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74 Cards in this Set
- Front
- Back
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mneumonic for HPI
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HPI (history of present illness)
Ask for: LIQOR AAA L Location of the symptom (forehead, wrist...) I Intensity of the symptom (scale 1-10, 6/10) Q Quality of the symptom (burning, pulsating pain...) O Onset of the symptom + precipitating factors R Radiation of the symptom ( to left shoulder and arm) A Associated symptoms ( palpitations, shortness of breath) A Alleviating factors (sitting with my chest on my knees) A Aggravating factors (effort, smoking, large meals) |
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mneumonic for PMHx
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PMH (past medical history)
Search for: PAM HUGS FOSS P Previous presence of the symptom (same chief complaint) A Allergies (drugs, foods, chemicals, dust ...) M Medicines (any drugs the patient used) H Hospitalization for any illness in the past U Urinary changes ( esp if diabetic, elderly...) G Gastrointestinal complains (diet changes, bowel movements...) S Sleep pattern (waking up/going to sleep...) F Family history (simmilar chief complaints/serious illness) O OB/GYN history (LMP, abortions, para...) S Sexual habits (active/preferences/STD...) S Social life (job/house/smoking/alcohol.....) |
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Psychosocial history
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HEADSSS
homelife education, employment activities (sports, school, friends) drugs (alcohol, tobacco, illicits) depression, suicide safety (selt belts, guns in the house abuse) Sexual activity |
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Define failure to thrive
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1. weight below 3rd percentile for age,
2. weight <80% of ideal for age, or 3. falling off growth curve |
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causes of failure to thrive
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non-organic versus organic
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non-organic failure to thrive
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1.neglect,
2.abuse, 3. inadequate food intake |
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risk factors for failure to thrive
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1.low social economic status (SES)
2. low maternal age 3. maternal depression 4. caretaker neglect 5. chronic illness 6. genetic disease 7. HIV infection |
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Causes of organic failure to thrive
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1. GI dysfxn: pyloric stenosis, duodenal atresia, malabsorption, celiac disease
2. infection: HIV, TB, intestinal parasites 3. Chronic disease: CF, bronchopulmonary dysplasia, CHD 4. Reduced growth potential: Congenital syndromes, skeletal dysplasias |
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Signs and symptoms of Failure to thrive
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1. weight below 3rd percentile for age
2. weight < 80% of the ideal for age 3. falling off the growth curve by crossing down 2 major percentile lines on a growth chart 4. GI complaints, odd eating behavior or lethargy |
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Workup for failure to thrive
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1. observe caregiver-child interaction for potential underlying psychosocial issues
2. labs: CBC, electrolytes, creatinine, albumin, protein, UA and urine culture 3. GI symptoms: order stool guaiac, culture 4. other test: sweat chloride test (CF), test for malabsorption (stool pH and reducing substances) |
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Treat for failure to thrive
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1. depends on etiology
2. keep food diary that includes caloric count 3. Nutritional supplementation if breast-feeding |
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How does failure to thrive manifest on growth charts
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children fall off the weight curve first, then the height curve and then the head circumference
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Average birth weight
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3.5 kg (7.7lbs)
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Average birth height
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50cm (20 in)
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Average birth head circumference
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35 cm
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Average head circumference growth
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1 inch/mth for 1 year. 90% of head growth occurs by age 2
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What are contraindications to vaccination
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1. current moderate to severe acute illness
2. severe allergy to a vaccine component or to a prior dose of vaccine 3. Anaphylactic reaction to eggs (influenza vaccine), gelatin (MMR), neomycin (MMR, IPV), polymyxin B (IPV), streptomycin (IPV) 4. encephalopathy within 7 days of prior pertussis vaccination (use DT instead of DTaP) 5. pregnancy, immune compromise, or use of high dose steroids (oral polio, MMR, varicella) 6. recent administration of antibody-containing blood products (live injected vaccines) |
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Anaphylactic reactions to vaccines
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Anaphylactic reaction to eggs (influenza vaccine), gelatin (MMR), neomycin (MMR, IPV), polymyxin B (IPV), streptomycin (IPV)
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who needs a meningitis vaccine form a pediatrician
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1. high school senior entering college dormitory
2. child with sickle cell dx or functional asplenia |
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What are the benefits for breast feeding
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1. infant benefits: mother-infant bonding, decreased risk of eczema and cows milk allergy, decreased risk of serious infections due to presence of maternal IgA antibodies
2. Maternal benefits: decreased risk of breast and ovarian cancer and earlier returns to pregnancy weight 3. economic benefits: decrease cost in comparision to formula and convenience |
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Contraindications of breast feeding
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1. mother infected with HIV or taking antiretroviral medicatiosn
2. mother has active , untreated TB 3. Mother is using or dependent on illicit drugs 4. mother is taking chemotherapeutic drugs or is undergoing radiation 5. mother infected with human T-cell lymphotrophic virus |
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How long should breast feeding occur
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1. exclusive breastfed for first 6 mths
2. continue breast feeding through 12 mths with fluoride and iron supplements bc maternal iron stores deplete around 6 mths |
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What supplementations do breast-fed infants need
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1.vitamin D
2. iron (at 6mths) 3. fluoride |
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types of formula
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cow's milk and soy
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infant nutrition guidelines
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1. in the first 2 mths of life, babies will eat 2-3 ounces every 2-3 hrs
2. New foods should be introduced after six mths of age at a rate of one per week to allow for identification of potential allergies 3. avoid honey in children <1 yr due to botulism risk 4. avoid foods that may lead to choking, including nuts, raisins, and hot dogs 5. avoid cow's milk until age 1 eggs until age 2 peanuts, tree nuts and fish until 3 |
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What is Tanner staging
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predictable sequence in all adolescents
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Male Tanner staging
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testicular enlargement -> penile enlargement -> growth spurt -> pubic hair
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female Tanner staging
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Thelarche (breast development) -> growth spurt-> pubic hair -> menarche (onset of menses)
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menarche
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onset of menses
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pubarche
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pubic hair development
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Thelarche
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breast development
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Left to right shunts
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The 3 D's
ASD VSD PDA |
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Congenital heart disease workup
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CXR
ECG Echo |
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categories of congenital heart disease
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acyanotic (pink babies, left to rt shunt), cyanotic (blue babies, rt to left shunt)
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Tetralogy of fallot
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PROVe
Pulmonic stenosis Right ventricular hypertrophy Overriding aorta VSD |
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Types of acyanotic congenital heart disease
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1. PDA
2. ASD 3. VSD 4. coarctation of the aorta |
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Eisenmenger's syndrome
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large ASD or VSD lesions may lead to Eisenmengers syndrome in which left to right shunt causes pulmonary HTN and shunt reversal
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Types of acyanotic heart conditions
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ASD
VSD PDA coarctation of aorta |
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Types of cyanotic heart conditions
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tetralogy of fallot
transposition of the great vessels truncus arteriosus tricuspid atresia hypoplastic left heart syndrome total anomalous venous return (pulmonary veins drain into rt heart) |
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Tx for all cyanotic congenital heart conditions
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surgical repair
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When do cyanotic lesions present
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first week of life bc they have been dependent on the ductus arteriosus, which closes w/in the first
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Which congenital heart lesion require immediate surgical repair to sustain life
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transposition of great vessels
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What is used to maintain PDA
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PGE1 maintain collateral flow
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what is the cause of diaper rash
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prolonged skin contact with urine and feces
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What infection often accompanies diaper rashes
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candida
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Workup for candidal infection
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scrape lesion, stain with 10% KOH, and observe pseudohyphae under microscope
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Treatment for Diaper Rash
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1. keep diaper clean and dry
2. use barrier cream in moist areas 3. Tx candidal infections with topical antifungals (nystatin) |
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What is Reyes syndrome
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1. aspirin when treating fever in the setting of viral infection
2. rare mitochondrial disorder characterized by acute and severe encephalopathy along with degenerative liver disease |
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Risk factors for intussusception
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1. polyps
2. Meckel' s diverticulum 3. adenovirus or rotavirus infection 4. Henoch-Schonlein purpura 5. intestinal lymphoma 6. celiac dz 7. CF |
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What is intussusception
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portion of bowel telescopes into adjacent portion usually proximal to ileocecal valve
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Most common cause of obstruction under 2 yrs old
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intussusception
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Signs and symptoms of intussusception
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sudden onset of intermitent colicky abdominal pain
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Intussusception differentials
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1. constipation
2. GI infection 3. Meckel's diverticulum 4. lymphoma 5. meconium ileus (neonates) |
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intussusception triad
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intermittent colicky pain
vomiting bloody mucous stools |
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signs for intussusception
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red currant jelly stools, lethargy and fever
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Workup and Tx for intussusception
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1. correct electrolyte abnormalities
2. Abdominal x ray or ultrasound |
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what confirms the diagnosis of intussception
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air contrast or barium enema
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Risk factors for pyloric stenosis
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first born males
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Differential diagnosis for pyloric stenosis
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Pylorospasm
overfeeding gastroenteritis hiatal hernia duodenal atresia (double bubble) esophageal stenosis malrotation/volvulus incarcerated hernia meconium ileus milk protein allergy GERD |
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Signs of pyloric stenosis
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1. projectile nonbilious vomiting
2. olive shaped mass in epigastric region 3. hypochloremic hypokalemic metabolic alkalosis with dehydration secondary to persistent vomiting |
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Which antibiotic is assoc with pyloric stenosis
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erythromycin
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Workup for pyloric stenosis
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1. basic metabolic panel
2. ultrasound 3. abdominal x ray show dilated, air filled stomach |
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Tx for pyloric stenosis
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1. NG tube placement; correction of dehydration and electrolytes
2. surgical pyloromyotomy |
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Asthma differential
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aspiration, foreign body
bronchilitis, pneumonia, bronchopulmonary dysplasia, CF, allergic bronchopulmonary aspergillosis GERD Vascular slings, TE fistula |
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Bronchilitis differentials
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asthma
pneumonia heart failure laryngomalacia foreign body aspiration GERD CF |
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Croup differentials
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Infectious: epiglottis, bacterial tracheitis, retropharyngeal abscess, foreign body aspiration
Other: foreign body aspiration, angioneurotic edema |
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Acute lymphocytic leukemia (ALL) differential diagnosis
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aplastic anemia, immune thrombocytopenic purpura, rheumatic diseases (SLE, JIA), lymphadenopathy, hepatosplenomegaly, testicular swelling
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Wilm's tumor (nephroblastoma) differential diagnosis
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neuroblastoma, polycystic kidneys, hydronephrosis, abdominal neoplasms,
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Neuroblastoma differential diagnosis
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Wilm's tumor, Ewing's sarcoma, rhabdomyosarcoma, lymphoma, hepatoblastoma
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Juvenile Idiopathic Arthritis (JIA) differential diagnosis
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Lyme disease, seronegative spondyloarthropathies, rheumatic fever, SLE, occult infection, sarcoidosis, juvenile dematomyositis, malignancy
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Meningitis differential diagnosis
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encephalitis, brain abscess, epidural or subdural empyema, mastoiditis, tumors, cysts trauma, vasculitis, intracranial hemorrhage, bacterial endocarditis with septic embolism, demyelinating disorders, drug intoxication or side effects
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Pneumonia differential diagnosis
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gastric aspiration, foreign body aspiration, atelectasis, congenital malformation, bronchopulmonary dysplasia, CHF, neoplasm, chronic interstitial lung disease, collagen vascular disease, pulmonary infarct
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Acute Otitis Media differential diagnosis
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otitis media with effusion, myringitis, otitis externa, mastoiditis, foreign body in the ear, ear trauma, a hard cerumen, mumps, toothache, pharyngitis, nasal congestion, temporomandibular joint dysfunction
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Respiratory distress syndrome differential diagnosis
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transient tachypnea of the newborn, meconium aspiration syndrome, congenital pneumonia, spontaneous pneumothorax, diaphragmatic hernia, cyanotic heart disease
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