Emergency Medicine (Pediatrics)

Front 1

What is the definition of apnea?

Back 1

cessation of respiration for 20 sec or more or for any duration if pallor, cyanosis, or bradycardia is present

Front 2

When evaluating apnea, what are signs that indicate an apparent life-threatening event (ALTE)?

Back 2

• change in color (ex. pallor, cyanosis)
• change in muscle tone
• change in mental status

Front 3

Why may urinalysis show WBCs in patients with appendicits?

Back 3

• due to appendix lying on ureter and causing inflammation
• causes a sterile pyuria (presence of WBCs without infectious organism)

Front 4

What can be used to treat severe cases of asthma?

Back 4

• epinephrine or terbutaline (SQ or IV)
• Heliox
• Mg Sulfate

Front 5

What are risk factors for bronchiolitis?

Back 5

• age < 3 months
• immunocompromised state
• prematurity
• underlying pulmonary or cardiac disease

Front 6

What is the MCC of congestive heart failure in pediatrics?

Back 6

congenital heart disease

Front 7

What is the MCC of dehydration in kids?

Back 7

extensive vomiting or diarrhea

Front 8

What is the gold standard for diagnosis of an esophageal foreign body?

Back 8

chest xray

Front 9

What are different techniques used to remove a foreign body?

Back 9

• esophagoscopy
• bougienage
• foley catheter

* don't use foley cath or Bougienage technique if objecy lodged > 1-2 days

Front 10

What is Bullous Impetigo?

Back 10

• superfical, thin-walled bullae, usually on extremities
• rupture easily, leaving a denuded base, dry to shiny coating

Front 11

What bacteria causes Bullous Impetigo?

Back 11

Staph aureus

Front 12

What is the treatment for Bullous Impetigo?

Back 12

• Cephalexin (Keflex)
OR
• Dicloxacillin
OR
• topical mupirocin

Front 13

What is the most common skin infection in children?

Back 13

Impetigo Contagiosum

Front 14

What are the causative agents of Impetigo?

Back 14

• group A ß-hemolytic strep (strep pyogenes)
• Staph aureus

Front 15

Describe the course of impetigo

Back 15

• starts as red macules/papules
• then forms vesicles/pustules
• ruptures and leaves golden "Honey colored" crusts

Front 16

What is the Erysipelas? What is the bacterial cause?

Back 16

• cellulitis and lymphangitis of the skin
• caused by group A B-hemolytic strep

Front 17

What is the most common site of erysipelas?

Back 17

face (from skin wound/pimple)

Front 18

What bacteria should be suspected in school-ages child with pneumonia (or URI) and a rash?

Back 18

• Mycoplasma
• Tx: Macrolide PO

Front 19

What bacteria causes scarlet fever?

Back 19

group A B-hemolytic streptococci

Front 20

What are characteristics of the rash caused by scarlet fever?

Back 20

• starts on neck, groin, axillae & accentuations in flexural creases (Pastia lines)
• sandpaper feel
• 1-2 days after illness onsetDescribe the skin lesion associated with lyme disease

Front 21

Describe the skin lesion associated with lyme disease

Back 21

bull's eye lesion (Erythema Migrans)

Front 22

What is the bacterial cause of Rocky Mountain Spotted Fever? What is the treatment?

Back 22

• caused by Rickettsia rickettsii
• Tx: Tetracycline or Chloramphenicol

Front 23

What are characteristics of the rash caused by Rocky Mountain Spotted Fever?

Back 23

• rash on 2nd/3rd day of illness on ankles, wrists, and spreads centrally to trunk
• + palm/sole involvement

Front 24

What is the enterovirus that causes Hand-foot-mouth disease?

Back 24

coxsackie

Front 25

Describe the typical course of hand-foot-mouth disease

Back 25

• onset: fever, anorexia, malaise, sore mouth
• painful oral vesivles on erythematous base on days 2-3 that then ulcerate
• followed by skin lesions (red papules that change to gray vesicles that heal on days 7-10
• lesions on palms, soles, buttock

Front 26

Which viral infection causes a "slapped-cheek appearance"?

Back 26

Erythema infectiosum (5th's disease)

Front 27

What is the virus that causes fifth's disease?

Back 27

human parvovirus B19

Front 28

What are first, second, third, fourth, fifth, & sixth disease?

Back 28

• first: measles
• second: scarlet fever
• third: rubella
• fourth: Dukes' disease
• fifth: Erythema infectiosum
• sixth: roseola

Front 29

What is the skin lesion that is pathognomonic for measles?

Back 29

Koplik spots (white "grains of sand" on buccal mucosa)

Front 30

What viral infection presents with a fine, irregular pink macular/papular rash at the hairline that spreads down to the neck, trunk, and arms?

Back 30

Rubella "German Measles"

Front 31

What is the incubation period for Rubella (German Measles)?

Back 31

12-25 days

Front 32

What is a Forchheimer's sign?

Back 32

soft palate petechiae (seen in Rubella)

Front 33

Patients with Rubella typically have lymphadenopathy in which lymph nodes?

Back 33

suboccipital/post-auricular

Front 34

What are characteristics of the rash caused by Varicella (aka Chicken Pox)?

Back 34

• starts as red macules on scalp or trunk
• within 1st day the lesions vesiculate with red base
• simulatneous multiple stages of the lesions
• spreads centrifugally (outward from center)
• palms/soles are spared

Front 35

What are characteristics of the rash caused by Roseola Infantum (Exanthem Subitum)?

Back 35

• as fever resolves, blanching maculpapular, rose/pink discrete lesions develop
• typically on neck, trunk, & buttock (usually spares face)
• rash lasts 1-2 days and rapidly fades

Front 36

What virus is believed to cause Roseola Infantum?

Back 36

Herpesvirus 6

Front 37

Roseola Infantum is common in what age group?

Back 37

6 months - 3 y/o

Front 38

Which inflammatory exanthem typically presents with tender nodules less than 5 cm on the shin and the skin overlying the nodules is red, smooth, and shiny?

Back 38

Erythema Nodosum

Front 39

What are some possible causes of Erythema Nodosum?

Back 39

• fungal disease
• inflammatory bowel disease
• leukemia
• medications (ex. OCP)
• sarcoid
• strep infections
• TB
• vasculitis
• Yersinia infections

Front 40

A diagnosis of Kawasaki Disease is made by several days of fever and 4 out of 5 criteria. What are the 5 criteria?

Back 40

• conjuctivitis
• rash
• lymphadenopathy
• oropharyngeal changes (injected pharynx/strawberry tongue)
• extremity erythema and edema

Front 41

What are other findings of patients with Kawaski Disease?

Back 41

• arthritis
• arthralgia
• increased ESR/CRP
• increased LFTs
• irritability
• leukocytosis

Front 42

What are later findings of Kawaski disease?

Back 42

• coronary artery aneurysms
• desquamation of fingers/toes
• increased platelets

Front 43

What is the treatment for Kawaski disease?

Back 43

• IV gamma globulin
• ASA
• steroids (controversial)

Front 44

What are characteristics of the rash caused by Pityriasis Rosea?

Back 44

• begins with "Herald Patch" (one red lesion with rasied border on trunk)

• 1-2 weeks later a widespread eruption of pink maculopapular oval patches on trunk in "Christmas Tree" pattern lasting 3-8 weeks

Front 45

What are maternal flora pathogens that infants < 30 days are at high risk for?

Back 45

• E. coli
• Enterococci
• group B strep
• Herpes simplex virus
• H. Flu
• Klebsiella
• Listeria monocytogenes
• strep pneumo

Front 46

What infectious agents can cause Hemolytic Uremic Syndrome?

Back 46

• E. coli 0157:57 (most common cause)
• Coxsackie virus
• Echovirus
• Campylobacter
• Salmonella
• S. pneumoniae
• Shigella
• Varicella
• Yersinia

Front 47

Diagnosis of HUS is made by clinical presentation of what three conditions?

Back 47

• hemolytic anemia
• thrombocytopenia
• acute renal failure

Front 48

What are characteristics of Henoch-Schonlein Purpura?

Back 48

• small vessel vasculitis
• characterized by purpura, arthritis, abd pain, hematuria, & occasional scrotal involvement
• symmetrical involving legs/buttocks
• polymigratory arthritis/arthralgias in large joints
• history of gastroenteritis, HTN, and seizures

Front 49

What is an important distinguishing feature between Henoch-Schonlein Purpura and meningococcemia?

Back 49

patients with Henoch-Schonlein Purpura have a rash that generally looks bad but the patient feels well

Front 50

What is the most common cause of intestinal obstruction in 3-12 month-old?

Back 50

Intussusception

Front 51

What is the most common area of the bowel that intususception occurs?

Back 51

iliocecal area

Front 52

What is the classic triad of intussusception?

Back 52

• intermittent abdominal pain
• vomiting
• bloody currant jelly stools

Front 53

What is the rule of 2's for Meckel Diveticulum?

Back 53

• 2% of the population
• 2% with Meckel's develop problem
• most common in 2 y/o
• 2 inches in length
• typically located with 2 feet of ileocecal valve

Front 54

What is the most common clinical presentation of Meckel Diverticulum?

Back 54

rectal bleeding

Front 55

What is the diagnostic test of choice for Meckel Diverticulum?

Back 55

nuclear scintigraphy

Front 56

What is the most common viral cause of meningitis?

Back 56

enterovirus

Front 57

What is the most common bacterial cause of meningitis from 0-3 months? older than 3 months?

Back 57

• 0-3 months:
- group B strep
- E. coli

• > 3 months:
- strep pneumo
- N. meningitidis
- H. Flu

Front 58

What are the 2 routes of infection of osteomyelitis?

Back 58

• hematogenous
• direct (ex. inoculation via penetrating wound)

Front 59

What are x-ray findings of osteomyelitis?

Back 59

• soft tissue swelling 3-4 days post symptoms
• lytic bone @ 7-10 days

Front 60

What is the treatment for acute otitis media?

Back 60

• 1st line: amoxicillin
• 2nd line: augmentin or cephalosporin

Front 61

Differentiate between periorbital and orbital cellulitis

Back 61

• periorbital cellulitis is an infection of the eyelids that does not extend into the posterior orbit
• orbital cellulitis may potentially affect vision and become life threatening

* can be differentiated with a CT scan of orbits

Front 62

What is the most common cause of pharyngitis?

Back 62

respiratory viruses (70-80%)
• adenovirus
• CMV
• coxsackie
• EBV
• parainfluenza
• rhinovirus

Front 63

What is the most common bacterial cause of pharyngitis in children?

Back 63

group A B-hemolytic streptococcus

Front 64

Pharyngitis with conjunctivits is most likely cause by what?

Back 64

adenovirus

Front 65

Pharyngitis with erythematous ulcers on post palate is most likely caused by what?

Back 65

coxsackievirus A (herpangina)

Front 66

Treatment for GABHS pharyngitis is penicillin or amoxicillin x 10 days. What is the treatment if the patient is penicillin allergic?

Back 66

• erythromycin
• clindamycin

Front 67

What is the most common cause of pneumonia in infants or younger children?

Back 67

viral
• adenovirus
• influenza
• parainfluenza
• RSV

Front 68

What are bacterial causes for pneumonia in neonates?

Back 68

• group B strep
• E. coli
• Listeria monocytogenes

Front 69

What is a common bacterial cause of pneumonia in 1-3 year-olds?

Back 69

chlamydia trachomatis

Front 70

What is a common bacterial cause of pneumonia in children ages 3 months - 5 years?

Back 70

s. pneumoniae

Front 71

What are bacterial causes of pneumonia in school-aged children?

Back 71

• mycoplasma pneumoniae
• chlamydia pneumoniae
• strep pneumoniae

Front 72

2-6 week old infant with projectile vomiting without bile suggests what cause?

Back 72

pyloric stenosis

Front 73

What is the most common cause of intestinal obstruction in infancy?

Back 73

pyloric stenosis

Front 74

What is the test of choice to confirm pyloric stenosis?

Back 74

ultrasound

Front 75

What are classic findings of pyloric stenosis?

Back 75

• olive mass in RUQ
• hypochloremic
• hypokalemic
• metabolic alkalosis

Front 76

What is the most common site of septic arthritis?

Back 76

lower extremity (knee or hip)

Front 77

What is the cause of bacterial tracheitis? What is the presentation?

Back 77

• caused by Staph aureus
• presents with high fever, painful cough, and toxic appearance
• xray shows shaggy trachea

Front 78

What is the abdominal xray finding of patients with a volvulus?

Back 78

double-bubble sign