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84 Cards in this Set

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Bronchiolitis
acute inflammatory illness of small airways
mostly affects <2y/o
RSV most common
RF for severe RSV
<6m old
prematurity
heart/lung dz
immunodeficiency
Bronchiolitis S/S
low grade T
rhinorrhea
cough
apnea (in young infants)
tachypnea
wheezing, crackles
prolonged expiration
hyperresonance to percussion
Bronchiolitis eval
CXR
- hyperinflation
- interstitial infiltrates
- atelectasis
ELISA of nasal washings (high sens/spec)
Bronchiolitis Rx
Mild
Outpt - fluids, nebulizers, O2
Admit if marked resp distress
O2<95%
toxic appearance
hx prematurity (<34wks)
age <3m
underlying cardiopulm dz
dehydration/poor oral feeding
Need contact isolation, hydration, O2
Ribavirin aerosol may shorten symptoms
RSV prophylaxis
poly/monoclonal Ab in winter for high risk pts
Croup (laryngotracheobronchitis)
Acute inflam disease of larynx especially subglottic space
3m-3y/o
PIV-1 (most common)
PIV-2,3
RSV
influenza
rubeola
adenovirus
M. pneumoniae
Croup S/S
typical prodrome URI symp followed by:
low grade T
mild dyspnea
insp stridor (88% present with stridor)
hoarseness
characteristic barking cough usually at night
Croup Dx, Rx
Dx - clinical
AP neck film - "steeple sign" (subglottic narrowing)
Rx
Mild
outpt - cool mist therapy and fluids
Moderate
+/- steroids
Severe
Admit
nebulized racemic epi
Epiglottitis
3-7y/o
serious and rapidly progressive infection of supraglottic structures (epiglottis, arytenoids)
Common causes
Strep species
non-typable H. flu
viral
epiglottitis S/S
sudden onset (4-12h) high fever (39-40°C)
dysphagia
drooling
muffled voice
insp retractions
cyanosis
soft stridor (8% present with stridor)
"sniffing dog" position (neck hyperextended and chin protruding)
"tripod" position (sitting, leaning fwd)
Epiglottits Dx
Dx - clinical
DO NOT examine throad unless anaesthesiologist present
Definitive Dx - direct fiberoptic visualization of cherry red, swollen epiglottitis and arytenoids
Lat C/S Xray - "thumbprint sign"
(swollen epiglottis obliterating valleculae)
Epiglottits Rx
Emergency!
call anaesthesia, transfer to OR
ETT or trach
IV abx - ceftriaxone or cefuroxime
Tracheitis
3m-2y/o
S. aureus
prodrome 3d (acute decompensation 10h)
intermediate grade T
variable resp distress
CXR - subglottic narrowing
Otitis Media
S.pneumo
H. flu
M. catarrhalis
children predisposed d/t shorter more horizontal eustachian tube
RF
viral URIs
Down's
CF
immunodeficiencies
smoke exposure
day-care
bottle feeding
cleft palate
prior OM
OM S/S
fever
ear tugging
hearing loss
irritability
crying/feeding difficulties
vomiting
O/E
erythema, opacity
TM bulging, ↓mobility
loss of light reflex and bony landmarks
OM Dx and Rx
Dx - clinical
erythema alone is insufficient
Rx
amoxicillin x 10d
if Rx failure after 3d - amox/clavulinic acid or ceftriaxone or cefuroxime
OM complications
mastoiditis
meiningitis
hearing loss
cholesteatoma
tympanosclerosis
chronic suppurative OM
Neonatal jaundice
↑serum bili >5mg/dL d/t ↑production/↓excretion
Conjugated/direct - ALWAYS pathologic
Unconjugated - path or phys
Kernicterus
Cx of unconjugated/indirect
D/t irreversible bili deposition in BG, pons, CB
occurs with >20mg/dL
can be fatal
RF
prematurity
asphyxia
sepsis
Neontal jaundice S/S
hx - breast or bottle?
- intrauterine drug exposure
FHx - hemoglobinopathies, enzyme deficiencies, RBC defects
Symp
abd distension
delayed passage meconium
light coloured stools
dark urine
low APGAR
wt loss
vomiting
Sign
cephalopedal progression
Kernicterus S/S
lethargy
poor feeding
high pitched cry
hypertonicity
seizures
cephalopedal progression of jaundice
neonatal jaundice conjugated vs unconjugated
Direct
extrahepatic cholestasis
- biliary atresia
- choledochal cysts
intraheptic cholestasis
- neonatal hepatitis
- inborn errors of metabolism
- TPN cholestasis
- ToRCHeS
Indirect
physiologic
hemolysis
breast milk jaundice
↑enterohepatic circulation (eg GI obstuction)
disorders of bili metabolism
sepsis
Neonatal jaundice eval
CBC with periph smear
blood type of mom and baby
Coomb's test
bili levels
Direct
LFTs
bile acids
blood cultures
sweat test
tests for aminoacidopathies and α1AT↓
septic w/u as indicated
Neonatal jaundice Rx
Rx underlying cause
unconjugated - phototherapy (mild↑) or exchange transfusion (severe)
start phototherapy earlier in preterm
Physiologic jaundice
physiologic
presents ≥72h after birth
bili ↑<5mg/dL/d
bili peaks at <14-15mg/dL
Direct bili <10% total
resolves by 1wk in term babies, 2wks in preterm
Pathologic jaundice
present in first 24h of life
bili ↑>0.5mg/dL/h (>6mg/dL/d)
bili ↑>15mg/dL
direct bili >10% total
persists beyond 1wk in term, 2wks in preterm
Erythema infectiosum
5th disease
Parvovirus B19
prodrome - none (fever Ø/↓gr)
Rash
"slapped cheeks" erythematous
pruritic
maculopapular
starts on arms → trunks, legs
worse with fever, sun exposure
Erythema infectiosum Cx
arthritis
hemolytic anemia
encephalopathy
congenital infection associated with fetal hydrops, death
Measles
paramyxovirus
Prodrome
- ↓gr T
- cough, coryza, conjunctivitis
Koplik spots
(small irregular red spots with central grey specks) on buccal mucosa afer 1-2d
Rash
erythematous
maculopapular
head→feet
Measles Cx
common
OM
pneumonia
laryngotracheitis
Rare
Subacute sclerosising panencephalitis
Rubella
rubella virus
prodrome
asymp or tender, generalized lymphadenopathy (post auricular and suboccipital)
Rash
erythematous, tender rose-pink maculopapular rash, slight fever
+/- polyarthritis in adolescents
eye pain on lateral and upwd eye mvts
conjunctivitis
sore throat
h/a
Rubella complications
encephalitis
TCP (rare Cx of post-natal infection)
congenital infection associated with congenital anomalies
Roseola infantum
HHV6
prodrome
acute onset ↑fever (>40°C)
no other symp for 3-4d
Rash
maculopapular rash appears as fever breaks
trunk → face & extremities
often <24h
Roseola infantum Cx
febrile sz d/t rapid fever onset
Varicella
VZV
prodrome
mild fever, malaise, & anorexia precede rash by 24h
Rash
generalized, pruritic "teardrop vesicular rash"
trunk → periphery
lesions at different stages
infectious from 24h before eruption until lesions crust over
Varicella Cx
progressive varicella with
meningoencephalitis and hepatitis in immunocompromised
Congenital infection associted with congenital anomalies
Congenital rubella
triad
sensorineural hearing loss (most common)
ocular abnormalities (cataracts, infantile glaucoma, pigmentary retinopathy)
congenital heart dz
(PDA, PA stenosis)
Also:
IUGR
blueberry muffin spots
hepatosplenomegaly, jaundice
Varicella Zoster Cx (reactivation Cx)
encephalopathy
aseptic meningitis
pneumonitis
TTP
Guillain-Barre
cellulitis
arthritis
Hand-foot-and-mouth disease
Coxsackie A
prodrome
fever, anorexia, oral pain
Rash
oral ulcers
maculopapular or vesicular on hands, feet +/- buttocks
Tracheoesophageal Fistula associations
Associated with:
esophageal atresia
VACTERL anomalies
Vertebral
Anal
Cardiac
Tracheal
Esophageal
Renal
Limb
Presentation
TEF presentation
polyhydramnios in utero
↑oral secretions
inability to feed
gagging
resp distress
TEF Dx and Rx
CXR after NGT identifies esophageal atresia
presence of air in GIT suggestive
Confirm Dx - bronchoscopy
Rx - Sx repair
Congenital Diaphragmatic Hernia
GIT segement protrudes thru diaphragm into thorax
90% posterior L
Presentation
resp distress (from pulm hypoplasia & PHTN)
sunken abdomen
bowel sounds over L hemithorax
Dx - U/S in utero
Confirm - CXR postnatal
Congenital Diaphragmatic hernia Rx
HF vent or ECMO to manage PHTN
Sx
Gastroschisis
Herniation of intestine thru abd wall next to umbilicus (R>L)with NO sac
Presentation
polyhydramnios in utero
prematurity
associated with GI stenosis/atresia
Rx - Sx emergency
Omphalocele
herniation of abd viscera thru abd wall at umbilicus into sac covered by peritoneum and amniotic memb
=
Omphalocele presentation and Rx
polyhydramnios in utero
prematurity
associated with other GI, cardiac defects
Rx
C/S to prevent sac rupture
if sac intact delay Sx until baby fully resuscitated
Keep sac covered/stable w petroleum jelly and gauze
intermittent NG suction to prevent abd distension
Duodenal atresia
complete/partial failure of duodenal lumen to recanulize during GA 8-10wks
Duodenal atesia presentation and Rx
polyhydramnios in utero
bilious emesis within hours of 1st feeding
associated with:
Down's
other cardiac/GI anomalies (annular pancreas, imperforate anus, malrotation)
Dx: "double-bubble" on AXR proximal to site of atresia
Rx - Sx repair
Meckel's diverticulum
vestigial remnant of omphalomesenteric duct
most common congenital GIT anomaly
"rule of 2's"
2x ♂:♀
2 feet from ileocecal valve (most common)
2 types of mucosa (gastric, pancreatic)
2% of people affected
Hirschsprung's disease
congenital aganglionic megacolon
absence of autonomic innervation of bowel wall; inadequate relaxation and peristalsis → obstruction
Meckel's diverticulum presentation and Dx
painless rectal bleeding (most common)
obstruction from intussusception/volvulus
painful diverticulitis (often misDx as appendicitis)
Dx - Meckel's scan (for ectopic mucosa - IV technetium pertechnetate - preferentially taken up by gastric mucosa)
Hirchsprung's disease presentation and Rx
abd distension
bilious emesis
failure to pass meconium in 1st 24h
Dx
barium enema - dilated prox segment, narrow distal seg
Rectal Bx - lack of ganglion cells confirms dx
Rx
colostomy prior to corrective Sx allows for pelvic growth and normalization of dilated bowel
hypospadias
abnormal urethral opening on ventral surface of penis d/t incomplete dvt of distal urethra
presentation
curved penis (chordee)
associate with herias, cryptorchidism
Rx
circumcision contraindicated
Sx repair with preputial tissue
RDS
most common cause resp failure in preterm (>70% of babies born 29-40wks GA)
surfactant deficiency → poor lung compliance & atelectasis
RDS risk factors
maternal DM

second born of twins
RDS S/S
presents in 1st 48-72h
RR>60
progressive hypoxemia
cyanosis
nasal flaring
intercostal retractions
expiratory grunting
RDS DDx
TTN
meconium aspiration
congenital pneumonia
spontaneous pneumothorax
diaphragmatic hernia
cyanotic heart disease
RDS evaluation
ABG, CBC, blood cultures
CXR
b/l diffuse atelectasis causes "ground-glass" appearance, air bronchograms
TTN CXR findings
retained amniotic fluid causes prominent perihilar streaking in interlobular fissures
Meconium aspiration CXR findings
coarse, irregular infiltrates
hyperexpansion
PTXs
Congenital pneumonia CXR findings
nonspecific patchy infiltrates
neutropenia, tracheal aspirate, & gram stain suggest Dx
RDS Rx
CPAP/intubation
artificial surfactant (↓mortality)
PREVENTION
betamethasone to mom
monitor FLM - lecithin:sphyingomyelin and phosphotidylglycerol
Complications of RDS
persistent PDA
BPD
retinopathy of prematurity
IVH
necrotizing enterocolitis
==> Cx of Rx
Cerebral palsy
nonprogressive, nonhereditary disorders
most common mvt disorder in children
RF
prematurity
perinatal asphyxia
IUGR
early infection/trauma
brain malformation
neonatal ICH
Types of CP
Pyramidal (spastic)
spastic paresis of ≥1 limb
75% of cases
MR present in ≤90%
Extraparamidal (nonspastic)
result of damage to extrapyramidal tracts
subtypes:
Ataxic
choreoathetoid
dystonic (uncontrollable jerking, writhing, or posturing)
abnormal mvts ↑with stress, disappear during sleep
CP S/S
+/- associated with:
- seizure disorder
- behavioural disorder
- hearing/vision impairment
- learning disabilities
- speech deficits
- hyperreflexia
- ↑tone/contractures
- weakness/underdevelopment
- toe walking/scissor gait
- hip dislocations
- scoliosis
Rx of spasticity
diazepam
dantrolene
baclofen
febrile seizures
usually 6m-6yrs with no evidence of intracranial infection or other cause
RF
rapid ↑T
FHx
febrile seizures S/S
occur during onset of fever
may be 1st sign of underlying illness (OM, roseola)
Simple
<15min
generalized
1 in 24hrs
fever >39°C
fever onset within hrs of sz
Complex
>15min
focal sz
>1 in 24hrs
low grade fever/fever for several days before sz
Febile seizures Eval and Rx
find the source of infection
LP if signs CNS involvement
labs as indicated (none if obvious febrile sz)
Rx
antipyretics (not ASA)
Rx underlying illness
complex sz - thorough neuro eval
diazepam, phenobarb if needed
EEG, MRI controversial for complex febrile sz
Complications of febrile sz
recur in 30%
Ø ↑risk epilepsy or developmental, intellectual, growth abnormalities
pts with complex sz have 10% risk developing epilepsy
Top childhood cancers
1. leukemia (ALL)
2. CNS tumors
3. lymphoma
4. neuroblastoma
Neuroblastoma
embryonal tumor of neural crest cell origin
>50% are <2y/o
Associated with:
hircshprung's
NF
N-myc oncogene
Neuroblastoma S/S
lesions anywhere (abdomen, mediastium)
nontender abd mass
horner's
HTN
Spinal cord compression
anemia, FTT, fever
Site specific mets → proptosis & periorbital bruising (racoon eyes0
subcutaneous tumor nodules
bone pain with pancytopenia
opsoclonus/myoclonus ("dancing eyes/dancing feet")
DDx of neuroblastoma
Wilm's tumor
rhabdomyosarcoma
lymphoma
renal cell ca
PCKD
Neuroblastoma eval
abd CT
24h urine catecholamines for ↑VMA, HVA
Staging
CXR
bone scan
CBC, LFTs, BUN/Cr, coags
Neuroblastoma Rx
localized - cured with excision
Chemo
cyclophosphamide & doxorubicin
adjuvant XRT for mets
Px better in subtype in infants <1y/o
Wilm's tumor
renal tumor of embryonal origin
most common renal tumor in kids
2-4y/o
Associated with:
Beckwith-Wiedemann syndrome
NF
WAGR syndrome (esp aniridia, hemihypertrophy)
Beckwith-Wiedemann syndrome
hemihypertrophy
macroglossia
visceromegaly
WAGR syndrome
Wilms'
Aniridia
GU abnormalities
mental Retardation
Wilms' S/S
painless abdominal/flank mass (does NOT cross midline) -most common finding
hematuria (usually micro)
fever
HTN
N/V
bone pain
dysuria, polyuria
wt loss
Wilm's eval
abd CT, U/S → solid intrarenal mass
Ax for mets
CXR
chest CT
CBC, LFTs, BUN/Cr
Wilms' Rx
transabd nephrectomy
AND
post-Sx chemo - vincristine & dactinomycin
+/- flank XRT
Px - generally good