Renal/GU/special topics Flashcards
Labial adhesions
tx
may present as recurrent UTIs
topical estrogen cream 2-4 weeks. no longer as can cause feminizing effects
prepubertal vaginitis
ddx and workup
- irritant–hygiene issue/sitz bath
- strep: febrile, vaginal dc, scarlatiniform rash–culture, tx
- lichen sclerosis–pale shiny white, not infectious. consider steroid
paraphimosis
-tx
- ice, steady manual reduction, consider topical viscous lidocaine
- local penile block of dorsal n, 2 and 10:00 positions
- conscious sedation/nitrous oxide
balanoposthitis
-presentation, tx
foreskin/glans inflamm
can be fungal infection, less likely bacterial
tx: topical antifungal
consider abx only if febrile and very tender (keflex), nsaids, sitz baths, hygeine
torsion of appendix testis:
presentation and tx
- pinpoint area of pain, transillumination shows blue dot sign
- NSAIDs and scrotal support (tighty whities)
ALTE/BRUE ddx
resp: bronchiolitis apnea, PNA/pertussis
sepsis
seizure
GERD: reflux
abuse
Peds C-spine XR
what to know (3)
- pseudosubluxation of C2 on C3 in 40% pts <8y
- ratio of C1-C2 to C2-C3 distance is >2.5
- retropharyngeal space: <6mm C2, <14mm C6 (<22mm adults)
persistent crying infant
- what to think about
- admit?
hx: timing, feeding related? specific positioning? time of day?
remember corneal abrasion, hair tourniquets, occult trauma, intussuception, testicular torsion
admit persistently crying infants without source
sandifer syndrome
gastric reflux leads to child arching back after feed. usu only infants
not a seizure, not dangerous
Colic
definition
rule of 3s
3h /day
3d/week
3pm (late afternoon/evening)
age 3 weeks-3 months
management: go for a drive, white noise, feed/change diaper, check temp. Tell parents to get their own rest. child will outgrow this
VP shunt
- how to eval
- tx of obstruction/malfunction
- eval of fever+shunt
CT head–look for ventricle dilation
Shunt series XR: eval position of shunt, esp if trauma to neck, popping noise. distal tips can migrate anywhere in body, beware
- tap the shunt, ok to use butterfly needle, sterile
- fever+shunt <2 mo since surgery: tap the shunt (not LP). If >2 mo since surgery, fever is likely due to another source. If shunt infected, likely staph epi, use vanc
G tubes
- what length of time before reliaable tract formed?
- what are the different types of tubes, who to contact for each, which can ED replace?
6 weeks for reliable tract to form. do not replace if <6 weeks! Call the person who placed
-regular G tube (usu surgery)
PEG tube (GI)
G-J tube (IR)–do not replace these (however can use foley to keep stoma open)
also do not replace non-balloon type G-tubes (again use foley)
G tube obstruction
-tx
try coca cola
G tube stoma site redness, ddx (3)
not necessarily cellulitis
- cellulitis–very tender, kid winces, purulent drainage
- granulation tissue–shiny pink. give topical steroids
- irritation (MCC): from leakage of GI contents. no fever. acidic if leakage tested. use topical maalox and calmoseptine (barrier cream with pain reliever)
also think fungal
trachs
-what are the brand names
Shiley and Bivona
trach obstruction ddx
(3)
- mucus plug
- granuloma–scar tissue, needs ENT to cauterize/excise
- false tract
trach bleeding
-approach
worry about erosion into innominate vessel. Sentinel bleed! be very cautious
blow balloon up further to occlude vessel.
If does not work, stick finger inside trach site to tamponade bleeding
call ENT
Trach decannulation
- how long to wait for mature stoma?
- how to replace trach?
<7 days worry about immature stoma, false tract. use BVM
when replacing remember to put obturator (internal cannula) prior to inserting trach
-can attempt orotracheal intubation or ETT through the trach stoma if mature
FB ingestion/aspiration:
coin appears as circle vs flat on AP XR, where is it
circle: esophagus
edge: trachea
(likely)
FB aspiration:
what see on CXR
air trapping on one side, if that side has mainstem bronchus obstruction
lung on that side bigger, darker, esp on expiration
FB aspiration:
what alternative dx other than bronchoscopy?
- digital subtraction fluoroscopy
- 3D CT virtual bronch
these have radiation risks
FB aspiration BLS maneuvers:
when to do back blows vs heimlich
<1y old: back blows
child abuse, suspect adult bite:
what measurement
measure bite:
if 3cm+ from molar to molar, suspect adult
Child abuse:
what are pathognomonic fx? (5)
suspicious but not pathognomonic (3)
- bucket handle/corner fx of metaphysis (periosteum pulled off with bone)
- rib fx
- scapular fx
- sternal fx
- spinous process fx
- multiple fx at different stages
- femur
- stellate skull
