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84 Cards in this Set
- Front
- Back
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Bronchiolitis
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acute inflammatory illness of small airways
mostly affects <2y/o RSV most common RF for severe RSV <6m old prematurity heart/lung dz immunodeficiency |
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Bronchiolitis S/S
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low grade T
rhinorrhea cough apnea (in young infants) tachypnea wheezing, crackles prolonged expiration hyperresonance to percussion |
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Bronchiolitis eval
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CXR
- hyperinflation - interstitial infiltrates - atelectasis ELISA of nasal washings (high sens/spec) |
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Bronchiolitis Rx
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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 |
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RSV prophylaxis
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poly/monoclonal Ab in winter for high risk pts
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Croup (laryngotracheobronchitis)
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Acute inflam disease of larynx especially subglottic space
3m-3y/o PIV-1 (most common) PIV-2,3 RSV influenza rubeola adenovirus M. pneumoniae |
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Croup S/S
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typical prodrome URI symp followed by:
low grade T mild dyspnea insp stridor (88% present with stridor) hoarseness characteristic barking cough usually at night |
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Croup Dx, Rx
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Dx - clinical
AP neck film - "steeple sign" (subglottic narrowing) Rx Mild outpt - cool mist therapy and fluids Moderate +/- steroids Severe Admit nebulized racemic epi |
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Epiglottitis
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3-7y/o
serious and rapidly progressive infection of supraglottic structures (epiglottis, arytenoids) Common causes Strep species non-typable H. flu viral |
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epiglottitis S/S
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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) |
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Epiglottits Dx
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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) |
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Epiglottits Rx
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Emergency!
call anaesthesia, transfer to OR ETT or trach IV abx - ceftriaxone or cefuroxime |
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Tracheitis
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3m-2y/o
S. aureus prodrome 3d (acute decompensation 10h) intermediate grade T variable resp distress CXR - subglottic narrowing |
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Otitis Media
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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 |
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OM S/S
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fever
ear tugging hearing loss irritability crying/feeding difficulties vomiting O/E erythema, opacity TM bulging, ↓mobility loss of light reflex and bony landmarks |
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OM Dx and Rx
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Dx - clinical
erythema alone is insufficient Rx amoxicillin x 10d if Rx failure after 3d - amox/clavulinic acid or ceftriaxone or cefuroxime |
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OM complications
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mastoiditis
meiningitis hearing loss cholesteatoma tympanosclerosis chronic suppurative OM |
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Neonatal jaundice
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↑serum bili >5mg/dL d/t ↑production/↓excretion
Conjugated/direct - ALWAYS pathologic Unconjugated - path or phys |
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Kernicterus
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Cx of unconjugated/indirect
D/t irreversible bili deposition in BG, pons, CB occurs with >20mg/dL can be fatal RF prematurity asphyxia sepsis |
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Neontal jaundice S/S
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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 |
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Kernicterus S/S
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lethargy
poor feeding high pitched cry hypertonicity seizures cephalopedal progression of jaundice |
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neonatal jaundice conjugated vs unconjugated
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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 |
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Neonatal jaundice eval
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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 |
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Neonatal jaundice Rx
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Rx underlying cause
unconjugated - phototherapy (mild↑) or exchange transfusion (severe) start phototherapy earlier in preterm |
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Physiologic jaundice
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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 |
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Pathologic jaundice
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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 |
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Erythema infectiosum
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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 |
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Erythema infectiosum Cx
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arthritis
hemolytic anemia encephalopathy congenital infection associated with fetal hydrops, death |
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Measles
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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 |
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Measles Cx
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common
OM pneumonia laryngotracheitis Rare Subacute sclerosising panencephalitis |
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Rubella
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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 |
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Rubella complications
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encephalitis
TCP (rare Cx of post-natal infection) congenital infection associated with congenital anomalies |
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Roseola infantum
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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 |
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Roseola infantum Cx
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febrile sz d/t rapid fever onset
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Varicella
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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 |
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Varicella Cx
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progressive varicella with
meningoencephalitis and hepatitis in immunocompromised Congenital infection associted with congenital anomalies |
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Congenital rubella
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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 |
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Varicella Zoster Cx (reactivation Cx)
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encephalopathy
aseptic meningitis pneumonitis TTP Guillain-Barre cellulitis arthritis |
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Hand-foot-and-mouth disease
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Coxsackie A
prodrome fever, anorexia, oral pain Rash oral ulcers maculopapular or vesicular on hands, feet +/- buttocks |
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Tracheoesophageal Fistula associations
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Associated with:
esophageal atresia VACTERL anomalies Vertebral Anal Cardiac Tracheal Esophageal Renal Limb Presentation |
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TEF presentation
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polyhydramnios in utero
↑oral secretions inability to feed gagging resp distress |
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TEF Dx and Rx
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CXR after NGT identifies esophageal atresia
presence of air in GIT suggestive Confirm Dx - bronchoscopy Rx - Sx repair |
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Congenital Diaphragmatic Hernia
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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 |
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Congenital Diaphragmatic hernia Rx
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HF vent or ECMO to manage PHTN
Sx |
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Gastroschisis
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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 |
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Omphalocele
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herniation of abd viscera thru abd wall at umbilicus into sac covered by peritoneum and amniotic memb
= |
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Omphalocele presentation and Rx
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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 |
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Duodenal atresia
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complete/partial failure of duodenal lumen to recanulize during GA 8-10wks
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Duodenal atesia presentation and Rx
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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 |
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Meckel's diverticulum
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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 |
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Hirschsprung's disease
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congenital aganglionic megacolon
absence of autonomic innervation of bowel wall; inadequate relaxation and peristalsis → obstruction |
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Meckel's diverticulum presentation and Dx
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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) |
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Hirchsprung's disease presentation and Rx
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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 |
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hypospadias
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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 |
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RDS
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most common cause resp failure in preterm (>70% of babies born 29-40wks GA)
surfactant deficiency → poor lung compliance & atelectasis |
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RDS risk factors
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maternal DM
♂ second born of twins |
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RDS S/S
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presents in 1st 48-72h
RR>60 progressive hypoxemia cyanosis nasal flaring intercostal retractions expiratory grunting |
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RDS DDx
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TTN
meconium aspiration congenital pneumonia spontaneous pneumothorax diaphragmatic hernia cyanotic heart disease |
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RDS evaluation
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ABG, CBC, blood cultures
CXR b/l diffuse atelectasis causes "ground-glass" appearance, air bronchograms |
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TTN CXR findings
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retained amniotic fluid causes prominent perihilar streaking in interlobular fissures
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Meconium aspiration CXR findings
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coarse, irregular infiltrates
hyperexpansion PTXs |
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Congenital pneumonia CXR findings
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nonspecific patchy infiltrates
neutropenia, tracheal aspirate, & gram stain suggest Dx |
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RDS Rx
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CPAP/intubation
artificial surfactant (↓mortality) PREVENTION betamethasone to mom monitor FLM - lecithin:sphyingomyelin and phosphotidylglycerol |
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Complications of RDS
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persistent PDA
BPD retinopathy of prematurity IVH necrotizing enterocolitis ==> Cx of Rx |
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Cerebral palsy
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nonprogressive, nonhereditary disorders
most common mvt disorder in children RF prematurity perinatal asphyxia IUGR early infection/trauma brain malformation neonatal ICH |
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Types of CP
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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 |
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CP S/S
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+/- 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 |
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Rx of spasticity
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diazepam
dantrolene baclofen |
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febrile seizures
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usually 6m-6yrs with no evidence of intracranial infection or other cause
RF rapid ↑T FHx |
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febrile seizures S/S
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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 |
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Febile seizures Eval and Rx
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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 |
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Complications of febrile sz
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recur in 30%
Ø ↑risk epilepsy or developmental, intellectual, growth abnormalities pts with complex sz have 10% risk developing epilepsy |
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Top childhood cancers
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1. leukemia (ALL)
2. CNS tumors 3. lymphoma 4. neuroblastoma |
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Neuroblastoma
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embryonal tumor of neural crest cell origin
>50% are <2y/o Associated with: hircshprung's NF N-myc oncogene |
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Neuroblastoma S/S
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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") |
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DDx of neuroblastoma
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Wilm's tumor
rhabdomyosarcoma lymphoma renal cell ca PCKD |
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Neuroblastoma eval
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abd CT
24h urine catecholamines for ↑VMA, HVA Staging CXR bone scan CBC, LFTs, BUN/Cr, coags |
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Neuroblastoma Rx
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localized - cured with excision
Chemo cyclophosphamide & doxorubicin adjuvant XRT for mets Px better in subtype in infants <1y/o |
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Wilm's tumor
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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) |
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Beckwith-Wiedemann syndrome
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hemihypertrophy
macroglossia visceromegaly |
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WAGR syndrome
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Wilms'
Aniridia GU abnormalities mental Retardation |
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Wilms' S/S
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painless abdominal/flank mass (does NOT cross midline) -most common finding
hematuria (usually micro) fever HTN N/V bone pain dysuria, polyuria wt loss |
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Wilm's eval
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abd CT, U/S → solid intrarenal mass
Ax for mets CXR chest CT CBC, LFTs, BUN/Cr |
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Wilms' Rx
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transabd nephrectomy
AND post-Sx chemo - vincristine & dactinomycin +/- flank XRT Px - generally good |
