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Quarter 3 > Peds Exam 2 > Flashcards

Peds Exam 2 Flashcards

1
Q

distance b/w adult maxillary inter-canines

A

2.5-3 cm

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2
Q

Orofacial injuries

A

common in child abuse, up to 50% abused children

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3
Q

Fractures of high suspicion

A 
Rib fx <1 YO
Long bone fx in non-walking
Sternum/scapular or spinal fx
Multiple fx in various stages of healing
Depressed skull fx
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4
Q

Two most common child abuse fractures

A

Metaphyseal lesions of long bone

Rib fracture

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5
Q

Seeking care after UNINTENTIONAL head injury

A

Localized swelling
Lethargy
Concern for children who were asymptomatic

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6
Q

Seeking care after CHILD ABUSE head trauma

A

Breathing diff
Apnea
Seizure
Lifelessness

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7
Q

Epidural hemorrhage

A

Accident

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8
Q

Subdural hemorrhage

A

Abuse or past abuse

Requires more force

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9
Q

Subarachnoid hemorrhage

A

All types

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10
Q

Retinal hemorrhage

A

If abuse: usually see MANY hemorrhages

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11
Q

Skull trauma

A

Suspect abuse if: fracture is more complex and depressed

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12
Q

Salicylate (ASA) overdose

A 
Diffuse bruising
Tachypnea
Hyperthermia
Tachycardia
Hypotension
Vomiting
*CHECK plasma salicylate
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13
Q

Mongolion spot

A

African american, Asian, Hispanic
Lower back/buttocks
Abscence of swelling or tenderness
Fade over mo-yrs rather than days

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14
Q

Vasculitis

A

Purpuric rash;lesions d/t breakdown of vascular walls

HSP- usually LE, arthralgia, abd pain

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15
Q

Osteogenesis imperfecta

A

Genetic disorder resulting in brittle bones

prone to repeated fx

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16
Q

Phytophotodermatitis

A

Burn-like skin lesion when sun interacts w certain fruits/veggies (lemons, oranges, celery, figs)

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17
Q

Congenital pain insensitivity

A

child doesn’t feel pain and/or temperature

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18
Q

Injuries that are likely abuse

A 
Bruise trunk, ear, neck
Bruise in infants who are not cruising
Long bone fx in non-walking
Rib <1 YO
Subdural hematoma <1YO
Hollow viscous <4 YO
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19
Q

Lab studies to order in Child Abuse case

A 
Coag
CBC w/diff
CMP
Amylase
UA
Toxicology
Stool gauc
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20
Q

Child abuse CTs

A

All are WITH contrast besides Skull

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21
Q

Osteog Imperfecta
“Brittle bone dz”
OI

A

A. Dominant

Type 1 collagen

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22
Q

OI

A

Type 1: mild, most common
Type 2: most severe (prenatal lethal)
Type 3-9: variable

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23
Q

OI clinical

A 
excessive/atypical fractures
BLUE SCLERAE
short stature, bowlegs
Scoliosis/kyphosis- breathing diff
Hearing loss
Opalescent teeth
Ligament/skin laxity
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24
Q

OI dx

A

“Wormion bones”
“Codfish vertebrae “

fractures at various stages of healing

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25
OI dx
Labs: Biochemic test: Type 1 collagen | Vit D, phosph, alk phos may be normal or elevated with recent fracture
26
OI dx
Hypercalcemia is common and relates to severity Think of all the Calcium leaving the bones- into the blood
27
Meds for OI
Pamidronate(Biphosphonate) IV infusion, extensive Risk: hypoCa2+, necrosis of jaw, Nephrotoxic
28
Dx of OI can be with:
biochemical testing of collagen
29
Buzz words for OI
Blue sclera Wormion bones Codfish vertebrae progressive hearing loss
30
Marfan synd
FBN1 mutation: connective tissue protein | A. Dominant
31
Marfan tall, thin, inc arm span
Scoliosis Arachnodactylyl* Pectus deformity Hypermobile joints with laxity
32
Two main clinical from Marfan
Arachnodactylyl | Hypermobile joints
33
Marfan synd
Cardiac: *AORTIC RUPTURE risk Mitral valve prolapse
34
Marfan synd
preD to spontaneous Pneumothorax
35
Marfan syn
Eye: myopia (nearsightedness), lens subluxation/ dislocation
36
Marfan synd dx
CVS or amniocentesis | DNA testing: defective gene
37
Marfan synd dx
Echo/ECG: routine eval and monitoring*
38
Marfan synd tx
Beta blockers**
39
FBN1 gene
Marfan synd
40
Key concerns for Marfan
Aortic diss Pneumothorax Ectopia lens
41
Prader Willi synd
Chromosome 15- long arm | absence of paternal gene expression
42
PWS
absence of Paternal gene expression Hypoth or Pit dysfx- primary central Growth Hormone deficiency
43
PWS
occur spontaneously | most common syndromic form of obesity
44
PWS and genetic imprinting
expression of gene depends on gender of parent donating this gene LOSS OF PATERNAL
45
PWS
``` Paternal deletion or Maternal disomy (more autistic behavior, less distinct features) ```
46
PWS
no father chromo information on chromo 15
47
PWS clinical
``` almond shaped eyes traingular mouth narrow forehead smaller hands and feet depigmentation (subtle) ```
48
PWS clinical
hypogonad sterile Intellectual disability increased risk Osteoporosis
49
PWS
behavorial, intellectual food seeking developmental delay
50
PWS classic *****
Infants: profound hypotonia (LOW TONE) Failure to thrive, feeding difficulty Then in early childhood: Hypophagia (overeat) and weight gain, bing eating
51
PWS dx
Molecular genetic test (methylation analysis)
52
PWS tx limited
Replace HGH and testosterone/estrogen | + other common sense
53
PWS complications
Diabetes, Heart dz, Stroke Sleep apnea Joint wear and tear Pyschological
54
Fragile X
Most common inherited INTELLECTUAL disability (Screen young M with intellectual concern) More common/severe in Males
55
Fragile X
X linked recessive
56
Fragile X
``` INTELLECTUAL impairment Developmental delay Autistic behavior Inability to cope w transition Hyperactive Anxiety Behavior tantrum Seizure ```
57
Fragile X clinical
``` soft smooth skin Macrocephaly large ears long narrow face MSK: joint laxity hypotonia pes planus Strabismus or blue iris Mitral valve prolapse Macro-orchidism after puberty ```
58
Fragile X dx
CGG repeated in FMR1 gene Pre-mutations: primary ovarian insuff (FXPOI) Tremor/ataxia synd (FXTAS)
59
Fragile X tx
``` Multidisc Echocardiogram MRI - seizures GERD- meds and therapy PT, OT, speech, Education (IEP) plan ```
60
DiGeorge synd
deletion on chromo 22 | Autosomal Dominant
61
DiGeorge synd triad
Cardiac abnormality Thymus- T cell deficiency Low Ca2+
62
DiG synd partial vs complete
depends on how much thymus fx they have --> immunity
63
Cardiac effects of DiG
Severe: cyanosis, HF, failure to thrive, resp distress
64
Thyroid effects of DiG
thymus absent in complete | IMMUNODEFICIENT
65
Calcium of DiG
hypocalcemia d/t underdeveloped Parathyroid
66
DiG sx
``` Palatal defects-cleft * GU abn* Recurrent infection* Developmental/intellectual behavioral ```
67
DiG dx
Decreased CD3 T cells + | clinical findings
68
Initial eval of DiG
Urgent echo Labs: CBC w/ diff showing Ca, Phosph, T, B cells Renal US CXR: "thymic shadow"
69
DiG tx
Cardiac possible surgery Speech, behavior CAUTION w LIVE VACCINES
70
Complete DiG
Life exp <1YO without treatment Thymic transplant HCT (stem cell transplant)
71
47XXY
Klinefelter microorchidism gynecomastia mild language delay/ learning dis
72
Klinefelter
Testosterone low, FSH and LH high (d/t lack of neg fdbck) infertility Speech therapy and counseling
73
Turner synd
45 XO higher risk of X linked recessive disorders (like hemophilia)
74
Turner synd
short stature Webbed neck broad chest/shield chest lymphedema on infants
75
Turner synd
Cardiac: COARCATATION OF AORTA and bicuspid AV, HTN
76
Turner synd
Cubitus Valgus (wide carrying angle) GU: streaked and underdeveloped Amenorrhea Renal: Horseshoe kidney
77
Turner synd tx
In vitro Fertilization IVF Estrogen therapy Monitor for gonadal malignancy (streaked gonads)
78
Tri 13: Patau
defect of Prechordial mesoderm midline Craniofacial, eyes, forebrain quite severe
79
Tri 13: P
Cleft lip sloping forehead MSK: hypotonia "rocker bottom" Majority die in utero
80
Tri 13:P
if survive birth, most die by 1 mo of age aggressive surgery may get to 2 YO
81
Tri 18: Edwards
more common Female 3:1 low birth weight HYPERTONIA, spasticity
82
Tri 18: Edwards
Majority die in utero, more likely to survive birth 50% die w/in 2 weeks only 5% survive past 1 yr Severe intellectual dis if make it to 5 YO
83
Tri 21
Most comm chromo abn Cognitive imp and develop delay vary Risk w advanced maternal age
84
Tri 21
``` Flat nasal bridge "Brushfield spots" large protruding tongue short neck narrow palate ```
85
Tri 21
``` Cataracts hearing imp abn teeth CHD: AVSD, VSD 50% of has CHD Pulm HTN sleep apnea GI: Hirchsprung, Celiac, chronic constipation ```
86
Tri 21
Hypotonia Atlanto-axial instability Short hands Transverse Palmar crease- straight across hand
87
Tri 21
Behavioral: autistic, ADHD, agressive | Thyroid, dermatologic, obesity, Alzheimers, leukemia, seizures
88
Tri 21
Cardiac*** Hearing, vision, ortho, endocrine, GI PT, OT, speech, feeding
89
All women should be offered Aneuploidy screening by
20 weeks gestation
90
Prenatal counseling
60-70% cases of Tri 21 diagnosed on prenatal 61-93% then terminated pregnancy following dx
91
Critical components of hx with Head Injury:
``` Witnessed fall Height of fall Immediate cry Consolable Vomiting Time since injury Arousable (nap time?) Size of mass Other injuries ```
92
Primary survey of Head Injury
ABCs (airway, breathing, circulation) Neuro status (GCS) -pupils, sucking, muscle tone Vital signs
93
GCS= Glasgow Come Scale
3-5: poor prognosis >8 pretty good/ full chance of recovery in b/w that: iffy
94
Cushing's triad of Vital signs | head injury
Wide pulse pressure Bradycardia Abnormal respirations
95
Secondary survey of Head Injury
Head/neck and | Rest of body
96
Primary survey 3 components
ABCs Neuro status Vital signs
97
Secondary survey of head injury: head/neck
C-spine alignment Funduscopic (eye) Hematomas, step offs, crepitus, lacerations, fontanels Basilar skull fracture (battle sign, raccoon eyes, hemotympanum, ororrhea/rhinorrhea (CSF))
98
X Ray for Head injury?
Minimal value (no brain visualization) Bony injury Air fluid level in sinus
99
CT head injury?
High dose of radiation, therefore not indicated for low-risk pts
100
When to order CT?
``` GCS<15 or Acute AMS Sign of skull fracture Vomiting > 3x Seizure < 2 YO Non frontal scalp hematoma LOC >5 sec Severe mechanism Lethargic/not acting right ```
101
Subdural Hematoma (BAD)
B/w Dura and Arachnoid membrane -diffuse, oozing blood -tearing of bridging veins Sx: LOC, irritable, lethargy, vomiting, bulging fontanelle
102
CT of Subdural Hematoma (BAD)
Crescent | Crosses suture lines
103
Epidural Hematoma (better prognosis)
B/w dura and skull -rupture of arteries Sx: brief LOC, lucid period, followed by DETERIORATION
104
CT of Epidural Hematoma (better prognosis)
Elliptical shape | Does NOT cross suture
105
Subarachnoid Hemorrhage (SAH) Most common bleed
Inj to parenchymal and subarachnoid vessels | Sx: RANGE from normal --> LOC
106
CT of Subarachnoid Hemorrhage (SAH) most common
"Slivers" Blood is in cisterns, sulci, and fissures Blood in CSF May take time to show up on CT
107
Management if NO intracranial hemorrhage and NO skull fracture
Precautions Monitor for: behavior change, vomiting, decreased arousability, seizure, irritability Sleeping is OK if concerned, wake up every 2-3 hrs
108
Management if + Intracranial hemorrhage (with or without skull fracture)
Neuro consult Admit to PICU (evaluation and surgery) VS Observation with repeat imaging
109
Concussion
Direct blunt force --> Stretching/shearing of axons
110
ACE: | regarding concussions
Acute Concussion Evaluation tool
111
Concussion tx
NO SAME DAY return to play Must be completely sx free to return NO SPORTS 1-2 wks No screen time, get sleep, noise reduction for first 48 hours
112
Concussion progress
HA, foggy, other mild sx tend to resolve in 7-10 days Post concussive synd: lasting 3 mo or longer
113
Emergent changes after a concussion is diagnosed
Severe, prolonged, or worsening HA, vomiting, or deterioration in mental status
114
2nd impact syndrome
2nd concussion w/in weeks --> brain swelling, herniation, death *children at increased risk
115
Chronic Traumatic Encephalopathy
Multiple concussions | Permanent change in mood, behavior, pain
116
Cervical spine injuries
extremely rare in peds
117
Cervical spine injury <8YO
C2-C4 | d/t falls
118
Cervical spine injury | >8YO
C5-C7 | d/t sports
119
Teens more commonly have SCIWORA
Spinal cord injuries without radiographic abnormalities
120
Test of choice for spinal cord injury
MRI
121
Sx concerning for a spinal cord injury
Bilateral pain Neuro def Torticollis Bony abnormality
122
Subdural (BAD)
Crescent shaped | Crosses suture line
123
Epidural (better prognosis)
Does not cross Elliptical shape (think elliptical machine is easy and nice on joints)
124
Fracture management
ALWAYS doc neurovascular status before and after manipulation/splinting/etc
125
Open fracture (Compound)
Splint/dress Start IV Abx Ortho consult
126
Open fracture (non-displaced) with overlying laceration
Start PO Abx Repair lac Splint Outpatient ortho f/u
127
Open fracture (grossly deformed/displaced)
Will require open/closed reduction, possible fixation | Ortho consult in ED
128
Osteomyelitis
most often spread from blood, leading to bone destruction
129
Osteomyelitis is most common in
<5YO Males Long bones
130
Most common pathogens causing Osteomyelitis
Staph Aureus (possible MRSA) Strep PNA Strep Pyogenes
131
Osteomyelitis
obvious sx focal tenderness Dx: X Ray Bone destruction with lytic lesions shows up 10-14 days later
132
Osteomyelitis best study for evaluation
MRI | marrow edema, abscesses
133
Labs to order to Osteomyelitis
CBC, CRP, ESR, Lactic acid, Wound culture, blood culture
134
Tx for Osteomyelitis
IV Empiric Abx (Vanoc, Clinda, Rocephin) Surgical drainage, debridgement, Hyperbaric oxyge therapy
135
Poision control #
1-800-222-1222
136
Meds that are deadly in a dose to Peds
``` ASA B-blocker CCB Camphor Chloroquine Clonidine Iron Lindane Methyl Salicylate Methadone Nicotine Oils Theophyline Tricyclic Antidep ```
137
Presentation of Anticholinergic poisoning (Antimuscarinic rhyme) "hot as a hare, dry as a bone, red as a beet, blind as a bat"
``` Delirium Flushed skin Dilated pupils Urinary retention Dec bowel sounds Memory loss Seizure ```
138
Vital signs with Anticholinergic poision
Tachycardia Hyperthermia HTN Everything HIGH
139
Examples of Anticholinergics
``` Antihistamine Scopolamine Jimson weed Angel trumpet Benztropine Tricylclic antidep Atropine ```
140
Cholinergic poisoning sx
``` Confusion weakness salivation lacrimation defecation emesis diaphoresis muscle twitch miosis seizures ``` OPP of Antimuscarinic
141
Cholinergic poisoning vitals
Brady cardia Hypothermia Tachypnea LOW everything except fast breathing
142
Cholinergic poisoning examples
Organophosphates Carbamates Mushrooms
143
Hallucinogenic poison sx
``` Disorientation panic reaction moist skin hyperactive bowel seizure ```
144
Hallucinogen vital signs
Tachycardia Tachyppnea HTN Everything HIGH
145
Hallucinogen examples
Amphetamines Cannabinoids Cocaine PCP
146
Opiate/Narcotic poisoning sx
AMS Unresponsive Miosis Shock
147
Opiate/Narcotic poison vital signs
``` Shallow respiration Slow resp rate Bradycardia Hypothermia Hypotension ``` Everything LOW
148
Opiate examples
Opiate Propoxyphene Dextromethorphan
149
Sedative/hypnotic poison sx
``` Coma stupor confusion sedation progressive CNS deterioration ```
150
Sedative/hypnotic vital signs
APnea
151
Sedative/Hypnotic examples
Barbiturates Benzos Ethanol Anticonvulsants
152
Symphatomimetics (symp like sx) poisoning presentation
``` Delusion Paranoid diaphoresis Piloerection Dilated eyes Hyperreflexia Seizures Anxiety ```
153
Symphathomimetics Vitals
Tachycardia OR Bradycardia (if pure a-agonist) HTN
154
Symphathomimetics examples
``` Cocaine Amphetamine Phenylpropano Lamine Ephedrine Pseudoephedrine Albuterol Mahuang ```
155
Treatment of poisioning ABC-DDD
ABC Contact poison center DDD- Disability, Drugs, Decontaminate
156
Acetaminophen antidote
Acetylcysteine
157
Anticholinergic antidode
Physostigmine
158
Benzo antidote
Flumazenil
159
Beta blocker antidote
Glucagon
160
Digoxin antidote
Digibind
161
Ca Channel blocker antidote
Ca
162
Heavy metal antidote
Chelating agent
163
Opoids (narcotics) antidote
Nalaxone (Narcan)
164
Where to start if you don't know what is causing the poison
Acetaminophen level** CMP, coag, ABCs Cardiac monitor Administer antidotes empirically
165
Where do things usually get stuck with FBI? narrow spaces
Cricopharyngeal narrowing- upper esoph sphincter Tracheal bifurc Aortic notch Lower esoph sphincter
166
Once object passes Pylorus,
usually continues to Rectum without issues
167
FB lodged in esophagus
Concerns: Airway obstruction Stricture Perforation with resulting complications
168
Aspirated veggie matter
can --> intense Pneumonitis, often diff to remove
169
Presentation of Esoph FB
``` Refusing to eat Vomiting, choking, cough, stridor Neck/throat pain Unable to swallow Inc salivation FB sensation in chest ```
170
Phys Exam finding for FB in esophagus
``` Red throat Palatal abrasion Anxiety Wheezing Fever Peritoneal signs ```
171
FB workup
``` Patency of airway X Ray (negative does not r/o) ```
172
Tx for Removing FB
Esophagus- Endoscopy Trachea- Bronchoscopy
173
When to consult for FB?
``` Sharp/elongated object Multiple FB (magnets) Button battery Perforation FB > 24 hrs Airway compromise Crico-pharyng level (depends where it is) ```
174
Above Crico-pharyng
ENT
175
Below Crico-pharyng
GI
176
Below esophageal sphincter?
leave it
177
Button battery
Esophageal Button Battery = TRUE EMERGENCY!!! Extremely rapid action of Alkaline substance on mucose --> pressure necrosis --> residual charge BURNS TO ESOPH in as little as 4 hours perforation in 8 hours
178
Esoph BB | EMERGENCY bc
Burn: 4 hrs Perforation: 8 hrs
179
Button battery | What type is worst?
LITHIUM
180
Mercuric oxide batteries
can fragment
181
If cell (battery?) is observed to split in GI tract,
Blood and urine mercury levels should be measured
182
Button ingestion, call
National Button Batter Ingestion Hotline | 1-202-625-3333
183
Tx of Button Battery
Emergent removal required if in Esophagus If passed esoph: no tx required if asymptomatic UNLESS it has not passed pylorus in 24-48 hours
184
Most drowning victims aspirate only
<4 mL of liquid
185
Peak incidence for drowning
<4YO OR 15-24 YO
186
2 primary concerns related to impaired ventilation (drowning)
Hypoxemia | Acidosis
187
CNS damage from hypoxemia (d/t drowning) can lead to:
Arrhythmia Ongoing pulm injury Reperfusion injury Multi-organ dysfx
188
"Wet drowning" Fresh OR salt water
More common Aspiration of water into lungs Dilution/washout of surfactant--> diminished gas exchange --> Atelectasis (lung collapse)--> V/q mismatch
189
"Dry drowning" no fluid in lungs
Laryngospasm --> Hypoxia--> LOC
190
Near drowning survival >24 hours post event
Severe brain damage in 10-30%
191
Near drowning sx at presentation
Alert or mildly obtunded MAY exp full recovery OR Comatose, receiving CPR en route, fixed and dilated pupils and no spontaneous respirations
192
Near drowning, | comatose and no spontaneous respiratoisn
very poor prog 30-60% will die 60-100% exp long term neuro damage
193
Near drowning, consider child abuse if
<6 mo
194
Secondary drowning
``` Seizure Head/spine trauma Cardiac arrhyth Hypothermia Alc/drug ingestion Syncope Apnea Hyperventilation Hypoglycemia Suicide ```
195
Secondary drowning
Death up to 72 hours (3 days) after near drowning
196
Secondary drowning causes | Fresh water
Hemodilution primarily from ingested water If large enough volume of water aspirated: Significant hemolysis Cardiac arrhythmia
197
Tx of drowning
Pre hospital care is CRITICAL | ED: assisted O2 ventilation, mechanical vent, warm isotonic IV fluids and warming blankets, CXR (repeat in 6 hrs, admit
198
When to repeat CXR after initial one obtained after drowning
in 6 hours
199
Prognosis of drowning bad
Under water >5 mintues= MOST CRITICAL FACTOR
200
Prognosis of drowning bad
Time to effective BLS >10 minutes
201
Prognosis of drowning bad
Resusc duration >25 min
202
Prognosis of drowning bad
Age >14 YO younger respond better
203
Prognosis of drowning bad
<5 (comatose)
204
Prognosis of drowning bad
Persisent apnea, require cardiopulm resusc in ED
205
Prognosis of drowning bad
Arterial blood pH <7.1 at presentaiton
206
Fever without source
Rectal temp >101 38.3 C (typically 5-8 days)
207
Goal with fever of unknown origin
``` ID sketchy systemic bacterial infections: PNA UTI Bacteremia HHV 6 (roseola infantum) Meningitis ```
208
If no identifiable source through Hx and PE
Septic workup
209
Septic workup based on
``` Age <3 mo: neonate 3mo-3 yr: infant and young kid Appearance Risk factors (birth hx, travel, exposure, vaccination, immune status) ```
210
Infants <3 mo with fever of unknown origin
temp >38.3 C Risk of incidence of serious bacterial infection WORKUP REGARDLESS OF APPEARANCE
211
Group B strep is associated with Meningitis
5-10% of the time
212
Neonatal fever | <3mo
Full septic workup ``` CBC w/diff and smear ESR and CRP Blood culture CMP UA w CandS CXR Lumbar Puncture ``` Consider Empiric Abx Trial of NSAIDs Admission pending results
213
Fever in infants and young kids | 3mo-3yr
If ill appearing: Labs UA w CandS Culture: blood, urine, stool, and CSF if meningitis suspected CXR (if tachypnea or Leukocytosis) Parenteral abx Admit
214
When to get CXR for ill appearing 3mo-3yo
If tachypnea or | Leukocytosis >20k
215
Management of Fever in 3mo-3yo in Well Appearing BUT not UTD on Immunizations
CBC w diff Blood cultures (if WBC >15k) UA CXR (if leukocytosis >20k)
216
Management of Fever in 3mo-3yo if Well Appearing AND UTD on immunizations
UA and culture If fever and abnormal UA, tx for UTI

Quarter 3 (17 decks)

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