NMS Medicine: Medicine: General Pediatrics Flashcards


Set Details Share
created 10 years ago by jgaversa5
950 views
book cover
NMS Medicine
Chapter 1
updated 10 years ago by jgaversa5
Subjects:
medical, critical care, education & training, internal medicine, test preparation & review
show moreless
Page to share:
Embed this setcancel
COPY
code changes based on your size selection
Size:
X
Show:

1

who is genreally the historian for children

parents

2

what are considered in addition to usual medical history

details of pregnancy/birth history

developmental history

immunization history

growth chart

3

what should you know about each of the common outpatient conditions

epidemiology (who gets it: age group, risk factors)

clinical features (key history physical)

diagnostic (labs and imaging)

managment (meds, interventions, natural history)

4

are fevers common in kids

yep

5

what in addition to a fever must be considered

appearance of child, age, and underlying medical conditions

6

what does fever do to heart and respiratory rate and vasoconstriction

increases them all

7

does fever cause brain damage

no

8

does heigh of fever predict severity of illness

no

9

should you treat the child or fever

child

10

what are the standard options in treating fever

acetaminophen or ibuprofen

11

are tepid baths recommended for fever

no

12

is aspirin recommended for fever

no

13

how many kids have febrile seiqures

2-4% in children under 5 years

14

what age group most often get febrile seizures

12-18 months

15

what is usually associated with febrile seizures

family history

16

what is the etiology like in febrile seizreus

certain interleukens be proconvulsant in susceptible patients

17

are febrile seizures a big deal

no, usually benign

18

what are the conditions in which febrile seizures usually have an excellent prognosis

generally tonic/clonic, non focal, last less than 15 minutes

no evidence of IC infection or neurologic signs

clear history of fever before seizure; more often at beginning of illness often at awakening or going to sleep

neurologcally and developmentally normal before and after the seizure

19

how many upper respiratory infections do kids have a year

6-7 epidosdes

20

what is the most common human illness

"cold"

21

what age group is URI most common in

infants and school age children

22

how many URIs are caused by rhinovirus

over half

23

besides rhinovirus what cuases colds

RSV
adenovirus
parainfluenze virus
influenza

24

what are the clinical manifestations of URIs

low grade fever (2-3 days) with sore throat, rhinorrhea, cough

25

how long do URIs last

7-14 days

26

are antibiotics indicated for URIs

no

27

what are recommended for URIs

humidifiers, nasal saline, adequate hydration

28

what are medications for symptom management in older children only given if

benefits outweigh side effects (minimal evidence for using antihistamines, cough suppressants, decongestants, or expectorants)

29

are OTC cold meds recoemmended for chilcren over 6

no

30

what % of kids have acute otitis media

70% by age 5

31

how many kids who have an acute otitis media will have more than 6 episodes

1/3

32

is AOM more common in males or females

males

33

is there a familial predisposition to AOM

yes

34

what increases risk of AOM

bottle feeding and daycare attendance

35

when does incidence for AOM increase

when the kid is under one year old

36

what is often concurrent or preceding with AOM

viral URI

37

what is AOM

acute otitis media is a bacterial infection of middle ear fluid

38

what is OME

otitis media with effusion (fluid pressent but not infected)

39

how can cultures for AOM be obtained

tympanocentesis

40

how many cultures of AOM are positive for bacteria

2/3

41

how many cultres of AOM are viral or sterile

1/3

42

is a canal drainage culture reliable or useful

unreliable but useful for chronic otorrhea

43

what accounts for 1/3 of AOM

strep pneumo

44

what accounts for 1/4 of AOM

haemophius influenza

45

are most H. flu AOMs typable

no

46

what accounts for 15% of AOM

moraxella catarrhalis

47

what are some low commonality AOM causes

staph aureus, miscellaneous strep

48

will young kids with AOM be able to localize the pain

young children will not localize pain well

49

what are the clincal presentation possibilities of AOM

irritiability
fever
not sleeping
pulling at ear or complaints of ear pain
vomiting and/or diarrhea
dizziness/balance problems

50

how would you diagnose AOM by otoscopy

bulging
dull/cloudy
ruptured
bullous
air fluid level
red
mobility

51

what is the most reliable AOM finding in otoscopy

bulging

52

what is a dull/cloudy TM mean

lack of light reflex

53

in a ruptured TM in AOM what does the canal often look like

purulent fluid, cant visualize perforation

54

what would a bullous TM have on it

blisters/bullae

55

what is the least reliable finding of AOM by otoscopy

red (injection from crying/staining/fever is common)

56

when wouuld a pneumatic otoscope be useful for AOM

espeiclly if ear "just red"

57

what is the most commmon diagnosis for antibiotic use in pediatrics

AOM

58

what does treatment reduce in terms of symptom duration of AOM

1 day of symptoms

59

how many AOMs resolve spontaneously

50%

60

what types of things are placed for recalcitrant cases

ventilation tubes

61

what is happening among AOM pathogens

increasing resistance

62

what types of AOM antibiotic options are there

amoxicillin
cephalosporin oral (cefinir, cefuroxime)
amoxicllin and clavulanate OR
ceftriaxone IM

63

if the child has had amoxil recently or you suspect h. flu what should you give

give 2nd/3rd generation cephalosporin (oral) like cefdinir or cefuroxime OR

64

how is ceftriaxone IM given

single dose and repeat in 48 hours if needed

65

what is an alternative to antibiotics for AOM

observation

66

what age group is observation appropriate for AOMs

over 2 yeras old, not ill appearing, unilateral disease and not prone to recurrent or frequent AOM

67

what would you encourage to someone who you wanted to observe with AOM

topical analgesic and oral NSAID

safey net prescritpion for antibiotics to increase parental comfort

68

what does acute bacterial sinusitis follo

5-15% of viral URIs in kids

69

what causes 30-43% of acute bacterial sinusitis

s. pneumo

70

what causes 20-28% of acute bacterial sinusitis

h. influ and moraxella

71

what causes 5-7% of acute bacterial sinusitis in kids

s. pyogenes and anaerobes

72

are there common complications in acute bacterial sinusitis

rarely

73

what will be considered in the acute bacterial sinusitis differential

nasal foreign body and allergic rhinitis

74

is there a definitive test based on acute bacterial sinusitis

no

75

what is usually how acute bacterial sinusitis works

initial improvement of URI symptoms then worsening of symptoms and high fever

persistant or prolonged URI symptoms (10 days), night cough, purulent nasal discharge, bad breath, variable facial pain/headache

severe symptosm over 3 days (high fever and purulent discharge)

76

how many acute bacterial sinusitises resolve spontaneously

505 at least

77

are antibiotics conclusively beneficial in acute bacterial sinusitis

no

78

what is the first line offense of acute bacterial sinusitis

amozil

79

what are some second options for acute bacterial sinusitis

amoxacillin/clavunate
2nd/3rd generation cephalosporins, clindamycin, macrolides, TMP/SMX

80

how long do you treat acute bacterial sinusitis

10-14 days or until no symptoms ofr 7 days

81

what is the most commmon cause of exudative pharyngitis in childhood

strep

82

is strep common in children under 3

no

83

what is strep pharyngitis a risk factor for

immune mediate rheumatic fever and post strep glomerulonerphitis

84

is s. pharyngtitis a clinical call

no, lab call

85

what is the test used for strep test

rapid strep (RS) antigen, tested in 5 minutes in office

86

what is specificity of RS being positive

95%

87

what is sensitivity of RS antigen

below 90%

88

how do you confirom RS

throat culture

89

what are the symptoms of s. pharyngitis

sudden onselt sore throat
swollen LNs
pain on swallowing
fever
headache
abdominal pain
nausea and vomiting
no URI symptoms

90

what are the signs of s. pharyngitis

tonsillopharyngeal erythema
tonsillopharyngeal exudate
soft palate petechiae
beefy red, swollen uvula
anterior cerivcal adenitis
scarlitiniform rash

91
card image

left and right

left: soft palate petechiae
right: tonsillar exudates

92
card image

what is this a picture of

scarlet fever

93
card image

what is this a picture of

post scarlet fever desquamation

94

what is the use in treating s. pharyngitis

prevents rheumatic fever and PSGN
shortens duratin of symptoms by a day and prevents transmission

95

what is given in s. pharyngitis treatment

amoxicllin first line, BID better compliance than penicllin QID

96

what is given in s. pharyngitis if someone has penicillin allergies

azithromycin

97

what is given if recent antibiotic failure for strep

cephalosporins or clindamycin

98

what is acute gastritis most common and severe in

children under 5 (avg 2 episodes a year)

99

when (season) is AGE most common

winter

100

is AGE contagious

yes

101

where does AGE spread

crowded areas

102

what are the symptoms of AGE

vomintg 12-24 hours and diarrhea for 3-5 days

103

what is the most common etiology of AGE

rotavirus
adenovirus
norovirus

104

what are the lses frequent causes of AGE

enteric pathogens
c diff
parasites

105

what are the ocmplciatins of AGE

dehydration, hospitalization in less than on percent

106

how can AGE be prevented

rotavirus vaccine but initial product puled for increased intusseception risk

107

what is the clinical eval for AGE

estimate degree of dehydration and risk for less common pathologies

108

what should you record for AGE

vital signs
weight change
temperature
respirations (deep breathing=metabolic acidosi)
pulse (elevated=anxiety and fear)
BP (postural changes in older kids, overall BP is late indicator of hypovolemia in kids)
history of bloody stools, ill contacts, antibiotics, travel

109

what will AGE look like on physcial exam

lethary in general appearance
skin turgor: check abdominal wall above umbilicus
capillary refill time (1.5-2 second normal)
dry mucus membranes, loss of tears, sunken eyes, sunken fontanelle
urine output and oral intake history

110

do you need diagnostics in AGE

no not usually unless looks ill

111

what will dehydration labs look like

BUN/creatinine elevated
sodium high or low
potassium low (lost in stool)
bicarbonate low (lost in stool)
urine specific gravity high (concentrated to preserve water)
stool studies rarely needed

112

is AGE self-limited

yes with supportive care

113

what is treatment if no or mild dehydration

small amounts of fluids frequently to prevent dehydration: increase volume as tolerate

pedialyte is good choice but probably doesnt matter what they drinnk

resume normal diet as soon as possible with exception of lactose and high sugar/fructose drinks (can worsen diarrhea)

avoid antidiarrheal agents

114

what do you use for moderate dehydration of AGE

oral rehydration solution with salt and no more than 3% sugar solutinons

pedialyte tast a problem, popsicle form better sometimes

115

should you give kids anti-emetics

no because of sedation and extra-pyramidal reactions

116

what is a beneficial kid anti emetic

zofran/odansetron (but expensive)

117

if moderate to severe dehydration fails oral hydration, what should be the next course

hospitalization for IV fluids

118

what is pyelonephritis

kidney infection (upper UTI)

119

what is cystitis

bladder infection (lower UTI)

120

what do you have to watch for in UTIs

increased potential for renal damage in infants and young children

121

why is UTI more difficult to diagnose in young children/infants

nonspecific symptoms or asymptomatic

122

what is the usually only symptom of UTI

unexplained fever

123

what kids have a higher risk of UTI

uncircumcised males and females

124

do clinical UTI manifestations vary with age

yes

125

what do newborns show in UTIs

sepsis, jaundice, diarrhea, vomiting, FTT (failure to thrive)

126

what do infants show in UTIs

fever, ab pain, FTT, irritability

127

what do older children show in UTI

similar to adults (urgency, frequency, dysuria), ab pain, incontinence

128

does the physcial exam show much in UTI

fever
flank mass (hydronephrotic kidney with urine flow obstructed)
costovertebral angle tenderness (kidney pain)

129

what are the diagnostics of UTI

urinarlysis/urine culture

130

what are the screening tests for urinalysis

leukocyte esterase and nitrate are indicatros

131

is bag urine good for culture

no it is contaminated with skin flora

132

what is a main diagnostic for UTI suspicion

urinalysis/urine culture

133

what are bag specimens for infants and toddlers used for and what indicates UTIs

screening test for urinalysis

leukocyte esterase and nitrate are the most useful indicators of UTI

134

do you use bag urine from infants/toddlers for culture

no (skin flora)

135

if a toddler is toilet trained how do you get a urine culture

midstream catch

136

what would indicate a UTI in a clean catch

more than 100,000 colonies/mL of a single bacterial pathogen

137

how would you get a urine culture from a kid who is under two years old or not toilet trained

bladder catherization (more than 100 colonies/mL is UTI)

bladder aspiration (rare, any growth suggests UTI)

138

how many of utis are E. coli

80%

139

how are UTIs treated normally

2nd or 3rd generation cephalosporins

address hygeiene (antibact soap, bubble bath, bowel habits)

140

if male and recurrent UTIs what should you think about

underlying anatomic issues like obstruction and reflux

141

if you have reflux causing UTIs what might be in order

preventive meds long term or surgery (controversial)

142

what is constiipation

hard, large, or infrequent stools

143

how does constipation present

abdominal pain

144

is frequency of stooling variant in kids

yes, maybe after every feeding, usually daily BM by 4 years

145

is infant dyschezia constipation

no

146

what should you do to diet if the infant passes hard, painful stool

higher fiber diet

147

what should you do if child has fear/anxiety related to defecation

toilet train

148

what must be done to rule out serious underlying disorder instead of constipation

abdominal exam
neurological exam
rectal exam

149

what are some reasons that child can be constipated

structural disorders of rectum, colon

metabolic disorders like thyroid disase, lead poisoning, hypokalemia, CF

150

is the typical american diet high fiber

low fiber

151

what are some constipation treatments

high fiber
fiber supplement
osmotic laxatives
enemas
behavioral changes

152

what is roseola cause by

HHV6

153

how many roseola cases are in kids younger than 2

90%

154

what is roseola characterized by

high fever 3-5 days then sudden appearance of transient blanching papular rash on trunk

155

is there a roseola seasonal pattern

no

156

is roseola self limiting

yes

157
card image

what is this rash

roseola

158

what causes erythema infectiosum

parvovirus B19

159

what are the prodromal symptoms of EI

fever
coryza
headache
nausea
diarrhea

160

what happens 2-5 days after EI nonspecific symptoms start

classic erythematous malar rash (slapped cheek rash)

facial rash followed by reticulated or lacelike rash on trunk and extremities

161

is EI slef limiting

yes in healthy person

162

who is EI dangerous in

pregnancy of 1st or 2nd trimester

163
card image

whats this kid have

EI

164

what causes herpangina and hand foot mouth disease

coxsackie virus

165

is herpangina contagious

yes, direct contact with secretions

166

where do people get ulcers in HFM

soft palate
hands
feet
buttocks

167

when is herpangia not herpangina anymore

when it is not limited to mmouth

168

who is most affected by herpangina/HFM

kids ages 3-10

169

is herpangina/HFM self limiting

yes

170
card image

what is this typical of

herpangina

171
card image

what is this typical of

HFM

172

what type of virus is mulloscum

pox virus

173

how is molluscum spread

direct contact and fomites, autoinoculation from scratching, sexually transmitted

174

where can mulloscum be present

anywhere except palms/soles

175

is molluscum self-limiting

yes but can take months/years to resolve

176

what helps to destroy molluscum lesions

card image

cryotheraphy
currette
chemical blistering agents

177

what is the most common cause of intestinal obstruction in infants between 6 and 36 months of age

intussesception

178

how many people who get intuss are younger than 2

80-90%

179

what is incidence of intuss

30 per 100000 live births

180

what is the cause of most intussecption

idiopathic

miniority due to structural variation

181

where are intuss most seen anatomically

near ileocecal junction

182

what is the mechanics of the msot seen intuss

proximal segment of bowel telescopes into distal segment taking mesentery with it

183

what is the "lead ponit" associated with

lymph node enlargement dragged by peristalsis into distal segment of instesting in intuss

184

how does the proximal segment get dragged into the distal one

venous and lymphatc congestion leads to intestinal edema trapping the distal segment

185

what does intuss lead to if left untreated

obstruction
ischemia
performatioon
peritointis

186

how does intuss present

sudden onset of intermittent, severe, progressive ab pain

inconsolable crying and drawing up of legs toward abdomen at 15-20 minute intervales

vomiting and bloody currant jelly stools, lethergy

sausage shaped mass in right side of abdomen

187

what will stools look like in intuss

currant jelly

188

where will there be a mass in intuss and what will it look like

sausage shaped right side of abdomen

189

how would you diagnose intuss

US: target sign

enema under fluoroscopy: filling defect

190

what is the non operative treatment of intuss

hydrostatic or pneumatic pressure by enema

191

when would you operate with intuss

if long duration of symptoms and/or suspected bowel perforation

192

how do pyloric stenoses come along

hypertrophy of pylorus with elongation and thickening, eventually progressing to the near complete obsrcution of gastric outlet

193

how common is pyloric stenosis

2-3.5 in 1000 live births

194

when do symptoms of pyloric stenosis begin

3-5 weeks of age, rarely after 12 weeks

195

what is the predisposition of pylori stenosis patients

"hungry vomiter"

196

describe the "hungry vomiter"

postprandial, non bilious vomit, often projectil vomiting in infant that demands to be refed soon after

197

what is the mass felt in pyloric stenosis

olive like mass at lateral edge of rectua abdominus in RUQ of abdomen

198

what usually results from pyloric stenosis (physiologically)

hypochorelmic, metabolic alkhalosis resulting from loss of large amounts of gastric hydrochloric acid

199

how can pyloric stenosis be diagnosed when oliver or peristaltic waves cant be detected

when "oliver" and/or peristaltic waves cannot be detected, confirm by imaging

200

what types of imaging could help diagnose pyloric stenosis

upper GI contrast study: STRING SIGN

abdominal ultrasound: measure of pyloric dimensions

201

how do you treat pyloric stenosis

pyloromyotomy

202

what does a pyloromyotomy involve

longitudinal incision of hypertrophic pylorus with blunt dissection to level of submucosa

203

what usually needs to be treated first before surgery in pyloric stenosis

electrolytes and dehydration

204

what is NEC from

unknown etiology: ischemic necrosis of intestinal mucosa

205

how common is NEC

1-3 /1000 live births

206

how many of the NEC cases are in premature infants

90%

207

what is mortality and long term morbidiy in NEC in survivors of neonatal intensive care

5-10%

208

how many of the low birth weight infants get NEC

6-7%

209

what are the risk factors of NEC

prematurity
microbial bowel overgrowth
milk feeding (relative to IV)
impaired mucosal defense
circulatory instability of intestinal tract
meds that cause intestinal mucosal injury or enhance microbial overgrowth

210

what are the general/nonspecific signs of NEC

apnea and lethargy

change in feeding tolerance

211

what are some gastric signs of NEC

gastric retention
abdominal distension, discoloration
vomiting

212

what are some fecal signs of NEC

rectal bleeding
bilious drainign from feeding tubs

213

what are some more serious signs of NEC

hypotension and shock

214

how would you diagnose NEC

heme positive stools
abdominal X ray

215

what would show up in NEC abdominal xray

pneumatosis intestinalis (air in bowel wall)

dilated bowel loops

free intraperitoneal air

portal venous gas

216

what are the "easier" treatments ofr NEC

bowel rest

parenteral feedings

antibiotic therapy (ampicillin, gentamicin, metronidazole)

217

what indicates surgery in NEC

peritonitis

pneumoperitoneum

218

what are some complications of NEC

strictures
short bowel syndrome
impiared neurodevelopmental and growth outcomes

219

when does meconium ileus present

first 3 days of life with ab distention or without vomiting and failure to pass meconium

220

what causes meconium ileus

meconium pellets that cause intestinal obstrcution at level of terminal ileum

221

how many people who have CF have meconium ileus

10%

222

how many meconium ileus patients have CF

80-90%

223

how would you diagnose meconium ileus

image with water soluble contrast enema

find: small caliber colon (microcolon); meconium pellets in terminal ileum, ileum proximal to obstrcution is dilated

224

how do yo utreat meconium ileus

enema of hyperosmolar constrast breaks up the plug

REMEMBER TO TEST FOR CF

225

what type of defect is congenital agang megacolon

defect in craniocaudal migration of neuroblasts originating fro neural crest that occurs during the first 12 weeks of gestatino

226

how common is congenital agang megacolon

1/5000 live births

227

how does agang megacolon present

neonatl period as failure to pass meconium within 48 hours of birth: bilious emesis, abdominal distention, and delay in passage of first meconium

228

what will be obstructed in congenital aganglioinc megacolon

distal intestinal obstruction

229

what is the "sign" associated with congenital agang megacolon

squirt sign or blast sign: explosive expulsion of gas and stool after digital rectal examination

230

how would you diagnose agang megacolon

suction biopsy of rectal mucosa

abdominal radiograph

contrast enema

anorectal manometry

231

what types of children could you use anorectal manometry to diagnose agang megacolon

older

232

what would you find on congental agang megacolon with contrast enema

transition zone in rectosigmoid area, residual barium in colon over 24 hours

233

what would you fine with cong agang megacolon with abdominal radiograph

dilated proximal loops

234

what would you find in cong. agang megacolon with suction biopsy of rectal mucsa

no ganglion cells

235

how do you treat agang megacolon

resect affected segment

236

what is VUR

incompetent or inadequate closure of the UVJ, a short segment of the ureter within the bladder wall (intravesical ureter)

237

how is VUR usually prevented

fully compressing intravesical ureter and sealing it off with surrounding bladder muscles

238

what else is VUR a risk factor for

pyelonephritis
renal scarring
chronic damage

239

how many kids with UTIs ahve VUR

30-45%

240

when would you look for VUR

recrurrnt UTI or personal history of renal anomalies

241

what test would demonstrate reflux of urine from bladder to upper UT

voiding contrast cystourethrogram (VCUG)

242

how can spontaneous resolution of primary VUR occur

growth of intravesical ureter length

243

when are antibiotics used in VUR

high grade reflux

244

what could severe VUR cases require

surgical reimplantation

245

what is the most commmon renal malignancy in children

wilms tumor

246

what is the fourth most common childhood cancer

wilms tumor

247

how many cases of wilms tumor are there per million under 15 years old

8

248

how many wilms tumors are diagnosed before age 5

2/3

249

how many wilms tumor cases are diagnosed before age 10

95%

250

where does wilms tumor arise from

foci of persistent metanephric cells referred to as nephrogenic rests or nephroblastomatosis

251

how does wilms tumor present

asymptomatic abdominal meas/swelling

abdominal pain

hematuria

fever

HTN

252

how will wilms tumor be on physical exam

firm
nontender
smooth mass eccentrically located and rarely crosses midline

253

how would you diagnose wilms tumor

abdomnal injury: US and CT

254

how would you proceed once you found wilms tumor

biopsy and surgical staging (dont spill tumor, could lead to further spread)

255

what would you do treatment wise for wilms tumor

nephrectomy

chemo and radiation before or after surgery

256

what is the 5 year survival rate for wilms tumor

90%

257

what are the long term risks for wilms tumor

renal insufficieny and failure