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Peds EM > Renal/GU/special topics > Flashcards

Renal/GU/special topics Flashcards

1
Q

Labial adhesions

tx

A

may present as recurrent UTIs

topical estrogen cream 2-4 weeks. no longer as can cause feminizing effects

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2
Q

prepubertal vaginitis

ddx and workup

A
  1. irritant–hygiene issue/sitz bath
  2. strep: febrile, vaginal dc, scarlatiniform rash–culture, tx
  3. lichen sclerosis–pale shiny white, not infectious. consider steroid
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3
Q

paraphimosis

-tx

A
  1. ice, steady manual reduction, consider topical viscous lidocaine
  2. local penile block of dorsal n, 2 and 10:00 positions
  3. conscious sedation/nitrous oxide
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4
Q

balanoposthitis

-presentation, tx

A

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

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5
Q

torsion of appendix testis:

presentation and tx

A
  • pinpoint area of pain, transillumination shows blue dot sign
  • NSAIDs and scrotal support (tighty whities)
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6
Q

ALTE/BRUE ddx

A

resp: bronchiolitis apnea, PNA/pertussis

sepsis

seizure

GERD: reflux

abuse

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7
Q

Peds C-spine XR

what to know (3)

A
  1. pseudosubluxation of C2 on C3 in 40% pts <8y
  2. ratio of C1-C2 to C2-C3 distance is >2.5
  3. retropharyngeal space: <6mm C2, <14mm C6 (<22mm adults)
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8
Q

persistent crying infant

  • what to think about
  • admit?
A

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

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9
Q

sandifer syndrome

A

gastric reflux leads to child arching back after feed. usu only infants

not a seizure, not dangerous

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10
Q

Colic

definition

A

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

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11
Q

VP shunt

  • how to eval
  • tx of obstruction/malfunction
  • eval of fever+shunt
A

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
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12
Q

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?
A

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)

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13
Q

G tube obstruction

-tx

A

try coca cola

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14
Q

G tube stoma site redness, ddx (3)

A

not necessarily cellulitis

  1. cellulitis–very tender, kid winces, purulent drainage
  2. granulation tissue–shiny pink. give topical steroids
  3. 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

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15
Q

trachs

-what are the brand names

A

Shiley and Bivona

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16
Q

trach obstruction ddx

(3)

A
  1. mucus plug
  2. granuloma–scar tissue, needs ENT to cauterize/excise
  3. false tract
17
Q

trach bleeding

-approach

A

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

18
Q

Trach decannulation

  • how long to wait for mature stoma?
  • how to replace trach?
A

<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

19
Q

FB ingestion/aspiration:

coin appears as circle vs flat on AP XR, where is it

A

circle: esophagus
edge: trachea

(likely)

20
Q

FB aspiration:

what see on CXR

A

air trapping on one side, if that side has mainstem bronchus obstruction

lung on that side bigger, darker, esp on expiration

21
Q

FB aspiration:

what alternative dx other than bronchoscopy?

A
  1. digital subtraction fluoroscopy
  2. 3D CT virtual bronch

these have radiation risks

22
Q

FB aspiration BLS maneuvers:

when to do back blows vs heimlich

A

<1y old: back blows

23
Q

child abuse, suspect adult bite:

what measurement

A

measure bite:

if 3cm+ from molar to molar, suspect adult

24
Q

Child abuse:

what are pathognomonic fx? (5)

suspicious but not pathognomonic (3)

A
  1. bucket handle/corner fx of metaphysis (periosteum pulled off with bone)
  2. rib fx
  3. scapular fx
  4. sternal fx
  5. spinous process fx
  6. multiple fx at different stages
  7. femur
  8. stellate skull
25
Q

you suspect child abuse with bruises

  • what labs to order
  • when to CT the abd for abnormal labs
  • typically up to what age to do skeletal survey?
A

cbc, pt/ptt, platelet function (PFA-100)

  • if ast/alt >80 and suspect abdominal injury, CT the abd
  • age 2, also obtain ct head/mri if <2y old
26
Q

sexual abuse

  • what time frame to consider PEP
  • what to look for on vaginal exam
A

if within last 72-96 hours, consider PEP and tx injuries, and consider rape kit

  • signs of genital/rectal injury
  • pre-pubescent girl: tears/scarring in hymen, hymen introitus opening is ~1mm/year of life (suspect abuse if larger), examine tear in posterior fourchette behind hymen
27
Q

child abuse

-what physical abilities to memorize in infant at what age?

A

1 mo: nothing

4 mo: rolls

6 mo: sit up unassisted

9 mo: crawling

12 mo: walking

Peds EM (13 decks)

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