Pediatrics: Exam 2: Nutrition, GI, ENT, Respiratory, Allergies, Infx Diseases
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| Why is breast milk superior food during 1st 6 months? What specifically is in it? (7) | Low but highly bioavailable concentrations of protein, fatty acids (DHA Omega 3), Na, Ca, Fe, Zn, contains antibodies
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| What is colostrum? What is different about it? | First milk secreted...higher protein, lower fat. Antibodies confer passive immunity to newborn
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| Single greatest breastfeeding benefit | Decreased illness
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| CONTRA for breastfeeding (6) | 1) Infant w/ galactosemia 2) Mother w/ HIV 3) Mother w/ TB/syphilis 4) Mother drug use 5) Mother on chemo 6) Mother undergoing radiation
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| How much weight in infant should be lost initially, then gained back? How long should this take? | Loss shouldn't exceed 7-10% and should be regained in 10 days
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| Breastfeeding supplementation: (3) | 1) Vitamin D 400 IU/day 2) Fluoride after 6 months 3) 1 time Vitamin K shot at birth
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| What vitamin supplementation is recommended after 6 months? | Really nothing except maybe fluoride
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| What should a formula be fortified with? | Iron
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| Rectal bleeding (healthy stools otherwise), eczema, wheezing, abdomen non-tender, no vomiting | Milk/Soy Protein Intolerance/Allergic Colitis
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| First step w/ allergic colitis: | Restrict mother's cow milk and soy in diet
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| What age do we transition infants to cows milk? What about if they are intolerant? | 1 year for BOTH (95% resolve intolerance
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| When should an older infant start solid foods? What kind of things are we looking for? What might we introduce? | 4-6 months but only when signs like holding head up, bringing objects to mouth, and interest in foods are happening; might introduce iron fortified cereal (single grain)
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| What food should be avoided under the age of 1? | HONEY, infant botulism
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| How much milk should toddlers get? How much juice? | <24 oz of milk. Juice NOT needed at all, but diluted apple juice good for constipation
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| What age should you give a sippy cup? | 1 year
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| RF for childhood obesity? (4) | African/Mexican/Native-American, sedentary lifestyle, less family dinners at table, unhealthy food
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| Complications of obesity other than those typically found in adults (3) | 1) Slipped capital femoral epiphysis 2) Blount disease (bowlegs due to weight) 3) Pseudotumor cerebri
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| Snoring, somnolence, heartburn, polys, acanthosis nigricans, orthopedic abnormalities, genetic syndrome stigmata | All things you might find on assessment in a child that is obese
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| Almond-shaped eyes, short, hypotonia as infant, rapid wt gain afterwards | Prader-Willi Syndrome
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| How much wt should be lost with management? How should it be managed? | 1 lb/month; healthy eating and increased activity
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| Contrary to what my Grandmother believed, what should you respect? | Child's appetite! Don't have to finish every bottle or meal
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| 5-2-1-0 campaign? | 5 fruits/veggies, 2 hours or less of screen time, 1 hour of vigorous activity, 0 sugared beverages
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| Leading cause of death worldwide? Why? | Undernutrition; Primary: socioeconomic (lack of food), Secondary: increased requirements, reduced caloric intake, increased calorie loss
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| Severe protein and energy malnutrition, common globally. Secondary to chronic illness or emaciation | Marasmus
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| Hypoalbuminemic, edematous malnurition due to inadequate protein intake though total calories may be adequate. | Kwashiorkor
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| Crucial complication of malnutrition | Delayed development, ESPECIALLY brain development
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| Thinning of outer skull leads to sensation of touching a ping pong ball on palpation (what's this?), enlargement of costachondral junction(what's this?), thickening of wrists/ankles, enlarged fontanels w/ delayed closure, greenstick fractures, bow legs | Clinical manifestations of Rickets; Craniotabes; Rachitic rosary
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| Inadequate sun exposure, insufficient intake, darker skin, breastfed infants, malabsorption, some drugs | Rickets due to Vitamin D deficiency: poor linear growth, bowing of legs, thickening at wrists and knees, prominent costochondral junction
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| How to Dx Rickets? Management? | Labs: Ca, phosphorus, 25-OH-D low, alk phos increased; Distal ulna and radiuis widened w/ frayed ends; Tx: Vit D 400 IU/day recommened who don't drink 32 oz of Vit D fortified milk/formula
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| What is something on general physical exam in an abdominal complaint that you don't want to forget to check in pediatrics? | Hydration status
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| T/F: Evaluation of peds abdominal pain is similar to adult evaluation. | True, let me know if you disagree....seriously
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| Younger children are more likely to have _________ rather than older children /teens having ___________ when it comes to abdominal pain | Malrotation, Appendicitis
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| Begins after 5, higher incidence in N/As including Alaskans, Black and Asian populations. Borborygmi, flatulence, diarrhea, bloating. Dx? Tx? | Lactose Deficiency, Dx: Lactose free diet trial Tx: reduce diet, Lactaid (enzyme pill)
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| Chronic abdominal pain associated with alteration in bowel habits without evidence of organic pathology. Gut motility issue, constipation/diarrhea fluctuation, relief w/ defecation. May cause school avoidance, secondary gain, anxiety. Tx: (3) | Irritable Bowel Syndrome (IBS); Tx: return to normal activities ASAP (limit school avoidance/secondary gains), fiber supplementation, reassurance
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| Daily or near daily GI discomfort not associated w/ eating/defecation, possibly associated w/ school. Interrupts daily daily function, perhaps due to family stress or school phobia. Tx? (3) | Functional Abdominal Pain; Tx: return to normal activities ASAP (limit school avoidance/secondary gains), fiber supplementation, reassurance
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| Vomiting, abnormal screening labs, fever, BILIOUS EMESIS, wt loss/GROWTH FAILURE, pain awakening from sleep, blood in stools/emesis | Red flags of chronic abdominal pain of underlying illness
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| Age> 18 months, Failure to thrive, Sandifier syndrome, respiratory symptoms, esophagitis (complication). Tx: | Pathological GERD; Tx: thickening feeds, smaller, frequent feedings, position upright, H2 antagonist or PPI or Nissen fundoplication
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| 66% of infants 4-6 months, Infants <12 months, normal growth, no other Sx. Tx? | Physiological GER; Tx: thickening feeds, smaller, frequent feedings, position upright
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| 4x more common in males, usually present at 3-6 weeks, frequently first born. Erythromycin use w/in 2 weeks associated w/ increase risk. Projectile vomiting progressively worsening that is non-bilious. Dx? (4) Imaging? (2) Tx: | Pyloric Stenosis; Dx: Hypochloremic, hypokalemic, metabolic alkalosis, elevated BUN. I: U/S. String sign with barium upper GI Tx: IVF and endoscopic pyloromyotomy
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| What does bilious vomiting suggest? Tx? | Intestinal obstruction; Tx: NGT and surgical consultation
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| Sandifer Syndrome | arching of back due to painful emesis
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| Double Bubble Sign | Duodenal atresia
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| What kind of etiology does most diarrhea in the US have? Tx? | Viral and self-limiting: stay hydrated
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| Toddler's Diarrhea? | Overconsumption of Juice
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| Most common cause of diarrhea in all ages, fever, vomiting early on, lethargy. Can be bacterial or viral (more common) | Gastroenteritis
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| Frequent cause of diarrhea in the winter. Profuse, watery. Damages epithelium and villi of upper small intestine | Rotavirus
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| 6 ways to evaluate hydration status | Skin turgor, cap refill, mucus membranes, urination, presence of tears, depressed fontanelles
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| Hydration Status: Tachycardia, little output, irritability, lethargy. Tx? | Moderate dehydration, 5-10%; oral rehydation
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| Normal HR, decrease in output, increased thirst. Tx? | Mild dehydration, 3-5%; oral rehydration
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| Tachycardia w/ weak pulse, tenting of skin. Tx? | Severe dehydration >10%; IV fluids
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| What is the rate of NS or RL you give IV for dehydration | 20 mL/kg
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| Bloating, diarrhea, FFT, poor wt gain, short, irritable, often occurs after adding grains to diet. Immune mediated enteropathy causing injury to villi of mucosa of small intestine, usually due to injestion of wheat, rye, barley. Dx? Tx? | Celiac Disease; Dx: Test IgA antibodies!!! (serology); Tx: Avoid all gluten in diet
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| Encopresis | involuntary leakage of stool around fecal impaction or voluntary withholding
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| Firmly packed stool in rectum, anal fissures, spincter tone; Tx? | Constipation; Tx: glycerin suppositories, prune/pear/apple juice at any age,, MoM, enemas if super impacted
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| What two disease associated w/ delayed passage of meconium? | Hirschsprung disease and Cystic Firbrosis
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| disorder due to congenital absence of ganglion cells in distal bowel. No Hx of large diameter stools as seen in functional constipation. Dx? Tx? | Hirschsprung disease/Congential aganglionic megacolon; Dx: rectal exam- tight sphincter w/ empty rectum -> explosive release after exam. Barium enema. Rectal suction Bx shows absence of ganglion cells. Tx: Surgical
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| Autosomal recessive disease w/ thick secretions in lungs, intestines, pancreas, bile ducts. Pancreatic insufficiency. Chronic bronchial infx, digital clubbing, chronic sinusitis, salty skin taste. Steatorrhea. Dx? Tx? | Cystic Fibrosis: Dx: Sweat Chloride Test > 60 meq/L. Prolonged direct neonatal jaundice. Tx: Replacement of pancreatic enzymes, pulmonary toilet
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| Most common cause of GI bleeding in newborns: | Ingested maternal blood, allergic colitis
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| Most common cause of GI bleeding in infancy-2 yo: (3) | Intussusception, meckel diverticulum, bacterial gastroenteritis
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| Most common cause of GI bleeding over 2 yo: (2) | Mallory-Weiss Syndrome/tear and NSAID injury
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| Apt Test | distinguishes fetal from maternal blood – a positive Apt test indicates fetal/neonatal blood
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| Abd pain, vomiting, blood per rectum. 6 month to 2 yo; Currant jelly stools. Dx? Tx? | Intussusception; Telescoping of a segment of bowel into adjoining bowel. Dx: Barium contrast enema can be Dx or therapeutic. Tx: IVF and surgical intervention
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| Massive bright red (or maroon or melana) rectal bleeding no pain (85%). May also cause intestinal obstruction - intussusception/ volvulus. Dx? Tx? | Meckel Diverticulum. Dx: Meckel scan (Technetium 99m). Tx: Surgical
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| What rule is associated w/ Meckel diverticulum? | Outpouching of the ileum about 2 ft from the ileocecal valve. 2% of the population. Males greater than females 2:1. 2% have complications, most under the age of 2 years.
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| Bilious vomiting, hematemesis and hematochezia with acute tender abdomen. May be due to malrotation. | Volvulus; Tx: IVF/surgical correction
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| Defects during development can lead to connections between the esophagus and trachea | Tracheoesophageal fistula (TEF)
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| Bubbling mucus and saliva from nose and mouth and drooling noted. Hx of polyhydramnios. What are the susceptible to? Tx? | Esophageal Atresia; susceptible to aspiration pneumonia. If suspected: do not feed. Tx: Surgical correction
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| Polyhydramnios | Excess of amniotic fluid in the amniotic sac during pregnancy
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| transmural, skip lesions - entire gut may be affected, crypt abscesses, strictures, fistula, colitis, malaise, fever, wt loss, rectal bleeding, abdominal pain, increased risk of cancer | Crohn's Disease
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| mucosal, continuous disease that involves the rectum and colon, colitis, malaise, fever, wt loss, rectal bleeding, abdominal pain, increased risk of cancer | Ulcerative Colitis (UC)
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| Abd pain, anorexia, N/V, periumbilical pain localizing to RLQ. Most common surgical emergency of childhood. Rare before age of 5. Tx: | Appendicitis; Tx: Surgical consult ASAP if suspected
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| Ear pain, tenderness on movement of external ear, especially tragus. Tx? | Otitis Externa, Topic otic drops or ABX drops like cirpo or ofloxacin
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| What confirms presence of middle ear effusion? | Tympanogram
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| Bottle instead of breast fed, URI, immature eustachian tube anatomy, Family Hx, smoke exposure, daycare attendance | RF for Otitis Media
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| Otalgia (ear pain), otorrhea (drainage of ear), URI Sx, Fever, irritability, poor feeding | Clinical presentation of Acute Otitis Media
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| 3 requirements for Dx of AOM: Tx? | 1) Hx of acute onset 2) Middle ear effusion 3) Sign of middle ear inflammation. Tx: Amox 80-90 mg/kg/day x 10 days or augmentin. ABX can be held in children over 2yo as 60% resolve on their own. Tympanostomy tubes for recurrent
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| Complications of OM (4) | Chronic effusion, hearing loss, cholesteatoma, intracranial extension
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| What is Otitis Media w/ Effusion? How does it differ from AOM? Management? | Effusion w/o evidence of acute infection. Watch those not at high risk for 3 months. Hearing testing if effusion continuse after 3 months. May require tubes.
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| Prominent rhinorrhea and nasal obstruction, sore throat, cough, nasal discharge, mild fever if one at all. Etiology? Tx? Complications? (3) | Common cold/Rhinosinusitis; E: Rhinoviruses. Tx: Sx. Cough suppresants aren't recommended under age 6. Cool mist humidifier. C: 1) Otitis Media 2) Bacterial sinusitis 3) Asthma exacerbation
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| Acute encephalopathy and liver failure while taking aspirin products during viral infections | Reye’s Disease/Syndrome
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| Persistent mucopurulent nasal discharge, stuffiness, cough, especially at night. Tx? | Sinusitis; 50% improve w/o ABX. Tx: High dose amox or augmentin…continue 7 days beyond Sx relief. Resistance can develop.
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| 3 main pathogens of sinusitis | S. pneumoniae, H. Influenza, Moraxella catarrhailis
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| Fever, poor PO intake, dehydration, malaise, mouth pain, drooling. Etiology? Tx? | Gingivostomatitis. E: HSV-1. Tx if Dx early: oral acyclovir
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| Common in young infants, white plaques somewhat adherent to mucosa. Can interfere w/ infant feeding. Tx? | Oral Candidiasis/Thrush; Tx: Nystatin suspension
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| Oral lesions on posterior oropharynx, fever, vomiting, HA, malaise, drooling, sore throat, dysphagia. Etiology? Tx? | Herpangina; Enteroviral etiology including coxsackie A16. Tx: Self-limited
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| Oral/pharyngeal mucosal lesions as well as maculopapular or vesicular lesions on palms, soles, digits, buttock (usually mild). Fussiness and poor PO intake. Etiology? | Hand-Foot-Mouth disease; Coxsackie virus (A16)
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| Cough, sore throat, dysphagia, fever. Etiology possibilities? What is most common? What is the other? | Pharyngitis; Viral: 90%, bacterial is usually Group A Beta Hemolytic Streptococci (GABHS)
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| Strep or Viral Pharyngitis? Rapid Onset | Strep
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| Strep or Viral Pharyngitis? Abdominal Pain | Strep
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| Strep or Viral Pharyngitis? N/V | Strep
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| Strep or Viral Pharyngitis? Rhinorrhea, diarrhea, cough | Viral
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| Strep or Viral Pharyngitis? Mild Fever | Viral
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| HA, N/V, abd pain, red pharynx, enlarged tonsils w/ exudate, anterior cervical lymph nodes enlarged/tender. Dx? Tx? | Strep; Dx: rapid strep- very specific but doesn’t always pick it up AND Cx. Tx: PCN, Amox, erythro
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| Fine diffuse erythematous macular-papular rash like sandpaper w/ a sunburn (scarlatina rash), circumoral pallor, strawberry tongue, Pastia’s lines | Scarlet Fever: strep w/ other distinct findings
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| Pastia’s lines | Prominent skin fold lines
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| Sore throat, dysphagia, hot potato/muffled voice, trismus, DROOLING, ASYMMETRIC TONSILLAR HYPERTROPHY, DEVIATION OF UVULA. Management? | Peritonsillar Abscess; M: CT scan, airway management, aspiration, ABX (PCN or Clinda IV)
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| Trismus | Limitation in mouth opening
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| Sore throat, fever, neck stiffness, odynophagia, drooling, dyspnea. Management? | Retropharyngeal Abscess: significant morbidity/mortality associated (mediastinitis, sepsis, airway obstruction); M: ENT or Emergency consult, lateral XRAY, PCN or Clinda, surgical drainage
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| Fever, pharyngitis, lymphadenopathy, exudative tonsils, splenomegaly. Etiology? Dx? (3) Tx? | Infectious Mono; E: Epstein-Barr Virus. Dx: 1) heterophile antibody (monotest) 10 days after onset. 2) IgM anti-viral capsid antigen 3) >10% atypical lymphocytosis (early test). Tx: Supportive! Avoidance of contact supports in case of splenomegaly
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| If you had pharyngitis and had Strep and Mono in your DD, why wouldn’t you order both a strep test and monospot? | Monospot will likely be negative…takes 8-10 to show up
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| Snoring, open mouth breathing, increased risk of AOM (acute otitis media) obstructive sleep apnea, enlarged lingual tonsils and adenoids | Upper Airway Obstruction
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| Respiratory pauses, gasping, restless sleep, daytime tiredness. Etiology? Dx? Management? | Obstructive Sleep Apnea; E: Obesity, tonsil/adenoid hypertrophy. Dx: Sleep study. Tx: ENT/sleep specialist referral
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| Best prevention of the common cold? | HANDWASHING
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| CF pathogens in infancy? Older patients? | I: S. aureus. Older: Pseudomonas aeruginosa or Burkholeria cepacia.
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| Partial obstruction in lower airways heard with exhalation | Wheezes
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| Due to secretions in airway | Rhonchi
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| Due to fluid in small airways | Crackles/Rales
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| #1 cause of pediatric cardiopulmonary arrest | Primary RESPIRATORY disturbances
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| What 4 conditions does grunting suggest? | Hypoxia, atelectasis, pneumonia, pulmonary edema
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| T/F: Upper respiratory tract infections and otitis media are the most common childhood infectious diseases in the U.S. | True
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| What does stridor suggest? | Upper airway obstruction
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| T/F: Physical exam techniques are more predictive of serious illness than observation | False, observation more predictive
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| RR Red flags? What 3 things affect RR? | RR> 60 in child < 2 yo and RR > in child > 2 years; 1) Fever 2) Anxiety 3) Pain
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| Inspiratory stridor, dyspnea, tachypnea, nasal flaring, retractions, hoarseness. Evaluation? | Upper Airway Obstruction; Eval: AP/Lateral neck Xrays
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| Young infant w/ chronic stridor that is worse w/ activity, feeding, URIs. Dx? Tx? | Laryngomalacia. Dx: Laryngoscopy. Tx: Resolves by 1-3 yo
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| Cough, localized wheezing, unilateral absence of breath sounds, unilateral air trapping stridor, no air exchange despite effort. Abrupt onset of choking/gagging. What is special about imaging? Intervention? | Foreign Body Aspiration; I: Get inspiratory and expiratory view on XR (expiratory may show air trapping) Tx: Back blows, CPR, Rigid Bronchoscopy that can remove FBs
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| Hoarseness, inspiratory stridor, harsh, barky cough, worse at night. Etiology? Dx? Imaging? Tx? | Croup. E: Parainfluenza. Dx: Clinical Dx. Imaging: Steeple sign (subglottic narrowing). Tx: Mild: 1 dose of dexamethasone. Moderate/severe: Cool mist, pulse ox, Dexamethasone, nebulized Epi
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| What must you do if you use nebulized epinephrine? | Observe child in hospital for at least 2 hours to make sure they don’t have rebound worsening.
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| What is Laryngotracheobronchitis? Major indications for hospitalization with this? (3) | Croup; No improvement w/ Tx, decreased LOC, serious infx
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| High fever, cough, stridor, toxic appearance. Rare superinfection. Etiology? Tx? | Bacterial tracheitis; E: Staph aureus, but can have coinfection w/ influenza; Tx: Abx, anti-virals for coinfection, airway support
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| Sudden onset of stridor w/ rapid progression, muffled voice, difficulty swallowing, refusal to sleep/eat, febrile, toxic, anxious, tripoding, drooling, absence of barking cough. Incidence? Dx? Imaging? Tx? | Epiglottitis; I: rare to see since we have a vaccine for it. Dx: cherry red epiglottis. Imaging: thumb sign. Tx: DO NOT AGITATE CHILD, tube in OR, ceftriaxone
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| Classic pneumonia w/ consolidation of 1 or more lobes | Lobar pneumonia
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| Higher incidence in children; increased interstitial markings. Etiology? (2) | Atypical pneumonia 1) Mycoplasma pneumonia 2) Chlamydophila pneumonia
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| Fever, chills, cough, malaise, pleuritic chest pain, SOB. Dx? | Bacterial Pneumonia; Dx: CXR showing lobar pneumonia and pleural effusion.
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| Cough, wheezing, stridor, fever less prominent. Dx? | Viral pneumonia; Dx: CXR will show diffuse, streaky infiltrates
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| Typical pathogen in neonate pneumonia. Tx? | Group B Strep; Tx: Hospitalization, Ampicillin and cefotaxime
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| Afebrile pneumonia: Sx (2), Etiology, Tx? | tachypnea, staccato cough and hyperinflation, Chlamydia trachomatis, Erythromycin.
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| Febrile pneumonia: Etiology, Tx? | RSV or other respiratory virus. Can be S. pneumoniae, Tx: inpatient cefuroxime (IV) if bacterial
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| Pneumonia etiology by age and Tx: 3-12 month? 1-5 years? >5 years? | 3-12: RSV, Amox; 1-5: RSV, Amox; >5: Mycoplasma pneumoniae and other atypical bacteria, erythromycin
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| What ABX are avoided in children and why? | 1) Fluoroquinolones: arthropathy 2) Tetracyclines: permanent staining of teeth
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| Pneumonia lab evaluation (4) | 1) Blood Cx, 2) WBC w/ differential, 3) cold agglutins positive for Mycoplasma, 4) PPD for TB
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| What ages is the influenza vaccine recommended for? | 6 months to 18 years
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| Viral induced wheezing in 2-6 month old, especially in the winter. Cough, coryza progressing over 7 days to raspy breathing and low grade fever. Etiology? Eval/Management? | Bronchiolitis: viral induced wheezing in young child. E: Respiratory Synctial Virus (RSV). Eval/Man: Pulse ox, swab for RSV, CXR: hyperinflation, Albuterol neb trial but only if continue if benefit. No steroids
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| Pertussis: Etiology? Dx? Tx? Most common complication? | E: Bordatella pertussis (gram neg). Dx: nasal swab, increased WBC especially lymphocytosis. Tx: EARLY, Azithromycin (or another –mycin). Tx close contacts. Vaccine. Comp: Pneumonia most common complication.
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| Pertussis Stages? Which stage is most contagious? | 1) Cattarhal: runny nose, low grade fever. 2) Paroxysmal: coughing w/ forceful inhalation causing whoop. Tx not effective here. 3) Convalescent: gradual resolution. Most contagious: Cattarhal
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| Sudden onset pain, dyspnea, cyanosis, decreased breath sounds. Predisposing conditions? Dx? Tx? | Pneumothorax; asthma, CF, trauma, Marfan’s syndrome, Valsalva maneuver. Dx: CXR. Tx: May resolve spontaneously, 100% O2, chest tube
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| Coryza | Stuffy nose!
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| Nasal itching and rubbing nose w/ palm of the hand…may see nasal crease across lower bridge of nose | Allergic salute
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| Clinical findings of Allergic disease (6) | 1) Allergic salute 2) Allergic shiners 3) Swollen eyelids 4) Hyperlinearity 5) Dennie lines 6) Keratosis pilaris
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| Dennie lines | prominent creases under lower eyelids
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| Allergy testing: describe the 2 types and issues with them | 1) In vivo skin testing: introduction of allergen under the skin (cheaper, look for wheal/flare reaction) 2) In vitro testing: of serum for IgE to specific antigens. Can have false positives and cause dermatitis
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| Inflammation, edema, airway hyperresponsiveness triggered by infxs, exercise, reflux, weather changes, emotions, smoke, scented products, air pollution, fumes/odors, allergens, pollens, molds | Asthma
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| SOB, wheezing, tightness in chest, cough, waking at night, prolonged expiratory phase, decreased FEV AND FEV1/FVC ratio. | Sx of Asthma
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| Assessment/Monitoring of Asthma: | Initial: assess severity and initiate Tx. Follow up: Reassess and determine if Tx should be adjusted. Follow up every 2 weeks to 6 months until controlled.
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| day time symptoms 2 or more times per week or nighttime awakening 2 or more times per month; further classified as mild, moderate, severe | Persistent Asthma
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| fewer than 2 times per week, waking with symptoms < 2 x per month | Intermittent
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| Asthma Tx | 1) ALL should be on a SABA (inhaled albuterol). 2) Foundation/First-line: Inhaled corticosteroids 3) If super severe, considere Leukotriene inhibitors or LABA
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| Steroid sparing that decreases inflammation and bronchoconstriction | Leukotriene Inhibitors
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| What do we use when we can’t control allergy-related asthma? | Omalizumab
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| Acute exacerbation not responding to therapy | Status asthmaticus
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| Intermittent allergic rhinitis | < 4 days a week or < 4 weeks
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| Persistent allergic rhinitis | >4 days a week or > 4 weeks
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| Clear rhinorrhea, nasal congestion, sneezing, pruritic eyes, ears, nose, palate, postnasal drip leading to throat clearing and hoarseness. Tx? | Allergic Rhinitis. Tx: Allergen avoidance, FIRST-LINE: oral meds; intranasal corticos, anti-histamines, decongestants, ipratropium, leukotriene inhibitor, cromolyn, Immunotherapy
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| What is better about second generation anti-histamines than first generation? | Less sedation
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| What is the concept of immunotherapy? | Little doses at a time desensitize and build up immunity
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| T/F: Children tend to get nasal polyps | False, they don’t
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| Intensely pruritic ill-defined plaques of erythema and scale | Acute atopic dermatitis
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| Generalized xerosis/dry skin, lichenification, fibrotic papules | Chronic dermatitis
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| T/F: Atopic dermatitis tends to be on extensor surfaces as children | True, flexor surfaces as adults
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| Goal of Tx for Atopic dermatitis? First two lines of Tx? | Goal: to control instead of cure; 1) Skin hydration 2) Topical corticosteroids
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| What is eczema herpeticum and Tx? | Herpes simplex superinfection secondary to eczema…Tx: IV Acyclovir
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| Bacterial superinfection of skin secondary to eczema? Etiology? Tx? | E: Staph or strep; Tx: Mupirocin (Bactroban) for small areas, oral cephalexin or augmentin for widespread
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| Raised erythematous lesions w/ pale centers that are pruritic. Tx? | Urticaria (hives); Tx: anti-histamines
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| What 4 food allergies usually resolve by age 5? | Egg, milk, wheat, soy
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| Causes of anaphylaxis and Tx? (4) | Foods, drugs, insect stings, latex; Tx: EPIPEN, diphenhydramine, rantididine, O2, IV fluid, Corticos, Nebulized albuterol
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| High fever, extensive erythematous maculopapular rash beings on face and spreads caudally. Cough, coryza, conjunctivitis, Koplik spots. | Measles
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| Retroauricular, posterior cervical and posterior occipital lymphoadenopathyw/ erythematous maculopauplar rash, low grade fever, polyarthritis in adults. | Rubella
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| Prodrome of mild fever, sore throat, malaise, 7 days later slapped/red checks, circumoral pallor, lacy reticulated truncal pruritic rash. Etiology? Tx? | Fifth Disease or Erythema Infectiosum. E: Parvovirus B19; Tx: Self-limited but support w/ anti-pyretics and fluids
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| Complications of Parvovirus B19: | Aplastic crisis in those w/ RBC disorders such as Sickle Cell disease (high turnover where parvovirus likes the RBC precursors)
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| Abrupt onset of high fever THEN rash as it goes away. Febrile Seizures. Etiology? Dx? | Roseola (Exanthem Subitum); E: Human Herpes virus 6 and 7; Dx: Dx clinically
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| Pruritic rash, dew drop on a rose petal lesions. Lesions will be at different outbreak/healing stages. Primary vs Reactivated infections | Varicella Zoster; Primary: chicken pox, Reactivated: Herpes zoster
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| Tx for Chicken Pox: | Sx Tx (anti-pyretics/oatmeal, anti-virals, VZIG in neonate
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| FTT, fever, direct hyperbilirubinemia. Dx? Etiology? Imaging? Tx? : | E. coli; Dx: Cx or >50,000 colonies/mL of single bacteria. Imaging: Urinary Tract U/S. Tx: Septra initial DOC.
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| Disturbed sleep, pruritis ani. Dx? Tx? Prevention? | Pinworms; Dx: Scotch tape. Tx: One dose of mebendazole. Prevention: Handwashing
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| Highest incidence of bacterial meningitis? | < 1 year of age
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| Difference in meningitis Sx from adult? | Less nuchal rigidity but bulging fontanel
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| Immunodeficiency, crowded conditions, N/A or Alaskan or Aboriginal natives: | RF of meningitis
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| Common bacterial cause of meningitis in Neonates and Tx: | GBS, Cefotaxime
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| Common bacterial cause of meningitis in > 1 month and Tx: | S. pneumonia, ceftriaxone
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| Adjunctive that assists ABX initiation? | Dexamethasone
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| Viral or Bacterial Meningitis? Elevated PMNs | Bacterial
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| Viral or Bacterial Meningitis? Normal glucose | Viral
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| Viral or Bacterial Meningitis? Increase protein | Bacterial
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| Viral or Bacterial Meningitis? CSF pressure increase | Bacterial
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| Genetic predisposition in childhood to _________ that is precipitated by fever | Simple Febrile Seizures
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| Simple febrile seizures are: (2); Prognosis? Tx? | 1) Generalized Tonic-clonic major motor convulsions lasting less than 15 min and 2) Occur only once in a 24 hour period. Prognosis: EXCELLENT, development of epilepsy is rare. Most require no Tx…can use rectal diazepam if seizure last longer than 5 min
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| Focal warmth, erythema, swelling, pain w/ decreased range of motion. Pseudoparalysis. Knees and hips most commonly affected. Etiology? Tx? | Septic arthritis. E: Staph. Aureus, GABHS (group A hemolytic strep). Tx: IV Antibiotics, ortho consultation.
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| What disease are sickle cell patients at risk for? | Salmonella
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| Pain, tenderness, decreased ROM, limp. Tx? | Toxic/Transient Synovitis; Tx: resolves in about 1 week, rest, NSAIDs
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| How to distinguish Septic Arthritis vs Toxic Synovitis | ESR >40 and WBC >12,000 in Septic Arthritis
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