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260 Cards in this Set
- Front
- Back
FEVER
HEADACHE STIFF NECK ALTERED MENTAL STATUS MOST LIKELY DZ |
BACTERIAL MENIGITIS
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CONFIRM DIAGNOSIS OF MENIGITIS BY
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LP
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TREATMENT OF MENIGITIS
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ANTIBIOTICS
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COMPLICATIONS OF MENIGITIS
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DEAFNESS
CN PALSIES HEMIPARESIS GLOBAL BRAIN INJURY |
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BRUDZINSKI SIGN IN MENIGITIS
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PT SITS UP, PASSIVELY FLEXES NECK THEN AS RESULT KNEES AND HIP FLEX INVOLUNTARILY
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KERNIG SIGN IN MENIGITIS
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PT SITS UP KNEES AND HIP ARE AT 90 DEGREE ANGLE AND EXTENDS THE LEGS AND GETS PAIN
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BRAIN PARENCHYMA IS INFLAMMED
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ENCEPHALITIS
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LEPTOMENENGEAL INFLAMMED
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MENIGITIS
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ECOLI
AND GROUP B STREP (AGALACTIAE) LISTERIA MOMCYTOGENES CAUSE WHAT MENIGITIS |
NEONATAL MENIGITIS
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PRETERM BABIES,
LOW BIRTH WEIGHT, BABIES BORN TO MOMS WITH RUPTURED MEMBRANES AND/OR CHORIOAMNIONITIS, AND BABIES WITH TRAUMATIC BIRTHING PROCESS ARE AT RISK OF |
MENIGITIS
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INFANT WITH THERMAL INSTABILITY LIKE HYPOTHERMIA, POOR FEEDING,EMESIS, SEIZURES,IRRITABILITY, APNEA , BULGING FONTENELLE MOST LIKELY DIAGNOSIS
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BACTERIAL MENIGITIS
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HOW DOES BACTERIAL MENIGITIS SPREAD IN INFANTS
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HEMATOGENOUS
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STREP PNEUMONIAE AND
NISSERIA MENIGITIDIS CAUSE BACTERIAL MENIGITS IN WHO |
OLDER CHILDREN
|
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WHAT BACTERIAL MENIGITIS IN OLDER KIDS THAT IS SEEN LESS DUE TO MORE KIDS GETTING VACCINATIONS
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H INFLUENZA B
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WHICH BACTERIAL MENIGITS ORGANISM IS ENCAPSULATED AND SEEN MOSTLY IN THE WINTER, ALSO IN BAD WORKING SPLEENS AND ASPLENIC KIDS AND SICKLE CELL KIDS MOORE
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PNEUMOCOCCAL
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OLDER KIDS WITH MENTAL STATUS CHANGES, NAUSEA, VOMTING, LETHARGY, RESTLESSNESS, ATAXIA, BACK PAIN, KERNIG , BRUDZINSKI, CN PALSIES MOST LIKELY DIAGNOSIS , SEIZURES
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BACTERIAL MENIGITS
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WHAT ELSE IS SEEN IN NISSERIA MENIGITIDIS
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PETECHIAL OR PURPURIC RASH CALLED PURPURA FULMINANS SIGNIFIES SPETICEMIA
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WHEN DO YOU NOT USE LP TO CONFIRM DIAGNOSIS
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IF THERE IS SKIN INFECTION AT PUCTURE SITE
REASON FOR INCREASE INTRACRAINIAL PRESSURE CRITICALLY ILL PT THAT MAY DIE FROM PROCEDURE |
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OTHER TEST TO CONFIRM DIAGNOSIS
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GRAM STAIN AND CULTURE
WHITE AND RED BLOOD CELLS PROTEIN AND GLUCOSE ANALYSIS BACTERIAL ANTIGEN SCREEN |
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CAN U PERFORM A BACTERIAL ANTIGEN SCREEN
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YES, BECAUSE ANTIGEN STAY IN BLOOD SEVERAL DAYS EVEN WHEN CULTURE IS NEGATIVE
|
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ELEVATED OPENING PRESSURE,
LOT OF WBC WITH A LOT OF PMNS, ELEVATED PROTIEN, DECREASED GLUCOSE LEVELS OF THE LP FLUID THINK THIS DISEASE |
BACTERIAL MENIGITIS
|
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DECISION ON WHICH DRUG TO GIVE IS BASED ON
|
CSF GRAM STAIN
|
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FOR NEONATES WITH MENIGITIS GIVE
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AMPICILLIN COMBINED WITH THIRD GENERATION CEPHALOSPORIN AND AMINOGYLCOSIDE
TO COVER GROUP B STREP L MONOCYTOGENES, ECOLI |
|
STREP PNEUMONIA AKA PNEUMOCOCCAL MENIGITIS
WHAT DRUG DO WE GIVE |
THIRD GENERATION CEPHALOSPORIN COMBINED WITH VANCOMYCIN RECOMMEND
|
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FEVER
NECK STIFFNESS PAINFUL EATING FULLNESS OF OROPHARYNX |
RETROPHARYNGEAL ABCESS
|
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WHAT TEST FOR RETROPHARYNGEAL ABCESS
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LATERAL NECK XRAY
|
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FULL ANTERIOR FONTENELLE WITH OTHER
MENIGITIS WHAT DO YOU DO? |
PERFORM LP
BLOOD CULTURE URINE CULTURE ADMIT TO THE HOSPITAL |
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SINUSITIS
PROLONGED HEADACHES NUCHAL RIGIDITY VOMITING MOST LIKELY DIAGNOSIS |
INTRACRAINIAL ABCESS
|
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CONFIRM DIAGNOSIS OF INTRACRANIAL ABCESS BY
|
CT WITH CONTRAST
|
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kid lives in old home, or near battery recycling plant or lives with sibling with lead posioning
mld( most likely diagnosis ) |
lead poisoning
|
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what do you do for screening of lead poisioning
|
capillary blood stick
|
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what do you do as a confirmation test for lead poisioning
|
serum venous blood level only if the capillary lead levels are >10
|
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if venous serum lead levels are >10 for lead whats next
|
counsel parent and recheck in 1 month. try to see if parent can remove child from the home
|
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what do you do if lead levels are >45
|
chelation therapy with dimercaprol or dimercaptosuccinic acid (DMSA or succimer)
|
|
sudden shortness of breath,
low blood pressure(hypotension) fast HR(tachycardia) itching (urticaria) stridor and wheezing(bronchospasms) with known allergy to food mld is |
allergic reaction to food
anaphylaxis |
|
how do we treat anaphylaxis in a pt that has a open airway
|
subcutaneous epinephrine injection as long as ventilation is good
|
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what type agonist is epinephrine
|
a1 and b2
increase hr and relax bronchioles |
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pt with aggression, acne starts popping up, male pattern baldness all the sudden, gynecomastia what drug do you think of
|
anabolic steroids
|
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side effects of anabolic steroids
|
mess with testicles decrease tetes size and sperm count
mess with the liver and get erythrocytosis hdl decrease (bad) cardiac problems can form increase in testosterone convert to estrogen which form girlie breast skin get messed up and get baldness and acne women can have virilizationa nd clitoral enlargement |
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what drug intoxication is this ?
euphoria with agression psych changes (cognitive impairment and mood disorders) multiorgan dysfunction |
cocaine intox
|
|
what intoxication is this?
mild euphoria to stupor to coma respiratory depression pupillary constriction decreased bowel function |
heroine intox
|
|
what drug intoxication is this ?
htn tachycardia sever aggression and aggressiveness psychosis. acne and facial sores due to picking |
meth intox
|
|
what drug intoxication is this ?
breif dissociative psychotic episodes agressive unaware of pain |
pcp intox
|
|
what drug intoxication is this ?
short lived psychotic experiences hypoxia brain damage bone marrow suppression |
inhalant intox ( spray paint )
|
|
baby with bulging fontenelle
fussy widely spaced sutures big scalp viens poor feeding vomiting decreased activity normal everything else mld |
hydrocephalus - accumulation of csf
|
|
ventricles and subarchnoid space working fine but decreased absorption what kind of hydrocephalus
|
communication hydrocephalus
|
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no communication between subarachnoid and ventricles what kind of hydrocephalus
|
noncommunication hydrocephalus
|
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what do you check for hydrocephalus
|
rapid head circumferience growth especially if it is greater than 97th percentile
|
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what diagnostic test do you do for hydrocephalus
|
ct of head
|
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what treatment exist for hydrocephalus
|
shunt from ventricles to to peritoneum, pleura, or right atrium
|
|
what test do you do for craniosysnostosis
|
skull radiograph
|
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what test do you do for seizures
|
eeg
|
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why do you not do lp if you suspect brain tumor or abcess
|
increased cranial pressure can lead to herniation
|
|
kid with fever
new onset of headache new onset of focal neurologic changes new onset of siezure spasticity or signs of increased cranial pressure(irritable, not feeding well) mld |
brain abcess
|
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what kids are highly likely to develop a brain abcess
|
kid s with
congenital heart disease head trauma infectionf of jaw and mouth infection of face or scalp menigitis cranial instrumentation |
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what vitamin is given to prevent neural tube defects
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folic acid
|
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what prevents hiv moms from passing it to baby
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zidovudine and c section
|
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what infection inutero can cause
microcephaly hepatosplenomegaly deafness chorioretinits thrombocytopenia |
TORCH infections
toxoplasmosis other(syphilis) rubella cmv hsv |
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what can smoking cause to a inutero baby
|
intrauterine growth retardation
neuro problems developmental problems |
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what test do all kids receive between the ages 0-5
|
vision
testing for strabismus, amblyopia, refractive errors |
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when do you give postexposure prophylaxis to kids for rabies
|
if they have been exposed to saliva or neural tissue of bats, wild carnivores, or an animal that could possibly have rabies
|
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in preterm infants when do you give vaccination
|
normal chronologically schedule
they are easier to get sick |
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what is the exception to the rule for given preterm infants vaccinations
|
dont give hep b if baby is not at least 2kgs
|
|
sickle cell concept
|
insert
|
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what drug do you give sickle cell patient to keep them from having a vasoocclusive crisis and acute chest syndrome
|
hydroxurea-
it increases fetal hb and dilutes the the number of sickled cells floating around |
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side effect of hydroxurea
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bone marrow suppression so you can see leukopenia, thrombocytopenia, and anemia
|
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what organ removes the sickling cells
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spleen
|
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what causes the vasooclusive crisis
|
microthrombi
|
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what drug is given to sickle pts to decrease encapsulated organisms
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penicillin
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what process to the sickle cell pts have to go through regularly that can cause iron over load and what do we do to fix the problem
|
blood transfusions
we fix the iron overload by iron chelators like deferoxamine to reduces the hemosiderosis |
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sickle cell pt going through crisis what appear on a peripheral blood screen and why
|
retics becasue bone marrow is trying to fix the problem of the hemolysis of the sickling cells that is going on
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what disease can cause childhood strokes
|
sickle cell disease
|
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how do strokes present in kids
|
sudden onset clumsy and difficulty walking along with sickle cell symptoms
|
|
kid with painful thighs or arms
tenderness of those areas fever tachycardia anxiety that is african american mld |
sickle cell
|
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what test do you do if you suspect sickle cell
|
cbc
retics peripheral smear |
|
poor weight gain , length retardation, head circumference sparing
and no other reason why |
non organic failure to thrive
|
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when you have failure to thrive
do a complete what next |
history gather as much info as possible especially diet
|
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how to evaluate failure to thrive
|
screen for dietary measures
dietary counseling frequent office visits to asses weight |
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growth below the 3rd or 5trh percentile in kids under 5 whose peers are taller
|
failure to thrive
|
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non organic ftt is due to
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poverty
poor care givr -child interaction. about 1/3 to 1/2 cases of ftt seen in tertiary car is due to nonorganic ftt mostly all cases seen in primary care are due to these reasons |
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poor growth becasue of medical conditon like inflammatory bowel disease, renal disease, congenital heart disease is called
|
organic ftt
|
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reasons kids dont gain weight
|
1. not getting enough calories- lack of appetite-depressed chronic dz, cant ingest the food-disorders, not able to get food-neglect
2.alter growth potential-prenatal, endocrine, genetic problems 3.calori wasting- emesis,malabsorption,renal problems 4. need more calories due to defect-increased metabolism, |
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kids nonorganic and renal caused organic tend to what when they are initally ftt
|
catch up
|
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labs for ftt
|
cbc
lead level u/a and culture lytes + ca, bun, creat tb or hiv if needed |
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tx nonorganic ftt by
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improved dietary inake
close follow up and attention to psychosocial issues |
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when a child is born as a premie, downs syndrome or turners use what to determine normal growth or not
|
premie growth chart
|
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developmental delay,
iugr(microcephaly) cataracts, seizures hepatomegaly prolong neonatal juandice purpura at birth calcified brain densities in periventricular pattern |
congenital cmv
|
|
developmental delay,
iugr(microcephaly) cataracts, seizures hepatomegaly prolong neonatal juandice purpura at birth calcified brain densities in scattered pattern in cortex |
congenital toxoplasmosis
|
|
child is a picky eater between 18-30 months old true or false
what do you do for the parents |
true 2-3 years old kids are picky
stop letting kids snack, dont force feed |
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most common cause or organix ftt
|
renal tubular acidosis due to bad bicarb reabsorption type 2 or distal tubule defects type 1
|
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kid who previously healthy but has sudden change in behavior at home and at school doing bad, or seems depressed think
|
1.substance abuse
2. psychiatric - depression mainia or bipolar |
|
how to evaluate drug abuse
|
complete history,
pe urine drug screen screen for common associated drug abuse consequences (std & hepatitis) its ok to ask these question with the kid patient alone if drug abuse is suspected |
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tx drug abuse
|
1. detox
2.f/u with support therapy 3.long term assistance with trained professional |
|
alcohol or other drugs leading to impairment ditress causing filure of school or work obligations, physical harm, substance legal problems, or continued use despite social or interpersonal consequences this is
|
substance abuse
|
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alcohol or other drugs causing loss of control with use compulsion to get more, and continued use despite persistent or recurrent negative consequences this is
|
substance dependence
|
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Risk factors for abuse
|
1. kid with behavior problems
2. kid with learning difficulties 3. kid in messed up family situation |
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most common legal drugs used by kids
|
cigarettes
alcohol |
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most common illiegal drug used by kids
|
marijuana
|
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clues that kids are doing drugs
|
1. behavor changes
2. decline in performance at school or work 3. involvemnet witht he law |
|
euphoria
grogginess impared short memory talkative respiratory depression think this drug |
alcholol intoxication
|
|
how long does alcohol stay in the blood and ruine
|
blood 7-10 hrs
urine 10-13 hrs vasodilation also |
|
elation & euphoria
impaired short term memory distortion of time poor performance of task the require you to concentrate loss of judgement what drug? |
weed
|
|
how long is weed in the urine
|
3-10 days for the occassional user
2 months for chronic user |
|
euphoria
increase motor activity decrease tiredness dialated pupils tachycardia hypertension hyperthermia paranoid iease doctor see in nose of pt nasal mucosa chnges what drug? |
cocaine
|
|
how long does coke stay in the urine
|
2-4 days
|
|
euphoria
increase sensory feeling increase psychic and emotional energy nausea teeth grinding blurred vision jaw clenching anxiety panic attacks psychosis what drug? |
meth & estacy
|
|
how long does meth and estacsy stay in urine
|
2 days
|
|
euphoria
decreased pain sensation pinpoint pupils hypothermia vasodilation respiratoyr depression doctors may see needle tracks over viens what drugs |
opiates
1. heroine 2. morphine 3. codiene |
|
how long does opiates stay in the urine
|
2 days
|
|
euphoria
nystagmus ataxia emotional lability hallucinations disorientation hypersalivation abusive language what drug |
pcp
|
|
how many days is pcp in the urine
|
8 days
|
|
sedation
pinpoint pupils hypotension bradycardia hypothermia hyporeflexia with cns depression and respiratory depression what drug? |
barbs
|
|
how long are barbs in the rine
|
1 day for short acting
2-3 weeks for long acting |
|
life threating tx of drug and alcohol use is
|
abc
manage airway control breathing assess circulation then treat the actual agent |
|
delusions
body distortion paranoid then pt get panicked symptoms start between 30-60mins after ingestion and peak in 2-4 hours and resolve in 10-12 hours what drug |
lsd
|
|
headaches
blurried vision personality changes think what dz |
brain tumor
do neuroimaging |
|
when doing a uds on an adolescent pt .
who do you ask permission from |
the kid
|
|
older women has baby with decrease tone, upslanting palpebral fissure, poor moro reflex, brushfield spotsepicathal folds, redundant nuchal sking, fifthfinger clindodacyly and bradydactyly and single palmar crease
what dx |
downs syndrome
brushfield spots - white or grey spots on the periphery of the iris brachydactyly- shortening of fingers and toes clindactyly- incurving of fifth digit |
|
what is the next step in evaluation of downs syndrome
|
1.infant chromosome evaluation
2.evaluate to see if pt displays other features of the syndrome 3.counseling and family support |
|
AFP, b hcg, estriol, test to see if a baby has genetic problems is called and done at how many weeks gestation
|
triple screen + chorioamniotic or chorionic viollous test
done at 15-20 weeks 60% of ds babies are found this way |
|
when ds baby at the actual birth you use
______ before looking for abnormalities |
abc of medicine
|
|
what cardiac problems do downs pts have.
|
endocardial cushion defect
vsd tetrology of fallot |
|
what do you do if your downs pt has a cardiac defect
|
1. echo
2. consult cardiology |
|
what gi problems to downs pt have
|
intestinal- doudenal atresia
may have history of polyhydraminios and vomiting after feeding(can be bilious) |
|
what do you do if you suspect doudenal atresia in downs pt
|
1.upper gi study you could see double bubble pattern
2. Surgury |
|
what is shown on the chromosoamal analysis
|
extra chromosome 21 because of a nondisjunction which is the failure to segregate during meiosis 95% of the time.
Translocation 2%-removal of one peiece of cx get attached to another peiece of cx Mosaic3%- more than one cell type |
|
other conditions associated with ds
|
hearing loss
strabismus cataracts nystagmus congenital hypothyroidism |
|
when do you check hearing and vision in ds baby
|
3 months for hearing
6months for vision |
|
long term problems of ds babies
|
leukemia
hypothyroidism atlantoaxial instability premature aging alzheimer mental retardation some mosiac have near normal intelligence |
|
uri infection for 12-48 hoursa then barky cough, with or without fever, inspiratory stridor, hoarse voice, and mild pharyngitis
|
croup
|
|
treament for croup
|
cool mist to relieve laryngeal spasms
aerosolized and oral epinephrine oral and aersoluzed steriods |
|
avoid in croup patients
|
tongue blades and needle stick
|
|
what makes croup worse
|
crying and agitation
|
|
what to monitor in croup babies
|
o2 sat
|
|
ages that get croup
|
6mons to 3 year old
in sept thru dec more boys than girls |
|
what bugs cause croup
|
parainfluenza
influenza a and b adenovirus rsv |
|
what is physio of croup
|
narrowing airway and subglottic edema
|
|
treatment for croup
|
corticosteroid:dexamethasone .6mg/kg : 1 time works for 2-4 days
observe for 4 hr no change do the following: blow by o2, corticosteroid:dexamethasone .6mg/kg nebulized racemic epi quick working 10-30 mins heliox if severe monitor for 2-4 hours after racemic epi observe for 3-10hr to reduce admission |
|
what is peak rsv season
|
dec to march
|
|
what increase risk of rsv
what decrease risk of rsv |
increase passive smoke
decrease breast feeding |
|
pathophysio of rsv
|
lower respiratory tract infection with inflammation, edema, and necrosis of epithelial cells lining the airway
increase mucus made bronchspasms |
|
rsv can present as
|
runny nose
tachypnea accessory muscles used nasal flaring grunting auscultation you here crackeles, cough wheezing |
|
diagnostic studies for rsv
|
rsvi viral test
pulse oximetry while awake and sleep if fever or toxic exist cxr, blood test, urinalysis |
|
treatment for rsv
|
02,
if dehydrated ivf , bulb suction of nose, hand washing treatments not recommended 1. albuterol 2. epi nebs 3. corticosteroids 4. antibiotics 5.chest pt |
|
complications of rsv
|
apnea
2ndary bacterial infections:pneumonia, uti, aom |
|
rsv organisms
|
rsv,
influenza adenovirus parainfluenza |
|
uti are ascending infection what bug causes 80% o infections
|
1st-ecoli- pill adhere to uroepithelium
2nd- kleb,proteus,enterobacter,citrobacter 3rd- enterococcus staph sap, stap aureus |
|
fever abdominal or back pain, dysuria, increase frequency, urgency, or incontinence
hematuria, suprapubic tenderness what disease |
uti / pylonephritis
|
|
test for a uti
|
u/a and cx midstream clean catch
renal U/S in first timers lp in kids less than 1mon connection with menigitis |
|
tx for uti in newborns and infants
|
ampicillian and gentimicin
14day course 7day in cyctitis 3 day in 1st timer older kid |
|
in ill looking uti kids give
|
3rd generation ccephlosporin
ceftriaxone + gentimicin if enterococcus consider ampicllin |
|
risk factors for kids with uti
|
females<4 males<1
parents with childhood uti female with short urethra uncircumcised males voiding dysfunction (holding it)lot of school age kids and recurrent vesicourteral reflux -most kids that are febrile obstruction sexual activity |
|
pt comes in weeks after a viral infection with drooping mouth on one side. cant close one eye think this dx
|
bells palsy
|
|
treatment for bells palsy
|
maintain moisture of eye especially at night to prevent keratitis
this resovles spontaneously in 80% of cases |
|
girl with limp and knee joint pain and iridocyclitis in the eye salmon pink rash, fever, serositis (which is pleuritis or pericarditis), increased wbc +ana + rf has what dx
|
pauciarticular juvenile arthritis
|
|
how do you treat juvenile arthritis
|
nsaids
methotrexate etanercept or infliximab goal is to prevent blindness |
|
kid with arthralgias, morning stiffness, butterfly or discoid rash, joints hurt, uvietis or retinitis, decreased wbc, +ana +rf , decreased complement, increased antibodies to ds dns, protienuria(renal dz), seroitis think this dx
|
sle
most have renal dz with sle long term complications avascular necrosis cardiac athersclerosis |
|
treatment for sle
|
nsaids
steroids hydroxchloroquine immunosuppressive agents |
|
arthalgia, erythema marginatum, polyarticular joint pain, increased aso anti dnase b, carditis, subcutaneous nodules, chorea think
|
rhumatic fever
|
|
rheumatic fever is caused by
|
group a strep
|
|
treatment for rheumatic fever is
|
penicillin prophylaxis
aspirin steroids to help the chorea give barbituates or chlorpromazine |
|
arthralgias, erythema migrans, mono or pauciarticular joint pain, conjunctivitis or keratitis, icrease in cryoglobulin, increase in immune complexes with carditis, neuropathy, or menigitis think this disease
|
lyme disease
|
|
cause of lyme disease
|
borrelia burgdorferi
|
|
treatment for lyme dz
|
penicillin
doxycycline ceftriaxone |
|
arthralgia, mono or pauciarticular joint pain, small joint pain, increased wbc or neutropenia+/- blast + bone marrow problem, thrombocytopenia think this dz
|
leukemia
|
|
what causes this type of leukemia in kids
|
all
|
|
treatment for all
|
steroids
chemotherapy |
|
female older than 12 that has sex and a menses with arthralgia, palms and soles papulopustules, mono or pauciarticular joint pain, increased wbc count, +gc culture,erosive arthritis think this dz
|
gonococcemia
|
|
gonococcemia is caused by
|
n gonorrhea
|
|
tx for gonococcemia
|
ceftriaxone
|
|
kid less than 5 years old with aacute phase arthralgia, sudden high fever, cervical lymphadenopathy, swollen hands and feet, mouth lesions strawberry tongue,diffuse maculopapular rash on inguinal and chest area andlarge and medium joint pain, bilateral conjunctivitis nonsupperative, uveitis, subacute phase desquamation with decrease in fever large , thrombocytosis, increase immune complexes, covalescent phase over by 6-8 weeks think this dz
|
kawasaki dz
|
|
what causes kawasaki
|
unknown
|
|
tx for kawasaki
|
aspirin
ivig |
|
rare complication of kawasaki
|
giant coronary artery aneurysm
|
|
galactosemia -ar dz- carbohydrate metabolism problem
where is galactose found what accumulates what organ get damaged |
milk
lactose liver |
|
furtosemia- ar dz- carb metabolism problem
where is fructose found what accumulates what organ does it hurt |
fruit juices
fructose and sucrose liver |
|
tyrosinemia - ar dz
what accumulates what organs are damaged |
tyrosine
liver, cns, kidney especially liver |
|
failure to thrive, hypogylcemia, hepatomegaly, and acidosis in a 3-4month old baby
|
glucose 6 phosphatase deficiency
|
|
infant with cholestatsis, bleeding into cns,gi,or umbilical stump and elevated transaminases think this dz
|
alpha 1 antitrypsin def
|
|
older kid with chronic hepatitis with cirrhosis and portal htn
think this dz |
alpha 1 antitrypsin def
|
|
babies born to moms with sle can get what complication
|
heart block
|
|
baby with born to a mom with hyperthyroidism is mostlikely to develop
|
neonatal thyrotoxicosis - TSI cross the placenta but tsh cant. but they thyrotoxicosis goes away in 2-4 month when the tsi diminishes
BABY PRESENTS WITH: tachycardia, tachypnea juandice hepatosplenomegaly thrombocytopenia irritable, diarrhea HEART DISEASE |
|
in girls constitutional precocious puberty is usually due to
|
gonads mature becasue of increase in pituitary gonadotrophin working to make sex steroid to work on the gonads
|
|
boys usually have precocious puberty due to
|
lesion of the cns
|
|
How do you close a PDA?
|
indomethacin, closure surgery
do nothing if pda is keeping them alive like in transposition, hypoplastic left heart, tetrology |
|
How do you keep a PDA open?
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PGE 1
|
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PDA is associated with -
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Rubella
- high altitudes - low o2 tension |
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Associated symptoms with PDA
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asymtomatic usually
ftt recurent lower resp infection lowe extremity clubbing dyspnea - possible CHF |
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pt with wide pulse pressure
continuous machinery murmur at 2nd left intercostal space loud s2 bounding peripheral pulse think this dz |
pda
|
|
diagonose pda by
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color flow doppler see blood flow from aorta to pulmonary artery
echo and ecg show lv and la enlargement cxr show cardiomegaly |
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Holostyolic murmur next to sternum
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VSD
|
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True or false: most VSDs resolve on their own?
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true
|
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What is the most common congenital heart defect?
|
VSD
|
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what dz have vsd
|
cri du chat
downs trisomies 13 and 18 apert |
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whats apert
|
crainal deformities
fusion of fingers and toes |
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left to right shunt that is asymptomatic at birth then pt get recurrent repiratory infections, ftt, chf with a pansystolic murmur at kiwer keft sternal border and loud pulmonic s2 think
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vsd
|
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diagnose vsd by doing a
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echo
|
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tx of vsd
|
spontaneously closes usually
if large do surgery for chf symptoms do the follow give diuretic, inotropes,acei treat respiratory infection |
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before dental or pulmponary procedures do the following in a vsd pt
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give prophylaxsis amoxicillin to prevent endocarditis and septic emboli
|
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What heart defect has a right ventricular heave, wide fixed split s2 with increased blood flow to the lungs , systolic ejection murmur at upper left sternal border, easy fatigiblity, frequent resp infecx, ftt
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ASD
|
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Treatment of ASDs
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No treatment unless very large
|
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What heart defect is asymptomatic until adulthood?
|
asd
|
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What heart defect often presents with palpitations?
|
asd
|
|
lrge asd lead to
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chf
|
|
diagonse asd by
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echo with color flow doppler shows blood flow between atria , ventricular wall motion, and dilated rght ventricle
ecg shows right axis devitiation with ostium secundum defects cxr shows cardiomegaly and increase pulmonary vascularture markings |
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tx asd
|
spontaneously close
give antibiotic for ostium primum defect to prevent bacterial endocarditis befoer dnetal work surgical closure if infant has chf to prevent arrythmias, esienmengers, right vent problems |
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l to r shunt causes pulmonary htn and shunt reverses this is called
|
eisenmengers syndrome
|
|
Upper extremity HTN =
|
coarctation or aorta
|
|
Radiofemoral delay
|
coarctation or aorta
|
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Systolic murmur heard over mid-upper back ,
|
coarctation or aorta
|
|
Heart defect with rib notching on x-ray
|
coarctation or aorta
|
|
Heart defect associated with Turner syndrome
|
coarctation
|
|
asymptomatic htn in childhood, dysnea on exertion, cludication, epistaxis, headache, systolic p is higher in right arm than left arm, femoral pulses are weak and delayed, here late systolic murmur in left axilla and forceful pulse at apex with lower limb wasting due to decreased blood flow think
|
coarctation
|
|
diagonose coarctation by
|
cardiac catherization
ecg echo color flow doppler cxr show 3 sign - due to pre and post dilattion of aorta and rib notching -due to flow thru intercostal arteries |
|
tx coarctation by
|
surgical correction or balloon angioplasty
give endocarditis prophylaxsis |
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pulmoary and systemic flow exist in parallel, the aorta is connected to right ventricle, the pulonary artery is conntecte to left ventricle what dz is this
|
transposition of great vessels
|
|
without two defects tga babies can not live after birth what are they
|
septal defect
pda |
|
very ill baby that is cyanotic right after birth, tachypnea, progressive repiratory failure then dies think
|
tga
|
|
diagnose tga
|
echo
cxr shows narrow heart base, no pulmonary artery part so it looks egg shaped |
|
tx of tga
|
if pt has pda keep it open with prostaglandin e 1
baloon atrial septomy surgical correction |
|
most common cyanotic heart dz in infancy
|
transposition
|
|
most common cyantotic heart dz in childhood
|
tetraolgy
|
|
The 4 anomalies of tetrology of fallot Most common cyanotic
Kids who squart after exertion likely have tetrology of fallow |
1. VSD
2. Right ventricular hypertrophy 3. pulmonary stenosis 4. overriding aorta prov |
|
Kids who squart after exertion to increase systemic vascular resistance during tet spells, hypoxema, ftt, mental status changes,systolic ejection murmur on left sternal border,right ventricular lift,sing s2 think this dz
|
tetrology
|
|
dx tetrology of fallot
|
echo and catherization
cxr boot shaped heart ecg show right deviation and rvh |
|
tx tetrology of fallot
|
pge1 to keep pda open
treat cyanosis with 02 propanolol , knee cheast position, fluids, morphine temporary palliation with artifical shunt before true surgery |
|
vomiting
sinus bradycardia, wondering pacemaker,parxysmal tachycardia,heart rate of less thant 100bpm what drug has the baby ingested too much of |
digoxin
|
|
kid with swelling of hands and feet comes and goes, with or without gi problems or laryngeal swelling think
|
heriditary angioedema (ad)
|
|
pathophys of hereditary angioedema
|
first step in complement cascade messed up sp increase vasoactive kinin
|
|
marfans is assciated to what heart dz
|
dilation of aorta
mr ar |
|
ellis van crevald syndrome associated to what heart dz
|
atrial septal defects
|
|
pulse rate greater than 250 bpm in a kid think
|
tachyarrymia like wolf parkinson white
|
|
EKG finding of Wolff-Parkinson-White syndrome
|
delta wave
|
|
What causes symptoms in Wolff-Parkinson-White syndrome?
|
Transient arrhythmias conducted on accessory pathways
|
|
tricuspid regurg murmur and mid diastolic murmur at the lower left sternum with right atrial hypertrophy and right ventricular conduction problems think
|
ebstein anomaly
|
|
tricuspid atresia shows what on cxr
|
left axis deviation and lvh
|
|
early cyanosis, decreased pulmonary arterial blood flow, left axis deviation, lvh think
|
tricuspid atresia
|
|
fluffy snowman shape from venous congestion, with obstruction of pulmonary venous return, think
|
total anomoly of venous return
|
|
pt with apical murmur in late systole preceded by click think
|
mitral valve prolapse that the valve billow in the atria at the end of systole
|
|
dx mitral valvle prolapse
|
echo show prolapse
ecg and cxr normal |
|
tx mitral valve prolaspe
|
use antiboittic to prevent endocarditis
|
|
Teenager with sudden cardiac death =
What triggers closure of the ductus arteriosis? increased O2 shuts off prostaglandin production |
hypertrophic obstructive cardiomyopathy
|
|
Treatment of hypertrophic obstructive cardiomyopathy -
|
B-blockers
- consider pacemaker placement |
|
Where is fetal circulation O2 highest?
|
Umbilical vein
|
|
Where is fetal circulation O2 lowest?
|
Umbilical artery
|
|
In fetus, which has highest O2 content, blood to arms or legs?
|
Blood to arms
Resting HR over 100 is normal up to age 10 years |
|
Medications that are contraindicated in obstructive hypertrophic cardiomyopathy -
|
positive ionotropes
- diuretics - vasodilators |
|
How does the foramen ovale close?
|
Increase in left-side heart pressures Heart pressure changes at time of birth - 1st breaths cause lung inflation and decreased pulmonary vascular resistance
--> increased arterial flow --> increase left sided pressures |
|
What triggers closure of the ductus arteriosis?
|
increased O2 shuts off prostaglandin production
|
|
vaccinations given at birth
|
hep b
|
|
vaccinations given at 1 month
|
vaccinations given at 1 month hep b, only if not given at birth
|
|
vaccinations given at 2 months
|
vaccinations given at 2 months Pediarix (HBV, DTaP, IPV)
Prevnar (pneumococc) Rotavirus Hib |
|
what is in pediarix
|
what is in pediarix HBV
DTaP IPV |
|
vaccinations given at 4 months
|
vaccinations given at 4 months Pediarix
Prevnar Hib Rotavirus |
|
vaccinations given at 6 months
|
vaccinations given at 6 months Pediarix
Prevnar Hib Rotavirus |
|
vaccinations given at 12 months
|
vaccinations given at 12 months DTaP
Hib MMR VZV Prevnar Influenza Hep A |
|
vaccinations given at 24 months
|
vaccinations given at 24 months none
|
|
vaccinations given at 4-6 yrs
|
vaccinations given at 4-6 yrs DTaP
IPV MMR Influenza |
|
vaccinations given at 11 yo
|
vaccinations given at 11 yo Tdap
Meningococcus vaccine |
|
what is the schedule for well visits starting from birth 1 mo
2 mo 4 mo 6 mo 9 mo 12 mo 15 mo 18 mo 24 mo then annually why shouldn't babies drink water because their kidneys aren't mature enough to handle the extra fluid so the babies will become hyponatremic since they can't excrete the water, and then they can have szs plagylocephaly mishapen head sunsetting sign increased icp, eyes are half closed 2ndary to the increased icp on the cranial nerves craniosynostosis premature closure of the fontanelles rash pattern in rmsf palms and soles, then spreads to trunk petechial rash pattern in rubella rash on face that spreads to the rest of the body rash pattern in measles rash starts at the head and spreads downwards and disappears in the same manner rash pattern for erythema infectiosum slapped cheek rash; lacy, reticular vzv rash pattern begins on trunk, followed by head, face, and extremities gross motor skills at 1 mo old raises head gross motor skills at 3 mo holds head up gross motor skills at 4-5 mo rolls front to back and back/front sits supported gross motor skills at 6 mo sits unsupported gross motor skills at 9 mo crawls cruises pulls to stand gross motor skills at 12 mo walks alone gross motor skills at 15 mo walks backwards gross motor skills at 18 mo runs gross motor skills at 24 mo walks well up and down stairs gross motor skills at 3 yrs rides tricycle throws ball overhand gross motor skills at 4 yo alternates feet going down stairs skips fine motor skills at 1 mo follows eyes to midline fine motor skills at 3 mo hands open at rest fine motor skills at 4-5 mo grasps with both hands together fine motor skills at 6 mo transfers hand to hand, reaches with either hand fine motor skills at 9 mo pincher grasp finger feeds fine motor skills at 12 mo throws, releases objects fine motor skills at 15 mo builds 2 block tower fine motor skills at 18 mo feeds self with utensils fine motor skills at 24 mo removes clothing builds 5 block tower fine motor skills at 3 yrs draws circle fine motor skills at 4 yrs catches ball dresses alone fine motor skills at 5 yrs ties shoes Simple febrile sz btwn 6mo - 6yr tonic clonic associated with fever >100.4 sz lasts <15 mins only 1 sz in 24 hrs minimal post-ictal state complex febrile sz 6 mo - 6 yrs focal sz >15 mins >1 sz/24 hrs management of simple febrile sz determine the source of the fever, otherwise, no other w/u is needed management of complex febrile sz full w/u should be done, but no anti-epileptics, no eeg needed if pt is <18 mo, LP eeg abnormality associated with infantile spasm hypsarrythmia definition of recurrent abdominal pain >3x in 3 mo #1 cause of abdominal pain gastroenteritis |
what is the schedule for well visits starting from birth 1 mo
2 mo 4 mo 6 mo 9 mo 12 mo 15 mo 18 mo 24 mo then annually |