Peds CLIPP Flashcards
Caused by a deficiency of lung surfactant and delayed lung maturation, can occur as late as 37 wk
RDS
What is the most common cause of respiratory distress in premature infants
RDS
Who is at increased risk for RDS
infants of diabetic mothers
Result of delayed clearance of fluid from lungs following birth
transietn tachypnea of the newborn
Caused by a collection of gas in the pleural space with resultant collapse of lung tissue
pneumothorax
Who is at increased risk for pneumothorax
mechanical ventilation or underlying lung disease like RDS; premature infants with RDS
What babies are at risk for hypoglycemia
infats of diabetic mothers due to chronic hyperinsulinemic state
Tachypnea is a nonspecific finding in newborns; possible causes
meconium aspiration, hypoglycemia, hypothermia, VSD, PDA, Coartation of aorta, RSD, TTN, pneumothorax, sepsis, congenital diaphragmatic hernia
Risk factors neonatal sepsis
maternal GBS, prolonged rupture of membranes (>18 hrs), delivery <37 wks, maternal fever or chorioamnionitis
premature and tachypneic
RDS, pneumothorax, sepsis
maternal diabetes and tachypneic
TTN and RDS
kernicterus presentation
abnormalities in tone and reflexes, choreoathetosis, tremor, oculomotor paralysis, sensorineural hearing loss and cognitive impairment
Risk factors for bilirubin toxicity
hemolysis, asphyxia, significant lethargy, temp instability, sepsis, acidosis, albumin
Predisposing factors to hyperbilirubinemia
ABO mismatch, breastfeeding, in utero infection, gestational age, Mediterranean ethnicity, microcephaly, Rh incompatibility, small for gestation age, weight loss > 10%
physiologic jaundice
total bili <15 mg/dL in full term infants who are asymptomtic
causes of physiologic jaundice
increased production (breakdown RBC), hepatocyte protein and UDPGT deficiency, lack of intestinal flora to metabilze bile, high B glucuronidase in meconium, intake
Breast feeding jaundice occurs
first week of life when milk supply is low so low intake
breast milk jaundice
first 4-7 d but may not peak until 10-14 d; can persist up to 12 wks
Crigler Nijjar
AR; causes severe unconjugated hyperbili starting in first few days. Caused by decrease bili clearance caused by deficient or completely absent UDPGT and can lead to kernicterus
Gilbert
less severe common cause of unconjugated hyperbilidecrease enzyme function interferes with glucuronidation and conjugation of bili is slowed
presentation biliary atresia
healthy infant who develops jaundice, dark urine, and acholic (pale) stools btw 3-6 wks
treatment biliary atresia
kasai procedure- anastomosis of the intrahep ducts to a loop of intestine to allow bile to drain directly into the intestine
major risk factors hyperbili (TSB >95th percentile)
jaundice iin first 24 hours, blood group incompatibility, gestational age 35-36 wk, previous siblibling, cephalohematoma or significant bruising, exclusive breaskfed, east asia
CXR for TTN
wet looking lungs, no consolidation and no air bronchograms
CXR RDS
diffuse reticulogranular appearance ground glass appearance and air bronchograms
late preterm infants are at risk for
hypothermia, hypoglycemia, respiratory istres, apnea, hyperbilirubinemia, and feeding difficulty
vitamin D dose for breastfed infants
400 IU
What should you ask about in a newborn visit
pregnancy history (age, gravida, infection, meds, complications) Birth hitory (age, weight, size, prenatal health) Feeding (type, amount, freq) Parent questions
Breastfed babies lose an avg of ___% of their birth weight in the ____
5.8; first few days
How many stools and voids is a 3-5 d; and 5-7 day old expected to make
3-5d: V-3-5 S-3-4
5-7d: V- 4-6 S- 3-6
Lethargy
failure to recognize parents or interact with persons or objects
Listless
no interest in what is happening around herself
Toxic newborn description
appearance of pending physiologic collapse such as may be seen in sepsis, poisoning, acute metabolic crisis or shock. Febrile, pale or cyanotic, with depressed mental awareness or extreme irritablility
Distressed child
working hard to maintain physiologic stability such as grunting, rapid breathing in order to maintain oxygenation and ventilation
What things are administered in the first hours or days of life
- hep b vaccine (first 12 hours)
Vit K (immediately) - Erythromycin eye ointment (gonorrhea prophylaxis)
- Critical Congenital Heart Disease Screen
- Hearing screen
differential for neonate with poor feeding and decreasesd activity
congenital hypothyroidism, shaken baby, downs, congenital adrenal hyperplasia and inborn error of metabolism
polycythemia usually occurs when after birth
first few hours to days
findings congenital hypothermia
feeding problems, decreased actiivty, constipation, prolonged jaundice, skin mottling, umbilical hernia
findings congenital adrenal hyperplasia
decreased feeding and activity, salt losing presents with lethargy, vomiting, and dehydration that can progress to shock
findings inborn error of metabolism
typically newborns appear well for at least the first 1-2 days and then become symptomatic d/t protein load in breast milk; initial signs include somnolence and poor feeding followed by voiting and lethargy
findings of botulism
poor suck and weak cry and usually presents 3-4 months of age
hypoxic ischemic encephalopathy
altered mental status shortly after birth; low apgar and multi system dysfunction early in neonatal course
Polycythemia
hematocrit above normal (>65%); may be found incidentally, or present with altered metnatl status and poor feeding; plethora, acrocyanosis or hyperbili; occurs in first few hours to days of lif
Conditions associated with large fontanels
skeletal disorders (rickets, osteogenesis imperfecta) chromosomal (downs) Hypothyroid malnutrition increased intracranial pressure
conditions associated with small fontanels
microcephaly, craniosynostosis, hyperthyroid, normal variant
sunken fontanels
dehydration
bulging fontanels
meningitis, hydrocephalus, subjural hematoma, and lead poisoning
umbilical hernias will spontaneously close by what age
5 yo
serum ammonia would be elevated in what newborn conditions
inborn errors of metabolism esp ornithine transcarbamylase deficiency
Sepsis
SIRS (temp or leukocyte count plus H, tachypnea or acute need for mechanical vent) plus suspected or proven infection
signs of meningitis in infants
fever, hypothermia, bulging fontanelles, lethargy, irriablility restlessness, paroxysmal crying, poor feeding, vomiting and or diarrhea
kernig’s sign
resistance to extension of the knee
brudzinski sign
flexion of the hip and knee in response to flexion of the neck
CSF for bacterial meningitis
Glucose- low
protein- high
WBC- high
CSF for viral meningitis
Glucose- normal
protein- normal or slightly elevated
WBC- elevated
gram stain- negative
pyuria
> 5 WBCs per high power fieild
what does a nitrite test test for
gram negative bacteria esp E coli, klebsiella and proteus
leukocyte esterase test
detects esterases released from broken down leukocytes; a positive test indicates the presence of WBCs thus a positive test is not alone sufficient to diagnose UTI
why is ampicillin not a good choice for treating treating a uti
resistance rats are rising so should be combined with gentamicin. Amp gives enterococci coverage which is a benefot
why is ciprofloxacin not a good choice for uti in kids
adverse reactions in kids plus expensive
Oral antibiotic tx for UTI
cephalexin (keflex), trimethoprim/sulfamethoxazole, nitrofurantoin (but only cystitis), augmentin (gi side effects)
what follow up studies are done after first episode of pyelonephritis
renal and bladder US
renal technetium
provides evidence of pyelonephritis; not required in a patient who has responded to tx
when would you get a VCUG
after second febrile UTI or if renal and bladder US suggest high grade reflux
meningococcemia
fever, chills, rash and may lead to shock and DIC
causes of unilateral cervical LAD
reactive cervical adenitis, kawaskai, bacterial cervicaladenitis, cat scratch disease, mycobacterial infection
strawberry tongue
strep pharyngitis, kawaski, TSS
diagnostic criteria for kawasaki disease
high fever at least 5 d and 4/5: strawberry tongue, extremity changes, unilateral cervical LAD, rash, conjunctivitis
typical age of onset for kawasaki
15-18 mo
what lab findings support a diagnosis of kawasaki
CBC (WBC elevated, hgb anemia, platelets - thrombocytosis)
iver enzyes (elevated and albumin low)
UA (sterile pyuria
complications of kawasaki
- aseptic meningitis 2. coronary artery aneurysm 3. liver dysfunction 4. arthritis, 5 hydrops of the gallbladder
initial management of kawasaki
ivig 2g/kg, asprin, echo and ec
HSV-1
causes gingivostomatitis and sometimes fever and malaise
Enterovirus
fever, tender vesicles on hands and feet and oral ulcers (cocksackie A)
sandpaperlike rash
group a strep scarlet fever
croup is most common in what age group
2-5 yo
Pertussis course
Catarrhal- 1-2 wks and has URI symptoms
Paroxysmal next 4-6 wks; repetitive, whoop cough
Convalescent- months with episodic cough
CXR asthma
hyperinflation, increased interstitial markings and patchy atelectasis
Tx acute exacerbation
anti-nflammatory therapy with corticosteroids and bronchodilation with B 2 agonists
Tx maintenance therapy asthma
freq symptoms- inhaled corticosteroids with B agonish
CXR bronchiolitis
hyperinflation, increased interstitial markings, peribronchial cuffing and scattered atelectasis
most common bacterial pneumonia neonate
GBS, E coli and Klebsiella
pneumonia at 4-12 wks suspect
chlamydia
school aged children bacterial pneumo
M pneumoniae then S pneumoniae
WBC findings in viral vs bacterial pneumo
Viral nml or slightly elevated
Bacterial- usually elevated with neutrophilic predominance
tx croup
supportive (humidified air or mist) if severe aerosolized epi or oral or IM dexamethasone
mono vs polyphonic wheeze
poly- multiple pitches and typical of asthma
Mono- typical of focal airway obstruction
chronic cough over how many weeks
4
Dry cough ddx
environmental irritant, asthma, fungal infection
Barking cough ddx
croup, subglottic disease, and foreign body
paroxysmal cough ddx
pertussis, chlamydia mycoplasma, foreign body
coughs worse at night
asthma and sinusitis
possible indication for change in voice in school age child with cough
laryngeal irritation due to chronic rhinitis or GERD
possible indication for chest pain in school age child with cough
GERD rarely myocardiits d/t infection
most common radiographic finding in ifants and children wih TB
hilar adenopathy although not present in 50%
allergic shiners
darkening of lower eyelids as a result of venous stasis
dennie morgan lines
infraorbital creases tha apear due to intermittent edema caused by allergies
tracheal deviation
pneumothorax or foreign body aspiration
retractions
asthma, bronchiolitis or foreign body
accessory muscle use
sign of significant respiratory distress
decreased inspiration time to expiration
obstructive disorders
general cause of wheezing
intraluminal obstruction and external compression
rhonchi
due to mucus secretions in airways
at what age are kids able to do spiromatry
5
rare but potential side effects of log term asthma therapy
elevated BP, monitor sugar and grwoth delay and cataracts
speech dev for an 18 mo
6 words
onset of otitis media
3-5 days after onset URI
bacterial pneumonia presentation
abrupt onset of high fever, productive cough, ill appearing and sometimes chest pain
viral pneumonia presentation
moderate fever, nonproductive cough and gradual onset of upper respiratory symptoms
sinusitis presentation
symptoms persistent > 10 d worsening or severe (fever >39)
bacterial organisms in AOM in order of frequency
S pneumo, H fluu, Moraxella catarrhalis, and S pyrogenes
visual reinforcement audiometry
evaluates 6 mo-2.5 yo hearing
which sinuses are large enough to become infected in infants
maxillary and ethmoid
Diagnosis DKA
a random blood glucose >200, a venous pH <7.3 or serum bicarb <15; moderate or large ketonuria or ketomenia
Early management of DKA
insulin drip after patient has received about 1 hour of fluid resuscitation
what should you suspect in a patient presenting with vomiting, wt loss, dehydration, SOB, abdominal pain or change in level of consciousness
DKA
signs of cerebral edema
headache, recurrence of vomiting, bradycardia, htn, decreased O2 sat, reslessness, lethargy, CN palsy, abn pupil responses,
admission orders for patient in DKA
monitor vitals, hourly neuro, ins and outs insulin drip until acidosis resolves, serum glucose q1 hr, check serum pH q1, urine dipstick for ketones
which pediatric patients should be screened for TIIDM
Overweight plus any two: maternal hx or gestation, FH in 1st or 2nd degree, race, signs of insulin resistance
how often should kids at increased risk for TIIDM be screened
fasting glucose plasma at 10 yo or puberty onset and then every 3 yrs
presentation of appendicitis in peds
often lacks migration of pain to RLQ, negative rovsing’s sign, and involuntary guarding and fever without perforation. Often worse with movt or coughing
Cushings triad
htn, bradycardia, and irregular respirations indicates increased ICP
kussmaul breathing
deep breaths that may be rapid, normal or slow associated with metabolic acidosis
Differential for limp or refusal to walk
leukemia, osteromyelitits, reactive arthritis, septic arthritis, transient synovitis, trauma, JIA, slipped capital femoral epiphysis, Legg calve-perthes disease
osteomyelitis is most often caused by
S aureus
peak age for transient synovitis
3-8 years
presentation of transient synovitis
acute onset without significant constitutional symptoms oftern following a viral URI
most common hip disorder in adolescents
slipped capital femoral epiphysis
presentation of slipped capital femoral epiphysis
months of vague hip or knee symptoms and limping
how do you diagnose slipped capital femoral epiphysis
plain film showing posterior displacement of the femoral head
who is most often affected by legg calve perthes disease
boys btw 4 and 10
presentation of legg calve perthes
indolent or chronic pain
developmental dysplasia of the hip
group of conditions in infants where the femoral head is not properly aligned with the acetabulum
Risk factors DDH
female, breech and FH
characteristics of synovial fluid in septic arthritis
turbid, increased WBC predom polymorphs, gram stain positive for bacteria
most common organisms for septic arthritis
S aureus, Strep, H flu, N gonorrhea, Kngellakingae (children <4)
tx septic arthritis
empiric IV antibiotic
tx transient synovitis
rest and Ibuprofen
difficulty breathing, respiratory distress and diaphorisis in 2 wk old
CHF, respiratory infection, sepsis and metabolic disorder
