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73 Cards in this Set
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- Back
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Kawasaki disease symptoms
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fever at least 5 days & unresponsive to abx if given
irritability out of proportion to degree of fever extremities: erythema, edema, desquamation conjunctivitis polymorphous rash cervical lymphadenopathy oropharyngeal erythema dry/fissured/swollen lips strawberry tongue coronary artery aneurysms! |
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Kawasaki disease lab tests
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If elevated CRP/ESR, then:
albumin < 3g anemia for age elevated ALT elevated platelets WBC >12000 presence of pyuria (If 3 or more positive, then diagnosis is made --> DO ECHO!) |
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incidence of congenital heart disease
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1% (2-6% if one child has CHD, 20-30% if two kids have CHD)
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Kawasaki disease treatment
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IVIg +/- aspirin (beware Reye's syndrome)
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DDH: subluxation vs dislocation
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subluxation: incomplete contact b/w articular surface of femoral head and acetabulum
dislocation: complete loss of contact |
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frequency of DDH
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overall 1:1000 (incidence in newborns as high as 1:60, but most stabilize with age)
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RFs for DDH
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race (higher in Native Americans, lower in southern Chinese and blacks)
genetics (10x if parents had DDH) female sex being first-born breech presentation intrauterine malpositioning/crowding oligohydramnios (left more than right due to common uterine position of left hip against mother's sacrum, forcing it into adducted position) |
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physical tests for DDH
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Barlow's and Ortolani's tests in newborns
for >3m, Galeazzi's test, asymmetry of gluteal thigh skin folds, decreased abduction of affected side, standing or walking in external rotation, leg-length inequality |
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benefits of prenatal diagnosis (5)
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reassurance of parents
Mx of pregnancy and delivery selective termination of pregnancy planned neonatal Mx possible intrauterine treatment |
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What is APGAR?
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A = appearance (skin color)
P = pulse G = grimace (reflex irritability) A = activity (muscle tone) R = respiratory effort usually recorded at 1, 5, and 10 min after birth. |
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signs of perinatal hypoxia (antepartum, intrapartum, and postpartum)
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antepartum:
IUGR reduced fetal mvmts abnormal fetal blood flow (Doppler) Intrapartum: meconium-stained amniotic fluid abnormal fetal heart rate (cardiotocograph) metabolic acidosis (fetal blood sample) Postpartum: bradycardia/apnea low Apgar delayed onset of respiration metabolic acidosis (cord blood) |
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primitive reflexes
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Moro
stepping rooting sucking asymmetric tonic neck palmar grasp Babinski Galant glabellar |
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acute otitis media incidence and age of peak prevalence
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2/3 have at least one by age 3
90% have at least one by school entry peak age prevalence 6-18m |
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acute otitis media etiology
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viral (25%)
Strep. pneumo (35%) non-typable H. influenzae (25%) Moraxella catarrhalis (15%) |
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acute otitis media exam findings
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1. usual middle ear landmarks (light reflex, handle of malleus, incus) not easily seen
2. Tympanic membrane (TM) dull, opaque, maybe bulging. Colour is characteristically yellow-grey. 3. TM mobility reduced with pneumatic otoscopy. assoc'd URTI signs A red TM alone is not acute OM. |
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acute otitis media complications
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TM perforation (usually w/relief of pain)
febrile convulsions commonly assoc'd suppurative Cx (mastoiditis, labyrinthitis, intracranial inf'n) less commonly facial nerve palsy lateral sinus thrombosis benign intracranial HTN |
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acute otitis media Mx
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ANALGESIA. Paracetamol 20-30mg/kg for 2-3 doses/d if pain is significant.
Short-term use of 1% lignocaine drops applied to TM for severe acute pain. Decongestants, antihistamines, and corticosteroids NOT shown to be effective. If Sx unresolving after 24-48h, or pt is not immunocompetent, give a 5-day course of amoxycillin along with a parent hand-out. If Sx still don't improve in 48h, consider alternative Dx or if none, switch to Augmentin. Once Sx resolve, advise parents to seek review if hearing problems, ear Sx, or irritability persist after 2-3m (to check for persistent effusion). Give handout if you haven't already. |
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complications of SGA/IUGR babies
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fetal distress/birth asphyxia (may necessitate rapid delivery via C-section)
meconium aspiration difficulty maintaining body temp polycythemia hypoglycemia |
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IUGR: definition
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intrauterine growth restriction - a condition in which a fetus is unable to reach its genetically determined potential size
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SGA: definition
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small for gestational age
growth at or less than the 10th percentile for weight of all fetuses at that gestational age. Not all are pathologically growth restricted. |
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causes of IUGR
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maternal:
HTN infection (eg. TORCHeS) advanced diabetes smoking/substance abuse malnutrition uterine malformations anemia heart or respiratory disease placental/umbilical cord causes: placental insufficiency placental abruption placenta previa cord anomalies fetal related: multiple gestation (twins, triplets, etc) inf'n birth defects chromosomal abnormality |
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How is SGA diagnosed?
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fundal height (in cm; should correspond to weeks gestation after 20th wk)
other: US, Doppler (fetal brain, cord vessels), mom's wt gain, |
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effects of prenatal exposure to smoking
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growth restriction (dose-response curve; fetal wt reduced 5% per pack per day)
reduces success rates of assisted reproductive technologies daughters have 4x risk of taking up smoking during adolescence SIDS "jittery baby" symptoms from nicotine withdrawal links to asthma overall lifetime lung fxn decreased |
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criteria for dx of fetal alcohol syndrome
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growth: IUGR, postnatal growth retardation
CNS alteration: tremor, poor sucking ability, hyper/hypotonia, attention deficit, mental impairment, developmental delay dysmorphism (at least 2): narrow eye width, short upper vermillion, absent philtrum, broad upper lip, short upturned nose, mid-face hypoplasia, micrognathia, microphthalmia, microencephaly (cardiac, spinal, limb, and urogenital defects may also be present) |
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causes of nonorganic FTT
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prenatal:
malnourished mother mother who doesn't bond with fetus teen pregnancy lower SES multiple gestations postnatal: poor feeding dysfxn'l family interactions lack of support (no friends, extended family) lack of parent preparation child neglect emotional deprivation syndrome feeding disorders |
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common brain tumor types in children
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astrocytoma
glioma ependymoma medulloblastoma (most common) |
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causes of organic FTT
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prenatal:
prematurity w/complications IUGR toxin exposure (eg. tobacco, EtOH) maternal factors (eg. HTN, heart disease) intrauterine inf'n placental abnormalities chromosomal abnormalities postnatal: 1. inadequate energy intake: poor appetite (eg. iron deficiency anemia, CNS pathology, chronic infection), inability to suck or swallow (CNS or muscular), vomiting, GERD, esophagitis 2. poor absorption/utilization: GI (CF, celiac's), renal (RF, RTA), endocrine (hypothyroidism, DM, GH-def), inborn error of metabolism, chronic inf'n 3. increased metabolic demands: hyperthyroidism, chronic dz, chronic inflammatory conditions (IBD, SLE), RF, malignancy |
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pre-vaccination procedures
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1. anaphylaxis response kit (min. 3 ampules 1:1000 adrenaline - check expiry dates)
2. ensure effective cold chain transport/storage/handling 3. valid consent 4. pre-vaccination screening (eg. unwell today, immunosuppressed, any severe allergies, any vaccine in past month, pregnant, bleeding disorder, etc.) (beware false contraindications) 5. Catch-up vaccines if necessary. |
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contraindications to vaccination
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two absolute:
- anaphylaxis following a previous dose of a relevant vaccine - anaphylaxis following any component of the relevant vaccine Live vaccines should not be given to immunosuppressed ppl and pregnant women (also advise women not to become pregnant w/in 4w) |
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maintenance fluids for children (>4wks old)
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0-10 kg: 100mL/kg/day OR 4 mL/kg/hr
10-20 kg: 1000 L + 50mL/kg/day OR 40mL + 2mL/kg/hr >20 kg: 1500mL + 20mL/kg/day OR 60mL + 1mL/kg/hr |
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early signs of shock
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tachypnea, tachycardia
decreased skin turgor sunken eyes & fontanelles delayed capillary refill (>2 s) mottled, pale, cold skin core-peripheral temp gap >4°C decreased urinary output |
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late signs of shock
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acidotic (Kussmaul) breathing
bradycardia confusion/depressed cerebral state blue peripheries absent urine output hypotension |
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factors to consider in febrile child
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PMHx
illness of other family members specific illness prevalent in community immunization status predisposition to infection, eg. nephrotic syndrome, sickle cell, HIV inf'n, chemo, 1° recent travel abroad, eg. malaria, typhoid contact with animals, eg. brucellosis |
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factors indicative of illness severity
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age <3m
systemically ill no localizing features high or prolonged fever features of potentially serious illness (eg. osteomyelitis, septic arthritis, septicemia, meningitis/encephalitis) predisposition to inf'n |
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At what GCS is a child's airway at risk?
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< 8
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signs of raised ICP
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papilledema
pupillary dilatation Cushing's triad: increased SBP, bradycardia, Cheyne-Stokes respiration (alternating apnea or hyperpnea) |
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pupil signs in coma
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pinpoint, fixed: opiates/barbiturates
pontine lesion fixed, dilated: severe hypoxia during/post-seizures anticholinergic drugs hypothermia unilateral dilated: expanding ipsilateral lesion tentorial herniation CNIII palsy seizures |
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DDx for coma causes
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inf'n, metabolic, poison, status epilepticus/post-ictal, trauma, intracranial lesion, HTN
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status epilepticus definition
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repeated seizure or seizure prolonged for at least 30 minutes
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most common age for SIDS
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2-4 months
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factors assoc'd w/SIDS
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infants:
age 1-6m (peak at 12 weeks) LBW/pre-term sex (boys 60%) multiple births lying prone parents: low income --> poor, overcrowded housing single unsupported mom high maternal parity smoking environment: outside ideal temp of 16-20°C smoking |
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steps to manage poisoning
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1. ABC
2. identify agent 3. assess agent's toxicity 4. is poison removal indicated? 5. Ix indicated? 6. plan clinical Mx (admit, observe, d/c); specific antidote?; reduce absorption; enhance elimination 7. assess social circumstances --> prevent further poisoning/accidents |
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What does a metaphyseal # suggest?
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usually wrenching --> highly suggestive of NAI
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How many genes are in the human genome?
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30000-35000
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incidence of Down syndrome (w/o antenatal screening)
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1:650
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What conditions puts people at highest risk of S. pneumo. inf'n?
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fxn'l or anatomical asplenia
Ig def. acute nephrotic syndrome organ transplant patient lymphoid malignancy multiple myeloma HIV/AIDS CRF |
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Mx of RDS
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keep baby alive and undamaged
- assisted ventilation - surfactant replacement therapy - stabilize blood gas status (low or high O2/CO2 has its own pathologies) |
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most common single cause of death in 1st month
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RDS
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What makes newborns more susceptible to hypothermia?
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high surface area to mass ratio
low subcutaneous fat high insensible water or heat loss |
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How is a PDA closed pharmacologically?
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prostaglandin synthetase inhibitor
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What is necrotizing enterocolitis?
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bacterial invasion of ischemic bowel wall
typically occurs in first 2wks, usually after milk feeding has begun about 10% of VLBW babies experience NEC distended abdomen! blood may be present in stool; vomiting |
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What are some x-ray signs of NEC?
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air in portal tract
distended bowel loops air under the diaphragm (if perforated) |
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What are the golden rules of physiological jaundice?
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- jaundice NOT apparent in first 24h
- infant remains well - serum bilirubin does not reach treatment level - jaundice has faded by 14 days |
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causes of neonatal jaundice
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- physiological
- hemolytic (often begins <24h) ABO/Rh incompatible other isoimmunization red cell defects - prolonged breast milk (mech. unk.) neonatal hepatitis hypothyroidism inborn errors of metabolism abnormal biliary tract |
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tests to order if neonatal hemolysis suspected
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bilirubin
Hb direct Coombs test check for maternal Ab |
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Mx of neonatal jaundice
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- phototherapy
- exchange transfusion if severe |
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signs of respiratory distress in newborn
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tachypnea (>60bpm)
sternal/subcostal/intercostal recession tracheal tug nasal flaring expiratory grunting paradoxical abdo mvmt cyanosis (if severe) |
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conditions assoc'd w/fetus of diabetic mother
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hypoglycemia
large size/obesity increased risk of respiratory distress syndrome polycythemia congenital malformation |
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usual characteristics of an innocent murmur
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soft, no thrill (Grade 1-3)
localized/no radiation mid-systolic often position dependent (may disappear while lying supine) not assoc'd w/other signs of heart disease (venous hum = continuous, low-pitched murmur heard best under right clavicle. Abolished by pressure over internal jugular.) |
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4 things to comment on in assessment of acutely ill infant
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- degree of sickness
- hydration - nutrition - circulation |
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inspection comments in respiratory exam
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1. Color.
2. How is the child coping? Is he comfortable? Noisy but managing? In resp. distress? Unstable w/very labored breathing? 3. What is his position of comfort? 4. Resp. rate. 5. Chest mvmt. Symmetrical? 6. Chest shape. 7. Pursing of lips in expiration? 8. Presence of frothiness, nasal flaring, or grunting? 9. Type of resp. mvmt. 10. Dyspnea? 11. Finger clubbing? 12. Sputum (rare - chronic suppurative lung dz), post-tussive vomiting (pertussis)? 13. Traumatic petechiae on eyelids, face, neck from severe coughing or prolonged crying? |
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definition of tachypnea (WHO criteria)
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<2m old = >60
2-12m old = >50 >12 m old = >40 |
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normal resting resp. rate
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newborn = 30-50
infant/toddler = 20-30 child = 15-20 |
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What is Harrison's sulcus/groove?
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indrawing of lower chest with rib flaring (diaphragmatic tug)
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usual features of significant murmurs
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pansystolic
conducted all over precordium grades 4-6/assoc'd with a thrill accompanied by other signs, eg. ventricular enlargement any diastolic |
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cyanosis + murmur = ?
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usually tetralogy of Fallot
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pink + loud systolic murmur
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probably VSD
(the single most common form of CHD) |
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pink + murmur + impalpable femorals
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probably coarctation of aorta
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maternal causes of IUGR
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vascular:
HTN, SLE, diabetes thrombophilia: - congenital (eg. protein C/S def, ATIII def, factor V Leiden, prothrombin gene mutation, hyperhomocysteinemia) - acquired (eg. pregnancy itself, smoking, immobility) toxins: EtOH, smoking, meds malnutrition anemia: malaria, Fe-def cardiac failure/hypoxia: respiratory, atmosphere |
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What is Barker's hypothesis?
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in utero environment has long term health consequences by imprinting/epigenetics (genes are switched on/off)
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fetal causes of IUGR
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congenital:
chromosomal, familial, structural infection: CMV, toxo multiple gestation: - dichorionic requires more blood, O2 - monochorionic has 15-20% TTTS |
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placental causes of IUGR
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abruption (leading to hemorrhagic infarct)
insufficiency |
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most common reason for giving up breastfeeding
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real or perceived low milk supply
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