Peds EOR Review (not all inclusive!)

"MUDPILES" mnemonic

Agents that can inc. anion gap:

Methanol

Uremia

DKA

Phenols

Iron/INH

Lactate

Ethanol/ethylene glycol

Salicylates

Antidote for:

Acetaminophen

N-acetylcysteine

Antidote for:

Narcotics

Naloxone (Narcan)

MC used analgesic in children

Acetaminophen

Minimal toxic acetaminophen dose for a child

150 mg/kg

The AAP states that "cold" medicines should not be used in children < _____ y/o

6

Respiratory & CNS depression + pinpoint pupils, think ______

Opiate poisoning

Electrolyte abnormalities associated with Salicylate toxicity

Metabolic acidosis + Respiratory alkalosis (HAGMA)

Salicylate poisoning Tx recommended in children

Activated charcoal

"DUMBELS" mnemonic

Cholinergic Crisis:

Diarrhea

Urination

Miosis

Bronchorrhea/Bronchospasm

Emesis

Lacrimation

Salivation

what is an autoimmune bleeding disorder cause by IgG attacking platelet membrane antigens?

Immune thrombocytopenia (ITP)

does ITP present with splenomegaly?

NO → superficial bleeding of the skin, nose, and GU tract → sudden onset petechiae, bruising, and/or bleeding

how is ITP diagnosed?

decreased platelets

smear shows megathrombocytes

what is the tx for severe/life-threatening ITP?

transfusion

methylprednisolone or dexamethasone

IVIG

which dx is characterized by severe thrombocytopenia, microangiopathic hemolytic anemia, neuro abnormalities?

Thrombotic thrombocytopenia purpura (TTP)

also see kidney dz and fever

what is seen on labs in TTP?

increased retic

increased LDH

thrombocytopenia

which dx shows schistocytes on peripheral smear?

TTP → tx with large volume plasmapheresis

what is the MC inherited bleeding disorder?

von Willebrand disease

which dx has prolonged bleeding time, prolonged PTT and is treated with DDAVP?

von willebrand's

what are the s/sx of von willebrand's?

easy bruising

mucosal bleeding

menorrhagia → microcytic anemia

hemarthrosis is rare!

in which dx is there extensive hemorrhage and thrombosis of vital organs?

disseminated intravascular coagulation

also see purpuric ecchymosis and thrombotic events

which dx has prolonged PT, PTT, and thrombin time?

DIC

also elevated fibrin or D-dimer, decreased fibrinogen, decreased factor V and VIII

which dx has delayed clotting and prolonged aPTT, decreased factor VIII?

hemophilia A

normal PT and platelet count

which dx is a deficiency of factor IX?

hemophilia B aka christmas dz → delayed clotting after trauma

which dx has prolonged apTT, normal PT, and decreased factor IX?

hemophilia B

which dx presents as easy bruising, hemarthrosis and forehead hematomas in children?

hemophilia A

and i guess B too?? slide says same s/sx as A

what is the MC childhood leukemia?

ALL "the great imitator"

what confirms dx of ALL?

bone marrow bx → >20% lymphoblasts confirms dx

CXR to detect mediastinal mass

what finding indicates poor prognosis in ALL?

Philadelphia Chromosome translocation

pt presents with fatigue, sweats, and easy bruising. on PE, they have LAD. labs show elevated WBC, prolonged PT and aPTT, and elevated uric acid. what is the likely dx?

ALL → tx w chemo

which dx has characteristic finding of gingival hyperplasia?

AML

also see fatigue, malaise, bone pain, sweats, bleeding, bruising (gingival hyperplasia is the only unique symptom)

which dx shows Auer Rods on blood smear?

AML → pathognomonic finding

which dx has painless LAD, mediastinal mass on CXR, and weight loss?

hodgkin lymphoma

which dx shows Reed Sternberg cells?*

Hodgkin Lymphoma

what are the s/sx of Non-hodgkin lymphoma?

LAD

abd pain

chest pain

cough

fever, weight loss, night sweats

what is the MCV in iron def anemia (IDA)?

microcytic <80

what is the MCV in vitamin B12 and folate deficiency?

macrocytic >100

what is the MCC of vitamin B12 deficiency in children?

malabsorption

which dx presents as demyelination of dorsal columns, peripheral neuropathy, myelopathy, memory loss?

vit B12 deficiency

the Schilling test is used to dx what dz?

rule out pernicious anemia in vit B12 deficiency

differentiates dietary vs. non-dietary

which dx has hyper-segmented neutrophils and increased MCV?

folate deficiency

confirmed by serum and red cell folate levels and vit B12 levels

what is the MC type of primary brain cancer in kids?

medulloblastoma → poorly differentiated neuroepithelial cells that arise in the cerebellum

who is medulloblastoma common in?

males <5 more common

what are the s/sx of medulloblastoma?

nocturnal/morning HA

N/V

AMS

gait ataxia

which brain tumor presents with AMS, HA, visual disturbances, motor impairments, and/or seizures?

astrocytoma → caused by hx of radiation exposure and genetics

where are Ependymomas MC located?

4th ventricle → block CSF flow

which dx is characterized by increased ICP, seizures, and focal deficits?

ependymomas

what is an inherited disorder resulting in production of defective hemoglobin?

sickle cell dz→ MC in AA

homozygous inheritance = disease

heterozygous = trait

what are common s/sx of sickle cell disease?

anemia → pallor, fatigue

hemolysis → jaundice

dactylitis

leg ulcer

priapism

retinal artery obstruction

pain crisis

acute chest syndrome

splenic sequestration

how is sickle cell diagnosed?

elevated retic

smear shows sickle cell

elevated bilirubin

hemoglobin electrophoresis = diagnostic

what is the tx for sickle cell?

hydroxyurea

what is the first value to drop in iron deficiency?

serum ferritin → total body stores → acute phase reactant

what are lab results in IDA?

low serum iron

high TIBC

low ferritin

high RDW

which vitamin aids in absorption of iron?

vit C

what is the MC location of Ewing sarcoma?

diaphysis of long bones

what is the MC location of osteosarcoma?

metaphysis of long bones

correlates with periods of linear growth

when should you obtain a head CT in a child abuse case?

include it always → even if neuro status is normal

which imaging modality detects cerebral edema, interhemispheric subdural hematoma?

CT

victim of shaking

which imaging modality is more sensitive for detecting small subdural hematomas and subtle contusions?

MRI → can also detect brainstem and cervical cord injuries

good at detecting signs of prior/old injuries

what is the MC site of fracture in abuse?

skull

what are the tanner stages?

breast

1. preadolescent

2. breast bud

3. areolar diameter enlarges

4. secondary mound, separation of contours

5. mature female

pubic hair

1. none

2. sparse, long, straight

3. darker, curling, increased #

4. coarse, curly, adult

5. adult, extends to thighs

what is no menarche by 14 with absent secondary sexual characteristics?

primary amenorrhea

no menarche by 16 regardless of secondary sex characteristics

what is secondary amenorrhea?

Absence of menses for 3 months in a woman who has previously menstruated. If a woman has an irregular period, then it must be 6 months

when should the HPV vaccine be given if you receive the first vax prior to age 15?

2 dose series

second dose is 6-12 months later

when should the HPV vaccine be given is the first vax is given after age 15?

3 dose series

0, 2, 6 months

at what age should children visit the dentist by?

by 12 months or after first tooth erupts

when should potty training be initiated?

when child is dry for periods of 2 hrs, knows wet and dry, can pull pants up/down and can indicate bowel movements

what HR indicates bradycardia in children?

infant < 100

toddler < 80

school-aged < 70

adolescents <60

what are causes of tachycardia in peds?

fever

anxiety

hypoxia

hypovolemia

what is the MC etiology of neonatal bacteremia/serious bacterial infection?

group B strep → tx with ampicillin and rocephin or cefotaxime

what is a rapidly progressive encephalopathy with hepatic dysfunction?

Reye's syndrome → caused by viral illness and aspirin use

when should babies be switched to milk from formula?

12 months

when should new foods be introduced to babies?

6 months

what is the ideal nutrition for newborns?

exclusively breastfeeding for the first 4-6 months

what is the bacteremia/SBI tx for infants 39-60 days old and 61-90 days old?

cefotaxine or rocephin

add vanco for MRSA coverage

how do you manage fever in a >3 year old?

antipyretics → tylenol and ibupforen

cooling techniques

fluids

sponging with tepid water

avoid rubbing skin

what are the s/sx of Reye's?

- persistent vomiting, confusion, personality changes, lethargy, hyperactive reflexes

- rapidly progresses to seizures/coma

- increased ICP

- hepatomegaly

insidious progression of a febrile illness over several days suggests which dx?

meningitis

what are the s/sx of meningitis?

infants → fever, irritability, lethargy, bulging fontanelle, poor feeding

older children → decreased responsiveness, vomiting, fever, photophobia, HA

what is the common etiology of meningitis in neonates?

GBS

E. coli

gram-neg bacilli

what are the common etiologies of meningitis in older infants?

S. pneumo

N. meningitidis

what is the MC etio of meningitis in adolescents?

N. meningitidis

which viruses commonly cause meningitis?

enterovirus

arbovirus

HSV

what is the MC finding in shaken baby syndrome?

retinal hemorrhages

assoc. with subdural hematomas

how does subdural hematoma present on non-contrast CT?

concave mass

crosses suture lines

foul smelling breath and unilateral bloody/purulent nasal discharge is a sign of what dx?

nasal FB

which type of burn: epidermis only, painful and erythematous, resolves in 1 week?

1st degree → conservative management

which type of burn: epidermis AND dermis, blister/bleb, red, painful, takes 1-3 weeks to heal?

2nd degree → tx with bacitracin

which type of burn: full thickeness involving epidermis, dermis, subQ tissue; dry, leathery, painless?

3rd degree → requires grafting or healing

IVF if burns >15%

burn center referral criteria

1. Partial thickness burns greater than 10% TBSA

2. Burns that involve the face, hands, feet, genitalia, perineum, or major joints

3. Third degree burns in any age group

4. Electrical burns, including lightning injury

5. Chemical Burns

6. Inhalation injury

7. Burn injury in patients with pre-exsisting conditions

8. Any patient with burns and concomitant trauma

9. Burned children in hospital without qualified personal

10.Burn injury in patients who will require long-term rehabilitative intervention

burn criteria for hospital admittance

- children with 5-10% TBSA burn

- full thickness burn 2-5% TBSA

- circumferential burn

- med prob predisposing to infection (DM)

- concern for injury

salter harris fractures

............ :|

which drug is commonly used to conscious sedation in peds?

ketamine*

also propofol, precedex, midazolam

which abx are used for animal bites?

augmentin

bactrim

clindamycin

how are asthma exacerbation treated?

hypoxemia → supp O2

bronchospasm→ SABA/cholinergic

inflam → glucocorticoids

raccoon eyes, battle signs, and hemotympanum are all signs of what?

basilar skull fracture → non-contrast CT

what dx shows up as a lens shaped opacity on imaging?

epidural hematoma

what is the MC seizure disorder of childhood?

febrile → temp >100.4

assoc. with infections HHV6 and influenza

what labs should be ordered in febrile seizures?

glucose

calcium

magnesium

electrolytes

when should you give benzos for febrile seizures?

if seizure is >5 mins