Peds Exam 3

Peds Exam 3

Epiglottitis

• Cause: Haemophilus influenzae

• Manifestations:

  • Drooling, agitation, absence of spontaneous cough

  • Tripod position, muffled voice (dysphonia)

  • Dysphagia, inspiratory stridor, retractions

  • High fever, sore throat, restlessness

• Education:

  • Droplet isolation for first 24 hours

  • Intubation may be needed in severe cases

• Treatment:

  • Corticosteroids, IV fluids

  • Avoid throat cultures

  • Humidified oxygen, continuous pulse ox monitoring

Asthma

• Cause: Allergens, tobacco smoke, exercise, temperature changes, meds (Aspirin, NSAIDs, Beta blockers, antibiotics), GERD, menses, pregnancy

• Manifestations:

  • Chest tightness, dyspnea, cough, wheezing, mucus production

  • Short speech, restlessness, anxiety, use of accessory muscles

  • Low SpO2, tripod position, retractions

• Education:

  • Avoid triggers, carry inhaler everywhere

  • Teach inhaler/nebulizer use, use peak flow meter daily

  • Encourage exercise, ensure proper nutrition and hand hygiene

  • Rinse mouth after inhaler use, monitor for side effects (dry mouth, dizziness, irritability)

• Treatment:

  • SABA: Albuterol, levalbuterol for acute attacks

  • LABA: Salmeterol, Foradil for long-term control

  • Anticholinergics: Atropine, ipratropium for bronchospasm relief

  • Corticosteroids: Fluticasone, methylprednisolone, prednisone

  • Leukotriene modifiers: Montelukast, zafirlukast

  • Mast cell stabilizers: Cromolyn

  • Monoclonal antibodies: Omalizumab, reslizumab

Cystic Fibrosis

• Cause: Genetic inheritance from both parents

• Manifestations:

  • Respiratory infections, growth failure, meconium ileus

  • Chronic cough, cyanosis, clubbing, barrel chest

  • Malnutrition, greasy stools, delayed growth

  • Fat-soluble vitamin deficiency, high sodium in sweat

• Education:

  • Chest physiotherapy, proper nutrition, infection control

  • Regular doctor visits, vaccinations, emotional support

• Treatment:

  • Albuterol for bronchospasm, antibiotics (tobramycin, piperacillin-tazobactam)

  • Aerosol therapy to reduce mucus viscosity

Pyloric Stenosis

• Cause: Genetic

• Manifestations:

  • Progressive nonbilious vomiting, dehydration, failure to thrive

  • Projectile vomiting, peristaltic waves before vomiting

• Education:

  • Post-surgery care instructions

• Treatment:

  • Surgery (pyloromyotomy)

  • Monitor intake/output, weight, pain, and incisional site

Intussusception

• Cause: Telescoping of bowel segment

• Manifestations:

  • Sudden crying, drawing up of legs, vomiting, currant jelly stools

  • Abdominal distention, fever, tachycardia, elevated WBC

• Education:

  • Surgery may be needed

• Treatment:

  • Barium enema or insufflation to reduce intussusception

Celiac Disease

• Cause: Genetic

• Manifestations:

  • Steatorrhea, malnutrition, abdominal distention, vitamin deficiencies

• Education:

  • Life-long gluten-free diet

• Treatment:

  • Avoid gluten-containing foods

Hirschsprung’s Disease

• Cause: Intestinal motility disorder

• Manifestations:

  • Failure to pass meconium, constipation, watery stools

  • Abdominal distention, vomiting, poor weight gain

• Education:

  • Ostomy care, surgical procedures

• Treatment:

  • Surgery (temporary ostomy or pull-through procedure)

GERD (Gastroesophageal Reflux Disease)

• Cause: Weak lower esophageal sphincter

• Manifestations:

  • Vomiting, irritability, poor weight gain in infants

  • Chest pain, sore throat in older children

• Education:

  • Tests: X-ray, esophagram, gastric emptying study, endoscopy

• Treatment:

  • Meds: Ranitidine, metoclopramide, PPIs (lansoprazole, omeprazole)

  • Surgery: Nissen fundoplication for severe cases

Rheumatic Fever

• Cause: Streptococcal infection (strep throat)

• Manifestations:

  • Carditis, polyarthritis, erythema marginatum, chorea

• Education:

  • Antibiotics to prevent recurrence

  • Emotional support, rest, monitoring of cardiac symptoms

• Treatment:

  • Penicillin G (IM), penicillin V (oral), or erythromycin (if allergic)

  • Long-term penicillin prophylaxis every 28 days

Kawasaki Disease

• Cause: Unknown respiratory pathogen triggers immune response

• Manifestations:

  • Acute phase: High fever, conjunctivitis, strawberry tongue, rash

  • Subacute phase: Desquamation, thrombocytosis, coronary artery changes

  • Convalescent phase: Resolution of symptoms, ongoing cardiac healing

• Education:

  • Vital sign monitoring, fluid intake, cardiac monitoring

  • Follow-up for blood work and vaccinations

• Treatment:

  • IV Immunoglobulin (IVIG) within 7-10 days

  • Aspirin therapy, avoid live vaccines during treatment

Congestive Heart Failure (CHF)

• Cause: Various, often secondary to structural heart defects

• Manifestations:

  • Fatigue, tachypnea, poor feeding, weight gain, swelling

• Education:

  • Monitor fluid intake, medication adherence, and activity

• Treatment:

  • Diuretics, ACE inhibitors, beta-blockers, monitoring for fluid overload

Ventricular Septal Defect (VSD)

• Cause: Abnormal opening between left and right ventricles

• Manifestations:

  • Small VSD: Asymptomatic

  • Large VSD: Failure to thrive, tachypnea, heart murmur

• Education:

  • Surgical options if needed

• Treatment:

  • Small VSD: Monitoring, may close on its own

  • Large VSD: Surgical repair or patch

Seizures

• Cause: Various (epilepsy, fever, head injury, etc.)

• Manifestations:

  • Uncontrolled shaking, loss of consciousness, staring spells

• Education:

  • Safety measures during seizures

• Treatment:

  • Anticonvulsants (Valproic acid, carbamazepine)

Head Injury

• Cause: Trauma to the head

• Manifestations:

  • Loss of consciousness, confusion, vomiting, dizziness

• Education:

  • Monitor for signs of intracranial pressure (ICP)

• Treatment:

  • Imaging (CT, MRI), rest, pain management

Diabetes (Type 1 & Type 2)

• Type 1 Diabetes:

  • Cause: Autoimmune destruction of pancreatic beta cells

  • Manifestations: Excessive thirst, hunger, blurred vision, slow healing

  • Treatment: Insulin therapy, glucose monitoring, diet

• Type 2 Diabetes:

  • Cause: Insulin resistance

  • Manifestations: Thirst, frequent urination, fatigue, weight loss

  • Treatment: Lifestyle changes, medications (metformin), insulin

Cerebral Palsy

• Cause: Prenatal brain injury or lack of prenatal care

• Types:

  • Spastic: Muscle tightness, poor coordination

  • Dyskinetic: Involuntary movements

  • Ataxic: Poor coordination, wide gait

• Manifestations:

  • Difficulty feeding, poor muscle control, developmental delays

• Education:

  • Medications (baclofen, diazepam) and therapy

  • Regular follow-ups for developmental support

• Treatment:

  • Muscle relaxants, anticonvulsants, surgery for spasticity

Urinary Tract Infections (UTIs)

• Cause: Bacterial infection, poor hygiene

• Manifestations:

  • Fever, pain with urination, frequent urination, abdominal pain

• Education:

  • Hygiene practices, increase fluid intake

• Treatment:

  • Antibiotics, pain management

CAKUT (Congenital Anomalies of the Kidney and Urinary Tract)

• Cryptorchidism (Undescended Testicle)

  • Cause: Undescended testicle(s) at birth

  • Manifestations: One or both testicles not palpable in the scrotum

  • Treatment: Surgery (orchiopexy) if not resolved by age 1

  • Education: Monitor for testicle descent; consult if not descended by 6 months

• Bladder Exstrophy

  • Cause: Birth defect where bladder is outside the body

  • Manifestations: Exposed bladder and urethra visible at birth

  • Treatment: Surgery to reconstruct bladder and close abdominal wall

  • Education: Post-surgery follow-up for long-term bladder care; possible urinary incontinence

• Epispadias

  • Cause: Abnormal placement of the urethra opening (on top of the penis)

  • Manifestations: Urethral opening located on the upper side of the penis

  • Treatment: Surgery to correct urethral placement

  • Education: Surgical follow-up; possible additional procedures for functional issues

• Hypospadias

  • Cause: Urethral opening on the underside of the penis

  • Manifestations: Urethra opening on the underside; may have a curved penis (chordee)

  • Treatment: Surgery to correct opening, typically before age 1

  • Education: Avoid circumcision before surgery; surgical follow-up required

• Hydrocele

  • Cause: Fluid-filled sac around the testicle

  • Manifestations: Scrotal swelling, noticeable when crying or standing

  • Treatment: Often resolves on its own; surgery if persistent after 1 year

  • Education: Monitor for swelling; consult if unresolved by age 1

• Phimosis

  • Cause: Tight foreskin that cannot be pulled back over the penis head

  • Manifestations: Inability to retract the foreskin

  • Treatment: Gentle stretching or circumcision if severe

  • Education: Teach proper hygiene; seek help if there are issues with urination or pain

• Vesicoureteral Reflux (VUR)

  • Cause: Backward flow of urine from the bladder to the kidneys

  • Manifestations: Recurrent urinary tract infections (UTIs)

  • Treatment: Antibiotics to prevent kidney damage; surgery if severe

  • Education: Monitor for UTIs; ensure antibiotics are taken as prescribed

• Hydronephrosis

  • Cause: Swelling of a kidney due to a blockage or obstruction of urine flow

  • Manifestations: Possible pain, urinary issues, or no symptoms

  • Treatment: Surgery to remove obstruction or antibiotics for infection

  • Education: Regular monitoring for kidney function; follow-up care