Peds Exam 3 Flashcards
4 Types of ▲ in blood flow patterns ♥
↑ pulmonary flow
↓ pulmonary flow
Obstruction
Mixed
3 ↑ ♥ pulmonary flow Disorders
Ventricular Septal Defect (VSD)
Atrial Septal Defect (ASD)
Patent Ductus Arteriosus (PDA)
VSD S/S and 3 Tx
loud harsh murmur on L sternal border
CC, banding, patch
ASD S/S and Tx
loud harsh murmur fixed by split second ♥ sound, MAY BE ASYMPTOMATIC
CC, patch
PDA 3 S/S wnth 3 Tx
Machine hum murmur, wide BP, bounding pulses
Indomethacin, coil insertion, thoracoscopic rapair
2 ↓ ♥ pulmonary flow Disorders
Tetraology of Fallot
Tricuspid Atresia
Tetraology of Fallot 4 included Dz, 2 S/S, and TX
pulmonary stenosis
Overriding Aorta
VSD
R Ventricular dystrophy
Cyanosis @ birth, systolic murmur
Shunt w/ surgery
Tricuspid of Atresia What? 2 S/S in infants vs. children. 3 step Tx
complete closure of tricuspid valve
infants = cyanosis and dypsnea
children = hypoxemia and clubbing
3 Step surgery (shunt, glenn, fontan)
3 ♥ Obstruction flow Disorders
Pulmonary stenosis
Aortic Stenosis
Coarctation of the Aorta
Pulmonary Stenosis 2 S/S. Tx infants vs. children
systolic ejection murmur and cyanosis that worsens w/ narrowing
infant - Brocks
children - Valvotomy
Aortic Stenosis 2 S/S infant vs. children and Tx
infant = faint pulses and HypoTN
child = dizziness, possible ejection murmur
valvotomy and Norwood
Coarctation of the Aorta 2 S/S
↑ BP arms w/ bounding pulses
↓ BP legs w/ cool skin
3 ♥ Mixed blood flow disorders
Transposition of Great arteries
Truncus Arteriosus
Hypoplastic Left ♥ Syndrome
Trans. of Great Arteries What? Oxygenation needs? Tx
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
Truncus Arteriosis What? 3 S/S? Tx
Failure of septum formation
Delayed growth, lethargy, poor eating habits
Surgery w/in 1 month life
Hypoplastic Left ♥ Syndrome What? Oxygenation needs? Development of? Tx?
Underdeveloped L ♥
ASD and foramen ovale
Mild cyanosis regresses as PDA closes
Norwood, Glenn, and Fontan procedure @ birth
Kawasaki Disease
Acute systemi vasculitis w/ fever > 5 days that Ø respond to antipyretics
Kawasaki Disease 3 Types
Acute
Subacute
Convalescent
red eyes, rashes, strawberry tongue
irritable w/ peeling skin around nails
ØS/S except abnormal labs (6 - 8 weeks onset)
Kawasaki Disease Labs (4)
CBC, CRP, ESR, serum albumin
Kawasaki 2 Dx and Tx (g/kg/time/of fever)
Chest Xray and echocardiogram
IVGG (Gamma globulin) 2g/kg/10-12hrs w/in 7 days of fever
♥ Medications function/look out for.. Digoxin Captopril/Enalapril Metoprolol/Carvedilol Furosemide/Chlorothiaszide
↓ 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
♥ Transplant 2 S/S of rejection. Dx with. 2 Medications.
Low grade fever and ↑ resting HR
Endomyocardial biopsy
Calcineurin inhibitors and corticosteroids
Infective Endocarditis What? 3 S/S. 2 Dx. 2 Tx.
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
Rheumatic Fever What? 2 S/S. Dx. Tx
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
Hyperlipidemia can r/in 2
atherosclerosis and coronary ♥ dz
Blood Disorders in Children (4)
Epistaxis
Iron Deficiency Anemia
Sickle Cell Anemia
Hemophillia
Epistaxis What? 3 Tx? If > 30 min?
nose bleed
sit up, lean forward. pressure 10 min
Possible hemorrhage, seek medical care.
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
Iron Deficiency Anemia 3 S/S
SoB, pallor, brittle fingernails
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
Iron Deficiency Anemia iron supplement timing preterm vs. exclusively breastfed
2 months
4 months
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
Food sources of Iron (7)
cereal, formula, beans, peanut butter, greens, poultry, red meat
Sickle Cell Anemia What? 3 S/S.
Abnormal HbS instead of HgbA r/in sickling
↑ viscocity
obstruction of blood flow
hypoxia
Sickle Cell Anemia 4 Crisis’
Vaso-occlusive (painful episode)
Sequestration
Asplastic
Hyperhemolytic
SCD - Vaso-occlusive
2 Acute v. 3 Chronic
4 - 6 days
Severe pain w/ swollen joints
respiratory infx, retinal detachment, and skeletal deformities
SCD - Sequestriation What? 2 S/S.
Pooling of blood in spleen/liver
Hypovolemia -> shock with irritability
SCD - Aplastic Crisis
Extreme anemia triggered by infx
SCD - Hyperhemolytic
RBC destruction
Sickle Cell Crisis ↑ 5 Labs
↑ Hgb, WBC, Bili, Reticulocytes
Sickle cells in peripheral blood smear
Definitive Dx Sickle Cell Anemia
Hemoglobin Elctrophoresis
How to test for CVa with SCD
Transcranial Doppler Test (TSD)
Vaccines that Counter SDC 3
PCV, MCV4, and Flu
Hemophilia What is? A v B?
Excessive bleeding
A = ↓ Factor VIII, classic
B = ↓Factor IX, christmas
Hemophilia Lab ▲ 4
↑ aPTT
Factors
Platlets/Prothrombin WITHIN range
Whole blood clotting WITHIN or PROLONGED
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
Hemophilia RICE Control
Rest, Ice, Compression, Elevation
Beta-Thalassemias What? 3 Types
Inherited blood disorder of Hgb synthesis r/in anemia
Trait = mild anemia
Intermdia = moderate
Major = req. transfusion
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
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
Hypoglycemia BgL vs. Hyperglycemia BgL
↓ 60 mg/dL v. ↑ 250 mg/dL
Hypoglycemia 3 S/S vs. Hyperglycemia S/S
hunger, shallow respirations, ↓LoC
thirst, polyuria -> oliguria, weakness
4 Diabetes Self-Tx
Self monitoring q3hrs
Foot care
Check eyes YEARLY
Diet control and Exercise
Diabetes 3 Dx levels
8hr fasting
Random
Oral BgL
↑ 126 mg/dL
↑ 200 mg/dL
↑ 200 mg/dL post fast and consumed glucosre
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
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
Human Growth Hormone 4 related hormones
ACTH
TSH
FSH
LG
Reason for GH deficiency?
idiopathic
3 S/S GH deficiency
short, insulin sensitivity, premature aging
Meauring time for GH deficient ↓ 3 y/o vs ↑ 3 y/o
↓ 3 y/o q6months
↑ qYEAR
GH deficiency 3 Dx
GH stimulation test at 0600 - 0800, FAST BEFORE
Radiologic/CT assessment
Evaluation vs. Growth curve
GH related labs (2)
Insulin-like growth factor 1 (IGF-1) and IFG binding protein 3 (IGFBP-3)
GH Replacement medication, route, qDaysPerweek, continue until what age? S/fx?
Somatropin SubQ 6 - 7 days/week 16♂/14♀ NO S/FX
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
Tumor General Tx 3
Chemo (ask for iodine/shellfish allergies)
Radiation (loose clothing/protect from sun)
Seek medical care for tender skin
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
Neuroblastoma 2 vs. 4 Nephroblastoma Labs
CBC, urine catecholamines
BUN, Creatinine, CBC, urinanalysis
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
Neuroblastoma vs. Nephroblastoma specific Tx notes
PICC may be inserted
DO NOT PALPATE ABDOMEN
Neuroblastoma vs. Nephroblastoma Medications
2 Med enders vs. 1 specific
-ides/-ines
Dactinomycin (Cosmogen)
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
Leukemia 3 WBC crowding areas and S/S
Bone marrow = ↓ RBC, WBC, Platelets
Endocrine = tissue fibrosis
CNS = ↑ ICP
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
Leukemia Early vs. Late manifesations (3 ea)
low grade fever
unsteady gait
constipation
pain
ulcers in mouth
-megalies
Leukemia 4 expected Labs
↓ CBC, platelets, neutrophils
+Leukemic Blasts (immature WBCS)
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)
Chemo Mucosal NO NO’s (4)
viscous lidocaine = aspiration
Hydrogen peroxide = ↓ healing
MoM = dries membranes
lemon glycerine = tooth/tissue decay
When to complete chemo and bladder protection drug
Early in the day
Mesna (Mesnex)
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
Bone Cancers 2 vs. Soft Tissue malignancies
Osteosarcoma and Ewing’s (PNET)
Rhabdomyosarcoma
Bone Cancer S/S vs. Rhabdomyosarcoma
Nonspecific pain relieved by flexing
Local pain r/t compression tumor MARBLE!!!
Osteosarcoma, Ewings, Rhabdomyosarcoma medications + TCAs
methotrexate/doxorubicin
vinicristin/doxorubicin, alternating -ides
All above for 1 year
Tricyclic Antidepressants for phantom/neuropathic pain
2 Bone Cancers + Rhabdomyosarcoma 4 Tx
localized radiation
surgical intervention
limb salvage (shrink tumor + joint replacement)
limb amputaiton
Immunizations ORDER
HRD
HPIV
HMH
HepB…RV…DTaP…HiB…PCV…IPV…TIV…MMR…VAR…HepA…MCV4…HPV
HepB Start + 3
Ø if..?
BIRTH
1 - 2 months
6 - 8 months
Allergic to bakers yeast
RV Start + 2 (S/fx?)
Ø if…?
6 WEEKS - DIARRHEA
2 months
4 months
Intussusception/immunocompromise
DTaP Start + 4
Ø if…?
6 WEEKS 2 months 4 months 6 months Encephalopathy, seizures, crying 3 hrs
HiB Start + 3
6 WEEKS
2
4
12- 15
PCV Start + 4
6 WEEKS
2
4
12 - 15
IPV Start + 4
Ø if…?
6 WEEKS 2 - 4 16 - 18 4 - 6 YEARS Allergic to neomycin
TIV Start + …?
Ø if…?
↑ 2 y/o for LIVE w/out other medical conditions
YEARLY (October)
Allergy to neomycin and eggs
MMR Start + 2
12 MO
12 - 15 months
4 - 6 years/months if travelling internationally
VAR Start + 2
Ø if…?
12 MO
12 - 15
4 - 6 years
Allergy to neomycin and corticosteroids
HepA Start + 2
12 MO
12 mo - 2 yrs
6 - 18 months post first
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
HPV Start + 3
Ø if…?
9 YEARS
2nd dose 1-2 months post first
3rd dose 6 months post first
Hypersensitive to yeast
Epstein Barr/Mononucleosis 2 S/S and vector
severe fatigue and swelling
saliva
Mumps/Paramyxovirus 2 S/S and 3 vectors
abd. pain and swollen salivary glands
direct contact, droplet, surfaces
Rubella (German Measles) 2 S/S and 2 vectors
low-fever + rash for 2 - 3 days
direct contact, droplet
Rubeola (Measles) 2 S/S + 3 vectors
Koplik spots on mucosa and reddish-brown rash from face down
direct contact, droplet, surfaces 2 hrs
Conjunctivitis S/S + vector
red/dischargy eye
Direct contact
Erythema Infectiosum (5ths disease) 2 S/S + vector
cold symptoms + face rash
blood droplet
HFMD S/S + vector
rash on named parts
direct contact
Pertussis/Bordetella 2 S/S + 2 vectors
cold symptoms + whooping cough
Varicella Chicken pox S/S + 4 vectors
the pox!
direct contact, droplet, shingles, airborne
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
Pneumatic Otoscope strat for ↓ 3 yrs and ↑ 3 yrs
down back
up back
Antibiotics r/t Otitis Media
wait 72 hours before starting
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
HIV S/S NO SUP, MOD SUP, SEVERE SUP types of evidence
no sup = no evidence
mod = itis, opathy, onia, arcomas
severe = fancy names
HIV name NABC 1,2,3 criteria
N= no, A=mild, B=moderate, C=severe 1= no evi, 2 = evidence, 3 =severe evidence
HIV Dx ↑ 18 months (2) vs ↓ 18 months
ELISA and Western Blot vs Polymerase Chaine Reaction (PCR)
Tx 4 Bacterial Skin Dz and R/F
warm skin compress, PO/topical antibiotic, soap
immunosuppresion
Tx 1 Viral Skin Dz and R/F
antiviral “-virs”
direct contact
Tx 5 Bites/Stings and R/F
antipruritic, histamine, biotic, venom
cool compress
Geographic area
Tx 3 Fungal Skin Dz and R/F
Topicaal antifungal (clotrimazole) and Oral griseofulvin (except w/ candidiasis), warm compress Geographic Area
Folliculitis pimple, furuncle boil, carbuncle boil are caused by…
Staph A.
S/S Viral.. Human Papillo HPV HSV Varicella Molluscum
gray-brown same but on feet 1 = cold sores, 2 = genital neurologi pain asymptomatic papules
Scabies S/S infant vs. Older children
widespread body pimples and blisters vs. head, wrists, genitals
Lyme Dz 3 Stages S/S and times
- Erythema w/ Bull’s Eye Rash 3 - 31 days
- Paralysis, muscle/joint swelling, ♥ problems weeks
- SEVERE arthritis, tingling, speech problems
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 ▲
3 Types of Burns
Thermal
Chemical
Electrical
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, charred3 Extents of Burns Definitions
Minor
Moderate
Major
tx in clinic
tx in hospital
req. medical services/burn center
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
Burn
Allo
Xeno
Synthetic Grafts
from human partial/full
from animal partial
synthetic partial
Burn Permanent autografts
sheet
mesh
artificatial
skin covers wound
skin + mesh for larger area
artificail heals better
