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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
Q

OI dx

A

Labs: Biochemic test: Type 1 collagen

Vit D, phosph, alk phos may be normal or elevated with recent fracture

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26
Q

OI dx

A

Hypercalcemia is common and relates to severity

Think of all the Calcium leaving the bones- into the blood

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27
Q

Meds for OI

A

Pamidronate(Biphosphonate)

IV infusion, extensive
Risk: hypoCa2+, necrosis of jaw, Nephrotoxic

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28
Q

Dx of OI can be with:

A

biochemical testing of collagen

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29
Q

Buzz words for OI

A

Blue sclera
Wormion bones
Codfish vertebrae
progressive hearing loss

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30
Q

Marfan synd

A

FBN1 mutation: connective tissue protein

A. Dominant

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31
Q

Marfan

tall, thin, inc arm span

A

Scoliosis
Arachnodactylyl*
Pectus deformity
Hypermobile joints with laxity

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32
Q

Two main clinical from Marfan

A

Arachnodactylyl

Hypermobile joints

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33
Q

Marfan synd

A

Cardiac:
*AORTIC RUPTURE risk

Mitral valve prolapse

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34
Q

Marfan synd

A

preD to spontaneous Pneumothorax

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35
Q

Marfan syn

A

Eye: myopia (nearsightedness), lens subluxation/ dislocation

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36
Q

Marfan synd dx

A

CVS or amniocentesis

DNA testing: defective gene

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37
Q

Marfan synd dx

A

Echo/ECG: routine eval and monitoring*

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38
Q

Marfan synd tx

A

Beta blockers**

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39
Q

FBN1 gene

A

Marfan synd

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40
Q

Key concerns for Marfan

A

Aortic diss
Pneumothorax
Ectopia lens

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41
Q

Prader Willi synd

A

Chromosome 15- long arm

absence of paternal gene expression

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42
Q

PWS

A

absence of Paternal gene expression

Hypoth or Pit dysfx- primary central Growth Hormone deficiency

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43
Q

PWS

A

occur spontaneously

most common syndromic form of obesity

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44
Q

PWS and genetic imprinting

A

expression of gene depends on gender of parent donating this gene

LOSS OF PATERNAL

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45
Q

PWS

A 
Paternal deletion or
Maternal disomy (more autistic behavior, less distinct features)
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46
Q

PWS

A

no father chromo information on chromo 15

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47
Q

PWS clinical

A 
almond shaped eyes
traingular mouth
narrow forehead
smaller hands and feet
depigmentation
(subtle)
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48
Q

PWS clinical

A

hypogonad
sterile
Intellectual disability
increased risk Osteoporosis

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49
Q

PWS

A

behavorial, intellectual
food seeking
developmental delay

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50
Q

PWS classic *****

A

Infants: profound hypotonia (LOW TONE)
Failure to thrive, feeding difficulty

Then in early childhood: Hypophagia (overeat) and weight gain, bing eating

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51
Q

PWS dx

A

Molecular genetic test (methylation analysis)

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52
Q

PWS tx limited

A

Replace HGH and testosterone/estrogen

+ other common sense

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53
Q

PWS complications

A

Diabetes, Heart dz, Stroke
Sleep apnea
Joint wear and tear
Pyschological

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54
Q

Fragile X

A

Most common inherited INTELLECTUAL disability
(Screen young M with intellectual concern)

More common/severe in Males

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55
Q

Fragile X

A

X linked recessive

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56
Q

Fragile X

A 
INTELLECTUAL impairment
Developmental delay
Autistic behavior
Inability to cope w transition
Hyperactive
Anxiety
Behavior tantrum
Seizure
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57
Q

Fragile X clinical

A 
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
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58
Q

Fragile X dx

A

CGG repeated in FMR1 gene

Pre-mutations: primary ovarian insuff (FXPOI)
Tremor/ataxia synd (FXTAS)

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59
Q

Fragile X tx

A 
Multidisc
Echocardiogram
MRI - seizures
GERD- meds and therapy
PT, OT, speech, Education (IEP) plan
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60
Q

DiGeorge synd

A

deletion on chromo 22

Autosomal Dominant

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61
Q

DiGeorge synd triad

A

Cardiac abnormality
Thymus- T cell deficiency
Low Ca2+

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62
Q

DiG synd partial vs complete

A

depends on how much thymus fx they have –> immunity

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63
Q

Cardiac effects of DiG

A

Severe: cyanosis, HF, failure to thrive, resp distress

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64
Q

Thyroid effects of DiG

A

thymus absent in complete

IMMUNODEFICIENT

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65
Q

Calcium of DiG

A

hypocalcemia d/t underdeveloped Parathyroid

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66
Q

DiG sx

A 
Palatal defects-cleft *
GU abn*
Recurrent infection*
Developmental/intellectual
behavioral
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67
Q

DiG dx

A

Decreased CD3 T cells +

clinical findings

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68
Q

Initial eval of DiG

A

Urgent echo
Labs: CBC w/ diff showing Ca, Phosph, T, B cells
Renal US
CXR: “thymic shadow”

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69
Q

DiG tx

A

Cardiac possible surgery
Speech, behavior
CAUTION w LIVE VACCINES

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70
Q

Complete DiG

A

Life exp <1YO without treatment

Thymic transplant
HCT (stem cell transplant)

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71
Q

47XXY

A

Klinefelter
microorchidism
gynecomastia

mild language delay/ learning dis

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72
Q

Klinefelter

A

Testosterone low, FSH and LH high (d/t lack of neg fdbck)
infertility

Speech therapy and counseling

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73
Q

Turner synd

A

45 XO
higher risk of X linked recessive disorders
(like hemophilia)

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74
Q

Turner synd

A

short stature
Webbed neck
broad chest/shield chest
lymphedema on infants

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75
Q

Turner synd

A

Cardiac: COARCATATION OF AORTA

and bicuspid AV, HTN

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76
Q

Turner synd

A

Cubitus Valgus (wide carrying angle)
GU: streaked and underdeveloped
Amenorrhea

Renal: Horseshoe kidney

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77
Q

Turner synd tx

A

In vitro Fertilization IVF
Estrogen therapy
Monitor for gonadal malignancy (streaked gonads)

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78
Q

Tri 13: Patau

A

defect of Prechordial mesoderm
midline Craniofacial, eyes, forebrain

quite severe

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79
Q

Tri 13: P

A

Cleft lip
sloping forehead
MSK: hypotonia
“rocker bottom”

Majority die in utero

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80
Q

Tri 13:P

A

if survive birth, most die by 1 mo of age

aggressive surgery may get to 2 YO

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81
Q

Tri 18: Edwards

A

more common Female 3:1

low birth weight
HYPERTONIA, spasticity

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82
Q

Tri 18: Edwards

A

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

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83
Q

Tri 21

A

Most comm chromo abn
Cognitive imp and develop delay vary

Risk w advanced maternal age

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84
Q

Tri 21

A 
Flat nasal bridge
"Brushfield spots"
large protruding tongue
short neck
narrow palate
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85
Q

Tri 21

A 
Cataracts
hearing imp
abn teeth
CHD: AVSD, VSD
50% of has CHD
Pulm HTN
sleep apnea
GI: Hirchsprung, Celiac, chronic constipation
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86
Q

Tri 21

A

Hypotonia
Atlanto-axial instability
Short hands
Transverse Palmar crease- straight across hand

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87
Q

Tri 21

A

Behavioral: autistic, ADHD, agressive

Thyroid, dermatologic, obesity, Alzheimers, leukemia, seizures

88
Q

Tri 21

A

Cardiac***
Hearing, vision, ortho, endocrine, GI
PT, OT, speech, feeding

89
Q

All women should be offered Aneuploidy screening by

A

20 weeks gestation

90
Q

Prenatal counseling

A

60-70% cases of Tri 21 diagnosed on prenatal

61-93% then terminated pregnancy following dx

91
Q

Critical components of hx with Head Injury:

A 
Witnessed fall
Height of fall
Immediate cry
Consolable
Vomiting
Time since injury
Arousable (nap time?)
Size of mass
Other injuries
92
Q

Primary survey of Head Injury

A

ABCs (airway, breathing, circulation)
Neuro status (GCS)
-pupils, sucking, muscle tone
Vital signs

93
Q

GCS= Glasgow Come Scale

A

3-5: poor prognosis
>8 pretty good/ full chance of recovery
in b/w that: iffy

94
Q

Cushing’s triad of Vital signs

head injury

A

Wide pulse pressure
Bradycardia
Abnormal respirations

95
Q

Secondary survey of Head Injury

A

Head/neck and

Rest of body

96
Q

Primary survey 3 components

A

ABCs
Neuro status
Vital signs

97
Q

Secondary survey of head injury: head/neck

A

C-spine alignment
Funduscopic (eye)
Hematomas, step offs, crepitus, lacerations, fontanels
Basilar skull fracture (battle sign, raccoon eyes, hemotympanum, ororrhea/rhinorrhea (CSF))

98
Q

X Ray for Head injury?

A

Minimal value (no brain visualization)
Bony injury
Air fluid level in sinus

99
Q

CT head injury?

A

High dose of radiation, therefore not indicated for low-risk pts

100
Q

When to order CT?

A 
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
Q

Subdural Hematoma (BAD)

A

B/w Dura and Arachnoid membrane
-diffuse, oozing blood
-tearing of bridging veins
Sx: LOC, irritable, lethargy, vomiting, bulging fontanelle

102
Q

CT of Subdural Hematoma (BAD)

A

Crescent

Crosses suture lines

103
Q

Epidural Hematoma (better prognosis)

A

B/w dura and skull
-rupture of arteries
Sx: brief LOC, lucid period, followed by DETERIORATION

104
Q

CT of Epidural Hematoma (better prognosis)

A

Elliptical shape

Does NOT cross suture

105
Q

Subarachnoid Hemorrhage (SAH)

Most common bleed

A

Inj to parenchymal and subarachnoid vessels

Sx: RANGE from normal –> LOC

106
Q

CT of Subarachnoid Hemorrhage (SAH)

most common

A

“Slivers”

Blood is in cisterns, sulci, and fissures

Blood in CSF

May take time to show up on CT

107
Q

Management if NO intracranial hemorrhage and NO skull fracture

A

Precautions
Monitor for: behavior change, vomiting, decreased arousability, seizure, irritability

Sleeping is OK
if concerned, wake up every 2-3 hrs

108
Q

Management if + Intracranial hemorrhage (with or without skull fracture)

A

Neuro consult
Admit to PICU (evaluation and surgery) VS
Observation with repeat imaging

109
Q

Concussion

A

Direct blunt force –> Stretching/shearing of axons

110
Q

ACE:

regarding concussions

A

Acute Concussion Evaluation tool

111
Q

Concussion tx

A

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
Q

Concussion progress

A

HA, foggy, other mild sx tend to resolve in 7-10 days

Post concussive synd: lasting 3 mo or longer

113
Q

Emergent changes after a concussion is diagnosed

A

Severe, prolonged, or worsening HA, vomiting, or deterioration in mental status

114
Q

2nd impact syndrome

A

2nd concussion w/in weeks –> brain swelling, herniation, death

*children at increased risk

115
Q

Chronic Traumatic Encephalopathy

A

Multiple concussions

Permanent change in mood, behavior, pain

116
Q

Cervical spine injuries

A

extremely rare in peds

117
Q

Cervical spine injury <8YO

A

C2-C4

d/t falls

118
Q

Cervical spine injury

>8YO

A

C5-C7

d/t sports

119
Q

Teens more commonly have SCIWORA

A

Spinal cord injuries without radiographic abnormalities

120
Q

Test of choice for spinal cord injury

A

MRI

121
Q

Sx concerning for a spinal cord injury

A

Bilateral pain
Neuro def
Torticollis
Bony abnormality

122
Q

Subdural (BAD)

A

Crescent shaped

Crosses suture line

123
Q

Epidural (better prognosis)

A

Does not cross
Elliptical shape
(think elliptical machine is easy and nice on joints)

124
Q

Fracture management

A

ALWAYS doc neurovascular status before and after manipulation/splinting/etc

125
Q

Open fracture (Compound)

A

Splint/dress
Start IV Abx
Ortho consult

126
Q

Open fracture (non-displaced) with overlying laceration

A

Start PO Abx
Repair lac
Splint
Outpatient ortho f/u

127
Q

Open fracture (grossly deformed/displaced)

A

Will require open/closed reduction, possible fixation

Ortho consult in ED

128
Q

Osteomyelitis

A

most often spread from blood, leading to bone destruction

129
Q

Osteomyelitis is most common in

A

<5YO
Males
Long bones

130
Q

Most common pathogens causing Osteomyelitis

A

Staph Aureus (possible MRSA)
Strep PNA
Strep Pyogenes

131
Q

Osteomyelitis

A

obvious sx
focal tenderness

Dx: X Ray
Bone destruction with lytic lesions shows up 10-14 days later

132
Q

Osteomyelitis best study for evaluation

A

MRI

marrow edema, abscesses

133
Q

Labs to order to Osteomyelitis

A

CBC, CRP, ESR, Lactic acid, Wound culture, blood culture

134
Q

Tx for Osteomyelitis

A

IV Empiric Abx
(Vanoc, Clinda, Rocephin)

Surgical drainage, debridgement, Hyperbaric oxyge therapy

135
Q

Poision control #

A

1-800-222-1222

136
Q

Meds that are deadly in a dose to Peds

A 
ASA
B-blocker
CCB
Camphor
Chloroquine
Clonidine
Iron
Lindane
Methyl Salicylate
Methadone
Nicotine
Oils
Theophyline
Tricyclic Antidep
137
Q

Presentation of Anticholinergic poisoning (Antimuscarinic rhyme)

“hot as a hare, dry as a bone, red as a beet, blind as a bat”

A 
Delirium
Flushed skin
Dilated pupils
Urinary retention
Dec bowel sounds
Memory loss
Seizure
138
Q

Vital signs with Anticholinergic poision

A

Tachycardia
Hyperthermia
HTN

Everything HIGH

139
Q

Examples of Anticholinergics

A 
Antihistamine
Scopolamine
Jimson weed
Angel trumpet
Benztropine
Tricylclic antidep
Atropine
140
Q

Cholinergic poisoning sx

A 
Confusion
weakness
salivation
lacrimation
defecation
emesis
diaphoresis
muscle twitch
miosis
seizures

OPP of Antimuscarinic

141
Q

Cholinergic poisoning vitals

A

Brady cardia
Hypothermia
Tachypnea

LOW everything except fast breathing

142
Q

Cholinergic poisoning examples

A

Organophosphates
Carbamates
Mushrooms

143
Q

Hallucinogenic poison sx

A 
Disorientation
panic reaction
moist skin
hyperactive bowel
seizure
144
Q

Hallucinogen vital signs

A

Tachycardia
Tachyppnea
HTN

Everything HIGH

145
Q

Hallucinogen examples

A

Amphetamines
Cannabinoids
Cocaine
PCP

146
Q

Opiate/Narcotic poisoning sx

A

AMS
Unresponsive
Miosis
Shock

147
Q

Opiate/Narcotic poison vital signs

A 
Shallow respiration
Slow resp rate
Bradycardia
Hypothermia
Hypotension

Everything LOW

148
Q

Opiate examples

A

Opiate
Propoxyphene
Dextromethorphan

149
Q

Sedative/hypnotic poison sx

A 
Coma
stupor
confusion
sedation
progressive CNS deterioration
150
Q

Sedative/hypnotic vital signs

A

APnea

151
Q

Sedative/Hypnotic examples

A

Barbiturates
Benzos
Ethanol
Anticonvulsants

152
Q

Symphatomimetics (symp like sx) poisoning presentation

A 
Delusion
Paranoid
diaphoresis
Piloerection
Dilated eyes
Hyperreflexia
Seizures
Anxiety
153
Q

Symphathomimetics Vitals

A

Tachycardia OR
Bradycardia (if pure a-agonist)
HTN

154
Q

Symphathomimetics examples

A 
Cocaine
Amphetamine
Phenylpropano
Lamine
Ephedrine
Pseudoephedrine
Albuterol
Mahuang
155
Q

Treatment of poisioning

ABC-DDD

A

ABC
Contact poison center
DDD- Disability, Drugs, Decontaminate

156
Q

Acetaminophen antidote

A

Acetylcysteine

157
Q

Anticholinergic antidode

A

Physostigmine

158
Q

Benzo antidote

A

Flumazenil

159
Q

Beta blocker antidote

A

Glucagon

160
Q

Digoxin antidote

A

Digibind

161
Q

Ca Channel blocker antidote

A

Ca

162
Q

Heavy metal antidote

A

Chelating agent

163
Q

Opoids (narcotics) antidote

A

Nalaxone (Narcan)

164
Q

Where to start if you don’t know what is causing the poison

A

Acetaminophen level**
CMP, coag, ABCs
Cardiac monitor
Administer antidotes empirically

165
Q

Where do things usually get stuck with FBI? narrow spaces

A

Cricopharyngeal narrowing- upper esoph sphincter
Tracheal bifurc
Aortic notch
Lower esoph sphincter

166
Q

Once object passes Pylorus,

A

usually continues to Rectum without issues

167
Q

FB lodged in esophagus

A

Concerns: Airway obstruction
Stricture
Perforation with resulting complications

168
Q

Aspirated veggie matter

A

can –> intense Pneumonitis, often diff to remove

169
Q

Presentation of Esoph FB

A 
Refusing to eat
Vomiting, choking, cough, stridor
Neck/throat pain
Unable to swallow
Inc salivation
FB sensation in chest
170
Q

Phys Exam finding for FB in esophagus

A 
Red throat
Palatal abrasion
Anxiety
Wheezing
Fever
Peritoneal signs
171
Q

FB workup

A 
Patency of airway
X Ray (negative does not r/o)
172
Q

Tx for Removing FB

A

Esophagus- Endoscopy

Trachea- Bronchoscopy

173
Q

When to consult for FB?

A 
Sharp/elongated object
Multiple FB (magnets)
Button battery
Perforation
FB > 24 hrs
Airway compromise
Crico-pharyng level (depends where it is)
174
Q

Above Crico-pharyng

A

ENT

175
Q

Below Crico-pharyng

A

GI

176
Q

Below esophageal sphincter?

A

leave it

177
Q

Button battery

A

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
Q

Esoph BB

EMERGENCY bc

A

Burn: 4 hrs
Perforation: 8 hrs

179
Q

Button battery

What type is worst?

A

LITHIUM

180
Q

Mercuric oxide batteries

A

can fragment

181
Q

If cell (battery?) is observed to split in GI tract,

A

Blood and urine mercury levels should be measured

182
Q

Button ingestion, call

A

National Button Batter Ingestion Hotline

1-202-625-3333

183
Q

Tx of Button Battery

A

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
Q

Most drowning victims aspirate only

A

<4 mL of liquid

185
Q

Peak incidence for drowning

A

<4YO
OR
15-24 YO

186
Q

2 primary concerns related to impaired ventilation (drowning)

A

Hypoxemia

Acidosis

187
Q

CNS damage from hypoxemia (d/t drowning) can lead to:

A

Arrhythmia
Ongoing pulm injury
Reperfusion injury
Multi-organ dysfx

188
Q

“Wet drowning”

Fresh OR salt water

A

More common
Aspiration of water into lungs

Dilution/washout of surfactant–> diminished gas exchange –> Atelectasis (lung collapse)–> V/q mismatch

189
Q

“Dry drowning”

no fluid in lungs

A

Laryngospasm –> Hypoxia–> LOC

190
Q

Near drowning

survival >24 hours post event

A

Severe brain damage in 10-30%

191
Q

Near drowning sx at presentation

A

Alert or mildly obtunded
MAY exp full recovery
OR
Comatose, receiving CPR en route, fixed and dilated pupils and no spontaneous respirations

192
Q

Near drowning,

comatose and no spontaneous respiratoisn

A

very poor prog
30-60% will die
60-100% exp long term neuro damage

193
Q

Near drowning, consider child abuse if

A

<6 mo

194
Q

Secondary drowning

A 
Seizure
Head/spine trauma
Cardiac arrhyth
Hypothermia
Alc/drug ingestion
Syncope
Apnea
Hyperventilation
Hypoglycemia
Suicide
195
Q

Secondary drowning

A

Death up to 72 hours (3 days) after near drowning

196
Q

Secondary drowning causes

Fresh water

A

Hemodilution primarily from ingested water

If large enough volume of water aspirated: Significant hemolysis
Cardiac arrhythmia

197
Q

Tx of drowning

A

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
Q

When to repeat CXR after initial one obtained after drowning

A

in 6 hours

199
Q

Prognosis of drowning bad

A

Under water >5 mintues= MOST CRITICAL FACTOR

200
Q

Prognosis of drowning bad

A

Time to effective BLS >10 minutes

201
Q

Prognosis of drowning bad

A

Resusc duration >25 min

202
Q

Prognosis of drowning bad

A

Age >14 YO

younger respond better

203
Q

Prognosis of drowning bad

A

<5 (comatose)

204
Q

Prognosis of drowning bad

A

Persisent apnea, require cardiopulm resusc in ED

205
Q

Prognosis of drowning bad

A

Arterial blood pH <7.1 at presentaiton

206
Q

Fever without source

A

Rectal temp >101
38.3 C
(typically 5-8 days)

207
Q

Goal with fever of unknown origin

A 
ID sketchy systemic bacterial infections:
PNA
UTI
Bacteremia
HHV 6 (roseola infantum)
Meningitis
208
Q

If no identifiable source through Hx and PE

A

Septic workup

209
Q

Septic workup based on

A 
Age 
<3 mo: neonate
3mo-3 yr: infant and young kid
Appearance
Risk factors (birth hx, travel, exposure, vaccination, immune status)
210
Q

Infants <3 mo with fever of unknown origin

A

temp >38.3 C
Risk of incidence of serious bacterial infection
WORKUP REGARDLESS OF APPEARANCE

211
Q

Group B strep is associated with Meningitis

A

5-10% of the time

212
Q

Neonatal fever

<3mo

A

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
Q

Fever in infants and young kids

3mo-3yr

A

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
Q

When to get CXR for ill appearing 3mo-3yo

A

If tachypnea or

Leukocytosis >20k

215
Q

Management of Fever in 3mo-3yo in Well Appearing BUT not UTD on Immunizations

A

CBC w diff
Blood cultures (if WBC >15k)
UA
CXR (if leukocytosis >20k)

216
Q

Management of Fever in 3mo-3yo if Well Appearing AND UTD on immunizations

A

UA and culture

If fever and abnormal UA, tx for UTI

Quarter 3 (17 decks)

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