S12C118-142 Peds: MSK, stridor, wheeze, PNA, heart dz, abdo pain

Question 1

central cord syndrome

Answer 1

• weakness: UE»LE

- variable sensory loss

Question 2

cervical lymphadenitis

Answer 2

• tx: amox clav or clinda
• Sx: tender, overlying skin erythema
• cause: staph, strep, GBS
• if b/l think: EBV, HSV, CMV, rubella, roseola, RSV
• chronic unilateral: bartonella, mycobacgerium

Question 3

croup

Answer 3

-occurs in fall/winter
-cause: parainfluenza, RSV, rhinovirus
-6mo-3yo
Sx: 1-2d of viral URTI with low-grade fever then harsh cough (barking), hoarse voice and stridor
-most severe sx are on 3rd/4th day of illness
-cxr: steeple sign
-ddx: epiglottitis, RPA, FB
-tx:
nebulized epi (for mod-severe)(L-epi 1:1000, 0.5ml/kg)
dexamethasone 0.3mg/kg, heliox
**do not give beta agonists (ventolin) b/c can worsen airway edema with vasodilation

Question 4

epiglottitis tx

Answer 4

• O2
• CTX or cefuroxime
• steroid

Question 5

Asthma and PEF

Answer 5

-will be

Question 6

Asthma Tx

Answer 6

-O2
-ventolin (beta agonist)
-atrovent (anticholinergic)
-systemic steroid (PO/IV)
-IV fluids
Severe;
-magnesium
-NPPV (IPAP 12, peep of 6)
-systemic SABA (epinephrine or terbutaline)
-ketamine
-heliox

Question 7

Normal pediatric CXR

Answer 7

• cardiac silhouette can occupy up to 60-65% of chest width
• thymus has a silhouette, can be seen better on lateral xr, should be anterior, if it extends behind the heart shadow or posterior to the trachea it should be investigated

Question 8

Kawasaki tx:

Answer 8

• IVIG and high dose ASA x6-8w

- to prevent coronary artery aneurysm, if aneurysm does occur then ASA indefinitely

Question 9

HACEK organisms

Answer 9

-hemophilus
actinobacillus
cardiobacterium
eikenella
kingella

Question 10

Intususception

Answer 10

-anywhere from 3mo-6yo but classically 6-18mo
-sudden onset colicky abdo pain (intermittent)
-vomitting develops after 6h
-red currant jelly stool is late manifestation
-lethargy
-may feel a sausage on palpation
Dx: u/s

Question 11

HSP

Answer 11

• 2-11yo
• triad: acute abdo pain, purpuric rash, arthritis
• renal involvement: hematuria, HTN
• u/a for hematuria and proteinuria and RBC casts

Question 12

Phimosis

Answer 12

• inability to retract foreskin over glans
• caused by stenosis at distal aspect of foreskin
• physiologic phimosis often resolves by 5yo, if it persists beyond school age and parents desire tx then topical steroids can be used
• acquired phimosis from balanoposthitis, poor hygiene or forcible retraction of foreskin may require circumcision
• may be so severe that it causes urinary retention

Question 13

Paraphimosis

Answer 13

-urologic emergency
-foreskin is retracted proximal to glans and becomes trapped in that position
-impaired lymphatic/venous drainage occurs and glans and foreskin become more swollen
-if uncorrected the glans can become necrotic
Tx: reduce ASAP, do a dorsal penile nerve block, apply ice to glans/foreskin and manually compress edema, place thumbs over glans and fingers over foreskin and unravel foreskin while pusing glans back
-all need f/u with uro

Question 14

balanoposthitis

Answer 14

• cellulitis of glans and foreskin

- warm soaks and Abx for tx

Question 15

Golden hour for testicular torsion

Question 16

Golden hour for priapsim

Question 17

HUS

Answer 17

• hemolytic-uremic syndrome
• TRIAD: AKI, thrombocytopenia, microangiopathic hemolytic anemia
• usually kids

Question 18

Options for Sz tx if no IV

Answer 18

• rectal diazepam

- intranasal midaz or buccal midaz

Question 19

Dfn febrile seiizure

Answer 19

• generalized tonic-clonic Sz
• lasts 38
• child is 6mo-5yo
• occurs only once in a 24h period
• 30-50% will have a recurrence
• if just one febrile Sz then no increased risk of epilepsy (same 1% risk as general popn)
• if FmHx of Sz, multipile febrile Sz or first febrile Sz before 12mo of age, dvpt delay, focal Sz, todd paralysis, focal neuro finding or abnormal EEg/CT then there is an increased risk of epilepsy (2-4%)

Question 20

signs of raised ICP in kids

Answer 20

bulging fontanelle, increased circumference of ehad, sun-setting, CN palsy, papilledema, somnolence

Question 21

tx of ITP

Answer 21

-IVIG if platelets

Question 22

hypoglycemia tx in peds

Answer 22

infants: 2ml/kg 25% dextrose
neonate: 5cc/kg 10% dextrose (D10)
older kids: 1cc/kg D50

Question 23

CAH

Answer 23

• deficiency/abnormality in cortisol, often an associated with a deficiency in aldosterone as well
• most common presentation: hyperkalemia, hyponatremia, virilizing variant (salt-losing - present in 2nd-5th wk of life)
• 25% are non-virilizing type
• may present mild with lethargy, irritability, poor feeding or may prsent in shock/dehydration
• ddx: sepsis, heart dz, inborn error of metabolism
• females may have fusion of labia and large clitoris, males may have micropenis or hypospadia
• evaluation: glucose, lytes (hyponatremia, hyperkalemia)
• tx: HCT 25mg/IV/IO to neonates, 50mg to toddlers, 100mg to adolescents