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Flashcards in pediatrics Deck (125)
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61

exam findings with RPA

1. Neck mass (91%)
2. Cervical adenopathy (83%)
3. Fever (86%)
4. Neck stiffness (59%)
5. Retropharyngeal bulge (43% - do not palpate in children)
6. Agitation (43%)
7. Lethargy (42%)
8. Drooling (22%)
9. Torticollis (18%)
10. Respiratory distress (4%)
11. Stridor (3%)

62

tx for RPA

1. Admission/Consultation
2. IV abx
3. Intubate if respiratory distress
4. ENT will decide wether to I&D (in OR) or not

63

Retropharyngeal space should measure

6 at 2 and 22 at 6

look at these XRAYS

64

flat faced coin on CXR

esophagus

trachea rings trap it like thi

65

Coins that fail to pass into the stomach can be removed

by a foley catheter under fluroscopy, or by endoscopy

66

why are button batteries bad

will short out and erode through tissues

67

neonates suspected of PNA

1. grunting, flaring nostrils, tachypnea, and retractions

2. lethargy, poor feeding, or irritability

3. Cough is rare

4. Fever may be absent (may be hypothermic)


DO NOT COUGH

68

this type of PNA is most commonly seen 24 hrs after birth

Beta Strep likely if within 24 hours of birth

69

this type of PNA is most commonly seen in the 2nd or 3rd week of life

Chlamydia pneumonia with conjunctivitis in 2nd or 3rd week

70

Infants PNA presentation

1. Cough
2. Preceding URI
3. grunting, flaring, tachypnea, retractions
4. lethargy; poor feeding; or irritability
5. Bacterial, usually feberile

71

infants sxs of PNA

1. Cough
2. Preceding URI
3. grunting, flaring, tachypnea, retractions
4. lethargy; poor feeding; or irritability
5. Bacterial, usually feberile

72

toddlers and small children have these sxs with PNA

1. Cough
2. Preceding URI
3. Vomiting (post-tussive emesis)
4. Abdominal pain
5. Fever

73

sxs and pathogens in children with PNA

1. Atypical pathogens, Mycoplasma, more common


2. May have other constitutional symptoms such as headache and pleuritic chest pain

74

boiling in the chest

bronchitis

astham like at the bronchioles

75

hx of a pt with bornchitis

1. Preceding URI
2. Fever
3. Increased work of breathing
4. Vomiting, especially post-tussive
5. Irritability
6. Poor feeding or anorexia

76

increased work of breathing in a child with bronchitis most commonly looks like

a. Wheezing
b. Cyanosis
c. Grunting
d. Noisy breathing

77

exam for bronchitis can look like

1. Tachypnea, up to 50-60 breaths per minute (most common physical sign)
2. Tachycardia
3. Fever, usually in the range of 38.5- 39°C
4. Mild conjunctivitis or pharyngitis
5. Diffuse expiratory wheezing
6. Nasal flaring, intercostal retractions
7. Cyanosis
8. Inspiratory crackles
9. Otitis media
10. Apnea, especially in infants younger than 6 weeks
11. Palpable liver and spleen from hyperinflation of the lungs and consequent depression of the diaphragm

78

labs for bronchiolitis

1. CBC: seldom useful
2. Urine specific gravity: possible dehydration.
3. Serum chemistries: gauging severity of dehydration.
4. ABG may be needed in the severely ill patients
5. Specific viral test for RSV helps confirm diagnosis but not essential.

79

CXR fir bronchiolitis can look like

1. Hyperinflation and patchy infiltrates may be seen.
These findings are nonspecific and may be observed in asthma, viral or atypical pneumonia, and aspiration.
2. Focal atelectasis
3. Air trapping
4. Flattened diaphragm
5. Increased anteroposterior diameter
6. Peribronchial cuffing

80

why would you get a CXR for bronchiolitis

ay also reveal evidence of alternative diagnoses, such as lobar pneumonia, congestive heart failure, or foreign body aspiration.

81

TX for bronchiolitis

1. Pulse oximetry monitoring
2. Respiratory support
3. O2, cool mist
4. Nasal suction = best tx
5. Supportive care
6. Comfort
7. Hydration
8. Antipyrexia, analgesia

82

admissions criteria for bronchiolitis

1. Oxygen saturation less than 94% after therapy. Some say less than 92%
2. Respiratory distress (eg. respiratory rate >60/min or retractions at rest)
3. Apnea or risk of apnea
4. Age younger than 2 months or history of prematurity
5. Underlying cardiopulmonary disease or immunosuppression

83

signs of resp distress in children

i. Grunting
ii. Flaring
iii. Severe tachypnea
iv. Retractions
v. Low O2 saturation
vi. Severe distress not responsive to supplemental O2?
1. Get help and prepare to intubate

84

signs of pyloric stenosis

i. History
1. Occurs by 3rd week of life
2. Projectile vomiting after feeding
3. Hungry
4. Failure to gain weight
5. Progresses to dehydration
ii. Hypochloremic, hypokalemic metabolic alkalosis.

85

PE with pyloric stenosis

1. Signs of dehydration(hyprochloremic hypokalemic metabolic acidosis.)

2. Palpable “olive” near lateral edge of right rectus, inferior to liver, is diagnostic

3. Ultrasound if “olive” not palpated (20% false negative)

4. Barium swallow

86

i. Most common cause of intestinal obstruction age 3mo-6yrs

b. Intussusception

87

who gets intussusception

ii. male:female = 4:1

88

sxs of intussusception

iii. Episodic abdominal pain, increasing severity and frequency
iv. Currant jelly stools in 50% (dark yellow)

89

i. Acute onset of billius vomiting, distension, pain.

c. Midgut volvulus

bilious vomit it the key here

90

c. Midgut volvulus most commonly seen

ii. 50% in 1st month; 90% in first year