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ABSN Cohort 19 > Peds Exam 3 > Flashcards

Peds Exam 3 Flashcards

1
Q

4 Types of ▲ in blood flow patterns ♥

A

↑ pulmonary flow
↓ pulmonary flow
Obstruction
Mixed

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2
Q

3 ↑ ♥ pulmonary flow Disorders

A

Ventricular Septal Defect (VSD)
Atrial Septal Defect (ASD)
Patent Ductus Arteriosus (PDA)

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3
Q

VSD S/S and 3 Tx

A

loud harsh murmur on L sternal border

CC, banding, patch

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4
Q

ASD S/S and Tx

A

loud harsh murmur fixed by split second ♥ sound, MAY BE ASYMPTOMATIC
CC, patch

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5
Q

PDA 3 S/S wnth 3 Tx

A

Machine hum murmur, wide BP, bounding pulses

Indomethacin, coil insertion, thoracoscopic rapair

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6
Q

2 ↓ ♥ pulmonary flow Disorders

A

Tetraology of Fallot

Tricuspid Atresia

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7
Q

Tetraology of Fallot 4 included Dz, 2 S/S, and TX

A

pulmonary stenosis
Overriding Aorta
VSD
R Ventricular dystrophy

Cyanosis @ birth, systolic murmur
Shunt w/ surgery

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8
Q

Tricuspid of Atresia What? 2 S/S in infants vs. children. 3 step Tx

A

complete closure of tricuspid valve
infants = cyanosis and dypsnea
children = hypoxemia and clubbing

3 Step surgery (shunt, glenn, fontan)

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9
Q

3 ♥ Obstruction flow Disorders

A

Pulmonary stenosis
Aortic Stenosis
Coarctation of the Aorta

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10
Q

Pulmonary Stenosis 2 S/S. Tx infants vs. children

A

systolic ejection murmur and cyanosis that worsens w/ narrowing
infant - Brocks
children - Valvotomy

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11
Q

Aortic Stenosis 2 S/S infant vs. children and Tx

A

infant = faint pulses and HypoTN
child = dizziness, possible ejection murmur
valvotomy and Norwood

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12
Q

Coarctation of the Aorta 2 S/S

A

↑ BP arms w/ bounding pulses

↓ BP legs w/ cool skin

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13
Q

3 ♥ Mixed blood flow disorders

A

Transposition of Great arteries
Truncus Arteriosus
Hypoplastic Left ♥ Syndrome

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14
Q

Trans. of Great Arteries What? Oxygenation needs? Tx

A

Aorta connect to R vent instead of L
P. artery connect to L vent instead of R
Requires PDA for O2
Surgery w/in 2 weeks life

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15
Q

Truncus Arteriosis What? 3 S/S? Tx

A

Failure of septum formation
Delayed growth, lethargy, poor eating habits
Surgery w/in 1 month life

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16
Q

Hypoplastic Left ♥ Syndrome What? Oxygenation needs? Development of? Tx?

A

Underdeveloped L ♥
ASD and foramen ovale
Mild cyanosis regresses as PDA closes
Norwood, Glenn, and Fontan procedure @ birth

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17
Q

Kawasaki Disease

A

Acute systemi vasculitis w/ fever > 5 days that Ø respond to antipyretics

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18
Q

Kawasaki Disease 3 Types
Acute
Subacute
Convalescent

A

red eyes, rashes, strawberry tongue
irritable w/ peeling skin around nails
ØS/S except abnormal labs (6 - 8 weeks onset)

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19
Q

Kawasaki Disease Labs (4)

A

CBC, CRP, ESR, serum albumin

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20
Q

Kawasaki 2 Dx and Tx (g/kg/time/of fever)

A

Chest Xray and echocardiogram

IVGG (Gamma globulin) 2g/kg/10-12hrs w/in 7 days of fever

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21
Q 
♥ Medications function/look out for..
Digoxin
Captopril/Enalapril
Metoprolol/Carvedilol
Furosemide/Chlorothiaszide
A

↓ HR ↑ contractility, infant hold ↓ 90 HR, child hold ↓ 80 HR
ACE inhibitor, vasodilates to ↓ resistance, Hyperkalemia
Beta Blocker, ↓ HR, ↓ BP, vasodilates, HypoTN
Diuretic, wastes Na. K, H2O, Hypokalemia

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22
Q

♥ Transplant 2 S/S of rejection. Dx with. 2 Medications.

A

Low grade fever and ↑ resting HR
Endomyocardial biopsy
Calcineurin inhibitors and corticosteroids

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23
Q

Infective Endocarditis What? 3 S/S. 2 Dx. 2 Tx.

A

injured endocardium by blood flow infected r/in platlet/fibrin deposition r/in vegetation
diaphoresis
splinter hemorrhages under nails
Osler nodes
Blood culture and tran/esophageal/thoracic endocardiography
Antibiotics and surgery in case of embolism

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24
Q

Rheumatic Fever What? 2 S/S. Dx. Tx

A 
inflammatory dz r/t Group A B-hemolytic Streptococus (GABHS) infection in throat
non-tender nodules over joints
pin rash
antistreptolysin-O titer
chorea safety/education
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25
Hyperlipidemia can r/in 2
atherosclerosis and coronary ♥ dz
26
Blood Disorders in Children (4)
Epistaxis Iron Deficiency Anemia Sickle Cell Anemia Hemophillia
27
Epistaxis What? 3 Tx? If > 30 min?
nose bleed sit up, lean forward. pressure 10 min Possible hemorrhage, seek medical care.
28
Iron Deficiency Anemia cause in children 12 - 36 months (1) vs. adolescents (3
↑ cow's milk intake w/out enough iron | Poor diet, menses, obesity
29
Iron Deficiency Anemia 3 S/S
SoB, pallor, brittle fingernails
30
Expected HH ranges 2 months 6 - 12 years 12 - 18 years (♂/♀)
9 - 14 / 28 - 42 11.5 - 15.5 / 35 - 45 ♂ 13 - 16 / 37 - 49 ♀ 12 - 16 / 36 -46
31
Iron Deficiency Anemia iron supplement timing preterm vs. exclusively breastfed
2 months | 4 months
32
Iron Supplement 5 Notes
1 -2 hrs before milk/antacid prevents malabsoprtion INJ with Z-track Drink via straw for teeth Take w/ VitC/protein
33
Food sources of Iron (7)
cereal, formula, beans, peanut butter, greens, poultry, red meat
34
Sickle Cell Anemia What? 3 S/S.
Abnormal HbS instead of HgbA r/in sickling ↑ viscocity obstruction of blood flow hypoxia
35
Sickle Cell Anemia 4 Crisis'
Vaso-occlusive (painful episode) Sequestration Asplastic Hyperhemolytic
36
SCD - Vaso-occlusive | 2 Acute v. 3 Chronic
4 - 6 days Severe pain w/ swollen joints respiratory infx, retinal detachment, and skeletal deformities
37
SCD - Sequestriation What? 2 S/S.
Pooling of blood in spleen/liver | Hypovolemia -> shock with irritability
38
SCD - Aplastic Crisis
Extreme anemia triggered by infx
39
SCD - Hyperhemolytic
RBC destruction
40
Sickle Cell Crisis ↑ 5 Labs
↑ Hgb, WBC, Bili, Reticulocytes | Sickle cells in peripheral blood smear
41
Definitive Dx Sickle Cell Anemia
Hemoglobin Elctrophoresis
42
How to test for CVa with SCD
Transcranial Doppler Test (TSD)
43
Vaccines that Counter SDC 3
PCV, MCV4, and Flu
44
Hemophilia What is? A v B?
Excessive bleeding A = ↓ Factor VIII, classic B = ↓Factor IX, christmas
45
Hemophilia Lab ▲ 4
↑ aPTT Factors Platlets/Prothrombin WITHIN range Whole blood clotting WITHIN or PROLONGED
46
Hemophilia 4 Medications and Rationales ea.
1-deamino-8-d-arginine vasopressin (DDVAP) ↑ factor VII for mild cases Factor VIII for hemorrhage Corticosteroids for hematuria NSAIDS for chronic synovitis
47
Hemophilia RICE Control
Rest, Ice, Compression, Elevation
48
Beta-Thalassemias What? 3 Types
Inherited blood disorder of Hgb synthesis r/in anemia Trait = mild anemia Intermdia = moderate Major = req. transfusion
49
Post-Bone Marrow Transplant Hematopoietic Stem Cell Transplantation What? Timing of chemo, infusion, cell formation.
Killing bone tumor w/ chemo 7 - 10 days prior to... histocompatible stem cell donor to infuse immediately cells form in 2 - 8 weeks
50
Disseminated Intravascular Coagulation. What? S/S? Timed? 2 monitor Tx?
abnormal activation of clotting r/in formation in small vessels which bleed/hemorrhage Observe breaks q1-2hrs Assess IV sites q15min
51
Hypoglycemia BgL vs. Hyperglycemia BgL
↓ 60 mg/dL v. ↑ 250 mg/dL
52
Hypoglycemia 3 S/S vs. Hyperglycemia S/S
hunger, shallow respirations, ↓LoC | thirst, polyuria -> oliguria, weakness
53
4 Diabetes Self-Tx
Self monitoring q3hrs Foot care Check eyes YEARLY Diet control and Exercise
54
Diabetes 3 Dx levels 8hr fasting Random Oral BgL
↑ 126 mg/dL ↑ 200 mg/dL ↑ 200 mg/dL post fast and consumed glucosre
55
``` Types of Insulin Identifiers Rapid Short/Regular Intermediate/NPH Long Which do you draw first when mixing? ```
simple name Ends w/ "R" Ends w/ "N" Starts with "L..." Draw short acting first
56
Diabetic Ketoacidosis is defined by... and 3 Tx
↑ 300 mg/dL BgL RAPID 0.9% NaCl follow w/ 1/2 NSS add glucose to fluides once BgL down to 250 mg/dL
57
Human Growth Hormone 4 related hormones
ACTH TSH FSH LG
58
Reason for GH deficiency?
idiopathic
59
3 S/S GH deficiency
short, insulin sensitivity, premature aging
60
Meauring time for GH deficient ↓ 3 y/o vs ↑ 3 y/o
↓ 3 y/o q6months | ↑ qYEAR
61
GH deficiency 3 Dx
GH stimulation test at 0600 - 0800, FAST BEFORE Radiologic/CT assessment Evaluation vs. Growth curve
62
GH related labs (2)
Insulin-like growth factor 1 (IGF-1) and IFG binding protein 3 (IGFBP-3)
63
GH Replacement medication, route, qDaysPerweek, continue until what age? S/fx?
``` Somatropin SubQ 6 - 7 days/week 16♂/14♀ NO S/FX ```
64
Neuroblastoma vs. Nephroblastoma (AKA) | where, % cases are, metastasis rate, age range
in adrenal gland, head area, 95% cases and 1/2 metastasized, ↓ 10 yrs/o in kidneys/abdomen (Wilms Tumor), 10% bilateral, metastasis rare, 3 - 5 yrs/o
65
Tumor General Tx 3
Chemo (ask for iodine/shellfish allergies) Radiation (loose clothing/protect from sun) Seek medical care for tender skin
66
Neuroblastoma vs. Nepohroblastoma S/S + Metastasized S/S (2ea)
few, when metastasized = look ill (racoon ecchymoses) w/ pain firm, non-tender mass in abdomen, when metastasized = dyspnea, SoB
67
Neuroblastoma 2 vs. 4 Nephroblastoma Labs
CBC, urine catecholamines | BUN, Creatinine, CBC, urinanalysis
68
Neuroblastoma vs. Nephroblastoma Dx + 2 Nephro rule outs
MIBG scan of marrow/soft tissue development Abdominal Ultrasonography Venacvogram for involvement vena cava Bone marrow aspiration for metastasis
69
Neuroblastoma vs. Nephroblastoma specific Tx notes
PICC may be inserted | DO NOT PALPATE ABDOMEN
70
Neuroblastoma vs. Nephroblastoma Medications | 2 Med enders vs. 1 specific
-ides/-ines | Dactinomycin (Cosmogen)
71
Blood Neoplasms What? 2 Types? Primary result/issue?
``` leukemia b/c malignancy in bone marrow Acute Lymphoid (ALL) Acute myelogenous (AML) ``` Production of immature WBC's which crowd
72
Leukemia 3 WBC crowding areas and S/S
Bone marrow = ↓ RBC, WBC, Platelets Endocrine = tissue fibrosis CNS = ↑ ICP
73
Leukemia 3 Chemotherapies Fx and 1 Tx all Induction CNS prophylactic Maintenance
remission of 5% prevent invasion of leukemic cells sustain remission phase Tx N/V
74
Leukemia Early vs. Late manifesations (3 ea)
low grade fever unsteady gait constipation pain ulcers in mouth -megalies
75
Leukemia 4 expected Labs
↓ CBC, platelets, neutrophils | +Leukemic Blasts (immature WBCS)
76
Leukemia 2 Dx
Bone marrow biopsy w/ Eutetic mixture of local anesthetic ELMA unless unconscious General sedation (pressure site for 5 - 10 min) CSF analysis Side lying lumbar puncture (remain for 4 - 8hrs)
77
Chemo Mucosal NO NO's (4)
viscous lidocaine = aspiration Hydrogen peroxide = ↓ healing MoM = dries membranes lemon glycerine = tooth/tissue decay
78
When to complete chemo and bladder protection drug
Early in the day | Mesna (Mesnex)
79
Hemapoietic Stem Cell Transplant (HCST) | What type, 1st/2nd remission, type of room, type filtration (acronym).
AML in 1st remission ALL after 2nd remission Positive pressure HEPA filration
80
Bone Cancers 2 vs. Soft Tissue malignancies
Osteosarcoma and Ewing's (PNET) | Rhabdomyosarcoma
81
Bone Cancer S/S vs. Rhabdomyosarcoma
Nonspecific pain relieved by flexing | Local pain r/t compression tumor MARBLE!!!
82
Osteosarcoma, Ewings, Rhabdomyosarcoma medications + TCAs
methotrexate/doxorubicin vinicristin/doxorubicin, alternating -ides All above for 1 year Tricyclic Antidepressants for phantom/neuropathic pain
83
2 Bone Cancers + Rhabdomyosarcoma 4 Tx
localized radiation surgical intervention limb salvage (shrink tumor + joint replacement) limb amputaiton
84
Immunizations ORDER HRD HPIV HMH
HepB...RV...DTaP...HiB...PCV...IPV...TIV...MMR...VAR...HepA...MCV4...HPV
85
HepB Start + 3 | Ø if..?
BIRTH 1 - 2 months 6 - 8 months Allergic to bakers yeast
86
RV Start + 2 (S/fx?) | Ø if...?
6 WEEKS - DIARRHEA 2 months 4 months Intussusception/immunocompromise
87
DTaP Start + 4 | Ø if...?
``` 6 WEEKS 2 months 4 months 6 months Encephalopathy, seizures, crying 3 hrs ```
88
HiB Start + 3
6 WEEKS 2 4 12- 15
89
PCV Start + 4
6 WEEKS 2 4 12 - 15
90
IPV Start + 4 | Ø if...?
``` 6 WEEKS 2 - 4 16 - 18 4 - 6 YEARS Allergic to neomycin ```
91
TIV Start + ...? | Ø if...?
↑ 2 y/o for LIVE w/out other medical conditions YEARLY (October) Allergy to neomycin and eggs
92
MMR Start + 2
12 MO 12 - 15 months 4 - 6 years/months if travelling internationally
93
VAR Start + 2 | Ø if...?
12 MO 12 - 15 4 - 6 years Allergy to neomycin and corticosteroids
94
HepA Start + 2
12 MO 12 mo - 2 yrs 6 - 18 months post first
95
MCV4 Start Prioritize what type of group? Booster needed when? Ø if...?
9 months high risk (African), if given ↓ 16 y/o Hx Guilliane Barre Syndrome
96
HPV Start + 3 | Ø if...?
9 YEARS 2nd dose 1-2 months post first 3rd dose 6 months post first Hypersensitive to yeast
97
Epstein Barr/Mononucleosis 2 S/S and vector
severe fatigue and swelling | saliva
98
Mumps/Paramyxovirus 2 S/S and 3 vectors
abd. pain and swollen salivary glands | direct contact, droplet, surfaces
99
Rubella (German Measles) 2 S/S and 2 vectors
low-fever + rash for 2 - 3 days | direct contact, droplet
100
Rubeola (Measles) 2 S/S + 3 vectors
Koplik spots on mucosa and reddish-brown rash from face down | direct contact, droplet, surfaces 2 hrs
101
Conjunctivitis S/S + vector
red/dischargy eye | Direct contact
102
Erythema Infectiosum (5ths disease) 2 S/S + vector
cold symptoms + face rash | blood droplet
103
HFMD S/S + vector
rash on named parts | direct contact
104
Pertussis/Bordetella 2 S/S + 2 vectors
cold symptoms + whooping cough
105
Varicella Chicken pox S/S + 4 vectors
the pox! | direct contact, droplet, shingles, airborne
106
Otitis Media AOM vs OME and 3 S/S ea
infection, no infection tugging/pain ear w/ drainage and fever full ear, orange tympanic membrane, hearing loss
107
Pneumatic Otoscope strat for ↓ 3 yrs and ↑ 3 yrs
down back | up back
108
Antibiotics r/t Otitis Media
wait 72 hours before starting
109
HIV Infection Severities between ↓ 12 mo, 1 - 5 years, and 6 - 12 years. NO, MODERATE, SEVERE
1500/25%, 1000/25%, 500/25% 740/15%, 500/15%, 200/15% ↓above ↓above ↓above
110
HIV S/S NO SUP, MOD SUP, SEVERE SUP types of evidence
no sup = no evidence mod = itis, opathy, onia, arcomas severe = fancy names
111
HIV name NABC 1,2,3 criteria
``` N= no, A=mild, B=moderate, C=severe 1= no evi, 2 = evidence, 3 =severe evidence ```
112
HIV Dx ↑ 18 months (2) vs ↓ 18 months
ELISA and Western Blot vs Polymerase Chaine Reaction (PCR)
113
Tx 4 Bacterial Skin Dz and R/F
warm skin compress, PO/topical antibiotic, soap | immunosuppresion
114
Tx 1 Viral Skin Dz and R/F
antiviral "-virs" | direct contact
115
Tx 5 Bites/Stings and R/F
antipruritic, histamine, biotic, venom cool compress Geographic area
116
Tx 3 Fungal Skin Dz and R/F
``` Topicaal antifungal (clotrimazole) and Oral griseofulvin (except w/ candidiasis), warm compress Geographic Area ```
117
Folliculitis pimple, furuncle boil, carbuncle boil are caused by...
Staph A.
118
``` S/S Viral.. Human Papillo HPV HSV Varicella Molluscum ```
``` gray-brown same but on feet 1 = cold sores, 2 = genital neurologi pain asymptomatic papules ```
119
Scabies S/S infant vs. Older children
widespread body pimples and blisters vs. head, wrists, genitals
120
Lyme Dz 3 Stages S/S and times
1. Erythema w/ Bull's Eye Rash 3 - 31 days 2. Paralysis, muscle/joint swelling, ♥ problems weeks 3. SEVERE arthritis, tingling, speech problems
121
Contact Dermatitis - 3 types, 3 tx Atopic Dermatitis - infant vs older Acne - Amnesteem
contact, diaper, seborrheic isopropyl alcohol/ zinc oxide w/ cornstarch eczema infant = generalized erythema + vsicles, older = lichenification and keratosis in wrists/ankles P. acnes - Amnesteem r/in behavioral ▲
122
3 Types of Burns
Thermal Chemical Electrical
123
5 Depths of Burns
``` Superficial 1st Superficial Partial 2nd Deep Partial Ø blanching Full thickness 3rd returning pain w/ leathery skin Deep full thickness 4th no pain, charred ```
124
3 Extents of Burns Definitions Minor Moderate Major
tx in clinic tx in hospital req. medical services/burn center
125
3 Tx burns and IV Tx
cool H2O BUT NO ICE! nonadherent hydrocolloid dressing Analgesia 0.9% NaCL 24 hr w/ LR ↓ 30 kg, urine output 1 -2 ml/kg/hr ↑ 30 kg, 30 ml/hr
126
Burn Allo Xeno Synthetic Grafts
from human partial/full from animal partial synthetic partial
127
Burn Permanent autografts sheet mesh artificatial
skin covers wound skin + mesh for larger area artificail heals better

ABSN Cohort 19 (28 decks)

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