of chronic asthma

Wet suggests secretions in the airway, due to a viral infection, post-nasal drip (allergies/sinusitis), GERD, CF, etc

92
Q

coughing with liquids is suggestive of _____, dysphagia with solids suggestive of ______

A

liquids: Aspiration (i.e. TEF)
solids: Narrowing

93
Q

How does assessing if voice or cry has been hoarse help with ddx of cough/wheezing?

A

Hoarseness/muffled sound = larynx/pharynx = pharyngitis, tonsillitis, epiglottitis (upper airway)

Problems with lower airway don’t affect quality of voice or cry

94
Q

In a coughing child without vaccinations, what are you most concerned about?

A

Pertussis

95
Q

what are the 3 phases of pertussis?

A
  1. Catarrhal (1-2 wks, URI)
  2. Paroxysmal (4-6 wks, whooping/forceful cough)
  3. Convalescent…decrease freq/severity of cough, can have episodic cough for months
96
Q

Child is immunized and has epiglottitis (tripod position). What is likely etiology?

A

Staph or Strep

97
Q

3 things that cause cough with wheeze

A
  1. Asthma,
  2. Bronchiolitis
  3. Foreign body aspiration
98
Q

4 things that cause cough with rhinorrhea

A
  1. Allergic rhinitis
  2. pertussis (catarrhal stage)
  3. Sinusitis
  4. Viral URI
99
Q

Finer breath sounds heard on inspiration associated with either fluid in the alveoli or with opening and closing of stiff alveoli (as in interstitial disease).

A

Crackles

100
Q

rationale for inspiratory/expiratory films

A

irway containing an obstruction does not allow the distal lung to deflate fully and results in asymmetric deflation with expiration.

101
Q

Soft-tissue neck films

A

croup or another supra- or subglottic abnormality

102
Q

Soft-tissue neck films

A

croup or another supra- or subglottic abnormality

103
Q

Chest x-ray findings in asthma

A

hyperinflation due to air trapping, increased interstitial markings and patchy atelectasis.

104
Q

Maintenance therapy for chronic asthma

A

inhaled corticosteroid as a daily, controller medication, with an inhaled beta-agonist such as albuterol as needed for breakthrough symptoms.

105
Q

most common cause of wheezing in infants

A

Acute bronchiolitis is a viral disease rsv

106
Q

Chest radiographs Acute bronchiolitis

A

hyperinflation, increased interstitial markings, peribronchial cuffing, and scattered atelectasis from bronchial obstruction.

107
Q

Chest radiographs Acute bronchiolitis

A

hyperinflation, increased interstitial markings, peribronchial cuffing, and scattered atelectasis from bronchial obstruction.

108
Q

most common cause of pneumonia in children

A

Adenovirus
RSV
Parainfluenza
Influenza

109
Q

When do you label cough as chronic?

A

> 4 weeks

110
Q

coughing thats worse at night

A
  • asthma
  • sinusitis
    (note: GERD not in this list for kids)
111
Q

cough ass. with gagging or choking

A

GERD

112
Q

paroxysmal cough

A

Pertussis
Chlamydia
Mycoplasma
Foreign body

113
Q

paroxysmal cough

A

Pertussis
Chlamydia
Mycoplasma
Foreign body

114
Q

hallmark of primary tb

A

primary complex (relatively large size of the hilar lymphadenopathy compared with the relatively small size of the initial lung focus

115
Q

+PPD aka mantoux test for TB

A

> 5 mm in high-risk children
10 mm in moderate-risk children
15 mm in low-risk children.

116
Q

Nasal congestion is a prominent feature, leading to complaint of nocturnal cough due to post-nasal drip

A

sinusitis

117
Q

t/f: Bronchitis in children is thought to be due to extension of viral inflammation into the lower respiratory tree and does not require antibiotic therapy.

A

true

118
Q

This is a term often used to describe when the lower eyelids appear darkened due to venous stasis.

A

Allergic shiners

119
Q

This is the name for the infraorbital creases that appear due to intermittent edema caused by allergies.

A

Dennie-Morgan lines

120
Q

This is the name for the infraorbital creases that appear due to intermittent edema caused by allergies.

A

Dennie-Morgan lines

121
Q

How can we distinguish btwn viral and bacterial URI?

A

Bacterial persists without improvment; viral tends to improve gradually over a week

122
Q

changes to I:E ratio in obstructive disease

A

Decreased I:E ratio (Expiration prolonged)

123
Q

Hyperresonance on percussion of lungs

A

Localized air trapping behind a: -mucus plug

  • foreign body
  • mass
124
Q

Dullness to percussion lungs

A

Lobar consolidation (aka airless) from pneumonia or atelectasis

125
Q

Continuous, musical or polyphonic sounds generally heard during expiration

A

Wheezing

126
Q

general causes of wheezing

A

Airflow through narrowed airways:

  1. Intraluminal (edema, mucus, FO)
  2. External compression (mass, lymphadenopathy)
127
Q

Continuous, low-pitched, polyphonic sounds that occur during either inspiration a/o expiration

A

Rhonchi

128
Q

What causes rhonchi?

A

(continuous low pitched sounds)

Mucus/secretion in the airways

129
Q

Discontinuous lung sounds, either fine or coarse

A

Crackles

130
Q

Are crackles inspiratory, expiratory, or both?

A

Typically Inspiratory

131
Q

What causes crackles

A

Alveolar/small airway conditions =

  • pneumonia
  • pulm edema
  • bronchitis
  • interstitial disease
132
Q

High-pitched inspiratory noise due to partial obstruction of larynx/trachea (extrathoracic airways)

A

Stridor

133
Q

Which lung sounds are continuous?

A

Wheezes, Rhonchi

134
Q

Which lung sounds are discontinuous?

A

Crackles

135
Q

Bilateral nasal secretions lasting for more than 10 days in children

A

Sinusitis

may have sore throat/bad breath

136
Q

Which lung sound is prominent in Bronchitis?

A

Rhonchi

also prominent in viral pneumonia

137
Q

T/F: Wheezing is prominent in bronchitis

A

FALSE –>Rhonchi, no wheezing

138
Q

The genetic predisposition to development of an IgE-mediated response to common aero-allergens

A

Atopy

139
Q

most effective pharmacologic agents for tx of allergic rhinitis

A

Topical nasal steroids

should not be used for short-term sxs of seasonal allergies

140
Q

History is key in asthma dx. What other test is the most specific for determination of asthma?

A

Spirometry (PFT) before and after bronchodilator therapy determines reversible obstructive airway disease (asthma)

141
Q

When is bronchoprovacation (methacholine/histamine/exercise challenges) used?

A

Only when asthma is suspected and spirometry is normal

142
Q

Chronic lung disease in which the airways are very sensitive, inflamed and narrowed = difficulty breathing. Tends to run in families. Variety of triggers can set off an episode (allegens, colds, exercise, stress)

A

Asthma

143
Q

What is the first phase of the biphasic inflammatory response of asthma exacerbations?

A

1st phase: ~1 hour. mast cells and eosinophils release PG/LT = increased vascular permeability, mucus hypersecretion rapid bronchoconstriction

144
Q

What is the second phase of the biphasic inflammatory response of asthma exacerbations?

A

Second phase: Starts 2 hrs after, peaks 4-8 hours, resolves 24 hours. Neutrophil, eosinophil, lymphocyte infiltration into bronchial epithelium = epithelial destruction, fibrotic remodeling, hyperplasia of bronchial smooth mm.

145
Q

T/F: All pts with persistent asthma should get daily prophylaxis with anti-inflam therapy (inhaled corticosteroids)

A

TRUE

–>Beclomethasone (QVAR), Fluticasone, Budesonide (Pulmicort)

146
Q

T/F: In well controlled asthma, Albuterol (SABA) aka “rescue” meds can be used daily

A

False. If well-controlled, should NOT be needed >2x/week…is jused more for exercise-induced asthma

147
Q

Patients with asthma should make sure to have which vaccination?

A

Varicella…those on steroids are @ high risk for severe primary varicella infection

148
Q

When doing spirometry, the standard time for exhalation is:

A

6 seconds

149
Q

T/F: Breath-holding spells in children occur during inspiration and are reflexive in nature

A

False. They are reflexive but actually occur during expiration (child starts to cry an suddenly falls silent in the expiratory phase of respiration

150
Q

breath holding spells: _____ associated with anger, ____ associated with injury/fall

A

Cyanotic (anger)

Pallid/acyanotic (falls)

151
Q

Elevated BP in 2mo old indicates response from the CV system to:

A
  • pain
  • compensated shock
  • increased ICP
152
Q

Glasgow scale score > _____ = mild or no neuro compromise

A

13

153
Q

Glasgow scale score

A

8

154
Q

_____ hematomas result from head trauma, either accidental or non-accidental

A

Subdural

155
Q

Prognosis for victims of abusive head trauma

A

Many with subdural hematomas and retinal hemorrhages have long term developmental delays, seizures, and difficulty with vision

156
Q

common features Downs

A
  • upslanting palp
  • small ears
  • flattened midface
  • epicanthal folds
  • redundant skin on back of neck
  • hypotonia (most consistent finding)
157
Q

T/F: FISH is the study of choice for dx of Down syndrome

A

False!

Its Lymphocyte Karyotype

158
Q

Infants with down syndrome have an increased chance of having:

A

Hypothyroidism

Peds (3 decks)

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