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78 Cards in this Set

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What is the definition of apnea?
cessation of respiration for 20 sec or more or for any duration if pallor, cyanosis, or bradycardia is present
When evaluating apnea, what are signs that indicate an apparent life-threatening event (ALTE)?
• change in color (ex. pallor, cyanosis)
• change in muscle tone
• change in mental status
Why may urinalysis show WBCs in patients with appendicits?
• due to appendix lying on ureter and causing inflammation
• causes a sterile pyuria (presence of WBCs without infectious organism)
What can be used to treat severe cases of asthma?
• epinephrine or terbutaline (SQ or IV)
• Heliox
• Mg Sulfate
What are risk factors for bronchiolitis?
• age < 3 months
• immunocompromised state
• prematurity
• underlying pulmonary or cardiac disease
What is the MCC of congestive heart failure in pediatrics?
congenital heart disease
What is the MCC of dehydration in kids?
extensive vomiting or diarrhea
What is the gold standard for diagnosis of an esophageal foreign body?
chest xray
What are different techniques used to remove a foreign body?
• esophagoscopy
• bougienage
• foley catheter

* don't use foley cath or Bougienage technique if objecy lodged > 1-2 days
What is Bullous Impetigo?
• superfical, thin-walled bullae, usually on extremities
• rupture easily, leaving a denuded base, dry to shiny coating
What bacteria causes Bullous Impetigo?
Staph aureus
What is the treatment for Bullous Impetigo?
• Cephalexin (Keflex)
OR
• Dicloxacillin
OR
• topical mupirocin
What is the most common skin infection in children?
Impetigo Contagiosum
What are the causative agents of Impetigo?
• group A ß-hemolytic strep (strep pyogenes)
• Staph aureus
Describe the course of impetigo
• starts as red macules/papules
• then forms vesicles/pustules
• ruptures and leaves golden "Honey colored" crusts
What is the Erysipelas? What is the bacterial cause?
• cellulitis and lymphangitis of the skin
• caused by group A B-hemolytic strep
What is the most common site of erysipelas?
face (from skin wound/pimple)
What bacteria should be suspected in school-ages child with pneumonia (or URI) and a rash?
• Mycoplasma
• Tx: Macrolide PO
What bacteria causes scarlet fever?
group A B-hemolytic streptococci
What are characteristics of the rash caused by scarlet fever?
• starts on neck, groin, axillae & accentuations in flexural creases (Pastia lines)
• sandpaper feel
• 1-2 days after illness onsetDescribe the skin lesion associated with lyme disease
Describe the skin lesion associated with lyme disease
bull's eye lesion (Erythema Migrans)
What is the bacterial cause of Rocky Mountain Spotted Fever? What is the treatment?
• caused by Rickettsia rickettsii
• Tx: Tetracycline or Chloramphenicol
What are characteristics of the rash caused by Rocky Mountain Spotted Fever?
• rash on 2nd/3rd day of illness on ankles, wrists, and spreads centrally to trunk
• + palm/sole involvement
What is the enterovirus that causes Hand-foot-mouth disease?
coxsackie
Describe the typical course of hand-foot-mouth disease
• onset: fever, anorexia, malaise, sore mouth
• painful oral vesivles on erythematous base on days 2-3 that then ulcerate
• followed by skin lesions (red papules that change to gray vesicles that heal on days 7-10
• lesions on palms, soles, buttock
Which viral infection causes a "slapped-cheek appearance"?
Erythema infectiosum (5th's disease)
What is the virus that causes fifth's disease?
human parvovirus B19
What are first, second, third, fourth, fifth, & sixth disease?
• first: measles
• second: scarlet fever
• third: rubella
• fourth: Dukes' disease
• fifth: Erythema infectiosum
• sixth: roseola
What is the skin lesion that is pathognomonic for measles?
Koplik spots (white "grains of sand" on buccal mucosa)
What viral infection presents with a fine, irregular pink macular/papular rash at the hairline that spreads down to the neck, trunk, and arms?
Rubella "German Measles"
What is the incubation period for Rubella (German Measles)?
12-25 days
What is a Forchheimer's sign?
soft palate petechiae (seen in Rubella)
Patients with Rubella typically have lymphadenopathy in which lymph nodes?
suboccipital/post-auricular
What are characteristics of the rash caused by Varicella (aka Chicken Pox)?
• starts as red macules on scalp or trunk
• within 1st day the lesions vesiculate with red base
• simulatneous multiple stages of the lesions
• spreads centrifugally (outward from center)
• palms/soles are spared
What are characteristics of the rash caused by Roseola Infantum (Exanthem Subitum)?
• as fever resolves, blanching maculpapular, rose/pink discrete lesions develop
• typically on neck, trunk, & buttock (usually spares face)
• rash lasts 1-2 days and rapidly fades
What virus is believed to cause Roseola Infantum?
Herpesvirus 6
Roseola Infantum is common in what age group?
6 months - 3 y/o
Which inflammatory exanthem typically presents with tender nodules less than 5 cm on the shin and the skin overlying the nodules is red, smooth, and shiny?
Erythema Nodosum
What are some possible causes of Erythema Nodosum?
• fungal disease
• inflammatory bowel disease
• leukemia
• medications (ex. OCP)
• sarcoid
• strep infections
• TB
• vasculitis
• Yersinia infections
A diagnosis of Kawasaki Disease is made by several days of fever and 4 out of 5 criteria. What are the 5 criteria?
• conjuctivitis
• rash
• lymphadenopathy
• oropharyngeal changes (injected pharynx/strawberry tongue)
• extremity erythema and edema
What are other findings of patients with Kawaski Disease?
• arthritis
• arthralgia
• increased ESR/CRP
• increased LFTs
• irritability
• leukocytosis
What are later findings of Kawaski disease?
• coronary artery aneurysms
• desquamation of fingers/toes
• increased platelets
What is the treatment for Kawaski disease?
• IV gamma globulin
• ASA
• steroids (controversial)
What are characteristics of the rash caused by Pityriasis Rosea?
• begins with "Herald Patch" (one red lesion with rasied border on trunk)

• 1-2 weeks later a widespread eruption of pink maculopapular oval patches on trunk in "Christmas Tree" pattern lasting 3-8 weeks
What are maternal flora pathogens that infants < 30 days are at high risk for?
• E. coli
• Enterococci
• group B strep
• Herpes simplex virus
• H. Flu
• Klebsiella
• Listeria monocytogenes
• strep pneumo
What infectious agents can cause Hemolytic Uremic Syndrome?
• E. coli 0157:57 (most common cause)
• Coxsackie virus
• Echovirus
• Campylobacter
• Salmonella
• S. pneumoniae
• Shigella
• Varicella
• Yersinia
Diagnosis of HUS is made by clinical presentation of what three conditions?
• hemolytic anemia
• thrombocytopenia
• acute renal failure
What are characteristics of Henoch-Schonlein Purpura?
• small vessel vasculitis
• characterized by purpura, arthritis, abd pain, hematuria, & occasional scrotal involvement
• symmetrical involving legs/buttocks
• polymigratory arthritis/arthralgias in large joints
• history of gastroenteritis, HTN, and seizures
What is an important distinguishing feature between Henoch-Schonlein Purpura and meningococcemia?
patients with Henoch-Schonlein Purpura have a rash that generally looks bad but the patient feels well
What is the most common cause of intestinal obstruction in 3-12 month-old?
Intussusception
What is the most common area of the bowel that intususception occurs?
iliocecal area
What is the classic triad of intussusception?
• intermittent abdominal pain
• vomiting
• bloody currant jelly stools
What is the rule of 2's for Meckel Diveticulum?
• 2% of the population
• 2% with Meckel's develop problem
• most common in 2 y/o
• 2 inches in length
• typically located with 2 feet of ileocecal valve
What is the most common clinical presentation of Meckel Diverticulum?
rectal bleeding
What is the diagnostic test of choice for Meckel Diverticulum?
nuclear scintigraphy
What is the most common viral cause of meningitis?
enterovirus
What is the most common bacterial cause of meningitis from 0-3 months? older than 3 months?
• 0-3 months:
- group B strep
- E. coli

• > 3 months:
- strep pneumo
- N. meningitidis
- H. Flu
What are the 2 routes of infection of osteomyelitis?
• hematogenous
• direct (ex. inoculation via penetrating wound)
What are x-ray findings of osteomyelitis?
• soft tissue swelling 3-4 days post symptoms
• lytic bone @ 7-10 days
What is the treatment for acute otitis media?
• 1st line: amoxicillin
• 2nd line: augmentin or cephalosporin
Differentiate between periorbital and orbital cellulitis
• periorbital cellulitis is an infection of the eyelids that does not extend into the posterior orbit
• orbital cellulitis may potentially affect vision and become life threatening

* can be differentiated with a CT scan of orbits
What is the most common cause of pharyngitis?
respiratory viruses (70-80%)
• adenovirus
• CMV
• coxsackie
• EBV
• parainfluenza
• rhinovirus
What is the most common bacterial cause of pharyngitis in children?
group A B-hemolytic streptococcus
Pharyngitis with conjunctivits is most likely cause by what?
adenovirus
Pharyngitis with erythematous ulcers on post palate is most likely caused by what?
coxsackievirus A (herpangina)
Treatment for GABHS pharyngitis is penicillin or amoxicillin x 10 days. What is the treatment if the patient is penicillin allergic?
• erythromycin
• clindamycin
What is the most common cause of pneumonia in infants or younger children?
viral
• adenovirus
• influenza
• parainfluenza
• RSV
What are bacterial causes for pneumonia in neonates?
• group B strep
• E. coli
• Listeria monocytogenes
What is a common bacterial cause of pneumonia in 1-3 year-olds?
chlamydia trachomatis
What is a common bacterial cause of pneumonia in children ages 3 months - 5 years?
s. pneumoniae
What are bacterial causes of pneumonia in school-aged children?
• mycoplasma pneumoniae
• chlamydia pneumoniae
• strep pneumoniae
2-6 week old infant with projectile vomiting without bile suggests what cause?
pyloric stenosis
What is the most common cause of intestinal obstruction in infancy?
pyloric stenosis
What is the test of choice to confirm pyloric stenosis?
ultrasound
What are classic findings of pyloric stenosis?
• olive mass in RUQ
• hypochloremic
• hypokalemic
• metabolic alkalosis
What is the most common site of septic arthritis?
lower extremity (knee or hip)
What is the cause of bacterial tracheitis? What is the presentation?
• caused by Staph aureus
• presents with high fever, painful cough, and toxic appearance
• xray shows shaggy trachea
What is the abdominal xray finding of patients with a volvulus?
double-bubble sign