Rotations Flashcards
Does the color of the nasal discharge predicts the presence of concurrent sinusitis?
No, it can also be purulent early in the course of URI
What do you suspect in a child with persistent fever or URI symptoms for more than 10 days?
Bacterial superinfection (Acute otitis media, sinusitis )
How do you diagnose URI
Clinically, symptoms are runny nose, low grade fever, cough, and sore throat
What is the most important step in URI management?
Adequate rehydration
Do over the counter medications like cough suppressants, mucolytics and antihistamines have an effect in the management of URI?
Minimal effectiveness and may cause side effects.
When do sphenoid sinuses develop?
3-5 years of age
When do frontal sinuses develop?
7-10 years of age
Is physical examination reliable in diagnosing uncomplicated sinusitis?
No
Management of uncomplicated sinusitis?
Empiric antibiotics (amoxicillin -clavulanate)
Most common pathogens in sinusitis
S. Pneumoniae, H. Influenzae, Moraxella catarrhalis
What is specific about EBV pharyngitis?
Enlarged posterior lymph nodes
Hepatosplenomegaly
Malaise
What is specific about coxsackievirus pharyngitis?
Painful Vesicles or ulcers on posterior pharynx and soft palate (hyperangina)
Blisters on hands and feet (hand-foot-mouth disease)
What is specific about group A beta hemolytics pharyngitis?
- lack of URI symptoms such as cough
- fever
- exudates on tonsils, peteachie on soft palate, strawberry tongue
- enlarged cervical anterior lymph nodes
- could present with scarlatiniform rash
- school aged children 5-15
Gray adherent tonsillar membrane?
Diphtheria
Gold standard for Group A beta hemolytics?
Culture (gold standard), rapid antigen test
Do you treat nonsymptomatic otitis media?
No, its self resolving. Only treat if there are symptoms.
What is Acute otitis media?
Acute infection of middle ear space
What is otitis media with effusion?
Fluid within middle ear space with no signs of infection
What cause acute otitis media?
S. Pneumonia, nontypeable H. Influenzae, m. Catarrhalis
Sometimes viral
Most reliable method for detecting fluid in middle ear space?
Otoscopy
Treatment for AOM?
Amoxicillin, if the patient already used antibiotics in the last 1-2 months, they might have penicillin resisted s. Pneumonia. So give them amoxicillin-clavulanic acid, high dose amoxicillin, cephalosporin
Is antibiotics indicated for otitis media with effusion?
No
Otitis externa etiology
P. Aeruginosa
S. Aureus
Candida albicans
Secondary to AOM with perforated membrane
Diagnosis of otitis externa?
Erythema and edema of EAC
Sometimes with white or purulent whitish material
Sometimes with tenderness in palpation of tragus
Symptoms of otitis externa?
Pain
Itching
Drainage
otitis externa management - Mild?
Acetic acid solution to restore acidic environment
otitis externa management - more severe ?
Topical antibiotics
Sometimes with topical steriods
otitis externa management - with perforated membrane
Oral and topical steroids
The most common causes of wheezing in children include?
asthma, allergies, infections, gastroesophageal reflux disease, obstructive sleep apnea
The least common causes of wheezing in children?
congenital abnormalities,
foreign body aspiration,
cystic fibrosis
Use of Bronchodilators?
A group of drugs that dilate the bronchi and bronchioles by relaxing smooth muscle. Used to decrease respiratory airway resistance and increase airflow to the lungs (e.g., to treat asthma and COPD).
Which type of beta-adrenergic stimulators may increase heart rate and the potential for cardiac arrhythmias?
Salbutamol being a beta-adrenergic stimulator may increase heart rate and the potential for cardiac arrhythmias
what can you also ask about in social history for patients suspected with asthma?
do you have pets?
does anyone smoke in the house?
What does Maternal tobacco use result in
low birth weight
is there a “safe” amount of alcohol that can be consumed during pregnancy to prevent fetal alcohol syndrome (FAS)?
no
What does Fetal alcohol syndrome cause?
facial abnormalities - microcephaly, smooth philtrum, thin upper lip
growth deficiency,
evidence of central nervous system dysfunction.
they may exhibit cognitive disability and learning problems (i.e., difficulties with memory, attention, and judgment) as well as neurobehavioral deficits such as poor motor skills and impaired hand-eye coordination.
Maternal heroin use is associated with? increased risk of fetal growth restriction, placental abruption, fetal death, preterm labor and intrauterine passage of meconium.
increased risk of|: fetal growth restriction, placental abruption, fetal death, preterm labor intrauterine passage of meconium.
All infants born to women who use opioids during pregnancy should be monitored for symptoms of _________? neonatal abstinence syndrome (i.e. uncoordinated sucking reflexes leading to poor feeding, irritability, and high-pitched cry) and treated if indicated.
neonatal abstinence syndrome (i.e. uncoordinated sucking reflexes leading to poor feeding, irritability, and high-pitched cry) and treated if indicated.
Cocaine and Other Stimulants use in pregnancy can cause
vasoconstriction leading to placental insufficiency and low birth weight, premature delivery, smaller head circumferences and shorter lengths.
may cause some aspects of cognitive performance, information processing, and attention to tasks abilities that are important for success in school
what is the percentage of infants who Without antibacterial prophylaxis will develop invasive disease (sepsis, pneumonia and meningitis) in mother colonized with GBS?
1-2%
what do you do if an infant is born ill-appearing?
full diagnostic evaluation (complete blood count [CBC], blood culture, chest x-ray and lumbar puncture) and receive IV antibiotics.
When do you give intrapartum antimicrobial prophylaxis against Group B streptococcal disease (GBS) ?
Previous infant with invasive GBS disease
GBS bacteriuria during any trimester of the current pregnancy
Positive GBS vaginal-rectal screening culture in the 36 0/7-37 6/7th weeks of current pregnancy
Unknown GBS status at the onset of labor (culture not done, incomplete, or results unknown) and any of the following:
Delivery at < 37 weeks’ gestation
Amniotic membrane rupture ≥ 18 hours
Intrapartum temperature ≥ 38°C (100.4°F)
Intrapartum nucleic acid amplification testing (NAAT) positive for GBS
if you have an Unknown GBS status at the onset of labor (culture not done, incomplete, or results unknown) when do you give prophylaxis antibiotics
if she has any of the following: Delivery at < 37 weeks' gestation Amniotic membrane rupture ≥ 18 hours Intrapartum temperature ≥ 38°C (100.4°F) Intrapartum nucleic acid amplification testing (NAAT) positive for GBS
what is the intrapartum antimicrobial prophylaxis against Group B streptococcal disease (GBS)
Appropriate antibiotics for intrapartum antibiotic prophylaxis include penicillin, amoxicillin, and cefazolin.
In the penicillin-allergic mother, clindamycin or vancomycin may be used after determining sensitivity.
what is grunting?
Grunting is a noise that is heard on expiration when an infant in respiratory distress is working to keep his or her alveoli open to increase oxygenation and/or ventilation. This is sometimes referred to as “auto-PEEP (positive end-expiratory pressure).”
Maternal factors that decrease placental blood flow result in caloric restriction and hypoxia in the fetus, leading to _______ glycogen stores and ______ red blood cell production
decreased, increased
Smaller infants have ______ subcutaneous fat, so they may become ________
less, hypothermic
An absent red reflex (no reflection noted) may be caused by:
A cataract
An opacified cornea (such as in mucopolysaccharidosis)
Inflammation of the anterior chamber
Developmental anomalies of the eye
Retinoblastoma, a potentially lethal malignancy (careful examination of the eye of an infant with retinoblastoma often identifies a white, irregular mass within the globe).
why is Erythromycin ointment, Hepatitis B vaccine and intramuscular vitamin K are recommended for routine prophylaxis?
gonococcal eye infection, Hepatitis B, and hemorrhagic disease of the newborn, respectively.
how do antiepileptic drugs or isoniazid affect newborns?
antiepileptic drugs or isoniazid interfere with how the body uses vitamin K. so they cause Vitamin K deficient bleeding
Caesarean section at 37 weeks ____ the risk for TTN
increases
Normal stool colors for newborn
If your newborn is on breastmilk, the optimum colour is a golden yellow. If your baby is on formula, it should look brown or tan to brown in color with some green and yellow.
Abnormal stool colors for newborn
- Solid black
- Watery streaked with red
- Raspberry poop with mucus
- Chalky white
What is Glutaric aciduria type 1 (GA1) ?
Glutaric aciduria type 1 (GA1), is a rare metabolic condition with a prevalence of approximately 1 in 100,000 newborns.
It is caused by a deficiency of the enzyme glutaryl-CoA dehydrogenase (GCDH), which is involved in the breakdown of the amino acids lysine, hydroxylysine and tryptophan.
What is a symptomatic neonatal plethora?
This clinical disorder includes symptoms due both to. hypervolemia and/or hematocrit elevations caused by large transfusions of blood at birth
Manifestation of symptomatic neonatal plethora
Tachypnea, mild cyanosis, plethoric skin color, and neurological depression persisted on average for 30 h after birth.
Causes of symptomatic neonatal plethora?
caused by large placental transfusions associated with delayed clamping of the umbilical cord.
Bengin skin lesions in newborns
The main lesions described as typical of the neonatal period include:
erythema toxicum neonatorum (ETN),
transient neonatal pustular melanosis (TNPM)
benign cephalic pustulosis (BCP).
These are a benign, self-limited, asymptomatic skin diseases that occur in the first days of life.
How do you tell if it’s a diaper rash or yeast infection?
A diaper rash is normally a patchwork of inflamed and chapped skin. Signs that point to a yeast infection include: Deep red inflamed patches with bumps around the edges.
yeast diaper rash will appear in the diaper area, even in the folds of your baby’s skin
“setting sun” sign in eyes of newborn/children is associated with?
The “setting sun” sign is an ophthalmologic phenomenon where the eyes appear driven downward bilaterally. The inferior border of the pupil is often covered by the lower eyelid, creating the “sunset” appearance.
This finding is classically associated with hydrocephalus in infants and children. It signifies intracranial hypertension
Describe Cephalohematoma
Cephalohematoma is a buildup of blood (hemorrhage) underneath a newborn’s scalp. It appears soon after birth. The bulge is discrete, does not cross the suture lines of the bones on their head, and is located at the back of the head.
How many mls of blood is there per kg in newborns?
Babies born full-term have about 75 milliliters (mL) of blood per kilogram of their body weight.
omphalocele is known to have _____ associated anomalies and _____ mortality rate than gastroschisis
more, higher
omphalocele has a _____ prognosis because it is associated with a significantly increased incidence of chromosomal abnormalities (approximately 12%).
worse
Ear malformations are associated with an increased frequency of clinically significant structural ______ anomalies compared with the general population.
renal
These include specific multiple congenital anomaly syndromes, Townes-Brocks syndrome (TBS), branchio-oto-renal (BOR) syndrome, among others.
What are the cause of Innocent heart murmurs?
Innocent heart murmurs are harmless sounds made by the blood circulating normally through the heart’s chambers and valves or through blood vessels near the heart. They can be common during infancy and childhood and often disappear by adulthood. They’re sometimes known as “functional” or “physiologic” murmurs.
Can you give supplemental oxygen using bag and mask to newborns with a congenital diaphragmatic hernia?
No
Infants born with congenital diaphragmatic hernia frequently require positive-pressure ventilation at delivery because of respiratory distress with cyanosis.
Provision of positive-pressure ventilation with bag and mask will drive large amounts of air into the upper GI tract, causing distention of a bowel that has herniated into the chest.
Such bowel distention will cause further lung compression and compromise respiratory function. For this reason, infants with diaphragmatic hernia should be promptly intubated in the delivery room if resuscitation is required.
When should you screen for postpartum depression
Mothers should be screened for postpartum depression during infant well-child visits at the 1-, 2-, 4-, and 6-month visits, as it can adversely affect the critical period of infant brain development.
which newborns need supplemental vitamin D?
Babies who are exclusively or partially breastfed should receive 400 international units of supplemental vitamin D daily beginning soon after birth.
Formula-fed babies consuming less than 1 L of formula per day also need vitamin D supplementation.
How do you prepare Powder formula?
For most formulas, the ratio is 2 oz water added for each scoop of powder.
Can infants drink cow milk before 12m?
Young infants cannot digest cow’s milk as completely or easily as they digest breast milk or formula.
Cow’s milk contains high concentrations of protein and minerals, which can stress a newborn’s immature kidneys.
Cow’s milk lacks iron, vitamin C, and other nutrients that infants need.
Cow’s milk can irritate the lining of the stomach and intestine, leading to blood loss in the stool.
Cow’s milk does not contain the optimal types of fat for growing infants.
___ kcal/kg/day is sufficient to maintain optimal growth of 20-30 grams per day in most full term babies for the first 2 months of life.
100
Infants born at < 37 weeks gestational age require __ to ___ kcal/kg/day.
115 to 130
Average daily weight gain for term infants is __ to __ grams.
20 to 30
Infants born at < 32 weeks gestational age require up to ___ kcal/kg/day.
150
What is Moro reflex? when does it disappear?
Symmetric abduction
Extension of the arms followed by adduction of the arms, sometimes with a cry.
The reflex is present at birth and disappears by age 4 months.
The Moro reflex may be used to detect peripheral problems such as congenital musculoskeletal abnormalities or neural plexus injuries.
What is Palmar Grasp? when does it disappear?
Infant grasps examiner’s finger placed in open palm and tightens grasp when finger withdrawn.
This reflex must disappear before the infant can begin grasping objects voluntarily.
This reflex persists until 2-3 months of age.
What is Plantar Grasp reflex? when does it disappear?
Infant flexes toes downward when examiner presses on ball of foot.
This reflex must disappear before the child begins to take steps.
What is Asymmetric Tonic Neck Reflex (Fencing Reflex)? when does it disappear?
When examiner turns head to one side, infant while supine assumes “fencing posture” extending the arm on the same side as the head is turned and bending the other arm at the elbow. This reflex is one of the first steps in hand/eye coordination and must disappear before the infant can reach for objects in or across the midline.
What is Babinski Response? when does it disappear?
Infant dorsiflexes the big toe and fans the other toes when examiner strokes the lateral aspect of the foot’s plantar surface.
This reflex is normal in children up to 2 years of age.
what causes neonatal cephalic pustulosis?
most likely due to colonization with malassezia species of yeast
what is Seborrheic dermatitis?
Most commonly presents as yellowish, greasy scales over the scalp, often called “cradle cap.” But it can also present as erythematous plaques around ears, eyebrows, nasolabial folds, and skin folds of the neck, axillae, and diaper area
Babies are developmentally ready to begin spoon feeding pureed solid foods between __ and __ months of age.
4 and 6
Most babies sleep through the night by age ___ to __ months.
4 to 6
position in the car for infants?
Back seat, facing the rear.
until they 2 years old
Common side effects of immunizations include
redness or swelling at the injection site, fussiness, and low-grade fever
By what ages should an infant double and triple his or her birth weight?
Double by 5 months, triple by 12 months
Former preemies, small for gestational age babies, and others with chronic health issues do not always follow this pattern, and there are separate growth charts available for these special populations.
In infants with more darkly pigmented skin the reflex may appear more ___ than red.
gray
Absence of a symmetric red reflex or the presence of leukocoria (white pupil) may indicate underlying abnormalities, including:
Cataracts
Glaucoma
Retinoblastoma
Chorioretinitis
The 6-month-old should be expected to take __ naps per day, and will probably sleep through the night.
2
The prophylactic administration of acetaminophen has been associated with ______ antibody concentrations for some vaccine antigens, although all concentrations remained in the protective range.
decreased
Neuroblastoma manifestations? presenting population
Fever, pallor, and weight loss are frequent presenting symptoms.
Neuroblastoma is a likely diagnosis in an infant younger than a year of age who has an asymptomatic RUQ abdominal mass and pallor and no jaundice.
Wilms’ tumor is commonly associated with ___________, a genetic overgrowth syndrome.
Beckwith-Wiedemann syndrome
Other features that may be seen in children with this syndrome include omphalocele, hemihypertrophy, hypoglycemia, large for gestational age, and other dysmorphic features.
Urine or serum VMA/HVA measures metabolites of catecholamines, which are elevated in ______.
This test is highly specific for neuroblastoma and can be 90-95% sensitive in its detection.
Small cell rosettes are highly suggestive of _____
neuroblastoma
MIBG (meta-iodobenzylguanidine) scan is used for?
MIBG (meta-iodobenzylguanidine) scan: because neuroblastoma cells absorb this protein it is used to look for metastases.
Most cases of neuroblastoma are due to _____ mutations.
somatic
That is, these mutations arise in cells other than the gametes. Somatic mutations are not passed to the next generation.
neonate (first 28 days) with fever?
sepsis until proven otherwise. Physical exam is unreliable
most common cancer in children
lymphoma
leukemia
infants born to ____ positive mothers have to be observed for __h, they can be infected up to ___ days
GBS
48
27
Kernig and Brudzinski signs are indicative of
meningitis
It is recommended that parents discontinue the bottle by the time the child is __ to ___ months old.
12 to 15
Although constant use of bottle milk is most damaging, even routine bedtime use of the bottle can lead to ____.
cavities
______ in toddlers is usually caused by tibial torsion. In tibial torsion, when the patella faces straight ahead, the foot turns inward. Tibial torsion resolves naturally with weight bearing – usually by ________
Intoeing, 4 years of age.
Intoeing in preschool- and school-aged children is usually caused by ______ . In femoral anteversion both the feet and knees turn inward. Femoral anteversion usually resolves spontaneously by ______
femoral anteversion
8 to 12 years of age.
strabismus noted with ________ test
cover/uncover
____________ is recommended as a screening test for anemia at 12 months for all children and at any age if risk factors for iron deficiency are present.
Fingerstick hemoglobin
Children living in lead-contaminated environments are at greatest risk for having elevated blood lead levels between _________ months, largely because of the _________ that occur during this developmental stage
6 and 36 months, normal mouthing behavior and increasing mobility
Milk can cause ______ through multiple mechanisms including microscopic GI bleeding as well as poor iron availability from milk.
anemia
In children, it is important to treat _______ because of its potential cognitive impact.
iron deficiency
Being able to jump in place is a ___-month-old milestone
30
A BMI greater than or equal to the ____ percentile for age is considered obese.
95th
Childhood depression is marked by a high rate of conversion to ________
bipolar disorders.
The following are “red flags” that might raise a clinician’s concern for _______:
History of maternal illness or substance abuse during pregnancy
Complications at the time of delivery
History of meningitis or other serious illness
History of serious head trauma]
Parental history of learning disabilities or difficulty at school
learning disabilities
Adverse Effects of ADHD Medications
Appetite suppression
Insomnia
Decrease in growth velocity
risk factors for childhood obesity?
high birth weight, low birth weight (small for gestational age), and maternal diabetes
Lower socioeconomic status
Obese parent
Certain genetic syndromes (such as Prader-Willi, Bardet-Biedl, and Cohen syndromes)
possible sequelae of obesity?
Dyslipidemia Hypertension Obstructive sleep apnea Slipped capital femoral epiphysis Steatohepatitis Type II diabetes mellitus
________ is cessation of breathing lasting at least __ seconds while sleeping. It is obstructive, rather than central, apnea and is characterized by loud snoring and labored breathing. It is estimated to occur in approximately 7% of overweight children.
Sleep apnea, 15
Testing should be considered in pediatric patients who are overweight (BMI >/= 85th percentile) or obese (BMI >/= 95th percentile) and have one or more additional risk factors for diabetes:
FHx of type 2 DM in first- or second-degree relative
Signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, polycystic ovary syndrome, hypertension, dyslipidemia)
Maternal history of diabetes or gestational diabetes during the child’s gestation
Age of initiation of screening for diabetes in kids
10 years
Placement of an ________ during the perinatal period may predispose to renal vascular disease.
umbilical arterial or venous line
Although less common in boys, _____ in childhood are one of the leading causes of hypertension and renal insufficiency later in life. This is due to renal scarring following the infection.
UTIs
Although some children with catecholamine excess, e.g. ____ or ______ may not have symptoms such as flushing or sweating or palpitations, a positive response to a screening question in a hypertensive child would merit urine catecholamine testing.
pheochromocytoma or neuroblastoma,
Both ___ and _______ can cause an increase in blood pressure
Both steroids and CNS stimulants can cause an increase in blood pressure, especially when used in combination. Steroids increase blood pressure by mimicking endogenous cortisol and the sympathetic fight or flight response. Stimulants mimic norepinephrine, stimulating alpha and beta adrenergic receptors, causing an overall increase in blood pressure.
Taking __________ during pregnancy may lead to cardiac defects, dysmorphic craniofacial features, hypoplastic nails and distal phalanges, IUGR, and microcephaly. Mental retardation may be seen. A rare neonatal side effect is methemoglobinuria.
anticonvulsants
_________ during pregnancy places the newborn at risk for neonatal abstinence syndrome. Affected newborns may exhibit CNS findings (irritability, hyperactivity, hypertonicity, incessant high-pitched cry, tremors, seizures), GI symptoms (vomiting, diarrhea, weight loss, poor feeding, incessant hunger, excessive salivation), and respiratory findings (including nasal stuffiness, sneezing, and yawning).
Maternal opiate use
Order of events during female puberty
Breast buds appear (age 10-11 years), then,
Pubic hair appears (age 10-11 years) then,
Growth spurt (age 12 years) then,
Periods begin/menarche (age 12-13 years) then,=
Attainment of adult height (age 15 years)
Order of events during male puberty
Growth of testicles ( age 12 years) then,
Pubic hair appears (age 12 years) then,
Growth of penis, scrotum (age 13-14 years) then,
First ejaculations (age 13-14 years) then,
Growth spurt (age 14 years) then,
Attainment of adult height (age 17 years)
Symptoms of von Willebrand Disease (vWD)?
Ecchymoses (small hematomas in areas of trauma)
Epistaxis
Menorrhagia (why vWD is diagnosed more often in women than men)
Bleeding post-tonsillectomy and dental extractions
Gingival bleeds
_________ is contraindicated in diaphragmatic hernia because it pumps air into the gastrointestinal tract, leading to further lung compression
Bag-and-mask ventilation
High levels of _____ antagonize cortisol, which results in delayed maturation of phosphatidylcholine and phosphatidylglycerol, vital phospholipid components of _____.
insulin
surfactant
______ are given to women in preterm labor to stimulate fetal surfactant production prior to delivery, decreasing the risk of RDS.
Corticosteroids
treatment for Apnea of prematurity
Mild apneic episodes may not require treatment;
however, spells that are prolonged, frequent, or associated with bradycardia or hypoxia (as seen in this patient) can cause repeated “watershed” insults to the brain white matter, which can result in cerebral palsy.
Therefore, treatment with caffeine therapy and/or noninvasive respiratory support (eg, high-flow nasal cannula, continuous positive airway pressure) is warranted. Caffeine is a methylxanthine that chemically stimulates the respiratory drive and is given until the respiratory centers mature, which typically occurs by the expected due date.
Complications of prolonged spells in apnea of prematurity
can cause repeated “watershed” insults to the brain white matter, which can result in cerebral palsy.
Treatment for obstructive apnea caused by severe bronchopulmonary dysplasia
Dexamethasone reduces inflammation in the airways and the alveolar-capillary interstitial space, and albuterol dilates the airways. These treatments can be considered for obstructive apnea caused by severe bronchopulmonary dysplasia, which occurs after age 28 days and can cause chronic (not episodic) hypoxia.
Healthy young children who attend day care or have older siblings may experience up to __ respiratory infections per year. The majority of these infections are __ and do not require antibiotics.
12
viral
Hypoxic-ischemic brain injury (as occurs with drowning and cardiac arrest) can cause neuronal cell death within minutes. Widespread neuronal necrosis then leads to ______, which increases ICP and compresses small arterioles, decreasing cerebral blood flow.
cerebral edema
Cushing triad is
HTN
Bradycardia
Irregular respirations
_________ can cause locked-in syndrome in which patients have complete quadriplegia and cannot speak; however, they typically retain consciousness, eye-opening, and vertical eye movements
Isolated pontine infarction
Stress-induced (takotsubo) cardiomyopathy, a reversible cardiomyopathy likely caused by toxicity from surging ________, can occur after severe physical stress. However, it most commonly occurs in postmenopausal women
catecholamines
__________ can cause hypertension in an intubated patient; however, tachycardia (not bradycardia) and increased motor activity (vs lack of response to painful stimuli) would be expected.
Uncontrolled pain
respiratory distress, unilaterally decreased breath sounds with increased brightness on transillumination—is consistent with___________.
pneumothorax
meconium aspiration syndrome (most common in postmature neonates) is associated with _________ because meconium plugging of airways traps distal gas, promoting alveolar overdistension and rupture.
pneumothorax
____________ is caused by air dissecting from the alveoli into the interstitial space. the greatest risk occurs within days of birth, when lung compliance is decreased and high airway pressures are needed to support breathing.
Pulmonary interstitial emphysema (PIE)
Defective surfactant metabolism and clearance can occur in __________ , which can cause neonatal respiratory failure and ground-glass opacities on x-ray. However, this condition is exceedingly rare, making RDS far more likely, particularly in a premature neonate.
pulmonary alveolar proteinosis
Apnea of prematurity is caused by an underdeveloped _______ and presents a few days after birth with episodes of apnea, bradycardia, and desaturation without increased work of breathing.
medullary respiratory center
deficiency of surfactant results in increased alveolar surface tension and diffuse atelectasis (lung collapse), as well as pulmonary inflammation and edema. The areas of collapsed lung are perfused but not ventilated (ie, ventilation/perfusion mismatch), with resultant intrapulmonary _____ shunting, leading to deoxygenated blood being delivered to the left side of the heart and to systemic circulation.
right-to-left
How does cholesteatoma present?
Recurrent AOM is a risk factor for developing a cholesteatoma. However, a cholesteatoma typically presents with recurrent painless otorrhea. Examination would show a pearly white mass or a retraction pocket in the superior portion of the tympanic membrane.
What is Necrotizing (malignant) otitis externa?
Necrotizing (malignant) otitis externa can present with severe ear pain and a swollen external auditory canal. However, it typically occurs in elderly patients with diabetes, and examination characteristically shows granulation tissue at the bony cartilaginous junction.
Chronic suppurative otitis media does not typically respond to oral antibiotics, as seen in this patient, because?
the middle ear is poorly vascularized due to chronic inflammation and scarring.
Malignant otitis externa represents osteomyelitis of the external auditory canal and skull base. It typically develops in __________. It can cause discharge and hearing loss but is typically characterized by severe ear pain, prominent discharge, and external auditory canal erythema.
elderly patients with diabetes mellitus
_______ is a condition associated with an accumulation of fluid in the inner ear that leads to hearing loss, vertigo, and tinnitus.
Meniere disease
An ______ is a benign, solitary area of bony overgrowth that can form in the outer ear and lead to hearing loss. they are more common in adults and typically involve the external ear (rather than the middle ear).
osteoma
________ is a condition in which there is bony overgrowth of the stapes footplate that results in conductive hearing loss.
Otosclerosis
_________ presents with fever, dysphagia, drooling, stridor, and a stiff neck in young children. Examination reveals swelling of the posterior pharyngeal wall , and x-ray shows widening of the retropharyngeal space.
Retropharyngeal abscess
_________ may occur in isolation or as part of the CHARGE syndrome (coloboma [missing eye tissue], heart defects, atresia choanae, growth retardation, genital abnormalities, and ear abnormalities).
Choanal atresia
Cholesteatoma, chronic otitis media, foreign body, and otosclerosis affect the middle or outer ear and can cause ______ hearing loss.
conductive. Patients with this type of hearing loss have louder bone conduction than air conduction in the affected ear; a tuning fork placed on the forehead is also louder in the affected ear.
______ treat allergic rhinitis, which presents with clear rhinorrhea, congestion, nasal itching, sneezing, and watery eyes.
Antihistamines
subglottic narrowing (eg, subglottic stenosis) often lead to __________
biphasic stridor.
In patients with tracheomalacia, the increased pressure narrows the intrathoracic tracheal airway, leading to ______________
expiratory stridor (rather than the inspiratory stridor seen with laryngomalacia).
________ (low-pitched, rattling sounds that may occur on inspiration or expiration) are often caused by secretions in the bronchi and can be heard often in pneumonia.
Rhonchi
________ is used for lower respiratory tract infection caused by atypical bacteria (eg, Mycoplasma pneumoniae, Chlamydia pneumoniae) and for whooping cough caused by Bordetella pertussis.
Azithromycin
___________ has activity against most S aureus strains, including methicillin-resistant strains.
Clindamycin
_______ can be used in the treatment of Clostridium difficile infection
Metronidazole
____________ are used to treat Pseudomonas aeruginosa, commonly seen in pulmonary infections in cystic fibrosis.
Piperacillin-tazobactam and tobramycin
____ must be ruled out in any child with abrupt onset of mood changes, bedwetting, and/or academic difficulties.
Abuse
