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81 Cards in this Set
- Front
- Back
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Physis
when does it close? |
growth plate
-close 2 yrs after onset of puberty (F 12-14, M: 14-16) |
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Salter Harris Classifications
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1: right through physis
2: through physis and metaphysis 3: through physis & epiphysis 4: all 3 layers 5: crush fracture |
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Scoliosis
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congenital
-10-15 yrs, F > M Tx: small curves: watch & wait 25-45 deg: bracing over 40deg: surgery, fuse spinal vertebrae |
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Congenital talipes equinovarus (CTEV)
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club foot
-MC congenital leg defect -inc risk w/fam hx bably born w/1 or both feet pointed down and inward |
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Tx for club feet
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Poinsetta method
-serial wkly casting w/stretchin -shoes w/ rods x 3 mos daily, then shoes during sleep x 3 yrs Surgery: outdated, not used often Outcome good if treat early |
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Legg-Calve Perthes
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MC: 5-13 yrs
S/Sx: hip pain, knee pain, child will usu limp cause: idiopathic avasculariation of femoral head of femur (femur head crumbles then remodels) -bone regrows less round, it is more coarse (epiphysis is wider) |
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Tx of LEgg-Calve Perthes
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remodeling ~2 yrs
serial x-rays to monitor progression -NSAIDS for pain & inflamm |
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Slipped Capital Femoral Epiphysis
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epiphysis of feumr separates posteriorly & inferior from femur
11-15 yrs, M > F, obese S/SX: hip pain & stiff, knee pain, walk w/ limp, dec ROM @ hip, affected leg turned outward |
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Tx for Slipped capital femoral epiphysis
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surgery 2/pinning of femur
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clavicle fracture & treatment
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tender over clavicle, bruising, swelling, bump, dec ROM, abduction/adduction
Tx: figure 8 splint, sling & swath, ice & NSAIDS first 72 hrs Surgery: if gone through skin - plates & screws |
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Humerus fx
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Proximal MC than shaft
swelling of shoulder, TTP shoulder & humerus, dec ROM of shoulder, <10-20 deg Tx: shoulder immobilizer x 4wks |
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Supracondylar fx
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fx of elbow joint
-fall on hyperextended outstretched upper forearm 2-8yrs MC -elbow pain, swelling |
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What are the 3 things you must do when you hear supracondylar fracture?
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think posterior fat pad, look at xray, make sure head of radius bisects capitulum to prevent dislocation
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Tx for supracondylar fx
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type 1: casting 4-6 wks
type 2-3: surgical consult for closed reduction w/percutaneous pinning |
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MUGR
-forearm fracture |
Monteggia: ulna fx
-proximal radias dislocation Galeazzi: radial fx -distal radioulnar dislocation, FOOSH, elbow flexed |
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Wrist Fx
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Colles' fx: distal radius
-falling w/wrist extended; cause "silver fork deformity", dorsal displacement & angulation of metaphysis of radius Smith's Fx: falling on flexed wrist -distal radius displaces towards palm (volarly) Tx for both: LAC 4-6 wks |
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Scaphoid fx
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fall w/wt onto wrist, skateboarding
-pain & swell at wrist, tenderness at SNUFF BOX (risk of necrosis bc of radial artery) Tx: thumb spica cast 4-6 wks |
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Buckle fx
Torus of toddler's fx |
out-pouching or swelling outward of bone (1-sided or through bone)
-cause: FOOSH, slides for toddler fx -TTP of wrist of lateral fibula, swelling TX: SAC 4-6 wks |
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Radial head subluxation
"nursemaid's elbow" |
annular ligament slides over radial head & gets trapped between radial head & capitulum
-child holds arm 90 deg, flexed & pronated TX: reduction (opening book), LAC x 2 wks |
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Transient synovitis
"toxic synovitis" |
pain & inflamm around hip joint
MC in BOYS (4:1) -1-sided hip pain, pain w/movement, low grade fever, knee or thigh pain, NO HX OF TRAUMA dx: xray hip, CBC, sed rate Tx: tylenol for fever, gone within 3-7 days |
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Osgood Schlatter's
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-inflamm of patellar tendon
MC boys 9-14 (will outgrow this) -knee pain, worse w/activity, pain on palp over tibia Tx: NSAIDS before activities, bracing, ice |
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Calcaneal apophysitis
"sever's disease" |
achilles tendon --> inc calcification
MC adolescents 9-14 Sx: heel pain, worse w/wt bearing & bare feet Tx: NSAIDS, tule heel cups |
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Difference between kids & adults circulation
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kids; lower blood circulation, less fat around organs, better vasoconstriction to protect, lose body heat faster, crash much quicker, larger tongue in relation to mouth (head tilt may occlude airway)
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AABC's of peds
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appearance: stable, shock, look sick?
Airway, Breathing, Circulation (pale? cap refill?) |
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Epiglottitis
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-epiglottis more ant & sup than adult (more floppy & U-shaped)
-H. influenza type B causes it Sx: looks sicker than croup -sore throat, sudden fever, "hot potato voice", fever, drooling Dx: thumbprint sign |
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Tx for epiglottitis
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O2, fluids
IV cefotaxim, certriaxone (3 gen cephalosporins) |
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Croup
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9mo=4yr --> steeple sign on xray
-hx of recent illness, fever, loud barking cough, inspiratory stridor |
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Tx for Croup
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mild: no tx
mod-severe; O2, buidesonide nebulizer, dexamethasone, adrenaline -if no improve: admit |
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Where is the most common place for a foreign body aspiration?
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Right main bronchus
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Meningitis
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inflam of membranes that cover brain
fever w/HA, stiff neck, vomit, bulging frontanel -petechial rash that doesn't blanch Severe sx; drowsy, confusion, photophobia |
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Encephalitis
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inflam of brain & spinal cord
-causes cerebral edema - intracranial hemorrhage - brain damage Cause: virus - looks sicker than meningitis -fever, mild HA, confusion, drowsy |
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Tx of meningitis & encephalitis
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-lumbar puncture, CT brain
-IV monitors, cepftriaxone, fluids, blood samples |
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Febrile seizures
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6mo - 6 yrs
-temp inc too fast for brain to react, causes brain to seize (usu no problems afterwards) -hx recent illness, last 30s - 15 min, usu benign Tx: inc O2 & passive cooling |
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DKA: diabetic Ketoacidosis
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MC type 1--insulin deficiency, body burns FA --> ketones
-inc blood glu > 15mmol/L, dehydration, N/V, acidosis, "Kuss-Maul"-deep breathing |
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Tx for DKA
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fluids: correct dehydration, give insulin, watch for hypokalemia after tx
-give bicarb -watch urine ketones & blood glu every hr, SLOWLY correct hyperglycemia |
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Dehydration
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dry mucosa, lips, sunken eyes
-inc RR & HR, cap refill -turgor retract or wrinkle Tx: rehydration, if more severe might give plasma |
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What are the SE of stimulants for ADD/ADHD?
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trouble sleeping, poor appetite, wt. loss, irritability, anxiety, HTN
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What are the 2 most common signs of depression in peds pts?
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behavior problems, separation anxiety
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What is the only med that is approved for depression in peds?
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Prozac (fluoxetine)
(psychotherapy is recommended for tx too) |
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What is the difference between autism and aspergers syndrome?
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aspergers have no delay in language or cognitive development
-they both have impaired social interaction & repetitive behaviors |
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Cerebral palsy
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non-progressive movement or posture disorder
-injury from prenatal, during birth, or shortly after birth -delayed motor milestones, inc muscle tone, inc reflexes, toe walking |
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How do you diagnose cerebral palsy?
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MRI w/ and w/o contrast of brain and spine
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Tx for cerebral palsy
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multidisciplinary approach
-PT, speech therapy... -may need meds for spasticity (botox, muscle relaxers) -CP is only physical, not intellectural problems |
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Spina Bifida
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spinal cord opening, visible or hidden
-vertebrae not formed correctly -3 types |
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Myelomeningocele
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sac contain abn formed spinal cord protrudes from opening in baby's back
-nerves at & below defect are damaged -need surgery |
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Meningocele
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sac protrudes from opening, NO spinal cord
-only few nerves affected -need surgery after birth |
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Spina Bifida Occulta
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bones around spinal cord fail to develop normally
-nerves usu normal -dimple, hair patch, red discoloration -rarely need surgery |
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Meningitis
-lab diff between viral and bacterial |
Need to do Lumbar puncture to Diagnose
Bacterial: - >1000 WBC count, glu low, protein high Viral: <500, glu: nl-high, Protein: nl to high |
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S/Sx of meningitis
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high fever, HA, stiff neck, mental status change, photophobia
(fever may be only sign in infants) |
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Pseudotumor Cerebri
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inc ICP w/o a cause
-risk of vision loss if not treated MC in overwt children -HA at night, vomit, blurry vision, optic disc swell & atrophy, visual field loss |
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Diag & tx for pseudotumor cerebri
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dx: CT to exclude mass or hydrocephalus
-inc CSF opening pressure Tx: furosemide/acetazolamide to dec vol & pressure of CSF LP to remove CSF |
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Febrile Seizures
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cannot prevent with antipyretics
Tx: if recurrent: give diazepam (diastat rectal) otherwise don't need tx -need to r/o meningitis |
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Head injury
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MUST GET HX OF LOC
Dx: CT scan -minor head trauma can be watched -if LOC >1 min: may have had seizure, HA, or lethargy -watch for vomit, abn behavior, make sure wake pt up throughout night |
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Concussion
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functional impairment of brain w/o structural involvement
-HA and depression are big symptoms!! |
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Headache
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MC complaint in peds
types: tension/psychogenic, vascular, inc ICP -Most children referred have migraine HA |
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Short Stature
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standing ht 2 standard deviations below mean (below 2.5 percentile)
Cause: hypothyroidism, malnutrition, achondrodysplasia (dwarfism), grwoth hormone deficiency, Turners |
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Neonatal Primary Hypothyroidism
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thyroid gland doesn't descend
transfer of thyroid antibodies in mom w/hashimoto's exposed to antithyroid drugs in preg Sx: mental retardation, short stature, puffy hands/feet, deaf, lethargy, fail to thrive!! |
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What is diag and tx of Neonatal primary hypothyroidism?
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inc TSH, low Ft4, low FT
Tx: thyroid replacement therapy |
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Growth hormone deficiency
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no GnRH, no gene for GH production, GH receptor defect
Sx: grow <5cm/yr, truncal adiposity, hypoglycemia |
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Diag for GH deficiency
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IFGBP-3 has greater specificy to diag
provocative test: insulin drip make them hypoglycemic and it should raise GH |
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Tx for GH deficiency
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give growth hormone
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Tuner's syndrome
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F with 1 x chromosome (45XO)
-never develop ovaries -short stature, low set ears, fishli,e mouth, shield like hest, short webbed necks, puffy dorsum -knuckle knuckle dimple knuckle |
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Delayed puberty
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girl 13, boy 14 w/no signs of puberty
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precocious puberty
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G: signs before 7-8yrs
-no underlying med problem B: before 9 yrs -usu have med problem (testicular problems) |
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Diag & tx for precocious puberty
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inc LH/FSH, inc estrogen & testosterone
get US, CT, MRI to r/o intracranial lesions of pituitary Tx: pulsatile GnRH- will down regulate LH & FSH and control puberty |
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Premature Thelarche
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1 or both breast enlarge w/no estro secretion of puberty
-no nipple development, hair growth, vag mucosal changes Tx: reassurance |
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Adolescent gynecomastia
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breast enlarge in men: pre-puberty
-inc estrogen/test ratio w/inc sex hormone binding globulin -usu goes away 6 mos-2 yrs -if severe, can take anti-estrogen meds or surgery |
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Polycystic ovarian syndrome
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aka Stein-Leventhal syndrome
-excess adrenal androgen production (converts to estrogen) -amenorrhea, deep voice, obese, hirsutism, "glistening' ovaries |
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Dx and Tx for PCOS
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Dx; LH: FSH ratio > 3:1, inc testosterone, inc androstenedione
Tx: ovulation induction w/Clomid-if want preg -oral BC to regulate cycle -spinolactone for hairy |
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Somogi
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hypoglycemia at night - hyperglycemia in morning
Tx: dec nightly insulin dose (give less insulin so you don't become hypoglycemic, then liver won't make more glu to make hyper in morning) |
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Dawn Phenomenon
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GH (turns off insulin) released at night = hyperglycemia
Tx: increase nightly insulin |
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DKA 5 I's
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infection, ignorance, infarction, ischemia, intoxication (for type 1 DM)
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Hyperosmolar/hyperglycemic non-ketotic acidosis
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assoc w/type 2 DM
Sx: inc glu, dehydration, aphasia, delirium --> coma -no ketones Tx: fluids, insulin |
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2 wks milestone
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recheck screening (PKU, Bilirubin)
ht, wt, head circumference immunizations (hep B is first) screen mom for PPD (should go away) |
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2 months
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turns head towards sound, coos, gurgles
holds head up & starts to push up on tummy |
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4 months
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babbles w/expression & copies sound
follows moving things from side to side starts to roll over |
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6 months
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should double birth weight
begins to say consonant sounds begins to pass things from hand to hand begins to sit w/o support |
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9 months
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stranger anxiety
different sounds like "mama" and "baba" plays peek a boo stands holding on, crawls |
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12 months
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walks w/support
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15 months
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walks independently
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female athlete triad
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disordered eating
amenorrhea osteoporosis |
