Peds Don't Miss Dx

Front 1

PEDIATRIC SORE THROAT

“Don’t Miss” Dx

Back 1

Pediatric Sore Throat “Don’t Miss” Dx

o Epiglottitis
o Retropharyngeal/peritonsillar abscess
o Caustic ingestion
o Kawasaki Disease

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EPIGLOTTITIS S&S

“Don’t Miss Dx”

Back 2

EPIGLOTTITIS S&S
 Acute onset of:
o Severe resp distress
o High fever
 Child sits in sniffing or tripod position
 Drooling
 Is much less common now due to H flu & pneumococci vaccines

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What NOT to do with epiglottis

“Don’t Miss Dx”

Back 3

WHAT NOT TO DO IF SUSPECT EPIGLOTTIS:

 Force pt to lie down
 Put any instrumentation in mouth or airway until equipment & personnel are available for trach/intubation.

Front 4

TONSILLAR/PERITONSILLAR ABSCESS

“Don’t Miss Dx”

Back 4

TONSILLAR/PERITONSILLAR ABSCESS S&S:

 Unilateral pain
 Peritonsillar swelling that makes swallowing even saliva difficult
 Drooling, maybe
 Dx made by direct visualization
 Tx = drainage + abx

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RETROPHARYNGEAL ABSCESS

“Don’t Miss Dx”

Back 5

RETROPHARYNGEAL ABSCESS:
Infection of posterior pharynx nodes that progresses to cellulitis & abscess
Typical pt is < 2 yrs of age
High fever
Increased respiratory noise
Extended neck, drooling
“Hot potato” (airy) voice

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KAWASAKI DISEASE S&S

“Don’t Miss Dx”

Back 6

KAWASAKI DISEASE (acute febrile illness causing severe vasculitis)
o At least 5 days of high fever AND other signs:
o Bilat bulbar conjunctivitis
o Solitary enlarged anterior cervical lymph node
o Cracked lips, strawberry tongue
o Peripheral extremity & skin changes (see next card)

Front 7

KAWASAKI DZ PE/SKIN S&S

“Don’t Miss Dx”

Back 7

KAWASAKI DZ peripheral extremity changes:

o Swollen hands or feet with eventual desquamation
o Maculopapular rash

Front 8

Sore Throat Common Dx 0-18 Yrs

Back 8

Sore Throat Common Dx 0-3 Yrs

 Viral pharyngitis (flu, rhinovirus, RSV, etc)
 Epstein Barr (infectious mononucleosis)
 Bact pharyngitis

In 0-3 years, Group A Strep & Epstein-Barr are rare

Front 9

FEVER AGES 0-2 MONTHS

“Don’t Miss Dx”

Back 9

FEVER – “Don’t Miss Dx” Ages 0-2 Months

o Meningitis
o Bacteremia/sepsis
o Neonatal Herpes Simplex Encephalitis
o Meningoencephalitis

Front 10

FEVER AGES 2-36 MONTHS

“Don’t Miss Dx”

Back 10

FEVER – “Don’t Miss Dx” ages 2-30 Months
o Meningitis
o Bacteremia/sepsis
o Meningococcemia
o Bacterial Tracheitis
o Appendicitis
o TB
o Kawasaki Dz

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FEVER AGES 3+ YEARS

“Don’t Miss Dx”

Back 11

FEVER – “Don’t Miss Dx” Ages 3+ Years

o Meningitis
o Meningococcemia
o Appendicitis
o TB
o Acute Lymphocytic Lymphoma

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Fever Common Ddx ages 0-2 months

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Fever Common Dx Ages 0-2 Months:

 Viral URI
 Viral gastroenteritis
 Bronchiolitis
 UTI
 Pneumonia

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Fever Common Dx Ages 2-36 Mos

Back 13

Fever Common Dx Ages 2-36 Months:
 Viral URI
 Viral gastroenteritis
 Bronchiolitis
 UTI
 Pneumonia
 Otitis media
 Immunization rxn

Front 14

Fever Common Dx Kids > Age 3

Back 14

Fever Common Dx Kids > Age 3:
 Viral URI
 Viral gastroenteritis
 UTI
 Pneumonia
 Strep Pharyngitis
 Sinusitis

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MENINGITIS S&S

“Don’t Miss Dx”

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MENINGITIS S&S:
o Fever, Nuchal Rigidity = stiff neck
o Rash (think virus, rickettsial (typhoid) dz, meningiococcal dz)
o H/A
o N/V
o Focal neuro abnormalities
o Sz & mental status changes
o Bulging fontanel

Front 16

“MENINGEAL SIGNS”

“Don’t Miss Dx”

Back 16

“MENINGEAL SIGNS”:

o KERNIG Sign: Supine pt with hips flexed @ 90 degrees. Extend knee & any resistance/pain in lower back or posterior thigh = Positive Kernig Sign
o BRUDZINSKI Sign: Passive flex neck of supine pt. Any flexion of hip or knees = Positive Brudzinski Sign.

Front 17

EARLY SEPSIS SIGNS

“Don’t Miss Dx”

Back 17

o High-cardiac output state
o Tachy
o HTN or normotension
o Normal tissue perfusion

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LATE SEPSIS SIGNS

“Don’t Miss Dx”

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LATE SEPSIS SIGNS:

o Decreased Cardiac Output
o Hypotension
o Deceased cap refill time
o Weakened peripheral pulses
o Cool extremities

Front 19

NEONATAL HERPES ENCEPHALITIS

“Don’t Miss Dx”

Back 19

NEONATAL HERPES ENCEPHALITIS (> one of these):
o Fever
o Mental status changes
o Focal sz (which may be subtle)
o Vesicular rash
o Initially, findings are subtle
o Devastating consequences to the young brain

Front 20

BACTERIAL TRACHEITIS

“Don’t Miss Dx”

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BACTERIAL TRACHEITIS

o Resembles viral croup except:
o Appears more toxic
o Has higher fever
If Tracheitis membrane is sloughed, can cause airway obstruction.

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Bronchiolitis

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Bronchiolitis:
 Infectious lower respiratory tract illness
 Almost always viral in origin (usually RSV)
 Small airway inflammation (indistinguishable from asthma exacerbation)
 A leading cause of hosp < age 2 yrs of age
 By age 3, 100% of children have become infected

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MENINGOCOCCEMIA

“Don’t Miss Dx”

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MENINGOCOCCEMIA:
o Petechia
o Purpura
o Ecchymoses
o Rash is often preceded by flu-like illness (fever, malaise, chills)
o Shock is common
o Sequale = gangrene & amputation of limbs or digits

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ACUTE (< 3 WEEKS) COUGH < 5 YRS


“DON’T MISS DX”

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ACUTE (< 3 WEEKS) COUGH, AGE < 5 YEARS:

o Foreign Body
o Caustic Ingestion

Front 24

CHRONIC (> 3 WKS) COUGH < 1 YR


“DON’T MISS DX”

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CHRONIC COUGH (> 3 WKS) AGE < 1 YEAR:

o Asthma
o Foreign body
o Cystic fibrosis
o Congenital anatomic abnormality

Front 25

CHRONIC (> 3 WKS) COUGH > 1 YR


“DON’T MISS DX”

Back 25

CHRONIC COUGH (> 3 WEEKS) OVER AGES 1+:

o Asthma
o Foreign body
o Cystic fibrosis

Front 26

ASTHMA TRIAD

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ASTHMA TRIAD:

o Asthma
o Allergic rhinitis
o Eczema

Front 27

ASTHMA DX:

Back 27

ASTHMA DX:
o Hx of cough, wheezing, or both
o CXR:
o Increased bronchial wall markings, maybe
o Airway hyperinflation or atelectasis, maybe
o Normal, maybe
o ***Clinical response to bronchodilator tx***

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Most asthma meds are delivered -

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Most asthma meds are delivered via inhalation

 MDI = metered dose inhaler
Nebulizer

Front 29

Short acting Beta-2 Agonists =

Back 29

SHORT-ACTING BETA-2 AGONISTS

Bronchodilators = Albuterol

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Long-acting Beta-2 Agonist + Inhaled Corticosteroid

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Inhaled corticosteroid + long-acting beta-2 antagonist:

Fluticasone/Salmeterol inhaled = Advair Discus = Advair HFA

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The mainstay of asthma exacerbation prevention are -

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Inhaled corticosteroids are the mainstay of asthma exacerbation prevention.

They decrease inflammation.

Front 32

Most widely used inhaled corticosteroids

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The most widely used inhaled corticosteroids:

1. Fluticasone = Flovent Discus
2. Budesonide = Pulmicort

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PO Leukotriene Inhibitor For Asthma

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O Leukotriene Inhibitor for Asthma:

o Monteleukast = Singulair

Front 34

Used in ER or ICU for Status Asthmaticus

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Used in ER or ICU for Status Asthmaticus:

o Cromolyn sodium = Intal

In addition to:
o Systemic corticosteroids, maybe
o O2
o IV mag sulfate, maybe

Front 35

CYSTIC FIBROSIS SIGNS

“Don’t Miss Dx”

Back 35

CYSTIC FIBROSIS SIGNS:
Infants:
o Meconium ileus
o Jaundice
o Rarely, hypocloremic alkalosis due to salt loss
Beyond infancy:
o FTT
o Recurrent pneumonia

Front 36

EAR PAIN


“Don’t Miss Dx”

Back 36

EAR PAIN “DON’T MISS DX”

o Foreign body
o Mastoiditis
o Peritonsillar abscess
o Dental abscess
o Hemotypmanum (think TBI)

Front 37

ABDOMINAL PAIN


“Don’t Miss Dx”

Back 37

ABDOMINAL PAIN “DON’T MISS DX”
o Appendicitis
o Incarcerated inguinal hernia
o Intussusception
o Ovarian/testicular torsion
o PID
o Pregnancy/ectopic pregnancy
o UTI

Front 38

INTUSSUSCEPTION


“Don’t Miss Dx”

Back 38

INTUSSUSCEPTION

o Between ages 6 mos & 3 years
o Most commonly seen in ileocecal area
o Older children: evaluate for lymphoma

Front 39

INTUSSUSCEPTION S&S


“Don’t Miss Dx”

Back 39

o Bilious or non-bilious emesis
o Lethargy
o Irritability
o Pull up legs & cry intermittently (when peristalsing)
o “Current jelly stool” is a late finding
o Sausage shaped-mass, maybe
o Abdominal distension, maybe

Front 40

INCARCERATED INGUINAL HERNIA


“Don’t Miss Dx”

Back 40

INCARCERATED INGUINAL HERNIA:
o Most commonly seen in 1st year of life
o Fussiness
o Emesis
o Acute onset of abdominal pain
o Generalize abdominal tenderness
o Firm, tender, & often discolored inguinal mass

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Etiologies of Abdominal Pain

BIG SKIP

Think of skipping school due to abdominal pain

Back 41

Etiologies of abdominal pain:
Biliary system & Liver
Intestinal (surgical)
Genital
Stomach
Kidney
Intestinal (non-surgical)
Pancreas

Front 42

Biliary/Liver Abdominal Pain

Back 42

Biliary/Liver Abdominal Pain:

 Cholelithiaisis
 Cholecystitis
 Malignancy

Front 43

Intestinal Pain, Surgical

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Intestinal Pain, Surgical:

 Appendicitis
 Intussusception
 Incarcerated inguinal hernia
 Malignancy

Front 44

Abdominal Pain, Genital

Back 44

Intestinal Pain, Genital:

 Ovarian or testicular torsion
 PID
 Ectopic pregnancy
Malignancy

Front 45

Abdominal Pain, Stomach

Back 45

Abdominal pain, stomach:

 Acute gastritis
 PUD
 Chronic gastritis
 Malignancy